1
|
Pellicciari L, Lucca LF, DE Tanti A, Formisano R, Estraneo A, Cava FC, Saviola D, LA Porta F. The structure of the Early Rehabilitation Barthel Index (ERBI) should be modified: evidence from a Rasch analysis study. Eur J Phys Rehabil Med 2023; 59:458-473. [PMID: 37534887 PMCID: PMC10595071 DOI: 10.23736/s1973-9087.23.07908-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/16/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The Early Rehabilitation Barthel Index (ERBI) comprises seven items of the Early Rehabilitation Index and ten items of the Barthel Index. The ERBI is usually used to measure functional changes in patients with severe acquired brain injury (sABI), but its measurement properties have yet to be extensively assessed. AIM To study the unidimensionality and internal construct validity (ICV) of the ERBI through Confirmatory Factor Analysis (CFA), Mokken Analysis (MA), and Rasch Analysis (RA). DESIGN Multicenter prospective study. SETTING Inpatients from five intensive rehabilitation centers. POPULATION Two hundred and forty-seven subjects with sABI. METHODS ERBI was administered on admission and discharge to study its unidimensionality through CFA and MA and its ICV, reliability, and targeting through RA. RESULTS The preliminary analyses showed a lack of unidimensionality (RMSEA=0.460 >0.06; SRMR=0.176 >0.06; CFI=1.000 >0.950; TLI=1.000 >0.950). According to CFA, "Confusional state" and "Behavioral disturbance" items showed low factor loadings (<0.40), whereas these two items composed a separate scale within the MA. Furthermore, the baseline RA showed that three items misfitted ("Mechanical ventilation," "Confusional state," "Behavioral disturbances") and a lack of conformity of several ICV requirements. After deletion of three misfitting items and further non-structural modifications (i.e., testlets creation to absorb local dependence between items and item misfit), the solution obtained showed adequate ICV, adequate reliability for measurements at the individual level (PSI>0.85), although with a frank floor effect. This final solution was successfully replicated in a total sample of the subjects. After post-hoc modifications of the score structure of two out of three misfitting items, the subsequent CFA (RMSEA=0.044 <0.06; SRMR=0.056 <0.06; CFI=1.000 >0.950 TLI=1.000 >0.950) and MA showed the resolution of the unidimensional issues. CONCLUSIONS Although the ERBI is a potentially valuable tool for measuring functioning in the coma-to-community continuum, our analyses suggested its lack of ICV, partly due to an incorrect scoring design of some items. A new perspective multicenter study is proposed to validate a modified version of the ERBI that overcomes the problems highlighted in this analysis. CLINICAL REHABILITATION IMPACT Our results do not support the use of the original structure of the ERBI in clinical practice and research, as a lack of ICV was highlighted.
Collapse
Affiliation(s)
| | | | | | | | | | - Francesca C Cava
- Montecatone Rehabilitation Institute, Montecatone, Bologna, Italy
| | | | - Fabio LA Porta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy -
| |
Collapse
|
2
|
Reis NFD, Biscaro RRM, Figueiredo FCXS, Lunardelli ECB, Silva RMD. Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. Rev Bras Ter Intensiva 2021; 33:353-361. [PMID: 35107546 PMCID: PMC8555403 DOI: 10.5935/0103-507x.20210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Traduzir, adaptar transculturalmente para o português do Brasil o
instrumento Early Rehabilitation Index e validar para uso
na unidade de terapia intensiva o instrumento Early Rehabilitation
Barthel Index, para avaliação do estado
funcional. Métodos Foram executadas as seguintes etapas: preparação,
tradução, reconciliação, tradução
reversa, revisão, harmonização, pré-teste e
avaliação psicométrica. Após esse processo
inicial, a versão em português foi aplicada por dois
avaliadores em pacientes que permaneciam pelo menos 48 horas internados na
unidade de terapia intensiva. Verificou-se a confiabilidade da escala por
meio da consistência interna, da confiabilidade entre avaliadores e
do efeito piso e teto. Para a validade de constructo, correlacionou-se o
Early Rehabilitation Barthel Index com instrumentos que
usualmente são utilizados para avaliação do estado
funcional na unidade de terapia intensiva. Resultados Participaram 122 pacientes com mediana de idade de 56 [46,8 - 66] anos. O
Early Rehabilitation Barthel Index teve confiabilidade
adequada com coeficiente alfa de Cronbach de 0,65. A confiabilidade entre
avaliadores foi excelente, com coeficiente de correlação
intraclasse de 0,94 (IC95% 0,92 - 0,96) e moderado a excelente com
índice de concordância de kappa de 0,54 a 1,0. Os efeitos piso
e teto foram mínimos. Observou-se a validade do Early
Rehabilitation Barthel Index por meio das
correlações com o escore total do Perme Escore (rô =
0,72), da Escala de Estado Funcional em UTI (rô = 0,77), do
Physical Function in Intensive Care Test-score
(rô = 0,69), do Medical Research Council sum score
(rô = 0,58), além das dinamometrias de preensão palmar
(rô = 0,58) e manual de coxa (rô = 0,55), todos com p <
0,001. Conclusão A versão adaptada do Early Rehabilitation Index para
o português brasileiro e na sua totalidade, Early
Rehabilitation Barthel Index é confiável e
válida para avaliação do estado funcional dos pacientes
na alta da unidade de terapia intensiva.
