I-Ping Hsueh

National Taiwan University, T’ai-pei, Taipei, Taiwan

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Publications (42)116.84 Total impact

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    ABSTRACT: The group-level responsiveness of the Stroke Rehabilitation Assessment of Movement measure (STREAM-30) is similar to that of the simplified STREAM (STREAM-15), even though the STREAM-30 has twice as many items as those of the STREAM-15. To compare the responsiveness of the STREAM-30 and STREAM-15 at both group and individual levels in patients with stroke. For the latter level, the Rasch-calibrated 27-item STREAM (STREAM-27) was used because the individual-level indices of the STREAM-30 could not be estimated. Repeated-measurements design. In total, 195 patients were assessed with the STREAM-30 at both admission and discharge. The Rasch scores of the STREAM-27 and STREAM-15 were estimated from the patients' responses on the STREAM-30. We calculated the paired t test, effect size, and standardized response mean as the indices of group-level responsiveness. The significance of change for each patient was estimated as the individual-level responsiveness index, and the paired t test and test of marginal homogeneity were used for individual-level comparisons between the STREAM-27 and STREAM-15. At the group level, the STREAM-30, STREAM-27, and STREAM-15 showed sufficient and comparable responsiveness. At the individual level, the STREAM-27 detected significantly more patients with significant improvement and fewer patients with no change or deterioration than the STREAM-15 did. Few patients with subacute stroke showed deterioration at discharge, so the abilities of the two measures to detect deterioration remain inconclusive. The STREAM-27 detected more patients with significant recovery than the STREAM-15 did, although the group-level responsiveness of the two measures was the same. The STREAM-27 is recommended as an outcome measure to demonstrate the treatment effects of movement and mobility for patients with stroke. © 2015 American Physical Therapy Association.
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    ABSTRACT: Objectives: To develop a computerized Digit Vigilance Test (C-DVT) with lower random measurement error than that of the DVT and to examine the concurrent validity, ecological validity, and test-retest reliability of the C-DVT in patients with stroke. Design: A cross-sectional study. Patients: Forty-four patients with stroke. Methods: We developed and tested the C-DVT. To examine the psychometric properties, the participants completed both the C-DVT and DVT twice with a 14-day interval. Results: We developed the C-DVT on the basis of expert input and examinee feedback. C-DVT scores were highly correlated with DVT scores (ρ = 0.75), supporting the concurrent validity. The C-DVT scores were moderately correlated with the scores of the Barthel Index and the Activities of Daily Living Computerized Adaptive Testing system (ρ = -0.60~-0.57), supporting the ecological validity. The test-retest agreement of the C-DVT was excellent (intra-class correlation coefficient = 0.92). The random measurement error of the C-DVT (minimal detectable change percent change (MDC%) = 15.4%) was acceptable and lower than that of the DVT (33.0%). The practice effects of the C-DVT were statistically significant, but the effect size d was small (0.15). Conclusion: A C-DVT with a limited amount of random measurement error was developed. These preliminary findings show that the C-DVT demonstrates satisfactory concurrent validity, ecological validity, and test-retest reliability in patients with stroke.
    Journal of Rehabilitation Medicine 02/2015; 47(4). DOI:10.2340/16501977-1945 · 1.90 Impact Factor
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    ABSTRACT: The Barthel Index (BI) assesses actual performance of activities of daily living (ADL). However, comprehensive assessment of ADL functions should include two other constructs: self-perceived difficulty and ability.
    PLoS ONE 10/2014; 9(10):e110494. DOI:10.1371/journal.pone.0110494 · 3.53 Impact Factor
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    ABSTRACT: Abstract Objectives: To investigate practice effect and test-re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke. Design: Single-group repeated measures design. Methods: Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: 'basic measures of attention and processing speed', 'selective attention', 'alternating attention', 'ability of inhibition' and 'ability of switching'. Results: The five indices of the FDT showed trivial-to-small practice effects (Cohen's d = 0.03-0.47) and moderate-to-excellent test-re-test reliability (intra-class correlation coefficient = 0.59-0.97). Practice effects of the five indices all appeared cumulative, but one index, 'basic measures of attention and processing speed', reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [-17.6, 11.2]. Conclusions: One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual's score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.
