Alan Jette

Publications (14)29.32 Total impact

• Article: Reliability, validity and administrative burden of the community reintegration of injured service members computer adaptive test (CRIS-CAT)"

  Linda Resnik, Matthew Borgia, Pengsheng Ni, Paul A Pirraglia, Alan Jette
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  ABSTRACT: BACKGROUND: The Computer Adaptive Test version of the Community Reintegration of Injured Service Members measure (CRIS-CAT) consists of three scales measuring Extent of, Perceived Limitations in, and Satisfaction with community integration. The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT. METHODS: This was a three-part study that included a 1) a cross-sectional field study of 517 homeless, employed, and Operation Enduring Freedom / Operation Iraqi Freedom (OEF/OIF) veterans; who completed all items in the CRIS item set, 2) a cohort study with one year follow-up study of 135 OEF/OIF veterans, and 3) a 50-person study of CRIS-CAT administration. Conditional reliability of simulated CAT scores was calculated from the field study data, and concurrent validity and known group validity were examined using Pearson product correlations and ANOVAs. Data from the cohort were used to examine the ability of the CRIS-CAT to predict key one year outcomes. Data from the CRIS-CAT administration study were used to calculate ICC (2,1) minimum detectable change (MDC), and average number of items used during CAT administration. RESULTS: Reliability scores for all scales were above 0.75, but decreased at both ends of the score continuum. CRIS-CAT scores were correlated with concurrent validity indicators and differed significantly between the three veteran groups (P < .001). The odds of having any Emergency Room visits were reduced for veterans with better CRIS-CAT scores, (Extent, Perceived Satisfaction respectively: OR = 0.94, 0.93, 0.95; P < .05). CRIS-CAT scores were predictive of SF-12 physical and mental health related quality of life scores at the 1 year follow-up. Scales had ICCs >0.9. MDCs were 5.9, 6.2, and 3.6, respectively for Extent, Perceived and Satisfaction subscales. Number of items (mn, SD) administered at Visit 1 were 14.6 (3.8) 10.9 (2.7) and 10.4 (1.7) respectively for Extent, Perceived and Satisfaction subscales. CONCLUSION: The CRIS-CAT demonstrated sound measurement properties including reliability, construct, known group and predictive validity, and it was administered with minimal respondent burden. These findings support the use of this measure in assessing community reintegration.
  BMC Medical Research Methodology 09/2012; 12(1):145. · 2.67 Impact Factor
• Article: Computer-adaptive test to measure community reintegration of Veterans.

  Linda Resnik, Feng Tian, Pengsheng Ni, Alan Jette
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  ABSTRACT: The Community Reintegration of Injured Service Members (CRIS) measure consists of three scales measuring extent of, perceived limitations in, and satisfaction with community reintegration. Length of the CRIS may be a barrier to its widespread use. Using item response theory (IRT) and computer-adaptive test (CAT) methodologies, this study developed and evaluated a briefer community reintegration measure called the CRIS-CAT. Large item banks for each CRIS scale were constructed. A convenience sample of 517 Veterans responded to all items. Exploratory and confirmatory factor analyses (CFAs) were used to identify the dimensionality within each domain, and IRT methods were used to calibrate items. Accuracy and precision of CATs of different lengths were compared with the full-item bank, and data were examined for differential item functioning (DIF). CFAs supported unidimensionality of scales. Acceptable item fit statistics were found for final models. Accuracy of 10-, 15-, 20-, and variable-item CATs for all three scales was 0.88 or above. CAT precision increased with number of items administered and decreased at the upper ranges of each scale. Three items exhibited moderate DIF by sex. The CRIS-CAT demonstrated promising measurement properties and is recommended for use in community reintegration assessment.
  The Journal of Rehabilitation Research and Development 06/2012; 49(4):557-66. · 1.78 Impact Factor
• Source

  Available from: Bethlyn Vergo Houlihan

  Article: A telerehabilitation intervention for persons with spinal cord dysfunction.

