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Thilarajah S, Low AY, Lee A, Ng S, Seow HC, Choo S, Bok CW, De Silva D, Chew ES, Chua TL, Kwah LK, Pua YH. Modifying the Mobility Scale for Acute Stroke (MSAS) for All Stroke Phases (MSA llS): Measurement Properties and Clinical Application. Arch Phys Med Rehabil 2024; 105:1262-1267. [PMID: 38430995 DOI: 10.1016/j.apmr.2024.02.722] [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: 05/07/2023] [Revised: 01/02/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To develop and examine the measurement properties and interpretability of the Mobility Scale for "All" Stroke Phases (MSAllS) as a potential single outcome measure to capture improvements in physical function throughout the stroke continuum. DESIGN Retrospective cross-sectional study. SETTING Inpatient rehabilitation unit. PARTICIPANTS People after stroke at discharge from rehabilitation (N=309). INTERVENTION Not applicable. MAIN OUTCOME MEASURE(S) We developed MSAllS by extending the highest MSAS level (walk 10 m independently) with 4 gait speed levels. To establish a clinical anchor, we extracted a 4-level discharge outcome. To assess the distributional properties and internal consistency of MSAllS, we evaluated its ceiling effects and calculated the Cronbach alpha, respectively. To assess structural validity, we performed a confirmatory factor analysis. To assess (i) its convergent validity with the FIM and (ii) its predictive validity with the clinical anchor, we used Spearman's rank correlations. To evaluate the clinical interpretability of MSAllS, we used an item-response theory-based method to estimate MSAllS thresholds associated with the clinical anchor. RESULTS The MSAllS had lower ceiling effects compared with MSAS (0% vs 25%). Internal consistency of MSAllS was excellent (α=0.94). Structural validity of MSAllS demonstrated a good fit (Comparative Fit Index=0.95; Tucker-Lewis Index=0.92; Root Means Square Error of Approximation=0.17). MSAllS demonstrated a moderate correlation (rho=0.66) with FIM score and with the clinical anchor (rho=0.75). MSAllS thresholds for increasing levels of the clinical anchor were 22 (20.8 to 23.6) - at least moderate assistance with walking/transfers, 28 (27.5 to 29.4) - at most supervision with walking, and 33 (32.5 to 33.4) - able to walk unassisted. CONCLUSION The MSAllS showed adequate measurement properties and clinical interpretability. MSAllS has the potential to be a single universal measure to evaluate physical function after stroke but further evaluation of clinical interpretability is required.
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Affiliation(s)
- Shamala Thilarajah
- Department of Physiotherapy, Singapore General Hospital, Singapore; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.
| | - Ai Ying Low
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Amanda Lee
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Sherie Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Hui Chueng Seow
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Silvana Choo
- Department of Occupational Therapy, Singapore General Hospital, Singapore
| | - Chek Wai Bok
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
| | - Deidre De Silva
- Department of Neurology, Singapore General Hospital, Singapore; National Neuroscience Institute, Singapore; DukeNUS Medical School, Singapore
| | | | - Tse Lert Chua
- Applied Analytics, Singapore General Hospital, Singapore
| | - Li Khim Kwah
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Yong Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
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Doubblestein D, Koehler L, Anderson E, Scheiman N, Stewart P, Schaverien M, Armer J. Development of a core set of outcome measures to be applied toward breast cancer-related lymphedema core outcome domains. Breast Cancer Res Treat 2024; 205:439-449. [PMID: 38517603 PMCID: PMC11101581 DOI: 10.1007/s10549-024-07298-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/14/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE For breast cancer survivors (BCS) living with breast cancer-related lymphedema (BCRL), what outcome measures (OMs) are recommended to be used to measure standardized outcome domains to fully assess the burden of the disease and efficacy of interventions? An integral component of a standardized core outcome set (COS) are the OMs used to measure the COS. METHODS A supplemental online survey was linked to a Delphi study investigating a COS for BCRL. OMs were limited to a maximum of 10 options for each outcome domain (OD). There were 14 ODs corresponding to the International Classification of Functioning, Disability, and Health (ICF) framework and respondents rated the OMs with a Likert level of recommendation. The feasibility of the listed OMs was also investigated for most outpatient, inpatient, and research settings. RESULTS This study identified 27 standardized OMs with a few ODs having 2-3 highly recommended OMs for proper measurement. A few of the recommended OMs have limitations with reliability due to being semi-quantitative measures requiring the interpretation of the rater. CONCLUSION Narrowing the choices of OMs to 27 highly recommended by BCRL experts may reduce selective reporting, inconsistency in clinical use, and variability of reporting across interdisciplinary healthcare fields which manage or research BCRL. There is a need for valid, reliable, and feasible OMs that measure tissue consistency. Measures of upper extremity activity and motor control need further research in the BCS with BCRL population.
