Unilateral and bilateral upper limb dysfunction at body functions, activity and participation levels in people with multiple sclerosis.

BACKGROUND: There has been limited research on upper limb dysfunction in people with multiple sclerosis (PwMS). OBJECTIVE: The objective of this paper is to study unilateral and bilateral upper limb dysfunction at different International Classification of Functioning (ICF) levels according to overall disability in PwMS. METHODS: A total of 105 PwMS (16 with EDSS<4 (mild); 17 with EDSS 4-5.5 (moderate); 37 with EDSS 6-6.5 (severe); 35 with EDSS>6.5 (severe non-ambulant)) were recruited from two rehabilitation centers and assessed in a cross-sectional study. RESULTS: The whole sample showed a diminished sensory function (median (first/third interquartile)) score of 3 (2/3) on the Monofilament Test and a reduced strength 91 (76/100) points on the Motricity Index (Body-Function level). Sensory dysfunction did not increase with higher EDSS while strength decreased from 100 (86/100) in the mild subgroups to 91 (80/100) points in the severe subgroup. All showed diminished dexterity, scoring 0.28 peg/s (0.17/0.35) on the Nine-Hole Peg Test (NHPT) (activity level). Score was better for the mild (0.38 (0.35/0.46)) peg/s compared to the severe subgroup (0.28 (0.17/0.35)). Sixty-eight percent, 44% and 75% of PwMS showed bilateral disorders in sensation, strength and dexterity, respectively. The Community Integration Questionnaire (participation level) showed a 35% reduction in home activities, even among PwMS with EDSS<4. CONCLUSION: This study showed uni-/bilateral upper limb abnormalities at all ICF levels increasing with the overall disability.

Kessler Foundation Neglect Assessment Process uniquely measures spatial neglect during activities of daily living.

OBJECTIVES: To explore the factor structure of the Kessler Foundation Neglect Assessment Process (KF-NAP), and evaluate the prevalence and clinical significance of spatial neglect among stroke survivors. DESIGN: Inception cohort. SETTING: Inpatient rehabilitation facility (IRF). PARTICIPANTS: Participants (N=121) with unilateral brain damage from their first stroke were assessed within 72 hours of admission to an IRF, and 108 were assessed again within 72 hours before IRF discharge. INTERVENTIONS: Usual and standard IRF care. MAIN OUTCOME MEASURES: During each assessment session, occupational therapists measured patients' functions with the KF-NAP, FIM, and Barthel Index (BI). RESULTS: The KF-NAP showed excellent internal consistency with a single-factor structure. The exploratory factor analysis revealed the KF-NAP to be unique from both the FIM and BI even though all 3 scales were correlated. Symptoms of spatial neglect (KF-NAP>0) were present in 67.8% of the participants at admission and 47.2% at discharge. Participants showing the disorder at IRF admission were hospitalized longer than those showing no symptoms. Among those presenting with symptoms, the regression analysis showed that the KF-NAP scores at admission negatively predicted FIM scores at discharge, after controlling for age, FIM at admission, and length of stay. CONCLUSIONS: The KF-NAP uniquely quantifies symptoms of spatial neglect by measuring functional difficulties that are not captured by the FIM or BI. Using the KF-NAP to measure spatial neglect, we found the disorder persistent after inpatient rehabilitation, and replicated previous findings showing that spatial neglect adversely affects rehabilitation outcome even after prolonged IRF care.

Associations of upper limb disability measures on different levels of the International Classification of Functioning, Disability and Health in people with multiple sclerosis.

