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Peiffer JW, Philippus A, Kanaster K, Monden KR. Understanding the association between perceived injustice, depression symptoms, and stigma in individuals with traumatic spinal cord injury. Spinal Cord 2024; 62:440-445. [PMID: 38871826 DOI: 10.1038/s41393-024-01007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
STUDY DESIGN This is a secondary analysis of data from a cross-sectional, observational study. OBJECTIVES The study aimed to determine whether stigma mediates the relationship between preceived injustice and depression symptoms among individuals with spinal cord injuries. SETTING Secondary analysis of participants enrolled in the Spinal Cord Injury Model System at a specialty rehabilitation hospital in the Western United States. METHODS A sample of 225 participants completed the questionnaires; eight participants were removed due to incomplete data, resulting in a final sample size of 217 participants (79% male; 21% female). Participants were, on average, 53 years old and were predominantly male, white, and 20 years post-injury. A bootstrapping mediation analysis was conducted to evaluate the stigma-mediated relationship between injustice appraisals and depression symptoms. Injustice appraisals were assessed using the Injustice Experience Questionnaire, stigma with the Spinal Cord Injury Quality of Life Stigma-Short Form, and depression symptoms with the Patient Health Questionnaire-9. RESULTS Stigma was found to mediate the relationship between injustice appraisals and depression, with an estimated proportion mediated of 80.9% (p ≤ 0.0001). CONCLUSIONS This study provides a novel finding that the relationship between injustice appraisals and depression symptoms is mediated by stigma. Consistent with previous research, injustice appraisals were associated with greater severity of depression symptoms. Results provide further evidence for the role of injustice appraisals after spinal cord injury and a potential mechanism (i.e., stigma) by which it may exert its effect on depression symptoms.
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Affiliation(s)
- Joshua W Peiffer
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Angela Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Karen Kanaster
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberley R Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
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Myers JB, Kurtzman JT. Bladder-Related Quality of Life After Spinal Cord Injury: Findings from the Neurogenic Bladder Research Group Spinal Cord Injury Registry. Urol Clin North Am 2024; 51:163-176. [PMID: 38609189 DOI: 10.1016/j.ucl.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
The Neurogenic Bladder Research Group (NBRG) was formed with the mission to optimize quality of life (QoL), surgical outcomes, and clinical care of patients with neurogenic lower urinary tract dysfunction. One of the original priorities of the organization was to support creation of the NBRG Spinal Cord Injury (SCI) Registry. The aim of this Registry was to establish a prospective database, in order to study bladder-related QoL after SCI. The study enrolled close to 1500 participants from across North America over an 18 month time-period (January 2016-July 2017).
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Affiliation(s)
- Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84103, USA.
| | - Jane T Kurtzman
- Division of Urology, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84103, USA
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Welk B. Questionnaires for Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2024; 51:233-238. [PMID: 38609195 DOI: 10.1016/j.ucl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
The evaluation of people with neurogenic lower urinary tract dysfunction (NLUTD) often involves objective parameters, however quality of life (QOL) assessments are crucial for patient-centered care. This article discusses how to measure QOL and urinary symptoms in NLUTD and highlights various questionnaires such as the Qualiveen, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Questionnaire (I-QOL). These questionnaires focus on bladder-related QOL or symptoms and have been validated in multiple NLUTD populations. These tools are important for advancing research and the clinical care of NLUTD patients, and have the potential to impact decision-making and improve patient outcomes.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, 268 Grosvenor Street, London, Onatrio N6A 4V2, Canada; Department of Epidemiology and Biostatistics, Western University, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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Tyner CE, Slotkin J, Kisala PA, Levin LS, Tintle SM, Tulsky DS. Assessment of quality of life after upper extremity transplantation: Framework for patient-reported outcome scale domains. Front Psychol 2023; 13:989593. [PMID: 36760917 PMCID: PMC9902934 DOI: 10.3389/fpsyg.2022.989593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/31/2022] [Indexed: 01/26/2023] Open
Abstract
Upper extremity transplantation offers the promise of restored function and regained quality of life (QOL) for individuals who have sustained hand or arm amputation. However, a major challenge for this procedure becoming an accessible treatment option for patients is the lack of standard measures to document benefits to QOL. Patient-reported outcomes (PRO) measures are well-suited for this kind of intervention, where the perspective of the patient is central to defining treatment success. To date, qualitative work with experts, clinicians, and patients has been used to identify the most important domains of QOL for PRO item development. Specifically, our group's qualitative work has identified several domains of QOL that are unique to individuals who have received upper extremity transplants, which are distinct from topics covered by existing PRO measures. These include emotional and social aspects of upper extremity transplant, such as Expectations and Perceived Outcomes, Integration and Assimilation of Transplant, Fitting in, and Post-Surgical Challenges and Complications. The broad topic of Satisfaction with Transplant was subdivided into three subtopics: Function, Sensation, and Aesthetics. Satisfaction with Sensation was also identified as a unique domain not evaluated by existing PRO measures. This report operationalizes these eight QOL domains by presenting scoping definitions. This manuscript describes the work that has been completed for domain characterization as an early step toward developing standardized PRO measures to evaluate these important outcomes specific to upper extremity transplantation.
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Affiliation(s)
- Callie E. Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States,*Correspondence: Callie E. Tyner,
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - L. Scott Levin
- Department of Orthopedic Surgery, Penn Medicine, Philadelphia, PA, United States,Department of Surgery, Division of Plastic Surgery, Penn Medicine, Philadelphia, PA, United States
| | - Scott M. Tintle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David S. Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States,Department of Physical Therapy, University of Delaware, Newark, DE, United States,Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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SCI-QOL and WOUND-Q Have the Best Patient-reported Outcome Measure Design: A Systematic Literature Review of PROMs Used in Chronic Wounds. Plast Reconstr Surg Glob Open 2023; 11:e4723. [PMID: 36699211 PMCID: PMC9831160 DOI: 10.1097/gox.0000000000004723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
Chronic wounds are a significant burden on healthcare systems due to high costs of care (2%-4% total healthcare cost) and a considerable burden on patient's quality of life. Patient-reported outcome measures (PROMs) are questionnaires developed to enable patient self-assessments of their outcomes. A gap in knowledge exists because previous reviews on wound-specific PROMs did not evaluate the quality of the development. The main question is which PROM has the best quality development properties and should be used in clinical care and research. Methods PubMed, Embase, and CINAHL were searched from their inception through December 2021. Studies that included patients aged 18 years or older, with chronic wounds, and who reported using a condition-specific PROM for wounds were extracted. We excluded generic PROMs, comments, guidelines, and editorial letters. The COSMIN-guidelines were used to evaluate the quality of the PROMs. Results Of the 16,356 articles, a total of 251 articles describing 33 condition-specific PROMs for wounds were used. In total, 17 of 33 (52%) PROMs were developed for specific wound types, and nine of 33 (27%) PROMs were developed for any type of wound. Two of 33 (6%) PROMs were not rated because no development article was available. Only the SCI-QOL (Spinal Cord Injury-QOL) and the WOUND-Q rated "very good" in PROM design. Conclusions Thirty-three condition-specific PROMs were found. Only the SCI-QOL and the WOUND-Q rated very good in PROM design. The WOUND-Q is the only condition-specific PROM, which can be used in all types of chronic wounds in any anatomic location.
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Nitsch KP, Stipp K, Gracz K, Ehrlich-Jones L, Graham ID, Heinemann AW. Integrating Spinal Cord Injury - Quality of Life instruments into rehabilitation: Implementation science to guide adoption of patient-reported outcome measures. J Spinal Cord Med 2021; 44:940-948. [PMID: 31971479 PMCID: PMC8725717 DOI: 10.1080/10790268.2020.1712893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context/objective: This study describes a development strategy for integrating the Spinal Cord Injury - Quality of Life (SCI-QOL) item banks into inpatient spinal cord injury (SCI) rehabilitation and recommendations for protocol implementation.Design: We adopted an implementation science approach to develop a strategy for adapting and contextualizing SCI-QOL use during SCI rehabilitation. We conducted focus groups and stakeholder meetings with clinical assessment champions to (1) identify barriers and supports to SCI-QOL adoption; (2) reduce barriers and emphasize supports; (3) evaluate and select relevant SCI-QOL domains and item banks; (4) develop administration and reporting guidelines; and (5) identify hospital roles to alert with SCI-QOL results.Setting: A regional inpatient rehabilitation hospital. This study focuses on clinicians providing inpatient rehabilitation to patients with SCI.Participants: Fifty-nine clinicians, including physicians, speech language pathologists, occupational and physical therapists, nurses, and social workers providing care to SCI inpatients.Interventions: N/A.Outcome measures: N/A.Results: Clinicians identified the SCI-QOL domains that were most relevant to inpatient care; when SCI-QOL should be administered; what hospital roles were best suited for administering SCI-QOL; how results should be displayed in the electronic medical record; and which clinical roles needed notification of SCI-QOL results.Conclusions: Clinicians acknowledge the value of patient-reported outcome measures in inpatient SCI rehabilitation, but noted barriers to adoption. Engaging clinicians in the decision-making process for developing an implementation and administration protocol can inform strategies to overcome barriers and emphasize supports.