Collapse
Affiliation(s)
- Nair Fritzen Dos Reis
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Roberta Rodolfo Mazzali Biscaro
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Fernanda Cabral Xavier Sarmento Figueiredo
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Elizabeth Cristiane Buss Lunardelli
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Rosemeri Maurici da Silva
- Programa de Pós-Graduação em Ciências Médicas, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| |
Collapse
|
3
|
Bartolome G, Starrost U, Schröter-Morasch H, Schilling B, Fischbacher L, Kues L, Graf S, Ziegler W. Validation of the munich swallowing score (mucss) in patients with neurogenic dysphagia: A preliminary study. NeuroRehabilitation 2021; 49:445-457. [PMID: 34180423 DOI: 10.3233/nre-210011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Munich Swallowing Score (MUCSS) is a clinician rated scale for the assessment of the functional level of swallowing saliva/secretions, food and liquids. The MUCSS consists of two eight-point subscales, MUCSS-Saliva and MUCSS-Nutrition. In a previous article, content validity and interrater reliability were described. OBJECTIVE The aim of the present study was to investigate criterion validity and sensitivity to change of the MUCSS. METHODS The research was conducted at a tertiary care academic hospital. Data were collected retrospectively in a cohort of 100 acute and subacute neurologic patients. Criterion validity was judged by comparison to the Gugging Swallowing Screen (GUSS), the Barthel Index (BI), Early Rehabilitation Barthel Index (ERI), Extended Barthel Index (EBI) and also by comparison to three physiological scales drawn from FEES videos: The Penetration - Aspiration Scale (PAS), the Yale Pharyngeal Residue Severity Rating Scale (YPR) and the Murray Secretion Scale (MSS). Changes in oral intake and saliva swallowing were followed up for three months. RESULTS Between MUCSS and scores directly reflecting dysphagic symptoms (GUSS, PAS, YPR, MSS, ERI), strong to moderate correlations were found, weaker but statistically significant associations were seen with global measures of disability (BI isolated, EBI-subscale cognitive functions). MUCSS was sensitive to positive change of saliva swallowing and oral intake during the recovery period. CONCLUSIONS These preliminary data suggest that the MUCCS is a valid scale and may be appropriate for documenting clinical change in swallowing abilities of patients with neurogenic dysphagia.
Collapse
Affiliation(s)
- G Bartolome
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - U Starrost
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - H Schröter-Morasch
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - B Schilling
- Department of Otorhinolaryngology/Phoniatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - L Fischbacher
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - L Kues
- Department of Early Rehabilitation and Physical Medicine, Academic Hospital Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - S Graf
- Department of Otorhinolaryngology/Phoniatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - W Ziegler
- Institute of Phonetics and Speech Processing, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
4
|
Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke. Can J Neurol Sci 2019; 46:209-215. [DOI: 10.1017/cjn.2018.386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT:Background: We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. Methods: A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. Results: Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. Conclusions: Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.
Collapse
|
5
|
Schmidt SB, Boltzmann M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, Rosen FV, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M, Rollnik JD. Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients. Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.05100-6 epub 2018 jun 11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Schmidt SB, Boltzmann M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, Rosen FV, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M, Rollnik JD. Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients. Eur J Phys Rehabil Med 2018; 54:939-946. [PMID: 29898584 DOI: 10.23736/s1973-9087.18.05100-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies analyzing risk factors of weaning failure in neurological and neurosurgical early rehabilitation (NNER) patients are rare. AIM The aim of this study was to identify clinical factors influencing the weaning of NNER patients. DESIGN An observational, retrospective data analysis of a German multicenter study was performed. SETTING German neurological early rehabilitation centers. POPULATION Inpatient ventilated NNER patients (N.=192) were enrolled in the study. METHODS Demographical data, main diagnosis, medical devices, special medical care and assessment instruments of functional abilities, consciousness and independence in activities of daily living were accrued and compared between patients with and without successful weaning. The prognostic power of factors associated with weaning success/failure was analyzed using binary logistic regression. RESULTS In total, 75% of the patients were successfully weaned. Colonization with multi-drug resistant bacteria and the need for dialysis were independent predictors of weaning failure. Successfully weaned patients had a shorter length of stay, better functional outcome, and lower mortality than non-successfully weaned patients. CONCLUSIONS Successfully weaned patients differ from patients with weaning failure in several clinical variables. All these variables are associated with the morbidity of the patient, indicating that the weaning process is strongly influenced by disease burden. CLINICAL REHABILITATION IMPACT Functional abilities, level of consciousness, independence in activities of daily living, colonization with multi-drug resistant bacteria, need for dialysis and disease duration might help to predict the weaning process of NNER.