  Bethlyn Vergo Houlihan, Alan Jette, Michael Paasche-Orlow, Jane Wierbicky, Stan Ducharme, Judi Zazula, Penelope Cuevas, Robert H Friedman, Steve Williams
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  ABSTRACT: Pressure ulcers and depression are common preventable conditions secondary to a spinal cord dysfunction. However, few successful, low-cost preventive approaches have been identified. We have developed a dynamic automated telephone calling system, termed Care Call, to empower and motivate people with spinal cord dysfunction to improve their skin care, seek treatment for depression, and appropriately use the healthcare system. Herein, we describe the design and development of Care Call, its novel features, and promising preliminary results of our pilot testing. Voice quality testing showed that Care Call was able to understand all voice characteristics except very soft-spoken speech. Importantly, pilot study subjects felt Care Call could be particularly useful for people who are depressed, those with acute injury, and those without access to quality care. The results of a randomized controlled trial currently underway to evaluate Care Call will be available in 2011.
  American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 03/2011; 90(9):756-64. · 1.56 Impact Factor
• Source

  Available from: PubMed Central

  Article: A functional difficulty and functional pain instrument for hip and knee osteoarthritis.

  Alan M Jette, Christine M McDonough, Pengsheng Ni, Stephen M Haley, Ronald K Hambleton, Sippy Olarsch, David J Hunter, Young-jo Kim, David T Felson
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  ABSTRACT: The objectives of this study were to develop a functional outcome instrument for hip and knee osteoarthritis research (OA-FUNCTION-CAT) using item response theory (IRT) and computer adaptive test (CAT) methods and to assess its psychometric performance compared to the current standard in the field. We conducted an extensive literature review, focus groups, and cognitive testing to guide the construction of an item bank consisting of 125 functional activities commonly affected by hip and knee osteoarthritis. We recruited a convenience sample of 328 adults with confirmed hip and/or knee osteoarthritis. Subjects reported their degree of functional difficulty and functional pain in performing each activity in the item bank and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Confirmatory factor analyses were conducted to assess scale uni-dimensionality, and IRT methods were used to calibrate the items and examine the fit of the data. We assessed the performance of OA-FUNCTION-CATs of different lengths relative to the full item bank and WOMAC using CAT simulation analyses. Confirmatory factor analyses revealed distinct functional difficulty and functional pain domains. Descriptive statistics for scores from 5-, 10-, and 15-item CATs were similar to those for the full item bank. The 10-item OA-FUNCTION-CAT scales demonstrated a high degree of accuracy compared with the item bank (r = 0.96 and 0.89, respectively). Compared to the WOMAC, both scales covered a broader score range and demonstrated a higher degree of precision at the ceiling and reliability across the range of scores. The OA-FUNCTION-CAT provided superior reliability throughout the score range and improved breadth and precision at the ceiling compared with the WOMAC. Further research is needed to assess whether these improvements carry over into superior ability to measure change.
  Arthritis research & therapy 08/2009; 11(4):R107. · 4.27 Impact Factor
• Article: Use of physical and occupational therapy by Medicare beneficiaries within five conditions: 1994-2001.

  Long Ngo, Nancy K Latham, Alan M Jette, Jane Soukup, Lisa I Iezzoni
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  ABSTRACT: To examine the use of physical therapy and occupational therapy among Medicare beneficiaries nationwide before and after the 1997 Balanced Budget Act, which introduced prospective payment for rehabilitation services. We analyzed responses from the longitudinal Medicare Current Beneficiary Survey, merged with Medicare claims, to track physical therapy and occupational therapy rates and intensity (units of service) from 1994 through 2001. This observational study focused on elderly and disabled Medicare beneficiaries within five conditions: stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis, and lower-limb mobility problems. We used cubic smoothing spline functions to describe trends in service intensity over time and generalized estimating equations to assess changes in service intensity. Controlling for demographic characteristics, adjusted mean level of physical therapy and occupational therapy intensity rose significantly between 1994 and 2001 for all five conditions. Service intensity leveled off in 1999 for occupational therapy and 2000 for physical therapy. With few exceptions, physical therapy and occupational therapy intensity was not significantly associated with patients' demographic characteristics. Medicare beneficiaries with conditions that can potentially benefit from physical therapy or occupational therapy or both continued to get these services at similar-and sometimes increasing-intensity during years after passage of the Balanced Budget Act.
  American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 02/2009; 88(4):308-21. · 1.56 Impact Factor
• Source

  Available from: va.gov

  Article: Development of CRIS: measure of community reintegration of injured service members.

