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Ho L, Malden S, McGill K, Shimonovich M, Frost H, Aujla N, Ho ISS, Shenkin SD, Hanratty B, Mercer SW, Guthrie B. Complex interventions for improving independent living and quality of life amongst community-dwelling older adults: a systematic review and meta-analysis. Age Ageing 2023; 52:afad132. [PMID: 37505991 PMCID: PMC10378722 DOI: 10.1093/ageing/afad132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning. OBJECTIVE to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults' independent living and quality of life (QoL). METHODS we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00-1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77-0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02-0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01-0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03-0.13). CONCLUSIONS complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs.
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Affiliation(s)
- Leonard Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen Malden
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kris McGill
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Michal Shimonovich
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Helen Frost
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Navneet Aujla
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Iris S-S Ho
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan D Shenkin
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stewart W Mercer
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
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Omar A, Cumal A, Vellani S, Krassikova A, Lapenskie J, Bayly M, Welch VA, Ghogomu E, Iaboni A, McGilton KS. Health and social interventions to restore physical function of older adults post-hip fracture: a scoping review. BMJ Open 2021; 11:e053992. [PMID: 34697124 PMCID: PMC8547508 DOI: 10.1136/bmjopen-2021-053992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Despite inpatient rehabilitation, many older adults post-hip fracture have difficulty returning to their prefracture levels of function and activity. This scoping review aims to identify interventions for community-dwelling older adults discharged from inpatient rehabilitation and examine the function and activity outcomes associated with these interventions. DESIGN This scoping review followed Arksey and O'Malley's five-stage framework. DATA SOURCES We searched MEDLINE, CINAHL, PsycINFO, EMBASE and Ageline electronic databases for English-language articles published between January 1946 and January 2020. ELIGIBILITY CRITERIA We included studies with health and social interventions involving community-dwelling older adults and their caregivers after hip fracture and inpatient rehabilitation. The interventions were selected if initiated within 60 days post-hip fracture surgery. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened abstracts and full texts and extracted the data based on the inclusion criteria. A third reviewer adjudicated any disagreement and collated the extracted data. RESULTS Of the 24 studies included in the review, most studies (79%) used exercise-based interventions, over half (63%) included activities of daily living training and/or home assessment and environment modification as intervention components, and three studies used social intervention components. Over half of the interventions (58%) were initiated in the inpatient setting and physiotherapists provided 83% of the interventions. Only seven studies (29%) involved tailored interventions based on the older adults' unique needs and progress in exercise training. Six studies (25%) enrolled patients with cognitive impairment, and only one study examined caregiver-related outcomes. Exercise-based interventions led to improved function and activity outcomes. 29 different outcome measures were reported. CONCLUSION While exercise-based multicomponent interventions have evidence for improving outcomes in this population, there is a paucity of studies, including social interventions. Further, studies with standardised outcome measures are needed, particularly focusing on supporting caregivers and the recovery of older adults with cognitive impairment.
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Affiliation(s)
- Abeer Omar
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario, Canada
| | - Alexia Cumal
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shirin Vellani
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Nursing, University of Toronto Lawrence S Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Alexandra Krassikova
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julie Lapenskie
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Melanie Bayly
- Centre for Health and Safety in Agriculture, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Vivian A Welch
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Poulin V, Jean A, Lamontagne MÈ, Pellerin MA, Viau-Guay A, Ouellet MC. Identifying clinicians' priorities for the implementation of best practices in cognitive rehabilitation post-acquired brain injury. Disabil Rehabil 2020; 43:2952-2962. [PMID: 32045534 DOI: 10.1080/09638288.2020.1721574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify clinicians' perceptions of current levels of implementation of cognitive rehabilitation best practices, as well as individual and consensual group priorities for implementing cognitive rehabilitation interventions as part of a multi-site integrated knowledge translation initiative. METHOD A two-step consensus-building methodology was used, that is the Technique for Research of Information by Animation of a Group of Experts (TRIAGE), including a cross-sectional electronic survey followed by consensual in-person group discussions to identify implementation priorities from a list of evidence-based practices for cognitive rehabilitation following traumatic brain injury and stroke. Thirty-eight professionals from three rehabilitation teams (n = 9, 13 and 16) participated, including neuropsychologists, occupational therapists, speech-language pathologists, educators, clinical coordinators and program managers. Descriptive statistics were used to document the perceived levels of implementation as well as individual and consensual group priorities. RESULTS Most of the best practices (81-100%) were perceived as at least partially implemented by a minimum of 50% of the participants but only 20-25% of the practices were considered fully implemented. Findings suggest that current practices are mostly consistent with general cognitive rehabilitation principles suggested in guidelines but that further efforts are needed to support the application of specific cognitive rehabilitation strategies and interventions. Executive function and self-awareness retraining, as well as interventions promoting the generalization of skills, were among the highest implementation priorities. Consensual in-person group discussions, included as part of the TRIAGE process, also helped to define and operationalize these best practices into more specific intervention components according to the teams' needs and priorities. CONCLUSIONS TRIAGE consensus-building methodology can be used to engage stakeholders and support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI in order to tailor the implementation process to local needs.IMPLICATIONS FOR REHABILITATIONThe Technique for Research of Information by Animation of a Group of Experts (TRIAGE) can be used to support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI.The combination of individual consultations followed by consensual in-person group discussions, as part of the TRIAGE process, may help clinicians in defining and operationalizing best practices into more specific intervention components to implement.Effective implementation strategies are needed to support the use of specific cognitive rehabilitation interventions in prioritized areas, such as executive function and self-awareness retraining, as well as generalization of skills.Some differences in clinicians' perceived priorities point up the importance of tailoring implementation to local needs and contexts from the early stages in the process.
