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Lin YN, Van Sang P, Chiu V, Kang JH, Liou TH, Ni P, Chang FH. Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study. Arch Phys Med Rehabil 2024; 105:487-497. [PMID: 37802175 DOI: 10.1016/j.apmr.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) after discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement. DESIGN A longitudinal, multicenter, prospective cohort study. SETTING The acute care wards of 3 hospitals in the Greater Taipei area of Taiwan. PARTICIPANTS Five hundred patients with stroke in acute care wards (mean age=60±12.2 years, 62% men, N=500). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms were assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points. RESULTS The mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (5∼26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P<.05). Patients with a higher functional stage at discharge were more likely to experience significant improvement. CONCLUSION This study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.
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Affiliation(s)
- Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Phan Van Sang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Valeria Chiu
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist TzuChi Medical Foundation, New Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Research Centre of Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pengsheng Ni
- Health Law, Policy, and Management: Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Mate KKV, Ow N, Hum S, Mayo NE. Admission and discharge profiles of people with MS accessing in-patient rehabilitation in Canada. Mult Scler Relat Disord 2023; 79:105008. [PMID: 37741026 DOI: 10.1016/j.msard.2023.105008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/28/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Rehabilitation is the mainstay of management for people with disabilities of neurological origin to maximize function and reduce disability. Access to in-patient rehabilitation is usually reserved for people after crises or those who are discharged from acute care such as in stroke or trauma. Access to people with Multiple Sclerosis (MS) differs across countries and unknown for Canada. With the progression of MS, quality of life (QOL) becomes more closely coupled with independence and hence timely access to rehabilitation is important. The objectives of this paper are (i) to characterize the disability profiles of people with MS admitted to in-patient rehabilitation in Canada; and (ii) to estimate the extent to which disability profiles differ from admission to discharge. METHODS A longitudinal study of a rehabilitation admission-to-discharge cohort of 3500 people with MS was conducting using latent class analysis on the five Functional Independence Measure (FIM) subscales for Self-care, Transfers, Locomotion, Bladder/Bowel, and Cognition. The extent to which age, sex, and calendar time was associated with latent class membership, at both admission and discharge, was estimated using ordinal logistic regression, and proportional odds model was calculated for each age and sex. RESULTS At admission five classes were identified. The two most prevalent classes included people with total or moderate dependency in all FIM subscales except cognition (n = 1205 and n = 1099). The third most common was dependent in ambulation only (n = 523), followed by dependence in ambulation with varying degree of limitation in self-care and transfers (n = 465, and n = 208). At discharge four classes were identified with the largest class comprising of people dependent in ambulation and to a lesser degree in transfers (n = 1010). The second most prevalent class was no dependency (n = 946), followed by two classes with varying dependency in all subscales but cognition (n = 678 and n = 771). CONCLUSION Overall 62.3% of admissions transitioned to a more functional class by discharge. By discharge 28% of the population was characterized by no dependencies; however, 23% remained with dependencies in all areas. Those in the most dependent classes showed the greatest probability of transitioning to a better class at discharge highlighting the importance of reserving scarce rehabilitation services to those with more disability.
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Affiliation(s)
- Kedar K V Mate
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Nikki Ow
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Stanley Hum
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nancy E Mayo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
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Rafiq RB, Yount S, Jerousek S, Roth EJ, Cella D, Albert MV, Heinemann AW. Feasibility of PROMIS using computerized adaptive testing during inpatient rehabilitation. J Patient Rep Outcomes 2023; 7:44. [PMID: 37162607 PMCID: PMC10172423 DOI: 10.1186/s41687-023-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND There has been an increased significance on patient-reported outcomes in clinical settings. We aimed to evaluate the feasibility of administering patient-reported outcome measures by computerized adaptive testing (CAT) using a tablet computer with rehabilitation inpatients, assess workload demands on staff, and estimate the extent to which rehabilitation inpatients have elevated T-scores on six Patient Reported Outcomes Measurement Information System® (PROMIS®) measures. METHODS Patients (N = 108) with stroke, spinal cord injury, traumatic brain injury, and other neurological disorders participated in this study. PROMIS computerized adaptive tests (CAT) were administered via a web-based platform. Summary scores were calculated for six measures: Pain Interference, Sleep Disruption, Anxiety, Depression, Illness Impact Positive, and Illness Impact Negative. We calculated the percent of patients with T-scores equivalent to 2 standard deviations or greater above the mean. RESULTS During the first phase, we collected data from 19 of 49 patients; of the remainder, 61% were not available or had cognitive or expressive language impairments. In the second phase of the study, 40 of 59 patients participated to complete the assessment. The mean PROMIS T-scores were in the low 50 s, indicating an average symptom level, but 19-31% of patients had elevated T-scores where the patients needed clinical action. CONCLUSIONS The study demonstrated that PROMIS assessment using a CAT administration during an inpatient rehabilitation setting is feasible with the presence of a research staff member to complete PROMIS assessment.
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Affiliation(s)
- Riyad Bin Rafiq
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA.
| | - Susan Yount
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, 76201, USA
- Department of Biomedical Engineering, University of North Texas, Denton, USA
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Evanston, USA
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, USA
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Balkman GS, Morgan SJ, Amtmann D, Baylor C, Hafner BJ. Development of a candidate item bank for measuring mobility of lower limb orthosis users. PM R 2023; 15:445-455. [PMID: 36270012 PMCID: PMC10119328 DOI: 10.1002/pmrj.12916] [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: 07/26/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Orthoses are often prescribed to improve mobility of people with chronic health conditions that affect lower limb function. Patient-reported survey instruments can be used to measure aspects of mobility that cannot be easily assessed in clinical or research settings. A population-specific item bank could be designed to measure aspects of mobility that are most important to lower limb orthosis users and used to evaluate the effects of orthoses. OBJECTIVE To develop items for a new survey instrument to measure mobility of lower limb orthosis users. DESIGN Survey items were developed using a qualitative item review process. SETTING Focus groups were held by video conferencing. Cognitive interviews were conducted by telephone. PARTICIPANTS Focus group and cognitive interview participants were adults with at least 6 months of experience using a lower limb orthosis that extended from the foot to a level above the ankle. METHODS Research methods included focus groups with lower limb orthosis users, an item generation and reduction process that involved a stakeholder advisory panel, and cognitive interviews with target respondents. RESULTS A total of 1180 extant items were identified in a literature review. Focus group participants (n = 29) provided feedback that informed the suitability of a construct definition and conceptual model. An advisory panel contributed to the selection of 118 candidate items for measuring orthotic mobility. Feedback from cognitive interview participants (n = 30) informed removal or revision of problematic items, resulting in a candidate bank of 100 mobility items. CONCLUSIONS The rigorous qualitative methods applied here resulted in a large set of candidate items that spanned a range of situations relevant to moving with a lower limb orthosis. Next steps include administration of the candidate items to a large sample of lower limb orthosis users and calibration of the item bank.
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Affiliation(s)
- Geoffrey S. Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Sara J. Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Gillette Children’s Specialty Healthcare, St. Paul, MN
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Bor P, de Leeuwerk ME, Valkenet K, van Hillegersberg R, Veenhof C. Physical functioning and physical activity after gastrointestinal or bladder oncological surgery: An observational cohort study. Eur J Cancer Care (Engl) 2022; 31:e13739. [PMID: 36250336 PMCID: PMC9786746 DOI: 10.1111/ecc.13739] [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: 11/24/2021] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the recovery of physical functioning and objective physical activity levels up to 3 months after oncological surgery and to determine the association between physical activity levels and the recovery of physical functioning. METHODS A longditudinal observational cohort study was conducted in patients who underwent gastrointestinal or bladder oncological surgery. Recovery of physical functioning was measured preoperatively, and 1 and 3 months after discharge. Physical activity was objectively measured with an accelerometer during hospitalisation, and 1 and 3 months after discharge. RESULTS Between February and November 2019, 68 patients were included. Half of the patients (49%) were not recovered in physical functioning 3 months after surgery. During hospitalisation, physical activity increased from 13 to 46 median active minutes per day. At 1 and 3 months after discharge, patients were physically active for 138 and 159 median minutes per day, respectively. Patients with higher levels of physical activity 1 month after discharge showed to have higher levels of physical functioning up to 3 months after discharge. CONCLUSION At 3 months after surgery, physical functioning is still diminished in half of the patients. It is important to evaluate both physical activity levels and physical functioning levels after surgery to enable tailored postoperative mobility care.
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Affiliation(s)
- Petra Bor
- Department of Rehabilitation, Physiotherapy Science and SportUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijke Elizabeth de Leeuwerk
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and SportUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and SportUniversity Medical Center UtrechtUtrechtThe Netherlands,Research Group Innovation of Human Movement CareHU University of Applied Sciences UtrechtUtrechtThe Netherlands
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Herbold J, Rajaraman D, Taylor S, Agayby K, Babyar S. Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study. Arch Rehabil Res Clin Transl 2022; 4:100204. [PMID: 36123982 PMCID: PMC9482026 DOI: 10.1016/j.arrct.2022.100204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A standardized Basic Mobility score of 42.9 predicts home vs institution discharge. Orthopedic diagnoses may have a cutoff score of 41.5 to predict home discharge. Cutoff scores vary by diagnostic group and discharge destination. Cutoff scores vary by time of assessment relative to admission for some diagnoses.
