Outcome measures

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Measures of health status and healthcare outcomes are tools to assess a person’s current or future health status and demonstrate the effectiveness of treatment.

Below you can access measures used by clinicians on the TAC Clinical Panel. The list is not exhaustive but includes measures that are particularly useful in clinical practice. Using the links provided, you can download and print the measure, or complete and score it online. All measures are free to use.

For terms you may be unfamiliar with, see Definitions.

Measuring and demonstrating the effectiveness of treatment is the first principle of the Clinical Framework for the Delivery of Health Services, an excellent companion to these tools.

Nonspecific measures

Patient Global Impression of Change (PGIC) / Global Rating of Change (GRC)

Link

Type

  • Evaluative

Description

  • Reviews the patient’s impression of progress they’ve made with treatment. See review.

Advantages

  • Simple to understand.
  • No scoring required.
  • A horizontal 7 point scale has good clinimetric properties.

Precautions or limitations

  • The wording that introduces the scale needs to be carefully considered to get an unambiguous response. Possible wording: very much better, better, slightly better, the same, slightly worse, worse, very much worse. For the midpoint, wording could be "unchanged" with end points spelt out in words and numbers or marks.
  • The scale should be used along with at least one standardised outcome measure.

Patient Specific Functional Scale (PSFS)

Link

Type

  • Evaluative

Description

  • Measures change in functional activities specifically relevant to individual clients.

Advantages

  • Useful for clients with very specific functional needs or goals.
  • Keeps treatment goal oriented.
  • Works well when it’s difficult to measure progress using standardised outcome measures (e.g. English language literacy issues) or the client has a condition that doesn't fit well with available outcome measures.
  • Can supplement standardised outcome measures and add an individualised aspect that can more fully engage clients with their own progress.

Precautions or limitations

  • If the functional activities chosen vary widely with respect to how likely/quickly they are to be achieved, the scoring will be affected.
  • Should be used along with other standardised outcome measures.

Work Productivity and Activity Impairment Questionnaire (WPAI)

Link

Type

  • Evaluative

Description

  • Measures work hours, absenteeism and presenteeism over the previous week.
  • A key measure in ePPOC.

Advantages

  • Measures aspects of work in a more nuanced way than just recording hours at work. Even if work hours don't/can't change, the WPAI can measure changes in absenteeism and presenteeism.
  • Simple to use (6 items). Scoring is moderately easy but requires a calculator. If the person is not working, it is easy to score.
  • Can be adapted to a specific condition.
  • Many translated versions available.

Precautions or limitations

  • None of note.

Screening measures

Orebro Musculoskeletal Pain Screening Questionnaire (OMSPQ)

Link

Type

  • Discriminative
  • Predictive

Description

  • Predicts long-term disability and failure to return to work when completed between 4 to 12 weeks.
  • Scores of 130 or above predict those who failed to return to work in studies. Scores of 105 or below predict recovery and those who will not take sick leave.
  • See a frequently asked questions document by one of the authors of the OMSPQ.

Advantages

  • While the short form (OMSPQ-10) has replaced the OMSPQ in many clinical practices, the longer version gives more clinical information.
  • The person's responses to each item may provide significant insights into their thoughts and beliefs about their pain and as such add value to the clinical assessment process.
  • Screening tools allow for risk factors and barriers to recovery to be addressed early via the implementation of early psychosocial interventions.
  • Available in many languages.

Precautions or limitations

  • Scoring is a little complex.
  • Has not been validated as an evaluative measure.
  • Should be introduced in the first 3 months after an injury.

Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMSPQ-10)

Link

Type

  • Discriminative
  • Predictive

Description

  • An easier-to-use version of the OMSPQ to identify risk of disability and long-term work absence.
  • A score of 50 or higher indicates a risk of long-term disability.
  • See a frequently asked questions document by one of the authors of the OMSPQ.

Advantages

  • Shorter and easier to score than the original form of the Orebro.
  • The person's responses to each item may provide significant insights into their thoughts and beliefs about their pain and as such add value to the clinical assessment process or indicate that referral to other clinicians is appropriate.
  • Screening tools allow for risk factors and barriers to recovery to be addressed early via the implementation of early psychosocial interventions.
  • Available in many languages.

Precautions or limitations

  • Has not been validated as an evaluative measure.
  • Should be introduced in the first 3 months after an injury.

Keele STarT Back Screening Tool

Link

Type

  • Discriminative
  • Predictive

Description

  • An easy-to-use measure for primary care clinicians to categorise patients with back pain into 3 risk related groups with a stratified care approach to clinical care.
  • See the implementation manual.

Advantages

  • Allows clients to be stratified within the practice. Clinicians with experience of psychologically informed practice can see higher-risk clients. Newer graduates can start off with lower-risk clients and can be mentored when they transition to seeing higher-risk clients.
  • Simple scoring.
  • Available in many languages.

Precautions or limitations

  • It’s important to understand the background before using STarTBack as a stratified care methodology rather than just a screening tool.

WhipPredict

Link

Type

  • Discriminative
  • Predictive

Description

  • A clinical prediction rule for whiplash that stratifies clients into 3 groups at various levels of risk of developing moderate / severe disability or experiencing full recovery following whiplash injury.

