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Pommerich UM, Stubbs PW, Eggertsen PP, Fabricius J, Nielsen JF. Regression-based prognostic models for functional independence after postacute brain injury rehabilitation are not transportable: a systematic review. J Clin Epidemiol 2023; 156:53-65. [PMID: 36764467 DOI: 10.1016/j.jclinepi.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES To identify and summarize validated multivariable prognostic models for the Functional Independence Measure® (FIM®) at discharge from post-acute inpatient rehabilitation in adults with acquired brain injury (ABI). METHODS This review was conducted based on the recommendations of the Cochrane Prognosis Methods Group and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were systematically searched in May 2021 and updated in April 2022. Main inclusion criteria were: a) adult patients with ABI, b) validated multivariable prognostic model, c) time of prognostication within 1-week of admission to post-acute rehabilitation, and d) outcome was the FIM® at discharge from post-acute rehabilitation. RESULTS The search yielded 3,169 unique articles. Three articles fulfilled the inclusion criteria, accounting for n = 6 internally and n = 2 externally validated prognostic models. Discrimination was estimated as an area under the curve between 0.76 and 0.89. Calibration was deemed to be assessed insufficiently. The included models were judged to be of high risk of bias. CONCLUSION Current prognostic models for the FIM® in post-acute rehabilitation for patients with ABI lack the methodological rigor to support clinical use outside the development setting. Future studies addressing functional independence should ensure appropriate model validation and conform to uniform reporting standards for prognosis research.
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Affiliation(s)
- Uwe M Pommerich
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Ultimo 2007, Australia
| | - Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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2
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Fabricius J, Huynh MNM, Pedersen AR, Sampedro Pilegaard M. Predicting length of stay with assessment of motor and process skills in subjects with acquired brain injury. Brain Inj 2023; 37:1-6. [PMID: 36597272 DOI: 10.1080/02699052.2022.2163291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/30/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM. METHODS A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM. RESULTS Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor. CONCLUSIONS The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS.
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Affiliation(s)
- Jesper Fabricius
- Department of Research, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Martin Nhut Minh Huynh
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Asger Roer Pedersen
- Department of Research, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Marc Sampedro Pilegaard
- Department of Social Medicine and Rehabilitation, Gødstrup Hospital, Denmark
- DEFACTUM, Central Region Denmark, Aarhus, Denmark
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3
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Cohen N, Manor Y, Green Y, Tahel G, Badichi I, Ben-Or G, Shtainshlaifer N, Shiffer A, Gabso-Rajuan M, Kurtzman H, Shtraifler L, Furst T, Shtein S, Shulman J, Hyute A, Levin I, Inbar N, Ariela H, Peled R, Gheriani N, Ezra A, Messer S, Geva N, Giladi N, Gurevich T. Multidisciplinary intensive outpatient rehabilitation program for patients with moderate-to-advanced Parkinson's disease. NeuroRehabilitation 2021; 49:47-55. [PMID: 33998554 DOI: 10.3233/nre-210031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intensive, multi-disciplinary, rehabilitation programs for patients with Parkinson's disease (PWPs) have shown to be effective. However, most programs are based on in-patient service, which is expensive. OBJECTIVE To demonstrate the feasibility of a multidisciplinary, intensive, outpatient rehabilitation program (MIOR) for moderate to advanced Parkinson's Disease (H&Y≥2). METHOD The MIOR program takes place at a community rehabilitation center ('Ezra Le'Marpe'), 3 times a week, 5 hours, 8 weeks, and includes 20 PWPs in each cycle. The multi-disciplinary team includes physical, occupational, speech and hydro therapists. Additional activities include, social work groups, boxing, dancing and bridge. RESULTS Data was collected retroactively for the first two years. Data analysis includes 158 patient files who completed the program (mean disease duration 10.1±6 and mean H&Y stage 2.8±0.67). Assessments were performed at the beginning and end of the intervention. Positive results were collected: improvement in number of falls (p < 0.0001), Functional Independence Measure (p < 0.0001), quality of life (p < 0.01), balance (p < 0.0001), upper limb function (p < 0.0001) and paragraph reading vocal intensity (p < 0.01). CONCLUSIONS MIOR is a feasible program, showing positive results in moderate to advanced PWP's, improving quality of life, daily function, and motor performance. The current outcomes demonstrate feasibility of MIOR in addition to medical treatment.
