Why can't children with autism integrate into society in China? Study based on the perspective of NGO classification

Introduction

In the field of protecting children with autism, NGOs have become a major force that cannot be ignored. Although NGOs for children with autism have expanded the number and improved the quality of the services they provide, a large number of autistic children still cannot achieve the goal of social inclusion in China. The existing literature has mostly tried to explain the reason from the perspective of the common characteristics of NGOs and has paid insufficient attention to the huge differences between these NGOs, so it is impossible to identify the obstacles that children with autism encounter accurately.

Methods

From the perspective of NGO classification, this study conducted an in-depth investigation of 4 NGO cases in City N, China, to show the impact of the difference of NGOs on the obstacles to the social inclusion of autistic children.

Results

The research has found that under the authoritarian regime, NGOs for children with autism that rely heavily on external funds include three common groups: government-oriented NGOs, foundation-supported NGOs, and individual-financed NGOs. The structural characteristics of the funders and their interaction with the NGOs for children with autism shape their different action logics, as the result that the desire of children with autism to integrate into society cannot be achieved as expected.

Discussion

The results of this study give more accurate insights into the barriers in social service provision for children with autism that impede their social inclusion and provide a reference for those seeking a solution to this problem.

"Patiently waiting": How do non-driving disabled adults get around in rural America?

Most mobility needs in rural America are primarily met via driving. Yet many disabled adults cannot drive. Lack of adequate public transportation in rural areas exacerbates transportation-related disparities. We interviewed 33 non-driving disabled adults throughout the U.S. to explore how they get around in their rural communities. Research questions primarily focused on the relationships between transportation, community participation, healthcare access, and social capital. We used thematic analysis to identify themes related to our research questions. In general, interviewees described a dearth of public transportation options. Even if public transit were available, other issues limited use such as inaccessibility, expenses, or schedules and routes. Many participants also described getting rides from others. While this was a critical component of many individuals' daily travel, it also introduced a layer of dependency and social pressure that otherwise would not exist with more independent means of transportation. Policy implications include improved public transit funding and strategies to promote universal auto access.

Exploring environmental measures in disability: Using Google Earth and Street View to conduct remote assessments of access and participation in urban and rural communities

The Americans with Disabilities Act has been in place since 1990. Yet, we still do not know the actual levels of accessibility in the nation, how access varies across communities or over time, or how it influences participation in community life. The present two studies explored the use of Google Earth (GE) and Google Street View (GSV) imagery as a database for examining the accessibility of rural and urban cities and towns in the United States. We developed procedures for selecting places in a community to observe multiple access features. Study 1 reports the findings from assessments of 25 communities across 17 states. We observed ≈50,000 m (31 miles) of pathways through the observed places. The Combined Access Score (CAS) averaged 65% across these communities. In Study 2, we evaluated 22 towns and cities in a large rural state. We observed ≈77,000 m (48 miles) of pathways through the Central Business Districts observed as core areas connecting people to community life. The CAS averaged 83.9% across these communities. We noted a Rural Access Penalty (RAP), such that rural areas tended to be less accessible, leading to less community participation. The method for using GSV to examine accessibility is discussed. This study demonstrates an inexpensive and reliable method for evaluating the accessibility of communities and participation in them. Future research should be conducted to gather a larger sample of communities in order to create a baseline from which to monitor changes in accessibility of infrastructure over time.

A Chinese version of the Measure of Stroke Environment (MOSE): psychometric evaluation in stroke survivors

PURPOSE

To translate the MOSE from English to Chinese and investigate the psychometric properties of the Chinese-translated version of the Measure of Stroke Environment (MOSE).

MATERIALS AND METHODS

The MOSE was translated into Chinese using a cultural adaptation process. To validate this Chinese version, 311 stroke survivors were recruited to complete the questionnaire. The psychometric properties of the MOSE were evaluated by determining item analysis, test-retest reliability, internal consistency, content validity, construct validity, and floor/ceiling effects, respectively.

RESULTS

The MOSE was translated without any major difficulties. Regarding psychometric performances, a moderate level of correlation between the items and the domains (r > 0.4), and the significant differences in items between the high group and the low group were tested by independent sample t-tests (p < 0.05). The test-retest reliability was excellent (Intraclass Coefficient Correlation = 0.938). Very high internal consistency was also observed (Cronbach's α = 0.945, split-half reliability = 0.778). An acceptable I-CVI ranged from 0.714 to 1.000 and a high S-CVI of 0.973. Correlations with the subscales of the WHODAS 2.0 were significant in similar domains reflecting good convergent validity. No floor or ceiling effects were observed.