BACKGROUND: It is unknown how impairments caused by multiple sclerosis (MS) affect upper limb capacity, performance, and community integration. OBJECTIVE: The aim of this study was to investigate the extent to which impairments explained the variance in activity level and participation level measures of the International Classification of Functioning, Disability and Health (ICF) and the extent to which upper limb capacity measures explained perceived performance on the activity level in people with MS and different dexterity levels. DESIGN: This was a cross-sectional study. METHODS: A total of 105 people with MS (median Expanded Disability Status Scale=6.5) were assessed with measures on the ICF body functions and structures level (strength, active range of motion of the wrist, tactile sensitivity, tremor, spasticity, and pain), activity level (Nine-Hole Peg Test [NHPT], Action Research Arm Test, and Manual Ability Measure-36 [MAM-36]), and participation level (Community Integration Questionnaire). The sample was divided into low- and high-dexterity subgroups on the basis of the median score on the NHPT. RESULTS: In the total group, muscle strength, tactile sensitivity of the thumb, and intention tremor explained 53% to 64% of the variance in activity level measures. In the low-dexterity subgroup, muscle strength and active range of motion explained 43% to 71% of the variance in activity level measures. In the high-dexterity subgroup, only 35% of the variance in the MAM-36 was explained by muscle strength. Capacity measures (NHPT and Action Research Arm Test) were moderately to highly associated with perceived performance (MAM-36) in the low-dexterity subgroup. LIMITATIONS: Some outcome measures showed ceiling effects in people with MS and a high dexterity level. CONCLUSIONS: Upper limb muscle strength is the most important impairment affecting capacity and perceived performance in daily life. Associations among outcome measures differ in people with MS and different dexterity levels.

Balance ability measured with the Berg balance scale: a determinant of fall history in community-dwelling adults with leg amputation.

OBJECTIVE: Falls are common among adults with leg amputations and associated with balance confidence. But subjective confidence is not equivalent with physical ability. This multivariate analyses of community-dwelling adults with leg amputations examined relationships among individual characteristics, falls, balance ability and balance confidence. DESIGN: Cross-sectional study. SUBJECTS/PATIENTS: Community-dwelling adults with leg amputations recruited from a support group and prosthetic clinic. METHODS: Subjects provided self-reported medical/fall history, prosthetic functional use, and Activities-specific Balance Confidence (ABC) questionnaire data. Balance ability was assessed with the Berg Balance Scale (BBS). Fall incidence was categorized as any fall (one or more) and recurrent falls (more than one). Multivariate logistic regression analyzed relationships within the two fall categories. Cross tabulations and ANOVA analyzed differences among subcategories. RESULTS: Fifty-four subjects (mean age 56.8) with various etiologies, amputation levels, and balance abilities participated. 53.7% had any fall; 25.9% had recurrent falls. Models for both fall categories correctly classified fall history in > 70% of subjects with combinations of the variables ABC, BBS, body-mass-index, and amputation level. CONCLUSION: Falls occurred regardless of clinical characteristics. Total BBS and select item scores were independent determinants of fall history. Unlike other balance-impaired populations, adults with leg amputation and better balance ability had greater odds of falling.

Responsiveness of the Manual Ability Measure-36 (MAM-36): changes in hand function using self-reported and clinician-rated assessments.

OBJECTIVE. To examine the responsiveness of the Manual Ability Measure-36 (MAM-36) compared with a clinician-administered functional assessment. METHOD. The MAM-36 was administered to 46 patients (Cohort A, n = 20; Cohort B, n = 26) with various upper-extremity conditions. All patients received occupational therapy intervention for 2-37 wk and were retested at discharge. Additionally, the Smith Hand Function Test (SHFT), including task performance speeds and grip strength measurements, was administered to Cohort B at intake and discharge. RESULTS. Manual ability improved significantly at discharge in all patients. Patients also showed significant improvement on the SHFT. The correlation between gain in MAM-36 and gain in grip strength was moderate. The standardized response mean for the MAM-36 was 1.18. CONCLUSION. The MAM-36 was responsive to changes in hand function in patients receiving occupational therapy services. MAM-36 results correlated positively with improvements in task performance speeds and grip strength.

Role of balance ability and confidence in prosthetic use for mobility of people with lower-limb loss.

