Predicting Discharge Destination in Older People From Acute General Medical Wards: A Systematic Review of the Psychometric Properties of 23 Assessment Tools

BACKGROUND

Predicting discharge in older people from general medicine wards is challenging. It requires consideration of function, mobility, and cognitive levels, which vary within the cohort and may fluctuate over a short period. A previous systematic review identified 23 assessment tools associated with discharge destination in this cohort; however, the psychometric properties of these tools have not been explored.

PURPOSE

To evaluate, synthesize, and compare the psychometric properties of 23 assessment tools used to predict discharge destination from acute general medical wards.

METHODS

Four databases were systematically searched: Medline (Ovid), Embase (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Evidence-Based Medicine Review databases. Studies were included if participants were from general medicine or acute geriatric wards and investigated at least one psychometric property (reliability, internal consistency, measurement error, responsiveness, hypothesis testing, and structural or criterion validity) in 23 previously identified assessment tools. Data were extracted and methodological quality were assessed independently by 2 assessors using the COnsensus-based Standards for selection of health Measure INstruments (COSMIN) checklist. As per the COSMIN checklist, results were rated against "sufficient," "insufficient," or "indeterminate."

RESULTS

Forty-one studies were included. The de Morton Mobility Index (DEMMI) was the most rigorously evaluated assessment tool; it scored "sufficient" psychometric properties in 5 of 7 psychometric categories. The Alpha Functional Independence Measure (AlphaFIM), Barthel Index, and Mini-Mental State Examination (MMSE) demonstrated "sufficient" psychometric properties in at least 3 psychometric categories. The remainder of the tools (n = 19, 83%) had "sufficient" psychometric properties in 2 or fewer psychometric categories.

DISCUSSION AND CONCLUSION

Based on current evidence, out of 23 assessment tools associated with discharge destination in acute general medicine, the DEMMI has the strongest psychometric properties. Other tools with substantial evidence in this cohort include the AlphaFIM, MMSE, and Barthel Index. Research is required to thoroughly evaluate the psychometric properties of the remaining tools, which have been insufficiently researched to date. Results can be used by physical therapists to guide selection of appropriate tools to assess mobility and predict discharge destination.

TRIAL REGISTRATION

A priori, PROSPERO (CRD 42017064209).

Occupation-based intervention in therapy for upper limb musculoskeletal conditions: A systematic review

Introduction

Using meaningful activities as a treatment modality is characteristic of occupation-based intervention (OBI). The benefits of OBI have been described, but not the effectiveness thereof. The aim of this review was to assess the effectiveness of OBI in relation to the type, commencement, duration and outcomes as reported in literature.

Methods

A comprehensive search of electronic databases was conducted, including EBSCOHost, PubMed, Cochrane Register for Controlled Trials, Web of Science, OTSeeker, PEDro and Google Scholar. Search terms included 'occupation-based', 'occupation-centered', 'intervention', 'upper limb' and 'outcome measures'. Studies including OBI for neurological or paediatric cases were excluded.

Results

Twelve studies met the inclusion criteria. Using the PEDro scale, three of the studies, all randomised controlled trials (RCTs), were viewed as high quality, one of fair and one of poor quality. Due to the heterogeneity of the studies, a meta-analysis was not possible, and a narrative synthesis is presented. Five studies used interviewing together with the Canadian Occupational Performance Measure (COPM) to determine the client's occupational profile when choosing meaningful activities. The commencement and duration of OBI varied amongst the studies, and a variety of outcome measures were used to determine the effectiveness of OBI.

Discussion

OBI used together with biomechanical approaches shows promising effectiveness. Outcome measures such as the COPM and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) that measure activity and participation, should be employed in client-centered practice. More robust scientific evidence regarding the effectiveness of OBI is needed.

Impact of occupational therapy in an integrated adult social care service: Audit of Therapy Outcome Measure Findings

Purpose

Health and social care services should demonstrate the quality of their interventions for commissioners, patients and carers, plus it is a requirement for occupational therapists to measure and record outcomes. Use of the “Therapy Outcome Measure” (TOMs) standardised tool was implemented by an occupational therapy adult social care service to demonstrate outcomes from April 2020, following integration to a community NHS Trust.

Design/methodology/approach

The aim was to demonstrate occupational therapy outcomes in adult social care through a local audit of the TOMs. The objective was to determine if clients improved following occupational therapy intervention in the four domains of impairment, activity, participation and wellbeing/carer wellbeing. 70 cases were purposively sampled over a 2-month timeframe, extracting data from the local electronic recording system.