CONCLUSION

This study provides psychometric evidence supporting the use of the Chinese version of the MOSE among stroke survivors.IMPLICATIONS FOR REHABILITATIONThe Measure of Stroke Environment was translated into Chinese through a rigorous cultural adaptation process.MOSE-C is now a reliable and valid tool for Chinese-speaking survivors who have suffered from a stroke.It is necessary to assess the perceived environmental barriers of stroke survivors and develop targeted intervention programs in China.

Transportation Patterns of Adults With Travel-Limiting Disabilities in Rural and Urban America

Introduction

Lack of transportation is a significant barrier to community participation for many disabled adults. Living in a rural area introduces additional transportation barriers, such as having to travel long distances to access services or socialize, and limited public transit options. While the importance of transportation access is clear, the mix of different transportation options used by people with disabilities to participate in their communities is less understood, particularly among those who do not or cannot drive.

Methods

We used data from the 2017 National Household Travel Survey to explore transportation behaviors among disabled adults in rural and urban areas and by four regions across the United States. We explored differences by transportation modalities (e.g., driver, passenger, public transportation, taxi/uber, walk) and trip purposes (e.g., social, independent living, healthcare, work). Our sample included 22,716 adults with travel-limiting disabilities.

Results

Several geographic differences emerged among non-drivers. Rural non-drivers were less likely to take any trip, particularly for social activities, and reported using less public transportation or walking/rolling than urban non-drivers. Further, respondents from the Northeast were more likely to report using public transportation and walking/rolling options, relative to the Midwest, South, and West. Overall, disabled rural adults reported lower odds of giving up driving, even after controlling for socio-demographic and health characteristics.

Discussion

These findings highlight the relative importance of different transportation modalities for participating in activities and the continued reliance upon personal vehicles, either as a driver or passenger, especially among rural disabled residents. Potential policy insights are discussed.

Cross-cultural adaptation of the Participation and Environment Measure for Children and Youth (PEM-CY) into German: a qualitative study in three countries

BACKGROUND

Concepts such as participation and environment may differ across cultures. Consequently, to use a measure like the Participation and Environment Measure for Children and Youth (PEM-CY) in other than the original English-speaking contexts, cultural adaptation needs to be assured. The aim of this study was to cross-culturally translate and adapt the PEM-CY into German as it is used in Germany, Austria and Switzerland.

METHODS

Fifteen parents of children and adolescents with disabilities from three German speaking countries participated in three rounds of think-aloud interviews. We followed the procedure of cultural equivalence guidelines including two additional steps. Data was analyzed by content analysis using semantic, idiomatic, experiential and conceptual equivalence.

RESULTS

Results show adaptations mainly focused on experiential and conceptual equivalence, with conceptual equivalence being the most challenging to reach. Examples of experiential equivalence included adapting the examples of activities in the PEM-CY to reflect those typical in German speaking countries. Conceptual equivalence mainly addressed aspects of "involvement" and "environment" of children and adolescents and was reached through adaptations such as enhanced instructions and structures, and additional definitions.

CONCLUSIONS

This study presents a cross-cultural translation and adaptation process to develop a German version of the PEM-CY that is suitable for Germany, Austria and Switzerland. Using a modified cultural adaptation process, a culturally adapted version of PEM-CY (German) is now available for research, practice and further validation.

Association of Physical Morbidity and Health-Related Quality of Life in a Representative Sample of Older German People

Abstract. The association between health-related quality of life (HRQoL; Short-Form Health Survey-12; SF-12) and patient-reported morbidity-related symptoms measured by the Patient Health Questionnaire-15 (PHQ-15) is analyzed in a representative sample of older people in the general German population. Data from 1,659 people aged 60 to 85 years were obtained. Latent class analysis identified six classes of patients, which optimally categorize clusters of physical symptoms the participants reported: musculoskeletal impairments (39.8%), healthy (25.7%), musculoskeletal and respiratory/cardiac impairments (12.8%), musculoskeletal and respiratory impairments, along with bowel and digestion problems (12.9%), general impairments (4.9%), and general impairments with no bowel and digestion problems (4.8%). The participants’ SF-12 Physical Health Scores (η2 = .39) and their Mental Health Scores (η2 = .28) are highly associated with these latent classes. These associations remain virtually identical after controlling for age. The results provide evidence that profiles of patient-reported physical impairments correspond strongly with reduced HRQoL independently from aging processes.

