Archives of Physical Medicine and Rehabilitation (2002)
Development of an index of physical functional health status in rehabilitation
Dennis L Hart, PhD, PT, Benjamin D. Wright, PhD
Arch Phys Med Rehabil 2002;83:655-665.

Abstract
Clinicians have in the past used different outcomes instruments designed to meet the needs of specific patients, but the process was burdensome to the clinicians when making the decision about which outcomes instrument to select for a specific patient. The purpose of this study was to co-calibrate items from different reliable and valid patient self-report outcomes instruments, so the clinician could use one outcomes instrument to assess the physical functional health status (FHS) of their patients. Results demonstrated that one item bank could be used to develop a scale, which assessed physical FHS of patients in outpatient rehabilitation that had adequate item calibration reproducibility and scale content and construct validity. The authors concluded that items from different outcomes instruments could be co-calibrated into one physical FHS scale, and the analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients.

Physical Therapy 2003
Using clinical outcomes to identify expert physical therapists
Linda Resnik, PhD, PT, OCS, Dennis Hart, PhD, PT
Phys Ther 2003; 83(11):990-1002

Abstract
In previous studies of expert physical therapists, experts were selected based on years of clinical experience or reputation, not on whether their patients obtained good outcomes following treatment. The purposes of this study were to identify expert physical therapists by using patient self-reported outcomes and to describe the characteristics of clinicians whose patients with lumbar spine syndromes reported higher health-related quality of life following rehabilitation. The results demonstrated expert therapists could be identified using patient self-reported outcomes, but years of clinical experience was poorly related to whether patients reported better outcomes. The authors concluded that extensive clinical experience was not necessary to achieve superior patient outcomes.

Journal of Orhopaedic & Sports Physical Therapy
Test-retest reliability of an abbreviated self-report overall health status measure
Dennis L. Hart, PT, PhD
J Orthop Sports Phys Ther 2003; 33:734-742

Abstract
For a measure of outcome to be appropriate for clinical or research use, the measure must be reliable, valid and responsive to clinically important change. The purpose of this study was to assess test-retest reliability and estimate minimal detectable change of an overall measure and summary measures of patient self-reported functional health status (FHS). Results demonstrated that the FHS measure of an abbreviated scale had good test-retest reliability and measurement error. The author concluded that in addition to good test-retest reliability, the FHS measure demonstrated good responsiveness by detecting improvement of patient self-report of FHS within the first few days of rehabilitation.

Physiotherapy Canada (2005)
Interpreting lower extremity functional status scores.
Stratford PW, Hart DL, Binkley JM, Kennedy DM, Alcock GK, Hanna SE
Physiother Can. 2005;57:154-162.

Abstract
In the past, clinicians had difficulty interpreting patient self-report functional health status scores, and therefore voiced skepticism about the use of patient self-report outcomes scores. The purpose of this study was to provide clinical meaning and usefulness to patient self-report scores from one outcomes instrument, the Lower Extremity Function Scale, which could be used to describe the patient’s expected rate of functional improvement for and assist in the treatment of a variety of patients with lower extremity impairments receiving therapy in outpatient clinics. Results from the analyses of three datasets demonstrated that we could provide clinical meaning to outcomes scores by matching the outcomes scores to item responses, we could predict improvement from baseline scores, and we could link the patient self-report data to clinical decision-making. The authors concluded that patient self-report data from this outcomes instrument could be used to provide clinicians with increased confidence interpreting outcomes scores that could assist in clinical decision-making.

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