Muscle Performance Metrics for Documentation and Justification

In this short blog, learn the basics of how to create a simplified, streamlined method to use muscle performance metrics in the field to track patient, client, and self-outcomes to prepare data for documentation and insurance justification.

The first step is to define what muscle metrics are. They are:

Muscle strength/force, velocity, and power.

Strength

The ability of muscle to produce force (strength). It is absolute strength without consideration for performance or function. Muscle strength is the foundation of performance and function.

Velocity

The rate of change of position of a muscle. This is muscle performance variable. Think in a straight line like a quadriceps muscle contracting from 90 degrees to 180 degrees during a leg extension.

Power

The ability of a muscle to produce as much force (strength) as quickly (velocity) as possible. This is also a muscle performance variable and reflects explosive strength.

Muscle strength versus performance metrics.

Muscle strength metrics measure absolute muscle strength/force while performance metrics measure velocity and power.

The problem to solve.

Before starting with metrics, clearly and concisely state the problem to solve. This is a focused statement about the outcome to show. For example, measure muscle strength in the quadriceps to show a strength improvement that is connected to walking ability. Showing both the metric improvement AND the outcome improvement is the insurance justification.

Measure

To justify, the therapist must measure muscle strength and performance. There are many tools that go beyond the scope of this blog. For example, for strength, use hand grip strength, dynamometry, and/or manual muscle testing. For performance factors like power, use force plates and wearables, EMG, and/or tensiomyography that measure velocity. Although there are many types of measurements tools, the key is to pick one OR two or more, known as layering, that effectively and reliability measure muscle strength and/or performance connected to the outcome.

Now that the basics are covered, use this step-by-step method to use metrics effectively for documentation and insurance justification:

Step #1: State the problem to solve.

This is the intended real-world outcome like improving up and go speed associated with walking ability, balance, and mobility.

#2: State metric.

What is being measured? Muscle strength or performance? How does it directly reflect the outcome?

#3: Choose a measurement tool.

Tools must accurately measure the variable that accurately reflects the outcome.

#4: Choose documentation and tracking tool(s).

These are electronic record management (EMRs) tools normally selected and provided by the employer. There are many EMRs and these can be both professionally required and/or a personal preference. Therapists may also use commercial and professional applications like Strengthlab360 for individual use or Teambuildr for team use.

#5: Program and execute exercise intervention.

Choose the exercises that connect to the outcome. For example, if sit to stand is the goal, include exercises like the seated knee extension to improve quadriceps strength.

The next step is using exercise programming metrics to design effective and safe exercise training programs. Exercise programming metrics include intensity, volume, duration, frequency, and rest. When structured correctly, exercise outcomes are easily achieved and documented for insurance justification.

#6: Reassess. Modify. Progress.

Measure muscle strength and performance metrics at baseline and again every two to three weeks.

Modify exercises as needed to either decrease or increase difficulty.

Progress weight and volume every two weeks.

Follow these simple steps to easily integrate metrics into your practice and for effective insurance documentation.

To learn more, visit physicaltherapy.education to take the 2 HR credit CE course titled Muscle Performance Metrics for Documentation and Justification.