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Affiliation(s)
| | - Linda Koehler
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Nicole Scheiman
- Occupational Therapy Assistant Program, Huntington University, Huntington, IN, USA
| | - Paula Stewart
- Parkridge Medical Center - Wound Care/Lymphedema Clinic, Parkridge Medical Center, Chattanooga, TN, USA
| | - Mark Schaverien
- Division of Surgery, Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jane Armer
- Professor Emerita, Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Ige JJ, Hunt DF, Mitchell A, Eaton E, Walker A, Fearn R, Kirkham L, Staples A, Giles A, Wilson B. Improving the standardisation, timeliness and efficiency of the occupational therapy admission process in an older adult inpatient service. BMJ Open Qual 2023; 12:e002514. [PMID: 38097284 PMCID: PMC10729176 DOI: 10.1136/bmjoq-2023-002514] [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: 07/25/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Occupational therapists (OTs) are at the forefront of providing recovery-oriented care for older people through timely assessments of patient's engagement in daily living activities among many other interventions. This aids a timely, safe and successful discharge from hospital.This project built on the foundations of previous work while considering the context and requirements of two older adult wards, the rates of admission and staff retention. The specific aim agreed was for 90% of patients admitted to the older adults' inpatient units to be assessed by the occupational therapy (OTY) team within days of admission by December 2022.The OTs worked in collaboration to initiate two tests of change with a total of five PDSA cycles.Our tests of change resulted in an increase of patients engaging in OTY initial assessments within seven days of admission from 47.65% (May to November 2021) to 78% (December 2021 to December 2022).Our team embarked on a quality improvement project to improve standardisation, efficiency and timeliness of the OTY process in an older adult inpatient service by using a pragmatic measure and tests of change evidenced in a previous study. This evidenced the generalisability of the findings of this study. While we were able to improve the timeliness of OTY initial assessments, we concluded that the overall impact on outcomes such as timely discharge was also dependent on other clinical and social factors.
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Affiliation(s)
| | - David Fancis Hunt
- Oxford Healthcare Improvement, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Amanda Mitchell
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Emma Eaton
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Anne Walker
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Rachael Fearn
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Lizzie Kirkham
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Abigail Staples
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Adam Giles
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Bethany Wilson
- Occupational Therapy, Derbyshire Healthcare NHS Foundation Trust, Derby, UK
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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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Facilitators and Barriers to the Use of Outcome Measures by Certified Lymphedema Therapists. REHABILITATION ONCOLOGY 2023. [DOI: 10.1097/01.reo.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Dos Santos RB, Fiedler A, Badwal A, Legasto-Mulvale JM, Sibley KM, Olaleye OA, Diermayr G, Salbach NM. Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1084085. [PMID: 36896249 PMCID: PMC9989207 DOI: 10.3389/fresc.2023.1084085] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Background Use of standardized tools to assess balance and mobility limitations is a recommended practice in stroke rehabilitation. The extent to which clinical practice guidelines (CPGs) for stroke rehabilitation recommend specific tools and provide resources to support their implementation is unknown. Purpose To identify and describe standardized, performance-based tools for assessing balance and/or mobility and describe postural control components challenged, the approach used to select tools, and resources provided for clinical implementation, in CPGs for stroke. Methods A scoping review was conducted. We included CPGs with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitations. We searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, standardized assessment tools, the approach for tool selection, and resources. Experts identified postural control components challenged by each tool. Results Of the 19 CPGs included in the review, 7 (37%) and 12 (63%) were from middle- and high-income countries, respectively. Ten CPGs (53%) recommended or suggested 27 unique tools. Across 10 CPGs, the most commonly cited tools were the Berg Balance Scale (BBS) (90%), 6-Minute Walk Test (6MWT) (80%), Timed Up and Go Test (80%) and 10-Meter Walk Test (70%). The tool most frequently cited in middle- and high-income countries was the BBS (3/3 CPGs), and 6MWT (7/7 CPGs), respectively. Across 27 tools, the three components of postural control most frequently challenged were underlying motor systems (100%), anticipatory postural control (96%), and dynamic stability (85%). Five CPGs provided information in varying detail on how tools were selected; only 1 CPG provided a level of recommendation. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country. Conclusion CPGs for stroke rehabilitation do not consistently provide recommendations for standardized tools to assess balance and mobility or resources to facilitate clinical application. Reporting of processes for tool selection and recommendation is inadequate. Review findings can be used to inform global efforts to develop and translate recommendations and resources for using standardized tools to assess balance and mobility post-stroke. Systematic Review Registration https://osf.io/, identifier: 10.17605/OSF.IO/6RBDV.