Advantages

  • Allows clients to be stratified within the practice. Clinicians with experience of psychologically informed practice can see higher-risk clients. Newer graduates can start off with lower-risk clients and can be mentored when they transition to seeing higher-risk clients.
  • More nuanced than using the Neck Disability Index alone as it includes aspects of hyperarousal that may represent posttraumatic stress.

Precautions or limitations

  • Further research is being undertaken as of 2019 to investigate treatment based on risk classification.

Pain measures

Brief Pain Inventory (BPI)

Link

Type

  • Discriminative of pain severity
  • Evaluative

Description

  • Allows rapidly but comprehensively assessment of pain severity and the impact of pain on daily functions.
  • A key measure in ePPOC.
  • Monitors change in both pain intensity and pain interference with many aspects of a person's life throughout a treatment program. (MDC = 1/10, MCID = 2+/10) This is sensitive to the initial severity and the individual circumstances.

Advantages

  • Simple to score. Two scores are for pain severity and pain interference.
  • Widely validated and extensively used in diverse research and clinical settings.
  • IMMPACT recommendations for assessing clinical significance for 0-10 numeric pain scales:
    • Change of ≥10% represents minimally important change.
    • Change of ≥30% represents moderate clinically important change.
    • Change of ≥50% represents substantial clinically important change.

Precautions or limitations

  • None of note.

Pain Self Efficacy Questionnaire (PSEQ)

Link

Type

  • Discriminative of severity
  • Evaluative

Description

  • Measures confidence of a person with persistent pain to do a range of activities while in pain.
  • A key measure in ePPOC.

Advantages

  • Establishes what treatments may be required while planning treatment.
  • Uses individual item responses to open a discussion and education session with a client
  • Evaluates the effect of treatment over time. MCID = 7 points combined with movement to a different severity band.
  • Available in many languages.
  • Easy to score. Severity bands are:
    • <20 = severe
    • 20 to 30 = moderate
    • 31 to 40 = mild
    • >40 = minimal impairment

Precautions or limitations

  • Unlike most outcome measures, an increase in score is an improvement.

Pain Catastrophising Scale (PCS)

Link

Type

  • Discriminative of severity of pain catastrophising
  • Evaluative
  • Predictive of persistent pain, disability and a poor return to work outcome

Description

  • Measures a person's thoughts and feelings related to their pain that are likely to impact on their outcome.
  • A key measure in ePPOC.

Advantages

  • Establishes what treatments may be required while planning treatment. For example, a client with a high score (>30) may need to progress quickly to multidisciplinary management.
  • Uses individual item responses to open a discussion and education session with a client.
  • Evaluates the effect of treatment over time. MCID = 6 points combined with a movement to a different severity category.
  • Severity bands for the PCS are:
    • <20 = mild
    • 20 to 30 = high
    • >30 = severe

Precautions or limitations

  • Care needs to be taken to introduce the concept of catastrophising cautiously with a client, as it can sound stigmatising if used inappropriately. See article on pain catastrophising.

Tampa Scale for Kinesiophobia (TSK)

Link

Type

  • Evaluative
  • Predictive

Description

  • Measures unhelpful thoughts and beliefs about pain and movement that represent a fear of movement (kinesiophobia) and are likely to impact a person’s outcome.

Advantages

  • Can be used as an alternative to the Pain Catastrophising Scale in some clients to:
    • help establish what treatments may be required while planning treatment. For example, a client with a high score (>36) may need to progress quickly to multidisciplinary management
    • use individual item responses to open a discussion and education session with a client
    • evaluate the effect of treatment over time
  • Has 2 subscales: an activity avoidance subscale and a somatic focus scale. These can provide additional information to the clinician to help direct management.

Precautions or limitations

  • There is no response category to allow respondents to “neither agree or disagree,” which may result in answers skewed in one direction or the other.

Self report Leeds Assessment of Neuropathic Symptoms and Signs Scale (s-LANSS)

Link

Type

  • Discriminative for neuropathic and nociceptive pain
  • Evaluative

Description

  • Useful for clinicians developing competency in diagnosing neuropathic components to pain presentations.

Advantages

  • Can be used as both an assessment checklist for neuropathic pain and to monitor a response to treatment over time.
  • Quick and easy to use and score.
  • This version can be completed by the client without the clinician present, unlike the LANSS which includes some aspects of physical examination.

Precautions or limitations

  • Although the cut-off score for diagnosing neuropathic pain is 12/24, some people scoring around this level may be incorrectly classified as either having or not having neuropathic components to their pain presentation.

painDETECT

Link

Type

  • Discriminative for neuropathic pain components in adults with low back pain

Description

  • Useful for clinicians developing competency in diagnosing neuropathic components to pain presentations.
  • Can be used as an assessment checklist for neuropathic pain and to assist in choosing appropriate therapy.

Advantages

  • Can be done online, including scoring and interpretation. Clients can do this at home and print results.

Precautions or limitations

  • When tested in people with fibromyalgia, the questionnaire demonstrated only a 46% positive predictive value, indicating that the painDETECT may not be suitable for use in other conditions.

Musculoskeletal measures

Back and lower limb

Hip Disability and Osteoarthritis Score (HOOS)

Link

Type

  • Evaluative

Description

  • Explores how the hip condition is impacting on the person and can be used to monitor changes in hip function, pain and quality of life with treatment interventions.

