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Deng H, Abouzeid CA, Shepler LJ, Ni P, Slavin MD, Barron DS, Herrera-Escobar JP, Kazis LE, Ryan CM, Schneider JC. Moderation Effects of Daily Behavior on Associations between Symptoms and Social Participation Outcomes after Burn Injury: A 6-month Digital Phenotyping Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01000-1. [PMID: 38754720 DOI: 10.1016/j.apmr.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To examine the moderation effects of daily behavior on the associations between symptoms and social participation outcomes after burn injury DESIGN: A 6-month prospective cohort study SETTING: Community PARTICIPANTS: 24 adult burn survivors INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Symptoms and social participation outcomes were assessed weekly using smartphone surveys, including symptoms of pain (Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Pain Interference), anxiety (PROMIS Anxiety), and depression (Patient Health Questionnaire (PHQ-8)), as well as outcomes of social interactions and social activities (Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities). Daily behaviors were automatically recorded by a smartphone application and smartphone logs, including physical activity (steps, travel miles, and activity minutes), sleep (sleep hours), and social contact (number of phone call and message contacts). RESULTS Multilevel models controlling for demographic and burn injury variables examined the associations between symptoms and social participation outcomes, and the moderation effects of daily behaviors. Lower (worse) LIBRE Social Interactions and LIBRE Social Activities scores were significantly associated with higher (worse) PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Anxiety, and PHQ-8 scores (p<0.05). Additionally, daily steps and activity minutes were associated with LIBRE Social Interactions and LIBRE Social Activities (p<0.05), and significantly moderated the association between PROMIS Anxiety and LIBRE Social Activities (p<0.001). CONCLUSIONS Social participation outcomes are associated with pain, anxiety, and depression symptoms after burn injury, and are buffered by daily physical activity. Future interventions studies should examine physical activity promotion on improving social recovery after burns.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Cailin A Abouzeid
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, USA
| | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA; Rehabilitation Outcomes Center at Spaulding, Boston, MA, USA
| | - Daniel S Barron
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA; Rehabilitation Outcomes Center at Spaulding, Boston, MA, USA
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Rehabilitation Outcomes Center at Spaulding, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Deng H, Shepler LJ, Chacon KL, Tenney D, Ni P, Stewart BT, Carrougher GJ, Kowalske K, Wolf SE, Slavin MD, Kazis LE, Ryan CM, Schneider JC. Predictors at 6 and 12 Months for Social Participation Outcome at 24 Months in the Adult Burn Injury Population: A Burn Model System National Database Study. Arch Phys Med Rehabil 2024; 105:235-242. [PMID: 37392780 PMCID: PMC10756920 DOI: 10.1016/j.apmr.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To identify clinical factors (physical and psychological symptoms and post-traumatic growth) that predict social participation outcome at 24-month after burn injury. DESIGN A prospective cohort study based on Burn Model System National Database. SETTING Burn Model System centers. PARTICIPANTS 181 adult participants less than 2 years after burn injury (N=181). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic and injury variables were collected at discharge. Predictor variables were assessed at 6 and 12 months: Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Sleep Disturbance, Fatigue, and Pain Interference short forms, and self-reported Heat Intolerance. Social participation was measured at 24 months using the Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities short forms. RESULTS Linear and multivariable regression models were used to examine predictor variables for social participation outcomes, controlling for demographic and injury variables. For LIBRE Social Interactions, significant predictors included the PCL-C total score at 6 months (β=-0.27, P<.001) and 12 months (β=-0.39, P<.001), and PROMIS-29 Pain Interference at 6 months (β=-0.20, P<.01). For LIBRE Social Activities, significant predictors consisted of the PROMIS-29 Depression at 6 months (β=-0.37, P<.001) and 12 months (β=-0.37, P<.001), PROMIS-29 Pain Interference at 6 months (β=-0.40, P<.001) and 12 months (β=-0.37, P<.001), and Heat Intolerance at 12 months (β=-4.55, P<.01). CONCLUSIONS Post-traumatic stress and pain predicted social interactions outcomes, while depression, pain and heat intolerance predicted social activities outcomes in people with burn injury.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Kaitlyn L Chacon
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | | | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
| | - Barclay T Stewart
- The University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA
| | | | - Karen Kowalske
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Boston University School of Public Health, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA
| | - Colleen M Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Rehabilitation Outcomes Center at Spaulding, Boston, MA; Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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Slavin MD, Bailey HM, Hickey EJ, Vasudevan A, Ledingham A, Tannenbaum L, Bateman L, Kaufman DL, Peterson DL, Ruhoy IS, Systrom DM, Felsenstein D, Kazis LE. Myalgic Encephalomyelitis-Chronic Fatigue Syndrome Common Data Element item content analysis. PLoS One 2023; 18:e0291364. [PMID: 37698999 PMCID: PMC10497138 DOI: 10.1371/journal.pone.0291364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a multisystem chronic disease estimated to affect 836,000-2.5 million individuals in the United States. Persons with ME/CFS have a substantial reduction in their ability to engage in pre-illness levels of activity. Multiple symptoms include profound fatigue, post-exertional malaise, unrefreshing sleep, cognitive impairment, orthostatic intolerance, pain, and other symptoms persisting for more than 6 months. Diagnosis is challenging due to fluctuating and complex symptoms. ME/CFS Common Data Elements (CDEs) were identified in the National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) Common Data Element Repository. This study reviewed ME/CFS CDEs item content. METHODS Inclusion criteria for CDEs (measures recommended for ME/CFS) analysis: 1) assesses symptoms; 2) developed for adults; 3) appropriate for patient reported outcome measure (PROM); 4) does not use visual or pictographic responses. Team members independently reviewed CDEs item content using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework to link meaningful concepts. RESULTS 119 ME/CFS CDEs (measures) were reviewed and 38 met inclusion criteria, yielding 944 items linked to 1503 ICF meaningful concepts. Most concepts linked to ICF Body Functions component (b-codes; n = 1107, 73.65%) as follows: Fatiguability (n = 220, 14.64%), Energy Level (n = 166, 11.04%), Sleep Functions (n = 137, 9.12%), Emotional Functions (n = 131, 8.72%) and Pain (n = 120, 7.98%). Activities and Participation concepts (d codes) accounted for a smaller percentage of codes (n = 385, 25.62%). Most d codes were linked to the Mobility category (n = 69, 4.59%) and few items linked to Environmental Factors (e codes; n = 11, 0.73%). DISCUSSION Relatively few items assess the impact of ME/CFS symptoms on Activities and Participation. Findings support development of ME/CFS-specific PROMs, including items that assess activity limitations and participation restrictions. Development of psychometrically-sound, symptom-based item banks administered as computerized adaptive tests can provide robust assessments to assist primary care providers in the diagnosis and care of patients with ME/CFS.
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Affiliation(s)
- Mary D. Slavin
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Spaulding Rehabilitation Hospital, Rehabilitation Outcomes Center (ROC), Boston, Massachusetts, United States of America
| | - Hannah M. Bailey
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Emily J. Hickey
- University Center for Excellence in Developmental Disabilities, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ananya Vasudevan
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Aileen Ledingham
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Linda Tannenbaum
- Open Medicine Foundation, Agoura Hills, California, United States of America
| | - Lucinda Bateman
- Bateman Horne Center of Excellence, Salt Lake City, Utah, United States of America
| | - David L. Kaufman
- Center for Complex Diseases, Mountain View, California, United States of America
| | - Daniel L. Peterson
- Sierra Internal Medicine, Incline Village, Nevada, United States of America
| | - Ilene S. Ruhoy
- Mount Sinai South Nassau, Neurology, Chiari/EDS Center, Oceanside, New York, United States of America
| | - David M. Systrom
- Brigham and Women’s Hospital, Lung Center, Boston, Massachusetts, United States of America
| | - Donna Felsenstein
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lewis E. Kazis
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Spaulding Rehabilitation Hospital, Rehabilitation Outcomes Center (ROC), Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Deng H, Vu KQ, Franco JR, Shepler LJ, Abouzeid CA, Hamner JW, Mercier HW, Taylor JA, Kazis LE, Slavin MD, Ryan CM, Schneider JC. Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review. J Med Syst 2023; 47:26. [PMID: 36792791 PMCID: PMC9931567 DOI: 10.1007/s10916-023-01914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
This review aims to identify and evaluate digital interventions for social participation in the growing population of adults with long-term physical conditions. Articles were sourced from MEDLINE, EMBASE, CINAHL and PsycINFO databases using subject headings and keywords related to "social participation" and "digital technology". Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Data on study methodology, participant and digital intervention characteristics, and findings related to social participation were extracted. The search yielded a total of 4646 articles and 14 articles met criteria for final review with five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Studies were organized based on the digital intervention strategy implemented to improve social participation: group support (n = 4), individual skill training or counseling (n = 6), education and support (n = 3), and mixed intervention (n = 1). The group support interventions developed a social network among participants through videoconference, app, or virtual reality platform. Three studies reported positive improvements in different aspects of social participation. Individual skill training or counseling mainly utilized phone calls to help participants cope with activity participation and interpersonal relationship issues. Only two studies demonstrated benefits for social participation. The education and support intervention, which used messages and website information to increase participants' knowledge and provide support, showed positive findings in three studies. This review suggests digital interventions for improving social participation in adults with long-term physical conditions are feasible and the effectiveness of different strategies may vary.Registration: This review was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (registry number: CRD42021254105).
