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Johnson JK. Learning Health Systems Are Well Suited to Define and Deliver the Physical Therapy Value Proposition. Phys Ther 2023; 103:pzad072. [PMID: 37379334 DOI: 10.1093/ptj/pzad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 04/04/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Joshua K Johnson
- Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Primary Care Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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From outcome measurement to improving health outcomes after lower limb amputation-A narrative review exploring outcome measurement from a clinical practice perspective. Prosthet Orthot Int 2022; 46:e341-e350. [PMID: 35357360 DOI: 10.1097/pxr.0000000000000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional body encouragement, and successful examples of system level outcome measurement within some health care settings, many barriers still exist preventing outcome measurement from becoming embedded in clinical practice. This paper presents a narrative review which aims to describe the state of the outcome measurement evidence base in prosthetic rehabilitation, as applied in clinical practice, with a view to identifying areas for future work aimed at making outcome measurement in prosthetic rehabilitation a meaningful reality. A literature search of four databases was undertaken, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis principals appropriate to narrative reviews, and using the search terms outcome, measur*, tool, scale, instrument, prosthe*, amput* and limb loss. A total of 1116 papers were identified. Following screening 35 papers, focusing on four main themes, were included in the review. Themes were: 1) What outcome domains should be measured? 2) How can these outcome domains be measured? 3) What are the barriers to outcome measurement? and 4) What can be learnt from examples of ROM in prosthetic rehabilitation? Findings suggest that successful outcome measurement is multifaceted. Understanding and embedding value at every step appears to be key to success. Addressing the questions of 'what' outcome domains to measure and 'how' to measure them, may help establish consensus. Routine outcome measurement practice at the clinical level should ensure data collection is valuable to clinical practice, makes use of information technology solutions and has organisational engagement.
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Scheel-Sailer A, Lampart P, Selb M, Baumberger M, Gmünder HP, Sigrist-Nix D, Schmitt K, Stucki G. The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:720395. [PMID: 36188783 PMCID: PMC9397844 DOI: 10.3389/fresc.2021.720395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
Introduction: Assessments during rehabilitation of spinal cord injury (SCI) align with the World Health Organization's classifications and national quality requirements. This paper aims to report on the development and first implementation experiences of an institutional standard of assessments performed after newly acquired SCI. Setting: Specialized SCI acute care and post-acute rehabilitation clinic in Switzerland. Methods: A situation analysis of an interdisciplinary post-acute SCI rehabilitation program was performed. The results informed a subsequent consensus-based selection of assessments, and an information and implementation strategy. Linking to the ICF Core Set for SCI in post-acute settings and ICF Generic-30 Set was performed. The Nottwil Standard was piloted for 18 months. Results: Situation analysis: A battery of 41 assessments were irregularly performed during initial rehabilitation after newly aquired SCI. Selection of assessments: A multidisciplinary group of clinicians agreed on 10 examinations, 23 assessments and two questionnaires that make up the Nottwil Standard. In total, 55 ICF categories are covered, including most of the ICF Generic-30 Set categories. The implementation strategy included Executive Board commitment, a structured improvement project, guidelines for documentation and assessments, a manual controlling system, and staff training on the Nottwil Standard. Pilot phase: 54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female) were included. Twenty-seven assessments out of 33 assessments were performed in more than 80% of all observed patients' rehabilitation. Conclusion: Implementation of a standard assessment schedule was feasible but required a well-structured process with good communication strategy and controlling mechanism, and full engagement of involved professions.
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Affiliation(s)
- Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- *Correspondence: Anke Scheel-Sailer
| | | | - Melissa Selb
- Swiss Paraplegic Research, Nottwil, Switzerland
- ICF Research Branch, Nottwil, Switzerland
| | | | | | | | | | - Gerold Stucki
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- ICF Research Branch, Nottwil, Switzerland
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4
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Ryan D, O’Sullivan C. Outcome measures used in intervention studies for the rehabilitation of mid‐portion achilles tendinopathy; a scoping review. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Deirdre Ryan
- Physiotherapy and Sports Science UCD School of Public Health Belfield, Dublin 4 Ireland
| | - Cliona O’Sullivan
- Physiotherapy and Sports Science UCD School of Public Health Belfield, Dublin 4 Ireland
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Chan T, Marta M, Hawkins C, Rackstraw S. Cognitive and Neurologic Rehabilitation Strategies for Central Nervous System HIV Infection. Curr HIV/AIDS Rep 2020; 17:514-521. [PMID: 32844275 PMCID: PMC7497368 DOI: 10.1007/s11904-020-00515-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Cognitive impairment leading to disability is increasingly seen in people living with human immunodeficiency virus (PLWH). Rehabilitation can alleviate the effects of cognitive impairment upon function. The aim of this paper is to discuss the strategies that have been used in cognitive and neurologic rehabilitation in PLWH. RECENT FINDINGS Studies examining pharmacological and non-pharmacological strategies were analysed. Medical management of HIV and co-morbidities should be optimised. Non-pharmacological strategies, including nerve stimulation techniques, exercise-based interventions, and paper and computer-based cognitive rehabilitation, have some evidence supporting their use in PLWH either as stand-alone interventions or as part of a multidisciplinary approach. Both pharmacological and non-pharmacological rehabilitation strategies have been used with PLWH. More intervention trials are needed to assess cognitive and neurological rehabilitation strategies and further evaluate their potential benefit in PLWH.
