Chapter 9: Acknowledging Barriers and Identifying Barrier-Busting Strategies

Introduction

Choosing a standardized outcome measure that will be effective in your clinical setting can be challenging and requires some work on the front end to help ensure success. All too often, physical therapists enthusiastic about using standardized outcome measures in their practices have become jaded when attempting to implement the measures. This has often led to abandoning them. There are two prominent reasons for this. The first is that the physical therapists did not have a clear vision of what they wanted to assess with the measure. The second reason is that the therapists did not consider potential barriers associated with implementing the selected outcome measure in the therapists' unique clinical settings. In this chapter we first identify potential barriers to the successful implementation of outcome measures in clinical practice and then offer six steps that will enhance your chance of selecting a measure that can be successfully implemented in your clinical setting.

Barriers to the Successful Implementation of Outcome Measures in Clinical Practice

It may seem rather strange to devote a section of this text to barriers associated with implementing outcome measures in clinical practice. After all, aren't we proponents of standardized outcome measures? However, without acknowledging and addressing these barriers, the chance of successfully implementing standardized measures in busy practice settings is greatly reduced.

A number of published reports have consistently identified these potential barriers.^1–4 In some instances, the rationale for a barrier is real; in other cases, the reasoning for a barrier is perceived or unfounded. In this section we identify frequently reported barriers under the following headings: (1) “Barriers Affecting the Therapist,” (2) “Barriers Affecting the Patient-Measure Interaction,” and (3) “Resource and Organizational Barriers.” This is followed by the introduction of six strategies that will facilitate the successful implementation of standardized outcome measures in your practice. We call these barrier-busting strategies.

Barriers Affecting the Therapist

1. “I'm really doing this for someone else, and that someone else is not my patient.” Often, the use of standardized outcome measures have been thrust on therapists by administrators, payers, or professional bodies. Consequently, there is a perception that the extra time and effort put into administrating and scoring the measure is for someone else, and little is to be gained by the therapist or patient. To overcome this barrier, the added value of applying “yet another” test or measure must be made obvious.

2. “I can infer activity limitations and participation restrictions with a high degree of confidence from impairment measures that I currently apply.” Several mistaken beliefs contribute to this barrier. The first misconception is that a high correlation exists among impairments (e.g., range of motion and strength), activities (e.g., walking and stairs), and participatory endeavors (e.g., working and recreational pursuits). This is not the case in most instances. Typical correlations between impairments and activities lie in the ...