Balancing practicality and validity of elder abuse identification measures: using data from adult protective services investigations.

Background and Objectives. In testing a comprehensive decision support system for Adult Protective Services (APS), this study addressed two problems common in APS research and practice: the psychometric quality of the measures and measurement burden. Research Design and Methods. Data were generated on 1,472 APS cases over six months in two California counties using the Identification, Services and Outcomes (ISO) Matrix, a comprehensive decision support system for APS. The ISO Matrix uses Short-Forms developed from the Elder Abuse Decision Support System (EADSS). Mini-Forms were developed from the Short-Forms and tested in order to reduce measurement burden. Mini-Forms were developed on each measure using sensitivity and specificity of the items in predicting the criterion of substantiation (yes/no). Psychometric quality was addressed by estimating predictive validity and Cronbach's alpha of Short-Forms. Predictive validity and reliability were also estimated on the Mini-Forms as was their correlation with the Short-Forms. Results. On Short-Forms, good predictive validity was found for all measures except those that were very rare. Results for even shorter Mini-Forms were mixed, and some will require further research on their reliability and validity. Discussion and Implications. Short-Forms had good psychometric properties and some Mini-Forms did as well. Ongoing adoption by several California counties and Montana demonstrates the viability and sustainability of using the ISO Matrix for research and practice.

Using the Rasch measurement model in psychometric analysis of the Family Effectiveness Measure.

BACKGROUND: Valid assessment of family functioning can play a vital role in optimizing client outcomes. Because family functioning is influenced by family structure, socioeconomic context, and culture, existing measures of family functioning-primarily developed with nuclear, middle-class European American families-may not be valid assessments of families in diverse populations. The Family Effectiveness Measure was developed to address this limitation. OBJECTIVES: The aim of this study was to test the Family Effectiveness Measure with data from a primarily low-income African American convenience sample using the Rasch measurement model. METHODS: A sample of 607 adult women completed the measure. Rasch analysis was used to assess unidimensionality, response category functioning, item fit, person reliability, differential item functioning by race and parental status, and item hierarchy. Criterion-related validity was tested using correlations with five other variables related to family functioning. RESULTS: The Family Effectiveness Measure measures two separate constructs: The Effective Family Functioning construct was a psychometrically sound measure of the target construct that was more efficient because of the deletion of 22 items. The Ineffective Family Functioning construct consisted of 16 of those deleted items but was not as strong psychometrically. Items in both constructs evidenced no differential item functioning by race. Criterion-related validity was supported for both. DISCUSSION: In contrast to the prevailing conceptualization that family functioning is a single construct, assessed by positively and negatively worded items, use of the Rasch analysis suggested the existence of two constructs. Whereas the Effective Family Functioning scale is a strong and efficient measure of family functioning, the Ineffective Family Functioning scale will require additional item development and psychometric testing.

A structural equation modelling approach to predicting adoption of a patient-handling intervention developed for EMS providers.

Patient-handling tasks are integral to Emergency Medical Service (EMS) work as are the musculoskeletal injuries associated with these tasks. The aim of this study was to develop and test a structural equation model that describes the interactions between previously identified factors that contribute to the adoption of a specific ergonomics intervention designed for EMS work. EMS responders (n = 187), from six different organisations, participated in a 2-month longitudinal study following the introduction of a foldable patient transfer-board (slide-board) designed to assist with lateral patient transfers. Surveys administered at baseline, after 1 month and after 2 months sampled factors potentially influencing EMS responders' adoption decisions. Perceived ergonomics advantage, which was influenced by access and storage concerns and prior tool experience, contributed most strongly to intention to use at the end of the first month and to the emergence of champions, which contributed to the intention to use at the end of the second month.

Identification of factors that affect the adoption of an ergonomic intervention among Emergency Medical Service workers.

