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Kwok A, Cheung D, Gordon M, Mudryk E, Manns PJ. Patient and therapist perspectives on physical therapy outcome measures and engagement after stroke: A case study. Physiother Theory Pract 2023; 39:2639-2650. [PMID: 35786128 DOI: 10.1080/09593985.2022.2092801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Outcome measures are highly recommended in stroke physical therapy, however, most of the existing research has been performed from the provider perspective. Understanding the patient perspective of outcome measures in conjunction with the therapist perspective may help to better support patient engagement and autonomy. PURPOSE The purpose of this study was to explore patient and therapist perspectives on physical therapy outcome measures post-stroke. METHODS This qualitative case study of a Canadian rehabilitation facility is based on patient-oriented research principles, with three patient partners embedded in the research team. Data collection included chart reviews, observations of physical therapy sessions, patient interviews, and therapist interviews. Field notes of observations and interview transcripts were analyzed using thematic analysis. RESULTS Ten patients and seven therapists participated. Analysis revealed the following two themes: 1) tracking progress; and 2) partnership. Tracking progress included the expectations patients had for improvement, the importance of objectively measuring change and the functional improvement observed day by day. Partnership described the relationship between therapist and patient including communication, encouragement and affirmation, the therapist as expert and the gradual shift in autonomy from therapist to patient. CONCLUSION Patients valued the objective results of outcome measures and were encouraged by measurable changes. Maximizing the use of physical therapy outcome measures may improve patient engagement and support relational autonomy.
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Affiliation(s)
- Alyson Kwok
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Healthcare Improvement Team, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Deacon Cheung
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maysyn Gordon
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Evan Mudryk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Hassan S, Tesio L, Kumbhare D. Standard Psychometric Criteria for Measurements in Physical and Rehabilitation Medicine. Am J Phys Med Rehabil 2022; 101:473-481. [PMID: 34050063 DOI: 10.1097/phm.0000000000001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Measurements of person's variable, such as behavior, perceptions, or attitudes, are essential to physical and rehabilitation medicine in both clinical practice and research. These measurements are commonly based on cumulative questionnaires and follow special statistical rules, belonging to the domain of psychometrics. Selecting the most appropriate measurement is critical. This article provides an overview of the standard psychometric criteria to consider in measurement selection. The article focuses on the criteria related to the contemporary psychometric approach as it considers the construct, the target population, and the purpose for which measurements are used. Common strategies related to psychometric testing are discussed and applied to critically appraise, as a representative example, one of the most commonly used pain measurements: Brief Pain Inventory. The measurement construct, conceptual framework, target population, purpose, and psychometric properties are highlighted. Observed limitations for its implementation in different settings also are discussed.
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Affiliation(s)
- Samah Hassan
- From the Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada (SH, DK); Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy (LT); Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milano, Italy (LT); and Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (DK)
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Ramos SDS, Oddy M, Haye L, Goodson A. Preliminary investigation of the reliability and validity of the BIRT Independent Living Scale. Disabil Rehabil 2017; 40:2817-2823. [PMID: 28805087 DOI: 10.1080/09638288.2017.1362594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Neurorehabilitation aims to increase independence and participation in ordinary life. It is argued that the fundamental indices of this are independent living and engagement in occupational or productive activity. The Brain Injury Rehabilitation Trust Independent Living Scale was designed to capture change in levels of participation and independence following neurorehabilitation. With greater use of outcome measures in health care, it becomes necessary to develop tools which are simple to use and that capture the holistic impact of rehabilitation. This study examines the inter-rater reliability and validity of the Brain Injury Rehabilitation Trust Independent Living Scale, which comprises two single item, multiple-choice sub-scales. METHOD Inter-rater reliability was assessed by comparing the ratings on the Brain Injury Rehabilitation Trust Independent Living Scale, by five pairs of graduate psychologists, of 37 individuals who had undergone neurorehabilitation. Retrospective data collected by other members of the clinical team for the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and Care And Needs Scale were correlated with the Brain Injury Rehabilitation Trust Independent Living Scale to establish concurrent validity. RESULTS Weighted kappa coefficients revealed moderate (occupation) to strong (accommodation) inter-rater reliability for the two sub-scales. All correlations between the Brain Injury Rehabilitation Trust Independent Living Scale and the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and the Care And Needs Scale were high, demonstrating good concurrent validity. CONCLUSIONS This study highlights some of the psychometric properties of the Brain Injury Rehabilitation Trust Independent Living Scale and demonstrates its utility in assessing independent living ability and level of social participation after neurorehabilitation. Implications for rehabilitation The BIRT Independent Living Scale is a validated method for ranking accommodation and occupation status as an indicator of independent living ability and occupational activity. The two freely available single-item scales emerging from this study provide a brief method for measuring independent living ability and participation following rehabilitation in research and clinical practice. The BIRT Independent Living Scale's simplicity means it does not require specific training to administer, facilitating its use by a wide range of multidisciplinary staff members and researchers.