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Affiliation(s)
- Renato B Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo - UNICID, Sao Paulo, Brazil.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Annabelle Fiedler
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Anchal Badwal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jean Michelle Legasto-Mulvale
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gudrun Diermayr
- School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,The KITE Research Institute, University Health Network, Toronto, ON, Canada
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Sidarta A, Lim YC, Wong RA, Tan IO, Kuah CWK, Ang WT. Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation. PLoS One 2022; 17:e0270693. [PMID: 35951544 PMCID: PMC9371309 DOI: 10.1371/journal.pone.0270693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.
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Affiliation(s)
- Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- * E-mail:
| | - Yu Chin Lim
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Russell A. Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Isaac O. Tan
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Christopher Wee Keong Kuah
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Centre for Advanced Rehabilitation Therapeutics (CART), Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Tech Ang
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Mechanical & Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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Use of Outcome Measures by Certified Lymphedema Therapists With Survivors of Breast Cancer With Breast Cancer–Related Lymphedema. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van der Veen R, Oosterlaan J, Bos M, van Dooren M, Düdükçü I, van Iperen A, Kooiman L, Nicolas K, Peerdeman S, Königs M. Measurement Feedback System for Intensive Neurorehabilitation after Severe Acquired Brain Injury. J Med Syst 2022; 46:24. [PMID: 35377012 PMCID: PMC8979932 DOI: 10.1007/s10916-022-01809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
AbstractOutcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to distinct heterogeneity between patients. Limited knowledge of the complex constellation of determinants at play interferes with the possibility to deploy precision medicine in neurorehabilitation. Measurement Feedback Systems (MFS) structure clinical data collection and deliver the measurement results as feedback to clinicians, thereby facilitating progress monitoring, promoting balanced patient-centered discussion and shared decision making. Accumulation of clinical data in the MFS also enables data-driven precision rehabilitation medicine. This article describes the development and implementation of a MFS for neurorehabilitation after ABI. The MFS consists of specialized measurement tracks which are developed together with representatives of each discipline in the multidisciplinary team. The MFS is built into a digital platform that automatically distributes measurements among clinicians, at predetermined time points during the inpatient treatment, outpatient treatment and follow-up. The results of all measurements are visualized in individual patient dashboards that are accessible for all clinicians involved in treatment. Since step-wise implementation, 124 patients have been registered on the MFS platform so far, providing an average of more than 200 new measurements per week. Currently, more than 15,000 clinical measurements are captured in the MFS. The current overall completion rate of measurements is 86,4%. This study shows that structured clinical assessment and feedback is feasible in the context of neurorehabilitation after severe ABI. The future directions are discussed for MFS data in our Health Intelligence Program, which aims at periodic care evaluation and the transition of neurorehabilitation care towards precision medicine.
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Iype T, Sasikumar A, Sivaram R. Development and Validation of a New Stroke Outcome Scale (Stroke Impact Assessment Questionnaire). Neurol India 2022; 70:1988-1994. [DOI: 10.4103/0028-3886.359211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Performance-Based Executive Function Instruments Used by Occupational Therapists for Children: A Systematic Review of Measurement Properties. Occup Ther Int 2021; 2021:6008442. [PMID: 34471400 PMCID: PMC8374859 DOI: 10.1155/2021/6008442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction The use of executive function (EF) instruments to assess children's functional performance is obscured with a lack of consensus on which is most suitable to use within the occupational therapy profession. This review identifies EF instruments used by occupational therapists (OTs) for children and evaluates their measurement properties. Methods This systematic review was registered in PROSPERO (CRD42020172107). We reviewed occupational therapy-related studies published until March 2021, to identify performance-based EF instruments used among children by OTs. Two review authors independently screened, extracted, and evaluated the methodological rigor of the included studies. Adequacy of the measurement properties was determined using the COSMIN, and the Terwee criteria were used for synthesis of best evidence. Results Five EF assessments were found across eight study articles: Behavioural Assessment of the Dysexecutive Syndrome for Children, Children's Cooking Task, Children's Kitchen Task Assessment, Do-Eat, and Preschool Executive Task Assessment. Adequacy of measurement properties and synthesis of best evidence varied, leading to a low GRADE rating on the certainty of evidence for the included instruments. Conclusions There is limited evidence that supports the certainty of evidence on the measurement properties of the reviewed tools in helping OTs assess performance-based EF among children. Nevertheless, the authors conditionally suggest their use based on the critical need to measure children's EF. Further research is needed to establish the measurement properties of these measures across different childhood populations.