For people with lower-limb loss, impaired balance is common and limits prosthetic function within the community. This cross-sectional study (1) analyzed relationships among prosthetic use for mobility, balance ability and confidence, and amputation-related variables and (2) determined multivariate models to identify level of prosthetic use. Subjects included 46 community-dwelling adults (mean age 56.2 yr) with limb loss (91.3% unilateral) of varied levels (52.2% transtibial) and etiologies (69.6% vascular). A three-variable linear regression model including balance ability, balance confidence, and years since amputation explained 63.7% of variance in the Houghton scale of prosthetic use score. A logistic regression model including the 14-task Berg Balance Scale, balance confidence, years since amputation, age, and number of comorbidities correctly differentiated between people who had reached a satisfactory level of prosthetic use or not 89.1% of the time. The first three variables demonstrated moderate accuracy with positive likelihood ratios from 2.34 to 4.35. The regression model was further reduced to correctly classify 87.0% of cases with three balance ability tasks (retrieving objects from floor, turning to look behind, and placing alternate foot on stool), balance confidence, and numbers of comorbidities. Logistic models that include balance ability, balance confidence, and numbers of comorbidities can identify level of prosthetic use in people with lower-limb loss. Increased balance confidence and ability when retrieving objects from floor, turning to look behind, and placing alternate foot on stool were most indicative of successful prosthetic use for mobility.

What do clinicians need from a rehabilitation treatment taxonomy? An alternate approach for describing treatment content versus process.

Clinician feedback and thought processes about treatment classification and description will aid development of the rehabilitation treatment taxonomy (RTT) presented in this supplement. Here, we discuss comparisons between the proposed RTT and an inductive practice-based evidence (PBE) model used to describe rehabilitation treatments. Interviews with clinicians well versed with PBE highlight the complexity of rehabilitation treatments, and bring to light potential advantages and challenges of a deductive, theory-driven classification to uncover the black box of rehabilitation.

Preliminary assessment of balance with the Berg Balance Scale in adults who have a leg amputation and dwell in the community: Rasch rating scale analysis.

BACKGROUND: Self-report measures of balance and multidimensional mobility assessments are common for people with a leg amputation, yet clinical assessment of balance ability remains less explored. The Berg Balance Scale (BBS), typically used for other populations with impaired balance, has been used for young people with a high level of functioning after traumatic amputation but rarely for older people after vascular amputation. OBJECTIVE: The study objective was to examine the psychometric properties of the BBS with Rasch rating scale analysis to determine the validity and utility of the BBS in assessing balance ability in adults who have a leg amputation and dwell in the community. DESIGN: Rating scale analysis was applied to BBS scores obtained from a single assessment. METHODS: Adult volunteers (men and women) who had a leg amputation (any level and etiology) and dwelled in the community were recruited from a hospital-based community support group and a prosthetic clinic. Rating scale analysis of the BBS was used to assess unidimensionality, internal validity, goodness of fit, structural integrity, and person and item analyses. RESULTS: The study participants were 40 people (26 men and 14 women; 57.8 [SD=9.7] years old) with leg amputations (24 transtibial, 13 transfemoral, and 3 bilateral) of mixed etiology (32 vascular and 8 nonvascular). The psychometric properties of the BBS confirmed that it measures the unidimensional construct of balance ability with adequate validity and with goodness of fit and structural integrity that meet the acceptability criteria. Person measures revealed that some participants scored near the top of the BBS, suggesting a ceiling effect; item measures revealed that participants with leg amputations had the most difficulty performing the following tasks: standing with 1 leg in front, turning 360 degrees, and placing alternate foot on a stool. LIMITATIONS: Limitations included a convenience sample and a lack of rater reliability testing. CONCLUSIONS: The BBS cohered with the unidimensional construct of balance ability and had strong internal validity for use in a variety of people with leg amputations.

The development and preliminary validation of the Taiwanese Manual Ability Measure for Burns.