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Affiliation(s)
- Huan Deng
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Kevin Q Vu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jessie R Franco
- Department of Rehabilitation Services, Brigham and Women's Hospital, Boston, MA, USA
| | - Lauren J Shepler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Cailin A Abouzeid
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - J W Hamner
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
| | - Hannah W Mercier
- Occupational Therapy Program, Stony Brook University, Stony Brook, NY, USA
| | - J Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Lewis E Kazis
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Mary D Slavin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Colleen M Ryan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA, 02129, USA.
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
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Rodríguez-Mercedes SL, Patel KF, Rencken CA, Grant GG, Surette K, Kinney EM, Brady KJ, Slavin MD, Schneider JC, Stoddard FJ, Kazis LE, Ryan CM. Item Pool Development for the School-Aged Life Impact Burn Recovery Evaluation Profile Computerized Adaptive Test: An Observer-Reported Outcome Assessment Measuring the Impact of Burn Injuries in School-Aged Children. J Burn Care Res 2022; 43:1114-1128. [PMID: 34965302 PMCID: PMC9255664 DOI: 10.1093/jbcr/irab247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The transition from early childhood to teen years (5-12) is a critical time of development, which can be made particularly challenging by a burn injury. Assessing postburn recovery during these years is important for improving pediatric survivors' development and health outcomes. Few validated burn-specific measures exist for this age group. The purpose of this study was to generate item pools that will be used to create a future computerized adaptive test (CAT) assessing postburn recovery in school-aged children. Item pool development was guided by the previously developed School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) conceptual framework. The item pool development process involved a systematic literature review, extraction of candidate items from existing legacy measures, iterative item review during expert consensus meetings, and parent cognitive interviews. The iterative item review with experts consisted of six rounds. A total of 10 parent cognitive interviews were conducted. The three broad themes of concern were items that needed 1) clarification, needed context, or were vague, 2) age dependence and relevance, and 3) word choice. The cognitive interviews indicated that survey instructions, recall period, item stem, and response choices were interpretable by respondents. Final item pool based on parental feedback consists of 57, 81, and 60 items in physical, psychological, and family and social functioning, respectively. Developed item pools (n = 198) in three domains are consistent with the existing conceptual framework. The next step involves field testing the item pool and calibration using item response theory to develop and validate the SA-LIBRE5-12 CAT Profile.
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Affiliation(s)
| | - Khushbu F. Patel
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Camerin A. Rencken
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Gabrielle G. Grant
- University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC
| | - Kate Surette
- Shriners Hospitals for Children – Boston, Boston, MA
| | | | - Keri J.S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Mary D. Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
| | - Jeffrey C. Schneider
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Frederick J. Stoddard
- Shriners Hospitals for Children – Boston, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
| | - Colleen M. Ryan
- Shriners Hospitals for Children – Boston, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA
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Deng H, Abouzeid CA, Shepler LJ, Slavin MD, Taylor JA, Mercier HW, Herrera-Escobar JP, Kazis LE, Ryan CM, Schneider JC. Using digital phenotyping to characterize psychosocial trajectories for people with burn injury. Burns 2022; 48:1262-1266. [PMID: 35504767 PMCID: PMC9357168 DOI: 10.1016/j.burns.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Cailin A. Abouzeid
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren J. Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary D. Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - J. Andrew Taylor
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Lewis E. Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Colleen M. Ryan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Shriners Hospitals for Children-Boston®, Boston, MA, USA
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Correspondence to: Spaulding Rehabilitation Hospital, 300 1st Avenue, Boston, MA 02129, USA., (J.C. Schneider)
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Rajala C, Waterhouse C, Evans E, Erler KS, Bergin MJ, Bannon SM, Slavin MD, Kazis LE. Conceptualization of Participation: A Qualitative Synthesis of Brain Injury Stakeholder Perspectives. Front Rehabilit Sci 2022; 3:908615. [PMID: 36188936 PMCID: PMC9397755 DOI: 10.3389/fresc.2022.908615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022]
Abstract
Background The return to participation in meaningful life roles for persons with acquired brain injury (pwABI) is a goal shared by pwABI, their families, clinicians, and researchers. Synthesizing how pwABI define participation will help to identify the aspects of participation important to pwABI and can inform a person-centered approach to participation outcome assessment. To-date, the qualitative synthesis approach has been used to explore facilitators and barriers of participation post-stroke, and views about participation among individuals with stroke in the UK. Objectives This paper's objectives are to (1) conduct a scoping review of qualitative literature that defines and characterizes participation from the perspective of pwABI of any type, (2) synthesize how pwABI define and categorize participation, and (3) link the themes identified in the qualitative synthesis to the International Classification of Functioning, Disability, and Health (ICF) using standardized linking rules to enhance the comparability of our findings to other types of health information, including standardized outcome measures. Methods We completed a scoping review of qualitative literature. Our search included PubMed, APA PsychInfo, CINAHL, and Embase databases and included articles that (1) had qualitative methodology, (2) had a sample ≥50% pwABI, (3) had aims or research questions related to the meaning, definition, perception, or broader experience of participation, and (4) were in English. Qualitative findings were synthesized using Thomas and Harden's methodology and resultant themes were linked to ICF codes. Results The search identified 2,670 articles with 2,580 articles excluded during initial screening. The remaining 90 article abstracts were screened, and 6 articles met the full inclusion criteria for the qualitative synthesis. Four analytical themes emerged: (1) Essential Elements of Participation (2) How pwABI Approach Participation, (3) Where pwABI Participate, and (4) Outcomes of Participation. Each overarching theme included multiple descriptive themes. Conclusion In this paper, we identified themes that illustrate key components of participation to pwABI. Our results provide insight into the complex perspectives about participation among pwABI and illustrate aspects of participation that should hold elevated importance for clinicians and researchers supporting participation of pwABI.
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Affiliation(s)
- Caitlin Rajala
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Caitlin Rajala
| | - Camden Waterhouse
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily Evans
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Kimberly S. Erler
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, United States
| | - Michael J. Bergin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah M. Bannon
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mary D. Slavin
- Rehabilitation Outcomes Center, Spaulding Rehabilitation Hospital, Boston University School of Public Health, Boston, MA, United States
| | - Lewis E. Kazis
- Rehabilitation Outcomes Center, Spaulding Rehabilitation Hospital, Harvard Medical School and Boston University School of Public Health, Boston, MA, United States
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Deng H, Shepler LJ, Abouzeid C, Hamner JW, Mercier HW, Andrew Taylor J, Kazis LE, Slavin MD, Ryan CM, Schneider JC. 774 Digital Interventions for Social Participation in Adults with Long-term Physical Conditions: A Systematic Review. J Burn Care Res 2022. [PMCID: PMC8945598 DOI: 10.1093/jbcr/irac012.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Burn survivors experience significant social participation challenges in their recovery. However, enrolment and compliance with face-to-face interventions for such issues are often limited by time, location, and financial resources. Digital technologies are increasingly utilized in healthcare and provide a flexible, accessible, and low-cost treatment option. Given the sparse literature on this topic in the burn field, this review evaluated digital interventions for social participation in adults with long-term physical conditions to inform future use in the burn population.
Methods
MEDLINE, EMBASE, CINAHL and PsycINFO databases were searched using keywords and Medical Subject Headings (MeSH) terms related to ‘digital intervention’ and ‘social participation’ for studies published in English between January 2010 and May 2021. Studies that adopted digital technology interventions to improve social participation in adults with long-term physical conditions were included. Study quality was evaluated using Oxford Levels of Evidence. Data on study methodology, digital intervention and findings related to social participation were summarized.