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Abstract
BACKGROUND. Occupational therapists are generally positive towards use of measuring tools. However, such use may be problematic. PURPOSE. To illuminate hidden and adverse effects of using measuring tools in occupational therapy. METHOD. A Foucauldian inspired thematic analysis of the use of measuring tools in 13 reports of practice development projects in Denmark. FINDINGS. Three themes were constructed: "Categorisation of loss", "Conduct of conduct: Self-tracking and competition", and "Conforming to expected forms of everyday living". Measuring tools tended to produce generalised truths about older adults and were used to predict outcome of or access to reablement programs. The measurements guided both older people and professionals, and measurements created both motivation and resistance. The tools served as an extension of the healthcare professionals' authority. IMPLICATIONS. When appropriately situated, measuring tools have the potential to empower and enhance older adults' lives and should be the focus of greater clinical attention.
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Affiliation(s)
- Stinne Glasdam
- Stinne Glasdam, Integrative Health Research, Department of Health Sciences, Faculty of Medicine, Lund University, Margaretavägen 1 B, S- 222 41 Lund, Sweden.
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Assessing the Use of Standardized Outcome Measures for Stroke Rehabilitation among Physiotherapists in Ghana. Stroke Res Treat 2020; 2020:9259017. [PMID: 32665830 PMCID: PMC7349619 DOI: 10.1155/2020/9259017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background The use of standardized outcome measures is an aspect of good clinical practice and essential to the rehabilitation of patients suffering from stroke. Literature reports regarding the extent of usage of outcome measures in stroke rehabilitation by physiotherapists globally are inconsistent. In addition, the patronage of outcome measures in stroke rehabilitation in low-resourced countries is uncertain. Objective This study was conducted to assess the current practice of physiotherapists in Ghana regarding the use of standardized outcome measures in the rehabilitation of stroke patients. Method A descriptive cross-sectional survey, was used involving 105 registered physiotherapists in Ghana. A 35-item adapted questionnaire was used to collect data on some commonly used outcome measures and frequency of use by physiotherapists for stroke patients. Results A total of 55 (52.4%) physiotherapists did not use outcome measures in their clinical practice. Physiotherapists below 40 years of age use outcome measures (64.7%) more than those 41 years and above (6.7%). Physiotherapists working in public facilities in Ghana are more likely to use outcome measures (56.2%) than those in private facilities (16.2%). Physiotherapists who attend to 1-10 patients in a week used outcome measures more (32.4%) than physiotherapists who attend to more than 30 patients (3.8%) in a week. Conclusion There is poor usage of outcome measures by Ghanaian physiotherapists, with more than half of the participants not using any standardized outcome measures for rehabilitation of patients in their practice. Physiotherapists who attends to fewer number of patients in a week are more likely to use outcome measures. There is the need for implementation of policy and guidelines on the use of outcome measures by the Allied Health Professions Council and the Ghana Physiotherapy Association.
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Miller KK, Lin SH, Neville M. From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke. Arch Phys Med Rehabil 2018; 100:1162-1175. [PMID: 30465739 DOI: 10.1016/j.apmr.2018.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.
