The NIH Toolbox and outcome measures


If Advance has an article that might be interesting, it might stay on my reading stack for a day or so until I need something that is easy to read in a short period. The most recent Advance for Physical Rehab Medicine had a brief article about the “new NIH Toolbox.” After having read the article I thought the toolbox would be the best outcome measures out there for rehab, but I wondered about using a dynamometer for lower extremity strength (given that quads are only one part of the equation in a sit-stand transfer).

I then went to the toolbox and looked around. It looks like balance is measured with a modified “foam and dome”, and locomotion/ gait speed is measured with the 4m walk test (for strength they have grip strength listed, but nothing for LE’s at the moment – maybe the Advance author got an advanced copy). While I realize that having a common toolkit can help compare across studies and settings, I’m curious why they didn’t pick other things, like a 30 second-sit stand test which is functional strength (and doesn’t require a dynomometer), or the BEST or mini-Best which measures more aspects of balance than just static stance. I looked at the scoring and interpretation manual, and if there are normative values for age ranges or MDC’s, they are not easy to find. As a clinician, I can’t say I’m impressed by the article or the toolbox. Yes, we should be using outcome measures and it would help to have some that are better, validated for more populations, more accessible, and have more data behind them, but for now I’ll keep using my toolbox (my favorite tool tray is the Rehab Measures Database from the Rehab Institute of Chicago) and keep the NIH toolbox in mind when I put on my researcher hat.

Photo credit: Bigger, originally uploaded by Leo-setä


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