Australian Therapy Outcome Measures (AusTOMs)

by Meg Morris, Karen Dodd and Nicholas Taylor (Physiotherapy manual and scales)

There are 9 AusTOMs scales for Physiotherapy:

1. Balance and Postural Control
2. Cardiovascular system related functions
3. Musculoskeletal movement related functions
4. Neurological movement related functions
5. Pain
6. Respiratory system functions
7. Sensory functions
8. Skin functions
9. Urinary & bowel continence

The AusTOMs for Physiotherapy scale headings are all based on the WHO ICF body functions and structures. Whereas the UK TOM physiotherapy card headings included a mixture of diagnoses, impairments, systems of care and global terms, Australian physiotherapists considered it important to have one underlying concept on which all the AusTOM card headings would be based. Because a substantial proportion of physiotherapy interventions are directed towards impairments of body function, choosing this for the card headings appeared to have strong face validity.

Each of the AusTOMs for Physiotherapy scales has four domains:

Impairment: Impairments are significant deviations or loss of body structure (anatomical) or function (physiological or psychological).

Activity Limitation: Activity Limitation results from the difficulty in the performance of an activity. An activity is the execution of a task by an individual.

Participation Restriction: Participation restrictions are difficulties the individual may have in the manner or extent of involvement in their life situation.

Wellbeing: The level of concern experienced by the individual. Concern may be evidenced by anger, frustration, apathy, depression etc.

The AusTOMs for Physiotherapy Scales were developed by Australian physiotherapy clinicians through focus groups, a mail out survey, and ongoing feedback during training and pilot data collection. Consumer groups also had input into the development of all of the AusTOMs scales, particularly the Participation Restriction and Wellbeing domains. 

by Carolyn Unsworth and Dianne Duncombe (Occupational Therapy manual and scales)

There are 12 AusTOMs scales for Occupational Therapy:

1. Learning and applying knowledge
2. Functional walking and mobility
3. Upper limb use
4. Carrying out daily life tasks and routines
5. Transfers
6. Using transport
7. Self-care
8. Domestic life- inside house
9. Domestic life- outside house
10. Interpersonal interactions and relationships
11. Work, employment and education
12. Community life, recreation, leisure and play

The AusTOMs for Occupational Therapy scale headings focus on the Activity Limitation domain, unlike the Physiotherapy and Speech Pathology scale headings, which reflect impairments. The scale headings reflect the Activities and Participations domain of the WHO ICF.

Each of the AusTOMs for Occupational Therapy scales has four domains:

Impairment: Impairments are significant deviations or loss of body structure (anatomical) or function (physiological or psychological).

Activity Limitation: Activity Limitation results from the difficulty in the performance of an activity. An activity is the execution of a task by an individual.

Participation Restriction: Participation restrictions are difficulties the individual may have in the manner or extent of involvement in their life situation.

Wellbeing: The level of concern experienced by the individual. Concern may be evidenced by anger, frustration, apathy, depression etc.

The AusTOMs for Occupational Therapy scales were developed by Australian occupational therapy clinicians through focus groups, a mail out survey, and ongoing feedback during training and pilot data collection. Consumer groups also had input into the development of all of the AusTOMs scales, particularly the Participation Restriction and Wellbeing domains.

by Alison Perry and Jemma Skeat (Speech Pathology manual and scales)

There are 6 AusTOMs scales for Speech Pathology:

1. Speech
2. Language
3. Voice
4. Swallowing
5. Fluency
6. Cognitive-Communication

The AusTOMs for Speech Pathology scale headings were chosen to reflect the broad areas of clinical practice in which Australian speech pathologists work. Five scale headings (Speech, Language, Voice, Swallowing, and Fluency) reflect the areas covered by the Competency-Based Occupational Standards developed by the national body, Speech Pathology Australia. The sixth scale heading, Cognitive-Communication was developed at the request of speech pathology clinicians to cover broad areas of cognition such as attention, orientation, and learning, as they relate to communication.

Each of the AusTOMs for Speech Pathology scales has four domains:

Impairment: Impairments are deviations or loss of body structure (anatomical) or function (physiological).

Activity Limitation: Activity Limitation results from the difficulty in the performance of an activity. An activity is the execution of a task by an individual.

Participation Restriction: Participation restrictions are difficulties the individual may have in the manner or extent of involvement in their life situation.

Distress/Wellbeing: The level of concern experienced by the individual. Concern may be evidenced by anger, frustration, apathy, depression etc.

The AusTOMs for Speech Pathology scales were developed by Australian speech pathology clinicians through focus groups, a mail out survey, and ongoing feedback during training and pilot data collection. Consumer groups also had input into the development of all of the AusTOMs scales, particularly the Participation Restriction and Wellbeing domains.

There are three individual AusTOMs kits: one for each of physiotherapy, speech pathology, and occupational therapy professions. The AusTOMs tools in each kit are based on a similar framework, but were developed separately by members of each profession.

The AusTOMs scales are based on:

• The Therapy Outcome Measures (UK TOM- Enderby and John, 1997; Enderby, John and Petherham, 1998);
• The World Health Organization International Classification of Functioning, Disability, and Health (WHO ICF);
• The input and feedback of Australian clinicians; and
• The input and feedback of consumers and advocates.

Each scale focuses on a specific area of clinical practice for the relevant profession. For example there is a Language scale in the speech pathology set, and a Musculoskeletal scale in the physiotherapy set.

Every AusTOMs scale incorporates a rating of four separate domains: Impairment, Activity limitation, Participation restriction, and Wellbeing. A rating between 0 and 5 is made for each domain. Whole points (eg 1, 4) are defined, with example descriptors, and there is the opportunity to use half points (eg 3.5).

On the AusTOMs and the TOM scales, 0 represents complete difficulty, while 5 represents no difficulty.

The domains are independent; that is, scores for each domain are not aggregated, nor do they necessarily affect each other. A client may show great improvement in one domain (for example, their ability to participate in society) without necessarily showing improvement in others (for example, their impairment may not have changed).