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1.
Artigo em Inglês | MEDLINE | ID: mdl-32251107

RESUMO

OBJECTIVE: We examined the association between home health rehabilitation referral and 90-day risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities (IRFs) among adult patients recovering from stroke (N=1,219). DESIGN: A secondary data analysis of the 2005-2006 Stroke Recovery in Underserved Population database with propensity score inverse probability weighting (PS-IPTW). A logistic regression model, multilevel model and the PS-IPTW model were used to evaluate the risk of 90-day rehospitalization between patients with stroke who received a referral for home health rehabilitation and those who did not receive a home health rehabilitation referral at IRF discharge. RESULTS: The regression, multilevel and PS-IPTW models indicated that IRF patients with stroke who received home health rehabilitation referral had substantially lower odds of 90-day rehospitalization following IRF discharge compared to those who were not referred to home health (OR=0.325, 95%CI=0.138-0.764; OR=0.340, 95%CI=0.139-0.832; OR=0.407, 95%CI=0.183-0.906, respectively). CONCLUSION: Our findings suggest the importance of continuation of care (home health) following hospitalization and intense inpatient rehabilitation for stroke. Additional research is needed to establish appropriate use criteria and explore potential underuse of home health services as well as the benefits for follow-up outpatient services for those who do not qualify for home health at IRF discharge.

2.
Am J Phys Med Rehabil ; 99(1): 48-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31343498

RESUMO

OBJECTIVE: The aim of the study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. DESIGN: A retrospective observational study using Medicare fee-for-service beneficiaries (N = 125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual functional independence measure score, dichotomized as ≥5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each functional independence measure item while controlling for many clinical and sociodemographic covariates. RESULTS: After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14 of 18 functional independence measure items. Males had higher odds of reaching a supervision level on 2 of 18 functional independence measure items. Individuals who lived alone before their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all functional independence measure items. CONCLUSIONS: When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who live alone before their stroke have higher odds of discharging at a supervision level or better.

3.
Work ; 64(4): 721-729, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31815712

RESUMO

BACKGROUND: The Social Security Administration has a thorough disability claims process, though one goal is to process claims more efficiently. This pilot described the creation and trial of a web-based tool to assist this process. OBJECTIVE: To empirically link the International Classification of Functioning, Disability and Health (ICF) model to the Occupational Information Network (O*NET) with a self-reported activity measure (physical domain). METHODS: ICF Activity domains and item difficulty calibrations were obtained from a self-reported ICF-Activity Measure. Three work/disability experts matched measurement constructs, job names, and item difficulties with job demands. Item difficulties were linked for "Positioning and Transfer" with O*NET data values of "Stamina"; "Trunk Strength", and "Walking and Moving" with O*NET data values of "Stamina." The system was then pilot tested with 14 adults with more than one activity challenges. RESULTS: An average total of 613 jobs were generated per participant and each job was categorized into one of 16 job clusters. Person ability measures and constructs were significant predictors for numbers of job (R2 = 0.92, p < 0.05). Participants demonstrated moderate satisfaction with program usability, and reported capability in performing jobs. CONCLUSIONS: The system provides a feasible means to assist disability examiners and claimants in identifying relevant job abilities and options.

