1
|
Zhang C, Zhang X, Zhang H, Zeng P, Yin P, Li Z, Zhao Y, Yao Y. Psychometric properties of the Barthel Index for evaluating physical function among Chinese oldest‐old. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission Beijing China
| | - Xuxi Zhang
- Center for Healthy Aging and Development Studies, National School of Development Peking University Beijing China
| | - Hao Zhang
- Department of healthcare policy and research Weill Cornell Medicine New York NY USA
| | - Ping Zeng
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission Beijing China
| | - Pengbin Yin
- Department of Orthopedics The Fourth Medical Centre, Chinese PLA General Hospital Beijing China
- National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation Beijing China
| | - Zhongquan Li
- School of Social and Behavioral Sciences Nanjing University Nanjing China
| | - Yali Zhao
- Central Laboratory Hainan Hospital of Chinese PLA General Hospital Sanya China
| | - Yao Yao
- Center for Healthy Aging and Development Studies, National School of Development Peking University Beijing China
- China Center for Health Development Studies Peking University Beijing China
| |
Collapse
|
2
|
O'Hoski S, Richardson J, Kuspinar A, Wald J, Goldstein R, Beauchamp MK. A Brief Measure of Life Participation for People with COPD: Validation of the Computer Adaptive Test Version of the Late Life Disability Instrument. COPD 2021; 18:385-392. [PMID: 34156315 DOI: 10.1080/15412555.2021.1934821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Computer-adaptive tests use respondents' answers to previous questions to select the subsequent questions. They are gaining popularity for their increased measurement precision and decreased administration time compared to static questionnaires. The purpose of this study was to estimate the test-retest reliability and construct validity of the computer-adaptive test version of a participation measure, the Late Life Disability Instrument (LLDI-CAT) for people with COPD and to compare scores and administration time with those of the static LLDI. Among 76 older adults with COPD, scores on the LLDI-CAT were compared to scores on measures of related constructs, between groups based on symptom severity, prognosis and frailty phenotype, and to scores on the static LLDI. A subsample of 28 people completed the LLDI-CAT a second time within one week of the initial administration for test-retest reliability. The LLDI-CAT had very good test-retest reliability (ICC2,1 0.88; SEM 2.74 points), fair correlations with physical function (r = 0.37-0.50), anxiety (r=-0.42), and depression (r=-0.50), fair to moderately-strong correlations with quality of life (r = 0.48-0.63), and strong correlation with the static LLDI limitation domain (r = 0.80). The LLDI-CAT scores differed between people with different symptom severity, prognosis and frailty phenotype (p ≤ 0.004). The mean administration time for the LLDI-CAT was 3.3 (1.5) minutes, less than that of the static LLDI at 6.3 (2.8) minutes (p < 0.001). The LLDI-CAT demonstrates evidence of test-retest reliability and construct validity, and correlates well with the limitation domain of the static LLDI for people with COPD. The LLDI-CAT can be used to assess participation for this population.
Collapse
Affiliation(s)
- Sachi O'Hoski
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Wald
- Firestone Institute for Respiratory Health, St. Joseph's Health Centre, Hamilton, Ontario, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Firestone Institute for Respiratory Health, St. Joseph's Health Centre, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Keeney T, Kumar A, Erler KS, Karmarkar AM. Making the Case for Patient-Reported Outcome Measures in Big-Data Rehabilitation Research: Implications for Optimizing Patient-Centered Care. Arch Phys Med Rehabil 2021; 103:S140-S145. [PMID: 33548207 DOI: 10.1016/j.apmr.2020.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/02/2022]
Abstract
Advances in data science and timely access to health informatics provide a pathway to integrate patient-reported outcome measures (PROMs) into clinical workflows and optimize rehabilitation service delivery. With the shift toward value-based care in the United States health care system, as highlighted by the recent Centers for Medicare and Medicaid Services incentive and penalty programs, it is critical for rehabilitation providers to systematically collect and effectively use PROMs to facilitate evaluation of quality and outcomes within and across health systems. This editorial discusses the potential of PROMs to transform clinical practice, provides examples of health systems using PROMs to guide care, and identifies barriers to aggregating data from PROMs to conduct health services research. The article proposes 2 priority areas to help advance rehabilitation health services research: (1) standardization of collecting PROMs data in electronic health records to facilitate comparing health system performance and quality and (2) increased partnerships between rehabilitation providers, researchers, and payors to accelerate health system learning. As health care reform continues to emphasize value-based payment strategies, it is essential for the field of physical medicine and rehabilitation to be at the forefront of demonstrating its value in the care continuum.
Collapse
Affiliation(s)
- Tamra Keeney
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI; Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Amit Kumar
- Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ
| | - Kimberly S Erler
- Department of Occupation Therapy, MGH Institute of Health Professions, Boston, MA
| | - Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA; Sheltering Arms Institute, Richmond, VA
| |
Collapse
|
4
|
Gill TM, Bhasin S, Reuben DB, Latham NK, Araujo K, Ganz DA, Boult C, Wu AW, Magaziner J, Alexander N, Wallace RB, Miller ME, Travison TG, Greenspan SL, Gurwitz JH, Rich J, Volpi E, Waring SC, Manini TM, Min LC, Teresi J, Dykes PC, McMahon S, McGloin JM, Skokos EA, Charpentier P, Basaria S, Duncan PW, Storer TW, Gazarian P, Allore HG, Dziura J, Esserman D, Carnie MB, Hanson C, Ko F, Resnick NM, Wiggins J, Lu C, Meng C, Goehring L, Fagan M, Correa-de-Araujo R, Casteel C, Peduzzi P, Greene EJ. Effect of a Multifactorial Fall Injury Prevention Intervention on Patient Well-Being: The STRIDE Study. J Am Geriatr Soc 2020; 69:173-179. [PMID: 33037632 PMCID: PMC8178516 DOI: 10.1111/jgs.16854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES In the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study, a multifactorial intervention was associated with a nonsignificant 8% reduction in time to first serious fall injury but a significant 10% reduction in time to first self-reported fall injury relative to enhanced usual care. The effect of the intervention on other outcomes important to patients has not yet been reported. We aimed to evaluate the effect of the intervention on patient well-being including concern about falling, anxiety, depression, physical function, and disability. DESIGN Pragmatic cluster-randomized trial of 5,451 community-living persons at high risk for serious fall injuries. SETTING A total of 86 primary care practices within 10 U.S. healthcare systems. PARTICIPANTS A random subsample of 743 persons aged 75 and older. MEASUREMENTS The well-being measures, assessed at baseline, 12 months, and 24 months, included a modified version of the Fall Efficacy Scale, Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scales, and Late-Life Function and Disability Instrument. RESULTS Participants in the intervention (n = 384) and control groups (n = 359) were comparable in age: mean (standard deviation) of 81.9 (4.7) versus 81.8 (5.0) years. Mean scores were similar between groups at 12 and 24 months for concern about falling, physical function, and disability, whereas the intervention group's mean scores on anxiety and depression were .7 points lower (i.e., better) at 12 months and .6 to .8 points lower at 24 months. For each of these outcomes, differences between the groups' adjusted least square mean changes from baseline to 12 and 24 months, respectively, were quantitatively small. The overall difference in means between groups over 2 years was statistically significant only for depression, favoring the intervention: -1.19 (99% confidence interval, -2.36 to -.02), with 3.5 points representing a minimally important difference. CONCLUSIONS STRIDE's multifactorial intervention to reduce fall injuries was not associated with clinically meaningful improvements in patient well-being.
Collapse
Affiliation(s)
- Thomas M Gill
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nancy K Latham
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katy Araujo
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Geriatric Research, Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Chad Boult
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Albert W Wu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Michael E Miller
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas G Travison
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan L Greenspan
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, A Joint Endeavor of Reliant Medical Group, Fallon Health and University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jeremy Rich
- HealthCare Partners, El Segundo, California, USA
| | - Elena Volpi
- University of Texas Medical Branch Claude D. Pepper Older Americans Independence Center; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | | | - Jeanne Teresi
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | | | - Siobhan McMahon
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne M McGloin
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Eleni A Skokos
- Yale Claude D. Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut, USA
| | - Peter Charpentier
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Shehzad Basaria
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pamela W Duncan
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas W Storer
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Priscilla Gazarian
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,University of Massachusetts, Boston, Massachusetts, USA
| | - Heather G Allore
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - James Dziura
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Denise Esserman
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | | | | | - Fred Ko
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neil M Resnick
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Charles Lu
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Can Meng
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Lori Goehring
- Boston Claude D. Pepper Older Americans Independence Center, Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maureen Fagan
- University of Miami Health System, Miami, Florida, USA
| | | | | | - Peter Peduzzi
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| | - Erich J Greene
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
5
|
Motyl CM, Ngo L, Zhou W, Jung Y, Leslie D, Boltz M, Husser E, Inouye SK, Fick D, Marcantonio ER. Comparative Accuracy and Efficiency of Four Delirium Screening Protocols. J Am Geriatr Soc 2020; 68:2572-2578. [PMID: 32930409 DOI: 10.1111/jgs.16711] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Systematic screening can improve detection of delirium, but lack of time is often cited as why such screening is not performed. We investigated the time required to implement four screening protocols that use the Ultra-Brief two-item screener for delirium (UB-2) and the 3-Minute Diagnostic Interview for Confusion Assessment Method (CAM)-defined Delirium (3D-CAM), with and without a skip pattern that can further shorten the assessment. Our objective was to compare the sensitivity, specificity, and time required to complete four protocols: (1) full 3D-CAM on all patients, (2) 3D-CAM with skip on all patients, (3) UB-2, followed by the full 3D-CAM in "positives," and (4) UB-2, followed by the 3D-CAM with skip in "positives." DESIGN Comparative efficiency simulation study using secondary data. SETTING Two studies (3D-CAM and Researching Efficient Approaches to Delirium Identification (READI)) conducted at a large academic medical center (3D-CAM and READI) and a small community hospital (READI only). PARTICIPANTS General medicine inpatients, aged 70 years and older (3D-CAM, n = 201; READI, n = 330). MEASUREMENTS We used 3D-CAM data to simulate the items administered under each protocol and READI data to calculate median administration time per item. We calculated sensitivity, specificity, and total administration time for each of the four protocols. RESULTS The 3D-CAM and READI samples had similar characteristics, and all four protocols had similar simulated sensitivity and specificity. Mean administration times were 3 minutes 13 seconds for 3D-CAM, 2 minutes 19 seconds for 3D-CAM with skip, 1 minute 52 seconds for UB-2 + 3D-CAM in positives, and 1 minute 14 seconds for UB-2 + 3D-CAM with skip in positives, which was 1 minute 59 seconds faster than the 3D-CAM (P < .001). CONCLUSION The UB-CAM, consisting of the UB-2, followed in positives by the 3D-CAM with skip pattern, is a time-efficient delirium screening protocol that holds promise for increasing systematic screening for delirium in hospitalized older adults.
