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LIST OF OUTCOME MEASURES

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LIST OF OUTCOME MEASURES Powered By Docstoc
					           LIST OF OUTCOME MEASURES
1. General quality of life

       UNIVERSITY OF WASHINGTON QOL HEAD AND NECK
       Has subscales for:
       Swallow
       Chewing
       Speech

       EORTC HEAD AND NECK SCALE

       DISTRESS THERMOMETER (Brennan 2007)
        Designed by a Clinical Psychologist at BHOC to use with patients undergoing
        radiotherapy.
        Covers – practical, family, emotional, spiritual, physical problems.
        Patient has to rank top 4 problems.

           TOMS WELLBEING/DISTRESS SCALE
           Measures on a 0 to 5 scale. 0 is severe and 5 in no difficulty for the following:

           frustrated /upset /anger/distress/embarrassment/concern/withdrawal


2. Dysphagia

   MANN ASSESSMENT SWALLOW ABILITY 2004

   Speech therapist to do
   Validated on CVA population.


   It also has diet recommendations for solids and liquids.

   A swallow integrity risk rating.
   Risk of dysphagia and/or aspiration: Definite, probable, possible, unlikely.

   FUNCTIONAL OUTCOME SWALLOW SCALE (FOSS)
   SALASSA 1999

           Speech therapist to do
           Has been used with Head and Neck patients
           Measures change with a 5 point scale

       FUNCTIONAL ORAL INTAKE SCALE (FOIS) CRARY 2005

               Validated on CVA
               Speech therapist to do
               Measures change with a 7 point scale
FUNCTIONAL INRAORAL GLASGOW SCALE

Jackson M (SLT) Canniesburn hospital 1992
Validated on Head and neck cancer patients
Self rating scale

ENDERBY THERAPEUTIC OUTCOME MEASURES (TOMS)

Scales cover with 6 point ratings:

       Impairment
       Disability
       Wellbeing/distress
       Risk of aspiration
       Staged oral feeding recommendations
       Therapeutic procedures
       Factors contributing to poor outcome

Different disorders: Dysphonia, dysarthria, dysphagia.

       Speech therapist to do

RISK OF ASPIRATION
Very high (1) to none (5)

VIDEOFLUOROSCOPY FINDINGS

FEES

ROSENBEK PENETRATION ANSD ASPIRATION SCALE Rosenbek 1996
8 point scale

FRENCHAY DYSPHAGIA PROFILE

PERFORMANCE STSTAUS SCALE FOR HEAD AND NECK CANCER
PATIENTS List, M (1990)
Clinician assessment
Designed specifically for Head and neck patients
Shown to discriminate levels of function across different types of H ad N cancer
Good inter rater reliability
Sensitive to differences in performance and change over time


DYSPHAGIA SEVERITY RATING SCALE GRAMIGA 2006 (adapted from
Waxman et al 1990)
3. VOICE

      GRBAS PECEPTUAL VOICE ASSESSMENT Hirano

      VOICE HANDICAP SCALE

      VOISS (VOICE SYMPTOMS SCALE)

      VISIPITCH

      ENDOSCOPY FINDINGS

4. SPEECH

CNS ASSESSMENT

FRENCHAY DYSARTHRIA PROFILE

McKINSTRY AND PERRY 2003 PATIENT RATING FOR SPEECH

      Validated on Head and Neck cancer patients

      5 point scale with 1 as NAD and 5 as very impaired.
      Covers: Intelligibility, Breathing, lips, tongue, nasality, sound of voice, pitch, volume.
      SCALES
     TOMS WELLBEING SCALE
     0 severe/constant
     1 Frequently severe
     2 Moderate constant
     3 Moderate frequent
     4 Mild occasional
     5 No inappropriate

      MANN ASSESSMENT OF SWALLOW ABILITY
Scale covers:
Alertness
Co-operation
Auditory comprehension
Respiration
Respiratory rate for swallow
Aphasia
Apraxia
Dysarthria
Saliva
Lip seal
Tongue movement
Tongue strength
Tongue co-ordination
Oral preparation
Gag
Palate
Olus clearance
Oral transit
Cough reflex
Volunatary cough
Voice
Trach
Pharyngeal phase
Pharyngeal response