4.
JAMA Netw Open ; 2(12): e1916646, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31800069

RESUMO

Importance: Health care reform legislation and Medicare plans for unified payment for postacute care highlight the need for research examining service delivery and outcomes. Objective: To compare functional outcomes in patients with stroke after postacute care in inpatient rehabilitation facilities (IRF) vs skilled nursing facilities (SNF). Design, Setting, and Participants: This cohort study included patients with stroke who were discharged from acute care hospitals to IRF or SNF from January 1, 2013, to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. Data analyses were conducted from January 17, 2017, through April 25, 2019. Exposures: Inpatient rehabilitation received in IRFs vs SNFs. Main Outcomes and Measures: Changes in mobility and self-care measures during an IRF or SNF stay were compared using multivariate analyses, inverse probability weighting with propensity score, and instrumental variable analyses. Mortality between 30 and 365 days after discharge was included as a control outcome as an indicator for unmeasured confounders. Results: Among 99 185 patients who experienced a stroke between January 1, 2013, and November 30, 2014, 66 082 patients (66.6%) were admitted to IRFs and 33 103 patients (33.4%) were admitted to SNFs. A higher proportion of women were admitted to SNFs (21 466 [64.8%] women) than IRFs (36 462 [55.2%] women) (P < .001). Compared with patients admitted to IRFs, patients admitted to SNFs were older (mean [SD] age, 79.4 [7.6] years vs 83.3 [7.8] years; P < .001) and had longer hospital length of stay (mean [SD], 4.6 [3.0] days vs 5.9 [4.2] days; P < .001) than those admitted to IRFs. In unadjusted analyses, patients with stroke admitted to IRF compared with those admitted to SNF had higher mean scores for mobility on admission (44.2 [95% CI, 44.1-44.3] points vs 40.8 [95% CI, 40.7-40.9] points) and at discharge (55.8 [95% CI, 55.7-55.9] points vs 44.4 [95% CI, 44.3-44.5] points), and for self-care on admission (45.0 [95% CI, 44.9-45.1] points vs 41.8 [95% CI, 41.7-41.9] points) and at discharge (58.6 [95% CI, 58.5-58.7] points vs 45.1 [95% CI, 45.0-45.2] points). Additionally, patients in IRF compared with those in SNF had larger improvements for mobility score (11.6 [95% CI, 11.5-11.7] points vs 3.5 [95% CI, 3.4-3.6] points) and for self-care score (13.6 [95% CI, 13.5-13.7] points vs 3.2 [95% CI, 3.1-3.3] points). Multivariable, propensity score, and instrumental variable analyses showed a similar magnitude of better improvements in patients admitted to IRF vs those admitted to SNF. The differences between SNF and IRF in odds of 30- to 365-day mortality (unadjusted odds ratio, 0.48 [95% CI, 0.46-0.49]) were reduced but not eliminated in multivariable analysis (adjusted odds ratio, 0.72 [95% CI, 0.69-0.74]) and propensity score analysis (adjusted odds ratio, 0.75 [95% CI, 0.72-0.77]). These differences were no longer statistically significant in the instrumental variable analyses. Conclusions and Relevance: In this cohort study of a large national sample, inpatient rehabilitation in IRFs for patients with stroke was associated with substantially improved physical mobility and self-care function compared with rehabilitation in SNFs. This finding raises questions about the value of any policy that would reimburse IRFs or SNFs at the same standard rate for stroke.

5.
J Aging Health ; : 898264319878549, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31583929

RESUMO

Objective: The association of family and social factors with the level of functional limitations was examined across the United States, Mexico, and Korea. Method: Participants included adults from the 2012 Health and Retirement Study (n = 10,017), Mexican Health and Aging Study (n = 6,367), and Korean Longitudinal Study of Aging (n = 4,134). A common functional limitation scale was created based on Rasch analysis with a higher score indicating better physical function. Results: The American older adults (3.65 logits) had better physical function compared with Mexican (2.81 logits) and Korean older adults (1.92 logits). There were different associations of family and social factors with functional limitations across the three countries. Discussion: The American older adults demonstrated less functional limitation compared with Mexican and Korean older adults at the population level. The findings indicate the need to interpret carefully the individual family and social factors associated with functional limitations within the unique context of each country.

6.
Ann Rehabil Med ; 43(3): 250-261, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31311246

RESUMO

OBJECTIVE: To compare the risk of depressive symptoms in adults with physical disabilities between rehabilitationreceivers and non-receivers. METHODS: A total of 3,568 adults with physical disabilities were retrieved from the 2014 Korean National Survey on People with Disabilities database. Four covariate adjustment methods (a multivariable regression model, inverse probability of treatment weighting [IPTW] adjusted for normalized weight, IPTW with stabilized weight, and greedy algorithm with 1:1 propensity score matching) were used to estimate the odds of having depressive symptoms. The dependent variable was depressive symptoms and the independent variable was the use of rehabilitation services. Baseline covariates were 19 demographic variables and 10 chronic condition variables. RESULTS: The four covariate adjustment methods revealed that adults with physical disabilities receiving rehabilitation services had a higher risk of depressive symptoms than those who did not receive these services (adjusted odds ratio, 1.191-1.294). CONCLUSION: Our findings suggest that adults with physical disabilities receiving rehabilitation services have higher risk of developing depressive symptoms. Therefore, rehabilitation professionals need to pay attention to depressive symptoms and establish therapeutic strategies that can reduce such risk in rehabilitation settings.