Collapse
Affiliation(s)
- Claire M Motyl
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Long Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Wenxiao Zhou
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yoojin Jung
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Douglas Leslie
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Erica Husser
- College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Sharon K Inouye
- Harvard Medical School, Boston, Massachusetts, USA.,Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Donna Fick
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA.,College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Edward R Marcantonio
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Psychometric Evaluation of Patient-reported Outcomes Measurement Information System Physical Function Computer Adaptive Testing in Minimally Invasive Lumbar Spine Surgery: An Analysis of Responsiveness, Coverage, Discriminant Validity, and Concurrent Validity. J Am Acad Orthop Surg 2020; 28:717-729. [PMID: 32833390 DOI: 10.5435/jaaos-d-19-00306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although the Patient-reported Outcomes Measurement Information System (PROMIS) is increasingly being used, there are few studies assessing the psychometric properties of PROMIS in minimally invasive spine (MIS) surgery. Thus, the purpose of this study was to perform a psychometric evaluation of PROMIS Physical Function Computer Adaptive Testing (PROMIS-PF CAT) in MIS lumbar surgery. METHODS The patient-reported outcome measures collected preoperatively and postoperatively of patients undergoing MIS lumbar surgery were retrospectively analyzed to assess responsiveness, coverage, discriminant validity, and concurrent validity of PROMIS-PF CAT. RESULTS Four hundred twenty-one patients were included. The responsiveness of PROMIS Physical Function (PROMIS-PF) was lower than that of the Oswestry Disability Index (ODI) in the decompression subgroup. Although the ODI had a ceiling effect of 16.7% at 1 year, the Short-Form 12 physical health score and PROMIS-PF did not show floor or ceiling effects. PROMIS-PF demonstrated discriminant validity preoperatively and postoperatively and convergent validity with the ODI, as evidenced by a significant strong negative correlation but not with the Short-Form 12 Physical Health Score, as evidenced by the variability in strength of correlation. CONCLUSIONS Although the PROMIS-PF showed lower responsiveness than the ODI, particularly in the decompression subgroup, it demonstrated discriminant validity preoperatively and postoperatively, convergent validity with ODI, and better coverage than ODI. These findings suggest that the PROMIS-PF CAT demonstrates reasonable psychometric properties and may be a good surrogate for the ODI.
Collapse
|
7
|
Gill TM, McGloin JM, Shelton A, Bianco LM, Skokos EA, Latham NK, Ganz DA, Nyquist LV, Wallace RB, Carnie MB, Dykes PC, Goehring LA, Doyle M, Charpentier PA, Greene EJ, Araujo KL. Optimizing Retention in a Pragmatic Trial of Community-Living Older Persons: The STRIDE Study. J Am Geriatr Soc 2020; 68:1242-1249. [PMID: 32212395 DOI: 10.1111/jgs.16356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) study is testing the effectiveness of a multifactorial intervention to prevent serious fall injuries. Our aim was to describe procedures that were implemented to optimize participant retention; report retention yields by age, sex, clinical site, and follow-up time; provide reasons for study withdrawals; and highlight the successes and lessons learned from the STRIDE retention efforts. DESIGN Pragmatic cluster randomized trial. SETTING A total of 86 primary care practices within 10 US healthcare systems. PARTICIPANTS A total of 5451 community-living persons, 70 years of age or older, at high risk for serious fall injuries. MEASUREMENTS Study outcomes were collected every 4 months by a central call center. Reconsent was required to extend follow-up beyond the originally planned 36 months. RESULTS Over a median follow-up of 3.2 years (interquartile range = 2.8-3.7 y), 439 (8.1%) participants died and 600 (11.0%) withdrew their consent or did not reconsent to extend follow-up beyond 36 months, yielding rates (per 100 person-years) of deaths and withdrawals of 2.6 and 3.6, respectively. The withdrawal rate increased with advancing age, was comparable for men and women, and did not differ much by clinical site. The most common reasons for withdrawal were illness and unable to contact for reconsent at 36 months. Completion of the follow-up interviews was greater than 93% at each time point. Most participants completed all (71.8%) or all but one (9.2%) of the follow-up interviews. The most common reason for not completing a follow-up interview was unable to contact, with rates ranging from 2.8% at 40 months to 4.6% at 20 months. CONCLUSION Completion of the thrice-yearly follow-up interviews in STRIDE was high, and retention of participants over 44 months exceeded the original projections. The procedures used in STRIDE, together with lessons learned, should assist other investigators who are planning or conducting large pragmatic trials of vulnerable older persons. J Am Geriatr Soc 68:1242-1249, 2020.
Collapse
Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Joanne M McGloin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amy Shelton
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Luann M Bianco
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eleni A Skokos
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Linda V Nyquist
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Margaret Doyle
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Peter A Charpentier
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erich J Greene
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Katy L Araujo
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
8
|
Vaishnav AS, Gang CH, Iyer S, McAnany S, Albert T, Qureshi SA. Correlation between NDI, PROMIS and SF-12 in cervical spine surgery. Spine J 2020; 20:409-416. [PMID: 31678044 DOI: 10.1016/j.spinee.2019.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT As the focus in spine surgery has shifted from radiographic to patient-centric outcome, patient-reported outcomes measures (PROMs) are becoming increasingly important. They are linked to patient satisfaction, and are used to assess healthcare expenditure, determine compensation and evaluate cost-effectiveness. Thus, PROMs are important to various stakeholders, including patients, physicians, payers, and healthcare institutions. Thus, it is vital to establish methods to interpret and evaluate these outcome measures. PURPOSE To evaluate the correlation between Neck Disability Index (NDI), Patient Reported Outcome Measurement Information System Physical Function (PROMIS-PF) and Short Form-12 Physical Health Score (SF-12 PHS) in cervical spinal surgery in order to determine the validity of PROMIS-PF in these patients. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Consecutive patients who underwent cervical surgery for degenerative spinal pathology with a minimum of 3 months follow-up. OUTCOME MEASURES Self-reported measures that is, PROMs including NDI, PROMIS-PF, and SF-12 PHS. METHODS No funding was received for this study. The authors report no relevant conflict of interest. PROM collected preoperatively and at each follow-up were analyzed using Pearson product-moment correlation. RESULTS Of the 121 patients included, 66 underwent anterior cervical discectomy and fusion, 42 cervical disc replacement, 13 posterior cervical decompression with or without fusion. A statistically significant improvement was achieved in all PROMs by 6 weeks and maintained at 1 year. Furthermore, the percentage of patients achieving an improvement greater than minimum clinically important difference was similar for NDI and PROMIS-PF, particularly at a follow-up of 3 months or more. A statistically significant negative correlation was seen between NDI and PROMIS-PF, which was moderate preoperatively and in the early postoperative period (r=-0.565 to -0.600), and strong at 3 months or longer follow-up (r=-0.622 to -0.705). A statistically significant, negative correlation was also seen between SF-12 PHS and NDI, which was moderate preoperatively and at 6 weeks (r=-0.5551 to -0.566); and strong at all other time-points (r=-0.678 to -0.749). There was a statistically significant positive correlation between SF-12 PHS and PROMIS-PF, which was strong to very-strong at all time-points (r=0.644-0.822), except at 2 weeks (r=0.570). CONCLUSIONS Although NDI and SF-12 have been used for several years, PROMIS is a new outcome measure that is increasingly being implemented. The results of our study demonstrate the convergent and discriminant validity of PROMIS-PF, supported by the strong correlation between SF-12 PHS and PROMIS-PF at all time-points and the moderate correlation between NDI and PROMIS-PF preoperatively and in the early postoperative period, respectively. Thus, while PROMIS-PF may not be a good surrogate for disease-specific outcome measures, it may extend value as a precise and efficient general health tool.
