A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods.

BACKGROUND AND PURPOSE: Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation. METHODS: For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills. RESULTS: Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI. DISCUSSION AND CONCLUSIONS: The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).

Development of a Multidimensional, Multigroup Measure of Self-Care for Inpatient Rehabilitation.

OBJECTIVE: To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation. DESIGN: Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT). SETTING: Freestanding inpatient rehabilitation hospital in the Midwestern United States. PARTICIPANTS: Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment. RESULTS: CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen dmax-min =1.13; Cohen dlast-first.=0.91) greater than the FIM self-care items (dmax-min.=0.94; dlast-first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM. CONCLUSIONS: This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation.

What Accounts for Prosocial Behavior? Roles of Moral Identity, Moral Judgment, and Self-Efficacy Beliefs.

Prior research suggests that moral identity influences individuals' willingness to engage in prosocial behavior. Little attention, however, has been given to the roles of and relations between moral identity and other factors, such as moral judgment, in accounting for types of prosocial behavior in adolescence. The current study examined the extent to which moral identity, moral judgment, and social self-efficacy contribute to prosocial behaviors in adolescence. Approximately 338 adolescents (Mage = 13.4 years) completed measures of moral identity, moral judgment, social self-efficacy, and prosocial behavior. Teachers rated adolescents' prosocial behaviors, which largely corroborated the adolescents' self-reports. Moral identity was found to predict most types of prosocial behavior. Moral judgment and moral identity were related and jointly predicted altruistic prosocial behaviors, but did not predict helping in front of others. Further, moral identity mediated the relationships between moral judgment and some forms of prosocial behavior (e.g., emotional, volunteering). Self-efficacy beliefs were found to predict some types of prosocial behavior (e.g., public), perhaps providing adolescents with confidence to engage in prosocial action. Overall, moral identity was especially effective in directly accounting for prosocial behavior, and may act as a mediator to bridge the moral judgment-moral action gap among adolescents.