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07 Fundamentals of Measurement
07 Fundamentals of Measurement
07 Fundamentals of Measurement
Fundamentals of Measurement:
Linking Evidence to Practice
J Orthop Sports Phys Ther 2019;49(2):114-115. doi:10.2519/jospt.2019.0701
M
easurement is fundamental to science, which means that tools are designed to direct a patient to-
physical therapists must engage with measurement if the ward a certain type of treatment, such as
profession wishes to call itself scientific. However, while it the STarT Back tool. Outcome measures
are designed to track the level or pres-
is simple enough to agree that measurement is a good idea,
ence of a symptom, function, or disease
there is more to measurement than meets the eye. marker, for example, the Patient-Specific
Downloaded from www.jospt.org by Uni Western Sydney on 01/31/19. For personal use only.
From the researcher’s point of view, tionnaire are also measures of disability Functional Scale. Some measures might
the reason for measuring various demo- in people with shoulder pain (FIGURE). serve several purposes; for example, pain
graphic, personal, and clinical factors is intensity measured on a numeric rating
self-evident: scores on the measures an- Purpose scale may form part of a diagnostic test,
swer the research question. In the clinic, There are many reasons to measure inform likely prognosis, and be tracked
physical therapists collect measurements something, and any number of avail- over time as an outcome measure.
(often informally) from the beginning of able measures. Screening measures are
the clinical encounter, whether by asking designed to estimate how likely it is that Subjective and Objective Measures
a question like, “What is bothering you a healthy person will have a certain con- A common mistake is to call measures
today?” or by observing the way the pa- dition in the future, and whether further rated by the patient “subjective” and
tient gets out of a chair and walks. This investigations (eg, screening for cardio- those rated by an observer “objective.”
information guides further assessment vascular risk) should be pursued. Diag- Subjectivity refers to the extent of per-
J Orthop Sports Phys Ther 2019.49:114-115.
and management. Clinicians and re- nostic measures (tests) are designed to sonal judgment involved in taking a mea-
searchers both face similar issues when it determine whether someone does or does sure, and the personal judgment could be
comes to interpreting the measures they not have a certain condition, an example on behalf of the patient or the observer;
collect. To do this accurately, understand- being the Lachman test for anterior cru- for example, a physical therapist’s rating
ing some basic concepts about measure- ciate ligament rupture. Prognostic tools of the amount of swelling is also subjec-
ment is necessary. are designed to help predict whether or tive. Further, it is better to consider mea-
when a patient will recover, such as the sures as more or less subjective—along
Constructs and Measures Örebro Musculoskeletal Pain Question- a hypothetical continuum—rather than
A construct is what you are interested in naire. Treatment-based classification wholly subjective or objective. Another
measuring. A measure (sometimes called
a tool or an instrument) is how the con-
Construct Measure Score
struct is measured. For example, you may Less disabled More disabled
be interested in the construct of “disabil- Disabilities of the Arm, Shoulder and 0 20 40 60 80 100
Hand questionnaire
ity” in a patient with shoulder pain, and
choose to use the Disabilities of the Arm, Shoulder
Shoulder Pain and Disability Index 0 20 40 60 80 100
Shoulder and Hand questionnaire as the disability
School of Public Health, University of Sydney, Camperdown, Australia; Centre for Pain, Health and Lifestyle, Australia. t Copyright ©2019 Journal of Orthopaedic & Sports Physical
1
Therapy®
name implies, these are ratings pro- activity. Even though these types of inappropriate measures has critical con-
vided by the patient. This might measures are typically toward the sequences for both clinical practice and
involve filling out a written question- more objective end of the spectrum, research. When reading research, it is im-
naire or answering questions verbally. their fit for purpose, reliability, and va- portant to check that the construct matches
Patient-reported measures are com- lidity should not be automatically as- the study question. From a clinical perspec-
monly used to rate symptom sever- sumed. For example, interpretation of tive, being able to clearly articulate why you
ity, the impacts of a condition, or to scans and images is highly subjective, want to measure a certain construct is key.
measure psychological constructs and findings may not have important Having decided on the appropriate con-
like quality of life, depression, and functional consequences. struct, you need to select the best measure.
self-efficacy. • Administrative data. These are most This involves consideration of reliability
• Observer-rated measures. These commonly used in research, and in- and validity, which will be the subject of the
measures involve observations made clude metrics such as hospital atten- next Evidence in Practice article. t
J Orthop Sports Phys Ther 2019.49:114-115.