1
|
Huber J, Slone S, Bae J. Computer vision for kinematic metrics of the drinking task in a pilot study of neurotypical participants. Sci Rep 2024; 14:20668. [PMID: 39237646 DOI: 10.1038/s41598-024-71470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024] Open
Abstract
Assessment of the upper limb is critical to guiding the rehabilitation cycle. Drawbacks of observation-based assessment include subjectivity and coarse resolution of ordinal scales. Kinematic assessment gives rise to objective quantitative metrics, but uptake is encumbered by costly and impractical setups. Our objective was to investigate feasibility and accuracy of computer vision (CV) for acquiring kinematic metrics of the drinking task, which are recommended in stroke rehabilitation research. We implemented CV for upper limb kinematic assessment using modest cameras and an open-source machine learning solution. To explore feasibility, 10 neurotypical participants were recruited for repeated kinematic measures during the drinking task. To investigate accuracy, a simultaneous marker-based motion capture system was used, and error was quantified for the following kinematic metrics: Number of Movement Units (NMU), Trunk Displacement (TD), and Movement Time (MT). Across all participant trials, kinematic metrics of the drinking task were successfully acquired using CV. Compared to marker-based motion capture, no significant difference was observed for group mean values of kinematic metrics. Mean error for NMU, TD, and MT were - 0.12 units, 3.4 mm, and 0.15 s, respectively. Bland-Altman analysis revealed no bias. Kinematic metrics of the drinking task can be measured using CV, and preliminary findings support accuracy. Further study in neurodivergent populations is needed to determine validity of CV for kinematic assessment of the post-stroke upper limb.
Collapse
Affiliation(s)
- Justin Huber
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, 40506, USA.
| | - Stacey Slone
- Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, KY, 40506, USA
| | - Jihye Bae
- Department of Electrical and Computer Engineering, University of Kentucky, Lexington, KY, 40506, USA
| |
Collapse
|
2
|
He D, Sikora WA, James SA, Williamson JN, Lepak LV, Cheema CF, Sidorov E, Li S, Yang Y. Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation. Am J Phys Med Rehabil 2024; 103:395-400. [PMID: 38261754 PMCID: PMC11031333 DOI: 10.1097/phm.0000000000002393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE This quasi-experimental study examined the effect of repetitive finger stimulation on brain activation in eight stroke and seven control subjects, measured by quantitative electroencephalogram. METHODS We applied 5 mins of 2-Hz repetitive bilateral index finger transcutaneous electrical nerve stimulation and compared differences pre- and post-transcutaneous electrical nerve stimulation using quantitative electroencephalogram metrics delta/alpha ratio and delta-theta/alpha-beta ratio. RESULTS Between-group differences before and after stimulation were significantly different in the delta/alpha ratio ( z = -2.88, P = 0.0040) and the delta-theta/alpha-beta ratio variables ( z = -3.90 with P < 0.0001). Significant decrease in the delta/alpha ratio and delta-theta/alpha-beta ratio variables after the transcutaneous electrical nerve stimulation was detected only in the stroke group (delta/alpha ratio diff = 3.87, P = 0.0211) (delta-theta/alpha-beta ratio diff = 1.19, P = 0.0074). CONCLUSIONS The decrease in quantitative electroencephalogram metrics in the stroke group may indicate improved brain activity after transcutaneous electrical nerve stimulation. This finding may pave the way for a future novel therapy based on transcutaneous electrical nerve stimulation and quantitative electroencephalogram measures to improve brain recovery after stroke.
Collapse
Affiliation(s)
- Dorothy He
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma
| | - William A. Sikora
- University of Oklahoma, Stephenson School of Biomedical Engineering, Norman, Oklahoma
| | - Shirley A. James
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma
| | - Jordan N. Williamson
- University of Illinois Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, USA
| | - Louis V. Lepak
- University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, Tulsa, Oklahoma
| | - Carolyn F. Cheema
- University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, Tulsa, Oklahoma
| | - Evgeny Sidorov
- University of Oklahoma Health Sciences Center, Department of Neurology, Oklahoma City, Oklahoma
| | - Sheng Li
- UT Health Huston McGovern Medical School, Department of Physical Medicine and Rehabilitation, Houston, Texas
| | - Yuan Yang
- University of Illinois Urbana-Champaign, Department of Bioengineering, Urbana, Illinois, USA
- University of Oklahoma Health Sciences Center, Department of Rehabilitation Sciences, Tulsa, Oklahoma
- Carle Foundation Hospital, Clinical Imaging Research Center, Stephenson Family Clinical Research Institute, Urbana, Illinois, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL 61820, USA
- Northwestern University, Department of Physical Therapy and Human Movement Sciences, Chicago, Illinois, USA
| |
Collapse
|
3
|
Bland MD, Moore JL, Anderl E, Eikenberry M, McCarthy A, Olivier GN, Rice T, Siles A, Zeleznik H, Romney W. Knowledge Translation Task Force for core measures clinical practice guideline: a short report on the process and utilization. Implement Sci Commun 2024; 5:43. [PMID: 38641675 PMCID: PMC11027410 DOI: 10.1186/s43058-024-00580-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/05/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND As part of the 2018 Clinical Practice Guideline (CPG): A Core Set of Outcome Measures for Adults with Neurologic Conditions Undergoing Rehabilitation, a Knowledge Translation (KT) Task Force was convened. The purpose of this short report was to (1) demonstrate the potential impact of a CPG KT Task Force through a practical example of efforts to implement a CPG into neurologic physical therapy practice and (2) describe the process to convene a KT Task Force and develop products (KT Toolkit) to facilitate implementation of the CPG. METHODS To describe the process used by the KT Task Force to develop and review a KT Toolkit for implementation of the CPG. RESULTS Utilizing the Knowledge-To-Action Cycle framework, eight tools were developed as part of the KT Toolkit and are available with open access to the public. Findings indicate that the Core Outcome Measures Homepage, which houses the KT Toolkit, has had greater than 70,000 views since its publication. CONCLUSIONS This short report serves as an example of the efforts made to implement a CPG into physical therapy practice. The processes to facilitate KT and the tools developed can inform future implementation efforts and underscore the importance of having a KT Task Force to implement a CPG. Moving forward, KT Task Forces should be convened to implement new or revised guidelines. TRIAL REGISTRATION N/A.