  Linda Resnik, Matthew Plow, Alan Jette
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  ABSTRACT: Identification and prevention of community reintegration problems of veterans is an important public health mandate. However, no veteran-specific measure exists. Study purposes were to (1) develop the Community Reintegration for Service Members (CRIS) measure and (2) test the validity and reliability of the measure. Formative research identified challenges in community reintegration postdeployment. The World Health Organization's International Classification of Functioning, Disability and Health participation domain guided item-bank development. Items were refined through cognitive interviews and clinician consultation. Pilot studies with 126 veterans examined unidimensionality, internal consistency, reliability, and construct validity. Three unidimensional CRIS scales were developed. Working subjects had better CRIS scores then unemployed subjects. Subjects with posttraumatic stress disorder, substance abuse, or mental health problems had worse scores than subjects without these conditions. The correlations between the CRIS and the 36-Item Short Form Health Survey scales of role physical, role emotional, and social functioning were 0.44-0.80. CRIS has strong reliability, conceptual integrity, and construct validity.
  The Journal of Rehabilitation Research and Development 01/2009; 46(4):469-80. · 1.78 Impact Factor
• Article: Predictors of basic and instrumental activities of daily living performance in persons receiving rehabilitation services.

  Wendy Coster, Stephen M Haley, Alan Jette, Wei Tao, Hilary Siebens
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  ABSTRACT: To examine the relations among cognitive and emotional function and other patient impairment and demographic variables and the performance of daily activities. Cohort. Acute inpatient rehabilitation, skilled nursing facilities, home care, and outpatient clinics. Adults (N=534) receiving services for neurologic (32.3%), lower-extremity orthopedic (42.7%), or complex medical (24.9%) conditions. Mean age was 63.8 years; 55% were women; 88.6% were white; and the time since condition onset ranged from 0.2 to 3.9 years. Not applicable. Activity Measure for Post-Acute Care: applied cognitive, personal care and instrumental, and physical and movement scales; Mental Health Inventory-5 (MHI-5); and patient-identified problems (vision, grasp). Path analyses resulted in good model fit both for the total sample and 3 patient subgroups (chi(2) test, P>.05; comparative fit index >.95). There was a significant (P<.05) direct relation between the applied cognitive, grasp, and personal care and instrumental variables in all patient groups. There were also significant indirect relations between the MHI-5, visual impairment, and grasp problems with the personal care and instrumental scale through an association with the applied cognitive scale. Strength and significance of associations between age, sex, and physical and movement and personal care and instrumental scales varied more across patient groups. The model R(2) for the personal care and instrumental scale for the total sample was .60, with R(2) values of .10, .72, and .62 for the lower-extremity orthopedic, neurologic, and complex medical groups, respectively. Results suggest that variations in cognitive function, along with visual impairment and lower perceived well-being are associated with a patient's ability to complete daily activities. Rehabilitation professionals should consider cognitive and emotional factors as well as physical performance when planning treatment programs to restore daily activity function.
  Archives of Physical Medicine and Rehabilitation 08/2007; 88(7):928-35. · 2.28 Impact Factor
• Source

  Available from: va.gov

  Article: Relationship between self-reported function and disability and balance performance measures in the elderly.

  Itshak Melzer, Ilan Kurz, Orly Sarid, Alan M Jette
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  ABSTRACT: This study evaluated the reliability and validity of the Hebrew version of the Late-Life Function and Disability Instrument (LLFDI). Fifty-five older adults (mean age 79.7 +/- 5.2) participated. We calculated test-retest reliability with intraclass correlation coefficients (ICCs). Partial correlations determined the construct validity with a balance measure (Berg Balance Scale [BBS]) and a mobility measure (Timed Up and Go [TUG] test). We examined known-group validity by comparing the scores of cane and noncane users. Test-retest ICCs ranged from good to excellent (0.77-0.90) for the function component and fair to good for the disability component (0.63-0.83), except for the disability management role subscale (0.46). BBS and TUG were associated with LLFDI overall function (r = 0.48, p < 0.001 and r = -0.52, p < 0.001, respectively). TUG and BBS were weakly associated with disability limitations (r = -0.26 and 0.32, respectively) and disability frequency (r = -0.16 and 0.24, respectively). Cane users showed significantly lower function scores than noncane users. We demonstrated that the Hebrew version of the LLFDI reliably and validly assesses older adults' function and disability. The LLFDI is recommended as an outcome instrument in studies in which older adults' function and disability are outcomes of interest.
  The Journal of Rehabilitation Research and Development 02/2007; 44(5):685-91. · 1.78 Impact Factor
• Article: Feasibility of implementing the Strong for Life program in community settings.

