The Chelsea Project: Turning Research and Wastewater Surveillance on COVID-19 Into Health Equity Action, Massachusetts, 2020-2021.

Chelsea, Massachusetts, had one of the highest COVID-19 transmission rates in New England in the summer of 2020. The Chelsea Project was a collaborative effort in which government entities, local nonprofit organizations, and startups partnered to deploy wastewater analysis, targeted polymerase chain reaction testing and vaccine outreach, and a community-led communications strategy. The strategy helped increase both testing rates and vaccination rates in Chelsea. Today Chelsea has one of the highest vaccination rates among US cities with comparable demographics. (Am J Public Health. 2023;113(6):627-630. https://doi.org/10.2105/AJPH.2023.307253).

Interpreting Life Impact Burn Recovery Evaluation Profile Scores for Use by Clinicians, Burn Survivors, and Researchers.

The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a patient-reported outcome measure developed to assess social participation in adult burn survivors. This study identified numeric score cut-points that define different levels of social participation ability and described each level. An expert panel identified numeric score cut-points that distinguish different levels of social participation for the six LIBRE Profile domains. Methods employed an iterative, modified-Delphi approach, and bookmarking to review calibrated item banks. Analyses (using calibration sample data and repeated in a validation sample) examined means, SDs, and sample distributions for each level. Analyses of variance examined score differences between levels. The panel developed descriptions for each established level. Initial cut-points resulted in four levels for five domains (Social Activities, Social Interactions, Romantic Relationships, Sexual Relationships, and Work & Employment) and five levels for the sixth domain (Relationships with Family & Friends). Comparisons demonstrated significant differences between level mean scores for all domains (P < .05) except Relationships with Family & Friends. Based on follow-up surveys, Relationships with Family & Friends score cut-points were adjusted to identify four levels with significant score differences between all levels. Panelists reached consensus for level descriptions. Score cut-points and descriptions identify different levels of social participation, providing a relevant context for interpreting LIBRE Profile numeric scores. LIBRE Profile Social Participation levels will help clinicians and persons with burn injury interpret LIBRE Profile numeric scores and promote use of this important new assessment.

Exploring the use of educational materials for increasing participation in a stretching program: a quality improvement project in people with motor neuron disease.

BACKGROUND: Decreased range of motion is a common secondary complication of motor neuron disease (MND) that can contribute to functional decline and decreased participation in daily activities. AIM: The purpose of this study was to develop and assess the effectiveness of educational brochures and videos aimed at improving knowledge regarding the importance of a regular stretching program. DESIGN: This was a quality improvement (QI) project. SETTING: Participants were seen in an outpatient multidisciplinary neuromuscular clinic. POPULATION: Individuals with motor neuron disease were invited to participate in this QI study. METHODS: Individuals were asked to complete surveys asking questions regarding current stretching program, pain levels, and knowledge of benefits of stretching before and after receiving the stretching brochures or videos. RESULTS: A total of 53 participants completed the pre-intervention survey, 28 in the brochure group and 25 in the video group. Of those, 86% and 88% completed the post-intervention survey in the brochure and video groups, respectively. The video group increased stretching frequency significantly more than the brochure group (2.04 and 0.62 days/week respectively, P=0.004). Significantly more participants in the video group reported usage of stretches from the educational materials on a regular basis (54% for brochure group and 86% for video group, P=0.024). CONCLUSIONS: Educational brochures and videos are two different strategies to improve knowledge of benefits of stretching for individuals with MND. Both groups increased frequency of stretching. Videos may be better able to improve frequency of stretching when compared to brochures. CLINICAL REHABILITATION IMPACT: The brochures and videos developed for this study can be used by clinicians treating individuals with MND. By improving knowledge regarding the benefits of stretching, individuals with MND may choose to prioritize stretching as a part of their routine. This in turn may help to prevent or address potential joint or muscle length issues or assist patients to incorporate preventative measures into their treatment plans.

Reliability & validity of the LIBRE Profile.

BACKGROUND: The Life Impact Burn Recovery Evaluation (LIBRE) Profile© was developed using Item Response Theory methods to assess social participation after a burn injury. The LIBRE Profile measures six areas of social participation: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. It can be administered through a computerized adaptive test or through fixed short forms. The goal of this study was to further examine the psychometric properties of the LIBRE Profile, including reliability and validity. METHODS: We examined the validity of the LIBRE Profile by administering the six LIBRE Profile scales as well as legacy measures that assessed similar constructs. We calculated the Pearson correlations between the LIBRE Profile scales and the scores on the same-domain and cross-domain legacy measures to evaluate convergent and divergent validity. We then administered the LIBRE Profile scales a second time, seven to ten days after the first administration, to a sample of adult burn survivors to evaluate test-retest reliability. We calculated repeatability coefficients, standard error of measurement, and minimal detectable change to establish the threshold beyond which the amount of change observed across an episode of care cannot be explained as measurement error. RESULTS: For reliability, the repeatability coefficients ranged from 7.31 to 9.27 and SEMs ranged from 2.62 to 3.39 for all six scales. MDC90 values ranged from 6.08 to 7.86 points, and MDC95 values ranged from 7.26 to 9.40 points. All correlations between the LIBRE Profile scales and legacy measures are significant (p<0.05) and in the expected directions for both convergent and divergent validity. CONCLUSIONS: This study provided evidence for the reliability and validity of the LIBRE Profile, one of the first tools that measures exclusively the social participation after a burn injury.

Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) Study.

Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery. This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total BSA or burns to critical areas (hands, feet, face, or genitals) were eligible to participate. Multivariate linear regression analyses were used to determine predictors of the Social Activities and Social Interactions scale scores. A total of 599 people completed the Social Interactions and Social Activities scales. Of these, 77% identified as White Non-Hispanic, 55% were female, 55% were unmarried, and 80% had burns to critical areas. Participants had a mean age of 45 years, a mean time since burn injury of 15 years, and a mean burn size of 41% total BSA. Younger age (P < .01) and being married/living with a significant other (P ≤ .01) were associated with higher Social Activities and Social Interactions scale scores. Individual item responses reveal that survivors had lower scores on items related to participating in outdoor activities (30.4%) or feeling uncomfortable with their appearance (32.4% report dressing to avoid stares). Social interactions and activities are long-term challenges for burn survivors. It is important for clinicians to identify patients who may struggle with social recovery in order to focus on future community-based interventions.

Development of the life impact burn recovery evaluation (LIBRE) profile: assessing burn survivors' social participation.

PURPOSE: Measuring the impact burn injuries have on social participation is integral to understanding and improving survivors' quality of life, yet there are no existing instruments that comprehensively measure the social participation of burn survivors. This project aimed to develop the Life Impact Burn Recovery Evaluation Profile (LIBRE), a patient-reported multidimensional assessment for understanding the social participation after burn injuries. METHODS: 192 questions representing multiple social participation areas were administered to a convenience sample of 601 burn survivors. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to identify the underlying structure of the data. Using item response theory methods, a Graded Response Model was applied for each identified sub-domain. The resultant multidimensional LIBRE Profile can be administered via Computerized Adaptive Testing (CAT) or fixed short forms. RESULTS: The study sample included 54.7% women with a mean age of 44.6 (SD 15.9) years. The average time since burn injury was 15.4 years (0-74 years) and the average total body surface area burned was 40% (1-97%). The CFA indicated acceptable fit statistics (CFI range 0.913-0.977, TLI range 0.904-0.974, RMSEA range 0.06-0.096). The six unidimensional scales were named: relationships with family and friends, social interactions, social activities, work and employment, romantic relationships, and sexual relationships. The marginal reliability of the full item bank and CATs ranged from 0.84 to 0.93, with ceiling effects less than 15% for all scales. CONCLUSIONS: The LIBRE Profile is a promising new measure of social participation following a burn injury that enables burn survivors and their care providers to measure social participation.

Measuring the Social Impact of Burns on Survivors.

Many burn survivors experience social challenges throughout their recovery. Measuring the social impact of a burn injury is important to identify opportunities for interventions. The aim of this study is to develop a pool of items addressing the social impact of burn injuries in adults to create a self-reported computerized adaptive test based on item response theory. The authors conducted a comprehensive literature review to identify preexisting items in other self-reported measures and used data from focus groups to create new items. The authors classified items using a guiding conceptual framework on social participation. The authors conducted cognitive interviews with burn survivors to assess clarity and interpretation of each item. The authors evaluated an initial pool of 276 items with burn survivors and reduced this to 192 items after cognitive evaluation by experts and burn survivors. The items represent seven domains from the guiding conceptual model: work, recreation and leisure, relating to strangers, romantic, sexual, family, and informal relationships. Additional item content that crossed domains included using self-comfort and others' comfort with clothing, telling one's story, and sense of purpose. This study was designed to develop a large item pool based on a strong conceptual framework using grounded theory analysis with focus groups of burn survivors and their caregivers. The 192 items represent 7 domains and reflect the unique experience of burn survivors within these important areas of social participation. This work will lead to developing the Life Impact Burn Recovery Evaluation profile, a self-reported outcome measure.

Development of a Conceptual Framework to Measure the Social Impact of Burns.

Measuring community reintegration following burn injury is important to assess the efficacy of therapies designed to optimize recovery. This project aims to develop and validate a conceptual framework for understanding the social impact of burn injuries in adults. The framework is critical for developing the item banks used for a computerized adaptive test. We performed a comprehensive literature review and consulted with clinical experts and burn survivors about social life areas impacted by burn injury. Focus groups with burn survivors and clinicians were conducted to inform and validate the framework. Transcripts were coded using grounded theory methodology. The World Health Organization's International Classification of Functioning, Disability and Health, was chosen to ground the content model. The primary construct identified was social participation, which contains two concepts: societal role and personal relationships. The subdomains chosen for item development were work, recreation and leisure, relating with strangers, and romantic, sexual, family, and informal relationships. Qualitative results strongly suggest that the conceptual model fits the constructs for societal role and personal relationships with the respective subdomains. This conceptual framework has guided the implementation of a large-scale calibration study currently underway which will lead to a computerized adaptive test for monitoring the social impacts of burn injuries during recovery.