EACE aims to standardize utilization of ‘Outcome Measures’ in amputation rehab

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas – The Extremity Trauma and Amputation Center of Excellence (EACE) will conduct this year’s Federal Advanced Amputation Skills Training (FAAST) Symposium completely online with live instruction, June 29 – July 1.

“Outcome Measures” is the focus of this year’s training.

Through standardizing the understanding, implementation and interpretation of outcome measures, clinicians will be more skilled at tracking patient progress and outcomes in amputation rehabilitation over time.

Despite the various challenges posed by the pandemic, EACE educational staff have spent the last year developing a synchronous, virtual FAAST course that will continue providing health care professionals and researchers with advanced knowledge, skills, tools and techniques that they can take back to their clinical practice.

Led by Stuart Campbell, chief of Global Health Engagement, and Dr. Laurie Lutz, chief of Training, Education and Simulation, the EACE will use the Adobe Connect digital platform to train more than 50 medical experts in an interactive setting that will allow attendees the ability to ask questions and give feedback.

The clinicians who were primarily selected from the three DoD Advanced Rehabilitation Centers (ARCs) – Military Advanced Training Center (MATC) at Walter Reed National Military Medical Center, Bethesda, Maryland; Center for the Intrepid (CFI) at Brooke Army Medical Center, San Antonio, Texas; and Comprehensive Combat and Complex Casualty Care (C5) at Naval Medical Center San Diego, California, will be thoroughly trained on the DoD standard for outcomes associated with amputation rehabilitation.

“Outcome measures are vital to understanding the impact of what we’re doing clinically,” said Campbell, explaining why he feels this year’s training is so important.

“Right now, there is no formal outcome measures program associated with amputation rehabilitation. The EACE and the three ARCs are building that,” Campbell said. “Over the last three years, we have been involved in selecting outcome measures with the best scientific evidence for the amputation population. It’s important to standardize how everyone is executing the measures.”

Most clinicians are familiar with the outcomes we are teaching, said Campbell, but many have learned variations of these measures. Standardizing one approach for each measure to ensure a thorough understanding of the individual measures and standardization of their utilization is imperative for clinical decision-making and performance improvement projects.

During the course, the clinicians will be trained on two types of outcome measures: Patient-reported and Performance-based. An example of a Patient-reported measure is when a patient is given a survey to fill out prior to their medical appointment, or anytime feedback is rendered by the patient directly in an oral or written manner. A Performance-based measure, however, involves the physical steps a clinician would take in treating a patient, e.g., when a therapist runs the patient through a series of physical tasks that are associated with a particular measure.

“This is what the outcome measures do for us,” Campbell said. “The purpose of FAAST is to ensure the performance of the outcome measure and the implementation is standardized across all three rehab centers. If the tests we are using at each site are conducted differently, we lose that ability to compare and to track over time.”

Confronting these challenges head-on, Lutz also understands the significance of this training. With limited support, she has spearheaded the development of this year’s synchronous, virtual course to ensure the clinicians get the training they need and the training they’ve requested.

“Traditionally in the past, it’s been a hands-on, in-person training activity located at different locations across the United States. This year, due to COVID-19, it’s an all-virtual activity which lends itself to many different challenges, one of which is the interactive component over a three-day span of having clinicians in front of the computer going through outcome measures,” Lutz explained. “We’ve mitigated that by putting in knowledge check slides that require responses, discussion points throughout the presentations, pre-tests and post-tests to measure learning data in between and maintaining a small group setting that allows for increased participant interaction.

“We have subject matter experts in each individual outcome measure presenting this training,” she continued. We’ve assembled a team of nationally-recognized experts in outcomes measures, and we have presenters from DoD, academia and our partners in the VA. We have an incredible line-up of presenters. If any of the clinicians have follow-on questions, we have a more cohesive group they can reach out to and get any further questions answered.”

The clinicians working at the ARCs undoubtedly have a direct impact on amputation rehabilitation and medical readiness overall. Because their role in patient care is so significant, it’s essential that these medical experts not only yield positive results in the treatment of their patients, but also understand those outcomes and share their best practices to benefit other patients as well.

“The information we get back is absolutely crucial to us because it helps us to understand what we’re doing clinically and if what we’re doing is actually working,” Campbell said. “Are we making a difference with the individual, and are we making a collective difference on the entire clinic side at all three ARCs? Or, is there an outlier or difference between one of the three sites where patients are getting better at one location over another?”

“We can use these results to compare and look at how we develop best practices,” he added. “These give us the most objective measures we can get to figure out what are our clinical best practices and then promulgate them throughout the system.”

The FAAST Symposium was designed to train DoD physical and occupational therapists, orthotists, prosthetists and physical medicine and rehabilitation physicians working with amputation in the ARCs. It is a culmination of various training courses sponsored by the EACE, which is the leading advocate for research and treatment of DoD/VA patients with extremity trauma and amputation.