Patient Evaluation Conference System

Abstract

The Patient Evaluation Conference System (PECS), developed by Harvey and Jellinek in 1981, is a comprehensive, multi-domain functional performance assessment tool specifically designed for use in rehabilitation settings. It provides a standardized method for interdisciplinary teams to evaluate a patient’s needs, capabilities, and progress across 18 distinct areas. The system is crucial for guiding clinical decision-making, setting measurable goals, and tracking outcomes from admission to discharge. Scoring utilizes a standardized rating scale, typically ranging from 0 (representing unmeasured or unmeasurable function) to 7 (representing full independence).

PECS integrates physical, medical, psychological, and social factors into a cohesive framework, making it highly valuable for patients with complex deficits, such as those resulting from brain injury or stroke. Its structured approach facilitates consistent communication and evaluation across various professional disciplines.

Keywords

Rehabilitation assessment, functional status, interdisciplinary care, patient outcome measure, Activities of Daily Living, physical disability, neuropsychological function, patient profile.

Authors

Harvey, R. F., Jellinek, H. M.

Purpose

The primary purpose of the Patient Evaluation Conference System (PECS) is to establish a systematic and standardized methodology for conducting interdisciplinary patient conferences in rehabilitation. By quantifying patient status across numerous domains, PECS ensures that all aspects of recovery are addressed objectively. This structured measurement process aids in setting realistic, measurable, and time-specific rehabilitation goals.

The scale serves as a communication tool, allowing professionals from diverse fields—such as physical therapy, nursing, Neuropsychology, and social work—to contribute standardized data points, thereby creating a unified patient profile used for treatment planning and prediction of post-discharge needs.

Construct

PECS measures the complex, multidimensional construct of functional status and rehabilitation outcome. This construct encompasses a patient’s capacity for independence in self-care, mobility, communication, cognitive functioning, and psychosocial adjustment following a debilitating illness or injury. The instrument operationalizes this construct through 18 distinct domains, each broken down into specific functional tasks or knowledge areas.

The use of the 0 to 7 rating scale provides a quantitative measure of the patient’s competence, moving beyond simple categorical descriptions to define the precise level of assistance required or the degree of mastery achieved, thereby facilitating the evaluation of incremental improvement over the course of rehabilitation.

Validity

The validity of PECS has been examined through various studies, particularly concerning its utility in predicting rehabilitation outcomes. Research has applied psychometric criteria to the instrument, demonstrating strong construct validity. For instance, studies have shown that PECS scores are reliable predictors of the ultimate level of care required by a patient post-discharge, validating its clinical utility in discharge planning.

Furthermore, the inclusion of 18 broad, clinically relevant domains—ranging from physical deficits (MED) to vocational planning (V/E)—ensures high content validity, as the scale comprehensively covers the scope of functional deficits typically encountered in severe disability rehabilitation.

Reliability

While the source materials suggest the PECS structure promotes reliability, the instrument relies heavily on the consensus and consistent application of the 0-7 rating scale by a multidisciplinary team. The structured nature of the evaluation conference and the clearly defined parameters for each item are designed to enhance inter-rater reliability across different clinical disciplines. The system’s strength lies in standardizing the subjective observations of diverse clinicians into objective, quantitative data points, ensuring longitudinal consistency in patient monitoring.

Factor Analysis

The design of the Patient Evaluation Conference System naturally segments functional assessment into 18 distinct, yet interrelated, domains. Research utilizing PECS, particularly in studies focused on brain-injured patients, suggests that the subscales contribute significantly to defining unique patient profiles related to long-term functional abilities and distress levels. While the instrument is structured around these 18 clinically derived factors, further formal statistical factor analysis may be required to fully delineate the underlying latent variables that govern patient improvement across the diverse medical, cognitive, and social sections.

Instrument

Test Type: Functional Assessment Scale / Interdisciplinary Outcome Measure

Format: Structured Rating Scale (0 to 7 points) based on consensus rating by an interdisciplinary team.

Language Available: English (Primary)

Population Group: Patients undergoing inpatient or outpatient Rehabilitation Medicine, often following traumatic injury or neurological events.

Age Group: Primarily Adults

Population Details: Individuals with acquired disabilities, including but not limited to, stroke, traumatic brain injury, spinal cord injury, and complex medical rehabilitation cases.

Test Methodology: Assessment based on observed performance and clinical judgment, finalized through consensus during a formal patient conference involving multiple clinical specialists.

Keywords

Functional independence, outcome prediction, patient profile, Harvey and Jellinek, brain injury, self-efficacy, discharge planning, interdisciplinary communication.