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Affiliation(s)
- Terrence Chan
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK
| | - Monica Marta
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Simon Rackstraw
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK.
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK.
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK.
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Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Alderman N, Pink AE, Williams C, Ramos SDS, Oddy M, Knight C, Jenkins KG, Barnes MP, Hayward C. Optimizing measurement for neurobehavioural rehabilitation services: A multisite comparison study and response to UKROC. Neuropsychol Rehabil 2019; 30:1318-1347. [DOI: 10.1080/09602011.2019.1582432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, Badby Park, Daventry, UK
- Department of Psychology, Swansea University, Swansea, UK
| | - Aimee E Pink
- Department of Psychology, Swansea University, Swansea, UK
- Independent Neurorehabilitation Providers Alliance, UK
| | | | | | - Michael Oddy
- Brain Injury Rehabilitation Trust, The Disabilities Trust, Burgess Hill, UK
| | - Caroline Knight
- The Oakleaf Group, Northampton, UK
- School of Psychology, University of Leicester, Leicester, UK
- Elysium Neurological Services, Elysium Healthcare, St Neots Hospital, Cambridge, UK
| | - Keith G Jenkins
- National Brain Injury Centre, St Andrew’s Healthcare, Northampton, UK
| | | | - Chloë Hayward
- Independent Neurorehabilitation Providers Alliance, UK
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Alderman N. Challenges and importance of measuring neurobehavioural disability in acquired brain injury: the 'St Andrew's Swansea - Neurobehavioural Outcomes Scale' (SASNOS). Expert Rev Neurother 2018; 18:807-810. [PMID: 30277093 DOI: 10.1080/14737175.2018.1531705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nick Alderman
- a Neurobehavioural Rehabilitation Services , Elysium Neurological , Badbury , Northants
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Sansonetti D, Nicks RJ, Unsworth C. Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury. Aust Occup Ther J 2018; 65:512-522. [DOI: 10.1111/1440-1630.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Danielle Sansonetti
- Acquired Brain Injury Rehabilitation Centre; Caulfield Hospital; Melbourne Victoria Australia
| | - Rebecca J. Nicks
- Occupational Therapy Department; Alfred Health; Melbourne Victoria Australia
| | - Carolyn Unsworth
- School of Health, Medical and Applied Science; Central Queensland University; Queensland Australia
- Department of Occupational Therapy; Jönköping University; Jönköping Sweden
- Department of Occupational Therapy; La Trobe University; Bundoora Victoria Australia
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Wu J, Faux SG, Poulos CJ, Harris I. Brain injury rehabilitation after road trauma in new South Wales, Australia - insights from a data linkage study. BMC Health Serv Res 2018; 18:204. [PMID: 29566689 PMCID: PMC5865364 DOI: 10.1186/s12913-018-3019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/15/2018] [Indexed: 12/29/2022] Open
Abstract
Background Population-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. The aims of this study are to describe the rehabilitation pathway for trauma survivors and to analyse the brain injury rehabilitation outcomes in the two care settings (specialist brain injury and non-specialist general rehabilitation units). Methods This is an observational study using routinely collected registry data (New South Wales Trauma Registry linked with the Australasian Rehabilitation Outcomes Centre Inpatient Dataset). The study cohort includes 268 road trauma patients who were admitted to trauma services between 2009 and 2012 and received inpatient rehabilitation because of a brain injury. Results Of those who need inpatient rehabilitation, 62% (n = 166) were admitted to specialist units with the remainder (n = 102) admitted to non-specialist units. Those admitted to a specialist units were younger (p < 0.001), had a lower cognitive FIM score (p = 0.003) on admission than those admitted to non-specialist units. Specialist units achieved better overall FIM score improvements from admission to discharge (43 vs 30 points, p > 0.001) but at a cost of longer length of stay (median 47 vs 24 days, p < 0.001). There were very few discharges to residential aged care facilities from rehabilitation (2% in non-specialist units and none from specialist units). There was a long time lag between trauma and admission to inpatient rehabilitation with only a quarter of the patients admitted to a specialist unit by end of week four. Few older patients (19%) with brain injury were admitted to specialist units. Conclusions It is feasible to use routinely collected registry data to monitor inpatient rehabilitation outcomes of trauma care. There were differences in characteristics and outcomes of patients with traumatic brain injury admitted to specialist units compared with non-specialist units.
