OATS: Outcomes Assessment Tools

3/21/16 jkc - Posted inquiry on VCAdoctalk, asking what Unified VCA members use for outcomes assessments.

Responses

An extremely important document that all DCs should have and be familiar with is “Options for Documenting Functional Improvement in Conservative Care” from the Industrial Insurance Chiropractic Advisory Committee of the Washington State Department of Labor & Industries.

Jay Greenstein, DC

Ft. Washington, MD

I use the VAS pain scale (blind, without numbers) and the Functional Rating Index questionnaire (FRI).

We do VAS on every visit and FRI on every examination, new and follow-up.

Elliott Eisenberg, DC

Richmond, VA

We use a Functional Rating Index (FRI) to mark a patient's progress.

Jennifer Hackley, CA

Blue Ridge Chiropractic & Acupuncture, LLC

Purcellville, VA

We use Neck and Back Oswestry and Visual Analog Pain Scale (VAS)

Thomas M. Connelly, DC

Washington DC

The most common, by far, are the NRS, the Oswestry, and the Vernon-Mior (aka NDI). After those three, you will find some using the smiley faces scale, Roland-Morris, HDI, and QVAS. Also the “general” disability form (don’t remember the official name) and the whiplash form (don’t remember the official name) will be seen occasionally. There are MANY others, but not frequently used in this profession, primarily due to lack of awareness.

When talking to doctors about these forms, it is important to stress that you don’t just “get” a copy and haphazardly use it. You must know the CORRECT way to implement these forms. It is important to know WHEN to administer them, WHICH ones are best under which circumstances, how to SCORE them, and what constitutes a clinically SIGNIFICANT change. If not used appropriately, they serve no purpose.

That is why I always strongly recommend they get Steve Yeomans’ text on the subject. It is the best one out there, IMHO, and will walk them through it. In addition, it is important to remember that not all of these tools are in “public domain.” Some of them are copyrighted and can only be used when obtained through a licensed source (Dr. Yeomans obviously has permission to use all the forms in his text). This can be important, especially in PI, because attorneys have been known to question doctors, while on the stand, whether or not they are legally using the forms.

Dr. Yeomans’ text is available in bookstores, on Amazon.com, etc. However, the discount is only available if you order directly from him. I have a form with a discount code on it if anyone would like me to forward it.

Susan McClelland, FICC

McClelland Consulting LLC

Roanoke, VA

I use the FRI.

Michael Pankow, DC

Virginia Beach, VA

When in daily practice, we used:

VAS, Neck pain index (NPI), Oswestry LBP, LEFS (lower extremity functional scale), Roland Morris, Shoulder pain scale, DASH, Headache disability index, Loss of enjoyment (PI cases).

Dennis O’Hara, DC

Bristow, VA

I use a variety of OATS and have since Dr. Mac McClelland wrote an article on them in the 1990s -- but I mainly use them for Medicare or PI cases to set goals based on the questions, not as a numerical outcome measure.

I loved Yeoman's book when it came out but have problems with Yeoman's tracking use. It is cumbersome, especially if the patient has many issues. Many OATs are constructed for evaluation in research settings and have been validated in relation to that purpose rather than to evaluate clinical outcomes related to patient satisfaction and real world function. A significant VAS change in research might be 3 but that is averaged over the whole sample. Most of my patients’ improvements do not correlate well with regard to their paper reporting.

About 10 years ago I was arguing with a TPA who burst out with, “Do you know how many VAS I look at each day? 300.” Even if there were 3 per record, it implies that he was looking at 100 records per day. Given the various errors that can creep into each individual’s reporting, I doubt they are as accurate as just asking how they are doing and looking at them. If ASH wants to use them to report effectiveness of their management and uses a large sample, it is different than working with individual patients.

Nelson Gregory, DC

Richmond, VA