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Affiliation(s)
- Noa Cohen
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Yael Manor
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Ono Academic College, Kiryat Ono, Israel
| | - Yitzhak Green
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Gail Tahel
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Inbal Badichi
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Galit Ben-Or
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | | | - Asaf Shiffer
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | | | - Hadar Kurtzman
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Liat Shtraifler
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Tova Furst
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Shlomi Shtein
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Juli Shulman
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Anat Hyute
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Issachar Levin
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel
| | - Noit Inbar
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Hilel Ariela
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Roni Peled
- Ezra Lemarpe Rehabilitation Center, Bnei-Brak, Tel-Aviv, Israel.,Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Nurit Gheriani
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Adi Ezra
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Stav Messer
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Noya Geva
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Nir Giladi
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Neurological Institute, Tel-Aviv Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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4
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Tarvonen-Schröder S, Niemi T, Hurme S, Koivisto M. Fall assessment in subacute inpatient stroke rehabilitation using clinical characteristics and the most preferred stroke severity and outcome measures. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1960600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sinikka Tarvonen-Schröder
- Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Tuuli Niemi
- Department of Expert Services, Turku University Hospital, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
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5
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Gartz R, Dickerson A, Radloff JC. Comparing Component-Based and Occupation-Based Interventions of a Person with Visual Deficits' Performance. Occup Ther Health Care 2020; 35:40-56. [PMID: 33347359 DOI: 10.1080/07380577.2020.1862443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.
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Affiliation(s)
- Rachel Gartz
- Rehabilitation - SCI/GR, Vidant Medical Center, Greenville, NC, USA
| | - Anne Dickerson
- Occupational Therapy, East Carolina University, Greenville, NC, USA
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Yazgan YZ, Tarakcı E, Gungor F, Kurtuncu M. Understanding the impact of cognitive impairment and disease severity on activities of daily living in MS patients with different disability levels. Clin Neurol Neurosurg 2020; 200:106398. [PMID: 33310534 DOI: 10.1016/j.clineuro.2020.106398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Physical impairments seen in people with multiple sclerosis (PwMS) affect the level of independence in activities of daily living (ADL). However, physical problems are insufficient to explain some debilitating conditions experienced by PwMS in daily life, especially in activities that require high cognitive ability. The aim of this study was to investigate the impact of cognitive impairment and disease severity on ADL in MS patients with different disability levels. METHODS Seventy PwMS were enrolled and divided into three groups according to their disability status. Cognitive functions were assessed with the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and independence level in ADL was assessed with Functional Independence Measure (FIM). RESULTS There were significant differences between groups in FIM and FIM motor (FIMm) scores (p < 0.001), however no significant differences were found between groups in terms of FIM cognitive (FIMc) and LOTCA scores (p = 0.195 and p = 0.348 respectively). There was a moderate positive correlation between FIM and LOTCA total scores (p < 0.001) for overall sample. While there was a low correlation between LOTCA and FIMm (p = 0.008), high correlation was found between LOTCA and FIMc (p < 0.001). CONCLUSION Although most of the limitations in ADL can be explained by the severity of the disability in MS, the ability to perform ADL including cognitive skills was found to be similar for all disability levels. Cognitive problems should be taken into consideration as well as motor problems in the process of planning treatment programs for PwMS with any levels of disability.
