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Zhao D, Jin J, Luo Q, Wang Z, An J. Pressure injury risk factors in adult orthopaedic surgical patients: a cross-sectional study and random forest. J Wound Care 2024; 33:143-152. [PMID: 38329830 DOI: 10.12968/jowc.2024.33.2.143] [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: 02/10/2024]
Abstract
OBJECTIVE To identify the most important risk factors for predicting pressure injury (PI) occurrence in adult orthopaedic surgical patients based on investigation data, thereby identifying at-risk patients and facilitating formulation of an effective patient care strategy. METHOD Patients were assessed with an instrument designed by the authors specifically for this study in a cross-sectional investigation following the STROBE checklist. The random forest method was adopted to select the most important risk factors and predict occurrence of PIs. RESULTS A dataset of 27 risk factors from 1701 patients was obtained. A subset of the 15 most important risk factors was identified. The random forest method had a high prediction accuracy of 0.9733 compared with 0.9281 calculated with a logistic model. CONCLUSION Results indicated that the selected 15 risk factors, such as activity ability, friction/shear force, skin type and anaesthesia score, performed very well in predicting the occurrence of PIs in adult orthopaedic surgical patients.
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Affiliation(s)
- Dan Zhao
- Beijing Jishuitan Hospital, Capital Medical University, P. R. China
- School of Nursing, Peking University, Beijing, P. R. China
| | - Jiao Jin
- School of Statistics, Beijing Normal University, Beijing, P. R. China
| | - Qiong Luo
- School of Nursing, Peking University, Beijing, P. R. China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, P. R. China
| | - Jinbing An
- School of Health Humanities, Peking University, Beijing, P. R. China
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de Clercq H, Naudé A, Bornman J. Development and Utility of an International Classification of Functioning, Disability and Health Code Set for Younger-Old Adults With Fall Risk: Implications for Audiologists. Am J Audiol 2022; 31:1116-1132. [DOI: 10.1044/2022_aja-21-00269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose:
Falling is a multifactorial condition that can cause severe injury and even death in older adults. Early identification of fall risk factors, as the first step of preventive health care, can assist in reducing the negative and often debilitating effects of falls in older adults. By using the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to develop an ICF code set to identify fall risk factors in older adults, health care practitioners could obtain health information in a multidimensional way.
Method:
This study describes the final phase of a comprehensive, three-phase, mixed-methods sequential study. For this third phase, a pre–post group design that focused on the audiologist's perceptions of the clinical utility of a newly developed ICF code set was employed. The questionnaire that was used for this purpose consisted of two distinct sections: clinical application and clinical utility (viz., appropriateness, accessibility, practicability, acceptability, and professional utility). Thirty practicing audiologists participated in the study. Data were analyzed for each of the two sections of the questionnaire.
Results:
Results related to clinical application indicated that regardless of the audiologists' experience in routine fall risk assessment or fall risk factor identification, the use of the developed ICF code set increased their ability to correctly identify relevant clinical aspects. Results related to clinical utility showed high scores across all five measure components, with the highest clinical utility component being acceptability, closely followed by appropriateness and professional utility, and the lowest being accessibility.
Conclusion:
Several clinical implications have emerged from this study, including the usefulness of the ICF code set to identify and document fall risk factors in older adults, the code set's ability to guide audiologists to determine individualized assessment needs either by themselves or by other health care disciplines, and that the code set could be used by audiologists regardless of their experience in vestibular assessments.
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Affiliation(s)
- Hendrika de Clercq
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, South Africa
| | - Alida Naudé
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, South Africa
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The Relationship Between Fall Risk and Hospital-Based Therapy Utilization Is Moderated by Demographic Characteristics and Insurance Type. Arch Phys Med Rehabil 2020; 102:1124-1133. [PMID: 33373599 DOI: 10.1016/j.apmr.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate whether indicators of patient need (comorbidity burden, fall risk) predict acute care rehabilitation utilization, and whether this relation varies across patient characteristics (ie, demographic characteristics, insurance type). DESIGN Secondary analysis of electronic health records data. SETTING Five acute care hospitals. PARTICIPANTS Adults (N=110,209) admitted to 5 regional hospitals between 2014 and 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occupational therapy (OT) and physical therapy (PT) utilization. Logistic regression models determined whether indicators of patient need predicted OT and PT utilization. Interactions between indicators of need and both demographic factors (eg, minority status, presence of significant other) and insurance type were included to investigate whether the relation between patient need and therapy access varied across patient characteristics. RESULTS Greater comorbidity burden was associated with a higher likelihood of receiving OT and PT. Relative to those with low fall risk, those with moderate and high fall risk were more likely to receive OT and PT. The relation between fall risk and therapy utilization differed across patient characteristics. Among patients with higher levels of fall risk, those with a significant other were less likely to receive OT and PT; significant other status did not explain therapy utilization among patients with low fall risk. Among those with high fall risk, patients with VA insurance and minority patients were more likely to receive PT than those with private insurance and nonminority patients, respectively. Insurance type and minority status did not appear to explain PT utilization among those with lower fall risk. CONCLUSIONS Patients with greater comorbidity burden and fall risk were more likely to receive acute care rehabilitation. However, the relation between fall risk and utilization was moderated by insurance type, having a significant other, and race/ethnicity. Understanding the implications of these utilization patterns requires further research.
