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ABSTRACT: BACKGROUND: Psychometric limitations of balance measures for community-dwelling elderly may be related to gaps in task and environmental representation. OBJECTIVE: To conduct item-level content analysis of balance measures for community-dwelling elderly based on task and environmental factors, and develop profiles of individual measures summarizing their task and environment representation. DESIGN: Systematic content analysis. METHODS: A literature search was conducted to identify balance measures. Item-level content analysis was based on seven criteria related to task and environment: (i) task role, (ii) environmental variation, (iii) object interaction, (iv) obstacle negotiation, (v) external forces, (vi) dual-tasking, and (vii) moving persons/objects in the environment. RESULTS: 26 measures were identified, containing 167 items. Task role was fairly evenly distributed, with majority of items examining gait tasks (32.3%), followed by dynamic body stability (29.9%) and static body stability (25.1%). Majority of items involved no environmental variation (58.1%), followed by variation of support surfaces (20.4%), visual conditions (13.2%), and both support and visual conditions (8.4%). Limited task role variability was seen within measures, with 73.1% of measures examining only one task role. Environmental variation was present in 65.3% of measures, primarily during static body stability tasks. Few measures involved object interaction (23.1%), obstacle negotiation (38.5%), external forces (11.5%), dual-tasking (7.7%), or moving persons/objects (0%). LIMITATIONS: Our classification framework was not externally validated. CONCLUSIONS: Existing measures focus on single-task assessment in static environments, underrepresenting postural control demands in daily-life situations involving dynamic changing environments, person-environment interactions, and multi-tasking. New items better reflecting postural control demands in daily-life situations are needed for more ecologically valid balance assessment. Individual balance measure profiles provided can help identify the most appropriate measure for a given purpose.
Physical Therapy 05/2013; · 3.11 Impact Factor
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ABSTRACT: OBJECTIVES: To develop and test an instrument to assess physical function (PF) for Social Security Administration (SSA) disability programs, the SSA-PF. Item Response Theory (IRT) analyses were used to 1) create a calibrated item bank for each of the factors identified in prior factor analyses, 2) assess the fit of the items within each scale, 3) develop separate Computer-Adaptive Test (CAT) instruments for each scale, and 4) conduct initial psychometric testing. DESIGN: Cross-sectional data collection; IRT analyses; CAT simulation. SETTING: Telephone and internet survey. PARTICIPANTS: Two samples: 1,017 SSA claimants, and 999 adults from the US general population. Interventions: None. MAIN OUTCOME MEASURE: Model fit statistics, correlation and reliability coefficients, RESULTS: IRT analyses resulted in five unidimensional SSA-PF scales: Changing & Maintaining Body Position , Whole Body Mobility , Upper Body Function , Upper Extremity Fine Motor , and Wheelchair Mobility for a total of 102 items. High CAT accuracy was demonstrated by strong correlations between simulated CAT scores and those from the full item banks. Comparing the simulated CATs to the full item banks, very little loss of reliability or precision was noted, except at the lower and upper ranges of each scale. No difference in response patterns by age or sex was noted. The distributions of claimant scores were shifted to the lower end of each scale compared to those of a sample of US adults. CONCLUSIONS: The SSA-PF instrument contributes important new methodology for measuring the physical function of adults applying to the SSA disability programs. Initial evaluation revealed that the SSA-PF instrument achieved considerable breadth of coverage in each content domain and demonstrated noteworthy psychometric properties.