7.
Am J Occup Ther ; 73(3): 7303205070p1-7303205070p11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120837

RESUMO

OBJECTIVE: This study's objective was to test the psychometrics of Smith's (2013) Low Vision Independence Measure (LVIM) using the Rasch model. METHOD: A cohort design was used with 93 participants receiving occupational therapy for low vision. Confirmatory factor analysis (CFA) with a parceling approach was used to test the LVIM factors and Rasch analysis to examine item-level psychometrics. RESULTS: Participants' average age was 78.9 yr (standard deviation = 12.1), and the majority were female (72.8%) with macular degeneration (62.3%). The CFA revealed two measurement factors: visual field or scotoma (n = 28) and visual acuity (n = 24). We removed six misfitting items, and the two factors of the revised LVIM demonstrated good rating scale function, good internal consistency (person reliability: visual field, .87; visual acuity, .90), good precision (person strata: visual field, 3.91; visual acuity, 4.40), no ceiling or floor effects, and no differential item functioning. CONCLUSION: The revised LVIM demonstrates good psychometrics on the Rasch model and can be used as a valid outcome measure in low vision rehabilitation.


Assuntos
Inquéritos e Questionários/normas , Baixa Visão , Pessoas com Deficiência Visual/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Perfil de Impacto da Doença , Baixa Visão/fisiopatologia , Acuidade Visual/fisiologia
8.
Autism Res ; 12(6): 952-966, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30912315

RESUMO

Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from the National Survey of Children's Health 2016 as indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) to compare differences in parent perceptions of their children with and without autism spectrum disorder (ASD). We anticipate that these findings will help identify intervention targets to support the well-being of individuals with ASD. Children between 6 and 17 years of age, without intellectual disability, brain injury, cerebral palsy, or Down syndrome were included. Total participants were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in three-factor structures (social competence, behavioral control, and school motivation) with good model fit (root mean square error of approximation = 0.08, comparative fit index = 0.92, Tucker-Lewis index = 0.89). The multivariate regression model and propensity score with inverse probability of treatment weighting (PS-IPTW) method revealed that children with ASD had lower scores in the social competence and behavioral control factors compared to the control group (all P < 0.05). However, no significant differences were found in the school motivation factor between the two groups (P > 0.05) in both multivariate regression model and PS-IPTW method. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD. Autism Res 2019, 12: 952-966. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from The National Survey of Children's Health 2016 to examine differences in parent perceptions of the indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) between children with and without autism spectrum disorders (ASD). We anticipate that this information will help to identify therapeutic targets to support the well-being of individuals with ASD. Children between 6 and 17 years old, without intellectual disability (ID), brain injury (BI), cerebral palsy (CP), or Down syndrome (DS) were included. From the total (N = 50,212), we excluded children under age 6 (n = 14,494), those who once, but do not currently have ASD (n = 81), and those with ID (n = 432), BI (n = 170), CP (n = 35), and DS (n = 17), resulting in 34,983 records used. Total participants, age 6-17 years, were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in the identification of three flourishing categories among the indicator variables (social competence, behavioral control, and school motivation). Children with ASD had lower scores in the social competence and behavioral control factors compared to the control group. However, there were no significant differences in the school motivation factor between the two groups. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD.

