Outcome of comprehensive medical rehabilitation: Measurement by PULSES Profile and the Barthel Index

Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.44). 05/1979; 60(4):145-54.
Source: PubMed

ABSTRACT In view of current emphasis on evaluation of benefits derived from rehabilitation programs, it is important that there be easily replicated measures for demonstrating the efficiency and effectiveness of services provided, as well as for transmitting information on patient functional status when transferring service responsibilities from one agency or facility to another. The authors used the PULSES profile and the Barthel index to measure severity of disability and to monitor rehabilitation progress in a heterogeneous sample of 307 severely disabled persons in 10 comprehensive medical rehabilitation centers, geographically selected. Gains in functional independence were registered for up to 2 years after admission. Cutting points of PULSES score totals or Barthel score totals distinguished the degree of severity of disability. The 2 scoring modalities appear valid, reliable, and sensitive for describing functional abilities and change over a period of time. They can be applied both to medical records and direct observations, and staff of medical facilities can readily be trained in their use.

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    • "Activities of daily living were assessed using the Barthel Index (BI: [31]). The measure is widely used in stroke research, and Granger and Albrecht et al. [32] report good test–retest reliability (r = 0.89). The modified 0–20 scoring system was used, with a higher score indicating better functioning. "
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    • "According to predetermined protocols, a comprehensive geriatric assessment was made within 72 h of admission (Stuck et al., 1993; Miralles et al., 2003) The principal domains assessed were functional status, cognitive function, depression and comorbidity, which were evaluated by standardized instruments. Functional status was evaluated by ability in activities of daily living (ADL) (expressed as BI, ranging 0–100) (Granger et al., 1979) and instrumental activities of daily living (IADL) (expressed as LI, ranging 0–8) (Lawton and Brody, 1969). BI was registered prior to admission, at admission and at discharge, and LI prior to admission. "
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    • "Delirium was scored by the CAM. Cognitive impairment was based on the medical history and functional impairment on the 10-item Barthel questionnaire below 13 points [Granger et al., 1979]. DNA was available for 100 patients, but genotyping of 5 patients was unsuccessful for all SNPs. "
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