Collapse
Affiliation(s)
- Marghuretta D Bland
- Physical Therapy, Neurology, & Occupational Therapy, Program in Physical Therapy, Washington University, St. Louis, MO, USA.
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | | | - Megan Eikenberry
- College of Health Sciences, Physical Therapy Program, Midwestern University, Glendale, AZ, USA
| | - Arlene McCarthy
- PT, MS, DPT, Board Certified in Neurologic Physical Therapy, Former Program Director of Neurologic Physical Therapy Residency, Rehabilitation Services, Kaiser Permanente, San Francisco, CA, USA
| | - Geneviève N Olivier
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Tracy Rice
- Department of Human Performance, Division of Physical Therapy, West Virginia University, Morgantown, WV, USA
| | - Amelia Siles
- School of Health and Rehabilitation Services, Physical Therapy Division, The Ohio State University, Columbus, OH, USA
| | - Hallie Zeleznik
- Strategic Initiatives and Professional Development, UPMC Centers for Rehab Services Pittsburgh, Pittsburgh, PA, USA
| | - Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| |
Collapse
|
4
|
Validation of Amazon Halo Movement: a smartphone camera-based assessment of movement health. NPJ Digit Med 2022; 5:134. [PMID: 36065060 PMCID: PMC9445016 DOI: 10.1038/s41746-022-00684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
Abstract
Movement health is understanding our body's ability to perform movements during activities of daily living such as lifting, reaching, and bending. The benefits of improved movement health have long been recognized and are wide-ranging from improving athletic performance to helping ease of performing simple tasks, but only recently has this concept been put into practice by clinicians and quantitatively studied by researchers. With digital health and movement monitoring becoming more ubiquitous in society, smartphone applications represent a promising avenue for quantifying, monitoring, and improving the movement health of an individual. In this paper, we validate Halo Movement, a movement health assessment which utilizes the front-facing camera of a smartphone and applies computer vision and machine learning algorithms to quantify movement health and its sub-criteria of mobility, stability, and posture through a sequence of five exercises/activities. On a diverse cohort of 150 participants of various ages, body types, and ability levels, we find moderate to strong statistically significant correlations between the Halo Movement assessment overall score, metrics from sensor-based 3D motion capture, and scores from a sequence of 13 standardized functional movement tests. Further, the smartphone assessment is able to differentiate regular healthy individuals from professional movement athletes (e.g., dancers, cheerleaders) and from movement impaired participants, with higher resolution than that of existing functional movement screening tools and thus may be more appropriate than the existing tests for quantifying functional movement in able-bodied individuals. These results support using Halo Movement's overall score as a valid assessment of movement health.
Collapse
|
5
|
Tosatto D, Bonacina D, Signori A, Pellicciari L, Cecchi F, Cornaggia CM, Piscitelli D. Spin of information and inconsistency between abstract and full text in RCTs investigating upper limb rehabilitation after stroke: An overview study. Restor Neurol Neurosci 2022; 40:195-207. [PMID: 35723125 DOI: 10.3233/rnn-211247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Researchers may be tempted to favorably distort the interpretation of their findings when reporting the abstract (i.e., spin). Spin bias overemphasizes the beneficial effects of the intervention compared with the results shown in the full text. OBJECTIVE To assess the occurrence of spin bias and incompleteness in reporting abstracts in post-stroke upper limb (UL) rehabilitation randomized clinical trials (RCTs). METHODS A sample of 120 post-stroke UL rehabilitation RCTs (indexed in PEDro database), published in English between 2012 and 2020, was included. The completeness of reporting and spin were assessed using the Consolidated Standards of Reporting Trials for Abstracts (CONSORT-A) and the spin checklist. The relationship between CONSORT-A and spin checklist scores with RCT and journal characteristics was assessed. RESULTS CONSORT-A and spin checklist scored 5.3±2.4 (max 15-points, higher scores indicating better reporting) and 5.5±2.0 (max 7-points, higher scores indicating presence of spin), respectively; Significant differences were detected between abstract and full-text scores in the CONSORT-A checklist (p < 0.01) and the spin checklist (p < 0.01). Items of the CONSORT-A checklist in the abstracts and full text showed a fair agreement (k = 0.31), while a moderate agreement (k = 0.59) for the spin checklist was detected. Completeness of abstract was associated (R2 = 0.46) with journal Impact Factor (p < 0.01), CONSORT Guideline endorsement (p = 0.04), and abstract word number (p = 0.02). A lower spin was associated with a higher journal Impact Factor (p = 0.01) and CONSORT Guideline endorsement (p = 0.01). CONCLUSIONS Post-stroke UL rehabilitation RCTs abstracts were largely incomplete showing spin. Authors, reviewers, publishers, and stakeholders should be aware of this phenomenon. Publishers should consider allowing more words in abstracts to improve the completeness of reporting abstracts. Although we have investigated only stroke rehabilitation, our results suggest that health care professionals of all disciplines should avoid clinical decision-making based solely upon abstracts.