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Affiliation(s)
- Valérie Poulin
- Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Québec, Canada
| | - Alexandra Jean
- Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Marie-Ève Lamontagne
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Québec, Canada.,Department of Rehabilitation, Université Laval, Québec, Canada
| | - Marc-André Pellerin
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Québec, Canada.,Department of Rehabilitation, Université Laval, Québec, Canada.,Faculty of Education Sciences, Université Laval, Québec, Canada
| | - Anabelle Viau-Guay
- Faculty of Education Sciences, Université Laval, Québec, Canada.,Centre de Recherche et d'intervention sur la Réussite Scolaire, Université Laval, Québec, Canada
| | - Marie-Christine Ouellet
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), Québec, Canada.,School of Psychology, Université Laval, Québec, Canada
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Glenny C, Kuspinar A, Naglie G, Stolee P. A qualitative study of healthcare provider perspectives on measuring functional outcomes in geriatric rehabilitation. Clin Rehabil 2017; 32:546-556. [PMID: 28958168 DOI: 10.1177/0269215517733114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore, from the perspective of healthcare providers, the barriers to and facilitators of using standardized outcome measures of physical function in geriatric rehabilitation settings. METHODS In-depth semi-structured interviews with medical doctors, nurses, physiotherapists and occupational therapists were conducted from three geriatric rehabilitation hospitals in Ontario. Qualitative content analysis through an inductive approach was used to identify barriers to and facilitators of outcome measurement in geriatric rehabilitation settings. RESULTS A total of 20 healthcare providers from different disciplines were interviewed. Barriers are standardized outcome measures that (1) cannot be used in isolation to inform clinical decision-making for older patients, (2) are difficult to complete and interpret in older complex patients, (3) may not be useful for all members of the clinical team and (4) are used for reasons unrelated to patient care. Facilitators are to (1) divide the standardized outcome measure into components that are useful for each team member's practice, (2) encourage standardized outcome measures as tools for improving daily communication and (3) provide adequate education and support for their daily use. CONCLUSION This study revealed important barriers to using standardized outcome measures in geriatric rehabilitation from the perspective of healthcare providers. However, it also identified multiple factors that may help facilitate their use.
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Affiliation(s)
- Christine Glenny
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,2 Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ayse Kuspinar
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,3 School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Gary Naglie
- 4 Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada.,5 Research Department, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,6 Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Paul Stolee
- 1 School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Coleman EA, Min SJ. Patients' and Family Caregivers' Goals for Care During Transitions Out of the Hospital. Home Health Care Serv Q 2017; 34:173-84. [PMID: 26496503 DOI: 10.1080/01621424.2015.1095149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aims of this study were to (a) describe the nature of patients' goals upon discharge from hospital, family caregivers' goals for their loved ones, and family caregivers' goals for themselves; (b) determine the degree of concordance with respect to the three elicited goals; (c) ascertain goal attainment across the three elicited goals; and (d) examine factors predictive of goal attainment. Our findings support the position that eliciting patient and family caregiver goals and promoting goal attainment may represent an important step toward promoting greater patient and family caregiver engagement in their care.