Objectives To establish cutoff scores for the Activity Measure for Post-Acute Care “6-Clicks” standardized Basic Mobility scores (sBMSs) for predicting discharge destination after acute care hospitalization for diagnostic subgroups within an acute care population and to evaluate the need for a second score to improve predictive ability. Design Retrospective, observational design. Setting Major medical center in metropolitan area. Participants Electronic medical records of 1696 adult patients (>18 years) admitted to acute care from January to October 2018. Records were stratified by orthopedic, cardiac, pulmonary, stroke, and other neurological diagnoses (N=1696). Interventions: None Main Outcome Measure Physical therapists scored patients’ sBMSs after referral for physical therapy and prior to discharge. Receiver operating characteristic curves delineated sBMS cutoff scores distinguishing various pairings of home, home with services, inpatient rehabilitation, or skilled nursing facility discharges. First and second sBMSs were compared with percentage change of the area under the curve and inferential statistics. Results Home vs institution cutoff score was 42.88 for combined sample, pulmonary and neurological cases. The cutoff score for orthopedic diagnoses score was 41.46. Cardiac and stroke model quality invalidated cutoff scores. Home without services vs skilled nursing discharges and home with services vs skilled nursing discharges were predicted with varying cutoff scores per diagnosis. sBMS cutoff scores collected closer to discharge were either the same or higher than first cutoffs, with varying effects on predictive ability. Conclusions sBMSs can help decide institution vs home discharge and finer distinctions among discharge settings for some diagnostic groups. A single sBMS may provide sufficient assistance with discharge destination decisions but timing of scoring and diagnostic group may influence cutoff score selection.
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Affiliation(s)
- Janet Herbold
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
| | - Divya Rajaraman
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Sarah Taylor
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Kirollos Agayby
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Suzanne Babyar
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
- Corresponding author Suzanne Babyar, PT, PhD, Department of Physical Therapy, Hunter College, The City University of New York, 425 East 25th Street, New York, NY 10010.
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Bouça-Machado R, Fernandes A, Ranzato C, Beneby D, Nzwalo H, Ferreira JJ. Measurement tools to assess activities of daily living in patients with Parkinson's disease: A systematic review. Front Neurosci 2022; 16:945398. [PMID: 35992900 PMCID: PMC9386643 DOI: 10.3389/fnins.2022.945398] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Parkinson's disease (PD) is associated with a progressive inability to accomplish essential activities of daily living (ADL) resulting in a loss of autonomy and quality of life. Accurate measurement of ADL in PD is important to monitor disease progression and optimize care. Despite its relevance, it is still unclear which measurement instruments are the most suitable for evaluating ADL in people with PD. Objective To identify and critically appraise which measurement instruments have been used to assess ADL in PD. Methods A systematic review was conducted using the databases CENTRAL, MEDLINE, and PEDro from their inception to October 2021 to identify all observational and experimental studies conducted in PD or atypical parkinsonism that included an ADL assessment. Titles and abstracts were screened independently by two authors. The clinimetric properties of the measurement instruments were assessed, and the instruments were classified as "recommended," "suggested," or "listed." Results A total of 129 articles were included, with 37 measurement instruments used. The Unified Parkinson's Disease Rating Scale (UPDRS), the Schwab & England ADL scale (S&E scale), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Barthel Index, the Lawton-Brody Instrumental Activities of Daily Living Scale, the Functional Independence Measure (FIM) and the Alzheimer's Disease Cooperative Study - ADL (ADCS-ADL) scale were the seven most frequently cited measurement instruments. Of these, only two included an assessment of basic and instrumental ADL. Conclusion MDS-UPDRS and the S&E scale were the only two scales that could be classified as recommended. For the MDS-UPDRS, either the full version or only Part II, which is focused on ADL, can be used. Future studies should explore the use of wearable devices to assess ADL remotely and more continuously.
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Affiliation(s)
- Raquel Bouça-Machado
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS-Campus Neuroloígico, Torres Vedras, Portugal
| | - Adriana Fernandes
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
| | - Carlo Ranzato
- European School of Physiotherapy, Hogeschool Van Amsterdam, Amsterdam, Netherlands
| | - Duane Beneby
- European School of Physiotherapy, Hogeschool Van Amsterdam, Amsterdam, Netherlands
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal.,Algarve Biomedical Center Research Institute, Algarve, Portugal
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,CNS-Campus Neuroloígico, Torres Vedras, Portugal.,Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Minor M, Jaywant A, Toglia J, Campo M, O'Dell MW. Discharge Rehabilitation Measures Predict Activity Limitations in Patients With Stroke 6 Months After Inpatient Rehabilitation. Am J Phys Med Rehabil 2022; 101:761-767. [PMID: 34686630 DOI: 10.1097/phm.0000000000001908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to identify rehabilitation measures at discharge from acute inpatient stroke rehabilitation that predict activity limitations at 6 mos postdischarge. DESIGN This is a retrospective analysis of a prospective, longitudinal, observational cohort study. It was conducted in an acute inpatient rehabilitation unit at an urban, academic medical center. Activity limitations in patients ( N = 141) with stroke of mild-moderate severity were assessed with the activity measure for post-acute care at inpatient stroke rehabilitation discharge and 6-mo follow-up. Rehabilitation measures at discharge were investigated as predictors for activity limitations at 6 mos. RESULTS Measures of balance (Berg Balance Scale), functional limitations in motor-based activities (functional independence measure-motor subscore), and motor impairment (motricity index), in addition to discharge activities measure for post-acute care scores, strongly predicted activity limitations in basic mobility and daily activities at 6 mos (51% and 41% variance explained, respectively). Functional limitations in cognition (functional independence measure-cognitive subscore) and executive function impairment (Trail Making Test-part B), in addition to the discharge activities measure for post-acute care score, modestly predicted limitations in cognitively based daily activities at 6 mos (12% of variance). CONCLUSIONS Standardized rehabilitation measures at inpatient stroke rehabilitation discharge can predict future activity limitations, which may improve prediction of outcome post-stroke and aid in postdischarge treatment planning.
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Affiliation(s)
- Maria Minor
- From the MD Program (MM), Department of Rehabilitation Medicine (AJ, JT, MWO), and Department of Psychiatry (AJ), Weill Cornell Medicine, New York, New York; School of Health and Natural Sciences, Mercy College, Dobbs Ferry, New York (JT, MC); and New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York (AJ, JT, MWO)
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Filiberto DM, Jimenez BF, Lenart EK, Huang DD, Hare ME, Tolley EA, Magnotti LJ. Long-term functional outcomes after traumatic spine fractures. Surgery 2022; 172:460-465. [DOI: 10.1016/j.surg.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
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Peiris CL, Shields N, Lowe A, Tan G, Taylor NF. Functional status of community-dwelling older adults after inpatient rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims: Factors that influence functional ability in older adults after rehabilitation are not well understood. The aim of this study was to investigate how older people function in their community after being discharged from inpatient rehabilitation. Methods A cross-sectional study was undertaken of community-dwelling older adults (n=86, 75 ± 6 years) discharged from rehabilitation in the previous 12 months. Basic functional independence was assessed using the Functional Independence Measure and complex functional independence was assessed using the Frenchay Activities Index. Multiple regression analyses were conducted to assess any association between predetermined factors and function. Results Functional Independence Measure scores and physical activity levels after being discharged accounted for 50% of the variance in basic function (R2=0.50, F=40.75, P<0.001). Frenchay Activities Index scores, physical activity, age, sex and migrant status accounted for 68% of variance in complex function (R2=0.68, F=29.75, P<0.001). Conclusions Clinicians are encouraged to implement strategies to improve function at discharge from rehabilitation and to promote physical activity among older people at risk of poor function following rehabilitation.
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Affiliation(s)
- Casey L Peiris
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
| | - Nora Shields
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
| | - Anna Lowe
- National Centre for Sport & Exercise Medicine, Sheffield-Hallam University, Sheffield, UK
| | - Germaine Tan
- Northern Health, Northern Centre for Health Education and Research, Epping, Australia
| | - Nicholas F Taylor
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, Melbourne, Australia
- Eastern Health, Allied Health Clinical Research Office, Melbourne, Australia
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11
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Yoshitaka T, Shimaoka Y, Yamanaka I, Tanida A, Tanimoto J, Toda N, Akimori T, Hamawaki J. Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People. Prog Rehabil Med 2022; 7:20220026. [PMID: 35633759 PMCID: PMC9110876 DOI: 10.2490/prm.20220026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their
activities of daily living (ADL). This study aimed to identify and analyze factors
associated with ADL following hip fracture treatment. Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in
our hospital were enrolled. Among these, 103 patients who underwent acute- to
recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the
functional independence measure (mFIM) score was ≥70 before the fracture were finally
included in this study. Single and multiple regression analyses were performed to
identify the factors correlated with ADL. The mFIM at hospital discharge was set as the
outcome variable, and various clinical factors, such as fracture type, surgical
technique, serum and biological data, mini-mental state examination (MMSE) score, and
serial mFIM scores, were used as explanatory variables. Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at
discharge, and MMSE had the larger effect on the outcome. Receiver operating
characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an
MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks
postoperatively compared with those with an MMSE score of ≥21. Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL
outcomes following hip fracture. Cognitive impairment was the most important factor
affecting ADL; treatment and postoperative rehabilitation should be carefully considered
for cognitively disturbed patients from the acute phase after hip fracture.