Collapse
Affiliation(s)
- Diego Tosatto
- Istituti Clinici Zucchi - Gruppo San Donato, Carate Brianza (MB), Italy
| | - Daniele Bonacina
- Istituti Clinici Zucchi - Gruppo San Donato, Carate Brianza (MB), Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
6
|
Resnik L, Clark MA, Freburger J, McDonough C, Poploski K, Ressel K, Whitten M, Stevans J. Development of a rehabilitation researcher survey of knowledge and interest in learning health systems research. Learn Health Syst 2022; 6:e10298. [PMID: 35434352 PMCID: PMC9006538 DOI: 10.1002/lrh2.10298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction LeaRRn, an NIH-funded rehabilitation resource center, is dedicated to developing learning health systems (LHS) research competencies within the rehabilitation community. To appropriately target resources and training opportunities for rehabilitation researchers, we developed and pilot tested a survey based on AHRQ LHS research core competencies to assess the training needs of rehabilitation researchers interested in LHS research. Methods Survey items were developed by the investigative team and iteratively refined with the assistance of an expert panel using two rounds of content validation. Survey items addressed knowledge of, ability to apply, and interest in LHS research competencies. The survey was pre-pilot tested with six rehabilitation professionals, refined again, and then pilot tested. Time to complete the survey was measured. Spearman correlations examined relationships between knowledge and ability. Results A 78-item survey was pilot tested. Forty-five individuals completed the pilot survey in full (71% female, 84% white, and 93% non-Hispanic). Due to concerns about response burden (mean 15 minutes to complete) and strong correlation between "knowledge" and "ability" ratings (all rho >0.57), "ability" was dropped, resulting in a 55-item survey assessing "knowledge" and "interest" in LHS research competencies. Conclusions We developed a survey of knowledge and interest in LHS research competencies for rehabilitation researchers. The resulting survey may be used to assess training needs and guide LHS research content development by educators, programs directors, and other initiatives within the rehabilitation research community.
Collapse
Affiliation(s)
- Linda Resnik
- Health Services, Policy and Practice, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
- Department of ResearchProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Melissa A. Clark
- Health Services, Policy and Practice, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Janet Freburger
- Department of Physical TherapySchool of Rehabilitation Sciences, University of PittsburghPittsburghPennsylvaniaUSA
| | - Christine McDonough
- Department of Physical TherapySchool of Rehabilitation Sciences, University of PittsburghPittsburghPennsylvaniaUSA
| | - Kathleen Poploski
- Department of Physical TherapySchool of Rehabilitation Sciences, University of PittsburghPittsburghPennsylvaniaUSA
| | - Kristin Ressel
- Department of Physical TherapySchool of Rehabilitation Sciences, University of PittsburghPittsburghPennsylvaniaUSA
| | - Margarite Whitten
- Health Services, Policy and Practice, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Joel Stevans
- Department of Physical TherapySchool of Rehabilitation Sciences, University of PittsburghPittsburghPennsylvaniaUSA
| |
Collapse
|
7
|
Henderson CE, Toth L, Kaplan A, Hornby TG. Step Monitor Accuracy During PostStroke Physical Therapy and Simulated Activities. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022; 7:e000186. [PMID: 35425853 PMCID: PMC9004549 DOI: 10.1249/tjx.0000000000000186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction/Purpose The amount of stepping activity during rehabilitation post-stroke can predict walking outcomes, although the most accurate methods to evaluate stepping activity are uncertain with conflicting findings on available stepping monitors during walking assessments. Rehabilitation sessions also include non-stepping activities and the ability of activity monitors to differentiate these activities from stepping is unclear. The objective of this study was to examine the accuracy of different activity monitors worn by individuals post-stroke with variable walking speeds during clinical physical therapy (PT) and research interventions focused on walking. Methods In Part I, 28 participants post-stroke wore a StepWatch, ActiGraph with and without a Low Frequency Extension (LFE) filter, and Fitbit on paretic and non-paretic distal shanks at or above the ankle during clinical PT or research interventions with steps simultaneously hand counted. Mean absolute percent errors were compared between limbs and tasks performed. In Part II, 12 healthy adults completed 8 walking and 9 non-walking tasks observed during clinical PT or research. Data were descriptively analyzed and used to assist interpretation of Part I results. Results Part I results indicate most devices did not demonstrate an optimal limb configuration during research sessions focused on walking, with larger errors during clinical PT on the non-paretic limb. Using the limb that minimized errors for each device, the StepWatch had smaller errors than the ActiGraph and Fitbit (p<0.01), particularly in those who walked < 0.8 m/s. Conversely, errors from the ActiGraph-LFE demonstrated inconsistent differences in step counts between Fitbit and ActiGraph. Part II results indicate that errors observed during different stepping and non-stepping activities were often device-specific, with non-stepping tasks frequently detected as stepping. Conclusions The StepWatch and ActiGraph-LFE had smaller errors than the Fitbit or ActiGraph, with greater errors in those walking at slower speeds. Inclusion of non-stepping activities affected step counts and should be considered when measuring stepping activity in individuals post-stroke to predict locomotor outcomes following rehabilitation.
