PMID- 29077929
OWN - NLM
STAT- MEDLINE
DCOM- 20171208
LR  - 20220318
IS  - 1538-6724 (Electronic)
IS  - 0031-9023 (Linking)
VI  - 97
IP  - 12
DP  - 2017 Dec 1
TI  - Responsiveness to Change of Functional Limitation Reporting: Cross-sectional 
      Study Using the Intermountain ROMS Scale in Outpatient Rehabilitation.
PG  - 1182-1189
LID - 10.1093/ptj/pzx093 [doi]
AB  - BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) require physical 
      therapists document patients' functional limitations. The process is not 
      standardized. 
A systematic approach to determine a patient's functional 
      limitations and responsiveness to change is needed. OBJECTIVE: The purpose of 
      this study is to compare patient-reported outcomes (PROs) responsiveness to 
      change using 7-level severity/complexity modifier scale proposed by Medicare to a 
      derived scale implemented by Intermountain Healthcare's Rehabilitation Outcomes 
      Management System (ROMS). DESIGN: This was a retrospective, observational cohort 
      design. METHODS: 165,183 PROs prior to July 1, 2013, were compared to 46,334 
      records from July 1, 2013, to December 31, 2015. Histograms and ribbon plots 
      illustrate distribution and change of patients' scores. ROMS raw score ranges 
      were calculated and compared to CMS' severity/complexity levels based on score 
      percentage. Distribution of the population was compared based on the 2 methods. 
      Sensitivity and specificity were compared for responsiveness to change based on 
      minimal clinically important difference (MCID). RESULTS: Histograms demonstrated 
      few patient scores placed in CMS scale levels at the extremes, whereas the 
      majority of scores placed in 2 middle levels (CJ, CK). ROMS distributed scores 
      more evenly across levels. Ribbon plots illustrated advantage of ROMS' using 
      narrower score ranges. Greater chance for patients to change levels was observed 
      with ROMS when an MCID was achieved. ROMS narrower scale levels resulted in 
      greater sensitivity and good specificity. LIMITATIONS: Geographic representation 
      for the United States was limited. Without patients' global rating of change, a 
      reference standard to gauge validation of improvement could not be provided. 
      CONCLUSIONS: ROMS provides a standard approach to identify accurately functional 
      limitation modifier levels and to detect improvement more accurately than a 
      straight across transposition using the CMS scale.
CI  - (c) 2017 American Physical Therapy Association
FAU - Brennan, Gerard P
AU  - Brennan GP
AD  - G.P. Brennan, PT, PhD, Rehabilitation Services, Intermountain Healthcare, 5848 
      South 300 East, Salt Lake City, UT 84107.
FAU - Hunter, Stephen J
AU  - Hunter SJ
AD  - S.J. Hunter, PT, DPT, Rehabilitation Services, Intermountain Healthcare.
FAU - Snow, Greg
AU  - Snow G
AD  - G. Snow, PhD, Rehabilitation Services, Intermountain Healthcare.
FAU - Minick, Kate I
AU  - Minick KI
AD  - K.I. Minick, PT, DPT, Rehabilitation Services, Intermountain Healthcare.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Phys Ther
JT  - Physical therapy
JID - 0022623
SB  - IM
EIN - Phys Ther. 2018 Jul 1;98(7):627. PMID: 29939332
MH  - Adult
MH  - Aged
MH  - *Ambulatory Care
MH  - Cross-Sectional Studies
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Reported Outcome Measures
MH  - *Physical Therapy Modalities
MH  - Recovery of Function
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Treatment Outcome
MH  - United States
EDAT- 2017/10/28 06:00
MHDA- 2017/12/09 06:00
CRDT- 2017/10/28 06:00
PHST- 2017/09/08 00:00 [received]
PHST- 2017/10/05 00:00 [accepted]
PHST- 2017/10/28 06:00 [pubmed]
PHST- 2017/12/09 06:00 [medline]
PHST- 2017/10/28 06:00 [entrez]
AID - 4430748 [pii]
AID - 10.1093/ptj/pzx093 [doi]
PST - ppublish
SO  - Phys Ther. 2017 Dec 1;97(12):1182-1189. doi: 10.1093/ptj/pzx093.