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Affiliation(s)
- Kristian P. Nitsch
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelsey Stipp
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | | | - Linda Ehrlich-Jones
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Ian D. Graham
- School Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine
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Moghalu O, Stoffel JT, Elliott S, Welk B, Lenherr S, Herrick J, Presson A, Myers J. Psychosocial aspects of health-related quality of life and the association with patient-reported bladder symptoms and satisfaction after spinal cord injury. Spinal Cord 2021; 59:987-996. [PMID: 33495582 PMCID: PMC8483561 DOI: 10.1038/s41393-020-00609-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
STUDY DESIGN Prospective, multi-centered, observational. OBJECTIVES To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. SETTING Multi-institutional sites in the United States, cohort drawn from North America. METHODS We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. RESULTS There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p < 0.001; NBSS-satisfaction 0.6, p < 0.001; SCI-QoL Difficulties 2.4, p < 0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence (NBSS -2.3, p = 0.03; NBSS-satisfaction -0.4, p < 0.001) and upper tertile SCI-QoL Positive Affect (NBSS -2.8, p < 0.001; NBSS-satisfaction -0.7, p < 0.001; SCI-QoL Difficulties -0.7, p < 0.001). CONCLUSIONS In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.
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Affiliation(s)
- Odinachi Moghalu
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA.
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Blayne Welk
- Department of Urology, Western University, London, ON, Canada
| | - Sara Lenherr
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Jennifer Herrick
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Angela Presson
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Jeremy Myers
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
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Bamer AM, McMullen K, Deutsch A, Sevigny M, Mroz T, Wiechman SA, Schneider JC, Amtmann D. Linking scores on the 4- and 5-item versions of the Satisfaction with Life Scale in people with traumatic brain, spinal cord, or burn injury: a National Institute on Disability, Independent Living, and Rehabilitation Research Model System study. J Patient Rep Outcomes 2021; 5:59. [PMID: 34273011 PMCID: PMC8286208 DOI: 10.1186/s41687-021-00335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/29/2021] [Indexed: 01/07/2023] Open
Abstract
Background The Satisfaction with Life Scale (SWLS) is a widely used measure of subjective well-being. Recent evidence indicates the fifth item of the scale reduces the reliability of the scale and is inappropriate for use in traumatic injury populations. The purpose of this study was to develop a linking procedure between the five-item version of the SWLS and a modified four-item version, which removes the problematic item, for use in Spinal Cord (SCI), Traumatic Brain (TBI), and Burn Injury populations. Methods Proration (i.e. adding the mean of the four items to their total) was identified as a potential linking solution that could be easily implemented in clinical or research settings. The validity of the proration approach was evaluated by examining mean differences, cross group classification by SWLS category, score correlations, the intraclass correlation coefficient, and visual inspection of Bland-Altman plots in a large sample of SCI, TBI, and Burn Injury survivors who were participants in the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Model Systems’ National Databases. Results A total of 17,897 (SCI n = 8566, TBI n = 7941, and Burn n = 1390) participants were included in this study. SWLS scores ranged from 5 to 35, and the average score difference between directly derived and prorated scores was 0.39 points. A large majority of the sample (93%) had score differences of < 4 points (i.e. approximately 0.5 SD). The correlation between the prorated and directly derived scores was very high (r = 0.97) and the ICC value indicated excellent reliability (ICC = 0.97). Conclusions This study provides a valid scoring approach for researchers or clinicians who don’t want to lose continuity with previously collected data but prefer to switch to the modified four-item version of the SWLS. Clear guidance is provided for traumatic injury researchers or clinicians on how to implement the proration scoring approach.
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Affiliation(s)
- Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, University of Washington Center on Outcomes Research in Rehabilitation, 12360 Lake City Way, Suite 502, Seattle, WA, 98125, USA
| | - Kara McMullen
- Department of Rehabilitation Medicine, University of Washington, University of Washington Center on Outcomes Research in Rehabilitation, 12360 Lake City Way, Suite 502, Seattle, WA, 98125, USA
| | - Anne Deutsch
- Shirley Ryan AbilityLab and Northwestern University, 355 E Erie St, Chicago, IL, 60611, USA.,RTI International, 230 W Monroe St, Chicago, IL, 60606, USA
| | - Mitch Sevigny
- Spinal Cord Injury Model System, Craig Hospital, 3425 S. Clarkson Street, Englewood, CO, 80113, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA, 98195, USA
| | - Shelly A Wiechman
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA, 98104, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Research Institute, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, University of Washington Center on Outcomes Research in Rehabilitation, 12360 Lake City Way, Suite 502, Seattle, WA, 98125, USA.
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Jafar MR, Nagesh DS. Literature review on assistive devices available for quadriplegic people: Indian context. Disabil Rehabil Assist Technol 2021; 18:1-13. [PMID: 34176416 DOI: 10.1080/17483107.2021.1938708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This literature review aims to find the current state of the art in self-help devices (SHD) available for people with quadriplegia. MATERIALS AND METHODS We searched original articles, technical and case studies, conference articles, and literature reviews published between 2014 to 2019 with the keywords ("Self-help devices" OR "Assistive Devices" OR "Assistive Product" OR "Assistive Technology") AND "Quadriplegia" in Science Direct, Pubmed, IEEE Xplore digital library and Web of Science. RESULTS Total 222 articles were found. After removing duplicates and screening these articles based on their title and abstracts 80 articles remained. After this, we reviewed the full text, and articles unrelated to SHD development or about the patients who require mechanical ventilation or where the upper limb is functional (C2 or above and T2 or below injuries) were discarded. After the exclusion of articles using the above-mentioned criterion 75 articles were used for further review. CONCLUSION The abandonment rate of SHD currently available in the literature is very high. The major requirement of the people was independence and improved quality of life. The situation in India is very bad as compared to the developed countries. The people with spinal cord injury in India are uneducated and very poor, with an average income of 3000 ₹ (41$). They require SHDs and training specially designed for them, keeping their needs in mind.Implications for rehabilitationPeople with quadriplegia are totally dependent on caregivers. Assistive devices not only help these people to do day-to-day tasks but also provides them self-confidence.Even though there are a lot of self-help devices currently available, still they are not able to fulfil the requirements of people with quadriplegia, hence there is a very high abandonment rate of such devices.This study provides an evidence that developing devices after understanding the functional and non-functional requirements of these subjects will decrease the abandonment rate and increase the effectiveness of the device.The results of this study can be used for planning and developing assistive devices which are more focussed on fulfilling the requirements of people with quadriplegia.
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Affiliation(s)
- Mohd Rizwan Jafar
- Department of Mechanical Engineering, Delhi Technological University, Delhi, India
| | - D S Nagesh
- Department of Mechanical Engineering, Delhi Technological University, Delhi, India
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Heinemann AW, Nitsch KP, Gracz K, Ehrlich-Jones L, Engel E, Wilson M, Zale C, Graham ID. Implementing Patient-Reported Outcome Measures in Inpatient Rehabilitation: Challenges and Solutions. Arch Phys Med Rehabil 2021; 103:S67-S77. [PMID: 34144004 DOI: 10.1016/j.apmr.2021.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/02/2022]
Abstract
A project with the goal of implementing electronic health record (EHR) - based patient-reported outcome measures (PROMs) into a large inpatient spinal cord injury (SCI) rehabilitation program took twice as long as expected. This report details the lessons learned from the barriers, successes, and unexpected issues that arose during this prolonged, but now successful project. The goals of this implementation project were to (1) identify barriers and supports to the use of PROMs; (2) develop an implementation strategy to incorporate the use of PROMs into inpatient rehabilitation; and (3) implement the strategy and evaluate its effects on team communication. In brief, we conducted an initial pilot phase outside of the EHR and used our findings to guide procedural and EHR incorporation during a demonstration phase. We encountered multiple barriers. Procedural issues were significant: even though grant funding covered the cost of writing the code for integration of the PROMs into the EHR, our institution's competing priorities slowed progress. Institutional inertia was reflected in the reluctance of some clinical staff members to assume new duties that would take away from direct patient care responsibilities. Therefore, we needed to obtain additional staffing. Detailed planning upfront, guided by changes when necessary, cooperation and interaction with our institution's Information Systems department, and identification of key players and implementation champions proved essential to our success. We now have an up-and-running system and are sharing our experience, observations, and recommendations to assist other healthcare organizations incorporate PROMs into their EHRs.
