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In the early years of physical and occupational therapy, clinicians regularly made judgment calls about how much progress their clients were making. Was someone walking with more confidence than the last time? Were they able to speak more clearly? The therapists’ case notes documented the course of treatment and the results. But inevitably, clinicians’ perceptions varied from person to person so it was hard to reach conclusions about which treatments really helped patients the most.
In the 1990s and 2000s, the number of rehabilitation assessments was on the rise and it was difficult for many busy therapists to keep up. Trudy Mallinson, PhD, Associate Director of the Center for Rehabilitation Outcomes 嫩B研究院 (CROR) at the Rehabilitation Institute of Chicago, had an idea: Why not aggregate evidence-based rehabilitation measures in one site on the internet? The site would describe how the measures worked, what populations they had been tested in and whether there was a charge to use them. “We wanted to create a one-stop shop,” says Mallinson, who is now an Associate Dean for Health Sciences 嫩B研究院 at the George Washington University School of Medicine and Health Sciences in Washington, D.C. “We wanted to make it easy for people. ‘Is my patient population there? How long does the assessment take? Do I have the training for it?’”
We wanted to create a one-stop shop
Trudy Mallinson, PhD
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The proposal was included in a Rehabilitation 嫩B研究院 Training Center grant request to the National Institute on Disability, Independent Living and Rehabilitation 嫩B研究院 (NIDILRR), which was approved by the federal agency in 2009. The timing was fortuitous. The Affordable Care Act was passed in 2010. The federal law called for the medical field to rely more heavily on evidence that a treatment actually achieved results. In 2011, the Rehabilitation Measures Database (RMD) was launched.
“Now clinicians don’t have to take time to troll the internet for measures—it’s all right there,” says CROR researcher Linda Ehrlich-Jones, RN, PhD, who oversees the RMD at Shirley Ryan 嫩B研究院 where it is now housed. “It’s really used well beyond our original plan for clinicians. We know researchers use it. Students use it. It’s really used all around the world.”
The RMD recently reached an important milestone: It includes more than 500 measures for everything from walking to executive function to aphasia. Last year, it received almost 5,500 site visits per day and more than 3.7 million page views. The most popular measure is the Berg Balance Scale, which assesses a patient’s static balance and risk of falling, the site’s analytics show. Other frequently consulted measures include a six-minute walk test and an apathy evaluation scale used to evaluate patients with brain injuries, stroke or other neurological conditions. Also popular are assessments that look at gait quality and a person’s ability to repeatedly rise from a seated position.
An early survey found that RMD users were a diverse group. Almost a third described themselves as clinicians while 37% said they were academics or researchers. Clinical managers and supervisors made up 12%; 6% were students and 4% were administrators. More than half were first time viewers from more than 150 countries. Survey respondents rated the RMD as highly effective in promoting the use of outcome measures in their clinical practice and research as well as manuscript and grant preparation.
It’s really used well beyond our original plan for clinicians. We know researchers use it. Students use it. It’s really used all around the world.
Linda Ehrlich-Jones, RN, PhD
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In a 2020 survey, more than 100 respondents said they used standardized assessments to track patient progress, change patient interventions, communicate with other clinicians about patient progress and document evidence-based clinical practice. Eighty percent said they shared their assessment results with patients (see related story).
Jennifer Weaver, an occupational therapist who learned about the RMD as a student in Southern California, says the database has helped her serve her patients better. She was working with a stroke patient who scored well on the Functional Independence Measure (FIM) scale but had to make repeated trips to the same drawer to get herself dressed. Weaver searched the RMD for an assessment of executive functioning skills and administered that. Sure enough, the test bore out her suspicions that the woman had a deficit. “I was able to show that addressing her executive dysfunction would be a great thing to work on in her follow-up treatment,” says Weaver, who is working on a PhD in Translational Health Science. “It was also important because I could tell her family what to look for when she went home and engaged in activities like cooking.”
Other users agree that access to the RMD has improved the quality of their practice and, in turn, helped their patients. “It’s critical to have all the information in one place. It’s very easy to access and the synthesis is there so you can gather the information about your population,” says Heidi Fischer, PhD, Clinical Associate Professor of Occupational Therapy at the University of Illinois at Chicago (UIC). “You can feel confident with the RMD that you’re making a choice with evidence behind it.”
You can feel confident with the RMD that you’re making a choice with evidence behind it.
Heidi Fischer, PhD
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In the early days, CROR’s small staff researched and wrote the descriptions of the measures. But they soon realized they needed help to reach a critical mass. The researchers reached out to university professors in physical therapy and together they came up with a plan for students to write up descriptions of assessments. The students would get a grade on their project and earn course credit but there would be an added bonus: their names would also be included on the RMD listing of the assessment. In other words, they would be published authors.
The model proved to be a big hit, and CROR now has students at University of North Texas, University of Washington, and University of Wisconsin-Madison writing assessments. On the front end, CROR staffers explain the process to the students by video and on the back end, they vet the assessments for content and accuracy. CROR even provides professors with a grading rubric. The collaboration is doing more than just augmenting the entries in the RMD, says Fischer, whose occupational therapy students at UIC are among those writing assessment summaries. “We’re training them to be evidence-based practitioners,” she says. “They now know how it works and they see the database as a resource.”