    Brain Injury 09/2014; 28(13-14):1-8. DOI:10.3109/02699052.2014.947618 · 1.86 Impact Factor
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    ABSTRACT: Objective: To examine the intrarater reliability, interrater reliability, and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system (ADL CAT) in patients with stroke. Design: One repeated-measures design (at an interval of 7d) was used to examine the intrarater reliability and interrater reliability of the ADL CAT. For the responsiveness study, participants were assessed with the ADL CAT at admission to the rehabilitation ward and at discharge from the hospital. Setting: Eight rehabilitation units. Participants: Three different (nonoverlapping) groups of patients (N=157) were recruited. Fifty-five and 42 outpatients with chronic stroke participated in the intrarater and interrater reliability studies, respectively; 60 inpatients who had recently had a stroke participated in the responsiveness study. Interventions: Not applicable. Main Outcome Measure: ADL CAT. Results: The intraclass correlation coefficient values were .94 and .80 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The classical test theory based minimal detectable change values were 6.5 and 9.5 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The Kazis' effect size and standardized response mean of the ADL CAT were moderate (.62-.73). Conclusions: The ADL CAT has good intrarater reliability and interrater reliability in outpatients with chronic stroke, and sufficient responsiveness in inpatients with stroke undergoing inpatient rehabilitation. Further investigations on the responsiveness of the ADL CAT in outpatients are needed to obtain more evidence on the utility of the ADL CAT. (C) 2014 by the American Congress of Rehabilitation Medicine
    Archives of Physical Medicine and Rehabilitation 05/2014; 95(11). DOI:10.1016/j.apmr.2014.04.025 · 2.44 Impact Factor
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    ABSTRACT: Background/Purpose Health-related quality of life (HRQOL) is considered an important outcome indicator in substances abuse studies. However, psychometric properties of HRQOL measures are largely unknown in people who abuse heroin. Therefore, the present study aimed to examine data quality, scaling properties, reliability, and construct validity of the 36-Item Short Form healthy survey (SF-36) in people who abuse heroin. Methods A total of 469 people who abuse heroin participated in the study. Data quality was determined by data completeness. Scaling properties were evaluated by item frequency distribution, equivalence of item means and standard deviations, item-internal consistency, and item-discriminant validity (calculating scaling success). Internal consistency was examined using Cronbach's α. Construct validity was examined by investigating convergent validity and divergent validity among the eight scales of the SF-36. Results The results of data quality showed low missing rates (0.0–3.8%) and high completion rates in the scales (91.9–98.7%). The results of scaling assumptions showed good item frequency distribution on each item, roughly equivalent item means and standard deviations within a scale, good item-internal consistency (>0.4) and good scaling success rates (77.5–100%), except on the two scales of bodily pain (BP) and social functioning (SF). Three scales showed ceiling and/or floor effects [i.e., physical functioning (PF), role limitations due to physical problems (RP), and role limitations due to emotional problems (RE)]. Cronbach's α was acceptable (>0.7), except for the BP and SF scales. Construct validity was partially supported by the results of convergent validity and divergent validity. Conclusion The results confirmed good data quality; satisfactory scaling assumptions and internal consistency (except for the BP and SF scales); and generally acceptable construct validity. However, the PF, RP, and RE scales showed ceiling and/or floor effects. Therefore, the BP, SF, PF, RP, and RE scales should be used with cautions in measuring HRQOL in people who abuse heroin.