Results
The search yielded a total of 4646 articles, of which 158 were full-text screened and 14 met inclusion and exclusion criteria. There were five randomized controlled trials, two non-randomized clinical trials and seven one-group pretest-posttest clinical trials. Twenty-five different measurement tools were utilized to assess social participation and two of them were used twice. Three types of digital interventions were implemented to improve social participation: group support, individual skill training or counselling, and education and support. The group support intervention developed a social network among affected people through videoconference, app, or virtual reality platform (3 of 4 studies with positive results). Individual skill training or counselling utilized phone calls or videoconference to help participants with activity participation and interpersonal relationships (2 of 6 studies with positive results). The education and support intervention used messages and website information to increase participants’ knowledge and provide support (3 of 3 studies with positive results).
Conclusions
This review presents evidence of different digital interventions’ effect on improving social participation in adults with long-term physical conditions. However, the existing literature is limited by the heterogeneity of outcome measures and varied methodology quality that preclude larger generalizations.
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Affiliation(s)
- Huan Deng
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Lauren J Shepler
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Callie Abouzeid
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Hannah W Mercier
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Lewis E Kazis
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Mary D Slavin
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Colleen M Ryan
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts; Stony Brook University, Stony Brook, New York; Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, Massachusetts; Boston Univ
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Kelter BM, Shepler LJ, Ni P, Slavin MD, Acton A, Kazis LE, Ryan CM, Schneider JC. Developing trajectories of social recovery after burn injury: Preliminary results from the LIBRE Journey Study. Burns 2022; 48:460-462. [PMID: 34924225 PMCID: PMC9275732 DOI: 10.1016/j.burns.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Brian M. Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
| | - Lauren J. Shepler
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, USA
| | - Mary D. Slavin
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, MI, USA
| | - Lewis E. Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Colleen M. Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Shriners Hospitals for Children - Boston®, Boston, MA, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Spaulding Research Institute, Boston, MA, USA
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10
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Kisala PA, Boulton AJ, Slavin MD, Cohen ML, Keeney T, Ni P, Tate D, Heinemann AW, Charlifue S, Fyffe DC, Felix ER, Jette AM, Tulsky DS. Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time. Arch Phys Med Rehabil 2022; 103:199-206. [PMID: 34717921 PMCID: PMC8810572 DOI: 10.1016/j.apmr.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish responsiveness of 3 Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI). DESIGN Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set. SETTING A total of 8 SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418). INTERVENTIONS In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures' responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness. MAIN OUTCOME MEASURES The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only). RESULTS In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65). CONCLUSIONS The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.
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Affiliation(s)
- Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Aaron J. Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Mary D. Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Matthew L. Cohen
- Dept. of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital,Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
| | - Pengsheng Ni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Denise Tate
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Denise C. Fyffe
- Kessler Foundation, West Orange, NJ and New Jersey Medical School, Newark, NJ
| | - Elizabeth R. Felix
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Alan M. Jette
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - David S. Tulsky
- Center for Health Assessment Research and Translation and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE
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11
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Kelter BM, Wolfe AE, Kazis LE, Ryan CM, Acton A, Slavin MD, Schneider JC. Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review. J Burn Care Res 2022; 43:1095-1104. [PMID: 34986488 PMCID: PMC9255662 DOI: 10.1093/jbcr/irab245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.
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Affiliation(s)
- Brian M Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey E Wolfe
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA,Department of Surgery, Shriners Hospitals for Children—Boston®, Massachusetts, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan, USA
| | | | - Jeffrey C Schneider
- Address correspondence to Jeffrey C. Schneider, MD, 300 1st Avenue, Boston, MA 02129, USA.
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12
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Grant GG, Brady KJS, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Patel KF, Sheldrick RC, Carter A, Sheridan RL, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the impact of burn injury on the parent-reported health outcomes of children 1-to-5 years: Item pool development for the Preschool 1-5 Life Impact Burn Recovery Evaluation (LIBRE) Profile. Burns 2021; 47:1511-1524. [PMID: 33832799 PMCID: PMC8711655 DOI: 10.1016/j.burns.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/23/2022]
Abstract
Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1-5 LIBRE Computer Adaptive Test (CAT) Profile.
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Affiliation(s)
- Gabrielle G Grant
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC, United States
| | - Keri J S Brady
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Frederick J Stoddard
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children - Galveston, Galveston, TX, United States
| | - Kathleen S Romanowski
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | | | - Lynda E Painting
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Laura A Fowler
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Judith K Nelson
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States
| | - Khushbu F Patel
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - R Christopher Sheldrick
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Alice Carter
- Department of Psychology, University of Massachusetts - Boston, Boston, MA, United States
| | - Robert L Sheridan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mary D Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Petra Warner
- Shriners Hospital for Children - Cincinnati, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Tina L Palmieri
- Shriners Hospital for Children - Northern California, Sacramento, CA, United States; University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States
| | - Jeffrey C Schneider
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States; Spaulding Research Institute, Boston, MA, United States
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Colleen M Ryan
- Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
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13
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Tulsky DS, Boulton AJ, Kisala PA, Heinemann AW, Charlifue S, Kalpakjian C, Kozlowski AJ, Felix ER, Fyffe DC, Slavin MD, Tate DG. Physical Function Recovery Trajectories following Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:215-223. [PMID: 34678295 DOI: 10.1016/j.apmr.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Explore trajectories of functional recovery that occur during the first two years after spinal cord injury (SCI). DESIGN Observational cohort study. SETTING Eight SCI Model System sites. PARTICIPANTS 479 adults with SCI completed four Spinal Cord Injury-Functional Index (SCI-FI) item banks within 4 months of injury and again at 2 weeks, 3, 6, 12, and 24 months following baseline assessment. INTERVENTION None. MAIN OUTCOME MEASURES SCI-FI Basic Mobility/Capacity (C), Fine Motor Function/C, Self-Care/C, and Wheelchair Mobility/Assistive Technology (AT) item banks. RESULTS Growth mixture modeling was used to identify groups with similar trajectory patterns. For the Basic Mobility/C and Wheelchair Mobility/AT domains, models specifying 2 trajectory groups were selected. For both domains, a majority class exhibited average functional levels and gradual improvement, primarily in the first six months. A smaller group of individuals made gradual improvements but had greater initial functional limitations. The Self Care/C domain exhibited a similar pattern; however, a third, small class emerged that exhibited substantial improvement in the first six months. Finally, for individuals with tetraplegia, trajectories of Fine Motor Function/C scores followed two patterns, with individuals reporting generally low initial scores and then making either modest or large improvements. In individual growth curve models, injury/demographic factors predicted initial functional levels but less so with regard to rates of recovery. CONCLUSIONS Trajectories of functional recovery followed a small number of change patterns, though variation around these patterns emerged. During the first two years after initial hospitalization, SCI-FI scores showed modest improvements; however, substantial improvements were noted for a small number of individuals with severe limitations in fine motor and self-care function. Future studies should further explore the personal, medical, and environmental characteristics that influence functional trajectories during these first two years and beyond.
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, DE.
