EDITORIAL

OUTCOME MEASURES FOR RESEARCH AND CLINICAL PRACTICE

Claire Johnson, MSEd, DCEditor-in-Chief, JMPT

0161-4754/$34.Copyright © 20doi:10.1016/j.jm

ABSTRACT

This editorial provides a brief discussion of the importance of the selection and utilization of outcome measures inresearch and clinical practice. (J Manipulative Physiol Ther 2008;31:329-330)

Key Indexing Terms: Outcome Assessment; Questionnaires; Health Status Indicators; Evidence-Based Medicine;Chiropratic

Outcome measures are necessary for sound research,such as when conducting and reporting a clinicaltrial.1 They provide an objective measurement of

what changes may have occurred because of an interventionand give researchers an idea of how much change occurred.From the results revealed by outcome measures, it can bedetermined if there was a statistically significant change, ifone treatment style was better than another, and/or if furtherresearch is necessary to uncover the reasons for any changes.

Outcome measures are also important for clinicalpractice.2,3 There are at least 3 constituents in the clinicalpractice setting that are interested in the outcomes of patientimprovement. First, the entity paying for health careservices, whether it is a third-party payer or the patient,wants to know if they are getting value for their health caredollar. Second, practitioners, whether they are from thechiropractic, medical, allied health, or other professions,want to know if the patient is improving under themanagement plan or if additional measures or otherdirections should be taken.4 The use of outcome measuressupports the healing process by providing a means to tracksymptoms and function over time, which allows cliniciansand patients to discuss patient care using a commonlanguage. Third, the patient typically wants to know if heor she is improving or is getting closer to his/her health caregoals. If part of the healing process includes self-awarenessand the patient's desire for wellness, then outcome measurescan provide the patient with the information necessary thatlets him or her know where they are on the path to health.

How does one choose the best outcome measure? Bothpractitioners and researchers need tools that are valid,

0008 by National University Health Sciences.pt.2008.05.001

reliable, feasible, practical, and economical. In research,the choice of outcome is determined by the aims andhypotheses of the research.5 In practice, the choice ofoutcome is determined by the goal of care.6 A patientneeding broad-based wellness care will need differentmeasures from a patient that has specific neuromusculoske-letal or other problems. But, in the end, both practitionersand researchers face the same challenge; how should theychoose which outcome measure is best for their needs? Mostdo not have the time or resources to develop their own toolsor to do extensive research to determine which ones are best.

Review articles are available to help answer this question.For example, in this issue of the Journal of Manipulative andPhysiological Therapeutics, Khorsan et al examined whatoutcome measures are commonly available and used withsome frequency in the chiropractic literature. Their studyevaluated these measures in terms of validity, reliability, andfeasibility and provides a framework for researchers andpractitioners so that both clinicians and researchers can makean informed choice. This study provides a detailed analysisof outcomes used in chiropractic practice and research andsuggests measures that are feasible, practical, economical,reliable, and valid. This article also examines the nature ofthe theories behind the outcomes because their assessmentrequires that the user know both the purpose of theinstrument and the theories that underlie it.

As with any tool, outcomes have the potential to bemisused. However, potential or infrequent misuse should notprevent us from using them in clinical practice. Outcomemeasures help to provide a level of accountability that isexpected in most professional disciplines. The use of outcomemeasures informs the research process, clinical practice, andprogrammatic decisions and can provide practitioners withinformation on treatment success and how quickly they areable to restore their patients back to health. Outcome measuresare an essential component of evidence-based practice.

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330 Johnson Journal of Manipulative and Physiological TherapeuticsOutcome Measures for Research and Clinical Practice June 2008

REFERENCES

1. Fitzpatrick R, Davey C, Buxton MJ, Jones DR. Evaluatingpatient-based outcome measures for use in clinical trials. HealthTechnol Assess 1998;2:1-74.

2. HaywoodKL. Patient-reported outcome I: measuring whatmattersin musculoskeletal care. Musculoskelet Care 2006;4:187-203.

3. Haywood KL. Patient-reported outcome II: selecting appropriatemeasures for musculoskeletal care. Musculoskelet Care 2007;5:72-90.

4. Hayes C. The use of patient based outcome measures inclinical decision making. Community Dent Health 1998;15:19-21.

5. Pesudovs K, Burr JM, Harley C, Elliott DB. The development,assessment, and selection of questionnaires. OptomVis Sci 2007;84:663-74.

6. Greenhalgh J, Long AF, Brettle AJ, Grant MJ. Reviewing andselecting outcome measures for use in routine practice. J EvalClin Pract 1998;4:339-50.