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Affiliation(s)
- Kristine K Miller
- Department of Physical Therapy, Indiana University, Indianapolis, IN.
| | - Susan H Lin
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Marsha Neville
- School of Occupational Therapy, Texas Woman's University, Dallas, TX
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Romney W, Salbach N, Parrott JS, Deutsch JE. A knowledge translation intervention designed using audit and feedback and the Theoretical Domains Framework for physical therapists working in inpatient rehabilitation: A case report. Physiother Theory Pract 2018; 35:686-702. [DOI: 10.1080/09593985.2018.1457113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Wendy Romney
- Department of Physical Therapy, Sacred Heart University, Fairfield, CT, USA
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
| | - Nancy Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - James Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Newark, NJ, USA
| | - Judith E Deutsch
- Department of Rehabilitation and Movement Sciences, Rutgers University, Newark, NJ, USA
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Kane K, Manns P, Lanovaz J, Musselman K. Clinician perspectives and experiences in the prescription of ankle-foot orthoses for children with cerebral palsy. Physiother Theory Pract 2018; 35:148-156. [PMID: 29465276 DOI: 10.1080/09593985.2018.1441346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Physiotherapists, orthotists, and physicians are involved in the prescription of ankle-foot orthoses (AFOs) for children with cerebral palsy (CP); however, little is known about how prescription decisions are made in practice. Therefore, the study objective was to identify current AFO prescription and clinical decision-making practices for children with CP in Canada. METHODS Focus groups were conducted in five pediatric rehabilitation facilities, with 32 clinicians. Semi-structured interviews focused on the goals and types of AFOs used, referral and follow-up processes, and clinical evaluation measures. Interpretive Description was used as a framework for analysis. Transcribed dialogue was imported into NVivo 11 for data coding and analysis. Three researchers participated in coding to establish categories and themes. RESULTS Categories included: what is made, how it is used, and factors that either support or challenge outcomes. Strengths and challenges of the current prescription process were discussed, including funding, communication, and technology to enhance clinical evaluation. Throughout the interviews, the theme of prescription as a collaborative, iterative, and individualized process emerged. CONCLUSIONS Processes, strengths, and challenges associated with AFO prescription in Canada were identified. This is a first step toward the development of guidelines to help clinicians improve AFO prescription for children with CP.
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Affiliation(s)
- Kyra Kane
- a School of Physical Therapy, College of Medicine , University of Saskatchewan , Saskatoon , Canada.,b Saskatchewan Health Authority , Children's Program , Regina , Canada
| | - Patricia Manns
- c Department of Physical Therapy, Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
| | - Joel Lanovaz
- d College of Kinesiology , University of Saskatchewan , Saskatoon , Canada
| | - Kristin Musselman
- a School of Physical Therapy, College of Medicine , University of Saskatchewan , Saskatoon , Canada.,e Toronto Rehabilitation Institute - University Health Network , Toronto , Canada.,f Department of Physical Therapy, Faculty of Medicine , University of Toronto , Toronto , Canada
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Willson ML, Vernooij RW, Gagliardi AR, Armstrong M, Bernhardsson S, Brouwers M, Bussières A, Fleuren M, Gali K, Huckson S, Jones S, Lewis SZ, James R, Marshall C, Mazza D. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review. J Clin Epidemiol 2017; 86:25-38. [DOI: 10.1016/j.jclinepi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 01/26/2023]
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Wales K, Clemson L, Lannin N, Cameron I. Functional Assessments Used by Occupational Therapists with Older Adults at Risk of Activity and Participation Limitations: A Systematic Review. PLoS One 2016; 11:e0147980. [PMID: 26859678 PMCID: PMC4747506 DOI: 10.1371/journal.pone.0147980] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/10/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. Methods A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. Results Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. Conclusions The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary.
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Affiliation(s)
- Kylie Wales
- Ageing Work and Health Research Unit and Centre of Excellence in Population Ageing Research, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- * E-mail:
| | - Lindy Clemson
- Ageing Work and Health Research Unit and Centre of Excellence in Population Ageing Research, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Natasha Lannin
- School of Allied Health, La Trobe University and Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
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Jaeger Pedersen T, Kaae Kristensen H. A critical discourse analysis of the attitudes of occupational therapists and physiotherapists towards the systematic use of standardised outcome measurement. Disabil Rehabil 2015; 38:1592-602. [PMID: 26678944 DOI: 10.3109/09638288.2015.1107630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate discourses relating to the implementation of standardised outcome measurement within rehabilitation practise. METHOD It is a critical discourse analysis of texts in professional occupational therapist (OT) and physiotherapist (PT) journals, along with transcriptions from three focus group interviews with 25 OTs and PTs in local rehabilitation settings. RESULTS Although positive attitudes towards outcome measurement were expressed in the professional journals, OTs and PTs in local settings had professional reservations about standardisation of the rehabilitation practise. The therapists were caught in what they considered to be a dilemma between taking a holistic approach and performing standardised practise. Systematic outcome measurement challenged the core values of their practise. Therapists often felt that 'it did not make sense' to use outcome measurement and this became a barrier to its implementation. CONCLUSION If the use of standardised outcome measurement is to be increased, reflection is needed on how the measurements can be integrated to provide a meaningful contribution to individual rehabilitation processes. To optimise implementation, it is essential to make use of research in knowledge translation and adapt it to fit with the ways in which new ideas and recommendations are implemented in local rehabilitation contexts. Implications for Rehabilitation Successful implementation of standardised outcome measurements depends on whether occupational therapists and physiotherapists have an experience of the measurements as being meaningful. Enforcement of standardised outcome measurements must be done by means of more than a few isolated arguments, if professional acceptance is to be gained. To reject established dogmas on, e.g. standardisation, deliberate and conscious reflections in local settings are needed. It is necessary to go beyond normal and familiar professional reflections. To this end, newcomers' opinions are valuable.