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Affiliation(s)
- Jane Wu
- St. Vincent's Hospital, Sacred Heart Rehabilitation Service, 170 Darlinghurst Road, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Steven G Faux
- St. Vincent's Hospital, Sacred Heart Rehabilitation Service, 170 Darlinghurst Road, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Christopher J Poulos
- School of Public Health and Community Medicine, University of New South Wales, University Clinics, 9 Judd Ave, Hammondville, NSW, 2170, Australia
| | - Ian Harris
- South Western Sydney Clinical School, UNSW; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
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Ashford S, Williams H, Nair A, Orridge S, Turner-Stokes L. Categorisation of goals set using Goal Attainment Scaling for treatment of leg spasticity: a multicentre analysis. Disabil Rehabil 2018; 41:1925-1930. [PMID: 29558228 DOI: 10.1080/09638288.2018.1451927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Goal-classification of person-centred goals, using Goal Attainment Scaling for leg spasticity treatment. Methods: The study was conducted in two phases: phase I, a retrospective review to evaluate categories of goal set in routine clinical practice. Findings were used to design a goal classification system. Phase II, a multi-centre study to confirm the goal categories. Goals set (n = 270) were analysed from data collected at three centres in the UK (one centre for phase I). Goal categories were mapped onto the domains of the World Health Organisation, International Classification of Functioning Disability and Health. Results: One hundred and twenty seven participants were recruited in two cohorts: phase I: 63; phase II: 64. Goal categories using both cohorts were assigned to two domains, each subdivided into three key goal categories: Domain 1: body structure impairment 121 (44%): (a) pain/discomfort 34 (12%), (b) involuntary movements 20 (7%), and (c) range of movement/contracture prevention 67 (25%). Domain 2: activity function 149 (56%): (a) passive function (ease of caring for the affected limb) n = 89 (33%), (b) active function (transfers) 26 (10%), and (c) active function (mobility) 27 (10%), other n = 7 (3%). Conclusions: Patients individual leg spasticity goals can be grouped into six categories and two domains, which will assist clinicians, patients and cares in setting and evaluating goals in practice. Implications for Rehabilitation Six goal areas used in clinical goal setting for leg spasticity management were identified, under the two domains: (1) body structure impairment: pain, involuntary movements, and range of movement and (2) activities/function: passive function (ease of caring), active function - transfers or standing and active function - mobility. Categorisation of goals is consistent on repeated evaluation and across different clinical services. Using clinical goals for leg spasticity treatment is an effective method to identify treatment priorities.
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Affiliation(s)
- Stephen Ashford
- a Regional Hyper-acute Rehabilitation Unit , Northwick Park Hospital , London , UK.,b Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care , King's College London , London , UK
| | - Heather Williams
- a Regional Hyper-acute Rehabilitation Unit , Northwick Park Hospital , London , UK
| | - Ajoy Nair
- c Alderbourne Rehabilitation Unit , Hillingdon Hospital , London , UK
| | | | - Lynne Turner-Stokes
- a Regional Hyper-acute Rehabilitation Unit , Northwick Park Hospital , London , UK.,b Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care , King's College London , London , UK
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Administration of assessment instruments during the first rehabilitation of patients with spinal cord injury: a retrospective chart analysis. Spinal Cord 2017; 56:322-331. [PMID: 29259347 DOI: 10.1038/s41393-017-0039-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/26/2017] [Accepted: 11/12/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective chart analysis. OBJECTIVES To examine which professionals administered which assessment instruments in which patient in clinical practice during first rehabilitation after newly acquired spinal cord injury (SCI) and the differences in the frequencies of different assessments between patient groups. SETTING Specialized SCI acute care and rehabilitation clinic. METHODS Patients after SCI, aged 18 years and above, admitted for first rehabilitation between December 2014 and December 2015 were analyzed. Descriptive statistics of 54 selected assessments. p values based on the χ 2 test were calculated for assessments used in both paraplegic and tetraplegic patients. RESULTS One hundred and nineteen patients were screened. Forty-one assessments were administered, of which 10 on average more than once per patient. The most frequently used assessments were Spinal Cord Independence Measure III (7.7 times per patient), Skin Assessment (3.6 times), and Manual Muscle Test (3.2 times for Lower Extremities; 2.5 times for Upper Extremities). The American Spinal Injury Association Impairment Scale was administered on average 1.9 times per patient. More variation in the number of assessments per patient was observed in patients with complete and incomplete lesions compared to patients with paraplegia and tetraplegia. CONCLUSION Assessments covering neurological functioning, mobility, and self-care are used in clinical practice during first rehabilitation of patients with SCI, while others covering autonomic functioning, pain, participation, or quality of life are still missing. Based on these observations and national and international requirements, a meaningful standard for an assessment toolkit, applicable in general and in specific subgroups, needs to be defined and implemented.