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation
| | | | - Claire Kalpakjian
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI
| | - Allan J Kozlowski
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI; Michigan State University College of Human Medicine, Department of Epidemiology and Biostatistics, Grand Rapids, MI
| | - Elizabeth R Felix
- University of Miami Miller School of Medicine, Department of Physical Medicine & Rehabilitation, Miami, FL
| | - Denise C Fyffe
- Kessler Foundation, East Hanover, NJ; Rutgers-New Jersey Medical School, Newark, NJ
| | - Mary D Slavin
- Boston University School of Public Health, Boston, MA
| | - Denise G Tate
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI
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14
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Ni P, Spellman K, Zafonte R, Wen H, Slavin MD, Jette AM. A Concordance Table to Convert FIM Basic Mobility and Self-Care Scale Scores to SCI-FI/AT Scores. Arch Phys Med Rehabil 2021; 103:688-695. [PMID: 34343522 DOI: 10.1016/j.apmr.2021.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) scores from Functional Independence Measure (FIM) motor items. DESIGN Secondary data analysis SETTING: 14 Spinal Cord Injury Model Systems (SCIMS) programs PARTICIPANTS: Persons with traumatic spinal cord injury (SCI) discharged from inpatient rehabilitation at 14 SCIMS programs (N=1237) INTERVENTIONS: Not Applicable MAIN OUTCOME MEASURES: FIM motor items were matched to SCI-FI/AT domains and summary scores for each measure were developed. The Kernel-based method was employed to develop a concordance table to estimate SCI-FI/AT domain summary scores from content-matched FIM motor item summary scores. We conducted analyses to compare agreement between actual SCI-FI/AT summary scores (actual-SCI-FI/AT_S) and estimated SCI-FI/AT summary scores (est-SCI-FI/AT_S) for the total sample and for participants with different SCI injury categories. RESULTS Nine FIM items matched SCI-FI/AT Basic Mobility and Self-Care domain content. Pearson correlations for actual and est-SCI-FI/AT_S scores (0.79) were adequate for using concordance linking methods. Intraclass correlation coefficient values (0.79, 95% CI: 0.77∼0.81) indicated moderate reliability. T-tests revealed no significant differences between actual and est-SCI-FI/AT_S scores in the total sample. For almost 60% of the sample, actual and est-SCI-FI/AT_S score differences were less than a 5-point (half of a standard deviation). Greater differences between actual- and est-SCI-FI/AT_S scores were noted for persons with tetraplegia AIS A, B & C. CONCLUSION(S) Despite differences between the FIM and SCI-FI/AT assessments, we developed a concordance table to estimate self-care and basic mobility SCI-FI/AT scores from content-matched FIM motor item scores. This concordance table allows researchers to merge FIM data with SCI-FI/AT data to analyze SCI functional outcomes at the group level. However, due to greater differences between actual and estimated scores, the concordance table should be used with caution to interpret scores for those with cervical-level injuries (AIS A, B, C).
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Affiliation(s)
- Pengsheng Ni
- Biostatistics & Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Kelly Spellman
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital Brigham and Women's Hospital and Harvard Medical School
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.
| | - Alan M Jette
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA
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15
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Slavin MD, Ryan CM, Schneider JC, Acton A, Amaya F, Saret C, Ohrtman E, Wolfe A, Ni P, Kazis LE. Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers. J Burn Care Res 2021; 42:23-31. [PMID: 32556266 PMCID: PMC8265741 DOI: 10.1093/jbcr/iraa100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.
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Affiliation(s)
- Mary D. Slavin
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Colleen M. Ryan
- Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Shriners Hospitals for Children-Boston®
| | - Jeffrey C. Schneider
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Spaulding Research Institute, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan
| | - Flor Amaya
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Cayla Saret
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Emily Ohrtman
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Audrey Wolfe
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Pengsheng Ni
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
| | - Lewis E. Kazis
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, Massachusetts
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16
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Tyner CE, Kisala PA, Heinemann AW, Fyffe D, Tate DG, Slavin MD, Jette AM, Tulsky DS. Validation of the Spinal Cord Injury Functional Index for Use in Community-Dwelling Individuals With SCI. Arch Phys Med Rehabil 2021; 103:191-198. [PMID: 33453193 DOI: 10.1016/j.apmr.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Spinal Cord Injury Functional Index (SCI-FI) instruments in a community-dwelling sample. DESIGN Cross-sectional study. SETTING Community setting. PARTICIPANTS Individuals (N=269) recruited from 6 SCI Model Systems sites. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity. RESULTS Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms. CONCLUSION Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.
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Affiliation(s)
- Callie E Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Denise Fyffe
- Kessler Foundation, West Orange, NJ; New Jersey Medical School, Newark, NJ
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA; Massachusetts General Hospital, Institute of Health Professions, Boston, MA
| | - Alan M Jette
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA; Massachusetts General Hospital, Institute of Health Professions, Boston, MA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE; Department of Physical Therapy, University of Delaware, Newark, DE; Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
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17
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Calhoun Thielen C, Slavin MD, Ni P, Mulcahey MJ. Development and initial validation of ability levels to interpret pediatric spinal cord injury activity measure and pediatric measure of participation scores. J Pediatr Rehabil Med 2021; 14:463-476. [PMID: 34250956 DOI: 10.3233/prm-200774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop ability levels and descriptions to interpret Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM) and Pediatric Measure of Participation (PMoP) scores. METHODS Mixed-methods approach to 1.) create item maps using PEDI-SCI AM and PMoP calibration data; 2.) employ bookmarking methods and an iterative consensus process including semi-structured interviews, focus groups and surveys to establish PEDI-SCI AM and PMoP level score cut-points and descriptions; 3.) use calibration sample data to examine mean score differences across levels [analyses of variance (ANOVAs)] and assess the sample distribution (%) across levels; 4.) repeat in a separate validation sample; 5.) develop level descriptions. Throughout the mixed methods approach, the sample participants include children with spinal cord injury (SCI), parents of children with SCI, and professionals who work with children with SCI. RESULTS Four or five ability levels were identified for each PEDI-SCI AM and PMoP domain along with descriptions for each level. ANOVA results revealed significant overall differences for level mean scores and pairwise comparisons (p < 0.05). Consensus (>80%) was achieved for all PEDI-SCI AM and some PMoP level descriptions. CONCLUSION PEDI-SCI AM and PMoP score cut-points identify different levels of activity and participation among children with SCI. These levels and descriptions provide clinical relevance for PEDI-SCI and PMoP numeric scores.
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Affiliation(s)
- Christina Calhoun Thielen
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary D Slavin
- Health Outcomes Unit, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Pengsheng Ni
- Biostatistics & Epidemiology Data Analytic Center, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Ohrtman EA, Shapiro GD, Wolfe AE, Trinh NHT, Ni P, Acton A, Slavin MD, Ryan CM, Kazis LE, Schneider JC. Sexual activity and romantic relationships after burn injury: A Life Impact Burn Recovery Evaluation (LIBRE) study. Burns 2020; 46:1556-1564. [PMID: 32948357 DOI: 10.1016/j.burns.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Engaging in healthy sexual activity and romantic relationships are important but often neglected areas of post-burn rehabilitation. The degree to which persons with burn injuries engage in sexual activity and romantic relationships is not well understood. This study examined demographic and clinical characteristics predicting engagement in sexual activity and romantic relationships in a sample of adult burn survivors compared to a general United States sample. METHODS Data for the adult burn survivor sample were from 601 adult burn survivors who participated in field-testing for the calibration of the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a burn-specific instrument assessing social participation on six scales including sexual activity and romantic relationships. Comparison data were obtained from a general population sample of 2000 adults through sample matching. Demographic predictors of sexual activity and romantic relationship status were examined in each sample using modified Poisson regression analyses. Clinical predictors of engaging in sexual activity and romantic relationships were also examined in the LIBRE sample. RESULTS Participants were slightly more likely to report being sexually active in the adult burn survivor sample than in the general sample (65% vs. 57%, p < 0.01). There was not a significant difference in romantic relationship status between the two samples (64% vs. 62%, p = 0.31). In multivariable regression analyses, men in both samples were more likely to report being in a sexual relationship (RR in LIBRE sample = 1.23, 95% CI 1.08-1.39; RR in general sample = 1.10, 95% CI 1.02-1.18). Participants in both samples who were not working were less likely to report being sexually active or in a romantic relationship (RRs ranging from 0.73 to 0.83, p < 0.05 for all estimates). In the adult burn survivor sample, respondents with hand burns were more likely to report being sexually active and in a romantic relationship (RR = 1.16, 95% CI 1.01-1.33). Time since burn injury, burn size, and burns to other critical areas were not significantly associated with either outcome in adjusted analyses. CONCLUSIONS The likelihood of engaging in sexual activity and romantic relationships is similar among adult burn survivors and the comparison group representing a general United States sample of adults. Further research addressing sexual activity and romantic relationships after burn injuries will help to foster better patient-clinician dialogue, pinpoint barriers, design interventions, and allocate appropriate resources.
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Affiliation(s)
- Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Gabriel D Shapiro
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Audrey E Wolfe
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
| | - Nhi-Ha T Trinh
- Massachusetts General Hospital, Boston, MA, United States
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA, United States
| | - Amy Acton
- The Phoenix Society for Burn Survivors, Grand Rapids, MI, United States
| | - Mary D Slavin
- Boston University School of Public Health, Boston, MA, United States
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston, MA, United States; Shriners Hospital for Children - Boston, Harvard Medical School, Boston, MA, United States
| | - Lewis E Kazis
- Boston University School of Public Health, Boston, MA, United States
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States.