  Caryn D Etkin, Thomas R Prohaska, Bette Ann Harris, Nancy Latham, Alan Jette
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  ABSTRACT: We describe the results of the dissemination of an efficacious, home-based exercise program called Strong for Life as it was implemented in a nationwide, volunteer caregiving program called Faith in Action, including training of volunteers who implemented the program, recruitment of older adult participants, exercise adherence, and attitudes and perceptions of program staff and participants. Frail, homebound older adults (N = 105) were recruited from 10 Faith in Action sites to participate in the Strong for Life exercise program. Volunteer trainers (n = 103) were trained by physical therapists to assist the older adults with the program. Surveys were conducted with older adults, volunteer trainers, and Faith in Action sites at baseline and after the older adults had been engaged in the program for 4 months. Satisfaction with program components was very high: At follow-up, 100% of volunteers and 98.6% of older adults rated the program positively. Participants reported engaging in exercise on average 2.2 times per week, with 53% of the participants exercising at least 2 to 4 times per week. Participants also had significant improvements in the Short Form-20 social functioning scale. There were no serious adverse events reported. Dissemination of the Strong for Life program in a community setting using trained lay volunteers was feasible, acceptable, and safe. Existing volunteer caregiving organizations such as Faith in Action offer a feasible and safe means of disseminating late-life exercise programs to the frail older population.
  The Gerontologist 05/2006; 46(2):284-92. · 2.48 Impact Factor
• Source

  Available from: maisativa.com.br

  Article: Randomized controlled trial of physical activity counseling for older primary care patients.

  Bernardine M Pinto, Michael G Goldstein, Jacqueline Ashba, Christopher N Sciamanna, Alan Jette
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  ABSTRACT: Regular physical activity reduces the risk for chronic diseases among older adults. Older adults are likely to be seen by primary care clinicians who can play a role in promoting physical activity among their patients. In this randomized controlled trial (1998-2003; data analyzed 2004-2005), we compared the effects of brief advice to exercise from a clinician supplemented by telephone-based counseling by health educators (extended advice) to brief advice from a clinician alone (brief advice). A total of 100 primary care patients (63.2% female, 14.7% minority, mean age=68.5 years) participated in the trial. The extended-advice intervention consisted of clinician advice plus exercise counseling via telephone provided by research staff, and the brief advice condition consisted of clinician advice alone. Both interventions focused on promoting moderate-intensity physical activity. Self-reported physical activity using the 7-Day Physical Activity Recall instrument and objective activity monitoring using Biotrainers were assessed at baseline, and at 3 and 6 months. Participants in the extended-advice arm reported significantly greater participation in moderate-intensity physical activity than the brief-advice group at 3 months (+57.69 minutes vs 12.45 minutes; 3.84 kcal/week vs 0.83 kcal/week) and 6 months (+62.84 minutes vs 16.60 minutes; 4.19 kcal/week vs 1.1 kcal/week). Objective activity monitoring also showed significantly increased physical activity among extended-advice versus brief-advice participants at both time points (+50.79 vs -11.11; +42.39 vs -24.18, respectively). These data indicate that clinician advice with follow-up counseling can promote adoption of moderate-intensity physical activity among older, primary care patients.
  American Journal of Preventive Medicine 12/2005; 29(4):247-55. · 4.04 Impact Factor
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  Available from: medicaljournals.se

  Article: Development of the home and community environment (HACE) instrument.

  Julie Keysor, Alan Jette, Stephen Haley
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  ABSTRACT: To develop and pilot test the Home and Community Environment instrument (HACE), a self-report measure designed to characterize factors in a person's home and community environment that may influence level of participation. A cross-sectional survey. Sixty-two adults recruited from community organizations and an outpatient rehabilitation center. Six environmental domains were assessed: (i) home mobility; (ii) community mobility; (iii) basic mobility devices; (iv) communication devices; (v) transportation factors; and (vi) attitudes. Descriptive statistics, Kappa statistics and Kruskal-Wallis tests were used to ascertain whether persons were capable of assessing characteristics of their environment, could do so reliably and whether the distribution of environmental factors differed by type of living situation. Participants were capable of characterizing their home environment and most aspects of their community with acceptable reliability. The median percent agreement of the 6 environmental domains ranged from 75% to 100% (median Kappa values ranged from 0.47 to 1.0). Percent agreement for individual HACE items ranged from 58% to 100%. The lowest reliability values were observed in the community mobility domain. As hypothesized, individuals who lived in private homes characterized home and community mobility factors differently from those who lived in multi-unit complexes; evidence of HACE's validity. HACE is a promising self-report instrument for assessing characteristics of an individual's home and community environments. Additional research is needed to assess its utility for rehabilitation research.
  Journal of Rehabilitation Medicine 02/2005; 37(1):37-44. · 2.05 Impact Factor
• Article: Function and disability in late life: comparison of the Late-Life Function and Disability Instrument to the Short-Form-36 and the London Handicap Scale.