Normierung des SF-12 Version 2.0 zur Messung der gesundheitsbezogenen Lebensqualität in einer deutschen bevölkerungsrepräsentativen Stichprobe

Zusammenfassung. Der Short-Form-Health Survey (SF-12) ist ein Screeninginstrument zur Erfassung der gesundheitsbezogenen Lebensqualität. Der Körperliche Skalenwert repräsentiert Allgemeine Gesundheitswahrnehmung, Körperliche Funktionsfähigkeit und Rollenfunktion sowie Schmerzen. Der Psychische Skalenwert bildet Emotionale Rollenfunktion, Psychisches Wohlbefinden, Negativen Affekt und Soziale Funktionsfähigkeit ab. Alternativ kann die Emotionale Rollenfunktion getrennt ermittelt werden. Die Daten entstammen einer schriftlichen Befragung einer für Deutschland repräsentativen Normstichprobe von N = 2 524 Personen. Der Körperliche Skalenwert kann mit R2 = .305 besser prädiziert werden als die Skalenwerte des psychischen Bereichs (R2 = .094 – .110). Das Alter determiniert den höchsten Varianzanteil. Zudem sind Geschlecht, Einkommen, Familienstand und Beruf prädiktiv. Die Normdaten werden für die Gesamtstichprobe sowie getrennt für Geschlechts- und Altersgruppen berichtet. Erwartungsgemäß treten in der nicht-klinischen Stichprobe Deckeneffekte am positiven Pol der Skalen auf. Einschränkungen der gesundheitsbezogenen Lebensqualität werden differenziert abgebildet.

Generische und indikationsspezifische Messeigenschaften des IRES-24-Patientenfragebogen

Zusammenfassung. Der Indikatoren des Reha-Status Patientenfragebogen (IRES-24) wird in der medizinischen Rehabilitation als Instrument zur Routinediagnostik der Dimensionen Funktionsfähigkeit im Alltag, Psychisches Befinden, Somatische Gesundheit und Schmerzen eingesetzt. Die generischen und indikationsspezifischen Messeigenschaften des IRES-24 Patientenfragebogen werden in einem Vergleich von Befragten aus der orthopädischen (N = 1 869; 37 % weiblich; MAlter = 50.3 Jahre) und der neurologischen Rehabilitation (N = 881; 49 % weiblich; MAlter = 64.6 Jahre) analysiert. Um Alters- und Geschlechtsverzerrungen zu vermeiden, wurden gematchte Stichproben gezogen (342 Befragte pro Gruppe; 55 % weiblich; MAlter = 51.6 bzw. 52.6 Jahre). Die Analyse erfolgte mittels des Differential Item Functioning auf Basis des ordinalen Rasch-Modells. Während Psychisches Befinden indikationsübergreifend testfair erfasst wird, indizieren einzelne Items der Skala Funktionsfähigkeit im Alltag und Schmerzen die jeweilige latente Merkmalsdimension unterschiedlich sensitiv. Bedeutsame Verletzungen der Homogenität der Skala Somatische Gesundheit, die durch die Erfassung unterschiedlicher Symptomkomplexe bedingt sind, müssen bei indikationsübergreifenden Anwendungen des IRES-24 berücksichtigt werden.

Sense of Community and Its Impact on the Life Satisfaction of Adults With Brain Injury

Sense of community (SOC) refers to feelings of belonging and attachment one has for a community. Despite a growing focus on adjustment and community outcomes following disability, this construct has received little attention in the rehabilitation literature. The primary aim of this study was to examine the extent to which SOC and social identification with one’s town contribute to life satisfaction outcomes among adults with brain injury, controlling for demographic, disability, and other related social constructs (e.g., social support and social integration). Members from brain injury associations across the United States ( N = 177) participated in a survey-based study. Results from hierarchical regression analysis indicated that the final model accounted for 45% of the variance in life satisfaction, with SOC variables contributing 11%. Symptom severity, perceived emotional support, and the SOC dimension reinforcement of needs were significant independent predictors of life satisfaction. Findings from this study highlight the importance of examining SOC variables among clients with brain injury to enhance subjective well-being.