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Affiliation(s)
- Yonca Zenginler Yazgan
- Istanbul University-Cerrahpasa, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Ela Tarakcı
- Istanbul University-Cerrahpasa, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Feray Gungor
- Istanbul University-Cerrahpasa, Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Murat Kurtuncu
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
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Liu Z, Zhou X, Zhang W, Zhou L. Resilience and its correlates among first ischemic stroke survivors at acute stage of hospitalization from a tertiary hospital in China:a cross-sectional study. Aging Ment Health 2020; 24:828-836. [PMID: 30596461 DOI: 10.1080/13607863.2018.1550630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: To measure the resilience of elderly patients with first ischemic stroke in mainland China and to identify variables that may be correlated with resilience at the acute stage of hospitalization.Methods: A cross-sectional survey was carried out in departments of neurology of two tertiary hospitals, where a convenience sample of one hundred and forty-seven elderly patients with first ischemic stroke voluntarily participated in our study. Resilience was assessed using the Chinese version of Connor-Davidson Resilience Scale with three dimensions (tenacity, strength, and optimism). The General Self-Efficacy Scale and Medical Coping Modes Questionnaire were applied to evaluate the respondents' general self-efficacy and coping style. Functional independency was also measured using the Functional Independency Measure.Results: The mean score of the 147 respondents' resilience was 62.51 ± 14.69. Together, general self-efficacy, resignation, confrontation, per capital monthly income, and being main source of family income explained 68.1% of the variance in resilience. General self-efficacy, resignation, and confrontation were the strongest explanatory factors. Specifically, 63.4% of the variance in tenacity was explained for general self-efficacy, resignation, being main source of family income, surgical history, and per capital monthly income. 63.2% of the variance in strength was ascribed to general self-efficacy, resignation, per capital monthly income and avoidance. 32.5% of the variance in optimism was attributed to general self-efficacy, religion, and resignation.Conclusion: General self-efficacy and coping style may be implied orientation in enhancing resilience of elderly patients with first ischemic stroke at acute hospitalization. Moreover, economic status may predict level of resilience.HighlightsResilience was measured in 147 older first-episode ischemic stroke survivors at acute hospitalization.General-efficacy was the strongest predictor of resilience.Resilience was significantly influenced by resignation.Coping strategy should be emphasized early after stroke.
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Affiliation(s)
- Zhihui Liu
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
| | - Xuan Zhou
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Clinical Nursing Department, School of Nursing, Second Military Medical University, Shanghai, China
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8
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Ransby TB, Hansen AØ, Rolving N. Psychometric properties of the Assessment of Motor and Process Skills in patients undergoing rehabilitation following hand-related disorders. HAND THERAPY 2020. [DOI: 10.1177/1758998320912761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Assessment of Motor and Process Skills (AMPS) has been proven to be a suitable measurement tool for assessing performance-based ADL ability; however, its reliability and validity have not been tested on patients with hand-related disorders. Methods Patients referred for outpatient hand rehabilitation were assessed with AMPS, The Canadian Occupational Performance Measure (COPM), dynamometer and goniometer at baseline and after eight weeks of hand therapy. Construct validity and responsiveness of AMPS were assessed by hypothesis testing. Construct validity was assessed by correlating the baseline score of AMPS with the baseline score of the other measurement tools. Responsiveness was assessed by correlating the change scores of each measurement tool with a Global Rating Scale. Results Fifty-one patients were recruited. The construct validity of AMPS indicated that the various measurement tools captured different aspects to functioning from the AMPS, as the correlations between AMPS and the other measurement tools were generally weak to low (r < 0.25 to 0.49). AMPS was less responsive than COPM when correlated with the GRS. The correlation between COPM and GRS was r = 0.62 compared with the AMPS motor, r = 0.45 and AMPS process, r = 0.33. Relative responsiveness of AMPS is similar to that of the dynamometer (r = 0.39) and goniometer (r = –0.34). Discussion In a sample of 51 patients, this study found that the construct validity of AMPS seemed to be moderate, while the responsiveness of AMPS seemed to be poor. However, due to the small sample size no conclusions can be made, and should be further assessed in larger studies.