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Affiliation(s)
- Teruhito Yoshitaka
- Department of Orthopedic Surgery, Hiroshima City Rehabilitation Hospital, Hiroshima, Japan
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12
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Kapadia N, Jovanovic L, Musselman K, Wang R, Marquez-Chin C, Popovic MR. Preliminary evaluation of the reliability and validity of the 3D printed Toronto Rehabilitation Institute-Hand Function Test in individuals with spinal cord injury. J Spinal Cord Med 2021; 44:S225-S233. [PMID: 34779739 PMCID: PMC8604468 DOI: 10.1080/10790268.2021.1961055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study objectives were to evaluate the inter-rater and intra-rater reliability; and criterion and construct validity of the 3D printed Toronto Rehabilitation Institute -Hand Function Test (3D TRI-HFT) in individuals with spinal cord injury (SCI). DESIGN Observational study. SETTING Inpatient Rehabilitation Hospital. PARTICIPANTS Four individuals with subacute and three individuals with chronic SCI. INTERVENTIONS Reliability and validity of the 3D TRI-HFT was assessed within two interventional studies. OUTCOME MEASURES Participants performed the 3D TRI-HFT, Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), Functional Independence Measure (FIM) and the Spinal Cord Independence Measure (SCIM) at baseline, after 20 and 40 sessions of therapy and at six month follow-up from baseline. 3D TRI-HFT assessments were graded at the time of performance and re-graded from the video recordings for purpose of reliability testing. Validity testing was done by comparing the scores on 3D TRI-HFT with the scores on the GRASSP, and the FIM and SCIM self care sub-scores. RESULTS The 3D TRI-HFT had high intra-rater and inter-rater reliability in sub-acute and chronic SCI with ICC values exceeding 0.99. Moderate to strong correlations were found between 3D TRI-HFT object manipulation scores and the FIM and SCIM self care sub-scores, with r values in the range of 0.7-0.8. Strong correlations were found between the various components of GRASSP and the 3D TRI-HFT, with r values exceeding 0.9. CONCLUSIONS The 3D TRI-HFT is a reliable and valid measure to assess unilateral hand gross motor function in individuals with SCI.
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Affiliation(s)
- Naaz Kapadia
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Correspondence to: Naaz Kapadia, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada; Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada, 550 University Avenue, Toronto, ONM5G 2A2, Canada; Ph: 416-597-3422 Ext: 7949. ; https://www.linkedin.com/in/naaz-desai-97099230/
| | - Lazar Jovanovic
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kristin Musselman
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Rosalie Wang
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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13
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Reid JC, Costa AP, Duong M, Ho T, Kruisselbrink R, Raina P, Kirkwood R, Jones A, Corriveau S, Griffith LE, Haider S, Marcucci M, Markle-Reid M, Morrison H, Raghavan N, Schumacher C, Vrkljan B, Junek M, Martin L, Patel A, Girolametto C, Pitre T, Beauchamp MK. Functional recovery following hospitalisation of patients diagnosed with COVID-19: a protocol for a longitudinal cohort study. BMJ Open 2021; 11:e053021. [PMID: 34903545 PMCID: PMC8671848 DOI: 10.1136/bmjopen-2021-053021] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/01/2022] Open
Abstract
INTRODUCTION COVID-19 is an international public health crisis with more than 132 million infections worldwide. Beyond acute infection, emerging data indicate patients diagnosed with COVID-19 may experience persistent sequelae similar to survivors of sepsis or acute respiratory syndromes, including mobility limitations and fatigue. However, there is limited evidence on the trajectory of functional recovery in those hospitalised with COVID-19. The primary aim of the Coronavirus Registry Functional Recovery (COREG-FR) study is to understand the trajectory of functional recovery among individuals hospitalised for COVID-19 over the medium (up to 6 months) and longer term (6-12 months) that will guide clinical care and optimal management of serious COVID-19 illness and recovery. METHODS AND ANALYSIS COREG-FR is a multicentre longitudinal cohort study. We will enrol a minimum of 211 adults age 18 years and older with COVID-19 from five hospitals. Participants will be followed from admission to hospital as an inpatient, to hospital discharge, and at 3-month, 6-month, 9-month and up to 12-month post-hospital discharge. We will conduct telephone interviews at ward admission and discharge, and telephone interviews plus in-person assessments of physical function and lung function at all remaining follow-ups. Our primary outcome is the Activity Measure for Post-Acute Care mobility scale measured at all time points. We will conduct linear mixed effects regression analyses to explore determinants of functional outcomes after COVID-19 illness. Subgroup analyses based on age (≤65 vs >65 years), frailty status (Clinical Frailty Scale score ≤4 vs >5) and variants of concern will be conducted. ETHICS AND DISSEMINATION COREG-FR has been approved by Research Ethics Boards at participating sites. We will disseminate this work through peer-reviewed manuscripts, presentations at national and international meetings and through the established COREG website (www.coregontario.ca). COREG-FR is designed as a data platform for future studies evaluating COVID-19 recovery. TRIAL REGISTRATION NUMBER NCT04602260; Pre-results.
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Affiliation(s)
- Julie C Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, Kitchener, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terence Ho
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Kruisselbrink
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, Kitchener, Ontario, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
| | - Renata Kirkwood
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Jones
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, Kitchener, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sophie Corriveau
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shariq Haider
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maura Marcucci
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hope Morrison
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Natya Raghavan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Connie Schumacher
- Department of Nursing, Brock University, St. Catharines, Ontario, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Mats Junek
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Leslie Martin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ameen Patel
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carla Girolametto
- Department of Research, Innovation, and Clinical Trials, Grand River Hospital, Kitchener, Ontario, Canada
| | - Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, Kitchener, Ontario, Canada
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
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14
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Ģiga L, Pētersone A, Čakstiņa S, Bērziņa G. Comparison of content and psychometric properties for assessment tools used for brain tumor patients: a scoping review. Health Qual Life Outcomes 2021; 19:234. [PMID: 34625062 PMCID: PMC8501604 DOI: 10.1186/s12955-021-01863-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/15/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS To determine the most frequently utilized functional status assessment instruments for patients with brain tumors, compare their contents, using the International Classification of Functioning, Disability and Health (ICF), and their psychometric properties. METHODS A scoping review was conducted to explore possible assessment instruments and summarize the evidence. A systematic literature search was performed for identification of the frequently used functional assessment tool in clinical trials in PubMed, ScienceDirect, and ProQuest databases. The content of most used instruments was linked to the ICF categories. The psychometric qualities of these assessment tools were systematically searched and analyzed. RESULTS Nine most used assessment tools in clinical trials were identified. The most frequently used assessment instrument is the Karnofsky Performance Scale, which is developed for a general assessment of oncological patients. Out of four self-assessment tools, two were disease-specific (EORTC QLQ-BN20 and FACT-Br), EORTC QLQ-C30 has been shown good psychometric properties in patients with brain tumors as well as in patients with various oncological diseases, similar to the SF-36, it is used in patients with brain tumors as well as in patients with various diseases. The Functional Independence Measure and the Barthel Index were two objective assessment tools that described functioning, but two were neuropsychological tests (MMSE and Trial Making Test). Two hundred eighty-three meaningful concepts were identified and linked to 102 most relevant second-level categories covering all components of the ICF. Forty-nine studies reporting psychometric properties of those nine assessment tools were identified, indicating good reliability and validity for all the instruments. CONCLUSION Nine most frequently utilized functional status assessment instruments for patients with brain tumors represent all components of the ICF and have good psychometric properties. However, the choice of the tool depends on the clinical question posed and the aim of its use.
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Affiliation(s)
| | - Anete Pētersone
- Riga Stradiņš University, Riga, Latvia.,Riga East University Hospital, Riga, Latvia
| | | | - Guna Bērziņa
- Riga Stradiņš University, Riga, Latvia. .,Riga East University Hospital, Riga, Latvia. .,Department of Rehabilitation, Riga Stradiņš University, Anniņmuižas Boulevard 26a, Riga, 1067, Latvia.
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15
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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16
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O'Dell MW, Jaywant A, Frantz M, Patel R, Kwong E, Wen K, Taub M, Campo M, Toglia J. Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation. Arch Phys Med Rehabil 2021; 102:645-655. [PMID: 33440132 DOI: 10.1016/j.apmr.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DESIGN Retrospective, longitudinal cohort study. SETTING Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS Among 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. INTERVENTION None. MAIN OUTCOME MEASURES Changes in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as "improved," "unchanged," or "declined" between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). RESULTS For the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. CONCLUSIONS Despite group gains from DC to 6M and an apparent "plateau" after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.