A systematic review of interventions to increase the use of standardized outcome measures by rehabilitation professionals

OBJECTIVE

To determine the types and effectiveness of interventions to increase the knowledge about, attitudes towards, and use of standardized outcome measures in rehabilitation professionals.

DATA SOURCES

An electronic search using Medline, EMBASE, PsycINFO, CINAHL, Ergonomics Abstracts, Sports Discus. The search is current to February 2016.

STUDY SELECTION

All study designs testing interventions were included as were all provider and patient types. Two reviewers independently conducted a title and abstract review, followed by a full-text review.

DATA EXTRACTION

Two reviewers independently extracted a priori variables and used consensus for disagreements. Quality assessment was conducted using the Assessment of Quantitative Studies published by the Effective Public Health Practice Group.

DATA SYNTHESIS

We identified 11 studies involving at least 1200 providers. Nine of the studies showed improvements in outcome measure use rates but only three of these studies used an experimental or quasi-experimental design. Eight of the studies used an educational approach in the intervention and three used audit and feedback. Poor intervention description and quality of studies limited recommendations.

CONCLUSIONS

Increased attention to testing interventions focused on known barriers, matched to behavior change techniques, and with stronger designs is warranted.

Holistic Practice in Traumatic Brain Injury Rehabilitation: Perspectives of Health Practitioners

Given that the literature suggests there are various (and often contradictory) interpretations of holistic practice in brain injury rehabilitation and multiple complexities in its implementation (including complex setting, discipline, and client-base factors), this study aimed to examine the experiences of practitioners in their conceptualization and delivery of holistic practice in their respective settings. Nineteen health practitioners purposively sampled from an extensive Brain Injury Network in Queensland, Australia participated in individual interviews. A systematic text analysis process using Leximancer qualitative analysis program was undertaken, followed by manual thematic analysis to develop overarching themes. The findings from this study have identified several items for future inter-professional development that will not only benefit the practitioners working in brain injury rehabilitation settings, but the patients and their families as well.

[Feasibility of a geriatric multidisciplinary outpatient rehabilitation program-lessons learned]

OBJECTIVE

To describe the feasibility of a geriatric multidisciplinary outpatient rehabilitation program, developed in Vivium Naarderheem.

DESIGN

A prospective pilot study using a pretest-posttest design with measurements of the level of (social) participation, health related quality of life, and caregiver strain at the start (T0) and the end (T1) of the program. Feasibility was studied by structured interviews with participants, professionals and management.

RESULTS

We included 18 patients, fifteen of which were admitted after stroke. The program was highly appreciated by patients. Management and professionals thought that factors of influence on the program were transportation of patients, adequate planning and deployment of staff, and adequate financing. The program was regarded feasible. Although some patients reported a higher level of participation, the only statistically significant finding was a deterioration in self-perceived health.

CONCLUSION

In this study most of the patients participated after stroke. The geriatric multidisciplinary outpatient rehabilitation program, following inpatient geriatric rehabilitation, was highly appreciated by patients, and considered feasible by management and professionals.

Structure, Processes, and Retrospective Outcomes From an Intensive Comprehensive Aphasia Program

PURPOSE

This study describes the structure, processes, and outcomes of an intensive comprehensive aphasia program (ICAP). The aim was to identify treatment gains and determine if outcomes were significantly different between participants grouped according to severity and type of aphasia, and time postonset.

METHOD

Data from 74 first-time ICAP participants were analyzed. Pre- and posttreatment scores on the Western Aphasia Battery-Revised and other impairment and participation measures were compared using paired t tests. Analyses of variance were used to compare outcomes related to aphasia severity (severe, moderate, and mild aphasia), aphasia type (fluent, nonfluent), and chronicity (0-6 months postonset, 7-12 months postonset, and 12+ months postonset).

RESULTS

Participants made significant changes on all impairment and participation measures. Large effect sizes were noted for one participation and three impairment measures. Medium effect sizes were noted for one impairment and three participation measures. There was no significant difference among groups on any factor.

CONCLUSION

ICAPs can have a significant effect on the language impairment and participation of people with aphasia, but further research is required to determine if the effect is comparable to other types of service delivery.

Social participation post stroke: a meta-ethnographic review of the experiences and views of community-dwelling stroke survivors

PURPOSE

There is currently no consensus on a definition of participation that describes experiences and challenges of people with stroke. This meta-synthesis aimed to identify, appraise and synthesise qualitative research on stroke survivors' views of their experiences of social participation.

