APTA's Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is an instrument that measures difficulty and self-confidence in performing 22 movements that a patient/client needs to accomplish in order to do various functional activities. OPTIMAL 1.1 has been updated from the original version to increase clinical utility. This includes adding the clinically relevant item of standing and providing changes to scoring instructions to increase clinical utility. These changes will assist patient and physical therapist discussion toward identifying the primary goal for the episode of care.
In response to changes to the Medicare outpatient therapy cap exceptions process and documentation requirements for 2007, the Centers for Medicare & Medicaid Services (CMS) recommended OPTIMAL as a measurement instrument to document objective, measurable physical function of beneficiaries.
Use of OPTIMAL for Functional Limitation Reporting for Therapy Services under Medicare Part B: CMS has mentioned the OPTIMAL assessment tool as an assessment tool that physical therapists use frequently to quantify beneficiary function. Below are a few ways that physical therapists can use OPTIMAL to assist with reporting functional limitations:
- OPTIMAL's 22 items easily map to the ICF-based G-codes that CMS is requiring.
- Scoring of OPTIMAL asks the patient to identify his or her primary goal of physical therapy. This will help with patient-centered care and provide additional information for the physical therapist to determine the primary goal to report to CMS.
- OPTIMAL's scoring of the patient's perceived difficulty and confidence in performing a specific activity can help the physical therapist make a clinical judgment on the severity of the impairment limitation restriction.
Clinicians are encouraged to use OPTIMAL to document that a patient qualifies for an automatic exception to the outpatient therapy cap. In addition, OPTIMAL is included in LOINC, the Regenstrief Institute Inc's Logical Observation Identifiers Names and Codes database that provides a definitive standard for identifying clinical information in electronic reports.
As of December 15, 2011, APTA no longer requires entities to request permission for using OPTIMAL. This applies to (1) clinicians within their facilities for patient care, (2) education institutions using material for in-classroom use, (3) entities conducting research, and (4) entities wishing to use it in commercial products or services, including other publications, courses, or software programs.
Note, however, that OPTIMAL remains the copyrighted intellectual property of Physical Therapy (PTJ), and the following citation must be included in all uses:
Copyright © 2012, 2006, 2005 American Physical Therapy Association. All rights reserved.
Forms & Guidelines
Baseline Form (.pdf)
Follow-up Form (.pdf)
Scoring Instructions (.pdf)
Mapping of OPTIMAL Items to Functional Measures (.pdf)
Formula for CMS Impairment Limitation (.pdf)
Physical Therapy (PJT) Research Report (June 2005)