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Affiliation(s)
- Tonny Jaeger Pedersen
- a Institute of Public Health , University of Southern Denmark , Odense , Denmark ;,b Svendborg Hospital, Rehabilitation Unit , Odense University Hospital , Svendborg , Denmark
| | - Hanne Kaae Kristensen
- c Institute of Clinical Research , University of Southern Denmark , Odense , Denmark ;,d Health Sciences Research Centre , University College Lillebaelt , Odense , Denmark
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Burton LJ, Tyson S. Screening for mood disorders after stroke: a systematic review of psychometric properties and clinical utility. Psychol Med 2015; 45:29-49. [PMID: 25066635 DOI: 10.1017/s0033291714000336] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Routine mood screening is recommended after stroke. However, clinicians report difficulty selecting appropriate tools from the wide range available. We aimed to systematically review the psychometric properties and clinical utility of mood screening tools for stroke survivors. METHOD Electronic databases (AMED, EMBASE, CINAHL, Medline and PsycINFO) were searched to identify studies assessing the sensitivity and specificity of mood screening tools. Tools that demonstrated at least 80% sensitivity and 60% specificity with stroke survivors with identifiable cut-off scores indicating major and/or any mood disorder in at least one study were selected and clinical utility was assessed. Those with high clinical utility (against predefined criteria) were selected for recommendation. RESULTS Thirty papers examining 27 screening tools were identified and 16 tools met the psychometric and clinical utility criteria: 10 were verbal self-report tools, four were observational and two incorporated visual prompts for those with communication problems. Only the Stroke Aphasic Depression Questionnaire -Hospital version (SADQ-H) met all the psychometric and utility criteria. The nine-item Patient Health Questionnaire (PHQ-9) can detect major depression and the 15-item Geriatric Depression Scale (GDS-15) can identify milder symptoms; both are feasible to use in clinical practice. The Hospital Anxiety and Depression Scale (HADS) was the only tool able to identify anxiety accurately, but clinical utility was mixed. CONCLUSIONS Valid and clinically feasible mood screening tools for stroke have been identified but methodological inconsistency prevented recommendations about the optimal cut-off scores.
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Affiliation(s)
- L-J Burton
- Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work,University of Manchester,UK
| | - S Tyson
- Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work,University of Manchester,UK
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Tyson SF, Burton L, McGovern A. The impact of a toolkit on use of standardised measurement tools in stroke rehabilitation. Clin Rehabil 2014; 29:926-34. [DOI: 10.1177/0269215514562590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/09/2014] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate the impact of a toolkit of psychometrically robust measurement tools, the Greater Manchester Assessment for Stroke Rehabilitation (G-MASTER) toolkit, on the use of measurement tools during stroke rehabilitation Design: Mixed methods cohort design using non-participant observation of multi-disciplinary team meetings and semi-structured interviews with members of the team over three months before and three months after implementation of the assessment toolkit. Development and implementation of the toolkit are also described. Setting: Ten in-patient stroke services in a large UK city. Subjects: Members of the participating multi-disciplinary stroke teams. Results: Before implementation standardised measures were seldom used in team meetings. After implementation, use of all measurement tools significantly increased (36% to 81% of occasions, P<0.000). Staff were generally positive about the toolkit and felt it enabled more accurate problem identification, effective progress monitoring, timely decision-making, communication and promoted inter-team relationships. Conclusions: A toolkit of standardised measurement tools can be feasibly and acceptably implemented into stroke rehabilitation. It increases the use of measurement tools by the multi-disciplinary team and improves the processes and quality of care.