Advantages

  • Can be completed and scored online.
  • More responsive than the WOMAC.
  • Available in over 20 languages.

Precautions or limitations

  • Can take up to 15 minutes to complete.
  • Complex to score if not done online.

Lower Extremity Functional Scale (LEFS)

Link

Type

  • Evaluative

Description

  • Can be used to monitor changes in functioning during treatment interventions. A change in score of 9 points or more is likely to represent a clinically meaningful change (MCID).

Advantages

  • Quick to complete.
  • Can be used for different joints and multiple joints in the lower limb.

Precautions or limitations

  • A number of the activities are quite high level and some clients will never be able to do them, which may contribute to a floor effect.

Foot and Ankle Disability Index (FADI)

Link

Type

  • Evaluative

Description

  • Measures foot and ankle symptoms and functioning.

Advantages

  • Designed with chronic ankle instability in mind so may be relevant to people who have experienced ankle trauma in a MVA. A change in score of at least 3 points, but preferably 4.5, is likely to represent a clinically meaningful change (MCID).
  • Has an additional sports component for more high functioning people.
  • More specific than the LEFS and can accurately reflect the person's functional situation.
  • Can be completed and scored online.

Precautions or limitations

  • None of note.

Oswestry Disability Questionnaire (ODQ)

Link

Type

  • Evaluative

Description

  • Explores functioning and changes in functioning in people with back pain.
  • Measures treatment efficacy. If there is no real change with treatment, clinician should question diagnosis and choice of treatment. MDC90 is 10 points (score range = 100). MCID = 5 to 9 points.

Advantages

  • Easy and quick to use and score.

Precautions or limitations

  • Pain and its impact are the major focus.
  • May be difficult for people with limited English language literacy skills to discriminate between each of the response categories.
  • Should be used in conjunction with other measures more biased towards psychosocial items.

Québec Back Pain Disability Scale (QBPDS)

Link

Type

  • Evaluative

Description

  • Explores functioning as the focus (rather than pain) in people with back pain.
  • Measures the efficacy of treatment, gives a baseline of the impact of the low back condition on the person and measures the impact of any intervention on their function. MDC90 is 19 points (score range = 100 points).

Advantages

  • Easy and quick to use and score.

Precautions or limitations

  • The MDC90 is large which means that there needs to be an even larger change in score to be certain that the change is greater than the inherent error of the measurement tool itself.

Head, neck and upper limb

Disabilities of the Arm Shoulder and Hand (DASH)

Link

Type

  • Evaluative

Description

  • Evaluates symptoms and functioning of the whole upper extremity in adults.
  • Measures pain and functioning and the effect of treatment. MCID: 10 (proximal: shoulder) 17 (distal: elbow, wrist and hand).

Advantages

  • Questions include all of the upper limb.
  • Includes an optional high performance sport/music or work section.

Precautions or limitations

  • Complex to score.

Quick DASH

Link

Type

  • Evaluative

Description

  • Measures pain and function in the upper limb and the effect of treatment on pain and shoulder function.
  • There needs to be a change in score of 10 to 19 points for the change to represent clinically important change (MCID).

Advantages

  • Optional high performance items are available for sport/music and work.
  • Easier to score than the original DASH.

Precautions or limitations

  • At least 10 of the 11 items must be completed to calculate a score.

Shoulder Pain and Disability Index (SPADI)

Link

Type

  • Evaluative

Description

  • Measures pain and functioning associated with shoulder pathology and the effect of treatment on pain and shoulder functioning. A change in score of at least 8 points represents the MCID.

Advantages

  • Specific to the shoulder, so useful when this alone is the problem being treated.
  • Easy to score
  • Questions are simple and easy for most people to understand.

Precautions or limitations

  • No psychosocial aspects are included in this outcome measure, so it should be used alongside other measures.

Upper Extremity Functional Index (UEFI)

Link

Type

  • Evaluative

Description

  • Evaluates upper extremity function. Measures functioning throughout the whole arm and evaluates the effect of treatment on this. A change in score of at least 9 points represents MCID.

Advantages

  • Easy to administer, score and interpret.
  • Easy for most people to understand.

Precautions or limitations

  • Very generalised upper limb functional activities.
  • May not be specific enough with some people.

Whiplash Disability Questionnaire (WDQ)

Link

Type

  • Evaluative

Description

  • Examines psychosocial factors as well as pain and functioning in people who have whiplash associated disorder.
  • Measures pain, functioning and yellow flags. The last 4 questions give an idea as to whether yellow flags are present. If the overall score is high, then clinician needs to be aware that manual therapy alone is inadequate. Can be used to measure treatment efficacy. The MDC90 is 15 points. (score range = 130)

Advantages

  • Easy to administer, score and interpret.
  • Easy for patients to understand.
  • Easy for people with limited English language literacy skills.
  • Developed for an Australian cohort and condition specific.

Precautions or limitations

  • None of note.

Headache Disability Index (HDI)

Link

Type

  • Evaluative

Description

  • Explores functioning and changes in functioning in people with subacute and chronic cervicogenic headache.
  • Measures treatment efficacy. If no real change with treatment then the clinician should question the diagnosis of cervicogenic headache and choice of treatment. The MDC95 is a 29-point change or greater in the total score (score range = 100).

Advantages

  • Easy and quick to use and score.