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Affiliation(s)
- Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
| | - Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Megan Frantz
- Kaiser Foundation Rehabilitation Center, Vallejo, California
| | - Ruchi Patel
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Erica Kwong
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Karen Wen
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Michael Taub
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York
| | - Marc Campo
- Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; Department of Allied Health and Natural Sciences, Mercy College, Dobbs Ferry, New York
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Functioning Profiles of Young People with MS in Inpatient Rehabilitation: Data from the National Rehabilitation Reporting System in Canada. Mult Scler Relat Disord 2020; 45:102418. [DOI: 10.1016/j.msard.2020.102418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/24/2020] [Accepted: 07/22/2020] [Indexed: 01/03/2023]
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18
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Askew RL, Capo-Lugo CE, Sangha R, Naidech A, Prabhakaran S. Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1366-1372. [PMID: 33032781 PMCID: PMC7547147 DOI: 10.1016/j.jval.2020.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/23/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION We aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure. METHODS Mean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences. RESULTS Seven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44). CONCLUSIONS Findings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.
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Affiliation(s)
- Robert L Askew
- Department of Psychology, Stetson University, DeLand, FL, USA.
| | - Carmen E Capo-Lugo
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajbeer Sangha
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew Naidech
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shyam Prabhakaran
- Department of Neurology, The University of Chicago, Chicago, IL, USA
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19
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Long-term functional outcomes after traumatic popliteal artery injury: A 20-year experience. J Trauma Acute Care Surg 2019; 88:197-206. [DOI: 10.1097/ta.0000000000002548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Seo YJ, Park SR, Lee JH, Jung C, Choi KH, Hong SK, Kim W. Feasibility, safety, and functional recovery after active rehabilitation in critically ill surgical patients. Aust Crit Care 2019; 33:281-286. [PMID: 31522973 DOI: 10.1016/j.aucc.2019.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The characteristics of critically ill surgical patients differ from those of medical patients. Few studies have evaluated rehabilitation in surgical intensive care units (SICUs), particularly in non-Western countries and in elderly patients. OBJECTIVE The objective of this study was to investigate the rehabilitation characteristics, safety, and functional recovery in non-Western SICU patients. METHODS Data from patients who received active rehabilitation in 2016 were retrospectively reviewed. Clinical characteristics, functional recovery, and safety were investigated and compared in patients aged <65 or ≥65 years. Potential safety events were also compared between the two age groups and according to the reason for SICU admission. RESULTS Data from 157 patients were included in the analysis. The number of patients who were able to stand or walk increased from the beginning of rehabilitation to the time of ICU discharge (from 52 to 102 patients, P < 0.01). The Activity Measure for Post-Acute Care (AM-PAC) score also increased during rehabilitation (from 11.6 to 13.9, P < 0.01). Functional recovery did not differ between the two age groups. During 780 rehabilitation sessions, 23 potential safety events (3.0%) were noted; no significant differences were seen between the two age groups. A significant difference was noted when patients were grouped according to the reason for SICU admission (1.7% in postoperative care patients vs 4.5% in patients admitted for other reasons, P = 0.02). CONCLUSIONS Active rehabilitation in critically ill surgical patients is feasible and safe and resulted in improved mobility, regardless of age. However, the reason for SICU admission should be considered.
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Affiliation(s)
- Yu Jin Seo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Sae Rom Park
- Division of Acute Care Surgery, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Jung Hoon Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Chul Jung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Suk-Kyung Hong
- Division of Acute Care Surgery, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
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21
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Acute Rehabilitation of a 27-Year-Old Man With Failure to Thrive. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Bravo G, Richards CL, Corriveau H, Trottier L. Converting Functional Autonomy Measurement System Scores of Patients Post-Stroke to FIM Scores. Physiother Can 2019; 70:349-355. [PMID: 30745720 DOI: 10.3138/ptc.2017-82] [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: 11/20/2022]
Abstract
Purpose: The Functional Independence Measure (FIM) is widely used to assess persons post-stroke. The Quebec government has selected the Functional Autonomy Measurement System (SMAF) for use in all care settings. In this article, we propose simple equations to convert SMAF scores to FIM scores for persons undergoing post-stroke rehabilitation. Method: Persons post-stroke (n=143) from three rehabilitation centres were assessed at admission and discharge using the FIM and SMAF. The sample was randomly split into derivation and validation data sets. Regression analysis was performed on the first data set to derive a conversion equation at each time point. The validity of the equations was measured using correlation coefficients, and differences between the observed and predicted FIM scores were computed from the second data set. Results: The relationship between the SMAF and FIM scores was linear at admission but quadratic at discharge. The proposed equations are, at admission, FIM=139-1.5×SMAF and, at discharge, FIM=118-0.018×SMAF2. The observed and predicted FIM scores were highly correlated in the validation data set (rs=0.92 and 0.93 at admission and discharge, respectively). Furthermore, the equations performed well in classifying stroke severity compared with a classification based on the observed FIM scores. Conclusions: SMAF scores can be reliably converted to FIM scores using the proposed equations, thus facilitating international trials in stroke rehabilitation.
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Affiliation(s)
- Gina Bravo
- Department of Community Health Sciences.,Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke
| | - Carol L Richards
- Department of Rehabilitation, Faculty of Medicine, Université Laval.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Que
| | - Hélène Corriveau
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Lise Trottier
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke
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23
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Shahan CP, Stavely TC, Croce MA, Fabian TC, Magnotti LJ. Long-Term Functional Outcomes after Blunt Cerebrovascular Injury: A 20-Year Experience. Am Surg 2018. [DOI: 10.1177/000313481808400430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since blunt cerebrovascular injury (BCVI) became increasingly recognized more than 20 years ago, significant improvements have been made in both diagnosis and treatment. Little is known regarding long-term functional outcomes in BCVI. The purpose of this study was to evaluate the impact of BCVI on those long-term outcomes. All patients with BCVI from 1996 to 2014 were identified from the trauma registry. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care. Multiple regression analysis was performed to identify potential predictors of outcomes. A total of 509 patients were identified. Overall mortality was 18 per cent (BCVI-related = 1%). Of the 415 survivors, follow-up was obtained in 77 (19%). Mean follow-up was five years, with a maximum of 19 years. Mean age and injury severity score were 47 and 25, respectively. Six (8%) patients suffered strokes. Mean Activity Measure for Post-Acute Care scores were 59 (mobility), 58 (activity), and 44 (cognitive function), each indicating significant impairment compared with normal. Multiple regression models identified 1) age as a predictor of decreased mobility, 2) injury severity score as a predictor of decreased mobility, activity, and cognitive function, and 3) stroke as a predictor of decreased activity, cognitive function, and likely mobility. Development of stroke and increased injury severity resulted in worse long-term functional outcomes after BCVI. Thus, stroke prevention with optimal diagnostic and treatment algorithms remains critical in the successful treatment of BCVI because it has significant impact on long-term functional outcomes and is the only modifiable predictor of outcomes in patients after BCVI.
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Affiliation(s)
- Charles P. Shahan
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Taylor C. Stavely
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martin A. Croce
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Timothy C. Fabian
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Louis J. Magnotti
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, Tennessee
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24
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Chang FH, Ni P, Chiou HY, Hou WH, Jette AM. Cultural and semantic equivalence of the activity measure post-acute care (AM-PAC) after its translation into Mandarin Chinese. Disabil Rehabil 2018; 41:1937-1942. [PMID: 29560734 DOI: 10.1080/09638288.2018.1453874] [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: 10/17/2022]
Abstract
Purpose: The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese. Method: This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis. Results: Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI adjusted conversion table was generated to transform the raw scores of the measure for comparisons between the two countries. Conclusions: This study provides evidence to support the conceptual equivalence of the AM-PAC when used in rehabilitation patients between American and Taiwanese cultural contexts. Some DFI items between the two groups were found, suggesting that some differences in semantic understanding of these items between cultures require cross-cultural adjustments. Implications for Rehabilitation Cultural equivalence needs to be tested before applying a clinical measure to another context. The findings of this study supported the three activity domains that the Activity Measure Post-Acute Care measures: Basic Mobility, Daily Activity, and Applied Cognition, which are all important rehabilitation outcomes that need to be assessed and monitored across rehabilitation settings. Differential item functioning was observed between the English and Chinese versions of the Activity Measure Post-Acute Care, indicating that linguistic and cultural differences across countries need to be adjusted for before using the translated measure in clinical practice.