Collapse
Affiliation(s)
| | | | - Sravisht Iyer
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Steven McAnany
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, 535 E. 70th St, New York, NY, USA; Weill Cornell Medical College, 407 E 61st St, New York, NY, USA.
| |
Collapse
|
9
|
Young Afat DA, Gibbons C, Klassen AF, Vickers AJ, Cano SJ, Pusic AL. Introducing BREAST-Q Computerized Adaptive Testing: Short and Individualized Patient-Reported Outcome Assessment following Reconstructive Breast Surgery. Plast Reconstr Surg 2019; 143:679-684. [PMID: 30589822 PMCID: PMC6713453 DOI: 10.1097/prs.0000000000005314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The BREAST-Q is a widely used patient-reported outcome instrument measuring health-related quality-of-life and patient satisfaction in breast surgery. Shorter assessment potentially increases patients' willingness to complete scales, but simply offering a shortened version leads to unacceptable loss in measurement precision. The authors aimed to develop a computerized adaptive test (CAT) to shorten the BREAST-Q's Satisfaction with Breasts scale while maintaining reliability of measurement. METHODS The authors created a CAT, which repetitively administered questions from the pool of 16 questions, until prespecified levels of reliability were reached [i.e., standard errors (SE) of 0.32 to 0.55]. In a simulation study, the authors tested the CAT's feasibility for all potential satisfaction scores. In a second study using actual patient data, 5000 breast reconstruction patients who had previously completed the full scale were randomly selected from a large database. Their full-scale satisfaction scores were compared with their CAT-derived scores. RESULTS In both studies, by applying CAT, the Satisfaction with Breasts scale could be reduced to an average of 10 questions when using the minimum level of measurement precision for individual-patient measurement (SE, 0.32), compared with four questions when using the minimum precision level for group-based research (SE, 0.55). Score estimates were highly correlated between the CAT assessment and the full scale (0.91 to 0.98 in the simulation study, and 0.89 to 0.98 in the patient data study). CONCLUSIONS Applying computerized adaptive testing to the BREAST-Q's Satisfaction with Breasts scale facilitates reliable assessment, with 38 to 75 percent fewer questions than the full version. The novel BREAST-Q CAT version may decrease response burden and help overcome barriers to implementation in routine care.
Collapse
Affiliation(s)
| | | | | | | | | | - Andrea L. Pusic
- Brigham and Women’s Hospital, Boston, USA
- Harvard University, USA
| |
Collapse
|
10
|
Wondergem R, Pisters MF, Wouters EM, de Bie RA, Visser-Meily JM, Veenhof C. Validation and responsiveness of the Late-Life Function and Disability Instrument Computerized Adaptive Test in community-dwelling stroke survivors. Eur J Phys Rehabil Med 2018; 55:424-432. [PMID: 30370749 DOI: 10.23736/s1973-9087.18.05359-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Follow-up of stroke survivors is important to objectify activity limitations and/or participations restrictions. Responsive measurement tools are needed with a low burden for professional and patient. AIM To examine the concurrent validity, floor and ceiling effects and responsiveness of both domains of the Late-Life Function and Disability Index Computerized Adaptive Test (LLFDI-CAT) in first-ever stroke survivors discharged to their home setting. DESIGN Longitudinal study. SETTING Community. POPULATION First ever stroke survivors. METHODS Participants were visited within three weeks after discharge and six months later. Stroke Impact Scale (SIS 3.0) and Five-Meter Walk Test (5MWT) outcomes were used to investigate concurrent validity of both domains, activity limitations, and participation restriction, of the LLFDI-CAT. Scores at three weeks and six months were used to examine floor and ceiling effects and change scores were used for responsiveness. Responsiveness was assessed using predefined hypotheses. Hypotheses regarding the correlations with change scores of related measures, unrelated measures, and differences between groups were formulated. RESULTS The study included 105 participants. Concurrent validity (R) of the LLFDI-CAT activity limitations domain compared with the physical function domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.46 respectively. R of the LLFDI-CAT participation restriction domain compared with the participation domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.41 respectively. A ceiling effect (15%) for the participation restriction domain was found at six months. Both domains, activity limitations and participation restrictions, of the LLFDI-CAT, scored well on responsiveness: 100% (12/12) and 91% (12/11) respectively of the predefined hypotheses were confirmed. CONCLUSIONS The LLFDI-CAT seems to be a valid instrument and both domains are able to detect change over time. Therefore, the LLFDI-CAT is a promising tool to use both in practice and in research. CLINICAL REHABILITATION IMPACT The LLFDI-CAT can be used in research and clinical practice.
Collapse
Affiliation(s)
- Roderick Wondergem
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands - .,Physical Therapy Research, Department of Rehabilitation, Physical Therapy and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands - .,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands -
| | - Martijn F Pisters
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Eveline M Wouters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Rob A de Bie
- Department of Epidemiology and Caphri Research School, Maastricht University, Maastricht, the Netherlands
| | - Johanna M Visser-Meily
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| |
Collapse
|
11
|
Amtmann D, Bamer AM, Kim J, Bocell FD, Chung H, Park R, Salem R, Hafner BJ. A comparison of computerized adaptive testing and fixed-length short forms for the Prosthetic Limb Users Survey of Mobility (PLUS-M TM). Prosthet Orthot Int 2018; 42:476-482. [PMID: 28866959 PMCID: PMC5832493 DOI: 10.1177/0309364617728118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND New health status instruments can be administered by computerized adaptive test or short forms. The Prosthetic Limb Users Survey of Mobility (PLUS-MTM) is a self-report measure of mobility for prosthesis users with lower limb loss. This study used the PLUS-M to examine advantages and disadvantages of computerized adaptive test and short forms. OBJECTIVES To compare scores obtained from computerized adaptive test to scores obtained from fixed-length short forms (7-item and 12-item) in order to provide guidance to researchers and clinicians on how to select the best form of administration for different uses. STUDY DESIGN Cross-sectional, observational study. METHODS Individuals with lower limb loss completed the PLUS-M by computerized adaptive test and short forms. Administration time, correlations between the scores, and standard errors were compared. RESULTS Scores and standard errors from the computerized adaptive test, 7-item short form, and 12-item short form were highly correlated and all forms of administration were efficient. Computerized adaptive test required less time to administer than either paper or electronic short forms; however, time savings were minimal compared to the 7-item short form. CONCLUSION Results indicate that the PLUS-M computerized adaptive test is most efficient, and differences in scores between administration methods are minimal. The main advantage of the computerized adaptive test was more reliable scores at higher levels of mobility compared to short forms. Clinical relevance Health-related item banks, like the Prosthetic Limb Users Survey of Mobility (PLUS-MTM), can be administered by computerized adaptive testing (CAT) or as fixed-length short forms (SFs). Results of this study will help clinicians and researchers decide whether they should invest in a CAT administration system or whether SFs are more appropriate.
Collapse
Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jiseon Kim
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Fraser D. Bocell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Ryoungsun Park
- College of Education, Wayne State University, Detroit, MI
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
12
|
Petersen MA, Aaronson NK, Arraras JI, Chie WC, Conroy T, Costantini A, Dirven L, Fayers P, Gamper EM, Giesinger JM, Habets EJ, Hammerlid E, Helbostad J, Hjermstad MJ, Holzner B, Johnson C, Kemmler G, King MT, Kaasa S, Loge JH, Reijneveld JC, Singer S, Taphoorn MJ, Thamsborg LH, Tomaszewski KA, Velikova G, Verdonck-de Leeuw IM, Young T, Groenvold M. The EORTC CAT Core—The computer adaptive version of the EORTC QLQ-C30 questionnaire. Eur J Cancer 2018; 100:8-16. [DOI: 10.1016/j.ejca.2018.04.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 11/12/2022]
|
13
|
Braun Y, Mellema JJ, Peters RM, Curley S, Burchill G, Ring D. The relationship between therapist-rated function and patient-reported outcome measures. J Hand Ther 2018; 30:516-521. [PMID: 27912920 DOI: 10.1016/j.jht.2016.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/12/2015] [Accepted: 02/18/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort study. INTRODUCTION Some third-party payers require hand therapists to rate patient's functional disability based on patient self-rating using patient-reported outcome measures (PROMs), objective measurements of impairment, and observation of functional tasks-hand therapist-rated function (HTRF). PURPOSE OF THE STUDY To test the correlation between HTRF and PROMs (upper limb functional index [ULFI] and Patient-Reported Outcomes Measurement Information System upper extremity [PROMIS UE]) and its association with psychological factors. METHODS In 2014, 100 new patients with upper extremity illness presenting to hand therapists were asked to participate in an observational cross-sectional study. Demographic-, condition-related, and psychological factors were obtained in addition to PROMs and HTRF. RESULTS HTRF correlated moderately with PROMIS UE (r = -0.49, P < .001) and ULFI (r = -0.56, P < .001). Correlation between PROMIS UE and ULFI was strong (r = 0.78, P < .001). Psychological factors explained most of the variations in both HTRF and PROMs. CONCLUSIONS Hand therapists' ratings of patient function correlate less strongly with PROMs than PROMs correlate with one other. The discrepancy between HTRF and PROMs may offer an opportunity to address stress, distress, or ineffective coping strategies that can interfere with recovery-an opportunity for therapists and patients to collaborate and develop goals and for future research to develop effective and feasible strategies for hand therapists. LEVEL OF EVIDENCE Level II, diagnostic study.