Collapse
Affiliation(s)
- Simone B Schmidt
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany -
| | - Melanie Boltzmann
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Guido Ketter
- Neurological Rehabilitation Centre "Godeshöhe", Bonn, Germany
| | | | | | | | | | | | | | | | | | - Hartwig Woldag
- Neurologisches Rehabilitationszentrum Leipzig, Leipzig, Germany
| | - Peter Peschel
- Department of Public Health, University of Dresden, Dresden, Germany
| | | | | | - Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany
| |
Collapse
|
7
|
Bschorer M, Schneider D, Hennig M, Frank B, Schön G, Heiland M, Bschorer R. Early intensive rehabilitation after oral cancer treatment. J Craniomaxillofac Surg 2018; 46:1019-1026. [PMID: 29709327 DOI: 10.1016/j.jcms.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 03/21/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The treatment of oral cancer requires an effective rehabilitation strategy such as an early intensive rehabilitation (EIR) program. MATERIALS AND METHODS The medical records and data of 41 patients who participated in an EIR program and 20 control group patients were analyzed. These patients all underwent surgical resection of the primary tumor followed by microsurgical reconstruction using free flaps. The length of stay (LOS) at the acute care hospital was compared between the two groups. Four indexes were used to evaluate the effectiveness of the EIR program. RESULTS EIR patients stayed an average of 11.6 fewer days at the acute care hospital. All indexes showed significant improvements (p < 0.001). The Barthel Index (BI) and the Early Intensive Rehabilitation Barthel Index (EIR-BI) improved by 36.0 and 103.6 points, respectively. At discharge, the Bogenhausener Dysphagia Score (BODS) had improved to a score of 11.0 compared to the 13.9 at admission. EIR patients had a Work Ability Index (WAI) score of 25.7. CONCLUSION Length of stay at the acute care hospital can be reduced using early intensive rehabilitation if patients are transferred to an intensive rehabilitation clinic early.
Collapse
Affiliation(s)
| | - Daniel Schneider
- Department of Oral and Maxillofacial Surgery, HELIOS Kliniken Schwerin, Germany
| | - Matthias Hennig
- Department of Oral and Maxillofacial Surgery, HELIOS Kliniken Schwerin, Germany
| | - Bernd Frank
- Clinic for Early Rehabilitation and Interdisciplinary Rehabilitation Center, HELIOS Klinik Leezen, Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Reinhard Bschorer
- Department of Oral and Maxillofacial Surgery, HELIOS Kliniken Schwerin, Germany.
| |
Collapse
|
8
|
Impact of Thyroid Hormone Levels on Functional Outcome in Neurological and Neurosurgical Early Rehabilitation Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4719279. [PMID: 28900623 PMCID: PMC5576392 DOI: 10.1155/2017/4719279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022]
Abstract
Background Neurological and neurosurgical early rehabilitation (NNER) is a specialized treatment option for patients with severe neurological disorders. The present study investigated whether thyroid hormone levels on admission have an impact on the outcome of NNER patients. Method The study included 500 NNER patients who were admitted to the BDH-Clinic Hessisch Oldendorf between 2009 and 2010. Data such as age, sex, diagnoses, comorbidities, Glasgow Coma Scale score, length of stay, and thyroid hormone levels (obtained as part of clinical routine care) were analyzed retrospectively. Improvement in the Early Rehabilitation Barthel Index (ERBI) at the end of the NNER treatment was defined as outcome parameter. Results Most patients made functional progress during treatment, as reflected in significant enhancements of the ERBI. Approximately half of the patients were transferred to further rehabilitation treatment. Young age, early onset of NNER treatment, low functional impairment on admission, and, in particular, low total T3 levels were independently associated with a good outcome. Conclusion Age, severity of disease, and time between injury and admission are known to predict outcome. The present study confirms the influence of these general factors. In addition, an association between thyroid hormones and functional outcome was demonstrated for NNER patients.
Collapse
|