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Outpatient Physical Therapy Improvement in Movement Assessment Log

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Purpose

APTA's Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is an instrument that measures difficulty and self-confidence in performing 22 movements that a patient/client needs to accomplish in order to do various functional activities. OPTIMAL 1.1 has been updated from the original version to increase clinical utility. This includes adding the clinically relevant item of standing and providing changes to scoring instructions to increase clinical utility. These changes will assist patient and physical therapist discussion toward identifying the primary goal for the episode of care.

Link to Instrument

Instrument Details

Acronym OPTIMAL

Area of Assessment

Balance – Non-vestibular
Coordination
Dexterity
Functional Mobility
Gait
Upper Extremity Function

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Brain Injury Recovery
  • Pain Management
  • Parkinson's Disease & Movement Disorders
  • Pulmonary Disorders

Populations

Musculoskeletal Conditions

Key Descriptions

  • The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is an instrument that measures difficulty and self-confidence in performing 22 movements that a patient/client needs to accomplish in order to do various functional activities.
  • Scoring is relatively simple, and it can be done in 3 different ways:
  • 1) The most expedient way to calculate a total score is to sum the responses (marked on a 1 to 5 scale) across all 22 items on difficulty and on self-confidence upon both the patient’s/client’s admission (baseline) and discharge from physical therapy (final). Then subtract the final sum from the baseline sum. The higher the change score, the more the patient has improved. If a particular item on the OPTIMAL is marked as "Not Applicable," then this item should be dropped completely from the overall scoring. For example, suppose that two items are marked "Not Applicable." The best possible score on "Difficulty" or "Self-confidence" for this patient would be "20" (1 x 20 items) and the worst possible score would be "100" (5 x 20 items). Do not add "9" to the score ("9" is an arbitrary coding convention to distinguish the item from missing data if you are entering information into a database).
  • 2) The instrument includes a question that asks the patient/client, “From the above list [referring to the 22 items], choose the 3 activities you would most like to be able to do without any difficulty,” which may also provide clinically meaningful information. The therapist can calculate a specific item score to appraise the changes between admission and discharge scores on these three items.
  • 3) Finally, The instrument includes a question that asks the patient/client, “From the above list of 3 activities please indicate the primary activity that you would most like to be able to do without any difficulty,” which may also provide clinically meaningful information. The therapist can calculate a specific item score to appraise the changes between admission and discharge scores on the primary goal. This scoring method allows the therapist to determine the outcome of treatment on the ability to perform the movement that is most important to the patient/client. This method particularly aids in the clinical decision-making process.

Number of Items

22

Time to Administer

20 minutes

Required Training

No Training

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Deb Kegelmeyer PT, DPT, MS, GCS & the PD EDGE Task Force of the Neurology Section of the APTA

ICF Domain

Body Function
Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

NR

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

No

Not reported

Considerations

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Musculoskeletal Conditions

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Internal Consistency

Musculoskeletal Diagnoses:

(Guccione et al, 2005) Cronbach alphas 

 

Baseline

  
 

Difficulty scale

Confidence scale

Lower extremity

0.95 

0.95 

Upper extremity

0.94 

0.94 

Trunk subscale

0.85 

0.87 

Total of all 3 subscales

0.75 

0.7

Criterion Validity (Predictive/Concurrent)

Musculoskeletal Diagnoses:

(Guccione et al. 2005) 

  • Baseline Difficulty Scale scores had strong correlations with PF-10 (physical function subscale of the SF-36) scores (-0.80) and moderate correlations with Visual Analogue Scale (VAS) scores for overall difficulty (-0.65) 
  • The baseline Confidence Scale scores had strong correlations with PF-10 scores (-0.72) and moderate correlations with VAS scores for overall confidence (-0.60)

Construct Validity

Musculoskeletal Diagnoses:

(Guccione et al. 2005) 

The Cronbach alphas for the subscales of the Difficulty Scale at 2- and 4-week follow-ups, respectively, were: 

  • Trunk (0.82, 0.87)
  • Lower extremity (0.95, 0.96)
  • Upper extremity (0.93, 0.94)

For the subscales of the Confidence Scale, the Cronbach alphas for the 2- and 4-week follow-ups, respectively, were: 

  • Trunk (0.87, 0.87)
  • Lower extremity (0.95, 0.95) 
  • Upper extremity (0.94, 0.95)

Floor/Ceiling Effects

Musculoskeletal Diagnoses:

(Guccione et al. 2005) 

There were minimal to moderate ceiling effects for some items on the OPTIMAL.

Responsiveness

Musculoskeletal Diagnoses:

(Guccione et al. 2005) 

  • 4 of the 6 subscales had medium effect sizes from 0.21 - 0.44 at the 4 week follow up, this time frame was the most sensitive to change. 
  • The upper extremity subscale of the Difficulty scale had a small effect size and the upper extremity subscale of the Confidence scale had a negative effect size, which indicates participants became less confident with mobility over time.

Bibliography

Guccione, A. A., Mielenz, T. J., et al. (2005). "Development and testing of a self-report instrument to measure actions: outpatient physical therapy improvement in movement assessment log (OPTIMAL)." Phys Ther 85(6): 515-530. Find it on PubMed

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