OBJECTIVE: To develop and validate the Taiwanese Manual Ability Measure for Burns (T-MAM for Burns), a task-oriented functional evaluation tool to assess self-reported manual ability in burn patients. DESIGN: A longitudinal study. PARTICIPANTS: A sample of 45 burn patients from burn rehabilitation centers with varying degrees of hand involvement. METHODS: The preliminary testing version was formed by adding burn specific items to the Taiwanese version of the Manual Ability Measure. A field test was then conducted for item reduction and psychometric properties testing. RESULTS: Out of 55 initial items, 20 were selected into the final version of the T-MAM for Burns. Psychometric analyses indicated that it was reliable (test-retest ICC=.99), with adequate concurrent validity with various other hand function tests (r=-.79 with the short form Disabilities of the Arm, Shoulder, and Hand, or, the QuickDASH) and discriminative validity (significant difference (t=2.99, P=.005) between groups with unilateral vs. bilateral hand burns), and responsive (ES=.24 and .44 at one- and 3-month evaluations). CONCLUSION: This study shows that the T-MAM for Burns has great potential to be a functional outcome measure for burn rehabilitation. Additional research with a larger sample should be conducted to further confirm its validity and reliability.

Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke.

OBJECTIVE: To estimate the smallest real difference (SRD) values of 2 instrumental activities of daily living measures (the Nottingham Extended Activities of Daily Living [NEADL] and the Frenchay Activities Index [FAI]) in patients with chronic stroke. DESIGN: Test-retest reliability study. SETTING: Physical rehabilitation units of 5 hospitals. PARTICIPANTS: Chronic stroke patients (N=52; 37 men, 15 women) who were discharged from the hospital for more than 6 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Both measures were administered twice about 2 weeks apart to participants. The SRD was calculated on the basis of standard error of measurement: SRD = 1.96 × âˆš2 × Standard error of measurement. SRD% (the value of SRD divided by total score of a measure) was used to compare measurement errors across both measures. Reproducibility between successive measurements of the measures was investigated with intraclass correlation coefficients (ICCs). RESULTS: The SRD (SRD%) values of the NEADL and the FAI were 12.0 (21.1%) and 6.7 (14.9%), respectively. Test-retest reproducibility of both measures was high (ICC: NEADL=.89, FAI=.89). CONCLUSIONS: Because of substantial SRD values of the NEADL and the FAI, prospective users should be cautious in using both measures to detect real change for a single subject.

Preoperative enoxaparin is safe to use in major gynecologic surgery for prophylaxis of venous thromboembolism: a retrospective cohort study.

OBJECTIVE: To evaluate the safety of preoperative enoxaparin in patients undergoing major gynecologic oncology surgery. METHODS: We identified a retrospective cohort group of patients undergoing major gynecologic oncology surgery from June 2002 to June 2004. Exclusion criteria included laparoscopic surgery, inferior vena cava filter, history of venous thromboembolism, and current anticoagulation for prior venous thromboembolism. All patients received prophylaxis with sequential pneumatic compression devices and early ambulation. We identified patients who received (preoperative and postoperative) enoxaparin (20-40 mg) and compared them to patients who received no additional prophylaxis other than pneumatic compression alone. Patient outcomes including estimated blood loss, blood transfusions, operative time, and length of hospital stay were collected. Statistical analysis was performed using the χ Wilcoxon rank sum tests. This study was approved by the institutional review board. RESULTS: We identified 122 patients who met our study criteria; there were 63 patients who received preoperative enoxaparin and 59 patients who received no additional prophylaxis. Both groups were similar in age, body mass index, race, comorbidities, cancer diagnosis, and surgical procedure. There was no significant difference between the enoxaparin group and the sequential pneumatic compression devices-only group regarding transfusion rates (29% and 27%; P = 0.86), operating time (150 and 140 minutes; P = 0.16), blood loss greater than 500 cc (35% and 37%; P = 0.79), and length of stay (5 vs 6 days). CONCLUSION: The use of preoperative enoxaparin is not associated with increased blood loss, transfusion requirements, operative time, or hospital stay among patients having major gynecologic surgery.

Factors influencing therapists' decision-making in the acceptance of new technology devices in stroke rehabilitation.

