2014 Annual Breast Cancer Rehabilitation Healthcare Provider Event A Manual Therapy and Exercise Approach to Breast Cancer Rehabilitation Course November 7 th and 8 th , 2014 Mercer University, Atlanta, GA Sponsored By: TurningPoint’s Edith Van Riper-Haase Breast Cancer Rehabiltation Advocacy Fund thevisualab.com Presentations are Available on TurningPoint’s Website: myturningpoint.org Click on Course Link www.oncologypt.org itsthejourney.org
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2014 Annual Breast Cancer Rehabilitation
Healthcare Provider Event
A Manual Therapy and Exercise Approach to Breast Cancer Rehabilitation Course
November 7th and 8th, 2014
Mercer University, Atlanta, GA
Sponsored By:
TurningPoint’s Edith Van Riper-Haase Breast Cancer
Rehabiltation Advocacy Fund
thevisualab.com
Presentations are
Available on TurningPoint’s Website:
myturningpoint.org
Click on Course Link
www.oncologypt.org itsthejourney.org
A Manual Therapy and Exercise
Approach to Breast Cancer
Rehabilitation Course
Functional Outcome
Measures in Breast
Cancer Rehabilitation
Jill Binkley, PT, MSc, FAAOMPT, CLT
This Presentation is available on TurningPoint’s Website:
myturningpoint.org
From Homepage Click on Course Link
Generic Health Status Condition/Region Specific Patient Specific
• does not refer to a specific
disease or problem
• taps a spectrum of health
concepts
• permits comparison among
groups with different health
problems (e.g. cancer, kidney
disease, OA, stroke)
Example: SF-36
• assesses characteristic or activities
most relevant to the condition or
intervention
Examples:
•Upper Extremity Functional Index
(UEFI), Disabilities of Arm, Shoulder
and Hand (DASH)
• assesses characteristic or
activities that are most
relevant to the individual
Example: PSFS
Functional Assessment of
Cancer Therapy – Breast
Cancer Quality of Life
Instrument
(FACT-B)
EORTC-C30 and BR23 Scales
“Hybrid”
•Measures a spectrum of health
concepts, including physical, social
and emotional
•Characteristics of both generic
health status and condition-specific
Classification of Self-Report Outcome Measures
Comparison of Types of Measures• Sensitivity to change: Patient Specific > Condition > Generic
• Generic measures • Tend to be influenced to a greater extent by co-morbid conditions
• Take longer to complete, often require a computer to score
• Patient and condition/region specific measures • Tend to be more efficient to administer and score
• Meaningful between-patient comparisons are difficult with patient specific measures
Clinical efficiency and sensitivity to change make patient-specific and condition specific measures appropriate choices for clinical application.
More generic health status measures important for measuring overall well-being.
Common Self-Report Measures of Upper Extremity Function
DASH = Disabilities of the Arm, Shoulder and Hand (Hudak, 1996)
Discriminates between subjects by work status (Stratford, Binkley, 2001) Convergent cross-sectional validity with UEFS (Stratford, Binkley, 2001; Chesworth, 2009)
Sensitivity to Change•Correlation of UEFI and Pooled Rating of Change (UEFS change, prognostic rating, pain severity change): r=.7 (.50-.83) (Stratford, Binkley, 2001)•SRM UEFI 1.54 (superior RC-QOL, WORC Index, ASES) (Razmjou, 2006) •UEFI superior compared to UEFS, RC-QOL, WORC Index and ASES standard shoulder form using global rating of change and SRM calculation (Chesworth, 2009; Razmjou, 2006
1 page, easy to complete
and score
DASH
And QuickDASH (/100)
Poor Function=100
No disability = 0
Test-retest : ICC = .77-.88
(Roy, 2009)
MDC = 11 (Roy, 2009; Polson,
2010)
(DASH and QuickDASH)
MID = 19 (QuickDASH)
•Convergent Validity and Sensitivity to Change well
established (Roy, 2009; Beaton, 2006, Slobogean,
2010)
•SRM DASH 0.5-2.0 (Roy, 2009)
•No significant difference in sensitivity to change
between DASH and UEFI using GRC and area under
ROC curve (Lehman, 2010)
UEFI shorter to complete
than DASH (3-5 minutes
versus 5-7 minutes)
(Lehman, 2010)
UEFI faster to score (20 s
versus 5 minutes) (Lehman,
2010)
DASH
And QuickDASH
(subjects with breast
cancer)
Not available DASH correlates with UE strength, ROM, grip
strength (Hayes, 2005)
DASH appears to have adequate construct validity
and responsiveness in breast cancer patients
(Harrington, 2013)
Comparison of Measurement Properties of Upper Extremity Functional Index (UEFI) with Disabilities of the Arm, Shoulder, Hand (DASH) Self-Report Measures for Women with Breast Cancer
UEFS = Upper Extremity Functional Scale; RC-QOL = Rotator Cuff-Quality of Life; WORC = Western Ontario Rotator Cuff Index; ASES = American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form
Patient Specific Functional Scale(Stratford & Binkley, 1995; Chatman, Binkley et al, 1997; Westaway, Stratford, Binkley 1998)
Initial Assessment Script
I’m going to ask you to identify up to 3 important activities that you are
unable to do or have difficulty with as a result of your breast cancer.
0 1 2 3 4 5 6 7 8 9 10
Unable to Able to
perform activity at perform activity
fully
Patient specific measures assess functional status activities that are most relevant to the individual patient
Patient Specific Functional Scale
• Measurement properties of the PSFS have been reported for patients with low back pain, knee, neck and upper limb dysfunction (Stratford, Binkley 95; Chatham, Binkley 97; Westaway, 98; Stewart, 07, Hefford, 2012)
• The Patient Specific Functional Scale (PSFS) has been shown to be highly reliable and valid and sensitivity to change is superior than relevant condition-specific or generic health status measures
Model of Evaluation of Pain, Function and Health-Related Quality of Life in Women with Breast Cancer
Discharge from PT
Pain Scale, PSFS, UEFI FACT-B
Intermittent (e.g. weekly) Re-evaluation of Functional Status and Goals
Pain Scale, PSFS, UEFI/DASH
Admission (Pre-Operative or Early Post-Op)Pain, Patient Specific Functional Scale, Condition Specific Scale and Multi-Dimensional Health Status Measure
Pain Scale, PSFS, UEFI/DASH FACT-B
Goal Setting Using Self-Report Functional Scales
• Select relevant measure
• Select measures that are expected to change related to your intervention
• Make goals measureable – goals of change should be greater than MDC for given scale and ideally greater than MCID if known
• Final anticipated functional level based on factors that impact expectations of change, including treatment factors (e.g. radiation), age, severity, chronicity
• Setting goals requires clinical experience with measures
• Individual PSFS items can be used to set goals or as PSFS average