Collapse
Affiliation(s)
- Yvonne Braun
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Jos J Mellema
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Rinne M Peters
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Suzanne Curley
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Gae Burchill
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
| |
Collapse
|
14
|
Bhasin S, Gill TM, Reuben DB, Latham NK, Gurwitz JH, Dykes P, McMahon S, Storer TW, Duncan PW, Ganz DA, Basaria S, Miller ME, Travison TG, Greene EJ, Dziura J, Esserman D, Allore H, Carnie MB, Fagan M, Hanson C, Baker D, Greenspan SL, Alexander N, Ko F, Siu AL, Volpi E, Wu AW, Rich J, Waring SC, Wallace R, Casteel C, Magaziner J, Charpentier P, Lu C, Araujo K, Rajeevan H, Margolis S, Eder R, McGloin JM, Skokos E, Wiggins J, Garber L, Clauser SB, Correa-De-Araujo R, Peduzzi P. Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods. J Gerontol A Biol Sci Med Sci 2018; 73:1053-1061. [PMID: 29045582 PMCID: PMC6037050 DOI: 10.1093/gerona/glx190] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Methods Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Results Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. Conclusions The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.
Collapse
Affiliation(s)
- Shalender Bhasin
- Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Thomas M Gill
- Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut
| | - David B Reuben
- Multicampus Program in Geriatrics Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nancy K Latham
- Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Reliant Medical Group, Worcester, Massachusetts
| | | | | | - Thomas W Storer
- Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - David A Ganz
- Multicampus Program in Geriatrics Medicine and Gerontology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Shehzad Basaria
- Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Erich J Greene
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - James Dziura
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Denise Esserman
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Heather Allore
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | | | | | | | - Dorothy Baker
- Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut
| | - Susan L Greenspan
- Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pennsylvania
| | | | - Fred Ko
- Mount Sinai School of Medicine, New York, New York
| | - Albert L Siu
- Mount Sinai School of Medicine, New York, New York
| | - Elena Volpi
- University of Texas Medical Branch, Galveston
| | - Albert W Wu
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | - Peter Charpentier
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Charles Lu
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Katy Araujo
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Haseena Rajeevan
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Scott Margolis
- Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Richard Eder
- Pepper Older Americans Independence Center, Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joanne M McGloin
- Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut
| | - Eleni Skokos
- Pepper Older Americans Independence Center, Yale University, New Haven, Connecticut
| | | | - Lawrence Garber
- Meyers Primary Care Institute, Reliant Medical Group, Worcester, Massachusetts
| | - Steven B Clauser
- Patient Centered Outcomes Research Institute, Washington, District of Columbia
| | | | - Peter Peduzzi
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| |
Collapse
|
15
|
Rodakowski J, Reynolds CF, Lopez OL, Butters MA, Dew MA, Skidmore ER. Developing a Non-Pharmacological Intervention for Individuals With Mild Cognitive Impairment. J Appl Gerontol 2018; 37:665-676. [PMID: 27106884 PMCID: PMC5075260 DOI: 10.1177/0733464816645808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study is to describe one potential intervention model that is designed to slow decline to disability for individuals at-risk for dementia due to Mild Cognitive Impairment. Strategy training is a treatment model that focuses on behavioral activation through addressing barriers to daily activities. Strategy training encourages development of goals and plans to address self-identified impaired processes, and it maintains or improves individuals' ability to perform desired activities. Progression to dementia may be slowed due to the link between engagement in daily activities and production of biological factors associated with neurocognitive health. We demonstrated that an older adult with mild cognitive impairment is able to develop goals, establish effective plans, and engage in daily activities through the strategy training intervention model.
Collapse
|
16
|
Rantanen T, Portegijs E, Kokko K, Rantakokko M, Törmäkangas T, Saajanaho M. Developing an Assessment Method of Active Aging: University of Jyvaskyla Active Aging Scale. J Aging Health 2018; 31:1002-1024. [PMID: 29291660 PMCID: PMC6572587 DOI: 10.1177/0898264317750449] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To develop an assessment method of active aging for
research on older people. Method: A multiphase process that
included drafting by an expert panel, a pilot study for item analysis and scale
validity, a feedback study with focus groups and questionnaire respondents, and
a test–retest study. Altogether 235 people aged 60 to 94 years provided
responses and/or feedback. Results: We developed a 17-item
University of Jyvaskyla Active Aging Scale with four aspects in each item
(goals, ability, opportunity, and activity; range 0-272). The psychometric and
item properties are good and the scale assesses a unidimensional latent
construct of active aging. Discussion: Our scale assesses older
people’s striving for well-being through activities pertaining to their goals,
abilities, and opportunities. The University of Jyvaskyla Active Aging Scale
provides a quantifiable measure of active aging that may be used in postal
questionnaires or interviews in research and practice.
Collapse
|
17
|
Stahl ST, Albert SM, Dew MA, Anderson S, Karp JF, Gildengers AG, Butters MA, Reynolds CF. Measuring Participant Effort in a Depression Prevention Trial: Who Engages in Problem-Solving Therapy? Am J Geriatr Psychiatry 2017; 25:909-916. [PMID: 28410857 PMCID: PMC5724523 DOI: 10.1016/j.jagp.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the acceptability of clinical interventions for depression prevention, identification of clinical characteristics associated with intervention engagement is needed. The purpose of this study is to describe levels and correlates of participant engagement in Problem Solving Therapy (PST) in adults 60 and older with subthreshold depression. METHODS As part of a clinical trial to prevent depression among older adults with subthreshold depression, participants who were randomized to receive PST completed 6-8 sessions in which they learned skills to solve self-selected problems that were contributing to stress and reduced quality of life. To measure participants' engagement with PST, interventionists completed 3 scales that rated participants' level of participation in problem solving activities, understanding of the multistep process of PST, and between-session homework effort. Using logistic regression, we examined whether physical health, level of cognitive function, gait speed, and disability served as correlates of engagement in the PST intervention. RESULTS Gait speed, a measure of physical and cognitive health, was significantly associated with engagement in PST. Participants who walked faster were more likely to engage with PST compared to participants who walked more slowly. No other baseline variables were significant correlates. CONCLUSIONS Older adults who walk more slowly may need alternative delivery methods to fully engage in PST. Gait speed reflects physical and cognitive health, and predicts frailty, disability, and psychomotor speed slowing. For these reasons, gait speed may be a marker for factors that will serve to predict poorer engagement in psychosocial interventions like PST.
Collapse
|
18
|
Mortenson WB, Jang S, Goldsmith CH, Hurd Clarke L, Hobson S, Emery R. Feasibility of a Systematic, Comprehensive, One-to-One Training (SCOOT) program for new scooter users: study protocol for a randomized control trial. Trials 2017; 18:235. [PMID: 28545498 PMCID: PMC5445361 DOI: 10.1186/s13063-017-1963-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/02/2017] [Indexed: 11/14/2022] Open
Abstract
Background Mobility scooters can facilitate community participation among individuals with mobility limitations. However, accidents are a serious concern with scooter use. Scooter training has been recommended to improve safety, but there are currently few validated programs available. Therefore, we developed a Systematic, Comprehensive, One-to-One Training (SCOOT) program for scooter users. We will conduct a study to evaluate the outcomes produced by the provision SCOOT. Methods This feasibility study will use a mixed-methods, rater-blinded, randomized control trial, with a two-step wedge design. The study has two arms: an immediate intervention group, which will receive the intervention directly after baseline assessments, and a delayed intervention group, which will receive the intervention after a 6-week period. Forty participants, who will be stratified based on whether or not participants have previously held a driver’s license, will be randomly assigned to each arm. The intervention for this study consists of 6 weeks of one-to-one scooter training by an experienced occupational therapist, who will provide training once or twice per week over the 6 weeks. The primary outcome measure is subjective scooter skills, measured using the Wheelchair Skills Test for scooters. Secondary outcomes include objective scooter skills, confidence, mobility, and satisfaction with selected participation activities. Descriptive measures include cognitive status, functional status, hearing, vision, physical accessibility of the home and community, and visual attention and task switching. Qualitative interviews will be conducted with the first ten willing participants from each group to learn about their scooter use and experiences with SCOOT. Discussion The results of this study will inform a larger randomized control trial. If the intervention is proven to be effective in this larger study, it may have important implications for policy and practice. Trial registration ClinicalTrials.gov identifier: NCT02696213. Registered on 23 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1963-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- W Ben Mortenson
- The Department of Occupational Science and Occupational Therapy, University of British Columbia, T-325-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Sharon Jang
- GF Strong Rehabilitation Center, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada
| | - Charlie H Goldsmith
- Mary Pack Arthritis Center, 895 West 10th Ave., Vancouver, BC, V5Z 1L7, Canada
| | - Laura Hurd Clarke
- University of British Columbia, 1924 West Mall, Vancouver, BC, V6T 1Z2, Canada.,School of Kinesiology, University of British Columbia, 1156-1924 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - Sandra Hobson
- University of Western Ontario, 1201 Western Road, London, ONT, N6G 1H1, Canada
| | - Richelle Emery
- Vancouver Coastal Health - Community Care, 520 West 6th Avenue, Vancouver, BC, V5Z 1A1, Canada
| |
Collapse
|
19
|
Translation, Validation, and Reliability of the Dutch Late-Life Function and Disability Instrument Computer Adaptive Test. Phys Ther 2016; 96:1430-7. [PMID: 26961363 DOI: 10.2522/ptj.20150265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/06/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adequate and user-friendly instruments for assessing physical function and disability in older adults are vital for estimating and predicting health care needs in clinical practice. The Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) is a promising instrument for assessing physical function and disability in gerontology research and clinical practice. OBJECTIVE The aims of this study were: (1) to translate the LLFDI-CAT to the Dutch language and (2) to investigate its validity and reliability in a sample of older adults who spoke Dutch and dwelled in the community. DESIGN For the assessment of validity of the LLFDI-CAT, a cross-sectional design was used. To assess reliability, measurement of the LLFDI-CAT was repeated in the same sample. METHODS The item bank of the LLFDI-CAT was translated with a forward-backward procedure. A sample of 54 older adults completed the LLFDI-CAT, World Health Organization Disability Assessment Schedule 2.0, RAND 36-Item Short-Form Health Survey physical functioning scale (10 items), and 10-Meter Walk Test. The LLFDI-CAT was repeated in 2 to 8 days (mean=4.5 days). Pearson's r and the intraclass correlation coefficient (ICC) (2,1) were calculated to assess validity, group-level reliability, and participant-level reliability. RESULTS A correlation of .74 for the LLFDI-CAT function scale and the RAND 36-Item Short-Form Health Survey physical functioning scale (10 items) was found. The correlations of the LLFDI-CAT disability scale with the World Health Organization Disability Assessment Schedule 2.0 and the 10-Meter Walk Test were -.57 and -.53, respectively. The ICC (2,1) of the LLFDI-CAT function scale was .84, with a group-level reliability score of .85. The ICC (2,1) of the LLFDI-CAT disability scale was .76, with a group-level reliability score of .81. LIMITATIONS The high percentage of women in the study and the exclusion of older adults with recent joint replacement or hospitalization limit the generalizability of the results. CONCLUSIONS The Dutch LLFDI-CAT showed strong validity and high reliability when used to assess physical function and disability in older adults dwelling in the community.