9.
Disabil Rehabil ; 41(5): 549-559, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29117726

RESUMO

PURPOSE: We aimed to evaluate the construct validity of the Eating Assessment Tool (EAT-10) by determining its dimensionality, rating scale integrity, item-person match, precision and relationship with the degree of airway invasion and functional oral intake. METHODS: We conducted a retrospective analysis of patients' EAT-10 scores. We used the Rasch rating scale model. We investigated correlations between the EAT-10 and scores on the Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). RESULTS: The median score of the EAT-10 from 127 patients was 16 of 40 (range 0-40). Confirmatory factor analysis supported unidimensionality. The 5-point rating scale categories met published criteria. Two items misfit the Rasch model and two other items displayed differential item functioning. Rasch person reliability was 0.79. Our patient cohort was divided into three person-strata. Correlations between the EAT-10 and the PAS and FOIS were weak to moderate in strength (respectively: r = 0.26, p = 0.0036; r = -0.27, p = 0.0027). CONCLUSIONS: Our analyses identified deficits in the construct validity of the EAT-10 suggestive of a need to improve the EAT-10 to support its frequent use in clinical practice and research. Implications for Rehabilitation Swallowing disorders are associated with severe complications, such as pneumonia and malnutrition, and impose both social and psychological burdens on patients. The Eating Assessment Tool is a self-report instrument developed to estimate initial dysphagia severity and monitor change in patient-reported dysphagia symptoms as a response to treatment. This study shows that the Eating Assessment Tool has deficits in its construct validity and a need to improve the instrument to support its frequent use in clinical practice and research.


Assuntos
Transtornos de Deglutição , Avaliação da Deficiência , Transtornos da Alimentação e da Ingestão de Alimentos , Inquéritos e Questionários/normas , Pesos e Medidas/normas , Adulto , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/reabilitação , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Autorrelato
10.
OTJR (Thorofare N J) ; 39(1): 32-40, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29882470

RESUMO

We tested if a propensity score (PS) matching method supports the unidimensionality assumption of the Rasch model which is critical to link similar rehabilitation instruments. We obtained 1,013 respondents from the 2009 Hispanic Established Populations for Epidemiologic Studies of the Elderly Frailty study. We used a unidimensional item pool of 10 SF-36 physical function and nine activities of daily living items. Subjects were matched based on their functionality (high and low), and exploratory factor analysis was used to test if the item pool in the matched sample holds the unidimensionality assumption. The study findings revealed that the matched sample demonstrated two distinct measurement structures with excellent model fit. This finding indicates that the PS matching did not mimic the common-person assumption. Therefore, the combination of PS matching and common-person equating method may not be appropriate to equate two rehabilitation-related instruments administered to two different groups.


Assuntos
Atividades Cotidianas/psicologia , Avaliação da Deficiência , Avaliação Geriátrica/métodos , Inquéritos e Questionários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Estudos de Viabilidade , Feminino , Idoso Fragilizado , Humanos , Masculino , Terapia Ocupacional/psicologia , Pontuação de Propensão , Psicometria , Reprodutibilidade dos Testes , Resultado do Tratamento
11.
Ann Rehabil Med ; 42(5): 758-766, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30404425

RESUMO

OBJECTIVE: To evaluate the utility of using the Personal Assistance Services classification system (PAS-CS) that examines individuals with disabilities for services and government funding. To this end, this study also tests for significant differences in PAS-CS scores across disability grades and disability types. METHODS: A retrospective analysis was conducted using the 2014 National Survey on People with Disabilities (NSPD) data set. We selected patients with three types of disabilities (physical disabilities, brain lesions, and visual impairments). We compared the average PAS-CS scores of patients with different disability types and grades using general linear models with multiple comparisons. RESULTS: A total of 4,810 patients were included in the analysis. Patients with brain lesions had the highest average PAS-CS scores in activities of daily living (ADL) and instrumental activities of daily living (IADL) domains. Patients with visual impairments had the highest average scores in 'Disease-specific disability' and 'Social-environment' domains. For patients with physical disabilities and visual impairments, no PAS-CS domains were significantly different between patients with disability grade III and those with disability grade IV (p>0.05). CONCLUSION: The PAS-CS scores of disability grades were not equivalent among individuals with different disability types. The Korean Ministry of Health and Welfare currently only considers certain disability grades for PAS preeligibility, as a result disregarding the characteristics of different disability types. Thus, the current PAS-CS requires modifications.

13.
J Appl Meas ; 19(2): 114-128, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29894982

RESUMO

This study compared disability levels between community-dwelling adults in the United States and South Korea using two national surveys of the United States and Korean National Health and Examination Survey (NHANES and KNHANES). The Rasch common-item equating method was used to create the same measurement framework and compared average disability levels. The disability levels between the two countries were estimated using the current disability estimation method (percentage of people having disability based on a single question). A higher percentage of American adults (20.5%) showed disability than the Korean adults (9.6%) based on the current estimation method; however, using the Rasch model American adults had significantly less disability (Mean = -3.00 logits, SD = 1.67) than the Korean adults (Mean = -2.48 logits, SD = 2.13). Complementary to comparisons of the frequency of disability, comparison of the combined magnitude and strength of disability across countries provides new information that may better inform public health and policy decisions.