Archives of physical medicine and rehabilitation 04/2013; · 2.18 Impact Factor
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ABSTRACT: PURPOSE: The Patient-Reported Outcomes Measurement Information System (PROMIS(®)) provides adult and pediatric self-report measures of health-related quality of life designed for use across medical conditions and the general population. The purpose of this study was to examine the feasibility and validity of the PROMIS(®) Pediatric Short Form and computer-adaptive test (CAT) mobility measures in children with cerebral palsy (CP). METHODS: Eighty-two children with CP completed self-report (PROMIS(®) Mobility Short Form, PROMIS(®) Mobility CAT, Pediatric Quality of Life Inventory™) and performance-based assessments of mobility (Timed Up and Go, Gross Motor Function Measure). Parents provided three proxy reports of child mobility (Pediatric Outcomes Data Collection Instrument, Functional Assessment Questionnaire, Shriners Hospitals for Children CP-CAT). Validity of PROMIS(®) instruments was examined through correlations with other measures and "known groups" analyses determined by Gross Motor Function Classification System (GMFCS). RESULTS: On average, the PROMIS(®) CAT required less than seven items and 2 minutes to administer. Both PROMIS(®) measures showed moderate to high correlations with child- and parent-proxy report of child mobility; correlations with performance-based measure were small for the PROMIS(®) Short Form and non-significant for the PROMIS(®) CAT. All measures except for the PROMIS(®) CAT were able to distinguish between GMFCS categories. CONCLUSIONS: Results support the convergent and discriminant validity of the pediatric PROMIS(®) Mobility Short Form in children with CP. The PROMIS(®) Mobility CAT correlates well with child report and parent report of mobility but not with performance-based measures and does not differentiate between known mobility groups.
Quality of Life Research 03/2013; · 2.30 Impact Factor
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ABSTRACT: OBJECTIVE: s: To develop a broad set of claimant-reported items to assess behavioral health functioning relevant to the Social Security disability determination processes, and to evaluate the underlying structure of behavioral health functioning for use in development of a new functional assessment instrument. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: Item pools of behavioral health functioning were developed, refined, and field-tested in a sample of persons applying for Social Security disability benefits (N=1015) who reported difficulties working due to mental or both mental and physical conditions. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Social Security Administration Behavioral Health (SSA-BH) measurement instrument RESULTS: Confirmatory factor analysis (CFA) specified that a 4-factor model (self-efficacy, mood and emotions, behavioral control, and social interactions) had the optimal fit with the data and was also consistent with our hypothesized conceptual framework for characterizing behavioral health functioning. When the items within each of the four scales were tested in CFA, the fit statistics indicated adequate support for characterizing behavioral health as a unidimensional construct along these four distinct scales of function. CONCLUSION: This work represents a significant advance both conceptually and psychometrically in assessment methodologies for work related behavioral health. The measurement of behavioral health functioning relevant to the context of work requires the assessment of multiple dimensions of behavioral health functioning. Specifically, we identified a 4-factor model solution that represented key domains of work related behavioral health functioning. These results guided the development and scale formation of a new SSA-BH instrument.
Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor
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Elizabeth E Marfeo,
Stephen M Haley, Alan M Jette,
Susan V Eisen,
Pengsheng Ni,
Kara Bogusz,
Mark Meterko,
Christine M McDonough,
Leighton Chan,
Diane E Brandt,
Elizabeth K Rasch
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ABSTRACT: Physical and mental impairments represent the two largest health condition categories for which workers receive Social Security disability benefits. Comprehensive assessment of physical and mental impairments should include aspects beyond medical conditions such as a person's underlying capabilities as well as activity demands relevant to the context of work. The objective of this paper is to describe the initial conceptual stages of developing new measurement instruments of behavioral health and physical functioning relevant for Social Security work disability evaluation purposes. To outline a clear conceptualization of the constructs to be measured, two content models were developed using structured and informal qualitative approaches. We performed a structured literature review focusing on work disability and incorporating aspects of the International Classification of Functioning, Disability, and Health (ICF) as a unifying taxonomy for framework development. Expert interviews provided advice and consultation to enhance face validity of the resulting content models. The content model for work-related behavioral health function identifies five major domains (1) Behavior Control, (2) Basic Interactions, (3) Temperament and Personality, (4) Adaptability, and (5) Workplace Behaviors. The content model describing physical functioning includes three domains (1) Changing and Maintaining Body Position, (2) Whole Body Mobility, and (3) Carrying, Moving and Handling Objects. These content models informed subsequent measurement properties including item development, measurement scale construction, and provided conceptual coherence guiding future empirical inquiry. The proposed measurement approaches show promise to comprehensively and systematically assess physical and behavioral health functioning relevant to work.
Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor
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ABSTRACT: OBJECTIVES: To build a comprehensive item pool representing work-relevant physical functioning and to test the factor structure of the item pool. These developmental steps represent initial outcomes of a broader project to develop instruments for the assessment of function within the context of Social Security Administration (SSA) disability programs. DESIGN: Comprehensive literature review; gap analysis; item generation with expert panel input; stakeholder interviews; cognitive interviews; cross-sectional survey administration; and exploratory and confirmatory factor analyses to assess item pool structure. SETTING: In-person and semi-structured interviews; internet and telephone surveys. PARTICIPANTS: A sample of 1,017 SSA claimants, and a normative sample of 999 adults from the US general population. INTERVENTIONS: Not Applicable. MAIN OUTCOME MEASURE: Model fit statistics RESULTS: The final item pool consisted of 139 items. Within the claimant sample 58.7% were white; 31.8% were black; 46.6% were female; and the mean age was 49.7 years. Initial factor analyses revealed a 4-factor solution which included more items and allowed separate characterization of: 1) Changing and Maintaining Body Position, 2) Whole Body Mobility, 3) Upper Body Function and 4) Upper Extremity Fine Motor. The final 4-factor model included 91 items. Confirmatory factor analyses for the 4-factor models for the claimant and the normative samples demonstrated very good fit. Fit statistics for claimant and normative samples respectively were: Comparative Fit Index = 0.93 and 0.98; Tucker-Lewis Index = 0.92 and 0.98; Root Mean Square Error Approximation = 0.05 and 0.04. CONCLUSIONS: The factor structure of the Physical Function item pool closely resembled the hypothesized content model. The four scales relevant to work activities offer promise for providing reliable information about claimant physical functioning relevant to work disability.
Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor
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ABSTRACT: OBJECTIVE: s: To use item response theory (IRT) data simulations to construct and perform initial psychometric testing of a newly developed instrument, the Social Security Administration Behavioral Health Function (SSA-BH) instrument, that aims to assess behavioral health functioning relevant to the context of work. DESIGN: Cross-sectional survey followed by item response theory (IRT) calibration data simulations SETTING: Community PARTICIPANTS: A sample of individuals applying for SSA disability benefits, claimants (N=1015), and a normative comparative sample of US adults (N=1000) INTERVENTIONS: None. MAIN OUTCOME MEASURE: Social Security Administration Behavioral Health Function (SSA-BH) measurement instrument RESULTS: Item response theory analyses supported the unidimensionality of four SSA-BH scales: Mood and Emotions (35 items), Self-Efficacy (23 items), Social Interactions (6 items), and Behavioral Control (15 items). All SSA-BH scales demonstrated strong psychometric properties including reliability, accuracy, and breadth of coverage. High correlations of the simulated 5- or 10- item CATs with the full item bank indicated robust ability of the CAT approach to comprehensively characterize behavioral health function along four distinct dimensions. CONCLUSIONS: Initial testing and evaluation of the SSA-BH instrument demonstrated good accuracy, reliability, and content coverage along all four scales. Behavioral function profiles of SSA claimants were generated and compared to age and sex matched norms along four scales: Mood and Emotions, Behavioral Control, Social Interactions, and Self-Efficacy. Utilizing the CAT based approach offers the ability to collect standardized, comprehensive functional information about claimants in an efficient way, which may prove useful in the context of the SSA's work disability programs.