Collapse
|
20
|
Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comp Eff Res 2016; 5:507-19. [PMID: 27427277 DOI: 10.2217/cer-2015-0014] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported outcomes (PROs) are reports of the status of a patient's health condition that come directly from the patient. While PRO measures are a well-developed technology with robust standards in research, their use for informing healthcare decisions is still poorly understood. We review relevant examples of their application in the provision of healthcare and examine the challenges associated with implementing PROs in clinical settings. We evaluate evidence for their use and examine barriers to their uptake, and present an evidence-based framework for the successful implementation of PROs in clinical practice. We discuss current and future developments for the use of PROs in clinical practice, such as individualized measurement and computer-adaptive testing.
Collapse
Affiliation(s)
- Ian Porter
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Gibbons
- Primary Care Unit, Cambridge Center for Health Services Research, University of Cambridge, UK.,The Psychometrics Centre, Judge Business School, University of Cambridge, UK
| | - Jaheeda Gangannagaripalli
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jose M Valderas
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
21
|
White DK, Master H. Patient-Reported Measures of Physical Function in Knee Osteoarthritis. Rheum Dis Clin North Am 2016; 42:239-52. [PMID: 27133487 DOI: 10.1016/j.rdc.2016.01.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Knee osteoarthritis is a common cause of an array of functional limitations in older adults, and the accurate assessment of such limitations is critical for practicing clinicians and scientists. Patient-reported measures are a valuable resource to track the type and severity of limitation, although the psychometric performance of each instrument should be thoroughly evaluated before adoption. This article reviews the validity, reliability, sensitivity to change, and responsiveness of 3 patient-reported measures of physical function: the Western Ontario and McMaster Universities Osteoarthritis Index, the Knee Injury and Osteoarthritis Outcome Score, and the Patient Reported Outcomes Measurement Information System Physical Function scale.
Collapse
Affiliation(s)
- Daniel K White
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, 210L, Newark, DE 19713, USA.
| | - Hiral Master
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, 210L, Newark, DE 19713, USA
| |
Collapse
|
22
|
Evaluation of Computerized Adaptive Tests (CATs) for longitudinal monitoring of depression, anxiety, and stress reactions. J Affect Disord 2016; 190:846-853. [PMID: 25481813 DOI: 10.1016/j.jad.2014.10.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 10/26/2014] [Accepted: 10/30/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Computerized adaptive testing (CAT) based on Item Response Theory, (IRT) offers an efficient way for accurate measurement of patient reported outcomes. The efficiency lies within a minimal response burden and a high measurement precision over a broad measurement range. The objective of the study was to evaluate and compare the responsiveness of CATs measuring anxiety, depression, and stress reaction to standard static self-assessment tools. METHODS Longitudinal data of n=595 psychosomatic inpatients were analyzed for evaluating retest-reliability and sensitivity to change of the CATs compared to static measures (GAD-7, PHQ-9, and PSQ) using correlational and ANOVA statistics. The study hypothesized that CATs are at least as retest-reliable and as sensitive to change as static tools. RESULTS The three CATs show a low burden for patients, administering on average 5-7 (±2-6SD) items with similar retest-reliability compared to the static tools applied (A-CAT: r=.78 vs. GAD-7: r=.75, D-CAT: r=.71 vs. PHQ-9: r=.75, S-CAT: r=.80 vs. PSQworries scale: r=.80). The CATs were overall as sensitive to change as the static tools (Cohen׳s d ranged between .19 and .69). LIMITATIONS This is a monocenter, observational, longitudinal study without external clinical criteria; thus generalization to other settings may be limited. CONCLUSIONS The tested CATs belong to the first generation of CATs being used in daily routine for more than a decade. They are as retest reliable and sensitive to change as static tools. Newer CATs may provide further practical advantages.
Collapse
|
23
|
Petersen MA, Gamper EM, Costantini A, Giesinger JM, Holzner B, Johnson C, Sztankay M, Young T, Groenvold M. An emotional functioning item bank of 24 items for computerized adaptive testing (CAT) was established. J Clin Epidemiol 2015; 70:90-100. [PMID: 26363341 DOI: 10.1016/j.jclinepi.2015.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To improve measurement precision, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is developing an item bank for computerized adaptive testing (CAT) of emotional functioning (EF). The item bank will be within the conceptual framework of the widely used EORTC Quality of Life questionnaire (QLQ-C30). STUDY DESIGN AND SETTING On the basis of literature search and evaluations by international samples of experts and cancer patients, 38 candidate items were developed. The psychometric properties of the items were evaluated in a large international sample of cancer patients. This included evaluations of dimensionality, item response theory (IRT) model fit, differential item functioning (DIF), and of measurement precision/statistical power. RESULTS Responses were obtained from 1,023 cancer patients from four countries. The evaluations showed that 24 items could be included in a unidimensional IRT model. DIF did not seem to have any significant impact on the estimation of EF. Evaluations indicated that the CAT measure may reduce sample size requirements by up to 50% compared to the QLQ-C30 EF scale without reducing power. CONCLUSION On the basis of thorough psychometric evaluations, we have established an EF item bank of 24 items. This will allow for more precise and flexible measurement of EF, while maintaining backward compatibility with the QLQ-C30 EF scale.
Collapse
Affiliation(s)
- Morten Aa Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
| | - Eva-Maria Gamper
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, A - 6020 Innsbruck, Austria
| | - Anna Costantini
- Psycho-oncology Unit, Sant'Andrea Hospital, Department of Oncological Sciences, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035 - 00189 Rome, Italy
| | - Johannes M Giesinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, A - 6020 Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, A - 6020 Innsbruck, Austria
| | - Colin Johnson
- Surgical Unit, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK
| | - Monika Sztankay
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, A - 6020 Innsbruck, Austria
| | - Teresa Young
- Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen, Denmark
| | | |
Collapse
|
24
|
Lu WS, Lien BYH, Hsieh CL. Psychometric properties of the Balance Computerized Adaptive Test in residents in long-term care facilities. Arch Gerontol Geriatr 2015; 61:149-53. [PMID: 26013166 DOI: 10.1016/j.archger.2015.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/05/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To validate the psychometric properties and efficiency of the Balance Computerized Adaptive Testing (Balance CAT) when applied to residents in long-term care (LTC) facilities. DESIGN AND METHODS A cohort study was conducted in central Taiwan. The Balance CAT, the Berg Balance Scale (BBS), and the Barthel Index (BI) were administered to each participant with the ability to follow simple instructions by a trained rater in two days. The Pearson's correlation coefficient (r) was used to determine the concurrent validity of the Balance CAT. ANOVA and post hoc analysis were employed to investigate the discriminative ability of the Balance CAT. The paired t test was used to validate the efficiency. RESULTS A total of 120 participants completed assessments of the Balance CAT, the BBS, and the Barthel Index (BI). The Pearson's r between the scores of the Balance CAT and the BBS was 0.90. Groups with different levels of dependence had significantly different mean scores of the Balance CAT. The mean IRT reliability of the Balance CAT scores was 0.93. The mean administration time of the Balance CAT was about 28% of that of the BBS, and the mean number of items used in the Balance CAT was 3.4. CONCLUSIONS The Balance CAT had excellent concurrent and discriminative validity, reliability, and efficiency in residents of LTC facilities. These results indicate that the Balance CAT is a sound and practical measure for assessing the balance function of residents of LTC facilities.