    Journal of the Formosan Medical Association 04/2014; 113(4):234–241. DOI:10.1016/j.jfma.2012.05.010 · 1.70 Impact Factor
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    ABSTRACT: Abstract Objective: To examine the measurement properties of Test of Everyday Attention (TEA) in patients with chronic stroke including: test-retest reliability between parallel forms (i.e. forms AB, BC and CA), practice effect and critical values for detecting true change corrected for practice effect and measurement error. Methods: Ninety patients with chronic stroke (months since onset >6) were randomly assigned to receive forms AB, BC or CA of the TEA in a counterbalanced order. A test-retest design was used with a 1-week interval. Results: All TEA sub-tests had good-to-excellent test-retest reliability among the three parallel forms except the Telephone Search While Counting (ICC = 0.51-0.59). Small practice effects were observed for almost all sub-tests. The reliable change index corrected for practice effect (RCIp) was provided for each sub-test. Conclusions: Most TEA sub-tests show promise as reliable measures of attention for repeated use with the parallel forms in patients with chronic stroke. Practice effects must be considered to interpret an individual change in clinical settings. Therefore, the value of RCIp provides a conservative estimate of a patient's progress, representing the smallest change in the TEA score that could be interpreted as true change, corrected for practice effects and measurement error.
    Brain Injury 07/2013; 27(10). DOI:10.3109/02699052.2013.775483 · 1.51 Impact Factor
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    ABSTRACT: BACKGROUND: The group-level responsiveness of the Postural Assessment Scale for Stroke Patients (PASS) is similar to that of the short form PASS (SFPASS). This result is counterintuitive because the PASS has more items (12) and response levels (4) than does the SFPASS (5 items and 3 response levels). OBJECTIVE: To compare individual-level responsiveness between both measures to determine whether the SFPASS can detect change as sensitively as the PASS. STUDY DESIGN AND SETTING: 251 patients were assessed using the PASS at 14 and 30 days after stroke onset in a medical center. METHODS: The SFPASS scores were calculated from the patients' responses on the PASS. We calculated individual-level responsiveness on the basis of the value of minimal detectable change (MDC). If a patient's change score was greater than the MDC of the PASS or SFPASS, his/her improvement was considered significant. We examined the difference of the number of patients scoring greater than the MDC and the units of MDC (the MDC ratio) improved by the patients on both measures. RESULTS: 53.0% of the patients scored greater than the MDC of the PASS, while 43.0% of the patients scored greater than the MDC of the SFPASS. The difference was significant. The mean MDC ratio of the PASS (1.8±1.7) was significantly higher than that of the SFPASS (1.2±1.3). LIMITATIONS: The scores of the SFPASS were retrieved from those of the PASS, which limits the generalization of our findings. CONCLUSION: The PASS has better individual-level responsiveness than does the SFPASS. To comprehensively report effects of clinical trials, future studies using the PASS should report the individual-level effect (e.g., number of patients scoring greater than the MDC).
    Physical Therapy 05/2013; 93(10). DOI:10.2522/ptj.20130042 · 3.25 Impact Factor
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    ABSTRACT: BACKGROUND: The responsiveness and predictive validity of the Hierarchical Balance Short Forms (HBSF) in patients with stroke is unknown, which limits the HBSF's utility in both clinical and research settings. OBJECTIVE: The purpose of this study was to investigate the responsiveness and predictive validity of the HBSF in inpatients with stroke receiving rehabilitation. DESIGN: A prospective cohort study was conducted. METHOD: Sixty-six participants completed both the 6-item HBSF and the 12-item Postural Assessment Scale for Stroke patients (PASS) after admission to the rehabilitation ward and before hospital discharge. Effect size (ES) and standardized response mean (SRM) were used to investigate the internal responsiveness of the HBSF and PASS. The changes in the Barthel Index (BI) and the mobility subscale of the Stroke Rehabilitation Assessment of Movement (MO-STREAM) were used as the external criteria for examining external responsiveness. Moreover, the admission scores of the HBSF and PASS and the discharge scores of the BI and MO-STREAM were analyzed to investigate the predictive validity of the two balance measures. RESULTS: The internal responsiveness of the HBSF was high (ES>0.9; SRM>1.6). The SRM of the HBSF was significantly larger than that of the PASS, whereas the ES of the HBSF was not significantly larger than that of the PASS. The external responsiveness and predictive validity of the HBSF were sufficient and similar to those of the PASS (external responsiveness: r≧0.35; predictive validity: r≧0.67). LIMITATIONS: The convenience sampling of inpatients with stroke may limit the generalization of the results. CONCLUSIONS: The HBSF has sufficient responsiveness and predictive validity in inpatients with stroke receiving rehabilitation and is thus recommended for both clinicians and researchers.