Archives of physical medicine and rehabilitation 03/2013; · 2.18 Impact Factor
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M Elizabeth Sandel, Alan M Jette,
Jed Appelman,
Joseph Terdiman,
Marian Teselle,
Richard L Delmonico,
Hua Wang,
Michelle Camicia,
Elizabeth K Rasch,
Diane E Brandt,
Leighton Chan
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ABSTRACT: OBJECTIVE: To determine the feasibility of tracking stroke patients' functional outcomes in an integrated health system across a care continuum using the computer version of the Activity Measure of Post-Acute Care (AM-PAC). SETTING: A large integrated health care system in northern California. PARTICIPANTS: A total of 222 stroke patients (aged ≥18 years) who were hospitalized after an acute cerebrovascular accident. METHODS: An AM-PAC assessment was made at discharge from sites of care, including acute hospital, inpatient rehabilitation hospital, skilled nursing facility, home during home care, and outpatient settings. Assessments also were completed in the patient's home at 6 months. Data from the AM-PAC program were integrated with the health care system's databases. MAIN OUTCOME MEASUREMENTS: (1) AM-PAC administration time at the various sites of care; (2) assessment of a floor or a ceiling effect; and (3) administrative burden of tracking participants. RESULTS: AM-PAC assessment sessions averaged 7.9 minutes for data acquisition in 3 domains: Basic Mobility, Activities of Daily Living, and Applied Cognition. Participants answered, on average, 27 AM-PAC questions per session. A small ceiling effect was observed at 6 months, and there was a larger ceiling effect when the instrument was administered in an institution, ie, when the AM-PAC institutional item bank was used rather than the community item bank. It was feasible to track patients and to assess their function using the AM-PAC instrument from institutional to community settings. Implementation of the AM-PAC in clinical environments, and the success of the project, were influenced by instrumental, technological, operational, resource, and cultural factors. CONCLUSIONS: This study demonstrates the feasibility of implementing a single functional outcome instrument in clinical and community settings to measure rehabilitation functional outcomes of stroke patients. Integrating the AM-PAC measurement system into clinical workflows and the electronic medical record could provide assistance to clinicians for medical decision making, functional prognostication, and discharge planning.
Der Notarzt 11/2012; · 0.28 Impact Factor
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ABSTRACT: OBJECTIVE: To determine the impact of post acute care site on stroke outcomes. Following a stroke, patients may receive post acute care in a number of different sites: inpatient rehabilitation (IRF), skilled nursing facility (SNF), and home health care/outpatient (HH/OP). We hypothesized that patients who received IRF would have better six-month functional outcomes than those who received care in other settings after controlling for patient characteristics. DESIGN: Prospective Cohort Study. SETTING: Four Northern California hospitals which are part of a single health maintenance organization. PARTICIPANTS: 222 patients with stroke enrolled between February 2008 and July 2010. INTERVENTION: Not Applicable. MAIN OUTCOME MEASURE: Baseline and 6 month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC™), a test of self-reported function in three domains: Basic Mobility, Daily Activities, and Applied Cognition. RESULTS: Of the 222 patients analyzed, 36% went home with no treatment, 22% received HH/OP care, 30% included IRF in their care trajectory, and 13% included SNF (but not IRF) in their care trajectory. At six months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a SNF in all 3 domains and in two out of three functional domains compared to those who received HH/OP care. CONCLUSIONS: Patients with stroke may make more functional gains if their post-acute care includes an IRF. This finding may have important implications as post-acute care delivery is reshaped through health care reform.
Archives of physical medicine and rehabilitation 11/2012; · 2.18 Impact Factor
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Alan M Jette,
David S Tulsky,
Pengsheng Ni,
Pamela A Kisala,
Mary D Slavin,
Marcel P Dijkers,
Allen W Heinemann,
Denise G Tate,
Gale Whiteneck,
Susan Charlifue,
Bethlyn Houlihan,
Steve Williams,
Steven Kirshblum,
Trevor Dyson-Hudson,
Jeanne Zanca,
Denise Fyffe
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ABSTRACT: 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.
To describe the calibration of the Spinal Cord Injury-Functional Index (SCI-FI) and report on the initial psychometric evaluation of the SCI-FI scales in each content domain.
Cross-sectional survey followed by calibration data simulations.
Inpatient and community settings.
A sample of participants (N=855) with traumatic spinal cord injury (SCI) recruited from 6 SCI Model Systems and stratified by diagnosis, severity, and time since injury.
None.
SCI-FI instrument.