Collapse
Affiliation(s)
- Wen-Shian Lu
- School of Occupational Therapy, Chung Shan Medical University, Occupational Therapy Room, Chung Shan Medical University Hospital, Taiwan; Department of Business Administration, National Chung Cheng University, Taiwan.
| | - Bella Ya-Hui Lien
- Department of Business Administration, National Chung Cheng University, Taiwan
| | - Ching-Ling Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan
| |
Collapse
|
25
|
Chang FH, Latham NK, Friedman RH, Jette AM. Interactive voice response version of the late-life function and disability instrument. J Am Geriatr Soc 2015; 63:770-5. [PMID: 25900491 DOI: 10.1111/jgs.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop an interactive voice response (IVR) version of the Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) and to evaluate its reliability and acceptability in older adults. DESIGN The IVR system was embedded within the LLFDI-CAT program. To test the test-retest reliability and concordance of the IVR version of LLFDI-CAT with the telephone interviewer form (TIF), participants received the two versions of the LLFDI at baseline and at 1-week follow-up. SETTING Community. PARTICIPANTS Community-dwelling adults aged 65 and older (N = 50). MEASUREMENTS The LLFDI is a self-reported outcome measure developed to assess function and disability in older adults. RESULTS The IVR version of the LLFDI-CAT showed acceptable overall test-retest reliability (intraclass correlation coefficient (ICC) = 0.79-0.80) and concordance (ICC = 0.74-0.97) with the TIF. Although most participants preferred the TIF, the majority did not find the IVR version more difficult to use. CONCLUSION The IVR version of the LLFDI-CAT achieved reliability levels that were comparable with those of the TIF version. Future work is needed to improve the IVR design to better fit older adults' needs and preferences.
Collapse
Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan; Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
| | | | | | | |
Collapse
|
26
|
Overbeek CL, Nota SPFT, Jayakumar P, Hageman MG, Ring D. The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness. Clin Orthop Relat Res 2015; 473:311-7. [PMID: 25099262 PMCID: PMC4390943 DOI: 10.1007/s11999-014-3840-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/22/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function-an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH). QUESTIONS/PURPOSES We aimed to find correlation between the PROMIS Physical Function and the QuickDASH questionnaires in patients with upper extremity illness. Secondarily, we addressed whether the PROMIS Physical Function and QuickDASH correlate with the PROMIS Depression CAT and PROMIS Pain Interference CAT instruments. Finally, we assessed factors associated with QuickDASH and PROMIS Physical Function in multivariable analysis. METHODS A cohort of 93 outpatients with upper extremity illnesses completed the QuickDASH and three PROMIS CAT questionnaires: Physical Function, Pain Interference, and Depression. Pain intensity was measured with an 11-point ordinal measure (0-10 numeric rating scale). Correlation between PROMIS Physical Function and the QuickDASH was assessed. Factors that correlated with the PROMIS Physical Function and QuickDASH were assessed in multivariable regression analysis after initial bivariate analysis. RESULTS There was a moderate correlation between the PROMIS Physical Function and the QuickDASH questionnaire (r=-0.55, p<0.001). Greater disability as measured with the PROMIS and QuickDASH correlated most strongly with PROMIS Depression (r=-0.35, p<0.001 and r=0.34, p<0.001 respectively) and Pain Interference (r=-0.51, p<0.001 and r=0.74, p<0.001 respectively). The factors accounting for the variability in PROMIS scores are comparable to those for the QuickDASH except that the PROMIS Physical Function is influenced by other pain conditions while the QuickDASH is not. CONCLUSIONS The PROMIS Physical Function instrument may be used as an upper extremity disability measure, as it correlates with the QuickDASH questionnaire, and both instruments are influenced most strongly by the degree to which pain interferes with achieving goals. LEVEL OF EVIDENCE Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Celeste L. Overbeek
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Sjoerd P. F. T. Nota
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Prakash Jayakumar
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Michiel G. Hageman
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - David Ring
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- />Orthopaedic Associates, Yawkey Center for Outpatient Care, Suite 2C, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
27
|
Psychometric properties of the Late-Life Function and Disability Instrument: a systematic review. BMC Geriatr 2014; 14:12. [PMID: 24476510 PMCID: PMC3909447 DOI: 10.1186/1471-2318-14-12] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/22/2014] [Indexed: 12/22/2022] Open
Abstract
Background The choice of measure for use as a primary outcome in geriatric research is contingent upon the construct of interest and evidence for its psychometric properties. The Late-Life Function and Disability Instrument (LLFDI) has been widely used to assess functional limitations and disability in studies with older adults. The primary aim of this systematic review was to evaluate the current available evidence for the psychometric properties of the LLFDI. Methods Published studies of any design reporting results based on administration of the original version of the LLFDI in community-dwelling older adults were identified after searches of 9 electronic databases. Data related to construct validity (convergent/divergent and known-groups validity), test-retest reliability and sensitivity to change were extracted. Effect sizes were calculated for within-group changes and summarized graphically. Results Seventy-one studies including 17,301 older adults met inclusion criteria. Data supporting the convergent/divergent and known-groups validity for both the Function and Disability components were extracted from 30 and 18 studies, respectively. High test-retest reliability was found for the Function component, while results for the Disability component were more variable. Sensitivity to change of the LLFDI was confirmed based on findings from 25 studies. The basic lower extremity subscale and overall summary score of the Function component and limitation dimension of the Disability component were associated with the strongest relative effect sizes. Conclusions There is extensive evidence to support the construct validity and sensitivity to change of the LLFDI among various clinical populations of community-dwelling older adults. Further work is needed on predictive validity and values for clinically important change. Findings from this review can be used to guide the selection of the most appropriate LLFDI subscale for use an outcome measure in geriatric research and practice.
Collapse
|
28
|
Vedel I, Akhlaghpour S, Vaghefi I, Bergman H, Lapointe L. Health information technologies in geriatrics and gerontology: a mixed systematic review. J Am Med Inform Assoc 2013; 20:1109-19. [PMID: 23666776 PMCID: PMC3822120 DOI: 10.1136/amiajnl-2013-001705] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/08/2013] [Accepted: 04/13/2013] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To review, categorize, and synthesize findings from the literature about the application of health information technologies in geriatrics and gerontology (GGHIT). MATERIALS AND METHODS This mixed-method systematic review is based on a comprehensive search of Medline, Embase, PsychInfo and ABI/Inform Global. Study selection and coding were performed independently by two researchers and were followed by a narrative synthesis. To move beyond a simple description of the technologies, we employed and adapted the diffusion of innovation theory (DOI). RESULTS 112 papers were included. Analysis revealed five main types of GGHIT: (1) telecare technologies (representing half of the studies); (2) electronic health records; (3) decision support systems; (4) web-based packages for patients and/or family caregivers; and (5) assistive information technologies. On aggregate, the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical processes. Although less frequently studied, positive impacts were found on patients' health, productivity, efficiency and costs, clinicians' satisfaction, patients' satisfaction and patients' empowerment. DISCUSSION Further efforts should focus on improving the characteristics of such technologies in terms of compatibility and simplicity. Implementation strategies also should be improved as trialability and observability are insufficient. CONCLUSIONS Our results will help organizations in making decisions regarding the choice, planning and diffusion of GGHIT implemented for the care of older adults.
Collapse
Affiliation(s)
- Isabelle Vedel
- Department of Family Medicine, McGill University, Solidage Research Group on Frailty and Aging, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Saeed Akhlaghpour
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
- Middlesex University Business School, Middlesex University, London, UK
| | - Isaac Vaghefi
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Solidage Research Group on Frailty and Aging, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada
| | - Liette Lapointe
- Department of Family Medicine, McGill University, Solidage Research Group on Frailty and Aging, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
29
|
Validation of PROMIS ® Physical Function computerized adaptive tests for orthopaedic foot and ankle outcome research. Clin Orthop Relat Res 2013; 471:3466-74. [PMID: 23749433 PMCID: PMC3792246 DOI: 10.1007/s11999-013-3097-1] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 2012, the American Orthopaedic Foot & Ankle Society(®) established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network's initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting. QUESTIONS/PURPOSES We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System(®) (PROMIS(®)) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients' physical function. METHODS After informed consent, 288 patients with a mean age of 51 years (range, 18-81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS(®) Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients' physical function levels. Instrument coverage was based on a person-item map. RESULTS Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of -0.657 (p < 0.001). Precision had an SEM of less than 3.3 (equivalent to a Cronbach's alpha of ≥ 0.90) across a broad range of function. Concerning coverage, the ceiling effect was 0.32% and there was no floor effect. CONCLUSIONS The PROMIS(®) PF CAT appears to be an excellent method for measuring outcomes for patients with foot and ankle surgery. Further validation of the PROMIS(®) item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.
Collapse
|
30
|
Roaldsen KS, Halvarsson A, Sarlija B, Franzen E, Ståhle A. Self-reported function and disability in late life - cross-cultural adaptation and validation of the Swedish version of the late-life function and disability instrument. Disabil Rehabil 2013; 36:813-7. [PMID: 23944179 PMCID: PMC4046868 DOI: 10.3109/09638288.2013.819387] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To translate and perform a cross-cultural adaptation of the Late-Life Function and Disability Instrument (LLFDI) to Swedish, to investigate absolute and relative reliability, concurrent validity, and floor and ceiling effects within a Swedish-speaking sample of community-dwelling older adults with self-reported balance deficits and fear of falling. Method Translation, reliability and validation study of the LLFDI. Sixty-two community-dwelling, healthy older adults (54 women and 8 men) aged 68–88 years with balance deficits and fear of falling performed the LLFDI twice with an interval of 2 weeks. Results Test–retest agreement, intra-class correlation coefficient was very good, 0.87–0.91 in the LLFDI function component and 0.82–0.91 in the LLFDI disability component. The standard error of measure was small, 5–9%, and the smallest real difference was 14–24%. Internal consistency (Cronbach’s alpha) was high (0.90–0.96). Correlation with the SF-36 PCS and PF-10 was moderate in both LLFDI function, r = 0.39–0.68 and r = 0.35–0.52, and LLFDI disability, r = 0.40–0.63 and 0.34–0.57, respectively. There was no floor or ceiling effects. Conclusion The Swedish version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community-dwelling older women with self-reported balance deficits and fear of falling.Implications for Rehabilitation The Swedish LLFDI is a highly reliable and valid instrument for assessing function and disability in older women with self-reported balance deficits and fear of falling. The instrument may be used both in clinical settings and in research. The instrument is sensitive to change and a reasonably small improvement is enough to detect changes in a group or a single individual.