Precautions or limitations

  • This is for cervicogenic headache. A large change needs to occur in scoring for it to be able to be considered greater than the error of this measurement tool.

Neck Disability Index (NDI)

Link

Type

  • Evaluative

Description

  • Explores functioning and changes in functioning in people with neck pain.
  • Measures treatment efficacy. If there is no real change with treatment, clinician should question diagnosis and choice of treatment. MDC90 is 10 points (score range = 100)

Advantages

  • Easy and quick to use and score.

Precautions or limitations

  • Pain and its impact are the major focus.
  • May be difficult for people with limited English language literacy skills to discriminate between each of the response categories.
  • Should be used in conjunction with other measures more biased towards psychosocial items.
  • Can be subject to ceiling effects.

Disability measures

Balance

Functional Independence Sitting Test (FIST)

Link

Type

  • Evaluative

Description

  • Assesses functional sitting abilities and tracks changes in sitting balance over time.
  • Used in clients who are suspected of having problems with balance and/or safety in a seated position.

Advantages

  • Can be conducted at the client's bedside.
  • Practical, easy and quick to administer and can be used for lower level patients.

Precautions or limitations

  • Patients who can stand may benefit from others types of balance testing.

5x sit to stand

Link

Type

  • Evaluative
  • Predictive

Description

  • Measures lower limb strength and balance during transitions from sit to stand to sit. Can also be used to evaluate falls risk.
  • The clinician times how long it takes for the client to move from sitting to standing 5 times and can use the time as an evaluative measure or a predictive falls risk tool.

Advantages

  • Can be used to predict recurrent fallers.

Precautions or limitations

  • Individuals who are weak may not be able to complete the requisite number of repetitions.

Timed Up and Go (TUG)

Link

Type

  • Evaluative
  • Predictive

Description

  • Determines falls risk and measures the progress of balance during movement transitions (sit to stand, stand to sit, turning and walking).
  • If a person takes more than 14 seconds to complete the test, this is associated with an increased risk of falling.

Advantages

  • Assesses several components of mobility in one test.

Precautions or limitations

  • Gait aide use must be recorded and standardised across test and retests. Test-retest error can be high.

Step Test

Link

Type

  • Evaluative

Description

  • Assesses the patient’s ability to use anticipatory postural control whilst performing a step task that is potentially destabilising
  • Measures dynamic balance.

Advantages

  • Fast and easy to conduct.

Precautions or limitations

  • Requires a step with a standardised rise of 7.5 centimetres.

Functional Reach Test

Link

Type

  • Evaluative

Description

  • Assesses anticipatory postural responses to an internally generated perturbation as the person reaches forward.

Advantages

  • A simple measure of functional standing balance.
  • Can be administered in sitting or standing or sitting (Modified functional reach test).

Precautions or limitations

  • None of note.

Balance Evaluation Systems Test (BESTest)

Link

Type

  • Discriminative
  • Evaluative

Description

  • Useful for clinicians looking for guidance on how to assess balance.
  • Differentiates balance into 6 underlying systems that may constrain balance.

Advantages

  • Appropriate across the age spectrum for ambulatory patients.

Precautions or limitations

  • Requires equipment and can take up to 30 minutes to complete.

Mobility

10 metre walk test

Link

Type

  • Evaluative
  • Predictive

Description

  • Assesses walking speed over a short duration.
  • Other gait parameters can be calculated from this simple test including velocity, step / stride length / width and cadence.

Advantages

  • One of the most widely used reliable and valid measures of functional mobility.
  • Quick and easy to administer.

Precautions or limitations

  • Gait aide use must be recorded and standardised across test and retests.

6 minute walk test

Link

Type

  • Evaluative

Description

  • Assesses distance walked over 6 minutes as a sub-maximal test of aerobic capacity/endurance.
  • Provides an idea of what people can achieve with functional mobility.

Advantages

  • Functional and simple to administer.

Precautions or limitations

  • Gait aide use must be recorded and standardised across test and retests.

HiMAT

Link

Type

  • Evaluative

Description

  • Quantifies high-level mobility outcomes following neurotrauma.
  • Assesses a person's ability to participate in running and other higher level mobility activities. The 13 items tested can also be used as treatment activities to progress towards higher level goals.

Advantages

  • Suitable for neurotrauma clients who have goals that require a level of mobility beyond independent level walking.

Precautions or limitations

  • One item for testing requires a flight of stairs.

Upper limb

Action Research Arm Test (ARAT)

Link

Type

  • Evaluative

Description

  • Useful for clinicians looking for guidance about how to assess upper limb functioning.
  • Commonly used in stroke research.
  • A 19-item measure divided into 4 sub-tests (grasp, pinch, grip and gross arm movement).

Advantages

  • Appropriate for use in stroke, brain injury and multiple sclerosis and Parkinson's disease populations. Most useful in people with moderate to high degrees of motor impairment.

Precautions or limitations

  • Requires equipment.
  • 4-point scale reflects the administrator's interpretation and is limited by issues related to insufficient detail around each point on the scale and the description of the testing materials.

Wheelchair User's Shoulder Pain Index (WUSPI)

Link

Type

  • Evaluative

Description

  • Measures the functional cost of shoulder pain in wheelchair users. A simple functional measure of shoulder pain in people with spinal cord injuries.
  • Targets activity limitation resulting from shoulder pain (4 subsections), including wheelchair transfers, wheelchair mobility, self-care and general activities. MDC = 5.