Assuntos
Avaliação da Deficiência , Inquéritos Epidemiológicos , Vida Independente , Psicometria , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , República da Coreia , Estados Unidos
14.
J Autism Dev Disord ; 48(11): 3783-3793, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29909498

RESUMO

Leisure activity participation is important for health and well-being. This study examined similarities and differences between typically developing children and those with autism spectrum disorders (ASD) from 6 to 17 years old in physical, recreational, social, skill, and jobs/chores activities from a large national database. Findings revealed that children with ASD had significantly lower participation levels than those without ASD between 11 and 17 years old. They suggest an increasing disparity among many types of leisure participation for children and youth with ASD as they age, eventually leading to limited participation in adult activities. They reinforce the importance of intervention at an early age to increase participation in these activities to promote development of skills that contribute to adult competencies.


Assuntos
Transtorno do Espectro Autista/reabilitação , Inquéritos Epidemiológicos , Recreação , Adolescente , Transtorno do Espectro Autista/epidemiologia , Criança , Feminino , Humanos , Masculino , Instituições Acadêmicas/estatística & dados numéricos , Estados Unidos
15.
Qual Life Res ; 27(9): 2431-2441, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29748824

RESUMO

PURPOSE: Cross-national comparisons of patterns of population aging have emerged as comparable national micro-data have become available. This study creates a metric using Rasch analysis and determines the health of American and Mexican older adult populations. METHODS: Secondary data analysis using representative samples aged 50 and older from 2012 U.S. Health and Retirement Study (n = 20,554); 2012 Mexican Health and Aging Study (n = 14,448). We developed a function measurement scale using Rasch analysis of 22 daily tasks and physical function questions. We tested psychometrics of the scale including factor analysis, fit statistics, internal consistency, and item difficulty. We investigated differences in function using multiple linear regression controlling for demographics. Lastly, we conducted subgroup analyses for chronic conditions. RESULTS: The created common metric demonstrated a unidimensional structure with good item fit, an acceptable precision (person reliability = 0.78), and an item difficulty hierarchy. The American adults appeared less functional than adults in Mexico (ß = - 0.26, p < 0.0001) and across two chronic conditions (arthritis, ß = - 0.36; lung problems, ß = - 0.62; all p < 0.05). However, American adults with stroke were more functional than Mexican adults (ß = 0.46, p = 0.047). CONCLUSIONS: The Rasch model indicates that Mexican adults were more functional than Americans at the population level and across two chronic conditions (arthritis and lung problems). Future studies would need to elucidate other factors affecting the function differences between the two countries.


Assuntos
Comparação Transcultural , Qualidade de Vida/psicologia , Aposentadoria/normas , Idoso , Avaliação da Deficiência , Feminino , História do Século XXI , Humanos , Masculino , Americanos Mexicanos , Pessoa de Meia-Idade , Psicometria/métodos , Reprodutibilidade dos Testes , Estados Unidos
16.
Ann Rehabil Med ; 42(2): 336-345, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29765888

RESUMO

Objective: To investigate the psychometric properties of the activities of daily living (ADL) instrument used in the analysis of Korean Longitudinal Study of Ageing (KLoSA) dataset. Methods: A retrospective study was carried out involving 2006 KLoSA records of community-dwelling adults diagnosed with stroke. The ADL instrument used for the analysis of KLoSA included 17 items, which were analyzed using Rasch modeling to develop a robust outcome measure. The unidimensionality of the ADL instrument was examined based on confirmatory factor analysis with a one-factor model. Item-level psychometric analysis of the ADL instrument included fit statistics, internal consistency, precision, and the item difficulty hierarchy. Results: The study sample included a total of 201 community-dwelling adults (1.5% of the Korean population with an age over 45 years; mean age=70.0 years, SD=9.7) having a history of stroke. The ADL instrument demonstrated unidimensional construct. Two misfit items, money management (mean square [MnSq]=1.56, standardized Z-statistics [ZSTD]=2.3) and phone use (MnSq=1.78, ZSTD=2.3) were removed from the analysis. The remaining 15 items demonstrated good item fit, high internal consistency (person reliability=0.91), and good precision (person strata=3.48). The instrument precisely estimated person measures within a wide range of theta (-4.75 logits < θ < 3.97 logits) and a reliability of 0.9, with a conceptual hierarchy of item difficulty. Conclusion: The findings indicate that the 15 ADL items met Rasch expectations of unidimensionality and demonstrated good psychometric properties. It is proposed that the validated ADL instrument can be used as a primary outcome measure for assessing longitudinal disability trajectories in the Korean adult population and can be employed for comparative analysis of international disability across national aging studies.