  Nicole Dubuc, Stephen Haley, Pengsheng Ni, Jill Kooyoomjian, Alan Jette
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  ABSTRACT: We evaluated the Late-Life Function and Disability Instrument's (LLFDI) concurrent validity, comprehensiveness and precision by comparing it with the Short-Form-36 physical functioning (PF-10) and the London Handicap Scale (LHS). We administered the LLFDI, PF-10 and LHS to 75 community-dwelling adults (> 60 years of age). We used Pearson correlation coefficients to examine concurrent validity and Rasch analysis to compare the item hierarchies, content ranges and precision of the PF-10 and LLFDI function domains, and the LHS and the LLFDI disability domains. LLFDI Function (lower extremity scales) and PF-10 scores were highly correlated (r = 0.74 - 0.86, p > 0.001); moderate correlations were found between the LHS and the LLFDI Disability limitation (r = 0.66, p < 0.0001) and Disability frequency (r = 0.47, p < 0.001) scores. The LLFDI had a wider range of content coverage, less ceiling effects and better relative precision across the spectrum of function and disability than the PF-10 and the LHS. The LHS had slightly more content range and precision in the lower end of the disability scale than the LLFDI. The LLFDI is a more comprehensive and precise instrument compared to the PF-10 and LHS for assessing function and disability in community-dwelling older adults.
  Disability and Rehabilitation 03/2004; 26(6):362-70. · 1.50 Impact Factor
• Article: Changes in function and disability after resistance training: does velocity matter?: a pilot study.

  Stephen P Sayers, Jonathan Bean, Anthony Cuoco, Nathan K LeBrasseur, Alan Jette, Roger A Fielding
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  ABSTRACT: To compare the effects of high- and low-velocity resistance training on functional performance and disability outcomes in physically limited older women. A total of 16 wk of high-velocity resistance training or traditional low-velocity resistance training consisting of knee extension and leg press exercises was performed three times per week by 30 women with self-reported disability to compare their effect on functional performance and disability. Tests of dynamic balance, stair-climb time, chair-rise time, and gait velocity were used to assess changes in functional performance. Changes in disability were assessed using the Medical Outcomes Study Short Form. Dynamic balance and stair-climb time improved 8% and 10%, respectively, with training. Self-reported disability, physical functioning, role physical, and mental health improved 11, 9, and 5% with training, respectively. There were no significant differences between high- and low-velocity training groups. High- and low-velocity training achieved similar improvements in functional performance and disability. Improvements in functional performance and disability were modest compared with robust increases in strength and power. Specific modes of training or behavioral strategies may be necessary to optimize improvements in these outcomes.
  American Journal of Physical Medicine & Rehabilitation 09/2003; 82(8):605-13. · 1.58 Impact Factor
• Article: Training Physicians to Conduct Physical Activity Counseling

  Bess H. Marcus, Michael G. Goldstein, Alan Jette, Laurey Simkin-Silverman, Bernardine M. Pinto, Felise Milan, Richard Washburn, Kevin Smith, William Rakowski, Catherine E. Dubé
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  ABSTRACT: Background.In accordance with the U.S. Preventive Services Task Force recommendations, the current pilot study tests the feasibility and efficacy of a physician-delivered physical activity counseling intervention.Methods.A sequential comparison group design was used to examine change in self-reported physical activity between experimental (counseling and self-help materials) and control (usual care) patients at baseline and 6 weeks after the initial office visit. Patients in both groups were contacted by telephone 2 weeks after their office visit and asked about the physical activity counseling at their most recent physician visit. Experimental patients also received a follow-up appointment to discuss physical activity with their physician 4 weeks after their initial visit.Results.Counseling was feasible for physicians to do and produced short-term increases in physical activity levels. Both groups increased their physical activity, but the increase in physical activity was greater for patients who reported receiving a greater number of counseling messages.Conclusions.Physician-delivered physical activity interventions may be an effective way to achieve widespread improvements in the physical activity of middle-aged and older adults.
  Preventive Medicine.