Item response theory analyses confirmed the unidimensionality of 5 SCI-FI scales: basic mobility (54 items), fine motor function (36 items), self-care (90 items), ambulation (39 items), and wheelchair mobility (56 items). All SCI-FI scales revealed strong psychometric properties. High correlations of scores on simulated computer adaptive testing (CAT) with the overall SCI-FI domain scores indicated excellent potential for CAT to accurately characterize functional profiles of adults with SCI. Overall, there was very little loss of measurement reliability or precision using CAT compared with the full item bank; however, there was some loss of reliability and precision at the lower and upper ranges of each scale, corresponding to regions where there were few questions in the item banks.
Initial evaluation revealed that the SCI-FI achieved considerable breadth of coverage in each content domain and demonstrated acceptable psychometric properties. The use of CAT to administer the SCI-FI will minimize assessment burden, while allowing for the comprehensive assessment of the functional abilities of adults with SCI.
Archives of physical medicine and rehabilitation 05/2012; 93(10):1733-50. · 2.18 Impact Factor
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ABSTRACT: BACKGROUND: Having psychometrically strong disability measures that minimize response burden is important in assessing of older adults. METHODS: Using the original 48 items from the Late-Life Function and Disability Instrument and newly developed items, a 158-item Activity Limitation and a 62-item Participation Restriction item pool were developed. The item pools were administered to a convenience sample of 520 community-dwelling adults 60 years or older. Confirmatory factor analysis and item response theory were employed to identify content structure, calibrate items, and build the computer-adaptive testings (CATs). We evaluated real-data simulations of 10-item CAT subscales. We collected data from 102 older adults to validate the 10-item CATs against the Veteran's Short Form-36 and assessed test-retest reliability in a subsample of 57 subjects. RESULTS: Confirmatory factor analysis revealed a bifactor structure, and multi-dimensional item response theory was used to calibrate an overall Activity Limitation Scale (141 items) and an overall Participation Restriction Scale (55 items). Fit statistics were acceptable (Activity Limitation: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.03; Participation Restriction: comparative fit index = 0.95, Tucker Lewis Index = 0.95, root mean square error approximation = 0.05). Correlation of 10-item CATs with full item banks were substantial (Activity Limitation: r = .90; Participation Restriction: r = .95). Test-retest reliability estimates were high (Activity Limitation: r = .85; Participation Restriction r = .80). Strength and pattern of correlations with Veteran's Short Form-36 subscales were as hypothesized. Each CAT, on average, took 3.56 minutes to administer. CONCLUSIONS: The Late-Life Function and Disability Instrument CATs demonstrated strong reliability, validity, accuracy, and precision. The Late-Life Function and Disability Instrument CAT can achieve psychometrically sound disability assessment in older persons while reducing respondent burden. Further research is needed to assess their ability to measure change in older adults.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 04/2012; · 4.60 Impact Factor
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ABSTRACT: The National Center for Medical Rehabilitation Research recently celebrated its 20th Anniversary. The celebration included a symposium highlighting advances in rehabilitation science over the past 2 decades. The anniversary also reminds us of the challenges that remain in order to strengthen the foundation of disability and rehabilitation research. These challenges have been described in 3 reports published by the Institute of Medicine (IOM) in 1991, 1997, and 2007. Three areas of concern appear across the IOM reports. These include (1) the lack of a comprehensive disability monitoring program, (2) the need for better integration and coordination of federally supported disability research, and (3) funding levels that are inconsistent with the current and projected impacts of disability on individuals, families, and communities. In this commentary we examine the lack of progress in addressing the recommendations contained in the IOM reports. We conclude that renewed efforts by consumers, clinicians, educators, researchers, administrators, and policy makers are needed to achieve the promise of rehabilitation and disability science identified 20 years ago.
Archives of physical medicine and rehabilitation 03/2012; 93(8):1392-4. · 2.18 Impact Factor
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ABSTRACT: Our objective was to examine the agreement between adult patients with stroke and family member or clinician proxies in activity measure for postacute care (AM-PAC) summary scores for daily activity, basic mobility, and applied cognitive function.
This study involved 67 patients with stroke admitted to a hospital within the Kaiser Permanente of Northern California system and were participants in a parent study on stroke outcomes. Each participant and proxy respondent completed the AM-PAC by personal or telephone interview at the point of hospital discharge or during ≥1 transitions to different postacute care settings.