Collapse
Affiliation(s)
- Christopher E. Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN,Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Lindsay Toth
- Department of Clinical and Applied Movement Science, University of North Florida, Jacksonville, FL
| | - Andrew Kaplan
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - T. George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN,Rehabilitation Hospital of Indiana, Indianapolis, IN,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Tulsky DS, Kisala PA. Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances. Arch Phys Med Rehabil 2021; 103:185-190. [PMID: 34756875 DOI: 10.1016/j.apmr.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
The Spinal Cord Injury - Functional Index is a system of patient reported outcomes (PRO) measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). The SCI-FI was designed to overcome limitations in measurement of the full range of activities and breadth of content of physical functioning commonly used in SCI research. Generic measurement tools of physical function (i.e., those focused on the general population) tend to overemphasize mobility and do not contain enough items at the lower end of the functional range (e.g., appropriate for individuals with tetraplegia). The SCI-FI consists of nine item response theory (IRT)-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including basic mobility, self-care, and fine motor function. Since the original publication of the SCI-FI in 2012, there have been significant advances in and publications on the reliability and psychometric properties of the measures. The manuscripts presented in this special section clarify the SCI-FI structure and present new research on the SCI-FI measurement system.
Collapse
Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE
| |
Collapse
|
10
|
Deom CE, Carpenter J, Bodine AJ, Taylor SM, Heinemann AW, Lieber RL, Sliwa JA. A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods. J Neurol Phys Ther 2021; 45:101-111. [PMID: 33675602 DOI: 10.1097/npt.0000000000000354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation. METHODS For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills. RESULTS Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI. DISCUSSION AND CONCLUSIONS The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).
Collapse
Affiliation(s)
- Caitlin E Deom
- Shirley Ryan AbilityLab, Chicago, Illinois (C.E.D., J.C., A.J.B., S.M.T., A.W.H., R.L.L., J.A.S.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (S.M.T.); Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois (A.W.H., R.L.L., J.A.S.); and Department of Biomedical Engineering, Northwestern University, Evanston, Illinois (R.L.L.)
| | | | | | | | | | | | | |
Collapse
|
11
|
Romney W, Wormley M, Veneri D, Oberlander A, Grevelding P, Rice J, Moore J. Knowledge translation intervention increased the use of outcome measures by physical therapists in inpatient rehabilitation. Physiother Theory Pract 2021; 38:2019-2028. [PMID: 33706647 DOI: 10.1080/09593985.2021.1898065] [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] [Indexed: 10/21/2022]
Abstract
Background and Purpose: Outcome measures (OMs) have been emphasized by healthcare professions to optimize patient examination; however, a lack of regular use of OMs exists. The purpose of this study was to describe the outcome of a knowledge translation (KT) intervention to increase the use of OMs by physical therapists in an inpatient rehabilitation setting.Methods: A quasi-experimental pre-post study design was used. A multi-component KT intervention including education, organizational support, documentation, and environmental changes to increase the use of five OMs was implemented. Audit and feedback (A&F) was added to the KT intervention at month 6. Documented use of OMs was determined through manual chart audit (n = 864) and electronically (n = 2599). Regression analyses were used to identify factors associated with OMs use across time and diagnoses.Results: Following the addition of A&F to the KT intervention at month 6, there was a significant increase in the odds of OMs use across all time intervals (months 6-12, 12-18, 18-24)(Odds Ratio (OR) 5.9, 95% Confidence Interval (CI) 4.1-8.5; OR 8.5, 95% CI 6.0-12.1; OR 10.8, 95% CI 7.6-15). There was also a significant increase in the odds of documenting OMs on individuals with neurological diagnoses (OR 0.3, 95% CI 0.5-0.8).Conclusions: This KT intervention increased and sustained OMs use over 24-months. This intervention can be replicated to improve the evidence-based practices of physical therapists.
Collapse
Affiliation(s)
- Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.,Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA.,Institute of Knowledge Translation, Carmel, IN, USA
| | - Michelle Wormley
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA
| | - Diana Veneri
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.,Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Andrea Oberlander
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT, USA.,Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Peter Grevelding
- Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Jennifer Rice
- Physical Therapy, Gaylord Specialty Healthcare, Wallingford, CT, USA
| | - Jennifer Moore
- Institute of Knowledge Translation, Carmel, IN, USA.,Southeastern Regional Center for Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| |
Collapse
|
12
|
An evidence-based methodology for systematic evaluation of clinical outcome assessment measures for traumatic brain injury. PLoS One 2020; 15:e0242811. [PMID: 33315925 PMCID: PMC7735614 DOI: 10.1371/journal.pone.0242811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The high failure rate of clinical trials in traumatic brain injury (TBI) may be attributable, in part, to the use of untested or insensitive measurement instruments. Of more than 1,000 clinical outcome assessment measures (COAs) for TBI, few have been systematically vetted to determine their performance within specific "contexts of use (COU)." As described in guidance issued by the U.S. Food and Drug Administration (FDA), the COU specifies the population of interest and the purpose for which the COA will be employed. COAs are commonly used for screening, diagnostic categorization, outcome prediction, and establishing treatment effectiveness. COA selection typically relies on expert consensus; there is no established methodology to match the appropriateness of a particular COA to a specific COU. We developed and pilot-tested the Evidence-Based Clinical Outcome assessment Platform (EB-COP) to systematically and transparently evaluate the suitability of TBI COAs for specific purposes. METHODS AND FINDINGS Following a review of existing literature and published guidelines on psychometric standards for COAs, we developed a 6-step, semi-automated, evidence-based assessment platform to grade COA performance for six specific purposes: diagnosis, symptom detection, prognosis, natural history, subgroup stratification and treatment effectiveness. Mandatory quality indicators (QIs) were identified for each purpose using a modified Delphi consensus-building process. The EB-COP framework was incorporated into a Qualtrics software platform and pilot-tested on the Glasgow Outcome Scale-Extended (GOSE), the most widely-used COA in TBI clinical studies. CONCLUSION The EB-COP provides a systematic methodology for conducting more precise, evidence-based assessment of COAs by evaluating performance within specific COUs. The EB-COP platform was shown to be feasible when applied to a TBI COA frequently used to detect treatment effects and can be modified to address other populations and COUs. Additional testing and validation of the EB-COP are warranted.