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Affiliation(s)
| | - Michael Oddy
- a Brain Injury Rehabilitation Trust , Horsham , UK
| | | | - Anna Goodson
- a Brain Injury Rehabilitation Trust , Horsham , UK
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Fyffe D, Kalpakjian CZ, Slavin M, Kisala P, Ni P, Kirshblum SC, Tulsky DS, Jette AM. Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI). J Spinal Cord Med 2016; 39:527-34. [PMID: 26781769 PMCID: PMC5020585 DOI: 10.1080/10790268.2015.1133483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To provide validation of functional ability levels for the Spinal Cord Injury - Functional Index (SCI-FI). DESIGN Cross-sectional. SETTING Inpatient rehabilitation hospital and community settings. PARTICIPANTS A sample of 855 individuals with traumatic spinal cord injury enrolled in 6 rehabilitation centers participating in the National Spinal Cord Injury Model Systems Network. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Spinal Cord Injury-Functional Index (SCI-FI). RESULTS Cluster analyses identified three distinct groups that represent low, mid-range and high SCI-FI functional ability levels. Comparison of clusters on personal and other injury characteristics suggested some significant differences between groups. CONCLUSIONS These results strongly support the use of SCI-FI functional ability levels to document the perceived functional abilities of persons with SCI. Results of the cluster analysis suggest that the SCI-FI functional ability levels capture function by injury characteristics. Clinical implications regarding tracking functional activity trajectories during follow-up visits are discussed.
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Affiliation(s)
- Denise Fyffe
- Kessler Foundation, West Orange, NJ, USA,Department of Physical Medicine & Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ, USA,Correspondence to: Denise Fyffe, Department of Physical Medicine and Rehabilitation New Jersey Medical School Rutgers, the State University of New Jersey, DOC Suite 3100, 90 Bergen Street, Newark, NJ 07103-2499, USA.
| | | | - Mary Slavin
- Health & Disability Research Institute, Boston University School of Public Health, Boston, MA, USA
| | - Pamela Kisala
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Pengsheng Ni
- Boston Rehabilitation Outcomes Center, Boston University School of Public Health, Boston, MA, USA
| | - Steven C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA,Department of Physical Medicine & Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ, USA,Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - David S. Tulsky
- Kessler Foundation, West Orange, NJ, USA,Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Alan M. Jette
- Health & Disability Research Institute, Boston University School of Public Health, Boston, MA, USA,Boston Rehabilitation Outcomes Center, Boston University School of Public Health, Boston, MA, USA
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Tyson SF, Burton LJ, McGovern A, Sharifi S. Service users’ views of the assessment process in stroke rehabilitation. Clin Rehabil 2014; 28:824-831. [DOI: 10.1177/0269215514523300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the service users’ (stroke survivors and care-givers) experiences and views of the rehabilitation assessment process. Design: Qualitative data analysis from three focus groups using a content analysis to identify the major themes. Setting: Participants were recruited from stroke support groups and community rehabilitation services in a large UK city. Subjects: Seventeen community-dwelling stroke survivors who had completed their rehabilitation within the previous year and six care-givers. Results: Five themes emerged: understanding the purpose of the assessment; repetition of assessments; feedback about assessments and progress; format of feedback and barriers to feedback. While all participants reported undergoing assessment, some felt their purpose was not always explained and resented unexplained repetitions of tests. Some participants reported a positive experience, but most wanted more information about their progress and predictions of recovery. They wanted regular, consistent, objective information presented in layman’s terms; verbally and in writing. Some carers reported difficulty accessing information particularly as a result of confidentiality policies. While some participants accepted these short-comings, others considered them due to staff’s disinterest or ineptitude, which undermined their trust in the team. Conclusions: Stroke service users require clear information about the purpose of assessments and regular, consistent, objective feedback about their progress using layman’s language both verbally and in writing.