Findings

Occupational therapy in adult social care clearly makes an impact with their client group and carers. Evidence from the dataset demonstrates clinically significant change, as 93% of clients seen by adult social care occupational therapy staff showed an improvement in at least one TOMs domain during their whole episode of care. 79% of activity scores, 20% of participation scores and 50% of wellbeing scores improved following intervention. 79% of carer wellbeing scores improved following occupational therapy.

Research limitations/implications

The audit did not collect data on uptake from the separate teams (equipment, housing, STAR and adult social care work) in occupational therapy adult social care. Potential sampling bias occurred as cases with completed scores only were purposively sampled. Sampling was not random which prevented data gathering on uptake of TOMs across the separate teams. Additionally, the audit results can only be applied to the setting from which the data was collected, so has limited external validity.

Originality/value

These novel findings illustrate the valuable and unique impact of occupational therapy in this adult social care setting. The integration of adult social care into an NHS Community Trust has supported the service to measure outcomes, by utilising the same standardised tool in use by allied health professions across the Trust.

Home Hazards With Fear of Falling: Findings From the Baseline Study of the Malaysian Elders Longitudinal Research (MELoR)

Background: Fear of falling (FoF) is a common issue among older people, impacting on psychological health, functional performance and mortality. Many factors associated with fear of falling have been investigated but little is known about the role of home hazards. Home hazards can be due to unsafe environmental and functional features. This study is aims to evaluate the association between home hazards with fear of falling among community-dwelling individuals aged 55 years and over. Methods: Baseline data with 1,489 older individuals from the Malaysian Elders Longitudinal Research (MELoR) study were analyzed. Home visits for interview and observations in the home were conducted with the participants. FoF was established with a single-item question and home hazards with the Home Falls and Accidents Screening Tool (HOME FAST). Results: The majority (76.4%) of older participants experienced FoF. The history of falls was not associated with FoF (p = 0.868), but FoF was associated with participants limiting their daily activities (p < 0.001). Home hazards were less likely (p = 0.023) and functional issues were more likely (p < 0.001) to be associated with a high degree of FoF. However, both home hazards domains were not associated with activity restriction due to FoF. Conclusions: Education about home hazards from the perspective of person-environment interaction may encourage home hazards management and reduce FoF which should be evaluated in future studies.

The validity and clinical utility of the Disabilities of the Arm Shoulder and Hand questionnaire for hand injuries in developing country contexts: A systematic review

STUDY DESIGN

Systematic review.

INTRODUCTION

The Disabilities of the Arm Shoulder and Hand Questionnaire has multiple language versions from many countries around the world. In addition there is extensive research evidence of its psychometric properties.

PURPOSE OF THE STUDY

The purpose of this study was to systematically review the evidence available on the validity and clinical utility of the Disabilities of the Arm Shoulder and Hand as a measure of activity and participation in patients with musculoskeletal hand injuries in developing country contexts.

METHODS

We registered the review with international prospective register of systematic reviews prior to conducting a comprehensive literature search and extracting descriptive data. Two reviewers independently assessed methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool, the checklist to operationalize measurement characteristics of patient-rated outcome measures and the multidimensional model of clinical utility.

RESULTS

Fourteen studies reporting 12 language versions met the eligibility criteria. Two language versions (Persian and Turkish) had an overall rating of good, and one (Thai) had an overall rating of excellent for cross-cultural validity. The remaining 9 language versions had an overall poor rating for cross-cultural validity. Content and construct validity and clinical utility yielded similar results.

DISCUSSION/CONCLUSIONS

Poor quality ratings for validity and clinical utility were due to insufficient documentation of results and inadequate psychometric testing. With the increase in migration and globalization, hand therapists are likely to require a range of culturally adapted and translated versions of the Disabilities of the Arm Shoulder and Hand. Recommendations include rigorous application and reporting of cross-cultural adaptation, appropriate psychometric testing, and testing of clinical utility in routine clinical practice.

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

Measuring Outcome in Psychiatric Rehabilitation

Outcome measures are becoming an essential component in the everyday practice of occupational therapy. Within mental health rehabilitation this can present as a challenge, because quality of life needs to be balanced against quantifiable data from standardised assessments. Determining what is considered to be a positive outcome can demonstrate differences for each client and, as such, intervention needs to be provided in an individualised manner. This opinion piece explores the challenges of using occupational therapy outcome measures within psychiatric rehabilitation, including examples from the author's practice.