Collapse
|
13
|
Wu J, Dodakian L, See J, Burke Quinlan E, Meng L, Abraham J, Wong EC, Le V, McKenzie A, Cramer SC. Gains Across WHO Dimensions of Function After Robot-Based Therapy in Stroke Subjects. Neurorehabil Neural Repair 2020; 34:1150-1158. [PMID: 33084499 DOI: 10.1177/1545968320956648] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear. OBJECTIVE This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships. METHODS Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 month after end of therapy. RESULTS At baseline, subjects (n = 40) were 134.7 ± 32.4 (mean ± SD) days poststroke and had moderate-severe arm motor deficits (arm motor Fugl-Meyer score of 35.6 ± 14.4) that were stable. Subjects averaged 2579 thumb movements and 1298 wrist movements per treatment session. After robot therapy, there was significant improvement in measures of body function/structure (Fugl-Meyer score) and activity limitations (Action Research Arm Test, Barthel Index, and Stroke Impact Scale-Hand), but not participation restriction (Stroke Specific Quality of Life Scale). Furthermore, while the degree of improvement in loss of body function/structure was correlated with improvement in activity limitations, neither improvement in loss of body function/structure nor improvement in activity limitations was correlated with change in participation restriction. CONCLUSIONS After a 3-week course of robotic therapy, there was improvement in body function/structure and activity limitations but no reduction in participation restriction.
Collapse
Affiliation(s)
- Jennifer Wu
- University of California, Irvine, Orange, CA, USA
| | | | - Jill See
- University of California, Irvine, Orange, CA, USA
| | - Erin Burke Quinlan
- University of California, Irvine, Orange, CA, USA.,Institute of Psychiatry, Psychology, & Neuroscience and King's College London, London, England, UK
| | - Lisa Meng
- University of California, Irvine, Orange, CA, USA
| | - Jeby Abraham
- University of California, Irvine, Orange, CA, USA.,Tripler Army Medical Center, Honolulu, HI, USA
| | - Ellen C Wong
- University of California, Los Angeles, and California Rehabilitation Institute, Los Angeles, CA, USA
| | - Vu Le
- University of California, Irvine, Orange, CA, USA
| | | | - Steven C Cramer
- University of California, Irvine, Orange, CA, USA.,University of California, Los Angeles, and California Rehabilitation Institute, Los Angeles, CA, USA
| |
Collapse
|
14
|
Beaudoin M, Best KL, Routhier F, Atack L, Hitzig SL, Kairy D. Usability of the Participation and Quality of Life (PAR-QoL) Outcomes Toolkit Website for Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:64-77. [PMID: 32095067 DOI: 10.1310/sci2601-64] [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] [Indexed: 01/12/2023]
Abstract
Background: Quality of life (QoL) is an important parameter to monitor during rehabilitation; however, accurate assessment is challenging. Among individuals with spinal cord injury (SCI), assessing QoL is further challenged due to complex sequelae, such as secondary health conditions and factors related to community integration. A Participation and Quality of Life (PAR-QoL) toolkit was created to aid clinicians and researchers in the selection of QoL outcomes tools specific to SCI. Objectives: The aim of this study was to evaluate the use and usability of the PAR-QoL toolkit. Methods: A cross-sectional study was conducted using an online survey from December 2013 to November 2016. Google Analytics were collected from April 2012 to April 2018. Survey sections addressed "use" (behavioral practices and actual use) and "usability" (perceived ease of use and perceived usefulness). Any person who visited the PAR-QoL website was invited to complete the survey. Summary statistics and percent concordances were calculated to describe results from the survey and Google Analytics. Results: The PAR-QoL website had 188,577 users. The five most visited webpages were outcome tools, with bounce rates ranging from 77% to 90%. Of the 46 survey respondents, 67% were not current users of the PAR-QoL website, and 87% intended to use the resources in the future. Conclusion: Uptake of the PAR-QoL website is currently limited. Usability of the PAR-QoL website may be improved by modifying navigation, removing the "less useful" components, ensuring regular updates of content and resources, and promoting the website.
Collapse
Affiliation(s)
- Maude Beaudoin
- Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Krista L Best
- Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - François Routhier
- Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Lynda Atack
- Applied Research and Innovation Centre, Centennial College, Toronto, Canada
| | - Sander L Hitzig
- Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada.,University of Toronto, Toronto, Canada.,York University, Toronto, Canada
| | - Dahlia Kairy
- Université de Montréal, Montréal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montréal, Canada
| |
Collapse
|
15
|
A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE. J Neurol Phys Ther 2019; 42:174-220. [PMID: 29901487 PMCID: PMC6023606 DOI: 10.1097/npt.0000000000000229] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings. Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy's Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions. Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient's balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care. Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.
Collapse
|
16
|
Hitch D, Pepin G, Lhuede K, Rowan S, Giles S. Development of the Translating Allied Health Knowledge (TAHK) Framework. Int J Health Policy Manag 2019; 8:412-423. [PMID: 31441278 PMCID: PMC6706979 DOI: 10.15171/ijhpm.2019.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 04/15/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While evidence-based practice is a familiar concept to allied health clinicians, knowledge translation (KT) is less well known and understood. The need for a framework that enables allied health clinicians to access and engage with KT was identified. The aim of this paper is to describe the development of the Translating Allied Health Knowledge (TAHK) Framework. METHODS An iterative and collaborative process involving clinician and academic knowledge partners was utilised to develop the TAHK Framework. Multiple methods were utilised during this process, including a systematic literature review, steering committee consultation, mixed methods survey, benchmarking and measurement property analysis. RESULTS The TAHK Framework has now been finalised, and is described in detail. The framework is structured around four domains - Doing Knowledge Translation, Social Capital for Knowledge Translation, Sustaining Knowledge Translation and Inclusive Knowledge Translation - under which 14 factors known to influence allied health KT are classified. The formulation of the framework to date has laid a rigorous foundation for further developments, including clinician support and outcome measurement. CONCLUSION The method of development adopted for the TAHK Framework has ensured it is both evidence and practice based, and further amendments and modifications are anticipated as new knowledge becomes available. The Framework will enable allied health clinicians to build on their existing capacities for KT, and approach this complex process in a rigorous and systematic manner. The TAHK Framework offers a unique focus on how knowledge is translated by allied health clinicians in multidisciplinary settings.