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19
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Kalpakjian CZ, Kreschmer JM, Slavin MD, Kisala PA, Quint EH, Chiaravalloti ND, Jenkins N, Bushnik T, Amtmann D, Tulsky DS, Madrid R, Parten R, Evitts M, Grawi CL. Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures. J Womens Health (Larchmt) 2020; 29:1427-1436. [PMID: 32429740 DOI: 10.1089/jwh.2019.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary D Slavin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Natalie Jenkins
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Tamara Bushnik
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Roxanne Madrid
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Evitts
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carolyn L Grawi
- Ann Arbor Center for Independent Living, Ann Arbor, Michigan, USA
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Ohrtman EA, Shapiro GD, Simko LC, Dore E, Slavin MD, Saret C, Amaya F, Lomelin-Gascon J, Ni P, Acton A, Marino M, Kazis LE, Ryan CM, Schneider JC. Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) Study. J Burn Care Res 2020; 39:1022-1028. [PMID: 30016442 DOI: 10.1093/jbcr/iry038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery. This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total BSA or burns to critical areas (hands, feet, face, or genitals) were eligible to participate. Multivariate linear regression analyses were used to determine predictors of the Social Activities and Social Interactions scale scores. A total of 599 people completed the Social Interactions and Social Activities scales. Of these, 77% identified as White Non-Hispanic, 55% were female, 55% were unmarried, and 80% had burns to critical areas. Participants had a mean age of 45 years, a mean time since burn injury of 15 years, and a mean burn size of 41% total BSA. Younger age (P < .01) and being married/living with a significant other (P ≤ .01) were associated with higher Social Activities and Social Interactions scale scores. Individual item responses reveal that survivors had lower scores on items related to participating in outdoor activities (30.4%) or feeling uncomfortable with their appearance (32.4% report dressing to avoid stares). Social interactions and activities are long-term challenges for burn survivors. It is important for clinicians to identify patients who may struggle with social recovery in order to focus on future community-based interventions.
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Affiliation(s)
- Emily A Ohrtman
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Laura C Simko
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Dore
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Mary D Slavin
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Cayla Saret
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Flor Amaya
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - J Lomelin-Gascon
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Pengsheng Ni
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan
| | - Molly Marino
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Lewis E Kazis
- Department of Health, Law, Policy and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Shriners Hospitals for Children, Harvard Medical School, Boston
| | - Jeffrey C Schneider
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
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Brady KJS, Grant GG, Stoddard FJ, Meyer WJ, Romanowski KS, Chang PH, Painting LE, Fowler LA, Nelson JK, Rivas P, Epperson K, Sheridan RL, Murphy M, O’Donnell EH, Ceranoglu TA, Sheldrick RC, Ni P, Slavin MD, Warner P, Palmieri TL, Schneider JC, Kazis LE, Ryan CM. Measuring the Impact of Burn Injury on the Parent-Reported Health Outcomes of Children 1 to 5 Years: A Conceptual Framework for Development of the Preschool Life Impact Burn Recovery Evaluation Profile CAT. J Burn Care Res 2019; 41:84-94. [DOI: 10.1093/jbcr/irz110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractDue to the rapid developmental growth in preschool-aged children, more precise measurement of the effects of burns on child health outcomes is needed. Expanding upon the Shriners Hospitals for Children/American Burn Association Burn Outcome Questionnaire 0 to 5 (BOQ0–5), we developed a conceptual framework describing domains important in assessing recovery from burn injury among preschool-aged children (1–5 years). We developed a working conceptual framework based on the BOQ0–5, the National Research Council and Institute of Medicine’s Model of Child Health, and the World Health Organization’s International Classification of Functioning, Disability, and Health for Children and Youth. We iteratively refined our framework based on a literature review, focus groups, interviews, and expert consensus meetings. Data were qualitatively analyzed using methods informed by grounded theory. We reviewed 95 pediatric assessments, conducted two clinician focus groups and six parent interviews, and consulted with 23 clinician experts. Three child health outcome domains emerged from our analysis: symptoms, functioning, and family. The symptoms domain describes parents’ perceptions of their child’s pain, skin-related discomfort, and fatigue. The functioning domain describes children’s physical functioning (gross and fine motor function), psychological functioning (internalizing, externalizing, and dysregulation behavior; trauma; toileting; resilience), communication and language development (receiving and producing meaning), and social functioning (connecting with family/peers, friendships, and play). The family domain describes family psychological and routine functioning outcomes.
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Affiliation(s)
- Keri J S Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
| | - Gabrielle G Grant
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
| | - Frederick J Stoddard
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Walter J Meyer
- Department of Psychiatry and Behavioral Sciences, The University of Texas Medical Branch, Galveston
- Shriners Hospitals for Children—Galveston, Texas
| | - Kathleen S Romanowski
- Shriners Hospital for Children—Northern California, Sacramento
- Department of Surgery, Division of Burn Surgery, University of California Davis School of Medicine, Sacramento
| | | | | | | | | | - Perla Rivas
- Shriners Hospitals for Children—Galveston, Texas
| | | | - Robert L Sheridan
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts
| | - Michael Murphy
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ellen H O’Donnell
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - T Atilla Ceranoglu
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - R Christopher Sheldrick
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Pengsheng Ni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Mary D Slavin
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Petra Warner
- Shriners Hospital for Children—Cincinnati, Ohio
- Department of Surgery, University of Cincinnati, Ohio
| | - Tina L Palmieri
- Shriners Hospital for Children—Northern California, Sacramento
- Department of Surgery, Division of Burn Surgery, University of California Davis School of Medicine, Sacramento
| | - Jeffrey C Schneider
- Shriners Hospitals for Children—Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Colleen M Ryan
- Shriners Hospitals for Children—Boston, Massachusetts
- Department of Surgery, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts
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22
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Kisala PA, Boulton AJ, Cohen ML, Slavin MD, Jette AM, Charlifue S, Hanks R, Mulcahey MJ, Cella D, Tulsky DS. Interviewer- versus self-administration of PROMIS® measures for adults with traumatic injury. Health Psychol 2019; 38:435-444. [PMID: 31045427 DOI: 10.1037/hea0000685] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess differential item functioning and observed mean differences across two modes of administration for PROMIS® measure scores in a sample of adults with traumatic injury. METHOD Items from 7 PROMIS® adult measures (v1.0 Physical Function, Fatigue, Pain Interference, Anger, Anxiety, and Depression and v2.0 Social Health-Emotional Support) were administered as fixed-length short forms in random order to a cross-sectional sample. Participants were randomly assigned to interviewer-administered (phone or in-person) or self-administered (via the Assessment Center website) conditions. The research was conducted at 5 medical rehabilitation institutions across the U.S. Participants included 277 adults with spinal cord injury (n = 148) or traumatic brain injury (n = 129). RESULTS DIF analyses indicated that all items were invariant to mode of administration. There was no significant effect of mode of administration for the majority of PROMIS® measures tested. Regarding observed scores, there were small but significant effects of mode of administration on the Emotional Support and Depression measures, with participants in the interview condition reporting better support/fewer symptoms. CONCLUSIONS PROMIS® instruments demonstrated measurement equivalence across interviewer-administered and self-administered conditions. These findings are particularly important for research or clinical applications where administration of PROMIS® measures by independent web- or tablet-based administration is not ideal, for example with individuals with physical or cognitive disabilities or with individuals who lack computer and/or Internet access. PROMIS® v1.0 Depression and PROMIS® v2.0 Emotional Support scores displayed a tendency toward social desirability that should be considered when these measures are interviewer-administered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Pamela A Kisala
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware
| | - Matthew L Cohen
- Department of Communication Sciences & Disorders, College of Health Sciences, University of Delaware
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Alan M Jette
- Massachusetts General Hospital Institute of Health Professions
| | | | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine
| | - M J Mulcahey
- Department of Occupational Therapy, College of Health Professions, Thomas Jefferson University
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - David S Tulsky
- Center for Health Assessment Research and Translation, Department of Physical Therapy, College of Health Sciences, University of Delaware
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23
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Mulcahey MJ, Slavin MD, Pengsheng N, Kratz A, Kisala PA, Tulsky DS, Jette AM. Examination of psychometric properties of PROMIS®: Pediatric upper limb measures in youth with cerebral palsy. Br J Occup Ther 2018. [DOI: 10.1177/0308022618757961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction This study examines the validity and distribution characteristics of the PROMIS® pediatric upper limb measures in a sample of young people with cerebral palsy. Method Data are a cross-sectional subset of a larger prospective study of the responsiveness to change of PROMIS® pediatric measures following surgery to improve functioning in young people with cerebral palsy. Ninety-three participants between the ages of eight and 21 years completed the PROMIS® pediatric mobility and upper limb computer adaptive tests and short forms in conjunction with a set of static “legacy” measures of physical functioning, including a parent-report of upper limb function. Results The PROMIS® Pediatric upper limb short form demonstrated acceptable internal consistency (Cronbach’s alpha = 0.85). PROMIS® pediatric upper limb computer adaptive tests and short form mean values (42.1(11) and 43(10.4), respectively) were nearly 1 SD below normal, which is appropriate when a generic measure is used in a sample of young persons with cerebral palsy. The PROMIS® pediatric upper limb computer adaptive tests had a higher frequency of ceiling effects (29.50%) compared to the short form (18.30%). Conclusion Results of this study suggest that the PROMIS® pediatric upper limb computer adaptive tests and the short form are valid indicators of upper limb function in young people with cerebral palsy. The item bank can be replenished to address ceiling effects.