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Affiliation(s)
- Thea Birch Ransby
- Department of Physical and Occupational Therapy, Diagnostic Center Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Alice Ørts Hansen
- Department of Rehabilitation, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nanna Rolving
- Department of Physical and Occupational Therapy, Diagnostic Center Silkeborg Regional Hospital, Silkeborg, Denmark
- DEFACTUM, Central Denmark region, Aarhus, Denmark
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9
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Saltan A, Baltaci G, Ankarali H. Does Kinesio® taping improve balance and functional performance in older adults? A pilot study. J Sports Med Phys Fitness 2019; 59:1346-1352. [DOI: 10.23736/s0022-4707.18.09207-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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High KP, Zieman S, Gurwitz J, Hill C, Lai J, Robinson T, Schonberg M, Whitson H. Use of Functional Assessment to Define Therapeutic Goals and Treatment. J Am Geriatr Soc 2019; 67:1782-1790. [PMID: 31081938 DOI: 10.1111/jgs.15975] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/10/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
This article summarizes the presentations and discussions from a workshop, "Using Functional Assessment to Define Therapeutic Goals and Treatment," which took place on November 30 to December 1, 2017. This workshop brought together transdisciplinary leaders in the fields of function and disability and clinical investigators engaged in research on geriatric populations to outline opportunities and challenges for incorporating measures of function in clinical research. Topics addressed included reliable and clinically feasible measures of function and key domains of health (eg, musculoskeletal, cognitive, and sensory) that are most strongly associated with patients' perceptions of well-being, independence, and quality of life across a wide array of diseases and interventions. The workshop also focused on the importance of function in medical decision making to inform communications between specialty physicians and patients about prognosis and goals of care. Workshop participants called for more research on the role of function as a predictor of an intervention's effectiveness and an important treatment outcome. Such research would be facilitated by development of a core set of simple, short, functional measures that can be used by all specialties in the clinical setting to allow "big data" analytics and a pragmatic research. J Am Geriatr Soc 67:1782-1790, 2019.
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Affiliation(s)
- Kevin P High
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Jerry Gurwitz
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Carl Hill
- National Institute on Aging, Bethesda, Maryland
| | - Jennifer Lai
- University of California, San Francisco, San Francisco, California
| | - Thomas Robinson
- Denver VA Medical Center, Veterans Affairs, Denver, Colorado
| | - Mara Schonberg
- Beth Israel Deaconess Medical Center, Brookline, Massachusetts
| | - Heather Whitson
- Duke University School of Medicine and Durham VA Geriatrics Research, Education, and Clinical Center, Durham, North Carolina
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11
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Snowdon DA, Leggat SG, Harding KE, Boyd J, Scroggie G, Taylor NF. The association between effectiveness of clinical supervision of allied health professionals and improvement in patient function in an inpatient rehabilitation setting. Disabil Rehabil 2019; 42:1173-1182. [PMID: 30668167 DOI: 10.1080/09638288.2018.1518493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effective clinical supervision of allied health professionals improves patients' outcomes. This study investigated whether effective clinical supervision of allied health professionals is associated with improved patient functional independence. Methods: A prospective longitudinal study design and multi-level regression analysis were used to explore the association between effective clinical supervision and patient functional independence. The effectiveness of clinical supervision was assessed using the Manchester Clinical Supervision Scale. Functional improvement in patients treated by allied health professionals was measured utilising the mobility and self-care subscales of the functional independence measure.Results: Physiotherapists (n = 27) and occupational therapists (n = 26) in inpatient rehabilitation were recruited and the medical records of their patients (n = 1846) audited. The effectiveness of clinical supervision of physiotherapists was positively associated with improvement in personal care. Therapist variables accounted for less than 2.5% of the variation in patient improvement in functional independence.Conclusions: Effectiveness of a reflective model of clinical supervision of physiotherapists and occupational therapists was not associated with an improvement in their patients' mobility or personal care, respectively.Implications for rehabilitationEffective clinical supervision of physiotherapists and occupational therapists using a reflective model of practice is a poor predictor of improved functional independence in rehabilitation inpatients.Patient variables, such as the intensity of therapy, were more important predictors of patient functional improvement than effective clinical supervision.Initiatives aimed at increasing intensity of therapy will likely have a greater effect on improving patient functional independence compared with initiatives aimed at improving the effectiveness of clinical supervision using a reflective model of practice.Initiatives to improve the effectiveness of clinical supervision in improving quality of care could explore the use of a direct model of practice where supervisors directly observe and support supervisees during patient treatment sessions.