Advantages

  • A simple self-report questionnaire.

Precautions or limitations

  • Does not obtain information about the type or frequency of pain experienced during the activities.

Goal setting

Goal Attainment Scale (GAS)

Link

Type

  • Evaluative

Description

  • Sets and measures a person's individualised goals.
  • An individualised outcome measure to calculate the extent to which a patient’s goals are met. Can be used to set realistic expectations of intervention outcomes by setting the criteria for a successful outcome before the intervention starts.

Advantages

  • Functional and meaningful to the client. The client has direct input to their own goals.
  • Highlights if a person is moving towards or away from their goal (has a +ve and -ve scale).

Precautions or limitations

  • The overall GAS score is complex to calculate manually.
  • Appropriate use of the GAS requires some training and clinical experience, as the clinician needs to be able to predict an individual's outcome.
  • Should be used alongside standardised outcome measures.

Quality of life

Canadian Occupational Performance Measure (COPM)

Link

Type

  • Predictive

Description

  • Assesses an individual's perceived occupational performance in the areas of self-care, productivity and leisure.
  • Identifies daily occupations of importance that clients want to do, need to do, or are expected to do but are unable to accomplish.

Advantages

  • Helps the client and therapist prioritise what activities they need to focus treatment interventions on.

Precautions or limitations

  • The therapist uses a semi-structured interview with the client, which can take time.

Community Integration Questionnaire – Revised (CIQ–R)

Link

Type

  • Evaluative

Description

  • Measures community integration (home, social, productivity and electronic social networking) in people with neurotrauma and other disabilities.

Advantages

  • Australian norms are available.
  • Can be completed by a proxy.
  • Takes 10 to 15 minutes to complete.

Precautions or limitations

  • None of note.

Performance measures

30 second chair stand test

Link

Type

  • Evaluative

Description

  • Tests sit-to-stand activity, lower body strength and dynamic balance.
  • Measures the maximum number of chair stand repetitions possible in a 30 second period.
  • Used to assess lower limb functional strength in any musculoskeletal or pain condition. MCID: 2-3 in hip osteoarthritis.

Advantages

  • Functional, quick and easy to administer.
  • Minimal equipment: standard chair and stop watch.
  • Language is not a barrier.
  • Can be used in range of conditions.

Precautions or limitations

  • Floor effect: ineffective at measuring change in clients who cannot perform this function.
  • Ceiling effect: ineffective at measuring change in strong and fit clients.

40 metre fast-paced walk

Link

Access the 40 metre fast-paced walk

Type

  • Evaluative

Description

  • Tests short distance walking ability with changing direction.
  • A timed walk of 4 x 10 metres for a total of 40 metres. Use useful for people with hip and/or knee osteoarthritis who require more challenge than 10-metre walk test or the Timed Up and Go. MCID: 0.2-0.3m/sec in hip osteoarthritis.

Advantages

  • Functional, quick and easy to administer.
  • Minimal equipment: standard chair and stop watch.
  • Language is not a barrier.
  • Can be used in range of conditions.

Precautions or limitations

  • Gait aide use must be recorded and standardised across test and retests.
  • Floor effect: ineffective at measuring change in clients who cannot perform this function.
  • Ceiling effect: Ineffective at measuring change in strong and fit clients.
  • Requires at least a 14-metre walkway.

6 minute walk test

Link

Type

  • Evaluative

Description

  • Tests aerobic walking capacity over longer distances.
  • Measures the maximal distance covered in a 6-minute period. Suitable for people with hip and/or knee osteoarthritis who require more challenge than 10 metre walk test or Timed Up and Go. MCID: 0.2-0.3m/sec Hip osteoarthritis.

Advantages

  • Functional, quick and easy to administer.
  • Minimal equipment: standard chair and stop watch.
  • Language is not a barrier.
  • Can be used in range of conditions.

Precautions or limitations

  • Gait aide use must be recorded and standardised across test and retests.
  • Requires a standardised area to test and retest in where distance can be measured.

Psychological measures

Depression, anxiety (dis)stress

Depression Anxiety and Stress Scale 42 Item (DASS-42)

Link

Type

  • Discriminative
  • Evaluative

Description

  • Measures the commonly experienced emotional states of depression, anxiety and stress.
  • Can identify individuals who may be at risk of future psychological problems.
  • Clarifies the locus of emotional disturbance, as part of a broader clinical assessment.
  • Can classify symptom severity (normal, moderate, severe).
  • Measures change in symptoms over time.

Advantages

  • Provides more information about symptoms and is more reliable than the DASS-21.
  • Translated into multiple languages.
  • Based on a dimensional rather than a categorical conception of psychological disorder.
  • Identifies high levels of distress in individuals who may not fit into a diagnostic category.

Precautions or limitations

  • Does not assess all symptoms that people may manifest if they are clinically depressed, anxious or stressed (e.g. sleep, appetite, sexual disturbances).
  • Ensure that the correct scoring template and severity categories are being used (not to be confused with the DASS-21).