The results suggest that for patients with a stroke proxy, AM-PAC data are robust for family or clinician proxy assessment of basic mobility function and clinician proxy assessment of daily activity function, but less robust for family proxy assessment of daily activity function and for all proxy groups' assessments of applied cognitive function. The pattern of disagreement between patient and proxy was, on average, relatively small and random. There was little evidence of systematic bias between proxy and patient reports of their functional status. The degree of concordance between patient and proxy was similar for those with moderate to severe strokes compared with mild strokes.
Patient and proxy ratings on the AM-PAC achieved adequate agreement for use in stroke research when using proxy respondents could reduce sample selection bias. The AM-PAC data can be implemented across institutional as well as community care settings while achieving precision and reducing respondent burden.
Stroke 03/2012; 43(3):824-9. · 5.73 Impact Factor
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ABSTRACT: Periacetabular osteotomy is a relatively common reconstructive procedure for the adolescent or young adult with acetabular dysplasia. Although several measures have been used to characterize the outcome, the responsiveness of these measures in this population has not been determined. The purpose of this study was to estimate the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-36 (SF-36) in patients with acetabular dysplasia treated with periacetabular osteotomy.
Eighty-three patients with acetabular dysplasia treated with periacetabular osteotomy between 2000 and 2005 completed the WOMAC and SF-36 both preoperatively and postoperatively. The scores on each domain of these outcome measures were calculated and analyzed to determine the parameters of responsiveness, including the minimal detectable change at the 90% confidence level.
The mean duration of follow-up was 1.9 years. Comparison of the effect size, standardized response mean, and minimal detectable change for the SF-36 and WOMAC demonstrated that the WOMAC was more sensitive to change than the SF-36 was, particularly in the physical function domain (minimal detectable change, 9.1) and the pain domain (minimal detectable change, 5.5). Only one of the eight domains of the SF-36, bodily pain, demonstrated a change in outcome that exceeded the minimal detectable change, which was 2.38.
Both the WOMAC and the SF-36 demonstrated adequate responsiveness to change over time in patients with acetabular dysplasia treated with periacetabular osteotomy, although the WOMAC was more sensitive to change. These results indicate that the WOMAC is sufficiently responsive to be used as a joint-specific measure for assessing changes following periacetabular osteotomy for the treatment of acetabular dysplasia.
The Journal of Bone and Joint Surgery 12/2011; 93(23):2214-8. · 3.27 Impact Factor
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ABSTRACT: Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically.
The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care.
This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise.
A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy.
Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R(2)), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores.
This study included older adults with mobility limitations and may not generalize to other populations.
Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was associated with age and physiologic factors, whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors.
Physical Therapy 12/2011; 91(12):1804-11. · 3.11 Impact Factor
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Physical Therapy 12/2011; 91(12):1708-11. · 3.11 Impact Factor
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ABSTRACT: Impaired balance has a significant negative impact on mobility, functional independence, and fall risk in older adults. Although several, well-respected balance measures are currently in use, there is limited evidence regarding the most appropriate measure to assess change in community-dwelling older adults.
The aim of this study was to compare floor and ceiling effects, sensitivity to change, and responsiveness across the following balance measures in community-dwelling elderly people with functional limitations: Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment total scale (POMA-T), POMA balance subscale (POMA-B), and Dynamic Gait Index (DGI).
Retrospective data from a 16-week exercise trial were used. Secondary analyses were conducted on the total sample and by subgroups of baseline functional limitation or baseline balance scores.
Participants were 111 community-dwelling older adults 65 years of age or older, with functional limitations. Sensitivity to change was assessed using effect size, standardized response mean, and paired t tests. Responsiveness was assessed using minimally important difference (MID) estimates.