Collapse
Affiliation(s)
- Danielle Hitch
- Occupational Therapy, Health & Social Development, Deakin University, Geelong, VIC, Australia
| | - Genevieve Pepin
- Occupational Therapy, Health & Social Development, Deakin University, Geelong, VIC, Australia
| | - Kate Lhuede
- Occupational Therapy, North West Mental Health, Melbourne, VIC, Australia
| | - Sue Rowan
- Occupational Therapy, Barwon Health, Geelong, VIC, Australia
| | - Susan Giles
- Occupational Therapy, Western Health, Melbourne, VIC, Australia
| |
Collapse
|
17
|
Miller KK, Lin SH, Neville M. From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke. Arch Phys Med Rehabil 2018; 100:1162-1175. [PMID: 30465739 DOI: 10.1016/j.apmr.2018.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.
Collapse
Affiliation(s)
- Kristine K Miller
- Department of Physical Therapy, Indiana University, Indianapolis, IN.
| | - Susan H Lin
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Marsha Neville
- School of Occupational Therapy, Texas Woman's University, Dallas, TX
| |
Collapse
|
18
|
Guarnieri R, Crocetta TB, Massetti T, Barbosa RTDA, Antão JYFDL, Antunes TPC, Hounsell MDS, Monteiro CBDM, Oliveira ASB, Abreu LCD. Test-Retest Reliability and Clinical Feasibility of a Motion-Controlled Game to Enhance the Literacy and Numeracy Skills of Young Individuals with Intellectual Disability. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 22:111-121. [PMID: 30346804 DOI: 10.1089/cyber.2017.0534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Games using motion capture from web cameras have become increasingly popular. However, there are no games specifically designed to teach literacy to individuals with intellectual disabilities (ID). The aim of this study was to investigate the feasibility of introducing young individuals with ID to a new augmented reality game, the MoviLetrando, and establish its test-retest reliability to determine its usefulness in teaching the alphabet and motor control skills. The performance of a sample of 88 ID participants (52 males, 36 females, mean ± standard deviation age, 11.2 ± 2.6 years) was measured on two different testing sessions. Five dependent variables (total points, number of correct vowels/numbers, number of mistakes, number of omissions, and average time to reach symbols) were used for data analysis. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha, and Bland-Altman plots were used to estimate the test-retest reliability and measurement precision. Feasibility was assessed by examining recruitment, adherence, and acceptability in both phases of the game. The dependent variables identified in the MoviLetrando demonstrated an ICC of 0.44 to 0.82, suggesting acceptable/good test-retest reliability, respectively. The internal consistency was satisfactory. The small SEM, as well as the narrow width of the 95 percent limits of agreement in the Bland-Altman plots, implied that measurements of these dependent variables were precise and accurate on both the occasions. Excellent test-retest reliability for performance measurement was demonstrated in the ID participants, indicating that the MoviLetrando could be used as an outcome measure for this population.
Collapse
Affiliation(s)
- Regiani Guarnieri
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil
| | - Tânia Brusque Crocetta
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil
| | - Thaís Massetti
- 2 Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brasil
| | | | | | | | - Marcelo da Silva Hounsell
- 3 Universidade do Estado de Santa Catarina-UDESC, Departamento de Ciência da Computação, Joinville, Brasil
| | - Carlos Bandeira de Mello Monteiro
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil.,2 Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brasil.,4 Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (EACH-USP), Departamento de Pós-Graduação em Ciências da Reabilitação, São Paulo, Brasil
| | | | - Luiz Carlos de Abreu
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil
| |
Collapse
|
19
|
Romney W, Salbach N, Parrott JS, Deutsch JE. A knowledge translation intervention designed using audit and feedback and the Theoretical Domains Framework for physical therapists working in inpatient rehabilitation: A case report. Physiother Theory Pract 2018; 35:686-702. [DOI: 10.1080/09593985.2018.1457113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Wendy Romney
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - James Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Newark, NJ, USA
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
| |
Collapse
|
20
|
Patel D, Koehmstedt C, Jones R, Coffey NT, Cai X, Garfinkel S, Shaewitz DM, Weinstein AA. A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians. J Multidiscip Healthc 2017; 10:429-435. [PMID: 29255363 PMCID: PMC5722016 DOI: 10.2147/jmdh.s146097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Research examining the utilization of evidence-based practice (EBP) specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice. Methods A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed. Results There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information. Conclusion Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur.