Depression Anxiety and Stress Scale 21 Item (DASS-21)

Link

Type

  • Discriminative
  • Evaluative

Description

  • Measures the commonly experienced emotional states of depression, anxiety and stress.
  • Can identify individuals who may be at risk of future psychological problems.
  • Clarifies the locus of emotional disturbance, as part of a broader clinical assessment.
  • Can classify symptom severity (normal, moderate, severe).
  • Measures change in symptoms over time.

Advantages

  • Quicker to administer than the DASS-42.
  • Translated into multiple languages.
  • Based on a dimensional rather than a categorical conception of psychological disorder.
  • Identifies high levels of distress in individuals who may not fit into a diagnostic category.

Precautions or limitations

  • Does not assess all symptoms that people may manifest if they are clinically depressed, anxious or stressed (e.g. sleep, appetite, sexual disturbances).
  • The full DASS is generally preferable because it provides more information about symptoms and is more reliable.
  • Ensure that the correct scoring template and severity categories are being used (not to be confused with the DASS-42).

Kessler Psychological Distress Scale (K-10)

Link

Type

  • Evaluative
  • Predictive

Description

  • Simply and quickly measures psychological distress and monitors outcomes following treatment for common mental health disorders.
  • Screens for psychological distress and to assist treatment planning and monitoring.

Advantages

  • 10-item questionnaire with a 5-level response scale that yields a global measure of distress.
  • Scores range from 10 to 50 and may indicate whether a client is likely to have a mild (20-24), moderate (25-29) or severe (30+) mental disorder.

Precautions or limitations

  • Clinical judgement is required for diagnosis and to determine whether a person needs treatment.

Posttraumatic stress disorder

Impact of Events Scale – Revised (IES–R)

Link

Type

  • Discriminative
  • Predictive

Description

  • Assesses for posttraumatic stress disorder (PTSD).
  • Cut-off scores can be used for a preliminary diagnosis of PTSD.
  • Can be used repeatedly to assess treatment progress.

Advantages

  • The revised version has an additional 7 questions to the original IES.
  • Brief completion and scoring.
  • Correlates with the DSM-IV criteria for PTSD.
  • Translated into several languages.

Precautions or limitations

  • Items correspond directly to 14 of the 17 DSM-IV symptoms of PTSD, rather than the DSM-5 PTSD criteria.

Posttraumatic Stress Disorder Checklist – 5 (PCL–5)

Link

Type

  • Discriminative
  • Evaluative
  • Predictive

Description

  • Screens for posttraumatic stress disorder (PTSD), making a provisional PTSD diagnosis and measuring symptom change during and after treatment.
  • Can be administered in one of three formats: without Criterion A, with a brief Criterion A assessment, or with the revised Life Events Checklist for DSM-5 and extended Criterion A assessment. MDC = 5, MCID = 10.

Advantages

  • The wording of PCL-5 items reflect both changes to existing symptoms and the addition of new symptoms in DSM-5.
  • Takes 5-10 minutes to complete.
  • Can be scored in different ways. These include total symptom severity score and DSM-5 cluster severity scores. A provisional PTSD diagnosis can be made by regarding each item rated as 2 or higher as a symptom endorsed and following the DSM-5 diagnostic rules (i.e. 1 B item, 1 C item, 2 D items, and 2 E items). A PCL-5 cut-point of 33 can be used.

Precautions or limitations

  • Change scores for PCL-5 are currently being determined. It is expected that reliable and clinically meaningful change will be in a similar range as for the PCL.

Substance abuse

Alcohol Use Disorders Identification Test short form (AUDIT-C)

Link

Type

  • Discriminative

Description

  • A shortened version of the 10-item AUDIT tool to screen for risky and high risk drinking.
  • A brief alcohol screen that reliably identifies people who are hazardous drinkers or have alcohol use disorders.
  • Comprises 3 questions, each with 5 response options. Scores greater than 4 or 3 in men and women, respectively, may indicate hazardous drinking or alcohol use disorder. The total score (out of 12) indicates, no, low, medium or high risk of harm.

Advantages

  • The AUDIT-C is approximately equal in accuracy to the full AUDIT.

Precautions or limitations

  • When points are all from question 1 alone, it is suggested that the clinician review the client's alcohol intake over the past few months to confirm accuracy.
  • It is not in itself a diagnostic instrument. If a client is identified as a harmful drinker by the AUDIT, they will need a more thorough clinical assessment.

Alcohol Use Disorders Identification Test (AUDIT)

Link

Access the Alcohol Use Disorders Identification Test (AUDIT)

Type

  • Evaluative
  • Predictive

Description

  • Screening tool for risky and high risk drinking.
  • Assesses alcohol consumption, drinking behaviours and alcohol-related problems.
  • The supplementary questions provide useful clinical information about the person's perception of whether they have a problem with alcohol and their confidence that change is possible in the short-term.

Advantages

  • Sub-scores for consumption, dependence, and alcohol-related problems can be calculated.
  • A cut-off score of 8 or more for men and 6 or more for women suggest alcohol-related problems.
  • Available in multiple languages.
  • Developed by the World Health Organization.
  • Shows good responsiveness to change.

Precautions or limitations

  • It is not in itself a diagnostic instrument. If a client is identified as a harmful drinker by the AUDIT, they will need a more thorough clinical assessment.

