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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1073 — Identifying Veteran-Centered Outcomes Using Qualitative Methods

Hannold EM (Rehabilitation Outcomes Research Center (RORC) REAP), Velozo CA (RORC REAP), Roach MJ (Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio), Hanjian JM (RORC REAP), Jordan MM (RORC REAP), Behrman AL (NF/SG Brain Rehabilitation Research Center of Excellence), Daly JJ (Cleveland COE in Functional Electrical Stimulation)

Objectives:
Clinical outcome measures have been developed with little input from patients. Outcome measures that are sensitive to change and responsive to patients’ priorities are needed to refine emerging treatments, and accurately monitor treatment effectiveness. The objective of this VA study is to apply qualitative methods to identify constructs reflecting veterans’ experiences of 3 emerging gait interventions. The VA has funded studies to test the effectiveness of these interventions in promoting recovery of gait following neurologic disability. This abstract summarizes Phase I of a larger study designed to combine qualitative and quantitative methods to develop improved, veteran-centered outcome measures.

Methods:
Qualitative methods are used to collect and analyze data from 20 patients (15 with stroke, 5 with incomplete spinal cord injury) enrolled in one of three gait interventions. Data are collected through a series of 3 in-depth interviews and 3 ethnographic video diaries per patient. To date, 12 patients have provided data from 27 interviews and 28 video diaries. All data are transcribed verbatim, coded using NVIVO software, and then systematically analyzed to identify prominent themes and relationships.

Results:
Prominent themes to emerge from the data include improvements in endurance, balance, posture, quality of gait, and increased participation in community ambulation. Patients viewed improved endurance and balance as particularly valuable—describing these outcomes as critical to completing tasks associated with their social roles in the home and community. For example, the renewed ability to “walk in the mall”, “clean the house”, and “rake the yard” were identified by patients as outcomes they valued the most. Patients rarely described gait speed, a common clinical outcome indicator for gait interventions, as a change they valued.

Implications:
Preliminary findings suggest a discrepancy between clinical outcomes targeted by current gait-related measures (gait speed), and gait-related outcomes perceived as meaningful by patients (tasks associated with their pre-injury social roles). Applying qualitative methods to capture patient perspectives appears effective in generating areas for outcomes measurement that are important to veterans participating in gait interventions.

Impacts:
Findings will lead to the development of measures that accurately reflect outcomes that are meaningful to veterans participating in emerging gait interventions.


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