Collapse
Affiliation(s)
- Drasti Patel
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Christine Koehmstedt
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Rebecca Jones
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Nathan T Coffey
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Xinsheng Cai
- American Institutes for Research, Washington, DC, USA
| | | | | | - Ali A Weinstein
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA
| |
Collapse
|
21
|
Moore JL, Carpenter J, Doyle AM, Doyle L, Hansen P, Hahn B, Hornby TG, Roth HR, Spoeri S, Tappan R, Van Der Laan K. Development, Implementation, and Use of a Process to Promote Knowledge Translation in Rehabilitation. Arch Phys Med Rehabil 2017; 99:82-90. [PMID: 28928025 DOI: 10.1016/j.apmr.2017.08.476] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years. DESIGN Successive independent samples study. SETTING Large rehabilitation system. PARTICIPANTS Successive samples of allied health clinicians (N=372) in 2009 (n=136), 2012 (n=115), and 2015 (n=121). INTERVENTIONS The Battery of Rehabilitation Assessments and Interventions includes 2 components: (1) a process to synthesize, adapt, and make recommendations about the application of evidence; and (2) a process to implement the recommended practices in 3 levels of care. MAIN OUTCOME MEASURES To assess the effect of the project, surveys on EBP perspectives, use, and barriers were conducted before Battery of Rehabilitation Assessments and Interventions implementation and 3 and 6 years after implementation. Questions about effect of the project on clinical practice were included 3 and 6 years postimplementation. RESULTS Survey data indicate the Battery of Rehabilitation Assessments and Interventions resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the project, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (P≤.01) in effect of the Battery of Rehabilitation Assessments and Interventions on practice were identified between therapists who were directly involved in the project and Interventions compared with uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists. CONCLUSIONS After 6 years of sustained implementation efforts, the Battery of Rehabilitation Assessments and Interventions expedited the adoption of EBPs throughout a large system of care in rehabilitation.
Collapse
Affiliation(s)
- Jennifer L Moore
- Regional Center of Knowledge Translation in Rehabilitation, Sunnaas Rehabilitation Hospital, Oslo/Nesodden, Norway; Institute for Knowledge Translation, Carmel, IN.
| | | | | | | | | | | | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University, Indianapolis, IN
| | - Heidi R Roth
- Shirley Ryan AbilityLab, Chicago, IL; Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| | | | - Rachel Tappan
- Shirley Ryan AbilityLab, Chicago, IL; Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| | - Krista Van Der Laan
- Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL
| |
Collapse
|
22
|
Shirota C, van Asseldonk E, Matjačić Z, Vallery H, Barralon P, Maggioni S, Buurke JH, Veneman JF. Robot-supported assessment of balance in standing and walking. J Neuroeng Rehabil 2017; 14:80. [PMID: 28806995 PMCID: PMC5556664 DOI: 10.1186/s12984-017-0273-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/08/2017] [Indexed: 11/10/2022] Open
Abstract
Clinically useful and efficient assessment of balance during standing and walking is especially challenging in patients with neurological disorders. However, rehabilitation robots could facilitate assessment procedures and improve their clinical value. We present a short overview of balance assessment in clinical practice and in posturography. Based on this overview, we evaluate the potential use of robotic tools for such assessment. The novelty and assumed main benefits of using robots for assessment are their ability to assess 'severely affected' patients by providing assistance-as-needed, as well as to provide consistent perturbations during standing and walking while measuring the patient's reactions. We provide a classification of robotic devices on three aspects relevant to their potential application for balance assessment: 1) how the device interacts with the body, 2) in what sense the device is mobile, and 3) on what surface the person stands or walks when using the device. As examples, nine types of robotic devices are described, classified and evaluated for their suitability for balance assessment. Two example cases of robotic assessments based on perturbations during walking are presented. We conclude that robotic devices are promising and can become useful and relevant tools for assessment of balance in patients with neurological disorders, both in research and in clinical use. Robotic assessment holds the promise to provide increasingly detailed assessment that allows to individually tailor rehabilitation training, which may eventually improve training effectiveness.
Collapse
Affiliation(s)
- Camila Shirota
- Rehabilitation Engineering Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, Lengghalde 5, 8092, Zürich, Switzerland
| | - Edwin van Asseldonk
- Department of Biomechanical Engineering, MIRA, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Zlatko Matjačić
- University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Heike Vallery
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Pierre Barralon
- Health Division, Tecnalia Research and Innovation, Paseo Mikeletegi 1, 20009, Donostia-San Sebastian, Spain
| | - Serena Maggioni
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zürich, Sonneggstrasse 3, 8092, Zürich, Switzerland.,Hocoma AG, Industriestrasse 4a, 8604, Volketswil, Switzerland
| | - Jaap H Buurke
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522 AH, Enschede, The Netherlands
| | - Jan F Veneman
- Health Division, Tecnalia Research and Innovation, Paseo Mikeletegi 1, 20009, Donostia-San Sebastian, Spain.
| |
Collapse
|
23
|
Jesus TS. Systematic Reviews and Clinical Trials in Rehabilitation: Comprehensive Analyses of Publication Trends. Arch Phys Med Rehabil 2016; 97:1853-1862.e2. [DOI: 10.1016/j.apmr.2016.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
|
24
|
On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists. J Neuroeng Rehabil 2016; 13:80. [PMID: 27608923 PMCID: PMC5017057 DOI: 10.1186/s12984-016-0186-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
Well-developed coordination of the upper extremities is critical for function in everyday life. Interlimb coordination is an intuitive, yet subjective concept that refers to spatio-temporal relationships between kinematic, kinetic and physiological variables of two or more limbs executing a motor task with a common goal. While both the clinical and neuroscience communities agree on the relevance of assessing and quantifying interlimb coordination, rehabilitation engineers struggle to translate the knowledge and needs of clinicians and neuroscientists into technological devices for the impaired. The use of ambiguous definitions in the scientific literature, and lack of common agreement on what should be measured, present large barriers to advancements in this area. Here, we present the different definitions and approaches to assess and quantify interlimb coordination in the clinic, in motor control studies, and by state-of-the-art robotic devices. We then propose a taxonomy of interlimb activities and give recommendations for future neuroscience-based robotic- and sensor-based assessments of upper limb function that are applicable to the everyday clinical practice. We believe this is the first step towards our long-term goal of unifying different fields and help the generation of more consistent and effective tools for neurorehabilitation.