17.
Am J Phys Med Rehabil ; 97(9): 636-645, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29595584

RESUMO

OBJECTIVE: The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. DESIGN: A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. RESULTS: The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. CONCLUSIONS: This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.


Assuntos
Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/epidemiologia , Feminino , Humanos , Hemorragias Intracranianas/epidemiologia , Masculino , Medicare , Amostragem , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Estados Unidos/epidemiologia
18.
Arch Phys Med Rehabil ; 99(11): 2378-2388, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29518375

RESUMO

Adults with mild stroke face substantial challenges resuming valued roles in the community. The term "mild" provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.


Assuntos
Condução de Veículo/psicologia , Equipe de Assistência ao Paciente , Retorno ao Trabalho/psicologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
Eval Health Prof ; 41(1): 44-66, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29179561

RESUMO

This study developed and validated a short form (SF) using activities of daily living (ADL) outcome measures from the Korea National Health and Nutrition Examination Survey (KNHANES) that can minimize survey administration burden for clinicians. This study utilized secondary data from the 2005 KNHANES with 422 community-dwelling stroke survivors. The KNHANES data were collected from April to June 2005 in South Korea. We created a 7-item SF from the 17 ADL questions in the survey using item response theory (IRT) methodologies. The precision and validity of the SF were compared to the full questionnaire of ADL items and the EuroQol-5D total score. Among the 17 ADL questions, 14 questions demonstrated unidimensional construct validity. Using IRT methodologies, a set of 7 items were selected from the full bank. The 7-item SF demonstrated good psychometric properties: high correlation with the full bank ( r = .975, p < .001), good internal consistency (Cronbach's α = .93), and a high correlation with the EuroQol-5D total score ( r = .678, p < .001). These findings indicate that a well-developed SF can precisely measure ADL performance capacity for stroke survivors compared to the full item bank, which is expected to reduce the administration burden of the KNHANES.


Assuntos
Atividades Cotidianas , Avaliação da Deficiência , Modalidades de Fisioterapia/normas , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , República da Coreia , Fatores Socioeconômicos , Reabilitação do Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários
20.
Eval Health Prof ; 41(1): 25-43, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-27856680

RESUMO

This study examined dimensionality and item-level psychometric properties of an item bank measuring activities of daily living (ADL) across inpatient rehabilitation facilities and community living centers. Common person equating method was used in the retrospective veterans data set. This study examined dimensionality, model fit, local independence, and monotonicity using factor analyses and fit statistics, principal component analysis (PCA), and differential item functioning (DIF) using Rasch analysis. Following the elimination of invalid data, 371 veterans who completed both the Functional Independence Measure (FIM) and minimum data set (MDS) within 6 days were retained. The FIM-MDS item bank demonstrated good internal consistency (Cronbach's α = .98) and met three rating scale diagnostic criteria and three of the four model fit statistics (comparative fit index/Tucker-Lewis index = 0.98, root mean square error of approximation = 0.14, and standardized root mean residual = 0.07). PCA of Rasch residuals showed the item bank explained 94.2% variance. The item bank covered the range of θ from -1.50 to 1.26 (item), -3.57 to 4.21 (person) with person strata of 6.3. The findings indicated the ADL physical function item bank constructed from FIM and MDS measured a single latent trait with overall acceptable item-level psychometric properties, suggesting that it is an appropriate source for developing efficient test forms such as short forms and computerized adaptive tests.


Assuntos
Atividades Cotidianas , Avaliação da Deficiência , Modalidades de Fisioterapia/normas , Inquéritos e Questionários/normas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Psicometria , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs
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