No floor effects were noted. Ceiling effects were observed on all measures, including in people with moderate to severe functional limitations. The POMA-T, POMA-B, and DGI showed significantly larger ceiling effects compared with the BBS. All measures had low sensitivity to change in total sample analyses. Subgroup analyses revealed significantly better sensitivity to change in people with lower compared with higher baseline balance scores. Although both the total sample and lower baseline balance subgroups showed statistically significant improvement from baseline to 16 weeks on all measures, only the lower balance subgroup showed change scores that consistently exceeded corresponding MID estimates.
This study was limited to comparing 4 measures of balance, and anchor-based methods for assessing MID could not be reported.
Important limitations, including ceiling effects and relatively low sensitivity to change and responsiveness, were noted across all balance measures, highlighting their limited utility across the full spectrum of the community-dwelling elderly population. New, more challenging measures are needed for better discrimination of balance ability in community-dwelling elderly people at higher functional levels.
Physical Therapy 11/2011; 92(3):388-97. · 3.11 Impact Factor
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Alan M Jette
Quality of Life Research 10/2011; · 2.30 Impact Factor
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ABSTRACT: To develop and test a prototype dyspnea computer adaptive test (CAT).
Prospective study.
Two outpatient medical facilities.
A convenience sample of adults (N=292) with chronic obstructive pulmonary disease (COPD).
Not applicable.
We developed a modified and expanded item bank and CAT for the Dyspnea Management Questionnaire (DMQ), an outcome measure consisting of 4 dyspnea dimensions: dyspnea intensity, dyspnea anxiety, activity avoidance, and activity self-efficacy.
Factor analyses supported a 4-dimensional model underlying the 71 DMQ items. The DMQ item bank achieved acceptable Rasch model fit statistics, good measurement breadth with minimal floor and ceiling effects, and evidence of high internal consistency reliability (α=.92-.98). With the use of CAT simulation analyses, the DMQ-CAT showed high measurement accuracy compared with the total item pool (r=.83-.97, P<.0001) and evidence of good to excellent concurrent validity (r=-.61 to -.80, P<.0001). All DMQ-CAT domains showed evidence for known-groups validity (P≤.001).
The DMQ-CAT reliably and validly captured 4 distinct dyspnea domains. Multidimensional dyspnea assessment in COPD is needed to better measure the effectiveness of pharmacologic, pulmonary rehabilitation, and psychosocial interventions in not only alleviating the somatic sensation of dyspnea but also reducing dysfunctional emotions, cognitions, and behaviors associated with dyspnea, especially for anxious patients.
Archives of physical medicine and rehabilitation 10/2011; 92(10):1561-9. · 2.18 Impact Factor
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ABSTRACT: To use item response theory (IRT) methods to link physical functioning items in the Activity Measure for Post Acute Care (AM-PAC) and the Quality of Life Outcomes in Neurological Disorders (Neuro-QOL).
Secondary data analysis of the physical functioning items of AM-PAC and Neuro-QOL. We used a nonequivalent group design with 36 core items common to both instruments and a test characteristic curve transformation method for linking AM-PAC and Neuro-QOL scores. Linking was conducted so that both raw and scaled AM-PAC and Neuro-QOL scores (mean ± SD converted-logit scores, 50 ± 10) could be compared.
AM-PAC items were administered to rehabilitation patients in post-acute care (PAC) settings. Neuro-QOL items were administered to a community sample of adults through the Internet.
PAC patients (N=1041) for the AM-PAC sample and community-dwelling adults (N=549) for the Neuro-QOL sample.
Not applicable.
Mobility (N=25) and activity of daily living (ADL) items (N=11) common to both instruments were included in analysis.
Neuro-QOL items were linked to the AM-PAC scale by using the generalized partial credit model. Mobility and ADL subscale scores from the 2 instruments were calibrated to the AM-PAC metric.
An IRT-based linking method placed AM-PAC and Neuro-QOL mobility and ADL scores on a common metric. This linking allowed estimation of AM-PAC mobility and ADL subscale scores based on Neuro-QOL mobility and ADL subscale scores and vice versa. The accuracy of these results should be validated in a future sample in which participants respond to both instruments.
Archives of physical medicine and rehabilitation 10/2011; 92(10 Suppl):S37-43. · 2.18 Impact Factor
