Initiative to develop outcome measures in Nepal

Outcome measures are really important aspects of any practices in health care system. For example, vital signs are routinely assessed in patients admitted in hospital; e.g., temperature, respiratory rate, pulse rate and blood pressure. These are very important to assess the condition of a patient and now is an established rule. Prognosis of the patient is assessed based on how the patients respond to these outcomes after therapy.

Likewise, in physiotherapy, we use goniometers/ inclinometers to assess range of motion of a joint, manual muscle testing to assess the strength of a muscle etc. However, using a valid and reliable tool for measurement of a body part is very important in order to get the accurate measurement results. Although these are important outcomes to assess impairments such as reduced range of motion and muscle weakness respectively, but to consider improvement, these measures many not be the most important measures of improvement for the patients. For example, we may improve range of motion of elbow from 45 degrees of flexion to 95 degrees, and strength of wrist extensors from grade 3- to 4+. However, this would not impress the patient because he/ she is still not able to eat food or comb hair.

There are other important assessment outcome measures that are important to assess in routine clinical practice. These measures are not only important for physiotherapy but also for all the discipline involved in treating someone with pain. Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommends assessment of pain intensity, physical function, pain interference, psychological aspect of pain and quality of life in research. Likewise, patient would be more happier if they get assessed what best means to them. For someone who is in a lot of pain, reducing their pain intensity will be important for them. As a result of pain, they would not be able to do their activities of daily living, be able to socialize or participate in sports or activities that give them enjoyment etc. Thus, measurement of physical function and pain interference are important for the patient so that they know the level of activities (function) that has improved after the therapy. Similarly, psychology of a patient largely affect the pain response and so does sleep quality. Thus, assessment of psychological contributors of pain and quality of sleep are also equally important that drive their pain.

I along with my colleagues, students and collaborators at the Department of Physiotherapy, Kathmandu University School of Medical Sciences, have taken up this lead to develop these very important outcome measures for clinical practice and research for those living with chronic pain in Nepal. We would be pleased to receive your support in this novel initiative.

How can I help?
1. If you are living with pain, you can be part of these studies.
2. If you are a physiotherapist, or a doctor or a nurse, you can be involved in this research by helping us at various stages of the research.
3. If you are none or both of the above, you can help us carry on this research, by supporting -- either psychologically or financially -- depending on your abilities.

To know more about the research or to extend support or help, you can contact me at

Thank you,

Saurab Sharma