Measuring outcomes in children's rehabilitation: A decision protocol

Objective: To develop and test the feasibility and clinical utility of a co mputerized self-directed software program designed to enable service provid ers in children's rehabilitation to make decisions about the most appropria te outcome measures to use in client and program evaluation. Design: A before-and-after design was used to test the feasibility and init ial impact of the decision-making outcome software in improving knowledge a nd use of clinical outcome measures. Setting: A children's rehabilitation center in a city of 50,000. Participants: All service providers in the children's rehabilitation center . Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. Intervention: Using a conceptual framework based on the International Class ification of Impairment, Disability, and Handicap (ICIDH), an outcome measu rement decision-making proto col was developed. The decision-making protoco l was computerized in an educational software program with an attached data base of critically appraised measures. Participants learned about outcome m easures through the program and selected outcome measures that met their sp ecifications. The computer software was tested for feasibility in the child ren's rehabilitation center for 6 months. Outcome Measures: Knowledge and use of clinical outcome measures were deter mined before and after the feasibility testing using a survey of all servic e providers currently at the centre and audits of 30 randomly selected reha bilitation records (at pretest, posttest, and follow-up). Results: Service providers indicated that the outcomes software was easy to follow and belie ved that the use of the ICIDH framework helped them in making decisions abo ut selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing wha t measures were available. Use of outcome measures as identified through th e audit did not change. Conclusions: The "All About Outcomes" software is clinically useful. Furthe r research should evaluate whether using the software affects the use of ou tcome measures in clinical practice. (C) 1999 by the American Congress of R ehabilitation Medicine and the American Academy of Physical Medicine and Re habilitation.