Authors

Author ORCID Identifier: N/A (Information Not Provided)

Affiliation Email addresses: N/A (Information Not Provided)

Correspondence Address: N/A (Information Not Provided)

Permissions & Fee and Test Year

The Patient Evaluation Conference System was first introduced in the literature in 1981. It is primarily used as a clinical and research tool in rehabilitation centers. Specific licensing fees are not detailed in the source material. The instrument itself is available online, and the original PDF can be downloaded here: www.a4ebm.org/sites/default/files/Measuring Health.pdf.

Reference’s

• Harvey, RF., Jellinek, HM. (1981). Functional performance assessment: a program approach. Archives of Physical Medicine and Rehabilitation, 62:456–461.

• Harvey, RF., Jellinek, HM. (1983). Patient profiles: utilization in functional performance assessment. Archives of Physical Medicine and Rehabilitation, 64:268–271.

• Jellinek, HM., Torkelson, RM., Harvey, RF.(1982). Functional abilities and distress levels in brain injured patients at long-term followup Archives of Physical Medicine and Rehabilitation, 63:160–162.

• Rao, N., Jellinek, HM., Harvey, RF., et al. (1984). Computerized tomography head scans as predictors of rehabilitation outcome. Archives of Physical Medicine and Rehabilitation, 65:18–20.

• Harvey, RF., Silverstein, B., Venzon, MA., et al. (1992). Applying psychometric criteria to functional assessment in medical rehabilitation: III. Construct validity and predicting level of care. Archives of Physical Medicine and Rehabilitation, 73:887–892.

• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS

Items of the Patient Evaluation Conference System

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

• Motor loss (including muscle weakness and limb deficiency)
• Spasticity/ involuntary movement (including dystonia and ataxia)
• Joint limitations
• Autonomic disturbance
• Sensory deficiency
• Perceptual and cognitive deficit
• Associated medical problems

• Performance of bowel program
• Performance of urinary program
• Performance of skin program
• Assumes responsibility for self-care
• Performs assigned interdisciplinary activities

• Performance of transfers
• Performance of ambulation
• Performance of wheelchair mobility (primary mode)
• Ability to handle environmental barriers (e.g.‚ stairs‚ rugs‚ elevators)
• Performance of car transfer
• Driving mobility
• Assumes responsibility for mobility

• Performance in fee ding
• Performance in hygiene/grooming
• Performance in dressing
• Performance in home management
• Performance of mobility in home environment (including utilization of environmental adaptations for communication)

• Ability to comprehend spoken language
• Ability to produce language
• Ability to read
• Ability to produce written language
• Ability to hear
• Ability to comprehend and use gestures
• Ability to produce speech

• Knowledge of medications
• Skill with medications
• Utilization of medications

• Nutritional status—body weight
• Nutritional status—lab values
• Knowledge of nutrition and/or modified diet
• Skill with nutrition and diet (adherence to nutritional plan)
• Utilization of nutrition and diet (nutritional health)

• Knowledge of assistive devices(s)
• Skill with assuming operating position of assistive device(s)
• Utilization of assistive device(s)

• Distress/comfort
• Helplessness/self- efficacy
• Self-directed learning skills
• Skill in self-management of behavior and emotions
• Skill in interpersonal relations

• Impairment of short-term memory
• Impairment of long-term memory
• Impairment in attention-concentration skills
• Impairment in verbal linguistic processing
• Impairment in visual spatial processing
• Impairment in basic intellectual skills

• Ability to problem solve and utilize resources
• Family: communication/resource
• Family understanding of disability
• Economic resources
• Ability to live independently
• Living arrangements

• Active participation in realistic voc/ed planning
• Realistic perception of work-related activity
• Ability to tolerate planned number of hours of voc/ed activity/ day
• Vocational/ educational placement
• Physical capacity for work

• Participation in group activities
• Participation in community activities
• Interaction with others
• Participation and satisfaction with individual leisure activities
• Active participation in sports

• Pain behavior
• Physical inactivity
• Social withdrawal
• Pacing
• Sitting
• Standing tolerance
• Walking endurance

• Knowledge of pulmonary rehabilitation program
• Skill with pulmonary rehabilitation program
• Utilization of pulmonary rehabilitation program

• Attended N Y
• Participated in goal setting N Y
• Family (significant other) attended N Y

• Recreational Therapy pass  N Y
• P.R.N. pass N Y
• T.L.O.A pass N Y
• Is this the dis ch‎arge conference?  N Y
• Equipment ordered N Y
• Type of assistive device
• Phase of device development
• Therapy schedule set according to priority N Y
• Rehab. Med. Clinic standard follow-up (1‚ 3‚ 6‚ 12 mo.) N Y

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