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Affiliation(s)
- Feng-Hang Chang
- a Graduate Institute of Injury Prevention and Control, College of Public Health , Taipei Medical University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan
| | - Pengsheng Ni
- c Health & Disabilities Research Institute , Boston University, School of Public Health , Boston , MA , USA
| | - Hung-Yi Chiou
- d School of Public Health, College of Public Health , Taipei Medical University , Taipei , Taiwan.,e Health Policy and Care Research Center, College of Public Health , Taipei Medical University , Taipei , Taiwan
| | - Wen-Hsuan Hou
- b Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan.,f Master Program in Long-Term Care and School of Gerontology Health Management, College of Nursing , Taipei Medical University , Taipei , Taiwan.,g Department of Physical Medicine and Rehabilitation , Taipei Medical University Hospital , Taipei , Taiwan
| | - Alan M Jette
- c Health & Disabilities Research Institute , Boston University, School of Public Health , Boston , MA , USA
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Navarro-Pujalte E, Gacto-Sánchez M, Montilla-Herrador J, Escolar-Reina P, Ángeles Franco-Sierra M, Medina-Mirapeix F. Sensitivity to change of mobility measures in musculoskeletal conditions on lower extremities in outpatient rehabilitation settings. Disabil Rehabil 2018; 41:1268-1274. [PMID: 29327598 DOI: 10.1080/09638288.2018.1424948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings. BACKGROUND Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported. METHODS Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age ± SD = 36.7 ± 11.1). MAIN OUTCOME MEASURES Mobility Activities Measure scales for lower extremity; PF-10; and PSFS. RESULTS All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively). CONCLUSIONS The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients' mobility. Implications for rehabilitation All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods. Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale, especially during the first four weeks of treatment. The summary measure also detected a higher percentage of participants with positive change that exceeded the minimal detectable change than the Patient-Specific Functional Scale and the Physical Functioning Scale at the first follow-up period. By demonstrating their consistency and sensitivity to change, the three Mobility Activities Measures scales can now be considered in order to track patients' functional progress. Mobility Activities Measure can be therefore used in patients with musculoskeletal conditions across outpatient rehabilitation settings to provide estimates of change in mobility activities focusing on the lower extremity.
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Affiliation(s)
| | - Mariano Gacto-Sánchez
- b Department of Physical Therapy , EUSES University School, University of Girona , Girona , Spain
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Chang FH, Liou TH, Brodersen J, Comins JD. Adaptation of the Activity Measure Post-Acute Care (AM-PAC) from English to Mandarin using the dual-panel translation approach. Disabil Rehabil 2017. [PMID: 28643571 DOI: 10.1080/09638288.2017.1339210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aims of this study were to translate and adapt the Activity Measure Post-Acute Care (AM-PAC) from US English to Mandarin using the dual-panel method, and to assess its psychometric properties in an outpatient rehabilitation setting. METHODS The AM-PAC outpatient short forms were translated using the dual-panel method. The translated AM-PAC was tested in 550 Chinese-speaking rehabilitation outpatients. Floor and ceiling effects were evaluated and internal consistency was assessed using Cronbach's alpha. Spearman correlation was used to assess the concurrent validity of the AM-PAC with the Barthel Index and the Mini-Mental State Examination. Test-retest reliability was determined by administering the AM-PAC twice to 57 participants within a 2-7 day interval. RESULTS Some ceiling effects (>20%) were observed in the Applied Cognition subscale. All subscales exhibited good internal consistency (α > 0.70). Supportive evidence for concurrent validity was found in strong correlations between Basic Mobility subscale and Barthel Index (r = 0.68), and Daily Activity subscale and Barthel Index (r = 0.70); and moderate correlations between Applied Cognition subscale and Mini-Mental State Examination (r = 0.50). Test-retest reliability for all subscales was high (intraclass correlation coefficient =0.89-0.98). CONCLUSIONS The dual-panel approach was successfully used to translate the AM-PAC from English to Mandarin. Adequate reliability and validity in rehabilitation outpatients in Taiwan were established. Implications for Rehabilitation The dual-panel method is a modern translation technique, which was successfully used to adapt the Activity Measure Post-Acute Care from English to Mandarin. The Mandarin version of Activity Measure Post-Acute Care demonstrates adequate internal consistency, concurrent validity, and test-retest reliability in rehabilitation outpatients. The Activity Measure Post-Acute Care is superior to existing functional measures used to monitor activity performance for rehabilitation patients in Taiwan.
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Affiliation(s)
- Feng-Hang Chang
- a Graduate Institute of Injury Prevention and Control , College of Public Health, Taipei Medical University , Taipei , Taiwan.,b Department of Physical Medicine and Rehabilitation , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan
| | - Tsan-Hon Liou
- b Department of Physical Medicine and Rehabilitation , School of Medicine, College of Medicine, Taipei Medical University , Taipei , Taiwan.,c Department of Physical Medicine and Rehabilitation , Shuang Ho Hospital, Taipei Medical University , Taipei , Taiwan
| | - John Brodersen
- d Center for Research in General Medicine , Institute of Public Health, Copenhagen University , Copenhagen , Denmark.,e Primary Health Care Research Unit , Centre of Research & Education in General Practice , Zealand Region , Denmark
| | - Jonathan D Comins
- d Center for Research in General Medicine , Institute of Public Health, Copenhagen University , Copenhagen , Denmark.,f Department of Rheumatology , University Hospital , Zealand Region , Denmark.,g Health & Disabilities Research Institute , Boston University, School of Public Health , Boston , MA , USA
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Bai C, Li K, Guo A, Fei Q, Li D, Li J, Wang B, Yang Y. Indication for hypertrophy posterior longitudinal ligament removal in anterior decompression for cervical spondylotic myelopathy. Medicine (Baltimore) 2017; 96:e7043. [PMID: 28591038 PMCID: PMC5466216 DOI: 10.1097/md.0000000000007043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022] Open
Abstract
The retrospective study aimed to investigate the indication for hypertrophy posterior longitudinal ligament (HPLL) removal in anterior decompression for cervical spondylotic myelopathy (CSM). A total of 138 consecutive patients with CSM were divided into 2 groups with developmental cervical stenosis (DCS) (group S) and non-DCS (group N), according to the Pavlov ratio. These 2 groups were subdivided into 2 further subgroups, according to whether HPLL was removed or preserved: group SR (49 patients) and group SP (32 patients) in group S, group NR (21 patients) and group NP (36 patients) in group N. The modified Japanese Orthopedic Association score (mJOA), the modified recovery rate (mRR), quality of life (QoL), and relevant clinical data were used for clinical and radiological evaluation. The mJOA scores improved from 7.3 ± 2.2 to 15.0 ± 1.8 in the SR group and from 7.9 ± 2.3 to 14.2 ± 1.5 in the SP group (P = .036), with postoperative QoL significantly higher in the SR group than the SP group. A reduction in the diameter of enlarged spinal canals occurred at a significantly faster rate in the SP group compared with the SR group (P = .002). Multivariate regression analyses showed removal of HPLL correlated with mJOA scores (coefficient = 7.337, P = .002), mRR (%) (coefficient = 9.117, P = .005), PCS (coefficient = 12.129, P < .001), and MCS (coefficient = 14.31, P < .001) in the S group at 24 months postoperatively, while removal of HPLL did not correlate with clinical outcomes in the N group. The HPLL should, therefore, be removed when mobility was reduced and the spinal cord remained compressed after anterior decompression procedures in the patients with DCS. However, in non-DCS patients, it remains unclear as to whether removal of HPLL provides any clinical benefit, thus, HPLL removal may not be necessary.
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Affiliation(s)
- Chengrui Bai
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
| | - Kanghua Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ai Guo
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
| | - Dong Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
| | - Jinjun Li
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
| | - Bingqiang Wang
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital Affiliated of Capital Medical University, Beijing
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Toglia J, Askin G, Gerber LM, Taub MC, Mastrogiovanni AR, O'Dell MW. Association Between 2 Measures of Cognitive Instrumental Activities of Daily Living and Their Relation to the Montreal Cognitive Assessment in Persons With Stroke. Arch Phys Med Rehabil 2017; 98:2280-2287. [PMID: 28478128 DOI: 10.1016/j.apmr.2017.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/28/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To explore the relation between a computer adaptive functional cognitive questionnaire and a performance-based measure of cognitive instrumental activities of daily living (C-IADL) and to determine whether the Montreal Cognitive Assessment (MoCA) at admission can identify those with C-IADL difficulties at discharge. DESIGN Prospective cohort study. SETTING Acute inpatient rehabilitation unit of an academic medical center. PARTICIPANTS Inpatients (N=148) with a diagnosis of stroke (mean age, 68y; median, 13d poststroke) who had mild cognitive and neurological deficits. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Admission cognitive status was assessed by the MoCA. C-IADL at discharge was assessed by the Executive Function Performance Test (EFPT) bill paying task and Activity Measure of Post-Acute Care (AM-PAC) Applied Cognition scale. RESULTS Greater cognitive impairment on the MoCA was associated with more assistance on the EFPT bill paying task (ρ=-.63; P<.01) and AM-PAC Applied Cognition scale (ρ=-.43; P<.01). This relation was nonsignificant for higher MoCA scores and EFPT bill paying task scores. The AM-PAC Applied Cognition scale and the EFPT bill paying task had low agreement in classifying functional performance (Cohen's κ=.20). A receiver operating characteristic curve identified optimal MoCA cutoff scores of 20 and 21 for classifying EFPT bill paying task status and AM-PAC Applied Cognition scale status, respectively. For values above 20 and 21, sensitivity increased whereas specificity decreased for classifying functional deficits. Approximately one third of the participants demonstrated C-IADL deficits on at least 1 C-IADL measure at discharge despite having a MoCA score of ≥26 at admission. CONCLUSIONS Questionnaire and performance-based methods of assessment appear to yield different estimates of C-IADL. Low MoCA scores (<20) are more likely to identify those with C-IADL deficits on the EFPT bill paying task. The results suggest that C-IADL should be assessed in those who have mild or no cognitive difficulties at admission.