OBJECTIVE: The aims of this study were to identify factors or barriers in therapists' decisions to acquire and use new technology devices (NTDs) and to examine rating differences across therapy disciplines. DESIGN: Literature review, key informant interviews, and focus group sessions were conducted to define a conceptual framework of acceptance/resistance of NTDs and to develop survey items. The survey was subsequently mailed to therapists. RESULTS: The survey responses showed that billability of services, having a sufficient caseload using a device, and initial cost were the most important factors in acquisition decisions; that patient acceptance, suitability for the setting, and logistics were the most important factors in use decisions; and that negative patient outcomes, problems with reimbursement, and perceived lack of patient interest were the most significant barriers to their use. Patient safety, motivation, and cognition were the most important patient considerations in the therapist's decision to use NTDs with a particular patient, whereas lack of progress, unavailability of the participants post discharge, and requiring too much patient effort were the most significant barriers to the use of NTDs with particular patients. Some rating variations existed across disciplines. CONCLUSIONS: This study confirmed that rehabilitation therapists consider clinical and practical factors, as well as the match between the patient and the device, when making acquisition and use decisions of NTDs. Research and education implications were discussed.

Psychometric validation of the Manual Ability Measure-36 (MAM-36) in patients with neurologic and musculoskeletal disorders.

OBJECTIVES: To evaluate the psychometric properties of the Manual Ability Measure-36 (MAM-36), a new hand function outcome measure, and to examine differences in manual abilities and item parameters in patients with neurologic and musculoskeletal conditions. DESIGN: Convenience sample from 2 time periods, cross-sectional. SETTING: Outpatient rehabilitation units and private hand clinics. PARTICIPANTS: Patients (N=337; mean age, 50.3+/-14.9y) with a variety of neurologic and musculoskeletal (orthopedic) diagnoses. Most of these individuals were community dwelling, and all had residual functional limitations in the hand(s). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rasch analysis was performed on MAM-36 data to evaluate both scale structure and psychometric properties, which include rating distribution, step measures, item fit, separation, and dimensionality. A t test was performed to examine the differences in manual abilities in patients with the 2 conditions. Uniform differential item functioning (DIF) between neurologic and musculoskeletal groups was examined. (DIF occurs when subgroup members within the sample with the same level of the underlying trait being measured respond differently to an individual item.) Manual ability estimates were recalibrated with step and common item anchoring; they were compared with those derived from the original analysis. RESULTS: The 36 items measured a single construct with no misfitting items. The scale was used as intended. The items can reliably separate the participants into 5 ability strata. Neurologic patients had a significantly lower mean manual ability than musculoskeletal patients. Fourteen items exhibited DIF. However, DIF had no effect on either scale quality or calibration of manual ability. We decided that a single rating scale is appropriate for both groups. CONCLUSIONS: This study showed that the MAM-36 has more than adequate psychometric properties and can be used as a generic outcome measure for patients with a wide variety of clinical diagnoses.

Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke.

OBJECTIVE: To investigate the test-retest reproducibility and smallest real difference (SRD) of 3 hand strength tests (grip, palmar pinch, and lateral pinch) and 2 dexterity tests (the Box and Block test [BBT] and the Nine Hole Peg test [NHPT]) in patients with stroke. METHODS: The 5 tests were administered on 62 stroke patients in 2 sessions, 3 to 7 days apart. The intraclass correlation coefficient (ICC) was used to determine the level of reproducibility between measurements on 2 sessions. The SRD was used to determine the extent of measurement error because of chance variation in individual patients. SRD percentage (SRD relative to mean score) was used to compare test-retest reliability across tests. We analyzed the group as a whole, then in 2 subgroups (hand spasticity vs none). RESULTS: The test-retest reproducibility of all 5 tests was high for all the patients, with ICCs ranging from 0.85 to 0.98. The SRDs for the more/less affected hand were: 2.9/4.7 kg for the grip test; 1.2/1.3 kg for the palmar pinch test; 1.4/1.0 kg for the lateral pinch test; 5.5/7.8 blocks/minute for the BBT; and 32.8/6.2 seconds for the NHPT. Unacceptably high SRD percentages (>30%) were found for the affected hand using the NHPT (54%), palmar pinch (35%), and lateral pinch (34%). When comparing these indices for participants with spasticity versus none for all 5 tests, the ICCs were lower and the SRD and SRD percentage were higher for the spasticity group. CONCLUSIONS: All 5 tests demonstrated satisfactory test-retest reproducibility for a diverse group of patients with stroke. However, all tests showed higher levels of measurement error when performed with the more affected hand and in patients with hypertonicity of that hand. Thus, baseline and postrehabilitation change scores using these common tests of strength and dexterity must be interpreted with some caution, especially in poorly controlled clinical trials. Repeated measures ought to be incorporated to examine reliability within a trial that includes participants with a hypertonic hand.