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Affiliation(s)
- Mary Jane Mulcahey
- Professor of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, USA
| | - Mary D Slavin
- Research Scientist, Law, Policy and Management, Boston University School of Public Health, USA
| | - Ni Pengsheng
- Statistician, Law, Policy and Management, Boston University School of Public Health, USA
| | - Anna Kratz
- Assistant Professor, Institute for Health Care Policy and Innovation, University of Michigan, USA
| | - Pamela A Kisala
- Associate Scientist, Center on Assessment Research and Translation, University of Delaware, USA
| | - David S Tulsky
- Professor, Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, USA
| | - Alan M Jette
- Professor, Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
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Coster WJ, Ni P, Slavin MD, Kisala PA, Nandakumar R, Mulcahey MJ, Tulsky DS, Jette AM. Differential item functioning in the Patient Reported Outcomes Measurement Information System Pediatric Short Forms in a sample of children and adolescents with cerebral palsy. Dev Med Child Neurol 2016; 58:1132-1138. [PMID: 27098277 PMCID: PMC5052096 DOI: 10.1111/dmcn.13138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
AIM The present study examined the Patient Reported Outcomes Measurement Information System (PROMIS) Mobility, Fatigue, and Pain Interference Short Forms (SFs) in children and adolescents with cerebral palsy (CP) for the presence of differential item functioning (DIF) relative to the original calibration sample. METHOD Using the Graded Response Model we compared item parameter estimates generated from a sample of 303 children and adolescents with CP (175 males, 128 females; mean age 15y 5mo) to parameter estimates from the PROMIS calibration sample, which served as the reference group. DIF was assessed in a two-step process using the item response theory-likelihood ratio-differential item functioning detection procedure. RESULTS Significant DIF was identified for four of eight items in the PROMIS Mobility SF, for two of eight items in the Pain Interference Scale, and for one item out of 10 on the Fatigue Scale. Impact of DIF on total score estimation was notable for Mobility and Pain Interference, but not for Fatigue. INTERPRETATION Results suggest differences in the responses of adolescents with CP to some items on the PROMIS Mobility and Pain Interference SFs. Cognitive interviews about the PROMIS items with adolescents with varying degrees of mobility limitations would provide better understanding of how they are interpreting and selecting responses to the PROMIS items and thus help guide selection of the most appropriate way to address this issue.
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Affiliation(s)
- Wendy J Coster
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA.
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Mary D Slavin
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Pamela A Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Ratna Nandakumar
- College of Education and Human Development, University of Delaware, Newark, DE
| | - Mary Jane Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - David S Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE,Kessler Foundation Research Center, West Orange, NJ, USA
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
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Slavin MD, Ni P, Tulsky DS, Kisala PA, Heinemann AW, Charlifue S, Fyffe DC, Graves DE, Marino RJ, Morse LR, Rosenblum D, Tate D, Worobey LA, Dawson MB, Jette AM. Spinal Cord Injury–Functional Index/Assistive Technology Short Forms. Arch Phys Med Rehabil 2016; 97:1745-1752.e7. [DOI: 10.1016/j.apmr.2016.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 10/21/2022]
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Keeney T, Slavin MD, Ni P, Tulsky DS, Kisala PA, Heinemann AW, Charlifue S, Fyffe DC, Graves DE, Marino RJ, Morse LR, Rosenbaum D, Tate D, Worobey LA, Dawson MB, Jette AM. Spinal Cord Injury Functional Index: Ability to Detect Change. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mulcahey MJ, Haley SM, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery. J Pediatr Orthop 2016; 36:749-56. [PMID: 26057065 PMCID: PMC4670604 DOI: 10.1097/bpo.0000000000000533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide patient-reported outcome measures that are designed as being universally relevant across health conditions, low burden, and precise. A major problem for research and clinical practice in cerebral palsy (CP) is the void of outcomes instruments that are capable of evaluating the wide range of abilities and broad age spectrum inherent in this clinical population. Given the tremendous potential of PROMIS, the research questions for this study were "How do PROMIS pediatric computer adaptive tests and short forms detect change in children with CP following elective musculoskeletal surgery?" and "How do PROMIS instruments compare to the Pediatric Quality of Life Inventory Cerebral Palsy Module Version 3.0 (PedsQL CP), Pediatric Outcomes Data Collection Instrument (PODCI), the Timed Up and Go (TUG), and the Gross Motor Functional Measure (GMFM)." METHODS PROMIS Pediatric computer adaptive tests and short forms and the PedsQL, PODCI, TUG, and GMFM were administered before and after surgery. Effect size (ES) and standardized response mean (SRM) were calculated. Floor and ceiling effects were evaluated and, exposure rates for the PROMIS item banks were examined. RESULTS ES and SRM for all PROMIS Pediatric Measures were nonsignificant. PedsQL CP detected significant, positive change in mobility at 6 (ES=0.26; SRM=0.31) and 12 (ES=0.36; SRM=0.36) months; pain at 12 months (ES=0.29; SRM=0.34); and fatigue at 6 (ES=0.24; SRM=0.22) and 12 (ES=0.36; SRM=0.41) months. Significant negative changes were detected by the PODCI (ES=-0.20; SRM=-0.26), GMFM (ES=-0.13; SRM=-0.24), and TUG (ES=-0.29; SRM=-0.25). Ceiling effects were high. Exposure to an appropriate range of the PROMIS Mobility item bank was limited. CONCLUSIONS PROMIS measures were less able to detect change than other measures. PROMIS measures may be improved by tailoring start/stop rules or by adding items to include content appropriate for children with mobility impairments. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- MJ Mulcahey
- Department of Occupational Therapy, School of Health Professions, Thomas Jefferson University, Philadelphia, PA
| | - Stephen M. Haley
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
- Deceased
| | - Mary D. Slavin
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Pengsheng Ni
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - David S. Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
- Kessler Foundation Research Center, West Orange, NJ
| | - Alan M. Jette
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
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Slavin MD, Mulcahey MJ, Calhoun C, Ni P, Vogel LC, Haley SM, Jette AM. Measuring activity limitation outcomes in youth with spinal cord injury. Spinal Cord 2016; 54:546-52. [PMID: 26572606 PMCID: PMC4870166 DOI: 10.1038/sc.2015.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/02/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVES The Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM), which includes calibrated item banks (child and parent versions) for general mobility, daily routines, wheeled mobility and ambulation, can be administered using computerized adaptive tests (CATs) or short forms (SFs). The study objectives are as follows: (1) to examine the psychometric properties of the PEDI-SCI AM item banks and 10-item CATs; and (2) to develop and evaluate the psychometric properties of PEDI-SCI AM SFs. SETTING US Shriners Hospitals for Children (California, Illinois and Pennsylvania). METHODS Calibration data from a convenience sample of 381 children and adolescents with SCI and 322 parents or caregivers were used to examine PEDI-SCI AM item banks, 10-item CATs and SF scores. We calculated group reliability, internal consistency (Cronbach's alpha) and interclass coefficients (ICCs) to assess agreement between 10-item CATs, SFs and item banks. The percent of the sample with highest (ceiling) and lowest (floor) scores was also determined. An expert panel selected items for 14 SFs. RESULTS PEDI-SCI item banks, 10-item CATs and SFs demonstrate acceptable group reliability (0.73-0.96) and internal consistency (0.77-0.98). ICC values show strong agreement with item banks for 10-item CATs (0.72-0.99) and SFs. Floor effects are minimal (<15%). Ceiling effects are minimal for children with tetraplegia but high in children with paraplegia for general mobility (13.41-26.05%) and daily activities (12.99-32.71%). CONCLUSIONS The PEDI-SCI AM exhibited strong psychometric properties for children with tetraplegia. Replenishment of the general mobility and daily routine item banks is needed to reduce ceiling effects noted for youth with paraplegia.