Collapse
Affiliation(s)
- Kirsti Skavberg Roaldsen
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Stockholm , Sweden
| | | | | | | | | |
Collapse
|
31
|
Cabrero-García J, Ramos-Pichardo JD, Muñoz-Mendoza CL, Cabañero-Martínez MJ, González-Llopis L, Reig-Ferrer A. Validation of a mobility item bank for older patients in primary care. Health Qual Life Outcomes 2012; 10:147. [PMID: 23216846 PMCID: PMC3547751 DOI: 10.1186/1477-7525-10-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 11/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex. METHODS A pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs. RESULTS The Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items. CONCLUSIONS During the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.
Collapse
Affiliation(s)
- Julio Cabrero-García
- Department of Nursing, University of Alicante, San Vicente del Raspeig, Alicante, Spain.
| | | | | | | | | | | |
Collapse
|
32
|
Gignac MAM, Cao X, Mcalpine J, Badley EM. Measures of disability: Arthritis Impact Measurement Scales 2 (AIMS2), Arthritis Impact Measurement Scales 2-Short Form (AIMS2-SF), The Organization for Economic Cooperation and Development (OECD) Long-Term Disability (LTD) Questionnaire, EQ-5D, World Health Organization Disability Assessment Schedule II (WHODASII), Late-Life Function and Disability Instrument (LLFDI), and Late-Life Function and Disability Instrument-Abbreviated Version (LLFDI-Abbreviated). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S308-24. [PMID: 22588753 DOI: 10.1002/acr.20640] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Monique A M Gignac
- Toronto Western Research Institute, and University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
33
|
Abstract
BACKGROUND Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted. METHODS We reviewed the literature and evaluated existing data to discuss the potential of CATs for use in ambulatory monitoring outside clinical facilities. RESULTS Computerized adaptive tests are not being used for ambulatory monitoring, but initial results from their use in health care research allow for discussion of some issues relevant to ambulatory care. Evidence shows that CATs can capture the most relevant health outcomes as well as established static tools, with substantially decreased respondent burden. They can be more precise than static tools of similar length and can reduce floor and ceiling effects. Computerized adaptive tests can reliably measure a construct over time with different items, which yields the potential of introducing item exposure control in ambulatory monitoring. Studies have shown that CATs can be at least as valid as well-designed static tools in group comparisons, but further investigation is needed to determine whether psychometric advantages lead to increased responsiveness of CATs. CONCLUSIONS Ambulatory monitoring of PROs demands short, yet very precise measurements, which can be repeated up to many times a day. Computerized adaptive tests may address several present shortcomings in ambulatory monitoring of PROs efficiently. However, most CAT developments have primarily focused on psychometric improvements. To use the full potential of CATs for ambulatory monitoring purposes, content must also be carefully considered.
Collapse
|
34
|
McDonough CM, Tian F, Ni P, Kopits IM, Moed R, Pardasaney PK, Jette AM. Development of the computer-adaptive version of the Late-Life Function and Disability Instrument. J Gerontol A Biol Sci Med Sci 2012; 67:1427-38. [PMID: 22546960 DOI: 10.1093/gerona/gls108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Having psychometrically strong disability measures that minimize response burden is important in assessing of older adults. METHODS Using the original 48 items from the Late-Life Function and Disability Instrument and newly developed items, a 158-item Activity Limitation and a 62-item Participation Restriction item pool were developed. The item pools were administered to a convenience sample of 520 community-dwelling adults 60 years or older. Confirmatory factor analysis and item response theory were employed to identify content structure, calibrate items, and build the computer-adaptive testings (CATs). We evaluated real-data simulations of 10-item CAT subscales. We collected data from 102 older adults to validate the 10-item CATs against the Veteran's Short Form-36 and assessed test-retest reliability in a subsample of 57 subjects. RESULTS Confirmatory factor analysis revealed a bifactor structure, and multi-dimensional item response theory was used to calibrate an overall Activity Limitation Scale (141 items) and an overall Participation Restriction Scale (55 items). Fit statistics were acceptable (Activity Limitation: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.03; Participation Restriction: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.05). Correlation of 10-item CATs with full item banks were substantial (Activity Limitation: r = .90; Participation Restriction: r = .95). Test-retest reliability estimates were high (Activity Limitation: r = .85; Participation Restriction r = .80). Strength and pattern of correlations with Veteran's Short Form-36 subscales were as hypothesized. Each CAT, on average, took 3.56 minutes to administer. CONCLUSIONS The Late-Life Function and Disability Instrument CATs demonstrated strong reliability, validity, accuracy, and precision. The Late-Life Function and Disability Instrument CAT can achieve psychometrically sound disability assessment in older persons while reducing respondent burden. Further research is needed to assess their ability to measure change in older adults.
Collapse
Affiliation(s)
- Christine M McDonough
- PT, MS, Health & Disability Research Institute, Boston University School of Public Health, 715 Albany Street-T5W, Boston, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Hung M, Clegg DO, Greene T, Weir C, Saltzman CL. A lower extremity physical function computerized adaptive testing instrument for orthopaedic patients. Foot Ankle Int 2012; 33:326-35. [PMID: 22735205 DOI: 10.3113/fai.2012.0326] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to develop a lower extremity (LE) physical function computerized adaptive testing (CAT) instrument based on Patient Reported Outcomes Measurement Information System (PROMIS) physical function items. METHODS The PROMIS physical function item bank was administered to adult outpatient orthopaedic patients. Three hundred eighty-two patients presenting with LE disorders were analyzed using item response theory modeling. A LE physical function item bank was developed by distilling relevant and psychometrically sound items from the full PROMIS physical function bank. Real data CAT simulations were conducted to examine specifications for a live CAT. RESULTS The LE physical function item bank was sufficiently unidimensional and free of item bias. It demonstrated high reliability along with content and construct validity. The flexible length LE CAT was highly correlated with the full LE instrument and showed uniformly high precision across the entire measurement continuum. The average CAT length was 6 to 7 items when standard error of measurement was 0.3 or less. CONCLUSION This LE physical function CAT is a valid, reliable and feasible physical function assessment tool for orthopaedic patients with LE problems that has the potential to reduce patient burden as well as administrative costs associated with data collection.
Collapse
|
36
|
Lapier TK. Utility of the late life function and disability instrument as an outcome measure in patients participating in outpatient cardiac rehabilitation: a preliminary study. Physiother Can 2012; 64:53-62. [PMID: 23277685 DOI: 10.3138/ptc.2010-30] [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: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to examine the concurrent validity of the Late Life Function and Disability Instrument (LLFDI) in patients with coronary heart disease (CHD) and to evaluate the accuracy of information obtained through self-report questionnaire versus interview formats. METHODS The study included 29 patients older than 60 years attending an outpatient cardiac rehabilitation program. Participants completed the LLFDI, three additional self-report criterion measures, and six performance-based tests; they completed the LLFDI a second time via interview. We used descriptive statistics, correlations, and t-tests to analyze the data. RESULTS All LLFDI components were correlated (rs=0.36-0.83) with the self-report criterion measures. The Function Component of the LLFDI was moderately correlated with the 6-Minute Walk Test (r=0.62), timed up-and-go (r=-0.58), walking speed (r=-0.57), and timed sit-to-stand (r=-0.56) scores. The LLFDI demonstrated a ceiling effect (10%) only in the Disability Limitation component. All LLFDI component scores obtained via self-report questionnaire were correlated with scores obtained via interview; except in a single subcategory, there was no difference between LLFDI scores obtained through self-report questionnaire and those obtained through interview. CONCLUSIONS RESULTS indicate that the LLFDI has appropriate validity for older patients (>60 years) with CHD and can be completed independently by patients rather than administered by clinicians.
Collapse
Affiliation(s)
- Tanya Kinney Lapier
- Department of Physical Therapy, Eastern Washington University, Spokane, Washington, USA
| |
Collapse
|
37
|
Abstract
BACKGROUND Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically. OBJECTIVE The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care. DESIGN This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise. METHODS A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy. RESULTS Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R(2)), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores. LIMITATIONS This study included older adults with mobility limitations and may not generalize to other populations. CONCLUSIONS Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was associated with age and physiologic factors, whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors.