Relationship between performance-based and self-reported assessment of hand function.

OBJECTIVE: To examine the relationships between self-reported and performance-based hand function. METHOD: Thirty participants with hand function limitations completed the Manual Ability Measure (MAM-36) and the Upper Extremity Performance Test for the Elderly (TEMPA). Participants were categorized into two groups: (1) Dominant Hand Affected and (2) Nondominant Hand Affected. Correlations between the two assessments were examined. The speed of task execution and TEMPA scores were compared between the two groups. RESULTS: A significant correlation was found between the MAM-36 and TEMPA Total Functional Rating (p = 0.79, p < .05). Significant differences were found in the speed of execution of unilateral tasks and the Unilateral Functional Ratings between the two groups. CONCLUSION: The MAM-36 is a promising assessment tool for measuring a client's perceived hand function. However, a performance-based assessment can supplement information about the quality and speed of hand-task performance.

Hand strength and perceived manual ability among patients with multiple sclerosis.

OBJECTIVES: To describe hand function among patients with multiple sclerosis (MS) and to examine the relationship between strength and self-reported abilities. DESIGN: Cross-sectional study using a convenience sample. SETTING: Outpatient department at a rehabilitation center. PARTICIPANTS: Forty-four community-dwelling adults with MS (mean age, 49+/-9 y; range, 34-68 y) who were monitored by rehabilitation practitioners. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Grip and pinch (tip, lateral, palmar) strengths and Manual Ability Measure (MAM-36). RESULTS: When compared with the 50- to 54-year-old female norms, the pinch and grip strengths of the sample were lower. MAM-36 correlated moderately with right pinch (tip, lateral, palmar) strengths (r range, .51-.59; P<.01). CONCLUSIONS: Manual ability seems to be more associated with pinch than grip strengths, probably because finger strength and dexterity are both needed to perform many hand tasks.

Grip strength, perceived ability, and health status in individuals with arthritis: an exploratory study.

The purpose of this study is twofold: (1) to describe the hand strength, self-reported manual ability and health status in individuals with osteo- or rheumatoid arthritis, and (2) to evaluate the scale (psychometric) properties of the 36-item Manual Ability Measure (MAM) as it applied to this sample. We administered four self-report assessments to the participants and measured their grip and pinch strength. The results indicated that persons with arthritis had decreased grip and pinch strength, more functional limitations, compromised health status and restricted participation in everyday occupations when compared to the general population. Manual ability was not related to grip strength, but was significantly related to role restriction (i. e., SF-36 Role Physical domain). The study provides evidence that the MAM has adequate psychometric properties when used with patients with osteo- or rheumatoid arthritis.

Psychometric properties and developmental differences in children's ADL item hierarchy: a study of the WeeFIM instrument.