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Affiliation(s)
- Mary D. Slavin
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of
Health Professions, Thomas Jefferson University, Philadelphia, PA
- Shriners Hospitals for Children, Philadelphia, PA
| | - Christina Calhoun
- Department of Occupational Therapy, Jefferson College of
Health Professions, Thomas Jefferson University, Philadelphia, PA
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
| | | | - Stephen M. Haley
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
| | - Alan M. Jette
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
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Mulcahey MJ, Slavin MD, Ni P, Vogel LC, Thielen CC, Coster WJ, Jette AM. The Pediatric Measure of Participation (PMoP) short forms. Spinal Cord 2016; 54:1183-1187. [DOI: 10.1038/sc.2016.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/14/2016] [Accepted: 03/30/2016] [Indexed: 11/09/2022]
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Mulcahey M, Slavin MD, Ni P, Vogel LC, Kozin SH, Haley SM, Jette AM. Computerized Adaptive Tests Detect Change Following Orthopaedic Surgery in Youth with Cerebral Palsy. J Bone Joint Surg Am 2015; 97:1482-94. [PMID: 26378264 PMCID: PMC6948780 DOI: 10.2106/jbjs.o.00179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Cerebral Palsy Computerized Adaptive Test (CP-CAT) is a parent-reported outcomes instrument for measuring lower and upper-extremity function, activity, and global health across impairment levels and a broad age range of children with cerebral palsy (CP). This study was performed to examine whether the Lower Extremity/Mobility (LE) CP-CAT detects change in mobility following orthopaedic surgery in children with CP. METHODS This multicenter, longitudinal study involved administration of the LE CP-CAT, the Pediatric Outcomes Data Collection Instrument (PODCI) Transfer/Mobility and Sports/Physical Functioning domains, and the Timed "Up & Go" test (TUG) before and after elective orthopaedic surgery in a convenience sample of 255 children, four to twenty years of age, who had CP and a Gross Motor Function Classification System (GMFCS) level of I, II, or III. Standardized response means (SRMs) and 95% confidence intervals (CIs) were calculated for all measures at six, twelve, and twenty-four months following surgery. RESULTS SRM estimates for the LE CP-CAT were significantly greater than the SRM estimates for the PODCI Transfer/Mobility domain at twelve months, the PODCI Sports/Physical Functioning domain at twelve months, and the TUG at twelve and twenty-four months. When the results for the children at GMFCS levels I, II, and III were grouped together, the improvements in function detected by the LE CP-CAT at twelve and twenty-four months were found to be greater than the changes detected by the PODCI Transfer/Mobility and Sports/Physical Functioning scales. The LE CP-CAT outperformed the PODCI scales for GMFCS levels I and III at both of these follow-up intervals; none of the scales performed well for patients with GMFCS level II. CONCLUSIONS The results of this study showed that the LE CP-CAT displayed superior sensitivity to change than the PODCI and TUG scales after musculoskeletal surgery in children with CP.
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Affiliation(s)
- M.J. Mulcahey
- Department of Occupational Therapy, School of Health Professions, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107. E-mail address:
| | - Mary D. Slavin
- Health and Disability Research Institute, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118
| | - Pengsheng Ni
- Health and Disability Research Institute, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118
| | - Lawrence C. Vogel
- Shriners Hospitals for Children, 2211 North Oak Park Avenue, Chicago, IL 60707
| | - Scott H. Kozin
- Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19438
| | | | - Alan M. Jette
- Health and Disability Research Institute, School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118
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Sinha R, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Functional Ability Level Development and Validation: Providing Clinical Meaning for Spinal Cord Injury Functional Index Scores. Arch Phys Med Rehabil 2015; 96:1448-57. [DOI: 10.1016/j.apmr.2014.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/25/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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Jette AM, Slavin MD, Ni P, Kisala PA, Tulsky DS, Heinemann AW, Charlifue S, Tate DG, Fyffe D, Morse L, Marino R, Smith I, Williams S. Development and initial evaluation of the SCI-FI/AT. J Spinal Cord Med 2015; 38:409-18. [PMID: 26010975 PMCID: PMC4445031 DOI: 10.1179/2045772315y.0000000003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe the domain structure and calibration of the Spinal Cord Injury Functional Index for samples using Assistive Technology (SCI-FI/AT) and report the initial psychometric properties of each domain. DESIGN Cross sectional survey followed by computerized adaptive test (CAT) simulations. SETTING Inpatient and community settings. PARTICIPANTS A sample of 460 adults with traumatic spinal cord injury (SCI) stratified by level of injury, completeness of injury, and time since injury. INTERVENTIONS None MAIN OUTCOME MEASURE SCI-FI/AT RESULTS: Confirmatory factor analysis (CFA) and Item response theory (IRT) analyses identified 4 unidimensional SCI-FI/AT domains: Basic Mobility (41 items) Self-care (71 items), Fine Motor Function (35 items), and Ambulation (29 items). High correlations of full item banks with 10-item simulated CATs indicated high accuracy of each CAT in estimating a person's function, and there was high measurement reliability for the simulated CAT scales compared with the full item bank. SCI-FI/AT item difficulties in the domains of Self-care, Fine Motor Function, and Ambulation were less difficult than the same items in the original SCI-FI item banks. CONCLUSION With the development of the SCI-FI/AT, clinicians and investigators have available multidimensional assessment scales that evaluate function for users of AT to complement the scales available in the original SCI-FI.
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Affiliation(s)
- Alan M. Jette
- New England Regional Spinal Cord Injury Center, Boston, MA, USA,Correspondence to: Alan M. Jette, Health and Disability Research Institute, Boston University School of Public Health, 715 Albany Street T5 W, Boston, MA 02118, USA. Reprints are available from David S. Tulsky at
| | - Mary D. Slavin
- New England Regional Spinal Cord Injury Center, Boston, MA, USA
| | - Pengsheng Ni
- New England Regional Spinal Cord Injury Center, Boston, MA, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | | | - Susie Charlifue
- The Rocky Mountain Regional Spinal Injury System, Englewood, CO, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | | | - Leslie Morse
- Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Ralph Marino
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ian Smith
- University of Pittsburgh Medical Centers, Pittsburgh, PA, USA
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Jette AM, Tulsky DS, Ni P, Kisala PA, Slavin MD, Dijkers MP, Heinemann AW, Tate DG, Whiteneck G, Charlifue S, Houlihan B, Williams S, Kirshblum S, Dyson-Hudson T, Zanca J, Fyffe D. Development and Initial Evaluation of the Spinal Cord Injury-Functional Index. Arch Phys Med Rehabil 2012; 93:1733-50. [DOI: 10.1016/j.apmr.2012.05.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/04/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
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Tulsky DS, Jette AM, Kisala PA, Kalpakjian C, Dijkers MP, Whiteneck G, Ni P, Kirshblum S, Charlifue S, Heinemann AW, Forchheimer M, Slavin MD, Houlihan B, Tate DG, Dyson-Hudson T, Fyffe DG, Williams S, Zanca J. Spinal cord injury-functional index: item banks to measure physical functioning in individuals with spinal cord injury. Arch Phys Med Rehabil 2012; 93:1722-32. [PMID: 22609299 PMCID: PMC3910090 DOI: 10.1016/j.apmr.2012.05.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/04/2012] [Accepted: 05/09/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To develop a comprehensive set of patient-reported items to assess multiple aspects of physical functioning relevant to the lives of people with spinal cord injury (SCI), and to evaluate the underlying structure of physical functioning. DESIGN Cross-sectional. SETTING Inpatient and community. PARTICIPANTS Item pools of physical functioning were developed, refined, and field tested in a large sample of individuals (N=855) with traumatic SCI stratified by diagnosis, severity, and time since injury. INTERVENTIONS None. MAIN OUTCOME MEASURE Spinal Cord Injury-Functional Index (SCI-FI) measurement system. RESULTS Confirmatory factor analysis (CFA) indicated that a 5-factor model, including basic mobility, ambulation, wheelchair mobility, self-care, and fine motor function, had the best model fit and was most closely aligned conceptually with feedback received from individuals with SCI and SCI clinicians. When just the items making up basic mobility were tested in CFA, the fit statistics indicated strong support for a unidimensional model. Similar results were demonstrated for each of the other 4 factors, indicating unidimensional models. CONCLUSIONS Though unidimensional or 2-factor (mobility and upper extremity) models of physical functioning make up outcomes measures in the general population, the underlying structure of physical function in SCI is more complex. A 5-factor solution allows for comprehensive assessment of key domain areas of physical functioning. These results informed the structure and development of the SCI-FI measurement system of physical functioning.
