Live, Dynamic Evidence-Based Outcome Measures

I've been confused by EBOs since I began this journey. As an example, in the Sit to Stand, EBOs say a man 76, non-Parkinson's, should do 11 stands in 30 seconds. During my most recent assessment, I did 17, with Parkinson's. I guess that 25 years ago a 76-year-old-man may not be the same as a 76-year-old man today? Evidently, (pun intended) EBOs get stale and obsolete. BTW, using the published EBO which did not include any people with Parkinson's is a real a problem for people with Parkinson's.

Another example of nonsensical EBOs is the Standing Jump which has a published EBO of "twice the client's foot length". That would be 22 inches for me. The first problem is I can't find whether you measure toe-to-heel or toe-to-toe, so consistency is a problem. About 9- or 10-inches difference for a man. Is this high school track or a scientific endeavor? But the serious problem is that I recently jumped 68 inches. So, I scored a "4", Fullerton's best score. What happens if 6 months from now, if I jump 48-inches? I still get a Fullerton gold star for beating 22 inches. Mr. Fullerton does not even know that I lost 20 inches because in Mr. Fullerton's test, you don't track the actual distance jumped. However, a 20-inch loss in 6 months is a serious loss. But I jumped more than twice my foot length, so I'm good.

Not to pick on UC Fullerton because all the prevalent assessment tests have the same problems. Berg, BESTest, Rickli and Jones, Tinetti, the Dynamic Gait Index. They were created in the days when paper was high tech. They were created to be used when indicated by a loss of balance or high fall risk (Stage 3) so they don't assess healthy people (Stages 1 & 2) very well. They used basic criteria such as gender and age. Isn't there a difference between a healthy 75-year-old and a 75-year-old with Parkinson's? Most of their EBOs have never been updated. Some of the individual tests are included in several assessment series with slightly different instructions. So, they can't be used across channels or communities, so the research value is questionable. If you search YouTube for Fullerton, you get 10 or so videos by physical therapists and they are all different.

Winning Insights spent years working on a solution. In our Insight Suite, we have thousands of clients with consistent administered assessments as our evidence. Contemporary, standardized and reliable evidence. And you can filter or sort the evidence to meet whatever criteria you desire:

People Like Me outcome measures is the Winning Insights solution. PLM has been the Insight Suite model for 2 years with great acceptance by physical therapists we have consulted with. PLM has even received a few "Wows!". Here is why.

• Live: Within Insight Suite, we have thousands of results for some of the individual assessment tests. And as we move forward, every test in our library will build a meaningful base of results. This data bank can be queried in real-time to create a relevant base of evidence. It will never become stale or obsolete.

• Dynamic: Define your EBO criteria to be as comprehensive as desired: Healthy or by a condition such as Parkinson's, add gender, age groups, stage of their condition, height, almost any data point in the system. No more using age and gender EBOs from 25 years ago. Insight Suite uses fresh, relevant filtering criteria to assist you in modeling each outcome question.

  Evidence: In the example below, Insight Suite has 27 records matching the criteria. Two thoughts... Those 27 records are for men, with Stage 1 Parkinson's and +/- 2 years of the age of the client. That's more specific and relevant than EBO "twice the client's foot length". And as the database grows to tens of thousands of clients and assessment records, the statistical significance will become compelling. That is certainly "evidence".

• Outcomes: The standardization of the tests processes, the on-screen administration instructions, the normalization of the scoring, and the fine filtering of the records to use in each PLM report are truly an outcome that can be demonstrated with consistency over time.

Below is a Standing Jump People Like Me progression graph for a 76-year-old man with Stage 1 Parkinson's. Me.

With 27 records, the graph shows the full evidence base criteria plus the actual Fullerton EBO of twice the client's foot length in purple plus the Insight PLM for the average jump distance (36 inches) and the max jump distance (55 inches) (throw out outliers) for the matching clients.

As the database of clients and assessments continues to grow, the sample population will grow and the statistical significance will grow as well.

Insight Suite's People Like Me feature is a game changer.