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Williams KS, Young DK, Burke GAA, Fountain DM. Comparing the WeeFIM and PEDI in neurorehabilitation for children with acquired brain injury: A systematic review. Dev Neurorehabil 2017; 20:443-451. [PMID: 28277891 DOI: 10.1080/17518423.2017.1289419] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We sought to compare the suitability of the Functional Independence Measure for Children (WeeFIM) and the Pediatric Evaluation of Disability Inventory (PEDI) as outcome measures in rehabilitation of children with acquired brain injury (ABI). METHODS We performed a systematic review of the evidence base using five databases. PRISMA guidelines were adhered to and the review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42015025370). RESULTS Twenty-six retrospective studies were included. Twelve studies utilized the PEDI, thirteen studies the WeeFIM, and one study included both. Statistically significant responsiveness was demonstrated for both the WeeFIM and PEDI, although significant ceiling effects were detected. Evidence of clinically significant responsiveness was limited to one center utilizing the PEDI. CONCLUSION Although requiring licensing to use, the WeeFIM is more suitable for the inpatient setting, is quicker to administer and showed minimal ceiling effects compared to the PEDI counterpart.
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Affiliation(s)
- Katie S Williams
- a Department of Paediatric Haematology, Oncology and Palliative Care , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - David K Young
- a Department of Paediatric Haematology, Oncology and Palliative Care , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - G A Amos Burke
- a Department of Paediatric Haematology, Oncology and Palliative Care , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Daniel M Fountain
- a Department of Paediatric Haematology, Oncology and Palliative Care , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
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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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Abstract
BACKGROUND There is an increasing need to assess the evidence of a multidisciplinary approach for both short-term and long-term management of neurological sequelae arising from the diagnosis and treatment of brain tumors in childhood. METHODS We performed a systematic review of the evidence base for multidisciplinary paediatric brain tumor rehabilitation using seven databases. PRISMA guidelines were adhered to and the review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42014015070). RESULTS The literature search identified 3,061 results. Three service evaluations were included. The review identified limited evidence in favor of multidisciplinary rehabilitation for children with brain tumors. Due to the lack of controlled trial data and heterogeneity of the interventions and outcome measures, no meta-analysis could be performed. CONCLUSIONS Studies utilising a coordinated multi-centre approach with standardized outcome measures are recommended in order to enable robust assessment of the efficacy of multidisciplinary rehabilitation services.
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Affiliation(s)
- Daniel M Fountain
- a Brainbow Neurorehabilitation Service, Department of Paediatric Haematology , Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK and.,b Clinical School, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - G A Amos Burke
- a Brainbow Neurorehabilitation Service, Department of Paediatric Haematology , Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK and
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Ford CEL, Malley D, Bateman A, Clare IC, Wagner AP, Gracey F. Selection and visualisation of outcome measures for complex post-acute acquired brain injury rehabilitation interventions. NeuroRehabilitation 2016; 39:65-79. [PMID: 27341362 PMCID: PMC5268089 DOI: 10.3233/nre-161339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outcome measurement challenges rehabilitation services to select tools that promote stakeholder engagement in measuring complex interventions. OBJECTIVES To examine the suitability of outcome measures for complex post-acute acquired brain injury (ABI) rehabilitation interventions, report outcomes of a holistic, neuropsychological ABI rehabilitation program and propose a simple way of visualizing complex outcomes. METHODS Patient/carer reported outcome measures (PROMS), experience measures (PREMS) and staff-rated measures were collected for consecutive admissions over 1 year to an 18-week holistic, neuropsychological rehabilitation programme at baseline, 18 weeks and 3- and 6-month follow-up. RESULTS Engagement with outcome measurement was poorest for carers and at follow-up for all stakeholders. Dependence, abilities, adjustment, unmet needs, symptomatology including executive dysfunction, and self-reassurance showed improvements at 18 weeks. Adjustment, social participation, perceived health, symptomatology including dysexecutive difficulties, and anxiety were worse at baseline for those who did not complete rehabilitation, than those who did. A radar plot facilitated outcome visualization. CONCLUSIONS Engagement with outcome measurement was best when time and support were provided. Supplementing patient- with staff-rated and attendance measures may explain missing data and help quantify healthcare needs. The MPAI4, EBIQ and DEX-R appeared suitable measures to evaluate outcomes and distinguish those completing and not completing neuropsychological rehabilitation.