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Affiliation(s)
- David S Tulsky
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Haley SM, Ni P, Hambleton RK, Slavin MD, Jette AM. Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank. J Clin Epidemiol 2006; 59:1174-82. [PMID: 17027428 DOI: 10.1016/j.jclinepi.2006.02.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 02/21/2006] [Accepted: 02/27/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Measuring physical functioning (PF) within and across postacute settings is critical for monitoring outcomes of rehabilitation; however, most current instruments lack sufficient breadth and feasibility for widespread use. Computer adaptive testing (CAT), in which item selection is tailored to the individual patient, holds promise for reducing response burden, yet maintaining measurement precision. We calibrated a PF item bank via item response theory (IRT), administered items with a post hoc CAT design, and determined whether CAT would improve accuracy and precision of score estimates over random item selection. METHODS 1,041 adults were interviewed during postacute care rehabilitation episodes in either hospital or community settings. Responses for 124 PF items were calibrated using IRT methods to create a PF item bank. We examined the accuracy and precision of CAT-based scores compared to a random selection of items. RESULTS CAT-based scores had higher correlations with the IRT-criterion scores, especially with short tests, and resulted in narrower confidence intervals than scores based on a random selection of items; gains, as expected, were especially large for low and high performing adults. CONCLUSION The CAT design may have important precision and efficiency advantages for point-of-care functional assessment in rehabilitation practice settings.
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Affiliation(s)
- Stephen M Haley
- Department of Rehabilitation Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commanwealth Ave, Boston, MA 02215, USA.
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Jette DU, Latham NK, Smout RJ, Gassaway J, Slavin MD, Horn SD. Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Phys Ther 2005; 85:238-48. [PMID: 15733048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to describe physical therapy provided to patients with stroke in inpatient rehabilitation facilities. SUBJECTS AND METHODS Data were collected from 972 patients with stroke receiving physical therapy services at 6 rehabilitation facilities in the United States. Descriptive statistics were derived to describe physical therapy sessions, including proportion of therapy time spent in specific functional activities and proportion of those activities that included any of 59 interventions. RESULTS Mean length of stay was 18.7 days (SD=10.3), and patients received physical therapy, on average, 13.6 days (SD=7.8). Patients attended, on average, 1.5 (SD=0.3) physical therapy sessions per day, with each session lasting 38.1 minutes (SD=17.1). Gait and prefunctional activities were performed most frequently (31.3% and 19.7% of total treatment time, respectively). For gait activity, physical therapists used balance and postural awareness training in more than 50% of sessions and used strength training for more than 50% of sessions of prefunctional activities. Eighty-six percent of the patients received evaluation, and 84% of the patients and families received education. DISCUSSION AND CONCLUSION Therapists selected an eclectic approach to intervention rather than specific intervention techniques. The approach to patients' care included interventions to remediate impairments and to compensate for functional limitations. Therapists also reported frequently using motor control and motor learning approaches to facilitate all activities. This approach to care is largely consistent with existing stroke care guidelines and advances in the scientific theories of motor control and motor learning.
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Affiliation(s)
- Diane U Jette
- Physical Therapy Program, Simmons College, 300 The Fenway, Boston, MA 02115, USA.
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Dejong G, Horn SD, Gassaway JA, Slavin MD, Dijkers MP. Toward a taxonomy of rehabilitation interventions: using an inductive approach to examine the “black box” of rehabilitation. Arch Phys Med Rehabil 2004; 85:678-86. [PMID: 15083447 DOI: 10.1016/j.apmr.2003.06.033] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A barrier in outcomes and effectiveness research is the ability to characterize the interventions under review. This has been the case especially in rehabilitation in which interventions are commonly multidisciplinary, customized to the patient, and lack standardization in definition and measurement. This commentary describes how investigators and clinicians, working together, in a major multisite stroke rehabilitation outcome study were able to define and characterize diverse stroke rehabilitation interventions in a comprehensive, yet parsimonious, fashion and thus capture what actually transpires in a hospital-based stroke rehabilitation program. We consider the implications of the study's classification system for a more comprehensive taxonomy of rehabilitation interventions and the potential utility of such a taxonomy in operationalizing practice standards, medical record keeping, and rehabilitation research.
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Affiliation(s)
- Gerben Dejong
- Brooks Center for Rehabilitation Studies and Department of Health Services Administration, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
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Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine the level of muscle force associated with ability to walk in the community without assistance, in the community with assistance, or at home only in individuals with amyotrophic lateral sclerosis (ALS). SUBJECTS AND METHODS Percentage of predicted maximal muscle force (%PMF) of lower-extremity muscles was determined, and walking ability was categorized in 118 patients with ALS during periodic visits to the Neuromuscular Research Unit. Data were derived from consecutive visits in which subjects demonstrated declines in walking ability. Means for %PMF of each muscle group and a limb average were calculated at each consecutive visit. RESULTS The mean lower-extremity average %PMF was: (1) 54.01% (SD=12.76%) for subjects who walked independently in the community and 50.19% (SD=14.38%) during the next visit when these same subjects required assistance in the community (difference=3.82%, 95% confidence interval [CI]= 2.45-5.19);(2) 37.52% (SD=15.17%) during the last visit that subjects walked with assistance in the community and 32.18% (SD=13.83%) during the next visit when they walked only at home (difference=5.33%, 95% CI=3.61-7.06); and (3) 19.12% (SD=9.08%) during the visit when subjects were last able to ambulate at home versus 13.70% (SD=7.36%) when they became unable to walk (difference=5.42%, 95% CI=2.97-7.96). CONCLUSION AND DISCUSSION The findings suggest there are required levels of lower-extremity muscle force for various categories of walking ability. Variations in forces within and between categories of walking ability, however, indicate the complexity of this relationship.
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Affiliation(s)
- D U Jette
- Graduate Program in Physical Therapy, Graduate School for Health Studies, Simmons College, Boston, Mass 02115, USA.
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Slavin MD, Jette DU, Andres PL, Munsat TL. Lower extremity muscle force measures and functional ambulation in patients with amyotrophic lateral sclerosis. Arch Phys Med Rehabil 1998; 79:950-4. [PMID: 9710168 DOI: 10.1016/s0003-9993(98)90093-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the relation between lower extremity muscle force production and functional ambulation in patients with amyotrophic lateral sclerosis (ALS). DESIGN Retrospective analysis of data collected from 1979 to 1995. PATIENTS Two hundred forty ALS patients referred to the New England Medical Center Neuromuscular Research Unit. MAIN OUTCOME MEASURES Muscle force production during a maximum, voluntary isometric contraction of ankle dorsiflexors, knee flexors, knee extensors, hip flexors, and hip extensors was calculated as percent predicted maximal force (PPMF). Functional ambulation status was classified as unable, home, or community. RESULTS The probability of community ambulation compared with home increased with progressively higher PPMF for all muscle groups. Subjects with knee flexion strength greater than 75% PPMF were 395 times more likely to ambulate in the community. Subjects with hip extension strength over 50% PPMF showed improved chance of ambulation at home. CONCLUSION Lower extremity PPMF is a critical factor determining functional ambulation in patients with ALS. Knee flexors play an important role in community ambulation while the hip extensors are important for home ambulation.
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Affiliation(s)
- M D Slavin
- Graduate School for Health Studies, Graduate Program in Physical Therapy, Simmons College, Boston, MA 02115-5898, USA
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Slavin MD, Held JM, Basso DM, Lesensky S, Curran E, Gentile AM, Stein DG. Fetal brain tissue transplants and recovery of locomotion following damage to sensorimotor cortex in rats. Prog Brain Res 1988; 78:33-8. [PMID: 3247434 DOI: 10.1016/s0079-6123(08)60263-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Adult rats with bilateral lesions of the caudate nucleus were treated with GM1 ganglioside. Although animals injected with a control solution were severely impaired in their ability to learn a complex spatial task, those treated with ganglioside were able to learn spatial reversals.
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