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Affiliation(s)
- David A Snowdon
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Sandra G Leggat
- School of Public Health, La Trobe University, Melbourne, Australia
| | - Katherine E Harding
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Jude Boyd
- Allied Health Department, Eastern Health, Box Hill, Australia
| | - Grant Scroggie
- Allied Health Department, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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12
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Gao F, Foster M, Newcombe P, Geraghty T. Applying bifactor modelling to improve the clinical interpretive values of Functional Independence Measure in adults with acquired brain injury. Disabil Rehabil 2018; 42:1753-1761. [PMID: 30499346 DOI: 10.1080/09638288.2018.1531153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To apply a modern robust approach, bifactor modeling, to critically examine psychometric properties of Functional Independence Measure (FIM) in adults with acquired brain injury and to propose a solution to improve the clinical interpretive values of the FIM to inform policy and clinical practice.Methods: The data came from a state-wide specialist in-patient brain injury rehabilitation service in Queensland, Australia for adults with acquired brain injury and discharged between 2012 and 2017. The sample included 457 people. Three measurement models (unidimensional, correlated first-order and bifactor) for FIM were tested using confirmatory factor analysis with structural equation modeling. Then, model-based reliability and incremental validity were assessed.Results: The bifactor model best fit the data. When operationalized as latent factors under structural equation modeling framework, general care burden had a large predictive effect, while Motor and Cognitive showed medium and small predictive effects respectively on rehabilitation length of stay.Conclusions: The total score of FIM was a reliable measure of general care burden, while the subscale scores were not. A solution is to apply a bifactor modeling approach based on structural equation modeling to disentangle the unique variance attributable to Motor and Cognitive factors. In the structural equation modeling framework, the FIM demonstrated good incremental validity to inform policy and clinical practice.Implications for rehabilitationClinicians and researchers can confidently use FIM total score in adults with acquired brain injury.The current study proposed an alternative solution to the poor reliability of Motor and Cognitive scores, that is, by applying a bifactor modeling approach, the unique contributions of the Motor and Cognitive factors can be examined.The current study has demonstrated the strengths of bifactor modeling in the robust validation and interpretation of FIM to better inform clinical practice and policy decision-making.The current study has the potential to make an important contribution to enhance more equitable decision-making in the areas of national benchmarking of rehabilitation outcomes and other program eligibility criteria and funding allocation.
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Affiliation(s)
- Fengsong Gao
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Peter Newcombe
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia
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13
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Pilegaard MS, la Cour K, Gregersen Oestergaard L, Johnsen AT, Lindahl-Jacobsen L, Højris I, Brandt Å. The 'Cancer Home-Life Intervention': A randomised controlled trial evaluating the efficacy of an occupational therapy-based intervention in people with advanced cancer. Palliat Med 2018; 32:744-756. [PMID: 29299957 PMCID: PMC5881790 DOI: 10.1177/0269216317747199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with advanced cancer face difficulties with their everyday activities at home that may reduce their health-related quality of life. To address these difficulties, we developed the 'Cancer Home-Life Intervention'. AIM To evaluate the efficacy of the 'Cancer Home Life-Intervention' compared with usual care with regard to patients' performance of, and participation in, everyday activities, and their health-related quality of life. DESIGN AND INTERVENTION A randomised controlled trial ( ClinicalTrials.gov NCT02356627). The 'Cancer Home-Life Intervention' is a brief, tailored, occupational therapy-based and adaptive programme for people with advanced cancer targeting the performance of their prioritised everyday activities. SETTING/PARTICIPANTS Home-living adults diagnosed with advanced cancer experiencing functional limitations were recruited from two Danish hospitals. They were assessed at baseline, and at 6 and 12 weeks of follow-up. The primary outcome was activities of daily living motor ability. Secondary outcomes were activities of daily living process ability, difficulty performing prioritised everyday activities, participation restrictions and health-related quality of life. RESULTS A total of 242 participants were randomised either to the intervention group ( n = 121) or the control group ( n = 121). No effect was found on the primary outcome (between-group mean change: -0.04 logits (95% confidence interval: -0.23 to 0.15); p = 0.69). Nor was any effect on the secondary outcomes observed. CONCLUSION In most cases, the 'Cancer Home-Life Intervention' was delivered through only one home visit and one follow-up telephone contact, which not was effective in maintaining or improving participants' everyday activities and health-related quality of life. Future research should pay even more attention to intervention development and feasibility testing.
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Affiliation(s)
- Marc Sampedro Pilegaard
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Karen la Cour
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Lisa Gregersen Oestergaard
- 3 Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,4 Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Thit Johnsen
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark.,6 Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Inger Højris
- 8 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Brandt
- 1 The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.,2 OPEN - Odense Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,9 Centre for Disability and Mental Vulnerability, The National Board of Social Services, Odense, Denmark
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