It rates each item between 10 (nad) and 1 (severe)

   FOSS
   Scale:
   Stage 0 Normal function

   Stage 1 Episodic/daily symptoms of dysphagia

   Stage 2 Compensated abnormal function – diet modifications or prolonged mealtimes.
   No weight loss and or aspiration.
Stage 3 Decompensated abnormal function with weight loss of 10% or less body
weight over 6 months due to dysphagia, daily cough, gagging or aspiration.

Stage 4 Severely decompensated abnormal function with weight loss more than 10 %
due to dysphagia or severe aspiration with broncho-pulmonary complications, non oral
feeding recommended for most nutrition.

Stage 5 Non-oral feeding for all nutrition.


 FOIS Scale:
 Level 1 NBM

 Level 2 Tube dependent with minimal attempts at food or liquid

 Level 3 Tube dependent with consistent oral intake of food or liquid

 Level 4 Total oral diet of a single consistency

 Level 5 Total oral diet with multiple consistencies but requiring special preparation or
 compensations

 Level 6 Total oral diet with multiple consistencies without special preparation but
 specific food limitations

 Level 7 Total oral diet with no restrictions

 TOMS Dysphagia scale:

 TOMS Impairment
 0 Severe dysphagia. Not safe swallow due to cognitive status/no bolus
 control/aspiration/absence of oral/pharyngeal swallow. Clinical signs of aspiration.
 No cough reflex. May need regular suction.

 1 severe dysphagia. Weak oral movements/ no bolus control/inadequate/ inconsistent
 swallow reflex. High risk of aspiration.

 2. Severe/moderate. Cough/swallow reflexes evident but abnormal or delayed. Unco-
 ordinated oral movements. Risk of aspiration.

 3. Moderate. Swallow and cough reflex present. May have poor oral control. At risk
 of occasional aspiration.

 4. Mild oral/pharyngeal inco-ordination. No evidence of aspiration.

 5. No evidence of dysphagia.

 TOMS Disability
 0 Non otral feeding to meet all hydration and nutrition needs.
1 Non oral feeding to meet all hydration and nutrition needs. Variable ability to take
practice amounts of modified consistencies using compensatory strategies. Needs
experienced supervision.

2 Non oral feeding/supplements needed to meet hydration and nutrition needs.
Consistently able to take practice amounts of modified consistencies using
compensatory strategies. Needs experienced supervision.

3. Consistently able to take modified consistencies using compensatory strategies.
Needs some supervision. May require feeding supplements, may eat very slowly.

4. Although eating and drinking is abnormal, it is good enough to meet nutritional
requirements. No supervision required. No alterantive or supplement feeding. May
avoid certain food, drinks or eating situations.
5. Functionally eating and drinking a normal diet.(My involve postures and strategies)

TOMS Handicap
0. Unable to fulfil any social/educational/family role. Not involved
indecision              making/no autonomy/no control over environment. No social
integration.
1. Low self confidence/poor self esteem/limited social integration/sociall
isolated/contributes to some basic and limited decisions.
2. Some self confidence/social integration/makes some decions and influences control
n familiar sitiations.
3. Some self confidence, autonomy emerging. Makes decisions and has control over
some aspects of life.
4. Mostly confident.Occasional difficulties integrating or fulfilling social
role.Participates in all appropriate decisions.
5. Achieving potential autonomous and unrestricted. Able to fulfill social role.

RISK OF ASPIRATION

PERFORMANCE STATUS SCALE HEAD AND NECK
1. Very high
2 High
3 Medium
4 Low
5 None

Eating in public
100 NAD
0 Always eats alone

Understandability of speech
100 NAD
0 Never understood

Normalcy of diet
100 full diet
0 non oral feeding
GRBAS
Grade 0 -3
0 in normal and 3 is severe impairment
Roughness
Breathy
Asthenia
Strain

				
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