Compulsory Third Party (CTP) insurers consider the progress a person has made through treatment and rehabilitation when deciding whether to fund further treatment. This progress helps determine whether continued treatment is reasonable and appropriate.
Using outcome measures is an effective way to objectively assess a person’s improvement and whether they are achieving meaningful and lasting results. It’s important to choose outcome measures that are valid, reliable, sensitive to change, and relevant to the individual’s recovery goals.
Here are some examples of outcome measures you may consider using to track progress and support your treatment plans.
The Neck Disability Index
The Neck Disability Index (NDI) is designed to give information on how neck pain has affected a person’s ability to manage everyday life. The result can be expressed as a percentage or as a raw score (out of 50).
H & Mior, S. (1991). The Neck Disability Index: A study of reliability and validity. Journal of Manipulative and Physiological Therapeutics. 1991; 14: 409-415.
The Patient Specific Functional Scale
The Patient Specific Functional Scale (PSFS) asks the patient to specify three important activities they are unable to do or have difficulty with as a result of their condition. They are required to rate their ability to perform each activity on a scale of 0–10.
Startford P., Gill, C., Westaway, M.,& Binkley, J. (1995). Assessing disability and change on individual patients: a report of a specific measure. Physiotherapy Canada, 47, 258-263.
Oswestry Disability Questionnaire
The Oswestry Disability Questionnaire (ODQ) has been designed to assess pain-related disability in persons with low back pain.
Please note: due to licensing requirements, the Oswestry Disability Questionnaire is not available on this website.
Örebro Musculoskeletal Pain Screening Questionnaire
The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) is designed to estimate the risk of future work disability. The short version of the ÖMPSQ includes 10 items selected from the full version. The total score will range between 1 and 100, with a score >50 indicating a higher estimated risk for future work disability.
Linton, S. J., Nicholas, M., MacDonald, S. (2011). Development of a Short Form of the Örebro Musculoskeletal Pain Screening Questionnaire.Spine, 36,1891–1895.doi: 10.1097/BRS.0b013e3181f8f775.
Patient Health Questionnaire-9 (PHQ-9)
The Patient Health Questionnaire-9 (PHQ-9) is self-administered and uses a scoring method to specifically measure depression-related symptoms.
Scoring: the total score of first 9 items ranges from 0-27. Scores of 5, 10, 15 and 20 represent cut off points for mild, moderate, moderately severe and severe depression respectively.
Spitzer, RL., Kroenke, K., Williams, J.B. and Patient Health questionnaire Primary Care Study Group (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282, 1737-1744.
Generalised Anxiety Disorder-7 (GAD-7)
This seven-item questionnaire is a valid and efficient clinical screening and severity measure for Generalised Anxiety Disorder (GAD).
Scoring: GAD-7 ranges from 0-21. Scores of 5, 10 and 15 represent cut off points for mild, moderate and severe anxiety respectively. A recommended cut point for further evaluation is a score of 10 or greater.
Spitzer, ARL., Kroenke, K., Williams, J.B., and Lowe, B. (2006) A brief measure for assessment generalized anxiety disorder: the GAD-7. Arch Intern Med, 166, 1092-1097.
Impact of Event Scale – Revised (IES-R)
The Impact of Event Scale – Revised (IES-R) is a valid self-reporting measure designed to assess current, subjective distress in response to a specific traumatic event.
Scoring: The 22 item scale has 3 subscales for the major symptom clusters of post-traumatic stress – intrusion, avoidance and hyperarousal. The scores for each subscale range from 0 (“not at all”) to 4 (“extremely”) and the maximum overall score is 12. There are no specific cut off scores, although higher scores are representative of greater distress.
The Impact of events scale – Revised Weiss, D.S. & Marmar, C.R. The impact of event scale-revised in Wilson, J.P. & Kean, T.M. (eds.) Assessing psychological trauma and PTSD: a practitioner’s handbook (chptr 15). N.Y: Guildford, 1995.
Posttraumatic Stress Disorder Checklist (PCL)
The Posttraumatic Stress Disorder Checklist (PCL) is a 20-item, self-reporting checklist of posttraumatic stress disorder (PTSD) symptoms based on the DSM-V criteria. There is also a PTSD Checklist (PCL) available based on DSM-IV if required.
Scoring: each item is rated from 0 (“Not at all”) to 4 (“extremely”). Scores can range from 0 to 80. Evidence for the PCL for DSM IV suggests a 5-10 point scale change is reliable and a 10-20 point change is clinically meaningful. 5 points can be used as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether improvement is clinically meaningful. Change scores for PCL-5 are currently being determined and it is recommended the DSM-IV recommendations be followed.
Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov.
Kessler Psychological Distress Scale (K10)
The Kessler Psychological Distress Scale (K10) is a validated 10-item, self-reporting questionnaire for a global measure of psychological distress, based on questions about anxiety and depressive symptoms.
Scoring: The numbers attached to the 10 responses are added. Scores will range from 10 to 50. Score range: 20-24 – mild; 25-29 – moderate; > 30 – severe.
Kessler R.C., Andrews, G., Colpe et al (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959-956.
Andrews, G.,Slade, T (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25, 494-497.
Depression Anxiety Stress Scales (DASS-21)
This is a 21-item, self-reporting questionnaire designed to measure the severity of a range of symptoms common to both depression and anxiety. This questionnaire is designed to measure the severity of the symptoms, as well as measuring treatment response. It is best given on the first presentation and after a period of treatment. www.psy.unsw.edu.au/dass/
Scoring: Each item is scored from 0 (not relevant over the past week) to 3 (applied most of the time all over the past week).