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Affiliation(s)
- Catherine Elaine Longworth Ford
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
| | - Donna Malley
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrew Bateman
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Isabel C.H. Clare
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, UK
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Adam P. Wagner
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Fergus Gracey
- The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust, Princess of Wales Hospital, Ely, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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Nayar M, Vanderstay R, Siegert RJ, Turner-Stokes L. The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation following a Stroke from the National UK Clinical Dataset. PLoS One 2016; 11:e0147288. [PMID: 26824696 PMCID: PMC4732596 DOI: 10.1371/journal.pone.0147288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 01/01/2016] [Indexed: 12/02/2022] Open
Abstract
The UK Functional Assessment Measure (UKFIM+FAM) is the principal outcome measure for the UK Rehabilitation Outcomes Collaborative (UKROC) national database for specialist rehabilitation. Previously validated in a mixed neurorehabilitation cohort, this study is the first to explore its psychometric properties in a stroke population, and compare left and right hemispheric strokes (LHS vs RHS). We analysed in-patient episode data from 62 specialist rehabilitation units collated through the UKROC database 2010-2013. Complete data were analysed for 1,539 stroke patients (LHS: 588, RHS: 566 with clear localisation). For factor analysis, admission and discharge data were pooled and randomised into two equivalent samples; the first for exploratory factor analysis (EFA) using principal components analysis, and the second for confirmatory factor analysis (CFA). Responsiveness for each subject (change from admission to discharge) was examined using paired t-tests and differences between LHS and RHS for the entire group were examined using non-paired t-tests. EFA showed a strong general factor accounting for >48% of the total variance. A three-factor solution comprising motor, communication and psychosocial subscales, accounting for >69% total variance, provided acceptable fit statistics on CFA (Root Mean Square Error of Approximation was 0.08 and Comparative Fit Index/ Tucker Lewis Index 0.922/0.907). All three subscales showed significant improvement between admission and discharge (p<0.001) with moderate effect sizes (>0.5). Total scores between LHS and RHS were not significantly different. However, LHS showed significantly higher motor scores (Mean 5.7, 95%CI 2.7, 8.6 p<0.001), while LHS had significantly lower cognitive scores, primarily in the communication domain (-6.8 95%CI -7.7, -5.8 p<0.001). To conclude, the UK FIM+FAM has a three-factor structure in stroke, similar to the general neurorehabilitation population. It is responsive to change during in-patient rehabilitation, and distinguishes between LHS and RHS. This tool extends stroke outcome measurement beyond physical disability to include cognitive, communication and psychosocial function.
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Affiliation(s)
- Meenakshi Nayar
- Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom
- Regional Hyper Acute Rehabilitation Unit (RHRU), Northwick Park Hospital, London, United Kingdom
| | - Roxana Vanderstay
- Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Richard J. Siegert
- School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Lynne Turner-Stokes
- Department of Palliative Care Policy and Rehabilitation, Kings College London, Faculty of Life Sciences and Medicine, London, United Kingdom
- Regional Hyper Acute Rehabilitation Unit (RHRU), Northwick Park Hospital, London, United Kingdom
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Turner‐Stokes L, Pick A, Nair A, Disler PB, Wade DT. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 2015; 2015:CD004170. [PMID: 26694853 PMCID: PMC8629646 DOI: 10.1002/14651858.cd004170.pub3] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence from systematic reviews demonstrates that multi-disciplinary rehabilitation is effective in the stroke population, in which older adults predominate. However, the evidence base for the effectiveness of rehabilitation following acquired brain injury (ABI) in younger adults has not been established, perhaps because this scenario presents different methodological challenges in research. OBJECTIVES To assess the effects of multi-disciplinary rehabilitation following ABI in adults 16 to 65 years of age. SEARCH METHODS We ran the most recent search on 14 September 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (OvidSP), Web of Science (ISI WOS) databases, clinical trials registers, and we screened reference lists. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing multi-disciplinary rehabilitation versus routinely available local services or lower levels of intervention; or trials comparing an intervention in different settings, of different intensities or of different timing of onset. Controlled clinical trials were included, provided they met pre-defined methodological criteria. DATA COLLECTION AND ANALYSIS Three review authors independently selected trials and rated their methodological quality. A fourth review author would have arbitrated if consensus could not be reached by discussion, but in fact, this did not occur. As in previous versions of this review, we used the method described by Van Tulder 1997 to rate the quality of trials and to perform a 'best evidence' synthesis by attributing levels of evidence on the basis of methodological quality. Risk of bias assessments were performed in parallel using standard Cochrane methodology. However, the Van Tulder system provided a more discriminative evaluation of rehabilitation trials, so we have continued to use it for our primary synthesis of evidence. We subdivided trials in terms of severity of brain injury, setting and type and timing of rehabilitation