    Physical Therapy 02/2013; 93(6). DOI:10.2522/ptj.20120259 · 3.25 Impact Factor
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    ABSTRACT: BACKGROUND: An efficient, reliable, and valid measure for assessing activities of daily living (ADL) function is useful to improve the efficiency of patient management and outcome measurement. OBJECTIVE: To construct a computerized adaptive testing (CAT) system for measuring ADL function for outpatients with stroke. STUDY DESIGN AND SETTING: Two cohort studies at six hospitals in Taiwan. METHODS: We developed a candidate item bank (44 items) and interviewed 643 outpatients. Then we fitted an item response theory model to the data and estimated the item parameters (e.g., difficulty and discrimination) for developing the ADL CAT. Another sample of 51 outpatients was interviewed to examine the concurrent validity and efficiency of the CAT. OUTCOME MEASURES: The ADL CAT, as the outcome measure, and the Barthel index (BI) and Frenchay Activities index (FAI) were administered on the second group of participants. RESULTS: Ten items did not satisfy the model's expectations and were deleted. Thirty-four items were included in the final item bank. We set 2 stopping rules (i.e., reliability coefficient >0.9 or =7 items) for the CAT. The patients' ADL scores had an average reliability of 0.93. The CAT scores were highly associated with those of the full 34 items (Pearson's r=0.98). The scores of the CAT were closely correlated with those of the combined BI and FAI (r=0.82). The time required to complete the CAT was about 1/5 of the time used to administer both the BI and FAI together. LIMITATIONS: The participants were outpatients living in the community. Further studies are needed to cross-validate the results. CONCLUSIONS: Our results demonstrated that the ADL CAT is quick to administer, reliable, and valid in outpatients with stroke.
    Physical Therapy 01/2013; 93(5). DOI:10.2522/ptj.20120173 · 3.25 Impact Factor
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    ABSTRACT: To examine the test-retest reliability, convergent validity, and predictive validity of the comprehensive activities of daily living (CADL) measure in patients with stroke. A repeated-assessments design, 10-14 days apart, was used to examine test-retest reliability in 70 patients. In the validity study, a further 168 patients were assessed at 6 months and 1 year after stroke. Three rehabilitation units. The CADL measure, providing Rasch-calibrated scores, assesses the entire continuum of basic and instrumental activities of daily living. Both domains (self-care and mobility) of the stroke-specific quality of life questionnaire (SS-QOL) were used to examine the convergent validity. The summary score of the SS-QOL was used as the criterion for examining the predictive validity of the CADL measure. The test-retest reliability was excellent (intraclass correlation coefficient = 0.96). The CADL measure and both domains of the SS-QOL exhibited strong associations at 6 months and 1 year post-stroke (Pearson's r ≥ 0.77). The score of the CADL at 6 months post-stroke was highly correlated with that of the SS-QOL at 1 year post-stroke (r = 0.75). The CADL measure showed satisfactory test-retest reliability, convergent validity, and predictive validity in patients with stroke.
    Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2012; 44(8):637-41. DOI:10.2340/16501977-1004 · 1.88 Impact Factor
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    ABSTRACT: To develop a computerized adaptive testing system of the Fugl-Meyer motor scale (CAT-FM) to efficiently and reliably assess motor function in patients with stroke. First, a simulation study was used to develop and examine the psychometric properties of the CAT-FM. Second, a field study was employed to determine the administration efficiency of the CAT-FM. One medical center and 1 teaching hospital. Patients' responses (n=301) were used for the simulation study; 49 patients participated in the field study. Not applicable. The 2 CAT-FM item banks (upper extremity and lower extremity) include 37 items from the original Fugl-Meyer scale. The reliability, validity, and responsiveness of the CAT-FM were determined by the simulation study. Two stopping rules (reliability ≥0.9 or an increase of reliability <.01 after testing an item) were used. The simulation study showed that the CAT-FM had high reliability (≥.93 for upper-extremity and lower-extremity subscales) and concurrent validity (Pearson r≥.91 for the upper-extremity and lower-extremity subscales and motor scale). The responsiveness was moderate (standardized response mean for the upper extremity=.67, lower extremity=.79, and motor=.77) for the 226 patients who completed both assessments at 14 and 90 days after stroke. The field study found that, on average, the time needed to administer the CAT-FM was 242 seconds with 4.7 items. The CAT-FM is an efficient, reliable, valid, and responsive clinical tool for assessing motor function in patients with stroke.
    Archives of physical medicine and rehabilitation 03/2012; 93(6):1014-20. DOI:10.1016/j.apmr.2011.12.005 · 2.18 Impact Factor
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    ABSTRACT: Patient perceived health care quality is a key indicator of health service quality. However, so far in Taiwan, no measure assesses the health care quality of Occupational Therapy services, leading serious impact on the promotion of occupational therapy quality. The purpose of the present study was to elaborate a generic methodology for developing the domains and items of Patient’s Review on Occupational Therapy for Stroke patients questionnaire (PROTS) for further psychometric testing. The procedure included 3 steps: (a) reviewing related literature and carrying out clinical interviews to develop preliminary domains and items; (b) consulting with the expert group to establish content validity of the PROTS; (c) conducting cognitive interviews with stroke patients or their main caregivers to establish the face validity of the PROTS. Finally, the PROTS pre-testing version was consisted of 102 items for 8 domains: Staff ’s attitude (14 items), Staff ’s ability (31 items), Information (8 items), Consistency of care (13 items), Timely care (9 items), Psychosocial support (6 items), Environment (11 items), and Discharge prepare/Home care guidance (10 items). The PROTS will be applied in further survey to establish its reliability and construct validity. The PROTS can be used to improve the health care quality of occupational therapy.
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    ABSTRACT: To compare the responsiveness and predictive validity of the Balance Computerized Adaptive Test (Balance CAT) and the Postural Assessment Scale for Stroke patients (PASS) in inpatients with stroke receiving rehabilitation. A pre-post test design. Eighty-five inpatients after stroke. Effect size d and Wilcoxon signed-rank test were used to assess the internal responsiveness of the Balance CAT and PASS. The changes in the Barthel Index (BI) and the mobility subscale of the Stroke Rehabilitation Assessment of Movement (MO-STREAM) scores were both chosen as the external criteria for examining external responsiveness. Moreover, to investigate the predictive validity, the admission scores of the two balance measures, and the discharge score of the BI/MO-STREAM, were examined by simple linear regression analysis. Both the Balance CAT and PASS had high internal responsiveness (effect size d ≥ 0.87) and fair external responsiveness (r(2) ≥ 0.20). The predictive validities of both measures were sufficient (r(2) ≥ 0.33). The Balance CAT took approximately 3 items (min-max = 2-4) to complete. The Balance CAT and PASS have sufficient responsiveness and predictive validity in inpatients with stroke receiving rehabilitation. The Balance CAT is more efficient to administer and is thus recommended over the PASS.
    Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 11/2011; 44(2):176-80. DOI:10.2340/16501977-0903 · 1.88 Impact Factor
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    ABSTRACT: To develop a set of 3 hierarchical balance short forms (HBSF; containing sitting, standing, and stepping forms) to measure balance function in patients with stroke. First, we developed the HBSF, based on a previous data set, with each short form containing 6 items. Second, we examined the psychometric properties and efficiency of the HBSF. Six teaching hospitals. Patients with stroke (n=764) for the first part of this study; inpatients and outpatients (n=85) for the second part of this study. Not applicable. We used the item bank (9 sitting-related, 14 standing-related, and 13 stepping-related items) from the Balance Computerized Adaptive Test to develop the HBSF. Both the HBSF and the Berg Balance Scale (BBS) were administered to patients, to determine the concurrent validity and time needed for administration of both measures. Each patient was assessed by 1 of the 3 short forms selected by a rater. The reliability of the HBSF was relatively high (reliability coefficients, .94-.95). The scores of the HBSF were highly correlated with those of the BBS (Spearman ρ=.80-.91), supporting the concurrent validity of the HBSF. The average time needed to administer the HBSF was 122 seconds (ie, about 40% of that for the BBS). Our results provide sufficient evidence that the HBSF is an efficient, reliable, valid, and practical way to measure balance function in patients with stroke.
    Archives of physical medicine and rehabilitation 07/2011; 92(7):1119-25. DOI:10.1016/j.apmr.2011.02.012 · 2.18 Impact Factor
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    ABSTRACT: To investigate the construct validity of the commonly used 8- and 12-domain versions of the Stroke-Specific Quality of Life (SS-QOL) with a first-order factor model. The better-fitted version was further evaluated by a second-order factor structure model in order to determine whether a summary score is justified. Cohort study. Outpatient stroke clinic. Patients (N=388) with ischemic stroke. Not applicable. The SS-QOL. We first conducted confirmatory factor analysis (CFA) to evaluate the construct validity of the first-order 8- or 12-domain versions of the SS-QOL. The better-fitted version was then validated by investigating the second-order health-related quality of life (HRQOL) factor. The 12-domain version, but not the 8-domain version, had sufficient goodness of fit (χ(2)=2041.7, df=1061, χ(2)/df=1.9, comparative fit index [CFI]=0.98, Tucker-Lewis index [TLI]=0.98, and root mean square error of approximation=0.05). All items of the 12-domain version showed acceptable factor loadings (>0.40) and were retained. Furthermore, the second-order CFA fit indices of the 12 domains were acceptable (χ(2)=2630.3, df=1115, χ(2)/df=2.4, CFI=0.97, TLI=0.97, root mean square error of approximation=0.06), indicating that a summary score was justified for representing the overall status of HRQOL. Our results show that the construct validity of the 12-domain SS-QOL is well supported for measuring HRQOL in ischemic stroke patients. Thus, we recommend the 12-domain version of the SS-QOL for use in capturing the multiple impacts of stroke as well as overall HRQOL status on the basis of patients' perspectives.
    Archives of physical medicine and rehabilitation 07/2011; 92(7):1113-8. DOI:10.1016/j.apmr.2011.02.008 · 2.18 Impact Factor
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    ABSTRACT: The Symbol Digit Modalities Test (SDMT) is commonly used to evaluate an individual's switching attention and processing speed. However, its test-retest reliability and practice effect are not well known in patients with stroke, limiting its utility in both clinical and research settings. The present study examined the two aforementioned psychometric properties of the oral-format SDMT on a group of 30 outpatients with stroke. The oral-format SDMT demonstrated excellent test-retest reliability (ICC = 0.89) and a small practice effect (Cohen's d = 0.26) within a 1-week interval. A practice effect-corrected reliable change index [-5.29, 10.89] was also provided to help clinicians and researchers interpret their clients' test results. Patients' characteristics and the test-retest interval should be considered before applying the findings of the present study to clinical settings.