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Gimigliano F. Are interventions for preventing falls in older people in care facilities and hospitals effective? A Cochrane Review summary with commentary. Int J Rheum Dis 2020; 23:833-836. [PMID: 32511885 DOI: 10.1111/1756-185x.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Napoli, Italy
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Huang SW, Lin LF, Chang KH, Escorpizo R, Liou TH. Development of a comprehensive core set from the international classification of functioning, disability and health for return to work among patients with stroke through Delphi-based consensus. Eur J Phys Rehabil Med 2020; 56:257-264. [PMID: 31976638 DOI: 10.23736/s1973-9087.20.05992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Young patients with stroke are typically the economic support of their families and societies, and their return to work (RTW) is crucial to maintaining their quality of life. However, the identification of RTW-related factors of different aspects is complicated and a systematic analysis of these factors is lacking. AIM The aim of this study was to develop a core set from the International Classification of Functioning, Disability and Health (ICF) for return to work (RTW) among patients with stroke. DESIGN Three-round Delphi-based consensus. SETTING University-based hospital. POPULATION Thirty experts in stroke-related domains from different institutions. METHODS A five-point Likert Scale was used to rate the importance of each item. Consensus of ratings was analyzed using Spearman's rho and semi-interquartile range indices. The International Classification of Functioning, Disability and Health core set for return to work among patients with stroke was based on a high level of consensus and a mean score of ≥4.0 in the third round of the Delphi. RESULTS The ICF core set comprised 58 categories distributed as follows: 16 body function, 30 activities and participation, 10 environmental factor, and 2 personal factors. CONCLUSIONS Our ICF core set for RTW among patients with stroke can inform effective rehabilitation strategies and goal setting for RTW among patients with stroke. However, further validation is warranted. CLINICAL REHABILITATION IMPACT ICF core set could provide information on rehabilitation strategies setting for RTW of stroke patients.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Institute of Gerontology and Health Management, Taipei Medical University, Taipei, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan - .,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Baris VK, Seren Intepeler S. Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability and health. J Clin Nurs 2018; 28:615-628. [DOI: 10.1111/jocn.14656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/30/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Veysel Karani Baris
- Nursing Faculty Nursing Management Department Dokuz Eylul University Izmir Turkey
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Krmpotic K, Van den Bruel A, Lobos AT. A Modified Delphi Study to Identify Factors Associated With Clinical Deterioration in Hospitalized Children. Hosp Pediatr 2017; 6:616-625. [PMID: 27686826 DOI: 10.1542/hpeds.2016-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. METHODS We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician health care providers from hospitals in Canada and the United States. RESULTS Consensus was reached that 21 of the 57 factors presented are associated with clinical deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors. CONCLUSIONS We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward.
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Affiliation(s)
- Kristina Krmpotic
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada; Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada;
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Anna-Theresa Lobos
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; and Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Hou WH, Kang CM, Ho MH, Kuo JMC, Chen HL, Chang WY. Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. J Clin Nurs 2016; 26:698-706. [PMID: 27533486 DOI: 10.1111/jocn.13510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the accuracy of the inpatient fall risk screening tool and to identify the most critical fall risk factors in inpatients. BACKGROUND Variations exist in several screening tools applied in acute care hospitals for examining risk factors for falls and identifying high-risk inpatients. DESIGN Secondary data analysis. METHODS A subset of inpatient data for the period from June 2011-June 2014 was extracted from the nursing information system and adverse event reporting system of an 818-bed teaching medical centre in Taipei. Data were analysed using descriptive statistics, receiver operating characteristic curve analysis and logistic regression analysis. RESULTS During the study period, 205 fallers and 37,232 nonfallers were identified. The results revealed that the inpatient fall risk screening tool (cut-off point of ≥3) had a low sensitivity level (60%), satisfactory specificity (87%), a positive predictive value of 2·0% and a negative predictive value of 99%. The receiver operating characteristic curve analysis revealed an area under the curve of 0·805 (sensitivity, 71·8%; specificity, 78%). To increase the sensitivity values, the Youden index suggests at least 1·5 points to be the most suitable cut-off point for the inpatient fall risk screening tool. Multivariate logistic regression analysis revealed a considerably increased fall risk in patients with impaired balance and impaired elimination. The fall risk factor was also significantly associated with days of hospital stay and with admission to surgical wards. CONCLUSIONS The findings can raise awareness about the two most critical risk factors for falls among future clinical nurses and other healthcare professionals and thus facilitate the development of fall prevention interventions. RELEVANCE TO CLINICAL PRACTICE This study highlights the needs for redefining the cut-off points of the inpatient fall risk screening tool to effectively identify inpatients at a high risk of falls. Furthermore, inpatients with impaired balance and impaired elimination should be closely monitored by nurses to prevent falling during hospitalisations.