offered. MAIN RESULTS We identified a total of 19 studies involving 3480 people. Twelve studies were of good methodological quality and seven were of lower quality, according to the van Tulder scoring system. Within the subgroup of predominantly mild brain injury, 'strong evidence' suggested that most individuals made a good recovery when appropriate information was provided, without the need for additional specific interventions. For moderate to severe injury, 'strong evidence' showed benefit from formal intervention, and 'limited evidence' indicated that commencing rehabilitation early after injury results in better outcomes. For participants with moderate to severe ABI already in rehabilitation, 'strong evidence' revealed that more intensive programmes are associated with earlier functional gains, and 'moderate evidence' suggested that continued outpatient therapy could help to sustain gains made in early post-acute rehabilitation. The context of multi-disciplinary rehabilitation appears to influence outcomes. 'Strong evidence' supports the use of a milieu-oriented model for patients with severe brain injury, in which comprehensive cognitive rehabilitation takes place in a therapeutic environment and involves a peer group of patients. 'Limited evidence' shows that specialist in-patient rehabilitation and specialist multi-disciplinary community rehabilitation may provide additional functional gains, but studies serve to highlight the particular practical and ethical restraints imposed on randomisation of severely affected individuals for whom no realistic alternatives to specialist intervention are available. AUTHORS' CONCLUSIONS Problems following ABI vary. Consequently, different interventions and combinations of interventions are required to meet the needs of patients with different problems. Patients who present acutely to hospital with mild brain injury benefit from follow-up and appropriate information and advice. Those with moderate to severe brain injury benefit from routine follow-up so their needs for rehabilitation can be assessed. Intensive intervention appears to lead to earlier gains, and earlier intervention whilst still in emergency and acute care has been supported by limited evidence. The balance between intensity and cost-effectiveness has yet to be determined. Patients discharged from in-patient rehabilitation benefit from access to out-patient or community-based services appropriate to their needs. Group-based rehabilitation in a therapeutic milieu (where patients undergo neuropsychological rehabilitation in a therapeutic environment with a peer group of individuals facing similar challenges) represents an effective approach for patients requiring neuropsychological rehabilitation following severe brain injury. Not all questions in rehabilitation can be addressed by randomised controlled trials or other experimental approaches. For example, trial-based literature does not tell us which treatments work best for which patients over the long term, and which models of service represent value for money in the context of life-long care. In the future, such questions will need to be considered alongside practice-based evidence gathered from large systematic longitudinal cohort studies conducted in the context of routine clinical practice.
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Affiliation(s)
- Lynne Turner‐Stokes
- King's College London and Northwick Park HospitalRegional Hyper‐acute Rehabilitation UnitWatford RoadHarrowMiddlesexUKHA1 3UJ
| | - Anton Pick
- Cicely Saunders Institute, King's College LondonLondonUK
| | - Ajoy Nair
- Hillingdon HospitalAlderbourne Rehabilitation UnitPield Heath RoadUxbridgeMiddlesexUKUB8 3NN
| | - Peter B Disler
- Bendigo Hospital and Monash Universityc/‐ 4th Floor Kurmala WingPO Box 126BendigoVictoriaAustralia3552
| | - Derick T Wade
- University of OxfordOxford Centre for EnablementWindmill RoadOxfordUKOX3 7LD
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Alexandrescu R, Siegert RJ, Turner-Stokes L. The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset. Disabil Rehabil 2015; 37:1976-83. [PMID: 25598001 PMCID: PMC4720035 DOI: 10.3109/09638288.2014.998779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose: To assess the internal reliability, construct and concurrent validity and responsiveness of the Northwick Park Therapy Dependency Assessment (NPTDA) scale. Method: A cohort of 2505 neurorehabilitation patients submitted to the UK Rehabilitation Outcomes Collaborative database. Cronbach’s coefficient-α was used to assess internal reliability and factor analysis (FA) to assess construct validity. We compared NPTDA scores at admission and discharge to determine responsiveness. Results: Coefficient-α for the whole scale was 0.74. The exploratory FA resulted in a four-factor model (Physical, Psychosocial, Discharge planning and Activities) that accounted for 43% of variance. This model was further supported by the confirmatory FA. The final model had a good fit: root-mean-square error of approximation of 0.069, comparative fit index/Tucker–Lewis index of 0.739/0.701 and the goodness of fit index of 0.909. The NPTDA scores at admission and discharge were significantly different for each of the factors. Expected correlations were seen between the admission scores for the NPTDA, the Rehabilitation Complexity Scale (r = 0.30, p < 0.01) and the Functional Independence Measure (r = −0.25, p < 0.01). Conclusions: The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA may be used to describe and quantify changes in therapy inputs in the course of a rehabilitation programme.Implications for Rehabilitation The Northwick Park Therapy Dependency Assessment (NPTDA) is designed as a measure therapy intervention, which reflects both quantitative and qualitative aspects of the inputs provided (including staff time and the different types of intervention) during inpatient rehabilitation. The scale demonstrated acceptable internal reliability and good construct and concurrent validity. NPTDA is responsive to change in the therapy inputs provided during neurorehabilitation between admission and discharge.