METHODS

Ten electronic databases were searched for relevant qualitative studies in English from January 2001 and ending September 2011. Searching was extended to grey literature, hand searching journals, checking references and contacting authors of included studies. Two independent reviewers extracted data and assessed methodological study quality. A meta-ethnographic approach described by Noblit and Hare was used to synthesise findings.

RESULTS

Eleven articles met the inclusion criteria. Five main themes were identified: (1) change and disruption; (2) perceived magnitude of individual barriers; (3) pursuing personal choices; (4) building individual confidence and (5) evaluating personal meaning.

CONCLUSION

The ability of the person to accept their stroke-related problems and adapt their behaviour and attitude by using active decision-making and self-management skills are central factors to social participation post stroke. This synthesis contributes an important addition to the conceptual understanding of social participation relevant to people with stroke within the UK. Implications for Rehabilitation Social participation post stroke appears to be a dynamic, complex and continuous individual process, and a personalised longer term approach to rehabilitation would be beneficial. Rehabilitation should be focussed on what is most meaningful to the person following their stroke. Professionals can do this by using questions which explore what stroke survivors want to do; what they perceive to be the significant barriers, and what skills and supportive networks are needed. Our findings emphasise the importance of rehabilitation practitioners supporting stroke survivors' to engage with meaningful self-selected social activities and the importance of stroke survivors having the freedom and autonomy to set their own goals within rehabilitation. The person's ability to adapt their behaviour and attitude by being positive, hopeful, determined, resilient and courageous is an essential part of pursuing their self-selected valued activities. Acknowledging and encouraging the importance of these behaviours and attitudes should be promoted in rehabilitation.

Feasibility of computerized adaptive testing for collection of patient-reported outcomes after inpatient rehabilitation

OBJECTIVE

To evaluate the feasibility of computer adaptive testing (CAT) using an Internet or telephone interface to collect patient-reported outcomes after inpatient rehabilitation and to examine patient characteristics associated with completion of the CAT-administered measure and mode of administration.

DESIGN

Prospective cohort study of patients contacted approximately 4 weeks after discharge from inpatient rehabilitation. Patients selected an Internet or telephone interface.

SETTING

Rehabilitation hospital.

PARTICIPANTS

Patients (N=674) with diagnoses of neurologic, orthopedic, or medically complex conditions.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

CAT version of the Community Participation Indicators (CAT-CPI).

RESULTS

From an eligible pool of 3221 patients, 674 (21%) agreed to complete the CAT-CPI. Patients who agreed to complete the CAT-CPI were younger and reported slightly higher satisfaction with overall care than those who did not participate. Among these patients, 231 (34%) actually completed the CAT-CPI; 141 (61%) selected telephone administration, and 90 (39%) selected Internet administration. Decreased odds of completing the CAT-CPI were associated with black and other race; stroke, brain injury, or orthopedic and other impairments; and being a Medicaid beneficiary, whereas increased odds of completing the CAT-CPI were associated with longer length of stay and higher discharge FIM cognition measure. Decreased odds of choosing Internet administration were associated with younger age, retirement status, and being a woman, whereas increased odds of choosing Internet administration were associated with higher discharge FIM motor measure.

CONCLUSIONS

CAT administration by Internet and telephone has limited feasibility for collecting postrehabilitation outcomes for most rehabilitation patients, but it is feasible for a subset of patients. Providing alternative ways of answering questions helps assure that a larger proportion of patients will respond.

Development of Rasch-based item banks for the assessment of work performance in patients with musculoskeletal diseases

PURPOSE

This study aimed to develop a self-description assessment instrument to measure work performance in patients with musculoskeletal diseases. In terms of the International Classification of Functioning, Disability and Health (ICF), work performance is defined as the degree of meeting the work demands (activities) at the actual workplace (environment). To account for the fact that work performance depends on the work demands of the job, we strived to develop item banks that allow a flexible use of item subgroups depending on the specific work demands of the patients' jobs.

METHODS

Item development included the collection of work tasks from literature and content validation through expert surveys and patient interviews. The resulting 122 items were answered by 621 patients with musculoskeletal diseases. Exploratory factor analysis to ascertain dimensionality and Rasch analysis (partial credit model) for each of the resulting dimensions were performed.