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Affiliation(s)
- Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY; Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY.
| | - Gulce Askin
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY
| | - Linda M Gerber
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY
| | | | - Andrea R Mastrogiovanni
- Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY; Weill Cornell Medicine, New York, NY
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Impact of early operative pelvic fixation on long-term self-reported outcome following severe pelvic fracture. J Trauma Acute Care Surg 2017; 82:444-450. [DOI: 10.1097/ta.0000000000001346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Shahan CP, Croce MA, Fabian TC, Magnotti LJ. Impact of Continuous Evaluation of Technology and Therapy: 30 Years of Research Reduces Stroke and Mortality from Blunt Cerebrovascular Injury. J Am Coll Surg 2017; 224:595-599. [PMID: 28111193 DOI: 10.1016/j.jamcollsurg.2016.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blunt cerebrovascular injury (BCVI) was underdiagnosed until the 1990s when blunt carotid injuries were found to be more common than historically described. Technological advancements and regionalization of trauma care have resulted in increased screening and improved diagnosis of BCVI. The aim of this study was to demonstrate that systematic evaluation of the screening and diagnosis of BCVI, combined with early and aggressive treatment, have led to reductions in BCVI-related stroke and mortality. STUDY DESIGN Patients with BCVI from 1985 to 2015 were identified and stratified by age, sex, and Injury Severity Score. BCVI-related stroke and mortality rates were then calculated and compared. Patients were divided into 5 eras based on changes in technology, screening, or treatment algorithms at our institution. RESULTS Five hundred and sixty-four patients were diagnosed with BCVI: 508 carotid artery and 267 vertebral artery injuries. Sixty-five percent of patients were male, mean age was 41 years, and mean Injury Severity Score was 27. Incidence of BCVI diagnosis increased from 0.33% to approximately 2% of all blunt trauma (p < 0.001) during the study period. Ninety (14%) patients suffered BCVI-related stroke, with the incidence of stroke significantly decreasing over time from 37% to 5% (p < 0.001). Twenty-eight (5%) patients died as a direct result of BCVI, and BCVI-related mortality also decreased significantly over time from 24% to 0% (p < 0.001). CONCLUSIONS Although increased screening has resulted in a higher incidence of injuries over time, BCVI-related stroke and mortality have decreased significantly. Continuous critical evaluation of evolving technology and diagnostic and treatment algorithms has contributed substantially to those improved outcomes. Appraisals of technological advances, preferably through prospective multi-institutional studies, should advance our understanding of these injuries and lead to even lower stroke rates.
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Affiliation(s)
| | - Martin A Croce
- University of Tennessee Health Science Center, Memphis, TN
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Vanbellingen T, Ottiger B, Pflugshaupt T, Mehrholz J, Bohlhalter S, Nef T, Nyffeler T. The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index. Front Neurol 2016; 7:152. [PMID: 27725808 PMCID: PMC5035834 DOI: 10.3389/fneur.2016.00152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Good responsive functional outcome measures are important to measure change in stroke patients. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients. Methods One hundred eighteen stroke patients participated in this study. Admission and discharge score distributions of the LIMOS motor, LIMOS cognition and communication, FIM motor and FIM cognition, and BI were analyzed based on skewness and kurtosis. Floor and ceiling effects of the scales were determined. Internal responsiveness was assessed with t-tests, effect sizes (ESs), and standardized response means (SRMs). External responsiveness was investigated with linear regression analyses. Results The LIMOS motor and LIMOS cognition and communication subscales were more responsive, expressed by higher ESs (ES = 0.65, SRM = 1.17 and ES = 0.52, SRM = 1.17, respectively) as compared with FIM motor (ES = 0.54, SRM = 0.96) and FIM cognition (ES = 0.41, SRM = 0.88) and the BI (ES = 0.41, SRM = 0.65). The LIMOS subscales showed neither floor nor ceiling effects at admission and discharge (all <15%). In contrast, ceiling effects were found for the FIM motor (16%), FIM cognition (15%) at discharge and the BI at admission (22%) and discharge (43%). LIMOS motor and LIMOS cognition and communication subscales significantly correlated (p < 0.0001) with a change in the FIM motor and FIM cognition subscales, suggesting good external responsiveness. Conclusion We found that the LIMOS motor and LIMOS cognition and communication, which are ICF-based multidisciplinary standardized observation scales, might have the potential to better detect changes in functional outcome of stroke patients, compared with the FIM motor and FIM cognition and the BI.
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Affiliation(s)
- Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Beatrice Ottiger
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Tobias Pflugshaupt
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Jan Mehrholz
- Wissenschaftliches Institut, Klinik Bavaria in Kreischa GmbH , Kreischa , Germany
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital , Luzern , Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Oncology EDGE Task Force on Prostate Cancer Outcomes: A Systematic Review of Outcome Measures for Functional Mobility. REHABILITATION ONCOLOGY 2016. [DOI: 10.1097/01.reo.0000000000000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Clark F, Sanders K, Carlson M, Blanche E, Jackson J. Synthesis of Habit Theory. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/15394492070270s103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the past century, numerous researchers and theorists have argued that human lives are largely shaped by the nonreflective realm of habit. Beyond this observation, however, scholarly conceptualizations of habit are widely divergent, ranging from neural-level to culturally saturated macro-level constructs. To clarify the multiple ways that habit has been construed and is related to rehabilitation, the authors present a typology of nine categories of habits: habit as tic; habit as neural networks; habit as conditioned responses; habit as addiction; habit as single, everyday activities; habit as routine; habit as custom, ritual, rite, or ceremony; habit as character; and habit as habitus. Although these categories overlap and share common properties, their conceptual features differ along several dimensions. Each category offers a distinct perspective from which to understand the role of habit in the lives of clients undergoing rehabilitation, which the authors illustrate using examples from the Pressure Ulcer Prevention Study (PUPS), a qualitative study on the contextual factors that lead to serious recurrent pressure ulcers in people with spinal cord injuries. The authors argue that habit is a ubiquitous, protean force that presents itself in many interlinking forms, steering the course of human lives in both health-promoting and destructive directions. To have the greatest effect on health and participation, rehabilitation professionals must examine the nuanced ways that habit may operate both in the lives of clients and in professional practice.
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Are CMS G-Code Functional Limitation Severity Modifiers Responsive to Change Across an Episode of Outpatient Rehabilitation? Phys Ther 2015; 95:1650-9. [PMID: 26294681 DOI: 10.2522/ptj.20150003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 08/04/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services has mandated rehabilitation professionals to document patients' impairment levels. There is no evidence of responsiveness to change of functional limitation severity modifier codes. OBJECTIVE The purpose of this study was to assess the validity of G-code functional limitation severity modifier codes in determining change in function. DESIGN This was a retrospective observational study. METHODS Patients completed the Activity Measure for Post-Acute Care (AM-PAC) and were assigned G-codes, with severity modifiers based on AM-PAC scores at initial and follow-up visits. Patients were classified as having AM-PAC scores in the upper or lower range for each severity modifier, and sensitivity, specificity, and positive and negative predictive values for change in severity modifier level and odds of changing by one severity modifier level using a change in AM-PAC score of at least 1 minimal detectable change at the 95% confidence interval (MDC95) as the standard were determined. RESULTS Sensitivity and specificity of change in severity modifier in determining change in function were dependent on patients' initial AM-PAC scores. Improvement in severity modifier level was 2.2 to 4.5 times more likely with scores at the higher end of the range within a severity modifier level than with scores in the lower end of the range. Decline in severity modifier level was 2.7 to 4.8 times more likely with scores at the lower end of the range within a severity modifier than with scores in the higher end of the range. LIMITATIONS Data were from one health care system, and most patients had orthopedic conditions. The MDC95 for AM-PAC tool may not be the best standard for defining functional change. CONCLUSIONS The G-code functional limitation severity modifier system may not be valid for determining change in function and is not recommended for determining if patients have changed over the course of outpatient therapy.