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Affiliation(s)
- Eric A Coleman
- a Division of Health Care Policy and Research , University of Colorado Denver Anschutz Medical Campus , Aurora , Colorado , USA
| | - Sung-Joon Min
- a Division of Health Care Policy and Research , University of Colorado Denver Anschutz Medical Campus , Aurora , Colorado , USA
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6
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Lamontagne ME, Routhier F, Auger C. Team Consensus Concerning Important Outcomes for Augmentative and Alternative Communication Assistive Technologies: A Pilot Study. Augment Altern Commun 2013; 29:182-9. [DOI: 10.3109/07434618.2013.784927] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stolee P, Awad M, Byrne K, DeForge R, Clements S, Glenny C. A multi-site study of the feasibility and clinical utility of Goal Attainment Scaling in geriatric day hospitals. Disabil Rehabil 2012; 34:1716-26. [DOI: 10.3109/09638288.2012.660600] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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8
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Byrne K, Orange JB, Ward-Griffin C. Care transition experiences of spousal caregivers: from a geriatric rehabilitation unit to home. QUALITATIVE HEALTH RESEARCH 2011; 21:1371-1387. [PMID: 21525238 DOI: 10.1177/1049732311407078] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to develop a theoretical framework about caregivers' experiences and the processes in which they engaged during their spouses' transition from a geriatric rehabilitation unit to home. We used a constructivist grounded theory methodology approach. Forty-five interviews were conducted across three points in time with 18 older adult spousal caregivers. A theoretical framework was developed within which reconciling in response to fluctuating needs emerged as the basic social process. Reconciling included three subprocesses (i.e., navigating, safekeeping, and repositioning), and highlighted how caregivers responded to the fluctuating needs of their spouse, to their own needs, and to those of the marital dyad. Reconciling was situated within a context shaped by a trajectory of prior care transitions and intertwined life events experienced by caregivers. Findings serve as a resource for scientists, rehabilitation clinicians, educators, and decision makers toward improving transitional care for spousal caregivers.
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Affiliation(s)
- Kerry Byrne
- University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada.
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9
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The role of physical and psychological variables in predicting the outcome of hospitalization in very old adults. Arch Gerontol Geriatr 2010; 53:146-51. [PMID: 21190738 DOI: 10.1016/j.archger.2010.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/17/2010] [Accepted: 11/19/2010] [Indexed: 11/23/2022]
Abstract
The aim of this study was to examine predictors of functional outcome in hospitalized geriatric patients with a focus on psychological variables, as these have been somewhat neglected in this population. A prospective study was conducted in aged-care wards in Melbourne, Australia. Consecutively admitted patients (n = 100, mean age 82 years) completed measures of health status, anxiety, depression, self-efficacy, personality and coping. Two months later data were collected with respect to three outcomes, namely overall functioning, ability to carry out activities of daily living as measured by the Barthel Index (BI), and quality of life (QoL), as measured by the assessment of quality of life (AQoL) instrument. Syndromal depression was highly prevalent (28%) and syndromal anxiety was less common (5% prevalence), but neither was predictive of functional outcome. The strongest predictor of outcome was physical health status on admission to hospital. The results suggest that in physically unwell, very old populations, physical health factors may be stronger predictors of functioning than psychological variables. The findings also highlight some difficulties in the use of psychological measures in old-old populations, and the need for more research that recognizes the oldest old as a distinct group.
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Comparison of the Responsiveness of the FIM and the interRAI Post Acute Care Assessment Instrument in Rehabilitation of Older Adults. Arch Phys Med Rehabil 2010; 91:1038-43. [DOI: 10.1016/j.apmr.2010.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 03/12/2010] [Accepted: 03/16/2010] [Indexed: 11/18/2022]
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Armstrong J, Glenny C, Stolee P, Berg K. A comparison of two assessment systems in predicting functional outcomes of older rehabilitation patients. Age Ageing 2010; 39:394-9. [PMID: 20308190 DOI: 10.1093/ageing/afq030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joshua Armstrong
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON N2L 3G1 Canada.
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12
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Demers L, Desrosiers J, Nikolova R, Robichaud L, Bravo G. Responsiveness of Mobility, Daily Living, and Instrumental Activities of Daily Living Outcome Measures for Geriatric Rehabilitation. Arch Phys Med Rehabil 2010; 91:233-40. [DOI: 10.1016/j.apmr.2009.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/05/2009] [Indexed: 11/16/2022]
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13
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Glenny C, Stolee P. Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature. BMC Geriatr 2009; 9:52. [PMID: 19943969 PMCID: PMC2795323 DOI: 10.1186/1471-2318-9-52] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 11/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems. METHODS English language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements. RESULTS In total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS. CONCLUSION Additional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.