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Affiliation(s)
- Allen W Heinemann
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine and Director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab.
| | - Kristian P Nitsch
- Department of Psychology, Shepherd Pathways, Shepherd Center, Atlanta, GA
| | | | - Linda Ehrlich-Jones
- Research Associate Professor, Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, and Associate Director, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab
| | - Edeth Engel
- Project Coordinator, Shirley Ryan AbilityLab
| | - Meghan Wilson
- Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Arkansas for Medical Sciences College of Medicine
| | - Colleen Zale
- Occupational/Physical Therapist, Shirley Ryan AbilityLab
| | - Ian D Graham
- FRSC Professor, School of Epidemiology and Public Health, University of Ottawa, and Senior Scientist, Clinical Epidemiology Program, Ottawa Hospital Research Institute
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Gorman PH, Forrest GF, Asselin PK, Scott W, Kornfeld S, Hong E, Spungen AM. The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions. J Clin Med 2021; 10:jcm10050964. [PMID: 33801165 PMCID: PMC7957745 DOI: 10.3390/jcm10050964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022] Open
Abstract
Bowel function after spinal cord injury (SCI) is compromised because of a lack of voluntary control and reduction in bowel motility, often leading to incontinence and constipation not easily managed. Physical activity and upright posture may play a role in dealing with these issues. We performed a three-center, randomized, controlled, crossover clinical trial of exoskeletal-assisted walking (EAW) compared to usual activity (UA) in people with chronic SCI. As a secondary outcome measure, the effect of this intervention on bowel function was assessed using a 10-question bowel function survey, the Bristol Stool Form Scale (BSS) and the Spinal Cord Injury Quality of Life (SCI-QOL) Bowel Management Difficulties instrument. Fifty participants completed the study, with bowel data available for 49. The amount of time needed for the bowel program on average was reduced in 24% of the participants after EAW. A trend toward normalization of stool form was noted. There were no significant effects on patient-reported outcomes for bowel function for the SCI-QOL components, although the time since injury may have played a role. Subset analysis suggested that EAW produces a greater positive effect in men than women and may be more effective in motor-complete individuals with respect to stool consistency. EAW, along with other physical interventions previously investigated, may be able to play a previously underappreciated role in assisting with SCI-related bowel dysfunction.
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Affiliation(s)
- Peter H. Gorman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Division of Rehabilitation Medicine, University of Maryland Rehabilitation and Orthopaedic Institute, Baltimore, MD 21207, USA
- Correspondence: ; Tel.: +1-410-448-6265
| | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School-Rutgers University, Newark, NJ 07103, USA
| | - Pierre K. Asselin
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA; (P.K.A.); (S.K.); (E.H.); (A.M.S.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - William Scott
- VA Maryland Healthcare System, Baltimore, MD 21201, USA;
| | - Stephen Kornfeld
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA; (P.K.A.); (S.K.); (E.H.); (A.M.S.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Eunkyoung Hong
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA; (P.K.A.); (S.K.); (E.H.); (A.M.S.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ann M. Spungen
- Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY 10468, USA; (P.K.A.); (S.K.); (E.H.); (A.M.S.)
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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13
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Weber L, Voldsgaard NH, Holm NJ, Schou LH, Biering-Sørensen F, Møller T. Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study. Spinal Cord 2021; 59:336-346. [PMID: 33564119 PMCID: PMC7943422 DOI: 10.1038/s41393-020-00608-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Study design Explorative qualitative study based on an interpretative phenomenological approach. Objectives This study explored the possibility of transferring knowledge and skills from a spinal cord injury (SCI) unit to the home environment; the individual and structural factors that potentially influenced this transfer; and its compatibility with a meaningful everyday life. Setting Hospital-based rehabilitation unit and community in Denmark. Methods Fourteen individuals with SCI were selected with maximum variation according to age, sex, marital status, and level of injury. In-depth, semi-structured interviews were conducted in the participants’ homes, 2–10 months after discharge from an SCI unit. Data analysis involved taking an interpretative phenomenological approach combined with a template analysis and applying the transfer of training theory to the discussion. Results Transitioning from the SCI unit to the home environment involved a multidimensional change of context in which most of the participants’ previous life roles had changed. This overarching theme had a decisive influence on: balancing loss and acceptance, facing external structural barriers, and the strength of social relationships when the knowledge and skills acquired at the unit were applied in a meaningful everyday life. Conclusions Transition from the SCI unit to the home environment is influenced by a multidimensional change of context that may restrict the use of acquired skills post-discharge, provide distant prospects for tertiary health promotion, and aggravate the experience of loss in people with SCI. Maintaining relationships is a strong mediator for transferring skills and re-establishing a meaningful everyday life.
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Affiliation(s)
- Lene Weber
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark. .,Research Unit on Brain Injury Rehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Nanna Hoffgaard Voldsgaard
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark
| | - Nicolaj Jersild Holm
- Department of Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Helle Schou
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Department of Spinal Cord Injuries, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tom Møller
- The University Hospitals Centre for Health Research (UCSF), Rigshospitalet, Copenhagen University Hospital, Department, 9701, Copenhagen, Denmark
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Tyner CE, Kisala PA, Heinemann AW, Fyffe D, Tate DG, Slavin MD, Jette AM, Tulsky DS. Validation of the Spinal Cord Injury Functional Index for Use in Community-Dwelling Individuals With SCI. Arch Phys Med Rehabil 2021; 103:191-198. [PMID: 33453193 DOI: 10.1016/j.apmr.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Spinal Cord Injury Functional Index (SCI-FI) instruments in a community-dwelling sample. DESIGN Cross-sectional study. SETTING Community setting. PARTICIPANTS Individuals (N=269) recruited from 6 SCI Model Systems sites. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity. RESULTS Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms. CONCLUSION Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.
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Affiliation(s)
- Callie E Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Denise Fyffe
- Kessler Foundation, West Orange, NJ; New Jersey Medical School, Newark, NJ
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA; Massachusetts General Hospital, Institute of Health Professions, Boston, MA
| | - Alan M Jette
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA; Massachusetts General Hospital, Institute of Health Professions, Boston, MA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE; Department of Physical Therapy, University of Delaware, Newark, DE; Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
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15
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Kalpakjian CZ, Kreschmer JM, Slavin MD, Kisala PA, Quint EH, Chiaravalloti ND, Jenkins N, Bushnik T, Amtmann D, Tulsky DS, Madrid R, Parten R, Evitts M, Grawi CL. Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures. J Womens Health (Larchmt) 2020; 29:1427-1436. [PMID: 32429740 PMCID: PMC7703246 DOI: 10.1089/jwh.2019.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary D. Slavin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Elisabeth H. Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Natalie Jenkins
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Tamara Bushnik
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David S. Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Roxanne Madrid
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Evitts
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carolyn L. Grawi
- Ann Arbor Center for Independent Living, Ann Arbor, Michigan, USA
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Spungen AM, Bauman WA, Biswas K, Jones KM, Snodgrass AJ, Goetz LL, Gorman PH, Kirshblum S, Sabharwal S, White KT, Asselin PK, Morin KG, Cirnigliaro CM, Huang GD. The design of a randomized control trial of exoskeletal-assisted walking in the home and community on quality of life in persons with chronic spinal cord injury. Contemp Clin Trials 2020; 96:106102. [PMID: 32800962 DOI: 10.1016/j.cct.2020.106102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
There are more than 300,000 estimated cases of spinal cord injury (SCI) in the United States, and approximately 27,000 of these are Veterans. Immobilization from SCI results in adverse secondary medical conditions and reduced quality of life. Veterans with SCI who have completed rehabilitation after injury and are unable to ambulate receive a wheelchair as standard of care. Powered exoskeletons are a technology that offers an alternative form of limited mobility by enabling over-ground walking through an external framework for support and computer-controlled motorized hip and knee joints. Few studies have reported the safety and efficacy for use of these devices in the home and community environments, and none evaluated their impact on patient-centered outcomes through a randomized clinical trial (RCT). Absence of reported RCTs for powered exoskeletons may be due to a range of challenges, including designing, statistically powering, and conducting such a trial within an appropriate experimental framework. An RCT for the study of exoskeletal-assisted walking in the home and community environments also requires the need to address key factors such as: avoiding selection bias, participant recruitment and retention, training, and safety concerns, particularly in the home environment. These points are described here in the context of a national, multisite Department of Veterans Affairs Cooperative Studies Program-sponsored trial. The rationale and methods for the study design were focused on providing a template for future studies that use powered exoskeletons or other strategies for walking and mobility in people with immobilization due to SCI.