RESULTS

Exploratory factor analysis resulted in four dimensions, and subsequent Rasch analysis led to the following item banks: 'impaired productivity' (15 items), 'impaired cognitive performance' (18), 'impaired coping with stress' (13) and 'impaired physical performance' (low physical workload 20 items, high physical workload 10 items). The item banks exhibited person separation indices (reliability) between 0.89 and 0.96.

CONCLUSIONS

The assessment of work performance adds the activities component to the more commonly employed participation component of the ICF-model. The four item banks can be adapted to specific jobs where necessary without losing comparability of person measures, as the item banks are based on Rasch analysis.

Responsiveness of two participation measures in an outpatient rehabilitation setting

OBJECTIVE

The responsiveness of a new participation measure, the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was compared with that of the Impact on Particpation and Autonomy (IPA). Furthermore, the concurrent validity of these two measures was assessed.

METHOD

Participants were patients with brain injury or neuromuscular disease, who received occupational therapy as part of a multidisciplinary outpatient rehabilitation programme. They completed the IPA and the USER-Participation at the start and end of the programme, and at three-month follow-up. Responsiveness was analysed using the effect size (ES) and the standardized response mean (SRM).

RESULTS

Responsiveness figures were small to moderate (-0.4 to 0.5) and similar for the IPA and the USER-Participation. The USER-Participation showed a consistent result, with Frequency scores declining and Restriction and Satisfaction scores inclining over time, and the IPA showed mixed results, with the different domain scores both inclining and declining over time. Correlations between IPA and USER-Participation scales were all significant, but by far strongest for the USER-Participation Satisfaction scale (-0.64 to -0.81).

CONCLUSION

The USER-Participation was at least as responsive as the IPA. Further, satisfaction with participation as measured with the USER-Participation is highly similar to the concept of autonomy in participation as measured with the IPA.

The effects of a rhythm and music-based therapy program and therapeutic riding in late recovery phase following stroke: a study protocol for a three-armed randomized controlled trial

BACKGROUND

Stroke represents one of the most costly and long-term disabling conditions in adulthood worldwide and there is a need to determine the effectiveness of rehabilitation programs in the late phase after stroke. Limited scientific support exists for training incorporating rhythm and music as well as therapeutic riding and well-designed trials to determine the effectiveness of these treatment modalities are warranted.

METHODS/DESIGN

A single blinded three-armed randomized controlled trial is described with the aim to evaluate whether it is possible to improve the overall health status and functioning of individuals in the late phase of stroke (1-5 years after stroke) through a rhythm and music-based therapy program or therapeutic riding. About 120 individuals will be consecutively and randomly allocated to one of three groups: (T1) rhythm and music-based therapy program; (T2) therapeutic riding; or (T3) control group receiving the T1 training program a year later. Evaluation is conducted prior to and after the 12-week long intervention as well as three and six months later. The evaluation comprises a comprehensive functional and cognitive assessment (both qualitative and quantitative), and questionnaires. Based on the International classification of functioning, disability, and health (ICF), the outcome measures are classified into six comprehensive domains, with participation as the primary outcome measure assessed by the Stroke Impact Scale (SIS, version 2.0.). The secondary outcome measures are grouped within the following domains: body function, activity, environmental factors and personal factors. Life satisfaction and health related quality of life constitute an additional domain.

CURRENT STATUS

A total of 84 participants were randomised and have completed the intervention. Recruitment proceeds and follow-up is on-going, trial results are expected in early 2014.

DISCUSSION

This study will ascertain whether any of the two intervention programs can improve overall health status and functioning in the late phase of stroke. A positive outcome would increase the scientific basis for the use of such interventions in the late phase after stroke.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT01372059.

A systematic scoping review of measures of participation in disability and rehabilitation research: a preliminary report of findings

PURPOSE/OBJECTIVE

The concept of participation is emerging as a gold-standard of outcome measurement in disability and rehabilitation. We aimed to assess the status of methods to measure this new concept.

METHOD/DESIGN

We conducted a scoping review and a content analysis to assess the literature on participation.

RESULTS

We identified 586 articles addressing participation. Seventy-two articles passed all exclusion criteria. Twenty-four articles cited the International Classification of Function as their conceptual foundation. Most studies included individuals with a broad range of impairments (cross disability). Most instruments relied on self-report in a cross-sectional design. We noted three levels of measurement (static, interactional, and dynamic). Few studies reported collecting data on the environment along with participation. Subjective aspects of participation emerged as an important consideration but few articles reported measuring it.