OBJECTIVE: To investigate the measurement properties of the WeeFIM instrument and examine the developmental differences in motor item difficulty in a pediatric inpatient rehabilitation sample. DESIGN: Database approach, retrospective study, using 814 WeeFIM records from 12 facilities. Rasch rating scale analysis was used for all analyses. Data for the complete sample were used to evaluate the dimensionality and item fit of the WeeFIM instrument. Patients were then divided into three age groups, <3 yrs of age (toddlers), 3-7 yrs of age (preschoolers and kindergartners), and >7 yrs of age (school-age children), and their data were used to compare the order of motor items by level of difficulty within and across different age groups. RESULTS: Principal component analysis of the WeeFIM suggests distinct motor and cognitive scales. Within the motor scale, bowel and bladder items misfit, suggesting they measure a distinct aspect of function. The order of motor item difficulty, an indicator of construct validity, varies across age groups, suggesting that motor tasks present different challenges to children at different developmental stages: toileting is the most difficult, whereas locomotion is the easiest motor item for toddlers. For children >3 yrs of age, eating is easiest and stair climbing is most difficult, followed by tub transfer and bathing. CONCLUSIONS: Similar to the adult FIMtrade mark instrument, the WeeFIM instrument has two distinct dimensions. The motor items form a unidimensional construct with acceptable measurement properties. Developmental differences in motor task mastery among children with disabilities are assumed but rarely tested. As evidenced by the age-specific item hierarchies found in this study, developmental differences among children with disabilities mimic that of children without disabilities.

Impact of pediatric rehabilitation services on children's functional outcomes.

OBJECTIVES: Relatively little is known about the treatment effectiveness and functional outcomes of pediatric rehabilitation therapies. This study was conducted to gain knowledge of the type and quantity of inpatient rehabilitation services provided to children who received acute inpatient rehabilitation and compare functional gains by age and diagnosis. METHOD: A retrospective cohort design was used. Records of rehabilitation therapies and functional assessments of 814 pediatric patients who received inpatient rehabilitation during 1996, 1997, and 1998 were collected. The admission and discharge item ratings of the WeeFIM instrument were first transformed into interval-level measures of self-care, mobility, and cognition. Parametric analyses were used to compare functional gains across impairment groups and to examine the relationship between amount of treatment and functional gains. RESULTS: Occupational therapy and physical therapy were the primary rehabilitation services received by patients across impairment groups (98% and 99%, respectively). A large proportion of children with traumatic brain injuries also received speech therapy (97%) and psychology services (60%). Across domains (self-care, mobility, cognition), the largest gains were made by children who were older than 7 years and had traumatic injuries. Functional gains were significantly related to the amount of discipline-specific treatment received, after controlling for age, impairment, and functional status at admission. CONCLUSION: Rehabilitation therapy provision in pediatric inpatient rehabilitation varies greatly depending on children's age and the nature of the impairment. Systematic reporting of type and quantity of rehabilitation therapies along with functional assessments before and after hospitalization would allow researchers to track functional changes and study the determinants of functional improvement.

Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities.

OBJECTIVES: To document patient, program characteristics, and therapy service provision in subacute rehabilitation across 3 types of facilities that provide subacute rehabilitation, to examine the determinants of therapy intensity, and to evaluate the contribution of rehabilitation services to functional gains. DESIGN: A retrospective study linking administrative billing data and patients' functional assessment records. SETTING: Twenty facilities part of the Uniform Data System for Medical Rehabilitation (UDSMR) subacute database PARTICIPANTS: A total of 1976 billing records of patients with stroke, orthopedic, and debility impairments, discharged in 1996 and 1997, were retrieved and linked with the FIM trade mark instrument ratings from UDSMR subacute database. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Total therapy intensity and Rasch-transformed FIM domain gains (ie, gains in self-care, mobility, cognition). RESULTS: Therapy intensity was mostly determined by impairment and facility type, although variances explained by the predictors were small. Patients in all 3 impairment groups made functional gains; gains were related weakly, although significantly, to therapy intensity and rehabilitation duration after controlling for other variables. CONCLUSIONS: The provision of rehabilitation therapies varied across facilities. Skilled nursing facilities with subacute rehabilitation units tended to provide more therapies than subacute units in acute or rehabilitation hospitals.