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Affiliation(s)
- Ann M Spungen
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Kousick Biswas
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States of America.
| | - Karen M Jones
- Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, MD 21902, United States of America.
| | - Amanda J Snodgrass
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM 87106, United States of America; University of New Mexico, College of Pharmacy, Albuquerque, NM 87106, United States of America.
| | - Lance L Goetz
- Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, United States of America; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23298, United States of America.
| | - Peter H Gorman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, United States of America; VA Maryland Healthcare System, Baltimore, MD 21201, United States of America.
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ 07052, United States of America; Rutgers New Jersey Medical School, Newark, NJ 07103, United States of America; Kessler Foundation, West Orange, NJ 07052, United States of America.
| | - Sunil Sabharwal
- VA Boston Health Care System, Boston, MA 02130, United States of America; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, United States of America.
| | - Kevin T White
- James A Haley Veterans' Hospital, Tampa, FL 33612, United States of America; University of South Florida, Tampa, FL 33612, United States of America.
| | - Pierre K Asselin
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Kel G Morin
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America.
| | - Christopher M Cirnigliaro
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY 10468, United States of America.
| | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC 20420, United States of America.
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17
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Mehta S, Hadjistavropoulos H, Nugent M, Karin E, Titov N, Dear BF. Guided internet-delivered cognitive-behaviour therapy for persons with spinal cord injury: a feasibility trial. Spinal Cord 2020; 58:544-552. [DOI: 10.1038/s41393-019-0398-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/22/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022]
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18
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Development and Calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction With Social Roles and Activities Item Banks and Short Forms. Arch Phys Med Rehabil 2020; 101:20-32. [DOI: 10.1016/j.apmr.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 11/21/2022]
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19
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Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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20
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Family-centered empowerment process in individuals with spinal cord injury living in Iran: a grounded theory study. Spinal Cord 2019; 58:174-184. [PMID: 31477808 DOI: 10.1038/s41393-019-0348-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This was a qualitative study using grounded theory method. OBJECTIVES To explain the process of family-centered empowerment in a population of individuals with SCI living in Iran. SETTING Brain and SCI Research Center, Social Welfare Center, and SCI Association of Tehran; Iran. METHODS Participants were 19 persons with traumatic SCI, 13 family member caregivers, and 11 health care providers selected through purposeful sampling. Data were collected using face-to-face, semi-structured interviews, which were continued until data saturation. The interview data were methodically collected and analyzed using Strauss and Corbin's (1998) recommended method for grounded theory. Constant comparative analysis was simultaneously conducted through reviews of the interview statements, observations of behavior, interviewer field notes, and interviewer memos. The analysis was managed in MAXQDA software version 10. RESULTS The process of family-centered empowerment following SCI included five categories: (1) disruption in the existential integrity of the individual; (2) constructive life recovery; (3) inhibitors of family-centered empowerment; (4) facilitators of family-centered empowerment, and (5) back on track. Constructive life recovery was selected as the core variable using the grounded theory method. This core variable identified the strategies most frequently used by the participants to cope with the challenges of SCI-related impairment, disability, and overall life management. CONCLUSIONS Family-centered empowerment process in individuals with SCI living in Iran emerged from the data. The model includes early disruptions in the bio-psycho-social and vocational lives of individuals with SCI and their families, strategies for recovery post injury, inhibitors and facilitators of family-centered empowerment, the gradual return to work and daily activities, and the expected social roles for individuals with SCI.
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21
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An Overview of the Traumatic Brain Injury–Quality of Life (TBI-QOL) Measurement System. J Head Trauma Rehabil 2019; 34:281-288. [DOI: 10.1097/htr.0000000000000531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Rohn EJ, Tate DG, Forchheimer M, DiPonio L. Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model. J Spinal Cord Med 2019; 42:469-477. [PMID: 30188802 PMCID: PMC6718176 DOI: 10.1080/10790268.2018.1517471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: The objective of this study was to gain greater insight into individuals' quality of life (QOL) definitions, appraisals, and adaptations following spinal cord injury (SCI). Design: A mixed-methods design, applying the Schwartz and Sprangers response shift (RS) model. RS is a cognitive process wherein, in response to a change in health status, individuals change internal standards, values, or conceptualization of QOL Setting: Community-dwelling participants who receive medical treatment at a major Midwestern medical system and nearby Veterans' Affairs hospital. Participants: A purposive sample of participants with SCI (N = 40) completed semi-structured interviews and accompanying quantitative measures. Interventions: Not applicable. Outcome Measures: Qualitative data were analyzed using content analysis to identify themes. Analysis of variance were performed to detect differences based on themes and QOL, well-being, and demographic and injury characteristics. Results: Four RS themes were identified, capturing the range of participant perceptions of QOL. The themes ranged from complete RS, indicating active engagement in maintaining QOL, to awareness and comparisons redefining QOL, to a relative lack of RS. Average QOL ratings differed as a function of response shift themes. PROMIS Global Health, Anxiety, and Depression also differed as a function of RS themes. Conclusion: The RS model contextualizes differences in QOL definitions, appraisals, and adaptations in a way standardized QOL measures alone do not.
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Affiliation(s)
- Edward J. Rohn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA,Correspondence to: Edward J. Rohn, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Suite 300, Ann Arbor, MI 48108, USA.
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa DiPonio
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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23
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Designing a Client and Family Empowerment Model to Promote Constructive Life Recovery Among Persons with Spinal Cord Injury: A Qualitative Study. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.87867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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LaVela SL, Etingen B, Miskevics S, Heinemann AW. What determines low satisfaction with life in individuals with spinal cord injury? J Spinal Cord Med 2019; 42:236-244. [PMID: 29733775 PMCID: PMC6419684 DOI: 10.1080/10790268.2018.1466480] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To examine variables associated with satisfaction with life (SWL) in individuals with a spinal cord injury (SCI). DESIGN Cross-sectional, national survey to assess SWL, demographic and injury characteristics, health care utilization, chronic conditions (obesity, diabetes, heart problems, lung problems, hypertension, high cholesterol), symptoms (poor sleep, pain, depression), social support, grief/loss, and independence. SETTING/PARTICIPANTS Community-dwelling Veterans with SCI. Outcome Measures/Analyses: Bivariate analyses were conducted to assess differences in demographics, injury characteristics, chronic conditions, symptoms, social support, grief/loss, and independence in individuals who reported low SWL (≤20) vs. average/high SWL (21-35). Multivariate logistic regression assessed factors independently associated with low SWL. RESULTS 896 Veterans with SCI (62%) responded. Average age was 62 years, the majority were male (94%), Caucasian (77%), and had paraplegia (61%). Odds of low SWL were 2.4 times greater for individuals experiencing pain (OR = 2.43, CI95: 1.47-4.02, P = 0.0005). Odds of low SWL were increased for individuals reporting greater grief/loss due to their SCI (OR = 1.14, CI95: 1.10-1.18, P < 0.0001). Lesser odds of low SWL were seen for individuals reporting greater emotional social support (OR = 0.97, CI95: 0.96-0.99, P < 0.0001) and independence (OR = 0.94, CI95: 0.90-0.97, P < 0.0001). CONCLUSIONS Pain and feelings of grief/loss due to injury were associated with low SWL. Self-perceived independence and good social support were associated with better SWL. Along with addressing pain and facilitating independence and social support, these findings suggest that interventions to improve SWL should focus on helping individuals deal with grief/loss due to injury.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Correspondence to: Sherri L. LaVela, PhD, MPH, MBA, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital (151-H, Building 1, Office D-312), 5th Avenue & Roosevelt Road, Hines, IL60141, USA; Ph: (708) 202-5895, (708) 202-2499.
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Illinois, USA
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25
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Xie G, Chen L, Yang S, Tao J, Chan CCH, Heinemann AW, Cella D, Lai JS, Correia H, Wong AWK. Simplified Chinese translation of 13 adult item banks from the Quality of Life in Neurological Disorders (Neuro-QoL). BMC Health Serv Res 2018; 18:825. [PMID: 30376828 PMCID: PMC6208024 DOI: 10.1186/s12913-018-3631-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Quality of Life in Neurological Disorders (Neuro-QoL) item banks evaluate and monitor the physical, mental, and social health of individuals with neurological conditions. Neuro-QoL items can be administered via short form or computerized adaptive testing. This paper describes the English-to-Simplified Chinese translation of 299 items from 13 adult item banks, which are publicly available. METHODS Items were translated according to the Functional Assessment of Chronic Illness Therapy (FACIT) method, including forward and backward translation, reconciliation, expert reviews, and cognitive debriefing with both general and clinical populations in China. RESULTS Most of the 299 Simplified Chinese items were well understood by the respondents. Revisions were made on a small number of items after cognitive debriefing. Although some difficulties were encountered in the translation process, all 13 item banks were linguistically validated with acceptable translations. CONCLUSION All Chinese adult Neuro-QoL measures are linguistically equivalent to their English sources. Future work includes psychometric validation of these measures in order to create a final version of the item banks. The translation methodology used in this study can serve as a blueprint for researchers in other countries interested in translating the Neuro-QoL.