Collapse
|
25
|
Deutsch JE, Romney W, Reynolds J, Manal TJ. Validity and usability of a professional association's web-based knowledge translation portal: American Physical Therapy Association's PTNow.org. BMC Med Inform Decis Mak 2015; 15:79. [PMID: 26450415 PMCID: PMC4599310 DOI: 10.1186/s12911-015-0178-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 07/06/2015] [Indexed: 11/15/2022] Open
Abstract
Background PTNow.org is an evidence-based, on-line portal created by a professional membership association to promote use of evidence in practice and to help decrease unwarranted variation in practice. The site contains synthesis documents designed to promote efficient clinical reasoning. These documents were written and peer-reviewed by teams of content experts and master clinicians. The purpose of this paper is to report on the content and construct validity as well as usability of the site. Methods Physical therapist participants used clinical summaries (available in 3 formats--as a full summary with hyperlinks, “quick takes” with hyperlinks, and a portable two-page version) on the PTNow.org site to answer knowledge acquisition and clinical reasoning questions related to four patient scenarios. They also responded to questions about ease of use related to website navigation and about format and completeness of information using a 1–5 Likert scale. Responses were coded to reflect how participants used the site and then were summarized descriptively. Preferences for clinical summary format were analyzed using an analysis of variance (ANOVA) and a Dunnett T3 post hoc analysis. Results Seventeen participants completed the study. Clinical relevance and completeness ratings by experienced clinicians, which were used as the measure of content validity, ranged from 3.1 to 4.6 on a 5 point scale. Construct validity based on the information on the PTNow.org site was supported for knowledge acquisition questions 66 % of the time and for clinical reasoning questions 40 % of the time. Usability ratings for the full clinical summary were 4.6 (1.2); for the quick takes, 3.5 (.98); and for the portable clinical summary, 4.0 (.45). Participants preferred the full clinical summary over the other two formats (F = 5.908, P = 0.007). One hundred percent of the participants stated that they would recommend the PTNow site to their colleagues. Conclusion Prelimary evidence supported both content validity and construct validity of knowledge acquisition, and partially supported construct validity of clinical reasoning for the clinical summaries on the PTNow.org site. Usability was supported, with users preferring the full clinical summary over the other two formats. Iterative design is ongoing. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0178-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Judith E Deutsch
- Rivers Lab, Department of Movement and Rehabilitation Sciences, Rutgers University-School of Health Related Professions, 65 Bergen St. SSB 723, Newark, NJ, 07101, USA.
| | - Wendy Romney
- Rivers Lab, Department of Movement and Rehabilitation Sciences, Rutgers University-School of Health Related Professions, 65 Bergen St. SSB 723, Newark, NJ, 07101, USA
| | - Jan Reynolds
- American Physical Therapy Association, 1111 North Fairfax St., Alexandria, VA, 22314, USA
| | - Tara Jo Manal
- University of Delaware 160 STAR- Health Sciences Complex, Newark, DE, 19713, USA
| |
Collapse
|
26
|
Descriptive data analysis examining how standardized assessments are used to guide post-acute discharge recommendations for rehabilitation services after stroke. Phys Ther 2015; 95:710-9. [PMID: 25504485 DOI: 10.2522/ptj.20140347] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/26/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Use of standardized assessments in acute rehabilitation is continuing to grow, a key objective being to assist clinicians in determining services needed postdischarge. OBJECTIVE The purpose of this study was to examine how standardized assessment scores from initial acute care physical therapist and occupational therapist evaluations contribute to discharge recommendations for poststroke rehabilitation services. DESIGN A descriptive analysis was conducted. METHODS A total of 2,738 records of patients admitted to an acute care hospital with a diagnosis of stroke or transient ischemic attack were identified. Participants received an initial physical therapist and occupational therapist evaluation with standardized assessments and a discharge recommendation of home with no services, home with services, inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). A K-means clustering algorithm determined if it was feasible to categorize participants into the 4 groups based on their assessment scores. These results were compared with the physical therapist and occupational therapist discharge recommendations to determine if assessment scores guided postacute care recommendations. RESULTS Participants could be separated into 4 clusters (A, B, C, and D) based on assessment scores. Cluster A was the least impaired, followed by clusters B, C, and D. In cluster A, 50% of the participants were recommended for discharge to home without services, whereas 1% were recommended for discharge to an SNF. Clusters B, C, and D each had a large proportion of individuals recommended for discharge to an IRF (74%-80%). There was a difference in percentage of recommendations across the clusters that was largely driven by the differences between cluster A and clusters B, C, and D. LIMITATIONS Additional unknown factors may have influenced the discharge recommendations. CONCLUSIONS Participants poststroke can be classified into meaningful groups based on assessment scores from their initial physical therapist and occupational therapist evaluations. These assessment scores, in part, guide poststroke acute care discharge recommendations.
Collapse
|
27
|
Eng JJ, Noonan VK, Townson AF, Higgins CE, Rogers J, Wolfe DL. Impact of an online medical internet site on knowledge and practice of health care providers: a mixed methods study of the Spinal Cord Injury Rehabilitation Evidence project. J Med Internet Res 2014; 16:e296. [PMID: 25537167 PMCID: PMC4285726 DOI: 10.2196/jmir.3453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 11/23/2014] [Indexed: 12/04/2022] Open
Abstract
Background It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. Objective The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. Methods A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. Results The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers’ clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers’ clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. Conclusions A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers’ practice, and influence their clinical decision making.
Collapse
Affiliation(s)
- Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | |
Collapse
|