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Robinson-Smith G, Harmer C, Sheeran R, Bellino Vallo E. Couples' Coping After Stroke-A Pilot Intervention Study. Rehabil Nurs 2015; 41:218-29. [PMID: 25865578 DOI: 10.1002/rnj.213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/10/2022]
Abstract
PURPOSE This mixed-methods pilot study examined the impact of a psychoeducational intervention (PEI) to expand coping skills and identify themes for focused nursing strategies to assist poststroke couples. DESIGN Outcome variables, including dyadic coping, quality of life, depression, and self-care self-efficacy, were measured in experimental and control groups initially and after PEI was created with experimental couples in six home sessions. METHOD Repeated measures analysis of variance compared control (n = 5 stroke survivors; n = 5 spouses) and experimental groups' (n = 5 stroke survivors; n = 5 spouses) on outcomes. FINDINGS Significant increase occurred in experimental group stroke survivors in coping by oneself and quality of life; depressive symptoms decreased. Significant increase in positive dyadic coping occurred for experimental group spouses. PEI intervention generated a major theme. CONCLUSIONS Nurse-initiated cognitive coping intervention was supported by experimental group's elements. CLINICAL RELEVANCE Nurses may use psychoeducational techniques to motivate stroke couples.
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Affiliation(s)
| | | | - Robin Sheeran
- Bryn Mawr Rehabilitation Hospital, Main Line Health System, Malvern, PA, USA
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Zhang Y, Zhou F, Sun Y. Assessment of health-related quality of life using the SF-36 in Chinese cervical spondylotic myelopathy patients after surgery and its consistency with neurological function assessment: a cohort study. Health Qual Life Outcomes 2015; 13:39. [PMID: 25889912 PMCID: PMC4380110 DOI: 10.1186/s12955-015-0237-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to calculate the responsiveness and statistically prove the reliability of the Medical Outcomes Study Short Form Health Survey (SF-36) in a prospective cohort study. We investigated the profile of mid-term health-related quality of life (QOL) outcome assessments after surgery for cervical spondylotic myelopathy (CSM) and determined the consistency of the SF-36 assessments of neurological function. Methods A total of 142 consecutive patients with CSM who underwent surgery were enrolled in the study. QOL and neurological assessments were evaluated before and at 3 months, 1 year, and more than 2 years postoperatively. We subsequently analyzed the reliability and responsiveness of the SF-36 and the QOL profile for its consistency regarding the neurological function assessment. Results (1) Cronbach’s α ranged from 0.73 (for role-emotional) to 0.85 (for physical function). The effect size ranged from 0.57 to 0.93 for SF-36’s eight scales. Minimum clinically important differences (MCIDs) in the physical scores (PCS) and mental scores (MCS) were 5.52 and 3.43, respectively. (2) The scores for all SF-36 scale sections indicated that patients with CSM were significantly impaired compared with healthy adults. SF-36 PCS and MCS peaked at 17.7 and 18.9 months after surgery, respectively. (3) At 3 months after surgery, improvements in the modified Japanese Orthopaedic Association (mJOA) scores significantly correlated only with patients’ physical function and bodily pain scores. At 1 year after surgery, improvements in the mJOA scores significantly correlated with physical function, general health, social function, and role-emotional. At the final follow-up, improvements in the mJOA scores significantly correlated with physical function, vitality, and role-emotional. Conclusions SF-36 is reliable and has moderate responsiveness for evaluating patients with CSM, with MCID at 5.52 for the PCS and at 3.43 for the MCS. The preoperative QOL of the CSM patients was severely impaired compared with that of the normal population. Postoperatively, each SF-36 domain improved to a variable degree. During the early stage of recovery the mJOA score improvements correlated with SF-36’s physical component domains, whereas during the later stages the improvements were associated with the mental component domains.
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Affiliation(s)
- Yilong Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China.
| | - Feifei Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China.
| | - Yu Sun
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China.
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Does activity limitation predict discharge destination for postacute care patients? Am J Phys Med Rehabil 2015; 93:782-90. [PMID: 24800717 DOI: 10.1097/phm.0000000000000097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to examine the ability of different domains of activity limitation to predict discharge destination (home vs. nonhome settings) 1 mo after hospital discharge for postacute rehabilitation patients. DESIGN A secondary analysis was conducted using a data set of 518 adults with neurologic, lower extremity orthopedic, and complex medical conditions followed after discharge from a hospital into postacute care. Variables collected at baseline include activity limitations (basic mobility, daily activity, and applied cognitive function, measured by the Activity Measure for Post-Acute Care), demographics, diagnosis, and cognitive status. The discharge destination was recorded at 1 mo after being discharged from the hospital. RESULTS Correlational analyses revealed that the 1-mo discharge destination was correlated with two domains of activity (basic mobility and daily activity) and cognitive status. However, multiple logistic regression and receiver operating characteristic curve analyses showed that basic mobility functioning performed the best in discriminating home vs. nonhome living. CONCLUSIONS This study supported the evidence that basic mobility functioning is a critical determinant of discharge home for postacute rehabilitation patients. The Activity Measure for Post-Acute Care-basic mobility showed good usability in discriminating home vs. nonhome living. The findings shed light on the importance of basic mobility functioning in the discharge planning process.
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Hula WD, Cherney LR, Worrall LE. Setting a Research Agenda to Inform Intensive Comprehensive Aphasia Programs. Top Stroke Rehabil 2015; 20:409-20. [DOI: 10.1310/tsr2005-409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Oncology Section EDGE Task Force on Breast Cancer Outcomes: A Systematic Review of Outcome Measures for Functional Mobility. REHABILITATION ONCOLOGY 2015. [DOI: 10.1097/01893697-201533030-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patients undergoing subacute physical rehabilitation following an acute hospital admission demonstrated improvement in cognitive functional task independence. ScientificWorldJournal 2014; 2014:810418. [PMID: 25544961 PMCID: PMC4270116 DOI: 10.1155/2014/810418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/11/2014] [Indexed: 11/25/2022] Open
Abstract
Objective. This study investigated cognitive functioning among older adults with physical debility not attributable to an acute injury or neurological condition who were receiving subacute inpatient physical rehabilitation. Design. A cohort investigation with assessments at admission and discharge. Setting. Three geriatric rehabilitation hospital wards. Participants. Consecutive rehabilitation admissions (n = 814) following acute hospitalization (study criteria excluded orthopaedic, neurological, or amputation admissions). Intervention. Usual rehabilitation care. Measurements. The Functional Independence Measure (FIM) Cognitive and Motor items. Results. A total of 704 (86.5%) participants (mean age = 76.5 years) completed both assessments. Significant improvement in FIM Cognitive items (Z-score range 3.93–8.74, all P < 0.001) and FIM Cognitive total score (Z-score = 9.12, P < 0.001) occurred, in addition to improvement in FIM Motor performance. A moderate positive correlation existed between change in Motor and Cognitive scores (Spearman's rho = 0.41). Generalized linear modelling indicated that better cognition at admission (coefficient = 0.398, P < 0.001) and younger age (coefficient = −0.280, P < 0.001) were predictive of improvement in Motor performance. Younger age (coefficient = −0.049, P < 0.001) was predictive of improvement in FIM Cognitive score. Conclusions. Improvement in cognitive functioning was observed in addition to motor function improvement among this population. Causal links cannot be drawn without further research.
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Kersten P, McPherson KM, Kayes NM, Theadom A, McCambridge A. Bridging the goal intention-action gap in rehabilitation: a study of if-then implementation intentions in neurorehabilitation. Disabil Rehabil 2014; 37:1073-81. [PMID: 25163832 DOI: 10.3109/09638288.2014.955137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To test the feasibility and acceptability of an implementation intention strategy (if-then plans) increasingly used in health psychology to bridge the goal intention-action gap in rehabilitation with people with neurological conditions who are experiencing difficulties with mobility. METHODS Twenty people with multiple sclerosis (MS) and stroke, randomised to an experimental and control group, set up to three mobility related goals with a physiotherapist. The experimental group also formulated if-then plans for every goal. DATA COLLECTION Focus groups and interviews with participants and therapists; Patient Activation Measure (PAM), 10-m walk test, Rivermead Mobility Index, self-efficacy, subjective health status, quality of life. RESULTS Qualitative data highlighted one main theme: Rehabilitation in context, encapsulating the usefulness of the if-then strategy in thinking about the patient in the context of complexity, the usefulness of home-based rehabilitation, and the perceived need for a few more sessions. Changes in walking speed were in the expected direction for both groups; PAM scores improved over 3 months in both groups. CONCLUSION If-then plans were feasible and acceptable in bridging the goal intention-action gap in rehabilitation with people with MS and stroke, who are experiencing difficulties with mobility. This approach can now be adapted and trialled further in a definitive study. IMPLICATIONS FOR REHABILITATION Goal planning in rehabilitation necessitates specific strategies that help people engage in goal-related tasks. If-then plans aim to support people to deal more effectively with self-regulatory problems that might undermine goal striving and have been found to be effective in health promotion and health behaviour change. This feasibility study with people with a stroke and multiple sclerosis has demonstrated that if-then plans are feasible and acceptable to patients and physiotherapists in supporting goal-directed behaviour.