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Affiliation(s)
- Guanli Xie
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
- Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine of the P.R.C., Fuzhou, Fujian China
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
- Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine of the P.R.C., Fuzhou, Fujian China
| | - Shanli Yang
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian China
- Rehabilitation Medical Technology Joint National Local Engineering Research Center, Fuzhou, Fujian China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, 1 Huatuo Road, Minhou Shangjie, Fuzhou, 350122 Fujian China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, Fujian China
| | - Chetwyn C. H. Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine & Center for Rehabilitation Outcomes Research, Shirley Ryan Ability Lab (formerly Rehabilitation Institute of Chicago), Chicago, IL USA
| | - David Cella
- Department of Medical Social Science & Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Jin-Shei Lai
- Departments of Medical Social Science & Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Helena Correia
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alex W. K. Wong
- Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, 4444 Forest Park Ave, Campus Box 8505, St. Louis, MO 63108 USA
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Cohen ML, Kisala PA, Dyson-Hudson TA, Tulsky DS. Measuring pain phenomena after spinal cord injury: Development and psychometric properties of the SCI-QOL Pain Interference and Pain Behavior assessment tools. J Spinal Cord Med 2018; 41:267-280. [PMID: 28185477 PMCID: PMC6055945 DOI: 10.1080/10790268.2017.1279805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To develop modern patient-reported outcome measures that assess pain interference and pain behavior after spinal cord injury (SCI). DESIGN Grounded-theory based qualitative item development; large-scale item calibration field-testing; confirmatory factor analyses; graded response model item response theory analyses; statistical linking techniques to transform scores to the Patient Reported Outcome Measurement Information System (PROMIS) metric. SETTING Five SCI Model Systems centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. INTERVENTIONS N/A. OUTCOME MEASURES Spinal Cord Injury - Quality of Life (SCI-QOL) Pain Interference item bank, SCI-QOL Pain Interference short form, and SCI-QOL Pain Behavior scale. RESULTS Seven hundred fifty-seven individuals with traumatic SCI completed 58 items addressing various aspects of pain. Items were then separated by whether they assessed pain interference or pain behavior, and poorly functioning items were removed. Confirmatory factor analyses confirmed that each set of items was unidimensional, and item response theory analyses were used to estimate slopes and thresholds for the items. Ultimately, 7 items (4 from PROMIS) comprised the Pain Behavior scale and 25 items (18 from PROMIS) comprised the Pain Interference item bank. Ten of these 25 items were selected to form the Pain Interference short form. CONCLUSIONS The SCI-QOL Pain Interference item bank and the SCI-QOL Pain Behavior scale demonstrated robust psychometric properties. The Pain Interference item bank is available as a computer adaptive test or short form for research and clinical applications, and scores are transformed to the PROMIS metric.
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Affiliation(s)
- Matthew L. Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware, USA,Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA,Center on Assessment Research and Translation, University of Delaware, Newark, Delaware, USA,Correspondence to: Matthew L. Cohen, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Center on Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Trevor A. Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David S. Tulsky
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA,Center on Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
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Floyd MS, Khadr RN. Role of gentamicin in reducing urinary tract infections in patients with neurogenic bladder. Can Urol Assoc J 2017; 11:427-428. [PMID: 29257743 DOI: 10.5489/cuaj.4945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael S Floyd
- Northwest Regional Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, Merseyside, United Kingdom
| | - Rauf N Khadr
- Northwest Regional Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, Merseyside, United Kingdom
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Walia P, Kaur J. Development and validation of Incontinence - Activity Participation Scale for spinal cord injury. Indian J Urol 2017; 33:159-164. [PMID: 28469306 PMCID: PMC5396406 DOI: 10.4103/0970-1591.203413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We aimed to develop and validate an Incontinence - Activity Participation Scale (I-APS) for measurement of activity limitation and participation restriction due to bladder problems in spinal cord injury (SCI). MATERIALS AND METHODS The process of development was initiated by formation of open-ended questions after thorough review of literature which were then administered to SCI participants, caretakers, and professionals working with SCI. Items were generated based on their responses and initial draft of scale was formulated. This initial draft of the scale containing 77 items was then administered to 56 SCI participants for reduction of items using factor analysis, and a prefinal version of the scale was obtained containing thirty items only. Content validity and face validity was then established. RESULTS The I-APS is both health professional and self-administered questionnaire including two domains: Activities of daily living and occupation with 16 items having a content validity of 0.84. The overall internal consistency reliability was 0.86. CONCLUSION The I-APS is a valid, comprehensive instrument that measures the activity limitation and participation restrictions due to bladder problems in SCI.
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Affiliation(s)
- Priya Walia
- Indian Spinal Injuries Centre, New Delhi, India
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30
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Relevance of the international spinal cord injury basic data sets to youth: an Inter-Professional review with recommendations. Spinal Cord 2017; 55:875-881. [DOI: 10.1038/sc.2017.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/29/2016] [Accepted: 01/06/2017] [Indexed: 01/22/2023]
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Amtmann D, Bocell FD, Bamer A, Heinemann AW, Hoffman JM, Juengst SB, Rosenberg M, Schneider JC, Wiechman S, McMullen K. Psychometric Properties of the Satisfaction With Life Scale in People With Traumatic Brain, Spinal Cord, or Burn Injury: A National Institute on Disability, Independent Living, and Rehabilitation Research Model System Study. Assessment 2017; 26:695-705. [DOI: 10.1177/1073191117693921] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | | | - Allen W. Heinemann
- Northwestern University, Chicago, IL, USA
- Rehabilitation Institute of Chicago, Chicago, IL, USA
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Simulation study of activities of daily living functions using online computerized adaptive testing. BMC Med Inform Decis Mak 2016; 16:130. [PMID: 27724939 PMCID: PMC5057399 DOI: 10.1186/s12911-016-0370-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022] Open
Abstract
Background Computer adaptive testing (CAT) of the activities of daily living (ADL) functions is required (i) to reveal the advantages of using an efficient and accurate estimation method, (ii) to determine the cutpoint for classifying ADL strata in patients with stroke, and (iii) to evaluate the feasibility of online CAT used in clinical settings for smartphones. Methods Normally standardized distributions of ADL measurements were simulated using item parameters from published papers. We retrieved item parameters of the combined Barthel Index and Frenchay Activities Index from the literature (the 23-item comprehensive ADL [CADL] and 34-item ADL scales) and simulated three 1000-person measures from a normal standard CAT distribution: [i] CADL (CADL-CAT), [ii] ADL (ADL-CAT), and [iii] NAT (Non-Adaptive Testing). The cutpoints of ADL person strata were determined using a norm-reference method. Maximum a posteriori estimation, expected a posteriori estimation, and maximum likelihood estimation (MAP) were used to compare the Pearson correlation coefficients and different number ratios of paired measures yielded by CAT and NAT. The number of items and the cutpoints for the scale were separately determined. Results We found that (i) correlation coefficients for the three CAT-estimated measures were 0.77 (CADL), 0.93 (Male ADL), and 0.93 (Female ADL) compared with their NAT counterparts. Different number ratios of person-paired measures between CAT and NAT for the three scales were all less than 5 %, indicating no difference exists between CAT and NAT. However, CAT might be 66 % more efficient than NAT. (ii) The estimated cutpoints of T scores (i.e., with a mean of 50 and a standard deviation of 10) were 45, 55, and 65 (e.g., separating person ADL function to four strata with not active, fairly active, active, and very active). (iii) An available-for-download online ADL-CAT APP for clinical practice was demonstrated. Conclusions An online ADL-CAT APP using the MAP method was created and used on smartphones to classify ADL strata in patients with stroke. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0370-8) contains supplementary material, which is available to authorized users.
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Hill JN, Balbale S, Lones K, LaVela SL. Starting a new conversation: Engaging Veterans with spinal cord injury in discussions of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function. Disabil Health J 2016; 10:114-122. [PMID: 27424945 DOI: 10.1016/j.dhjo.2016.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 05/17/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them. OBJECTIVES/HYPOTHESIS We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning. METHODS Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data. RESULTS Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of 'normalcy,' aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip. CONCLUSION(S) Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans.