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Affiliation(s)
- Wen-Hsuan Hou
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chun-Mei Kang
- Nursing Department, Cathay General Hospital, Taipei, Taiwan.,School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mu-Hsing Ho
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | | | | | - Wen-Yin Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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Geerse OP, Wynia K, Kruijer M, Schotsman MJ, Hiltermann TJN, Berendsen AJ. Health-related problems in adult cancer survivors: development and validation of the Cancer Survivor Core Set. Support Care Cancer 2016; 25:567-574. [PMID: 27743119 PMCID: PMC5196012 DOI: 10.1007/s00520-016-3439-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/02/2016] [Indexed: 12/28/2022]
Abstract
Purpose Improved survival rates from cancer have increased the need to understand the health-related problems of cancer treatment. We aimed to develop and validate the “Cancer Survivor Core Set” representing the most relevant health-related problems in adult cancer survivors using the International Classification of Functioning, Disability, and Health (ICF). Methods First, a Delphi study was conducted to select ICF categories representing the most relevant health-related problems. There were three Dutch expert panels, one each for lung, colorectal, and breast cancer. Each panel comprised lay experts and professionals. The experts reached within- and between-panel consensus in two rounds (≥70 % agreement). Second, a validation study was performed. Generic cancer survivorship questionnaires assessing health-related problems or quality of life among cancer survivors were selected. Items of selected questionnaires were linked to the best-fitting ICF category and to the selected ICF categories from the Delphi study, respectively. Results In total, 101 experts were included, of which 76 participated in both rounds, reaching consensus on 18 ICF categories. The Distress Thermometer and Problem List, the Impact of Cancer (v2), and the Quality of Life in Adult Cancer Survivors questionnaires were selected for the validation study, which led to the inclusion of one additional ICF category. Conclusions The developed Cancer Survivor Core Set consisted of 19 ICF categories representing the most relevant health-related problems in adult cancer survivors: five from the “body functions and structures” component, eight from the “activities and participation” component, and six from the “environmental factors” component. Highlights • Many adult cancer survivors have persistent health-related problems. • The Cancer Survivor Core Set was developed using the Delphi method. • The patients’ perspectives were prioritized in this Delphi study • Content validity was confirmed by validated cancer survivorship questionnaires. • The Cancer Survivor Core Set may help optimize care for cancer survivors. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3439-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- O P Geerse
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - K Wynia
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Kruijer
- Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J Schotsman
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T J N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Systematic review with meta-analysis of childhood and adolescent risk and prognostic factors for musculoskeletal pain. Pain 2016; 157:2640-2656. [DOI: 10.1097/j.pain.0000000000000685] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lien WC, Guo NW, Chang JH, Lin YC, Kuan TS. Relationship of perceived environmental barriers and disability in community-dwelling elderly in Taiwan--a population-based study. BMC Geriatr 2014; 14:59. [PMID: 24885956 PMCID: PMC4013536 DOI: 10.1186/1471-2318-14-59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background To identify the relationship between perceived environmental barriers and disability in community-dwelling elderly. Methods Cross-sectional study in two community service centers in Tainan. We enrolled 200 community-dwelling residents, aged above 65 years, who had resided in the same community for at least 12 months. Basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were assessed using the Hierarchy of Care Required (HCR). There were 59 participants in BADL disability and 109 in IADL disability. Perceived environmental barriers were assessed using the Craig Hospital Inventory of Environmental Factors (CHIEF). We used multinomial logistic regression to examine the relationship of perceived environmental barriers and disability. Results The presence of perceived environmental barriers was related to BADL disability (OR = 4.39, 95% CI = 1.01-19.11) and IADL disability (IADL with difficulty in 1–2 tasks: OR = 9.93, 95% CI = 3.22-30.56; IADL with difficulty in more than 2 tasks: OR = 8.40, 95% CI = 1.83-38.51). The presence of physically/structurally perceived environmental barriers was related to BADL disability (OR = 4.90, 95% CI = 1.01-23.86) and IADL disability (IADL with difficulty in 1–2 tasks: OR = 4.61, 95% CI = 1.27-16.76; IADL with difficulty in more than 2 tasks: OR = 17.05, 95% CI = 2.82-103.30). Conclusions Perceived environmental barriers are related to disability in community-dwelling elderly.
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Affiliation(s)
| | | | | | | | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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