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Affiliation(s)
- Paula Kersten
- Person Centred Research Centre, School of Rehabilitation and Occupation Studies, AUT University , Auckland , New Zealand
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Saji N, Kimura K, Ohsaka G, Higashi Y, Teramoto Y, Usui M, Kita Y. Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study. Disabil Rehabil 2014; 37:331-7. [DOI: 10.3109/09638288.2014.918195] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naoki Saji
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan,
- Department of Neurology, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
| | - Kazumi Kimura
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan,
| | - Goro Ohsaka
- Department of Rehabilitation Medicine, Hyogo Prefectural Rehabilitation Hospital, Tatsuno, Hyogo, Japan,
| | - Yasuto Higashi
- Department of Neurology, Himeji Central Hospital, Himeji, Hyogo, Japan,
| | - Yoichi Teramoto
- Department of Rehabilitation Medicine, Ishikawa Hospital, Himeji, Hyogo, Japan, and
| | - Masanobu Usui
- Department of Rehabilitation Medicine, Steel Memorial Hirohata Hospital, Himeji, Hyogo, Japan
| | - Yasushi Kita
- Department of Neurology, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
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Stubbs PW, Pallesen H, Pedersen AR, Nielsen JF. Using EFA and FIM rating scales could provide a more complete assessment of patients with acquired brain injury. Disabil Rehabil 2014; 36:2278-81. [DOI: 10.3109/09638288.2014.904935] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Standardized assessment of patients' activity limitations in acute care settings can provide valuable information. Existing measures have not been widely implemented. OBJECTIVES The aim of this study was to provide evidence for validity of scores on Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" measures of basic mobility and daily activity in acute care. DESIGN A retrospective measurement study was conducted. METHODS The study used a database from one health system containing "6-Clicks" scores from first and last physical therapist and occupational therapist visits for 84,446 patients. Validity was analyzed by examining differences in "6-Clicks" scores across categories of patient characteristics; the ability of "6-Clicks" scores to predict patients' having more than one therapy visit; correlation of "6-Clicks" scores with Functional Independence Measure (FIM) scores; and internal responsiveness over the episode of care. Internal consistency reliability also was determined. RESULTS The "6-Clicks" scores differed across patients' age, preadmission living situation, and number of therapy visits. The areas under receiver operating characteristic curves derived using "6-Clicks" scores at the first visit to predict patients receiving more than one visit were 0.703 and 0.652 using basic mobility and daily activity scores, respectively. The "6-Clicks" scores at the final visit were correlated with scores on subscales of the FIM completed on admission to inpatient rehabilitation facilities (r=.65 and .69). Standardized response means were 1.06 and 0.95 and minimal detectable changes with 90% confidence level (MDC90) were 4.72 and 5.49 for basic mobility and daily activity scores, respectively. Internal consistency reliability of basic mobility and daily activity scores was .96 and .91, respectively. LIMITATIONS Using clinical databases for research purposes has limitations, including missing data, misclassifications, and selection bias. Rater reliability is not known. CONCLUSIONS This study provides evidence for the validity of "6-Clicks" scores for assessing patients' activity limitations in acute care settings.
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Coster WJ. Making the best match: selecting outcome measures for clinical trials and outcome studies. Am J Occup Ther 2013; 67:162-70. [PMID: 23433270 DOI: 10.5014/ajot.2013.006015] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Selecting an appropriate outcome measure is a critical step in designing valid and useful clinical trials and outcome studies. This selection process needs to extend beyond examining basic psychometric properties to consider additional features of instruments that may affect their validity and utility for the study's purpose. This article discusses these additional factors and their potential impact on outcome measurement. Guidelines are proposed to help clinical researchers and consumers of clinical research literature evaluate the match between the study purpose, population, and instrument.
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Affiliation(s)
- Wendy J Coster
- Department of Occupational Therapy, Boston University, College of Health and Rehabilitation Sciences, Boston, MA 02215, USA.
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Koh GCH, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open 2013; 3:e003483. [PMID: 24068767 PMCID: PMC3787469 DOI: 10.1136/bmjopen-2013-003483] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs. DESIGN Systematic review. DATA SOURCES PubMed and references in primary articles. STUDY SELECTION First, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case-control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed. RESULTS The five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy. CONCLUSIONS 5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.
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Affiliation(s)
- Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
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What elements of the informational, management, and relational continuity are associated with patient satisfaction with rehabilitation care and global rating change? Arch Phys Med Rehabil 2013; 94:2248-54. [PMID: 23643715 DOI: 10.1016/j.apmr.2013.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the quality of patients' continuity experiences in a population of outpatients receiving postacute rehabilitation care, and to check which elements and types of continuity most strongly determine their satisfaction with care and functional changes. DESIGN Cross-sectional self-report survey. SETTING Three postacute ambulatory centers in metropolitan areas. PARTICIPANTS Outpatients (N=218; mean age ± SD, 38.5±11.7y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The questionnaire included experiences regarding aspects of informational (transference of information, accumulated knowledge), management (consistency and flexibility of care), and relational (established relation and consistency of provider) continuity, as well as questions concerning patients' sociodemographic characteristics, satisfaction with care, and global rating change. RESULTS Respondents indicated more problems in terms of management and relational continuity than in informational continuity. For all patient groups, experiences regarding elements of management continuity (R(2)=15.3%-22.4%), followed by relational continuity (R(2)=14.3%-25.2%), explained most of the variance of satisfaction. Consistency and flexibility of care, together with an established relation, were the most determining elements of satisfaction. Experiences regarding elements of management continuity explained most of the variance of change (18.5%), and flexibility was the most decisive element. CONCLUSIONS Patient satisfaction and functional changes are related with experiences in aspects of management continuity, where there is room for improvement. Measures of management continuity may be promising as indicators of continuity, and they should be prioritized.
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Medina-Mirapeix F, Jimeno-Serrano FJ, Escolar-Reina P, Del Baño-Aledo ME. Is patient satisfaction and perceived service quality with musculoskeletal rehabilitation determined by patient experiences? Clin Rehabil 2012; 27:555-64. [PMID: 23258933 DOI: 10.1177/0269215512468142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the relationships between patient experiences and two overall evaluations - satisfaction and service quality - in outpatient rehabilitation settings. DESIGN A cross-sectional, self-reported survey carried out in the year 2009. SETTING Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville. SUBJECTS Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years. MAIN MEASURES Self-reported experiences on aspects of care, participants' perception of service quality, satisfaction with care, socio-demographic and health characteristics. RESULTS Satisfaction and service quality were highly correlated (rho = 0.72, P< 0.001). Two multivariate logistic regression models using satisfaction and service quality (with adjusted R(2) 31.5% and 37.1%, respectively) indicated that patients' experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied. CONCLUSIONS Satisfaction and service quality provide a poor indicator of patients' experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.
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Affiliation(s)
- Francesc Medina-Mirapeix
- Regional Campus of International Excellence Campus Mare Nostrum, University of Murcia, Murcia, Spain.
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Aronow HU, Sharkey P, Siebens HC, Horn SD, Smout RJ, DeJong G, Munin MC, Radnay CS. Initial Recovery Trajectories Among Patients With Hip Fracture: A Conceptual Approach to Exploring Comparative Effectiveness in Postacute Care. PM R 2012; 4:264-72. [DOI: 10.1016/j.pmrj.2011.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/20/2011] [Accepted: 10/05/2011] [Indexed: 11/16/2022]
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Haley SM, Ni P, Lai JS, Tian F, Coster WJ, Jette AM, Straub D, Cella D. Linking the activity measure for post acute care and the quality of life outcomes in neurological disorders. Arch Phys Med Rehabil 2011; 92:S37-43. [PMID: 21958921 PMCID: PMC3372982 DOI: 10.1016/j.apmr.2011.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To use item response theory (IRT) methods to link physical functioning items in the Activity Measure for Post Acute Care (AM-PAC) and the Quality of Life Outcomes in Neurological Disorders (Neuro-QOL). DESIGN Secondary data analysis of the physical functioning items of AM-PAC and Neuro-QOL. We used a nonequivalent group design with 36 core items common to both instruments and a test characteristic curve transformation method for linking AM-PAC and Neuro-QOL scores. Linking was conducted so that both raw and scaled AM-PAC and Neuro-QOL scores (mean ± SD converted-logit scores, 50 ± 10) could be compared. SETTING AM-PAC items were administered to rehabilitation patients in post-acute care (PAC) settings. Neuro-QOL items were administered to a community sample of adults through the Internet. PARTICIPANTS PAC patients (N=1041) for the AM-PAC sample and community-dwelling adults (N=549) for the Neuro-QOL sample. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mobility (N=25) and activity of daily living (ADL) items (N=11) common to both instruments were included in analysis. RESULTS Neuro-QOL items were linked to the AM-PAC scale by using the generalized partial credit model. Mobility and ADL subscale scores from the 2 instruments were calibrated to the AM-PAC metric. CONCLUSIONS An IRT-based linking method placed AM-PAC and Neuro-QOL mobility and ADL scores on a common metric. This linking allowed estimation of AM-PAC mobility and ADL subscale scores based on Neuro-QOL mobility and ADL subscale scores and vice versa. The accuracy of these results should be validated in a future sample in which participants respond to both instruments.
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Affiliation(s)
- Stephen M Haley
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA 02118, USA
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