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Affiliation(s)
- Roxana Alexandrescu
- a Department of Palliative Care, Policy and Rehabilitation , School of Medicine, King's College London , London , UK
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Harding K, Robinson D, Grant M, Hale L. Old tool, new tricks? A new adaptation of the Modified Falls Efficacy Scale. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: Measuring outcomes is important in community rehabilitation programs (CRPs), both at the individual and service level. Identifying global outcome measures that can be used for all patients is challenging given the diversity of this client group. Method: This observational study explored measurement properties of the Modified Efficacy Scale (MES), which is an adaptation of the Modified Falls Efficacy Scale. The MES was used to assess patient confidence in performing activities without reference to falls and was trialled with 221 CRP patients. Floor and ceiling effects, responsiveness to change and minimal clinically important difference (MCID) scores were measured and compared with scores for the same sample of patients using the Lawton Instrumental Activities of Daily Living (IADL) scale. Results: The MES showed evidence of convergent validity and was responsive to change. Both scales showed ceiling effects on discharge, although this was more pronounced with the Lawton IADL scale (40%) than the MES (21%). Both scales had small values for MCID relative to scale width. Conclusions: The MES demonstrated evidence of validity and has a less pronounced ceiling effect compared with the Lawton IADL scale. The implications of a ceiling effect should be considered in the context of the assessment purpose.
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Affiliation(s)
- Katherine Harding
- Senior research fellow, Allied Health Clinical Research Office, Eastern Health, Australia
| | - Dianne Robinson
- Team leader, Angliss Hospital Community Rehabilitation Program, Eastern Health, Australia
| | - Michelle Grant
- Neuropsychologist, Sunshine Coast Hospital and Health Service, Queensland Health, Brisbane, Australia
| | - Leigh Hale
- Associate Professor and Deputy Dean, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Grant M, Ponsford J. Goal Attainment Scaling in brain injury rehabilitation: Strengths, limitations and recommendations for future applications. Neuropsychol Rehabil 2014; 24:661-77. [DOI: 10.1080/09602011.2014.901228] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fadyl JK, McPherson KM, Schlüter PJ, Turner-Stokes L. Development of a new tool to evaluate work support needs and guide vocational rehabilitation: the Work-ability Support Scale (WSS). Disabil Rehabil 2014; 37:247-58. [PMID: 24786967 DOI: 10.3109/09638288.2014.914586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joanna K Fadyl
- Auckland University of Technology, Centre for Person Centred Research, Health and Rehabilitation Research Institute , Northcote, Auckland , New Zealand
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Turner-Stokes L, Thu A, Williams H, Casey R, Rose H, Siegert RJ. The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation. Disabil Rehabil 2013; 36:23-31. [PMID: 23721497 PMCID: PMC3906250 DOI: 10.3109/09638288.2013.775360] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To examine the construct validity and inter-rater reliability of the Neurological Impairment Scale (NIS) and compare ratings by medical and multidisciplinary teams in a mixed neurorehabilitation sample. To assess its concurrent and predictive validity as a predictor of outcome and functional gains during inpatient rehabilitation. Methods The NIS was rated in a consecutive cohort of patients (n = 428) recruited from nine specialist neurorehabilitation units in London. Dimensionality and internal consistency were explored through principal components analysis with Varimax rotation. Inter-rater reliability and the relationship between NIS and functional outcome (UK Functional Assessment Measure (FIM + FAM)) were analysed in a sub-sample (n = 94) from one centre. Results Factor analysis identified two principal domains (“Physical” and “Cognitive”) together accounting for 35% of the variance: their Cronbach’s alpha values were 0.76 and 0.67, respectively. Inter-rater reliability was excellent for overall scores between doctors (ICC = 0.95 (95% CI = 0.91–0.97)) and acceptable between the medical and multidisciplinary team (ICC = 0.92 (95% CI = 0.88–0.95)). Change in NIS-physical score predicted 29% of the variance in functional gain (FIM + FAM change). Conclusion These findings provide the first formal evidence for the validity and reliability of the NIS as a measure of neurological impairment for use in general neuro-rehabilitation settings. Its further application and exploration are now warranted. Implications for Rehabilitation
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Affiliation(s)
- Lynne Turner-Stokes
- School of Medicine, Department of Palliative Care Policy and Rehabilitation, King's College London , London , UK
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Ashford S, Turner-Stokes L, Siegert R, Slade M. Initial psychometric evaluation of the Arm Activity Measure (ArmA): a measure of activity in the hemiparetic arm. Clin Rehabil 2013; 27:728-40. [DOI: 10.1177/0269215512474942] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To evaluate the psychometric properties of the Arm Activity Measure (ArmA), a patient-reported measure of active and passive function in the paretic upper limb. Design: Psychometric evaluation study. Setting: Two specialist rehabilitation and spasticity management services. Method: Patients ( n = 92) with upper limb paresis were recruited from two specialist neurorehabilitation centres. Mean age 44.5 (SD 16.7). Diagnostic distribution: stroke 48 (52%); other brain injury 28 (31%); or other neurological condition 16 (17%). Evaluation of convergent and divergent validity; unidimensionality, scaling, reliability (internal consistency and test–retest); responsiveness to change and feasibility of the ArmA were undertaken. Results: Expected convergent and divergent relationships were seen with the Leeds Adult Spasticity Impact Scale and the Disabilities of Arm Shoulder and Hand (DASH) (rho 0.5–0.63). Principal components analysis confirmed that active and passive function formed two separate constructs in each sub-scale. Mokken analysis corroborated the findings of the principal components analysis and demonstrated scaling using the monotone homogeneity model (Item H>0.5 for all items). Cronbach’s alpha was 0.85 and 0.96, respectively, for the passive and active function subscales. Item level test–retest agreement ranged from 92-97.5% (quadratic-weighted Kappa 0.71-0.94). In the subgroup treated for spasticity with botulinum toxin ( n = 58), the ArmA passive function scale identified a significant difference between responder and non-responder groups (Mann Whitney U = 0.85, p < 0.01). Respondents reported the ArmA to be relevant (77%), easy to use (90%) and timely to complete (83% under 10 minutes). Conclusion: The ArmA is a valid and reliable tool feasible for use in the evaluation of upper limb function in the context of treatment for spasticity.