Collapse
|
38
|
Hanania NA, King MJ, Braman SS, Saltoun C, Wise RA, Enright P, Falsey AR, Mathur SK, Ramsdell JW, Rogers L, Stempel DA, Lima JJ, Fish JE, Wilson SR, Boyd C, Patel KV, Irvin CG, Yawn BP, Halm EA, Wasserman SI, Sands MF, Ershler WB, Ledford DK. Asthma in the elderly: Current understanding and future research needs--a report of a National Institute on Aging (NIA) workshop. J Allergy Clin Immunol 2011; 128:S4-24. [PMID: 21872730 PMCID: PMC3164961 DOI: 10.1016/j.jaci.2011.06.048] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/27/2022]
Abstract
Asthma in the elderly is underdiagnosed and undertreated, and there is a paucity of knowledge on the subject. The National Institute on Aging convened this workshop to identify what is known and what gaps in knowledge remain and suggest research directions needed to improve the understanding and care of asthma in the elderly. Asthma presenting at an advanced age often has similar clinical and physiologic consequences as seen with younger patients, but comorbid illnesses and the psychosocial effects of aging might affect the diagnosis, clinical presentation, and care of asthma in this population. At least 2 phenotypes exist among elderly patients with asthma; those with longstanding asthma have more severe airflow limitation and less complete reversibility than those with late-onset asthma. Many challenges exist in the recognition and treatment of asthma in the elderly. Furthermore, the pathophysiologic mechanisms of asthma in the elderly are likely to be different from those seen in young asthmatic patients, and these differences might influence the clinical course and outcomes of asthma in this population.
Collapse
Affiliation(s)
- Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Asthma Clinical Research Center, Baylor College of Medicine, Houston, Tex., USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Hou WH, Chen JH, Wang YH, Wang CH, Lin JH, Hsueh IP, Ou YC, Hsieh CL. Development of a Set of Functional Hierarchical Balance Short Forms for Patients With Stroke. Arch Phys Med Rehabil 2011; 92:1119-25. [DOI: 10.1016/j.apmr.2011.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 11/17/2022]
|
40
|
Chien TW, Lai WP, Lu CW, Wang WC, Chen SC, Wang HY, Su SB. Web-based computer adaptive assessment of individual perceptions of job satisfaction for hospital workplace employees. BMC Med Res Methodol 2011; 11:47. [PMID: 21496311 PMCID: PMC3101159 DOI: 10.1186/1471-2288-11-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 04/17/2011] [Indexed: 11/30/2022] Open
Abstract
Background To develop a web-based computer adaptive testing (CAT) application for efficiently collecting data regarding workers' perceptions of job satisfaction, we examined whether a 37-item Job Content Questionnaire (JCQ-37) could evaluate the job satisfaction of individual employees as a single construct. Methods The JCQ-37 makes data collection via CAT on the internet easy, viable and fast. A Rasch rating scale model was applied to analyze data from 300 randomly selected hospital employees who participated in job-satisfaction surveys in 2008 and 2009 via non-adaptive and computer-adaptive testing, respectively. Results Of the 37 items on the questionnaire, 24 items fit the model fairly well. Person-separation reliability for the 2008 surveys was 0.88. Measures from both years and item-8 job satisfaction for groups were successfully evaluated through item-by-item analyses by using t-test. Workers aged 26 - 35 felt that job satisfaction was significantly worse in 2009 than in 2008. Conclusions A Web-CAT developed in the present paper was shown to be more efficient than traditional computer-based or pen-and-paper assessments at collecting data regarding workers' perceptions of job content.
Collapse
Affiliation(s)
- Tsair-Wei Chien
- Department of Management, Chi-Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | | | |
Collapse
|
41
|
Marsh AP, Ip EH, Barnard RT, Wong YL, Rejeski WJ. Using video animation to assess mobility in older adults. J Gerontol A Biol Sci Med Sci 2010; 66:217-27. [PMID: 21127192 DOI: 10.1093/gerona/glq209] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the importance of the context of task performance in the assessment of mobility in older adults is generally understood, there is little empirical evidence that demonstrates how sensitive older adults are to subtle changes in task demands. Thus, we developed a novel approach to examine this issue. METHODS We collected item response data to 81 animated video clips, where various mobility-related tasks were modified in a systematic fashion to manipulate task difficulty. RESULTS The participants (N = 234), 166 women and 68 men, had an average age of 81.9 years and a variety of comorbidities. Histograms of item responses revealed dramatic and systematic effects on older adults' self-reported ability when varying walking speed, use of a handrail during ascent and descent of stairs, walking at different speeds outdoors over uneven terrain, and carrying an object. For example, there was almost a threefold increase in reporting the inability to walk at the fast speed compared with the slow speed for a minute or less, and twice as many participants reported the inability to walk at the fast speed outdoors over uneven terrain compared with indoors. CONCLUSIONS The data provide clear evidence that varying the contextual features and demands of a simple task such as stair climbing has a significant impact on older adults' self-reporting of ability related to mobility. More work is needed on the psychometric properties of such assessments and to determine if this methodology has conceptual and clinical relevance in studying mobility disability.
Collapse
Affiliation(s)
- Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, P.O. Box 7868, Winston-Salem, NC 27109, USA.
| | | | | | | | | |
Collapse
|
42
|
Abstract
Over the past 2 decades, there has been considerable progress in the assessment of function and disability in older persons. Tests of physical performance are now routinely included in longitudinal studies to measure functional limitations, which are considered the building blocks of functioning. In addition, new strategies have been developed to assess the presence and onset of disability and to expand the scope of disability assessments beyond traditional indicators of difficulty and dependence. Contemporary measurement technologies, such as item response theory and computer adaptive testing, show great promise in the assessment of functional status and disability, but prospective studies are needed to demonstrate their true value, particularly to identify the circumstances in which their use will improve the assessment of functional outcomes in older persons. Another high priority for future research is to validate and further refine strategies to more completely and accurately ascertain the occurrence of disability in older persons.
Collapse
Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA.
| |
Collapse
|
43
|
Stineman MG, Streim JE. The biopsycho-ecological paradigm: a foundational theory for medicine. PM R 2010; 2:1035-45. [PMID: 21093839 PMCID: PMC3071421 DOI: 10.1016/j.pmrj.2010.06.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 01/01/2023]
Abstract
The current biomedical and psychosocial frameworks that form the conceptual basis of medicine today are insufficient to address the needs of the medically complex and environmentally challenged populations of patients often cared for by physical medicine and rehabilitation specialists. The expanded biopsycho-ecological model of health, illness, injury, and disability operating through mechanisms of Health Environmental Integration (HEI) encourages a more complete understanding of illness, injury, activity limitation, and participation restriction as arising at the interface between the person and the environment. HEI recognizes complex interacting multilevel functional hierarchies beginning at the cellular level and ending at the individual's experience of the environment. Although the foci of illness and injury are within the body and mind, the physical and social environments contain elements that can cause or exacerbate disease and barriers that interact in ways that lead to injuries and disabilities. Furthermore, these environments hold the elements from which treating agents, facilitators, and social supports must be fashioned. The highly integrative biopsycho-ecological framework provides an expanded basis for understanding the objective causes and subjective meanings of disabilities. Disabilities are reduced through HEI by seeking to maximally integrate the body and mind (the self) with both the surrounding physical environment and other people in society. HEI offers mechanisms for interdisciplinary research, an expanded framework for education and empowerment, and a blueprint for optimizing day-to-day clinical care at both the individual patient and treatment population levels in the ever-changing scientific, political, and policy environments.
Collapse
Affiliation(s)
- Margaret Grace Stineman
- Department of Physical Medicine and Rehabilitation, Center for Clinical Epidemiology and Biostatistics, 904 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, USA.
| | | |
Collapse
|
44
|
Abstract
BACKGROUND An efficient and precise measure of balance is needed to improve administration efficiency and to reduce the assessment burden for patients. OBJECTIVE The purpose of this study was to develop a computerized adaptive testing (CAT) system for assessing balance function in an efficient, reliable, and valid fashion in patients with stroke. DESIGN Two cross-sectional prospective studies were conducted. SETTING This study was conducted in the departments of physical medicine and rehabilitation in 6 hospitals. PATIENTS The participants were inpatients and outpatients who were receiving rehabilitation. MEASUREMENTS A balance item pool (41 items) was developed on the basis of predefined balance concepts, expert opinions, and field testing. The items were administered by 5 raters to 764 patients. An item response theory model was fit to the data, and the item parameters were estimated. A simulation study was used to determine the performance (eg, reliability, efficiency) of the Balance CAT. The Balance CAT and the Berg Balance Scale (BBS) then were tested on another independent sample of 56 patients to determine the concurrent validity and time needed for administration. RESULTS Seven items did not meet the model's expectations and were excluded from further analysis. The remaining 34 items formed the item bank of the Balance CAT. Two stopping rules (ie, reliability coefficient > 0.9 or < or = 6 items) were set for the CAT. The simulation study showed that the patients' balance scores estimated by the CAT had an average reliability value of .94. The scores obtained from the CAT were closely associated with those of the full item set (Pearson r=.98). The scores of the Balance CAT were highly correlated with those of the BBS (Pearson r=.88). The average time needed to administer the Balance CAT (83 seconds) was only 18% of that of the BBS. LIMITATIONS The convenience sampling of both samples may limit the generalization of the results. Further psychometric investigation of the Balance CAT is needed. CONCLUSION The results provide strong evidence that the Balance CAT is efficient and has reliability and validity for patients with stroke.
Collapse
|
45
|
LaPier TK, Mizner R. Outcome Measures in Cardiopulmonary Physical Therapy: Focus on the Late Life Function and Disability Instrument (LLFDI). Cardiopulm Phys Ther J 2009; 20:32-5. [PMID: 20467536 PMCID: PMC2845262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
| | - Ryan Mizner
- Department of Physical Therapy, Eastern Washington University, Spokane, WA
| |
Collapse
|