    Archives of Clinical Neuropsychology 06/2011; 26(4):356-63. DOI:10.1093/arclin/acr029 · 2.00 Impact Factor
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    ABSTRACT: Clinical stroke trials have been increasing interest in patient-centred assessments such as functional status and health-related quality of life. There is a consensus that these measurement factors must be relevant to, and obtained from, the patients of interest. The main purpose of this study was to evaluate the patients' reactions and concerns that individuals experience after having had a stroke. A focus group and individual interviews were conducted to identify and describe the patients' reactions to living with the results of a stroke. One hundred twelve patients participated in the study. Fifteen factors were identified as problems for the 112 participants. For the level of impact and importance, the highest percentages of responses rated by the participants in each factor were all towards the physical aspects of functioning such as hand/arm function and mobility. These findings provide important information on the impact of stroke that could be useful for occupational therapists in treatment planning and outcome measurement. Further research is recommended to understand the impact of a stroke on an individual's adjustment at home and in the community.
    Occupational Therapy International 09/2010; 17(3):152-8. DOI:10.1002/oti.301 · 0.67 Impact Factor
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    ABSTRACT: An efficient and precise measure of balance is needed to improve administration efficiency and to reduce the assessment burden for patients. The purpose of this study was to develop a computerized adaptive testing (CAT) system for assessing balance function in an efficient, reliable, and valid fashion in patients with stroke. Two cross-sectional prospective studies were conducted. This study was conducted in the departments of physical medicine and rehabilitation in 6 hospitals. The participants were inpatients and outpatients who were receiving rehabilitation. A balance item pool (41 items) was developed on the basis of predefined balance concepts, expert opinions, and field testing. The items were administered by 5 raters to 764 patients. An item response theory model was fit to the data, and the item parameters were estimated. A simulation study was used to determine the performance (eg, reliability, efficiency) of the Balance CAT. The Balance CAT and the Berg Balance Scale (BBS) then were tested on another independent sample of 56 patients to determine the concurrent validity and time needed for administration. Seven items did not meet the model's expectations and were excluded from further analysis. The remaining 34 items formed the item bank of the Balance CAT. Two stopping rules (ie, reliability coefficient > 0.9 or < or = 6 items) were set for the CAT. The simulation study showed that the patients' balance scores estimated by the CAT had an average reliability value of .94. The scores obtained from the CAT were closely associated with those of the full item set (Pearson r=.98). The scores of the Balance CAT were highly correlated with those of the BBS (Pearson r=.88). The average time needed to administer the Balance CAT (83 seconds) was only 18% of that of the BBS. The convenience sampling of both samples may limit the generalization of the results. Further psychometric investigation of the Balance CAT is needed. The results provide strong evidence that the Balance CAT is efficient and has reliability and validity for patients with stroke.
    Physical Therapy 09/2010; 90(9):1336-44. DOI:10.2522/ptj.20090395 · 3.25 Impact Factor

Publication Stats

671 Citations
116.84 Total Impact Points

Institutions

  • 2006–2015
    • National Taiwan University
      • School of Occupational Therapy
      T’ai-pei, Taipei, Taiwan
    • University of Queensland 
      • School of Health and Rehabilitation Sciences
      Brisbane, Queensland, Australia
    • Jen-Teh Junior College Of Medicine, Nursing And Management
      Miao-li-chieh, Taiwan, Taiwan
  • 2007
    • National Cheng Kung University
      • Institute of Cognitive Science
      臺南市, Taiwan, Taiwan
  • 2004–2007
    • Chung Shan Medical University
      臺中市, Taiwan, Taiwan
    • Kaohsiung Medical University
      • Department of Physical Therapy
      Kaohsiung, Kaohsiung, Taiwan
  • 2003–2004
    • DePaul University
      • Department of Psychology
      Chicago, Illinois, United States