CONCLUSIONS

The concept of participation represents more than a "shift from negative to more positive language." It represents a transformational concept that requires new, dynamic measures collected in context.

Evaluation of the "Consultation and Relational Empathy" (CARE) measure by means of Rasch-analysis at the example of cancer patients

OBJECTIVE

The aims of this study are: (1) analysis of unidimensionality of the German version of the "Consultation and Relational Empathy" (CARE) measure and (2) identification of moderating variables affecting the scale structure.

METHODS

The CARE-measure was evaluated by means of Rasch-analysis in a sample of N=326 cancer patients. Association of diagnosis and treatment as well as patients' characteristics was analyzed by person-fit measures and Differential Item Functioning.

RESULTS

Nine of the original 10 CARE items fit to the Rasch-model. For breast and prostate cancer, as well as for patients taking complementary and alternative medicine treatment, item biases affect the scale structure. Furthermore, older patients and patients with higher social support exhibit substantial deviations from model predictions.

CONCLUSIONS

Only the nine-item version of the CARE-measure allows for the unidimensional assessment of physician empathy. Especially for specific diagnosis and treatment groups, the CARE-items indicate variations in the underlying latent construct of physician empathy.

PRACTICE IMPLICATIONS

The CARER-measure provides a theory-based and psychometrically sound basis for the assessment of PE. It can be used to enhance the fairness of the assessment and to further identify valuable information about the influence of patient characteristics on the structure of the construct PE.

Exploring the Relation of Health-Promoting Behaviors to Role Participation and Health-Related Quality of Life in Women With Multiple Sclerosis: A Pilot Study

OBJECTIVE. We examined the relation of health-promoting behaviors to participation in life roles and health-related quality of life (HR–QOL) in women with multiple sclerosis.

METHOD. We used a correlational design. Frequency of health-promoting behaviors was obtained from the Health-Promoting Lifestyle Profile–II. Role participation was measured by the SF–36 Role-Physical, Role-Emotional, and Social Functioning scales, and HR–QOL was measured with the Physical and Mental Component scales.

RESULTS. Eleven significant positive correlations were found among specific health-promoting behaviors (e.g., nutrition, stress management, physical activity, positive interpersonal relations, spiritual growth), role participation, and HR–QOL.

CONCLUSION. The findings suggest that involvement in health-promoting behaviors is associated with greater participation in life roles and HR–QOL for women with multiple sclerosis. This study provides preliminary evidence for the use and development of health promotion in occupational therapy treatment.

Rasch analysis of the Beck Depression Inventory-II in a neurological rehabilitation sample

PURPOSE

To apply Rasch analysis to the Beck Depression Inventory-II (BDI-II) responses of a mixed neurorehabilitation sample to determine its suitability for assessing depression among this group.

METHOD

Three hundred and fifteen in-patients undergoing post-acute specialist in-patient rehabilitation at the Regional Rehabilitation Unit (RRU) of Northwick Park Hospital in North London were administered the Beck Depression Inventory. All patients were administered the BDI-II by a clinical psychologist using a large print version and taking as much time as patients required. Rasch analysis was completed using the RUMM2020 software. Where disordered thresholds were identified item rescoring was undertaken. Each item was also examined for Differential Item Functioning. Where misfit to model expectations was identified items were removed in an iterative fashion. The effect of any deletion upon person estimates was examined. Specific tests of unidimensionality were undertaken at each iterative phase.

RESULTS

Rescoring was necessary before Items 1-4, 6, 8-12, 20 and 21 showed ordered thresholds. Three items failed to satisfy model expectations - items 16 (changes in sleeping pattern), 18 (changes in appetite) and 21 (loss of interest in sex) and were deleted - after which good overall fit to the Rasch model was observed. The three items deleted affected person estimates in a significant way such that the 21 item version in this group of patients may be biased because of multidimensionality.

CONCLUSIONS

The BDI-II in a sample of patients undergoing neurorehabilitation satisfies unidimensional Rasch model expectations in an 18-item format. Some disordering of response categories was evident, but this evidence requires replication before any common rescoring option should be considered.