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Affiliation(s)
- Stephen Ashford
- Regional Rehabilitation Unit, Northwick Park Hospital, UK
- Department of Palliative Care, Policy and Rehabilitation, King’s College London, UK
| | - Lynne Turner-Stokes
- Regional Rehabilitation Unit, Northwick Park Hospital, UK
- Department of Palliative Care, Policy and Rehabilitation, King’s College London, UK
| | | | - Mike Slade
- Health Service and Population Research Department, King’s College London, Institute of Psychiatry, UK
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Abstract
Purpose: To evaluate the psychometric properties of the UK FIM + FAM. Methods: (a) A systematic literature review integrating the evidence for psychometric qualities of both the original and UK versions, and (b) exploratory and confirmatory factor analysis of admission/discharge data from an inpatient general neuro-rehabilitation cohort using parametric and non-parametric techniques. A prospective cohort of 459 patients with a male:female ratio of 57:43 and mean age of 44.5 (SD 14.3) years participated in this study. Results: Seven published articles together demonstrated acceptable utility, concurrent validity, inter-rater reliability and responsiveness of the UK FIM + FAM. Factor analysis demonstrated that all items loaded high (>0.58) on the first principal component and distinct motor and cognitive factors emerged after rotation. A four-factor solution also demonstrated four distinct, interpretable dimensions (Physical, Psychosocial, Communication and Extended Activities of Everyday Living (EADL)). Mokken analysis of the second data set confirmed these dimensions. Cronbach’s αs were 0.97 and 0.96 for the motor and cognitive domains and 0.90–0.97 for the subscales. Analysis of responsiveness demonstrated “large” effect sizes (0.86–1.29). Conclusions: The UK FIM + FAM, including the newer EADL module, is a valid, reliable scale of functional independence. It has high internal consistency in two domains and four subscales and is responsive to changes occurring in a general inpatient neuro-rehabilitation population.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation , London , UK
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Turner-Stokes L, Poppleton R, Williams H, Schoewenaars K, Badwan D. Using the UKROC dataset to make the case for resources to improve cost-efficiency in neurological rehabilitation. Disabil Rehabil 2012; 34:1900-6. [PMID: 22506504 PMCID: PMC3477888 DOI: 10.3109/09638288.2012.670042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose A key challenge for providers and commissioners of rehabilitation services is to find optimal balance between service costs and outcomes. This article presents a “real-lifeâ application of the UK Rehabilitation Outcomes Collaborative (UKROC) dataset. We undertook a comparative cohort analysis of case-episode data (n = 173) from two specialist neurological rehabilitation units (A and B), to compare the cost-efficiency of two service models. Key messages (i) Demographics, casemix and levels of functional dependency on admission and discharge were broadly similar for the two units. (ii) The mean length of stay for Unit A was 1.5 times longer than Unit B, which had 85% higher levels of therapy staffing in relation to occupied bed days so despite higher bed-day costs, Unit B was 20% more cost-efficient overall, for similar gain. (iii) Following analysis, engagement with service commissioners led to successful negotiation of a business plan for service reconfiguration with increased staffing levels for Unit A and further development of local community rehabilitation services. Conclusion (i) Lower front-end service costs do not always signify optimal cost-efficiency. (ii) Analysis of routinely collected clinical data can be used to engage commissioners and to make the case for resources to maximise efficiency and improve patient care.
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Affiliation(s)
- Lynne Turner-Stokes
- King's College London School of Medicine, Department of Palliative Care Policy and Rehabilitation, London, UK.
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