Drug Use Disorders Identification Test (DUDIT)

Link

Type

  • Discriminative
  • Evaluative

Description

  • Developed as a parallel instrument to the AUDIT for identification of individuals with drug-related problems.

Advantages

  • The most widely used drug screening tool. A client with a score of 25 or more is likely to be dependent on one or more drugs. A cut-off score of 6 or more for men and 2 or more for women suggest drug-related problems.
  • Tested in a variety of settings and populations.
  • Takes about 5 minutes to complete.

Precautions or limitations

  • It is not in itself a diagnostic instrument. If a client is identified as a harmful drug user by the DUDIT, they will need a more thorough clinical assessment.

Child/Adolescent

Clinician-Administered PTSD Scale for DSM-5 – Child/Adolescent version (CAPS-CA-5)

Link

Type

  • Discriminative
  • Evaluative

Description

  • A 30-item clinician-administered posttraumatic stress disorder (PTSD) scale based on DSM-5 criteria for children and adolescents aged 7 and over.
  • The clinician asks standardised questions and probes about each of the 20 DSM-5 PTSD symptoms. Can be used to measure changes in symptoms since a previous CAPS administration.

Advantages

  • This is a modified version of the CAPS-5 that includes age-appropriate items and picture response options. Questions also target the onset and duration of symptoms, subjective distress, impact of symptoms on social functioning, impairment in development, overall response validity, overall PTSD severity, improvement in symptoms since a previous CAPS administration, and specifications for the dissociative subtype (depersonalization and derealisation).

Precautions or limitations

  • Designed to be administered by clinicians who have a working knowledge of PTSD, but can also be administered by appropriately trained paraprofessionals.

Strengths and Difficulties Questionnaire (SDQ)

Link

Type

  • Evaluative
  • Predictive

Description

  • Screens for emotional and behavioural difficulties in children/adolescents and measures change following intervention.
  • A brief behavioural screening questionnaire for 2-17 year olds. It has several different versions, including parent- and teacher-report and self-report for 11-17 year olds.
  • Used as an outcome measure in child and adolescent mental health services in Australia.
  • 25 items divided between 5 scales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviour.

Advantages

  • Free to access, quick to administer and available in self-, parent-, and teacher-report versions.
  • In community samples, multi-informant SDQs can predict the presence of a psychiatric disorder with good specificity and moderate sensitivity.
  • Translated into more than 80 languages.

Precautions or limitations

  • Further research may be necessary to examine it as a tool for guiding treatment and for measuring outcomes resulting from treatment. The SDQ may have some weaknesses in terms of its ability to detect specific disorders. There are no specific scales focusing on trauma symptomatology.

Neuropsychology

Overt Behaviour Scale (OBS)

Link

Type

  • Evaluative

Description

  • Clarifies the types of observable challenging behaviours that can occur following acquired brain injury.
  • Can help show how behaviours may have changed over time and can inform decisions related to clinical interventions. Can also be used to measure the frequency and impact of the behaviour.
  • 9 categories of behaviour can be scored. Clinicians can score the severity, frequency, and impact of each behaviour.

Advantages

  • Covers the most commonly encountered behaviours of concern in community settings.
  • A children's version of the scale could be used: OBS-C.

Precautions or limitations

  • Because this scale was validated with adults with an acquired brain injury in community settings, it may not describe the behaviours most commonly seen in other populations (e.g. intellectual disability or autism).

Definitions

Types of measures

discriminative

A discriminative measure tries to maximally discriminate between a ‘patient’ group and a ‘healthy control’ group, or two ‘patient’ groups (for example, within a triage process) at one point in time.

evaluative

An evaluative outcome measure focuses on capturing clinical changes over time.

predictive

A predictive measure can be utilised to infer the likelihood of a particular outcome occurring in the future.

Other terms

absenteeism

Unexcused and unscheduled absence from duty by an employee. In the context of occupational health and safety in the workplace, absenteeism is the absence or habitual absences of an employee from their workplace without legitimate causes or excuse. Legitimate causes for absenteeism include personal illness and family issues. Unexcused absenteeism can be caused by factors such as poor work environment, lack of commitment by the employee to their job, mental health issues such as depression or marital problems, or substance abuse. See presenteeism.

catastrophising

Refers to a negative cognitive-affective response to anticipated or actual pain. Catastrophising is an exaggerated and negative cognitive and emotional response during an actual or anticipated painful stimulation. Catastrophising is often characterised by people magnifying their feelings about painful situations and ruminating about them, which can combine with feelings of helplessness. Catastrophising plays an important role in models of pain chronicity, showing a high correlation with both pain intensity and disability.

Access information on catastrophising in an overview of the psychological basis of pain by Physiopedia.

clinical prediction rule

A mathematical tool intended to guide clinicians in their everyday decision making. Ideally, a reliable predictive factor or model would combine both a high sensitivity with a high specificity. In other words, it would correctly identify as high a proportion as possible of the patients fated to have the outcome in question (sensitivity) while excluding those who will not have the outcome (specificity).

Access information in an article published by the BMJ.

CAPS 5

Clinician Administered PTSD Scale for DSM-5 (CAPS-5).

Access information from the US Department of Veterans Affairs.

clinimetrics

Refers to a methodologic discipline that focuses on the quality and utility of clinical measurements. The clinimetric properties of an outcome measure are not fixed but vary among different settings and populations in which the outcome measure is used. The clinimetric properties of outcome measures include both psychometric aspects (validity, reliability and responsiveness) and clinical utility (feasibility, interpretability and external validity).

ePPOC

Electronic Persistent Pain Outcomes Collaboration.