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Affiliation(s)
- SF Tyson
- Stroke Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester UK
| | - L Burton
- Stroke Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester UK
- Greater Manchester Strategic Clinical Network, UK
| | - A McGovern
- Greater Manchester Strategic Clinical Network, UK
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Wallace J, Byrne C, Clarke M. Improving the uptake of systematic reviews: a systematic review of intervention effectiveness and relevance. BMJ Open 2014; 4:e005834. [PMID: 25324321 PMCID: PMC4202007 DOI: 10.1136/bmjopen-2014-005834] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Little is known about the barriers, facilitators and interventions that impact on systematic review uptake. The objective of this study was to identify how uptake of systematic reviews can be improved. SELECTION CRITERIA Studies were included if they addressed interventions enhancing the uptake of systematic reviews. Reports in any language were included. All decisionmakers were eligible. Studies could be randomised trials, cluster-randomised trials, controlled-clinical trials and before-and-after studies. DATA SOURCES We searched 19 databases including PubMed, EMBASE and The Cochrane Library, covering the full range of publication years from inception to December 2010. Two reviewers independently extracted data and assessed quality according to the Effective Practice and Organisation of Care criteria. RESULTS 10 studies from 11 countries, containing 12 interventions met our criteria. Settings included a hospital, a government department and a medical school. Doctors, nurses, mid-wives, patients and programme managers were targeted. Six of the studies were geared to improving knowledge and attitudes while four targeted clinical practice. SYNTHESIS OF RESULTS Three studies of low-to-moderate risk of bias, identified interventions that showed a statistically significant improvement: educational visits, short summaries of systematic reviews and targeted messaging. Promising interventions include e-learning, computer-based learning, inactive workshops, use of knowledge brokers and an e-registry of reviews. Juxtaposing barriers and facilitators alongside the identified interventions, it was clear that the three effective approaches addressed a wide range of barriers and facilitators. DISCUSSION A limited number of studies were found for inclusion. However, the extensive literature search is one of the strengths of this review. CONCLUSIONS Targeted messaging, educational visits and summaries are recommended to enhance systematic review uptake. Identified promising approaches need to be developed further. New strategies are required to encompass neglected barriers and facilitators. This review addressed effectiveness and also appropriateness of knowledge uptake strategies.
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Affiliation(s)
- John Wallace
- Department of Continuing Education, Wellington Square, Oxford, UK
| | - Charles Byrne
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Mike Clarke
- Department of Continuing Education, Wellington Square, Oxford, UK
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Tyson SF, Brown P. How to measure fatigue in neurological conditions? A systematic review of psychometric properties and clinical utility of measures used so far. Clin Rehabil 2014; 28:804-816. [PMID: 24519920 DOI: 10.1177/0269215514521043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systemically review the psychometric properties and clinical utility (feasibility) of tools to measure fatigue in neurological conditions. DATA SOURCES AMED, CINAHL, MEDLINE, Science Direct and Web of Knowledge were searched for studies of the psychometric properties of fatigue measures in adults with central nervous system disorders. Search terms were: Fatigue AND assess* OR measure* OR tool OR outcome OR index OR test OR scale AND stroke OR cerebrovascular* OR hemi* OR parkinson* OR sclerosis OR head injury OR brain injury OR motor neurone disease OR neuro* REVIEW METHODS: Articles that addressed validity; reliability and ability to detect change were selected. Two authors independently selected articles and extracted data. Strength of the psychometric properties and clinical utility were assessed against predetermined thresholds. RESULTS A total of 25 articles were selected and 17 measurement tools identified including six versions of the Fatigue Severity Scale and five versions of the Fatigue Impact Scale. All were clinically feasible but none met all the criteria. Most were valid. Reliability and ability to detect change were infrequently evaluated, but were adequate when reported. The most thoroughly developed and psychometrically robust measures were the Neurological Fatigue Indices. CONCLUSION Although many measures of fatigue in neurological conditions have published, none met all of the criteria for psychometric robustness and clinical utility but the Neurological Fatigue Indices are the best and can be used with caution.
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Affiliation(s)
- Sarah F Tyson
- Stroke Research Centre, University of Manchester, Manchester, UK
| | - Philip Brown
- Stroke Research Centre, University of Manchester, Manchester, UK
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