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Affiliation(s)
- Jennifer N Hill
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA.
| | - Salva Balbale
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Keshonna Lones
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA
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Lanzino D, Sander E, Mansch B, Jones A, Gill M, Hollman J. Life Space Assessment in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2016; 22:173-182. [PMID: 29339859 DOI: 10.1310/sci2203-173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objectives: To examine the Life Space Assessment (LSA) in persons with spinal cord injury (SCI), exploring its psychometric properties, differences between persons with cervical versus thoracolumbar injuries, and cutoff score differentiating a restricted from an unrestricted life space. Method: We conducted a test-retest reliability study in a community setting involving 50 persons with SCI (25 injured above C7, 25 injured below T1). Data were collected in 2 phone interviews approximately 9 days apart using the LSA. Results: Mean LSA scores were 66 ± 25 (n = 50): 62 ± 23 for the cervical group, and 70 ± 25 for the thoracolumbar group. Scores were not significantly different between phone interviews [t(49) = 0.379, p = .706] or between groups [t(48) = -1.214, p = .231]. Test-retest reliability intraclass correlation coefficient (ICC) was 0.876 (95% CI, 0.792-0.928). Spearman's rho correlations between the LSA and Reintegration to Normal Living Index total and subscores ranged from .509 to .538 (p < .001). LSA scores were normally distributed. The minimum detectable change was approximately 23 points. A cutoff score of 78.5 (sensitivity 76.9%, specificity 81.1%) differentiated between persons with a restricted from an unrestricted life space if equipment and personal assistance were not needed for mobility. If equipment was needed, the cutoff score was found to be 49 (sensitivity of 90%, specificity of 90%). Conclusions: The LSA is a reliable and valid measure of life space in persons with SCI and can be used to identify persons with a restricted life space who may be at increased risk of mobility disability.
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Affiliation(s)
- Desiree Lanzino
- Mayo School of Health Sciences, College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth Sander
- Minneapolis Veteran's Administration Health Care System, Physical Medicine and Rehabilitation, Minneapolis, Minnesota
| | - Bethany Mansch
- Allina Health: Mercy Hospital - Sister Kenny Rehabilitation Institute, Coon Rapids, Minnesota
| | - Ashley Jones
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Megan Gill
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - John Hollman
- Mayo School of Health Sciences, College of Medicine, Mayo Clinic, Rochester, Minnesota
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LaVela SL, Etingen B, Miskevics S. Factors Influencing Self-Care Behaviors in Persons with Spinal Cord Injuries and Disorders. Top Spinal Cord Inj Rehabil 2016; 22:27-38. [PMID: 29398891 DOI: 10.1310/sci2201-27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Individuals with spinal cord injury/disorder (SCI/D) must learn to adjust to and manage functional challenges after SCI/D onset. For these individuals, resilience (ie, the adaptive response to stressful events) may be related to their willingness and ability to conduct self-care behaviors. Objective: The study objectives were to examine the relationship between patient-reported perceptions of independence in performing self-care behaviors and resilience among Veterans with SCI/D and to examine variables (including resilience) associated with high self-care scores (controlling for confounders). Methods: In this cross-sectional survey, we conducted bivariate analyses to examine differences in demographic, injury, and health characteristics and resilience scores for individuals with SCI/D. We conducted a multivariate block-design linear regression to examine factors associated with ability to perform self-care. Results: Level of injury (β = 7.74, P < .0001), resilience (β = 0.08, P = .0216), marital status (β = 1.75, P = .0445), and living arrangement (β = 4.37, P < .0001) were positively related to higher self-care behaviors. Completeness of injury (β = -2.79, P < .0001), age (β = -0.09, P = .0052), age at injury (β = -0.05, P = .0129), and number of comorbid health conditions (β = -0.72, P < .0001) showed negative relationships with higher self-care. Conclusions: Self-care ability is related to multiple factors, including resilience. The positive relationship between resilience and self-care suggests that greater resilience, independent of injury level/severity, may contribute to improved self-care behaviors in individuals with SCI/D. Other factors that showed a positive relationship with self-care included younger age, living alone, paraplegic level injury, and fewer health conditions. Understanding the profile of persons with SCI/D with regard to self-care behaviors is important to the development of tailored interventions to improve self-care.
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois.,Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois
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Magasi S, Wong A, Gray DB, Hammel J, Baum C, Wang CC, Heinemann AW. Theoretical foundations for the measurement of environmental factors and their impact on participation among people with disabilities. Arch Phys Med Rehabil 2015; 96:569-77. [PMID: 25813889 DOI: 10.1016/j.apmr.2014.12.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 10/23/2022]
Abstract
The ascendance of the World Health Organization's International Classification of Functioning, Disability and Heath (ICF) as the global standard for describing and characterizing aspects of disability has refocused attention on the role that environmental factors (EFs) have on the health and participation of people with disabilities, both as individuals and as a group. There has been a rise in the development of instruments designed to measure EFs alone and in relation to participation. Some instrument developers have used the ICF as a theoretical base for instrument development and to substantiate content validity claims. We contend that this is a misapplication of the ICF. There is a need to step back and reexamine the role that environmental theories can play in developing a conceptually driven approach to measuring the interaction between EFs and participation. For this review, we draw on the fields of social, community, and developmental psychology; disability studies; gerontology; public health; and rehabilitation. We discuss different approaches to the measurement of EFs. We suggest that given the complex nature of EFs and their influence on participation, there is a need for a fresh approach to EF measurement. The thoughtful application of theories and the use of advanced psychometric, measurement, and e-technologies and data visualization methods may enable researchers and clinicians to better quantify, document, and communicate the dynamic interrelationship between EFs and participation and health outcomes for people with disabilities at the individual, group, and population levels.
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Affiliation(s)
- Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Alex Wong
- Department of Occupational Therapy, Washington University, St. Louis, MO
| | - David B Gray
- Department of Occupational Therapy, Washington University, St. Louis, MO; Department of Neurology, Washington University, St. Louis, MO
| | - Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
| | - Carolyn Baum
- Department of Occupational Therapy, Washington University, St. Louis, MO; Department of Neurology, Washington University, St. Louis, MO; Department of Social Work, University of Illinois at Chicago, Chicago, IL
| | - Chia-Chiang Wang
- Department of Counseling, School, and Educational Psychology, University at Buffalo, The State University of New York, Buffalo, NY
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL
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Hammel J, Magasi S, Heinemann A, Gray DB, Stark S, Kisala P, Carlozzi NE, Tulsky D, Garcia SF, Hahn EA. Environmental barriers and supports to everyday participation: a qualitative insider perspective from people with disabilities. Arch Phys Med Rehabil 2015; 96:578-88. [PMID: 25813890 DOI: 10.1016/j.apmr.2014.12.008] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe environmental factors that influence participation of people with disabilities. DESIGN Constant comparative, qualitative analyses of transcripts from 36 focus groups across 5 research projects. SETTING Home, community, work, and social participation settings. PARTICIPANTS Community-dwelling people (N=201) with diverse disabilities (primarily spinal cord injury, traumatic brain injury, and stroke) from 8 states. INTERVENTIONS None. MAIN OUTCOME MEASURES Environmental barriers and supports to participation. RESULTS We developed a conceptual framework to describe how environmental factors influence the participation of people with disabilities, highlighting 8 domains of environmental facilitators and barriers (built, natural, assistive technology, transportation, information and technology access, social support and attitudes, systems and policies, economics) and a transactional model showing the influence of environmental factors on participation at the micro (individual), mesa (community), and macro (societal) levels. Focus group data validated some International Classification of Functioning, Disability and Health environmental categories while also bringing unique factors (eg, information and technology access, economic quality of life) to the fore. Data were used to construct items to enable people with disabilities to assess the impact of environmental factors on everyday participation from their firsthand experience. CONCLUSIONS Participants with disabilities voiced the need to evaluate the impact of the environment on their participation at the immediate, community, and societal levels. The results have implications for assessing environmental facilitators and barriers to participation within rehabilitation and community settings, evaluating outcomes of environmental interventions, and effecting system and policy changes to target environmental barriers that may result in societal participation disparities versus opportunities.
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Affiliation(s)
- Joy Hammel
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL; Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL.