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Affiliation(s)
- Sarah F Tyson
- University of Manchester, Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Louisa-Jane Burton
- University of Manchester, Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Alison McGovern
- Greater Manchester, Lancashire and South Cumbria Strategic Clinical Network and Senate, Stroke Rehabilitation Programme, Manchester, UK
| | - Sudi Sharifi
- University of Salford, Business School, Salford, UK
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Krohne K, Torres S, Slettebø Å, Bergland A. Everyday uses of standardized test information in a geriatric setting: a qualitative study exploring occupational therapist and physiotherapist test administrators' justifications. BMC Health Serv Res 2014; 14:72. [PMID: 24528609 PMCID: PMC3927824 DOI: 10.1186/1472-6963-14-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health professionals are required to collect data from standardized tests when assessing older patients' functional ability. Such data provide quantifiable documentation on health outcomes. Little is known, however, about how physiotherapists and occupational therapists who administer standardized tests use test information in their daily clinical work. This article aims to investigate how test administrators in a geriatric setting justify the everyday use of standardized test information. METHODS Qualitative study of physiotherapists and occupational therapists on two geriatric hospital wards in Norway that routinely tested their patients with standardized tests. Data draw on seven months of fieldwork, semi-structured interviews with eight physiotherapists and six occupational therapists (12 female, two male), as well as observations of 26 test situations. Data were analyzed using Systematic Text Condensation. RESULTS We identified two test information components in everyday use among physiotherapist and occupational therapist test administrators. While the primary component drew on the test administrators' subjective observations during testing, the secondary component encompassed the communication of objective test results and test performance. CONCLUSIONS The results of this study illustrate the overlap between objective and subjective data in everyday practice. In clinical practice, by way of the clinicians' gaze on how the patient functions, the subjective and objective components of test information are merged, allowing individual characteristics to be noticed and made relevant as test performance justifications and as rationales in the overall communication of patient needs.
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Affiliation(s)
- Kariann Krohne
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo 0130, Norway.
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Burton LJ, Tyson S, McGovern A. Staff perceptions of using outcome measures in stroke rehabilitation. Disabil Rehabil 2012; 35:828-34. [DOI: 10.3109/09638288.2012.709305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tyson SF, Greenhalgh J, Long AF, Flynn R. The influence of objective measurement tools on communication and clinical decision making in neurological rehabilitation. J Eval Clin Pract 2012; 18:216-24. [PMID: 20860596 DOI: 10.1111/j.1365-2753.2010.01555.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
RATIONALE Routine collection of outcome measures is advocated to improve quality of care. However, there has been scant investigation of how measurement tools are used in clinical practice and what impact they may have. This paper compares two neuro-rehabilitation teams, one which routinely used standardized measurement tools and the other which did not. We explore differences in communication and clinical decision making within multidisciplinary team (MDT) meetings to illuminate the influence measurement tools could have on clinical practice. METHOD Non-participant observation of MDT meetings in two neurological rehabilitation units in England. Semi-structured interviews were also carried out with at least one member of each profession in each team. Grounded theory techniques were used to analyse the data. RESULTS Differences in team members' communication within MDT meetings underscored differences in the process of clinical decision making within the teams. Using measurement tools provided a shared understanding to facilitate communication by focusing discussion on the patient's abilities rather than individual professionals' contributions. This led to differences in the way team members identified the nature and cause of patients' problems, monitored their progress and planned for discharge. They provided a 'neutral ground' to reach a shared perspective between professionals, thereby avoiding conflict. Externally, use of the tools enabled objective discussion with patients and their families about their progress and was a vehicle to facilitate giving bad news. CONCLUSION Using standardized measurement tools can promote a patient-focused approach to care, thus facilitating treatment planning and clinical decision making.
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Affiliation(s)
- Sarah F Tyson
- School of Health, Sport and Rehabilitation Sciences, University of Salford, Salford, UK.
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Poor concurrence between disabilities as described by patients and established assessment tools three months after stroke: A mixed methods approach. J Neurol Sci 2012; 313:160-6. [DOI: 10.1016/j.jns.2011.08.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 11/30/2022]
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