Access information from the Australian Health Services Research Institute at the University of Wollongong.

fear avoidance

When a person misinterprets pain in a catastrophising way, this can lead to pain-related fear and associated safety-seeking behaviours, such as avoidance. Outcomes of fear-avoidance behaviour can include disuse and disability and, in turn, a lowering of the threshold at which the person will experience pain.

Access information on the fear avoidance model by Physiopedia.

floor effect, ceiling effect

Scale width, or the capacity of a scale to have initial scores that are able to demonstrate change over time, is an important aspect of the interpretability of an outcome measure. Scale width encompasses the concepts of floor and ceiling effects. A floor effect occurs when a patient scores so low on an outcome measure that further deterioration cannot be measured. Ceiling effects occur when a patient scores so high on an outcome measure that improvement cannot be measured. Interpretability of outcome measures is therefore compromised when floor and ceiling effects occur (Daly, 2010).

IMMPACT

Initiative on Methods, Measurement and Pain Assessment in Clinical Trials.

Access information on the IMMPACT website.

kinesiophobia

An excessive, irrational and debilitating fear of movement and activity resulting from a feeling of vulnerability to painful injury or reinjury.

Access information in an overview of the psychological basis of pain by Physiopedia.

minimum clinically important difference (MCID)

The smallest change in outcome measure score that an individual perceives as important. This value may be affected by many factors such as who determines the MCID, for example, a patient, a clinician or a third party; the cost of the intervention being measured; the risk and the extent of an adverse event that may occur with an intervention and also the level and context of the patient’s disability or pain intensity. MCID can measure deterioration as well as improvement, but it should not be assumed that the absolute value of these changes is equal, as a small deterioration can be of greater or lesser importance to the patient than a small improvement and vice versa. An approximation, from a systematic review of studies of chronic pain, suggests that the MCID is close to half a standard deviation or one point on a seven point scale. The results from a number of studies on different types of pain have demonstrated that the baseline entry score has an effect on the MCID.

It is important to recognise that the MCID measures a different construct to the MDC. Together they provide an interpretation of the statistical and clinical importance of a change in score on an outcome measure. If the MCID is smaller than the MDC it can be concluded that the outcome measure cannot reliably measure MCID (Daly, 2010).

MDC, MDC90, MDC95

Minimum detectable change (MDC) utilises a statistically derived distribution based approach to determine the magnitude of change in score required to be certain that a change is greater than that expected due to error alone. The MDC is a statistical distribution of the margins of error based on the standard error of measurement (SEM) which can be altered to reflect different confidence intervals. Some researchers report the MDC90 which can be interpreted as meaning that 90% of stable patients, i.e patients that are not changing, are likely to display a retest less than the value of the MDC90. Others determine the MDC95 to correspond with the 95% confidence interval.

It is important to recognise that the MDC measures a different construct to the MCID. Together they provide an interpretation of the statistical and clinical importance of a change in score on an outcome measure. If the MCID is smaller than the MDC it can be concluded that the outcome measure cannot reliably measure MCID (Daly, 2010).

neuropathic pain

Pain caused by a lesion or disease of the somatosensory nervous system. Neuropathic pain is a clinical description (not a diagnosis) which requires a demonstrable lesion that satisfies established neurological diagnostic criteria.

Access information in an overview of pain terminology by the International Association for the Study of Pain.

nociceptive pain

Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors (high threshold sensory receptors of the peripheral somatosensory nervous system that are capable of transducing and encoding noxious stimuli).

Access information in an overview of pain terminology by the International Association for the Study of Pain.

positive predictive value (PPV)

Indicates how likely it is for someone who tests positive to actually have the disease (true positive). It answers the question, “I tested positive. Does this mean I definitely have the disease?”

Equally, the negative predictive value (NPV) indicates how likely it is for someone who tests negative to not have the disease (true negative). It answers the question “I tested negative. Does this mean I definitely don’t have the disease?”

Access information by the Students 4 Best Evidence.

presenteesim

A workplace situation in which an employee is present for duty but is not fully capable of performing workplace tasks due to an illness or other condition. Reasons for presenteeism include chronic physical or mental illness, use or abuse of medications or drugs, external stress or other difficulties in the employee’s personal life. Presenteeism leads to a loss of productivity for the employee and hidden costs to the employer. In addition, when presenteeism leads to a lack of care and diligence, it may create serous health and safety risks to the employee or to others. See absenteeism.

revised life events checklist

A self-report measure designed to screen for potentially traumatic events in a respondent’s lifetime.

Access a Life Events Checklist PDF.

WOMAC

Western Ontario and McMaster Universities Osteoarthritis Index (requires purchase of a license).

Access information on the Shirley Ryan AbilityLab website.

yellow flags

The flags model has been used to describe risk factors for the development of persistent pain and work disability. Yellow flags are psychosocial indicators suggesting an increased risk of progression to long-term distress, disability and potential drug misuse. They include the patient’s attitudes and beliefs, coping strategies and adopting a passive role during recovery.

Access information in the Clinical Framework for the Delivery of Health Services PDF.