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
| | - Allen Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David B Gray
- Program in Occupational Therapy, Washington University, St Louis, MO
| | - Susan Stark
- Occupational Therapy, Neurology and Social Work, Washington University, St Louis, MO
| | - Pamela Kisala
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE
| | - Noelle E Carlozzi
- Center for Clinical Outcomes and Assessment Research, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Ann Arbor, MI
| | - David Tulsky
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE; Kessler Foundation Research Center, West Orange, NJ
| | - Sofia F Garcia
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL
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Kisala PA, Tulsky DS, Choi SW, Kirshblum SC. Development and psychometric characteristics of the SCI-QOL Pressure Ulcers scale and short form. J Spinal Cord Med 2015; 38:303-14. [PMID: 26010965 PMCID: PMC4445021 DOI: 10.1179/2045772315y.0000000017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop a self-reported measure of the subjective impact of pressure ulcers on health-related quality of life (HRQOL) in individuals with spinal cord injury (SCI) as part of the SCI quality of life (SCI-QOL) measurement system. DESIGN Grounded-theory based qualitative item development methods, large-scale item calibration testing, confirmatory factor analysis (CFA), and item response theory-based psychometric analysis. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES SCI-QOL Pressure Ulcers scale. RESULTS 189 individuals with traumatic SCI who experienced a pressure ulcer within the past 7 days completed 30 items related to pressure ulcers. CFA confirmed a unidimensional pool of items. IRT analyses were conducted. A constrained Graded Response Model with a constant slope parameter was used to estimate item thresholds for the 12 retained items. CONCLUSIONS The 12-item SCI-QOL Pressure Ulcers scale is unique in that it is specifically targeted to individuals with spinal cord injury and at every stage of development has included input from individuals with SCI. Furthermore, use of CFA and IRT methods provide flexibility and precision of measurement. The scale may be administered in its entirety or as a 7-item "short form" and is available for both research and clinical practice.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Tulsky DS, Kisala PA. The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system: Development, psychometrics, and item bank calibration. J Spinal Cord Med 2015; 38:251-6. [PMID: 26010961 PMCID: PMC4445017 DOI: 10.1179/2045772315y.0000000035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Department of Physical Therapy, University of Delaware, College of Health Sciences, 540 S. College Ave., Newark, DE 19713.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
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Kalpakjian CZ, Tulsky DS, Kisala PA, Bombardier CH. Measuring grief and loss after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Grief and Loss item bank and short form. J Spinal Cord Med 2015; 38:347-55. [PMID: 26010969 PMCID: PMC4445025 DOI: 10.1179/2045772315y.0000000015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop an item response theory (IRT) calibrated Grief and Loss item bank as part of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. DESIGN A literature review guided framework development of grief/loss. New items were created from focus groups. Items were revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF). SETTING We tested a 20-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI answered the grief and loss questions. RESULTS The final calibrated item bank resulted in 17 retained items. A unidimensional model was observed (CFI=0.976; RMSEA=0.078) and measurement precision was good (theta range between -1.48 to 2.48). Ten items were flagged for DIF, however, after examination of effect sizes found this to be negligible with little practical impact on score estimates. CONCLUSIONS This study indicates that the SCI-QOL Grief and Loss item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Tulsky DS, Kisala PA, Tate DG, Spungen AM, Kirshblum SC. Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale. J Spinal Cord Med 2015; 38:288-302. [PMID: 26010964 PMCID: PMC4445020 DOI: 10.1179/2045772315y.0000000030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale. DESIGN Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning. SETTING Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY. PARTICIPANTS Seven hundred fifty-seven adults with traumatic SCI. RESULTS The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale. CONCLUSION The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
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Bertisch H, Kalpakjian CZ, Kisala PA, Tulsky DS. Measuring positive affect and well-being after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Positive Affect and Well-being bank and short form. J Spinal Cord Med 2015; 38:356-65. [PMID: 26010970 PMCID: PMC4445026 DOI: 10.1179/2045772315y.0000000024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To develop an item response theory (IRT)-calibrated spinal cord injury (SCI)-specific Positive Affect and Well-being (PAWB) item bank with flexible options for administration. DESIGN Qualitative feedback from patient and provider focus groups was used to expand on the Neurological Disorders and Quality of Life (Neuro-QOL) positive affect & well-being item bank for use in SCI. New items were created and revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis, graded response IRT modeling and evaluation of differential item functioning (DIF). SETTING We tested a 32-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI answered the PAWB questions. RESULTS A unidimensional model was observed (Confirmatory Fit Index=0.947; Root Mean Square Error of Approximation=0.094) and measurement precision was good (reliability in theta of -2.9 to 1.2 is roughly equivalent to classical reliability of 0.95 or above). Twelve items were flagged for DIF, however, after examination of effect sizes, the DIF was determined to be negligible and would have little practical impact on score estimates. The final calibrated item bank resulted in 28 retained items CONCLUSIONS This study indicates that the Spinal Cord Injury--Quality of Life PAWB bank represents a psychometrically robust measurement tool. Short form items are also suggested and a computer adaptive test is available.
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Affiliation(s)
- Hilary Bertisch
- Rusk Rehabilitation, New York University Langone Medical Center, New York, NY, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Kisala PA, Tulsky DS, Pace N, Victorson D, Choi SW, Heinemann AW. Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short form. J Spinal Cord Med 2015; 38:386-96. [PMID: 26010973 PMCID: PMC4445029 DOI: 10.1179/1079026815z.000000000410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated item bank and computer adaptive test (CAT) to assess the effects of stigma on health-related quality of life in individuals with spinal cord injury (SCI). DESIGN Grounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis, and item response theory (IRT)-based psychometric analyses. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES SCI-QOL Stigma Item Bank RESULTS A sample of 611 individuals with traumatic SCI completed 30 items assessing SCI-related stigma. After 7 items were iteratively removed, factor analyses confirmed a unidimensional pool of items. Graded Response Model IRT analyses were used to estimate slopes and thresholds for the final 23 items. CONCLUSIONS The SCI-QOL Stigma item bank is unique not only in the assessment of SCI-related stigma but also in the inclusion of individuals with SCI in all phases of its development. Use of confirmatory factor analytic and IRT methods provide flexibility and precision of measurement. The item bank may be administered as a CAT or as a 10-item fixed-length short form and can be used for research and clinical applications.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Natalie Pace
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Heinemann AW, Kisala PA, Hahn EA, Tulsky DS. Development and psychometric characteristics of the SCI-QOL Ability to Participate and Satisfaction with Social Roles and Activities item banks and short forms. J Spinal Cord Med 2015; 38:397-408. [PMID: 26010974 PMCID: PMC4445030 DOI: 10.1179/2045772315y.0000000028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To develop a spinal cord injury (SCI)-focused version of PROMIS and Neuro-QOL social domain item banks; evaluate the psychometric properties of items developed for adults with SCI; and report information to facilitate clinical and research use. DESIGN We used a mixed-methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups helped define the constructs; cognitive interviews helped revise items; and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. SETTING Five SCI Model System sites and one Veterans Administration medical center. PARTICIPANTS The calibration sample consisted of 641 individuals; a reliability sample consisted of 245 individuals residing in the community. RESULTS A subset of 27 Ability to Participate and 35 Satisfaction items demonstrated good measurement properties and negligible differential item functioning related to demographic and injury characteristics. The SCI-specific measures correlate strongly with the PROMIS and Neuro-QOL versions. Ten item short forms correlate >0.96 with the full banks. Variable-length CATs with a minimum of 4 items, variable-length CATs with a minimum of 8 items, fixed-length CATs of 10 items, and the 10-item short forms demonstrate construct coverage and measurement error that is comparable to the full item bank. CONCLUSION The Ability to Participate and Satisfaction with Social Roles and Activities CATs and short forms demonstrate excellent psychometric properties and are suitable for clinical and research applications.