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Affiliation(s)
- Christine Glenny
- Department of Health Studies and Gerontology, University of Waterloo (200 University Avenue East), Waterloo (N2L 3G1), Canada.
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A conceptual framework of outcomes for caregivers of assistive technology users. Am J Phys Med Rehabil 2009; 88:645-55; quiz 656-8, 691. [PMID: 19620830 DOI: 10.1097/phm.0b013e3181ae0e70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop and validate the content of a conceptual framework concerning outcomes for caregivers whose recipients are assistive technology users. DESIGN The study was designed in four stages. First, a list of potential key variables relevant to the caregivers of assistive technology users was generated from a review of the existing literature and semistructured interviews with caregivers. Second, the variables were analyzed, regrouped, and partitioned, using a conceptual mapping approach. Third, the key areas were anchored in a general stress model of caregiving. Finally, the judgments of rehabilitation experts were used to evaluate the conceptual framework. RESULTS An important result of this study is the identification of a complex set of variables that need to be considered when examining the experience of caregivers of assistive technology users. Stressors, such as types of assistance, number of tasks, and physical effort, are predominant contributors to caregiver outcomes along with caregivers' personal resources acting as mediating factors (intervening variables) and assistive technology acting as a key moderating factor (effect modifier variable). CONCLUSIONS Recipients' use of assistive technology can enhance caregivers' well being because of its potential for alleviating a number of stressors associated with caregiving. Viewed as a whole, this work demonstrates that the assistive technology experience of caregivers has many facets that merit the attention of outcomes researchers.
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Farley N, Demers L, Swaine BR. [Development of the French Canadian version of the Montgomery Borgatta caregiver burden scale]. Can J Aging 2008; 27:181-90. [PMID: 18845513 DOI: 10.3138/cja.27.2.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Assessing the burden linked to caring for the frail elderly is becoming an important issue in rehabilitation. The purpose of this study was to translate/validate the Montgomery Borgatta Caregiver Burden Scale into French for use in Canada. This easy-to-use questionnaire evaluates aspects of burden such as objective, subjective stress and subjective demand burden. The instrument underwent: 1) parallel translation/back-translation; 2) expert's committee review leading to an experimental version; 3) pre-test to ensure wording clarity; and 4) study of psychometric properties with bilingual subjects (n = 27) and French-speaking subjects (n = 18). Results suggest that convergence between the original and the French versions is satisfactory for two of the three sub-scales of the MBCBS (ICC 0.83 & 0.96). The test-retest stability coefficients are also very good (ICC of 0.92 & 0.91), as is internal consistency (0.90, 0.66). The objective burden sub-scale correlates moderately with a measure of functional autonomy (SMAF). Results for the subjective burden scale linked to demand are, however, inadequate. All in all, two of the three sub-scales of the French-Canadian version of the Montgomery Borgatta Caregiver Burden Scale demonstrate adequate psychometric properties, thereby favouring its use in geriatric rehabilitation.
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Affiliation(s)
- Nathalie Farley
- Ecole de réadaptation, Faculté de médecine, Université de Montréal
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Ollonqvist K, Aaltonen T, Karppi SL, Hinkka K, Pöntinen S. Network-based rehabilitation increases formal support of frail elderly home-dwelling persons in Finland: randomised controlled trial. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:115-125. [PMID: 18290977 DOI: 10.1111/j.1365-2524.2007.00733.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The AGE study is a national randomised, long-term, multicentre research project aimed at comparing a new network-based rehabilitation programme with the use of standard health and social services. The use of home help services is associated with increasing age, living alone and having difficulties with activities of daily living. During a rehabilitation intervention the elderly participants' need for care can be assessed. The focus of this paper is to investigate the possible effects of the network-based rehabilitation programme on the use of informal and formal support among home-dwelling elderly at a high risk of long-term institutionalisation. The randomised controlled trial with a 12-month follow-up was implemented in 7 rehabilitation centres and 41 municipalities in Finland. The participants were recruited between January and October 2002. A total of 708 home-dwelling persons aged 65 years or older with progressively decreasing functional capacity and at the risk of being institutionalised within 2 years participated. Persons with acute or progressive diseases or poor cognitive capacity (Mini Mental State Examination<18 points), and those who had participated in any inpatient rehabilitation during the preceding 5 years, were excluded. Participants were randomly allocated to the intervention group (n=343) or to the control group (n=365). The intervention consisted of a network-based rehabilitation programme specifically designed for frail elderly people. Main outcome measures included the help received from relatives and municipal or private services. The use of municipal services increased more in the intervention group (P<0.05) than in the control group. Support from relatives decreased in the control group. The rehabilitees' ability to manage with daily activities decreased and they received additional help; hence, in this respect the rehabilitation model seems successful. A longer follow-up within the still ongoing AGE study is needed to verify whether the programme actually can delay long-term care.