Development and validation of the Utrecht Scale for Evaluation of Clinical Rehabilitation (USER)

OBJECTIVE

The Utrecht Scale for Evaluation of Rehabilitation (USER) is a measure of functional independence that covers physical functioning (mobility, self-care), cognitive functioning and additional domains of pain, fatigue and mood. USER is implemented in the Netherlands as a generic rehabilitation outcome measure. This article reports the development and psychometric characteristics of USER.

DESIGN

(1) Inter-rater reliability study and (2) responsiveness study with measurements at admission and at discharge from clinical rehabilitation.

SETTING

Three rehabilitation facilities in the Netherlands.

PATIENTS

Rehabilitation inpatients (N = 319).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Effect size (ES) and standardized response mean (SRM) of USER scales were compared to those of the Barthel Index, Functional Independence Measure (FIM) and to relevant scales of the SF-36.

RESULTS

Inter-rater reliability of USER was satisfactory to good. Strong correlations were found between the physical and cognitive functioning scores of USER, the Barthel Index and FIM (0.84-0.94). Correlations between USER pain, fatigue and mood scores and SF-36 scores were also strong (0.58-0.84). Responsiveness of USER physical functioning (1.0-1.2) was very good and slightly better than responsiveness of the Barthel Index (0.9-1.1) and the FIM motor score (0.8-1.1). Responsiveness of the USER cognitive score was below standard (0.2-0.3), but better than responsiveness of the FIM cognitive scores (0.1-0.2).

CONCLUSIONS

USER is a reliable, valid and responsive measure of functional independence that can be used as an alternative for the FIM. The pain, fatigue and mood scores were adapted after this study and need additional validation.

The international classification of functioning, disability and health-orientated Occupational Therapy Assessment: a Rasch analysis of its domains

The aim of the study was to evaluate and improve the psychometric properties of the Occupational Therapy Assessment (OTA) by means of Rasch analysis. The OTA is a tool developed to enhance diagnostics, documentation, therapy planning and evaluation of the individual client process in occupational therapy for adult clients. To assess the central aspects concerning patients' activities and the consequences of their impairments on these activities, therapists rated 50 items relating to the five domains 'activities for self-care', 'activities for independent living', 'consequences of sensory-motor functions in everyday life', 'consequences of neuropsychological functions in everyday life' and 'consequences of psychosocial functions in everyday life'. The study sample consisted of 785 patients consecutively admitted to 44 institutions. These patients participated in occupational therapy and suffered from functional, neurological, psychiatric or multiple impairments (geriatrics). For each OTA domain, unidimensional item groups could be identified. Psychometric properties were satisfactory in all medical fields except for psychiatric patients. Between different medical fields, for all domains, differential item functioning exists, indicating field-specific definitions of the latent dimensions. The OTA provides a psychometrically well developed and tested basis for diagnostic and evaluative purposes in occupational therapy settings.

Evidence-based assessment

Evidence-based assessment (EBA) emphasizes the use of research and theory to inform the selection of assessment targets, the methods and measures used in the assessment, and the assessment process itself. Our review focuses on efforts to develop and promote EBA within clinical psychology. We begin by highlighting some weaknesses in current assessment practices and then present recent efforts to develop EBA guidelines for commonly encountered clinical conditions. Next, we address the need to attend to several critical factors in developing such guidelines, including defining psychometric adequacy, ensuring appropriate attention is paid to the influence of comorbidity and diversity, and disseminating accurate and up-to-date information on EBAs. Examples are provided of how data on incremental validity and clinical utility can inform EBA. Given the central role that assessment should play in evidence-based practice, there is a pressing need for clinically relevant research that can inform EBAs.

Measuring quality of life in prosthetic practice: benefits and challenges

There is an increasing awareness that the inclusion of quality of life as an outcome measure is important in ensuring a client-centred and holistic assessment. This review outlines the benefits of quality of life as an outcome measurement in the field of prosthetics. It introduces the key concepts and challenges in the definition and assessment of quality of life post-amputation, including the relative advantages and disadvantages of adopting generic, disease/condition specific, dimension specific and individualized measures of quality of life. In conclusion, the review delineates and recommends issues and guidelines for consideration when undertaking quality of life research and assessment. A co-ordinated approach by practitioners in the field of prosthetics is necessary to ensure the inclusion of quality of life as an outcome measure and to ensure its measurement in a standardized and rigorous manner.

Applicability of a toolkit for geriatric rehabilitation outcomes

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.