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Affiliation(s)
- Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, 345 E. Superior St. Chicago, IL 60611, USA
| | - Pamela A. Kisala
- Center on Assessment Research and Translation, College of Health Sciences and the Department of Physical Therapy, University of Delaware, STAR Health Sciences Complex, 540 South College Avenue, Newark, DE 19713 USA
| | - Elizabeth A. Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Kalpakjian CZ, Tate DG, Kisala PA, Tulsky DS. Measuring self-esteem after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Self-esteem item bank and short form. J Spinal Cord Med 2015; 38:377-85. [PMID: 26010972 PMCID: PMC4445028 DOI: 10.1179/2045772315y.0000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Self-esteem item bank. DESIGN Using a mixed-methods design, we developed and tested a self-esteem item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory-(IRT) based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. SETTING We tested a pool of 30 items at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI completed the self-esteem items. RESULTS A unidimensional model was observed (CFI=0.946; RMSEA=0.087) and measurement precision was good (theta range between -2.7 and 0.7). Eleven items were flagged for DIF; however, effect sizes were negligible with little practical impact on score estimates. The final calibrated item bank resulted in 23 retained items. CONCLUSION This study indicates that the SCI-QOL Self-esteem item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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Victorson D, Tulsky DS, Kisala PA, Kalpakjian CZ, Weiland B, Choi SW. Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form. J Spinal Cord Med 2015; 38:366-76. [PMID: 26010971 PMCID: PMC4445027 DOI: 10.1179/2045772315y.0000000016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Resilience item bank and short form. DESIGN Using a mixed-methods design, we developed and tested a resilience item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory based analytic approaches, including tests of model fit and differential item functioning (DIF). SETTING We tested a 32-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs medical center. PARTICIPANTS A total of 717 individuals with SCI completed the Resilience items. RESULTS A unidimensional model was observed (CFI=0.968; RMSEA=0.074) and measurement precision was good (theta range between -3.1 and 0.9). Ten items were flagged for DIF, however, after examination of effect sizes we found this to be negligible with little practical impact on score estimates. The final calibrated item bank resulted in 21 retained items. CONCLUSION This study indicates that the SCI-QOL Resilience item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Brian Weiland
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, Kirshblum SC, Fyffe D, Gershon R, Spungen AM, Bombardier CH, Dyson-Hudson TA, Amtmann D, Z. Kalpakjian C, W. Choi S, Jette AM, Forchheimer M, Cella D. Overview of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. J Spinal Cord Med 2015; 38:257-69. [PMID: 26010962 PMCID: PMC4445018 DOI: 10.1179/2045772315y.0000000023] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
CONTEXT/OBJECTIVE The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system was developed to address the shortage of relevant and psychometrically sound patient reported outcome (PRO) measures available for clinical care and research in spinal cord injury (SCI) rehabilitation. Using a computer adaptive testing (CAT) approach, the SCI-QOL builds on the Patient Reported Outcomes Measurement Information System (PROMIS) and the Quality of Life in Neurological Disorders (Neuro-QOL) initiative. This initial manuscript introduces the background and development of the SCI-QOL measurement system. Greater detail is presented in the additional manuscripts of this special issue. DESIGN Classical and contemporary test development methodologies were employed. Qualitative input was obtained from individuals with SCI and clinicians through interviews, focus groups, and cognitive debriefing. Item pools were field tested in a multi-site sample (n=877) and calibrated using item response theory methods. Initial reliability and validity testing was performed in a new sample of individuals with traumatic SCI (n=245). SETTING Five Model SCI System centers and one Department of Veterans Affairs Medical Center across the United States. PARTICIPANTS Adults with traumatic SCI. INTERVENTIONS n/a OUTCOME MEASURES n/a RESULTS The SCI-QOL consists of 19 item banks, including the SCI-Functional Index banks, and 3 fixed-length scales measuring physical, emotional, and social aspects of health-related QOL (HRQOL). CONCLUSION The SCI-QOL measurement system consists of psychometrically sound measures for individuals with SCI. The manuscripts in this special issue provide evidence of the reliability and initial validity of this measurement system. The SCI-QOL also links to other measures designed for a general medical population.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise G. Tate
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | | | - Richard Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | | | - Alan M. Jette
- Boston University School of Public Health, Boston, MA, USA
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tulsky DS, Kisala PA, Victorson D, Choi SW, Gershon R, Heinemann AW, Cella D. Methodology for the development and calibration of the SCI-QOL item banks. J Spinal Cord Med 2015; 38:270-87. [PMID: 26010963 PMCID: PMC4445019 DOI: 10.1179/2045772315y.0000000034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a comprehensive, psychometrically sound, and conceptually grounded patient reported outcomes (PRO) measurement system for individuals with spinal cord injury (SCI). METHODS Individual interviews (n=44) and focus groups (n=65 individuals with SCI and n=42 SCI clinicians) were used to select key domains for inclusion and to develop PRO items. Verbatim items from other cutting-edge measurement systems (i.e. PROMIS, Neuro-QOL) were included to facilitate linkage and cross-population comparison. Items were field tested in a large sample of individuals with traumatic SCI (n=877). Dimensionality was assessed with confirmatory factor analysis. Local item dependence and differential item functioning were assessed, and items were calibrated using the item response theory (IRT) graded response model. Finally, computer adaptive tests (CATs) and short forms were administered in a new sample (n=245) to assess test-retest reliability and stability. PARTICIPANTS AND PROCEDURES A calibration sample of 877 individuals with traumatic SCI across five SCI Model Systems sites and one Department of Veterans Affairs medical center completed SCI-QOL items in interview format. RESULTS We developed 14 unidimensional calibrated item banks and 3 calibrated scales across physical, emotional, and social health domains. When combined with the five Spinal Cord Injury--Functional Index physical function banks, the final SCI-QOL system consists of 22 IRT-calibrated item banks/scales. Item banks may be administered as CATs or short forms. Scales may be administered in a fixed-length format only. CONCLUSIONS The SCI-QOL measurement system provides SCI researchers and clinicians with a comprehensive, relevant and psychometrically robust system for measurement of physical-medical, physical-functional, emotional, and social outcomes. All SCI-QOL instruments are freely available on Assessment CenterSM.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Richard Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kisala PA, Tulsky DS, Kalpakjian CZ, Heinemann AW, Pohlig RT, Carle A, Choi SW. Measuring anxiety after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Anxiety item bank and linkage with GAD-7. J Spinal Cord Med 2015; 38:315-25. [PMID: 26010966 PMCID: PMC4445022 DOI: 10.1179/2045772315y.0000000029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated item bank and computer adaptive test to assess anxiety symptoms in individuals with spinal cord injury (SCI), transform scores to the Patient Reported Outcomes Measurement Information System (PROMIS) metric, and create a statistical linkage with the Generalized Anxiety Disorder (GAD)-7, a widely used anxiety measure. DESIGN Grounded-theory based qualitative item development methods; large-scale item calibration field testing; confirmatory factor analysis; graded response model item response theory analyses; statistical linking techniques to transform scores to a PROMIS metric; and linkage with the GAD-7. Setting Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. Participants Adults with traumatic SCI. MAIN OUTCOME MEASURES Spinal Cord Injury-Quality of Life (SCI-QOL) Anxiety Item Bank RESULTS Seven hundred sixteen individuals with traumatic SCI completed 38 items assessing anxiety, 17 of which were PROMIS items. After 13 items (including 2 PROMIS items) were removed, factor analyses confirmed unidimensionality. Item response theory analyses were used to estimate slopes and thresholds for the final 25 items (15 from PROMIS). The observed Pearson correlation between the SCI-QOL Anxiety and GAD-7 scores was 0.67. CONCLUSIONS The SCI-QOL Anxiety item bank demonstrates excellent psychometric properties and is available as a computer adaptive test or short form for research and clinical applications. SCI-QOL Anxiety scores have been transformed to the PROMIS metric and we provide a method to link SCI-QOL Anxiety scores with those of the GAD-7.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Allen W. Heinemann
- Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - Adam Carle
- Cincinnati Children's Hospital, Cincinnati, OH, USA
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Tulsky DS, Kisala PA, Kalpakjian CZ, Bombardier CH, Pohlig RT, Heinemann AW, Carle A, Choi SW. Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Depression item bank and linkage with PHQ-9. J Spinal Cord Med 2015; 38:335-46. [PMID: 26010968 PMCID: PMC4445024 DOI: 10.1179/2045772315y.0000000020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated spinal cord injury-quality of life (SCI-QOL) item bank, computer adaptive test (CAT), and short form to assess depressive symptoms experienced by individuals with SCI, transform scores to the Patient Reported Outcomes Measurement Information System (PROMIS) metric, and create a crosswalk to the Patient Health Questionnaire (PHQ)-9. DESIGN We used grounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis, item response theory (IRT) analyses, and statistical linking techniques to transform scores to a PROMIS metric and to provide a crosswalk with the PHQ-9. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES Spinal Cord Injury--Quality of Life (SCI-QOL) Depression Item Bank RESULTS Individuals with SCI were involved in all phases of SCI-QOL development. A sample of 716 individuals with traumatic SCI completed 35 items assessing depression, 18 of which were PROMIS items. After removing 7 non-PROMIS items, factor analyses confirmed a unidimensional pool of items. We used a graded response IRT model to estimate slopes and thresholds for the 28 retained items. The SCI-QOL Depression measure correlated 0.76 with the PHQ-9. CONCLUSIONS The SCI-QOL Depression item bank provides a reliable and sensitive measure of depressive symptoms with scores reported in terms of general population norms. We provide a crosswalk to the PHQ-9 to facilitate comparisons between measures. The item bank may be administered as a CAT or as a short form and is suitable for research and clinical applications.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE, USA
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University and Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Adam Carle
- Cincinnati Children's Hospital, Cincinnati, OH, USA
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