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Auger C, Demers L, Desrosiers J, Giroux F, Ska B, Wolfson C. Applicability of a toolkit for geriatric rehabilitation outcomes. Disabil Rehabil 2007; 29:97-109. [PMID: 17364761 DOI: 10.1080/09638280600731540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To field test the applicability of a multidimensional toolkit for geriatric rehabilitation outcomes which includes nine standardized tools. Applicability is defined as context- and population-specific pragmatic qualities of an assessment tool such as respondent and examiner burden, score distribution and format compatibility. METHOD A sample of 48 older adults representing four diagnostic groups, as well as 26 caregivers, were assessed at home in the first month after discharge from intensive rehabilitation (T1) and 2 months later (T2). Pre-determined qualitative and quantitative applicability criteria were coded and compared at T1 and T2, as well as responsiveness. RESULTS A higher respondent burden was found for three self-report tools, as well as a ceiling effect on social functioning tools. Respondent burden, examiner burden and score distribution remained stable or diminished at T2. Format compatibility deteriorated only for the mobility test due to a higher proportion of non ambulatory participants (17%). Low to moderate associations between the tools corroborated that they were not redundant (rPearson <or= 0.77). Responsiveness estimates confirmed that mean scores were stable between T1 and T2. CONCLUSION Overall, the toolkit was found to be applicable at home after geriatric rehabilitation. Modifications are proposed to further improve its applicability. This study highlighted practical aspects that could alleviate the burden on research participants and facilitate the use of those tools for community follow-up for clinical and research purposes.
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Affiliation(s)
- Claudine Auger
- Research Centre, Montréal Geriatric University Institute, Canada.
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Grill E, Hermes R, Swoboda W, Uzarewicz C, Kostanjsek N, Stucki G. ICF Core Set for geriatric patients in early post-acute rehabilitation facilities. Disabil Rehabil 2005; 27:411-7. [PMID: 16040544 DOI: 10.1080/09638280400013966] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this consensus process was to decide on a first version of the ICF Core Set for geriatric patients in early post-acute rehabilitation facilities. METHODS The ICF Core Set development involved a formal decision-making and consensus process, integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS Fifteen experts selected a total of 123 second-level categories. The largest number of categories was selected from the ICF component Body Functions (51 categories or 41%). 14 (11%) of the categories were selected from the component Body Structures, 30 (29%) from the component Activities and Participation, and 28 (23%) from the component Environmental Factors. CONCLUSION The Post-acute ICF Core Set for geriatric patients is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first version of the ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.
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Affiliation(s)
- Eva Grill
- ICF Research Branch of the WHO FIC Collaborating Center (DIMDI), IMBK, Ludwig-Maximilians-University, Munich, Germany
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Demers L, Desrosiers J, Ska B, Wolfson C, Nikolova R, Pervieux I, Auger C. Assembling a Toolkit to Measure Geriatric Rehabilitation Outcomes. Am J Phys Med Rehabil 2005; 84:460-72. [PMID: 15905661 DOI: 10.1097/01.phm.0000163718.50002.d0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To gather and assemble relevant patient-based outcome measures with emphasis placed on the older adults' level of functioning and activity performance. DESIGN The study was conducted in two phases. First, a set of relevant measurement instruments was identified, and their was value analyzed according to general characteristics and metrologic criteria. Second, this "toolkit" was pretested on 22 older adults with respect to the burden of assessment and the quality of the data. RESULTS The toolkit includes eight measurement instruments related to mobility, basic activities of daily living, independent living, leisure, physical functioning, psychologic functioning, social functioning, and caregiver status. Participants' acceptance of the toolkit was high, with all subjects completing the toolkit in two sessions (30-90 mins each). The leisure participation and satisfaction measure was the most difficult to complete. Distributional properties were adequate to ascertain variability between subjects, except for a ceiling effect found for the social functioning measure. CONCLUSION Measurement tools that are used in combination are needed to optimize the applicability and utility of outcome results. The toolkit has the potential to become a valuable method for researchers and clinicians reporting geriatric rehabilitation outcomes.
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Affiliation(s)
- Louise Demers
- Research Centre, Institut universitaire de gériatrie de Montréal, Montréal, Quebec, Canada
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