By: 4-2-00 Sigmund Miller, DC (webinfo@ChiroViewPresents.com) Dean of Academic Affairs Texas Chiropractic College 281.998.6058 Roland Morris Outcome Assessment Tool - It's almost too simple! Several weeks ago I authored a broadcast on the Neck Disability Index [NDI]. There are many other very excellent Outcome Assessment Tools [OAT's] one can use relating to both the neck and back. I would like to shift focus to another OAT called the Roland Morris Questionnaire [RM], which is used mostly for low back pain, although I've included thoracic spine, as well. I want to briefly touch upon two points made in a previous broadcast regarding OAT's. Firstly, from a chiropractic perspective, I consider daily charting the most important component of clinical documentation. In addition, I believe the OAT carries as much weight since this information comes directly from the patient. More than ever, payers and attorneys serving the workers' compensation and personal injury arenas have become very familiar with OAT's. Without question, more recently they have come to rely upon these tools when evaluating efficacy of treatment prescribed. Chiropractors who know "what's up", are acutely aware that using OAT's and scoring them properly can have a profound impact on getting their services reimbursed quickly and with less hassle. In the past when reviewing files, if OAT's demonstrated improved scoring that's statistically significant, then recommending ongoing treatment was a "slam dunk"! Trust me on this one! Secondly, most believe one primary objective when managing patients is to improve their quality of life. That includes providing patients an opportunity to return to activities of daily living they would like to perform but can't, because of discomfort experienced. That is what many different OAT's allow you to objectively score. In other words, after concluding brief periods of treatment, OAT's help confirm that your patient 1] can now perform activities they couldn't before beginning treatment, or 2] can perform specific activities for longer periods of time and with less discomfort. When completing the RM questionnaire patients read the following introduction - "When your back hurts you may find it difficult to perform many activities throughout the day. Statements listed below have been used by people to describe those times when they are experiencing back pain. As you read them, some may stand out because they describe your pain today. Therefore, please check the box that best describes your pain today. If the sentence does not fit, then just leave it blank and move on to the next one." The Roland Morris Questionnaire consists of 24 statements and here are two examples - 1. I don't sleep well because of my back. 2. Because of my back, I am not doing any of the jobs that I usually do around the house. Each box checked by the patient counts as "one point" with a total possible score of 24. A word of caution. I would recommend performing several non-provocative tests on patients scoring 20+ since there may be a degree of symptom augmentation. I will touch on this issue during a future broadcast. From my experience, most patients reporting moderate to severe pain score between 15-20. I recommend patients completing RM during initial visits, following the initial two weeks of treatment, and then after completing one month of care. I then recommend having patients complete RM at monthly intervals, or when flares occur during the course of treatment, and at discharge. If the patient is receiving "supportive care", and then returns reporting a flare after not receiving treatment for a period of time, I would then have the patient complete the RM during that initial visit and again at 2-week intervals until discharge. When comparing consecutive scores of RM, I typically look for change of 4 or more points, which is considered statistically significant. I also recommend using additional assessment tools such as pain drawings, pain scales, and patient satisfaction surveys. These are very easy to integrate into everyday practice. Your office assistant can have the patient complete each one of these at the appropriate time, and before you begin treatment that day. I will broadcast on many of these tools, shortly. For Member Subscribers, I've posted the Roland Morris questionnaire which can be easily downloaded and saved to a file. There is room at the top of the form so you can "paste in" your logo. I've also posted other OAT's, including NDI, Oswestry, General Pain Index, Patient Satisfaction Survey, Pain Drawing. As many know, I also designed a SOAPing form that has a VAS alongside each visit. There are about 15 other forms posted at the site for your inspection. If you would like to become a Member Subscriber, go to http://www.ChiroViewPresents.com. A six-month subscription is just $36 with 25% of monies going to FCER and other worthy chiropractic causes.