An evaluation of Therapy Outcome Measures (TOMs) in community rehabilitation

Background/Aims:

This study considers the feasibility of using Therapy Outcome Measure (TOMs) in a community rehabilitation therapy team working with patients over 65 years of age.

Methods:

An action research approach was used. Data collection and analysis included completion of the outcome measure scores over a 22-week period through semi-structured individual interviews with the therapy team participants, group reflections and the researcher's reflections.

Results:

Sixty-seven patients were considered in this study, with 26 patient scores included. Nineteen (73%) of those scored for admission and discharge demonstrated sensitivity, with a difference of one score or more. However, the study participants agreed that the TOMs scales and descriptors did not best describe their patient group. They acknowledged that the study had included a small sample size.

Conclusions:

TOMs was agreed to be an ‘OK fit’ for community rehabilitation patients rather than a ‘best fit’. It should be used as part of a variety of outcome measures to evidence the multidimensional aspects of this speciality, where patients have complex needs and therefore require more complex interventions. This study also highlights the need for further research with a larger sample size.

Validating an Irish-Language Version of the Rivermead Behavioural Memory Test — Second Edition

Introduction:

This study translates and assesses the psychometric properties of an Irish-language version of the Rivermead Behavioural Memory Test — Second Edition (Wilson et al 2003), a screening measure for memory impairment in adults.

Method:

All four versions of the Rivermead Behavioural Memory Test — Second Edition were translated to Irish and administered to a sample of 21 participants aged 21–64 years. Equivalent translation of the Rivermead Behavioural Memory Test — Second Edition was achieved through multiple translations and back-translations of the instrument and field-testing with both bilingual and monolingual participants.

Findings:

Strong evidence of concurrent validity was clear from the results. Test—retest reliability of the measure proved to be low in comparison with the English version. In general, the four parallel versions seem to be of equal difficulty, and the Irish version of the Rivermead Behavioural Memory Test — Second Edition was no more difficult than the English version.

Conclusion:

The results support an Irish Rivermead Behavioural Memory Test — Second Edition as a valid test of everyday memory. Overall, the reliability of the tool is acceptable, but results must be considered cautiously due to the preliminary nature of the study and given the small sample size.

Proving the Effectiveness of Community Occupational Therapy in the Equipment and Adaptation Setting Using the Canadian Occupational Performance Measure

The Community Occupational Therapy Service (Equipment and Adaptations) at Worcestershire Health and Care National Health Service Trust, Redditch and Bromsgrove Locality identified the need to find an outcome measure that would determine its effectiveness. The Canadian Occupational Performance Measure was chosen as a client-centred, reliable, and validated outcome measure that was integrated within existing paperwork. The process followed is outlined in this practice analysis.

The service completed 1,869 Canadian Occupational Performance Measure scores, which showed a statistically significant increase in client ratings of performance and satisfaction in 90% of clients, illustrating the effectiveness of the service. The aim of this practice analysis is to explain the process that this service followed to integrate the Canadian Occupational Performance Measure into practice and, thus, share the benefit of using it as an outcome measure with colleagues who work in a similar setting. The authors highlight the importance of continuing with the Canadian Occupational Performance Measure and look to develop its use further.

Use of Standardised Assessments and Outcome Measures among a Sample of Irish Occupational Therapists Working with Adults with Physical Disabilities

This study was carried out to explore the current usage of standardised assessments and outcome measures by occupational therapists working with adults with physical disabilities. A survey research design, using a postal questionnaire specifically designed for the study, was employed.

Completed questionnaires were returned by 109 occupational therapists working in a variety of settings, including acute care, community and inpatient rehabilitation. A range of standardised assessments and outcome measures was in use, with an average of four different measures being used by the individual respondents. The most commonly used measures were the Mini Mental State Examination (Folstein et al 1975), Rivermead Behavioural Memory Test (Wilson et al 1985), Functional Independence Measure (Uniform Data System for Medical Rehabilitation 1999), Barthel Index (Mahoney and Barthel 1965) and the Chessington Occupational Therapy Neurological Assessment Battery (Tyerman et al 1986). However, the consistency of use tended to be low. The barriers to a more consistent use of standardised assessments and outcome measures included time restraints, the unsuitability of the available measures and a lack of sensitivity of the available measures to capture the effectiveness of occupational therapy.

The findings support those of previous studies exploring this issue among occupational therapists from different areas of practice. The respondents in this study highlighted the need for a multifaceted approach, encompassing educational, managerial and individual responsibility, to address the issue of the usage of standardised assessments and outcome measures among occupational therapists.