This study explored factors contributing to intervention adoption decisions among Emergency Medical Service (EMS) workers. Emergency Medical Service workers (n = 190), from six different organisations, participated in a two-month longitudinal study following the introduction of a patient transfer-board (also known as slide-board) designed to ease lateral transfers of patients to and from ambulance cots. Surveys administered at baseline, after one month and after two months sampled factors potentially influencing the EMS providers' decision process. 'Ergonomics Advantage' and 'Patient Advantage' entered into a stepwise regression model predicting 'intention to use' at the end of month one (R (2 )= 0.78). After the second month, the stepwise regression indicated only two factors were predictive of intention to use: 'Ergonomics Advantage,' and 'Endorsed by Champions' (R (2 )= 0.58). Actual use was predicted by: 'Ergonomics Advantage' and 'Previous Tool Experience.' These results relate to key concepts identified in the diffusion of innovation literature and have the potential to further ergonomics intervention adoption efforts. Practitioner Summary. This study explored factors that potentially facilitate the adoption of voluntarily used ergonomics interventions. EMS workers were provided with foldable transfer-boards (slideboards) designed to reduce the physical demands when laterally transferring patients. Factors predictive of adoption measures included perceived ergonomics advantage, the endorsement by champions, and prior tool experience.

Examining Adult Protective Services Outcomes: Services Associated With the Decrease of Mistreatment Differed by Elder Mistreatment Type.

BACKGROUND AND OBJECTIVES: Adult Protective Services (APS) are the frontline agencies investigating elder mistreatment and providing/coordinating postinvestigation services. Yet, their effectiveness in reducing different types of mistreatment in relation to services is unknown. This study aimed to address the knowledge gap by identifying services provided by mistreatment type, and examining the associations of services with mistreatment reduction. RESEARCH DESIGN AND METHODS: A pretest-post-test design was implemented using the Identification, Services, and Outcomes (ISO) Matrix to assess mistreatment levels during case investigation and at case closure after services were provided. San Francisco and Napa APS participated in a 6-month data collection. RESULTS: The 4 most prevalent types of mistreatment were examined: emotional, physical, financial abuse, and neglect by others. On average, level of mistreatment decreased across mistreatment types after APS intervention. Care/case management, mental health, and other services were most common, while specific services differed depending on type of mistreatment. Care/case management services were associated with physical and emotional abuse reduction, legal services further correlated with emotional abuse reduction; financial planning services were associated with financial abuse reduction; care/case management and other services were associated with neglect reduction. DISCUSSION AND IMPLICATIONS: This is the first study to address APS services by mistreatment type and the outcomes of services. Adoption of the ISO Matrix by APS programs opens the possibility of research and practice collaboration in APS outcomes research using a standardized approach.

Abuser Risk Measure: Reports by Alleged Victims to Adult Protective Services.

BACKGROUND AND OBJECTIVES: Within the elder abuse field, research on the characteristics of the abusers is scant, and no validated measure of abuser risk exists. The purpose of this study was to develop and test the Abuser Risk Measure (ARM). RESEARCH DESIGN AND METHODS: The Rasch measurement model and traditional psychometrics were used on a sample of 425 elder abuse cases that completed an elder abuse investigation and had a substantiation decision (yes/no). All had usable ARM responses that were obtained primarily from the alleged victim. ARM construct/criterion validity was tested against four types of elder abuse using substantiation decision as the criterion. Item analyses guided the development of a full 21-item ARM measure and, subsequently, a short, 9-item screener. RESULTS: The 21-item ARM met the Rasch criteria. Although the screener was borderline on Rasch criteria, the combination of a good Cronbach's alpha with strong criterion validation provided a rationale for endorsing its validity. Both versions of the ARM were significantly and most strongly predictive of physical and emotional abuse, and significant for financial exploitation. While not significantly predictive of neglect alone, they were strongly and significantly predictive of total types of abuse. DISCUSSION AND IMPLICATIONS: This study was innovative in developing abuser risk items, analyzing client data, and generally supporting ARM validity for elder abuse. Theoretically, and now empirically, it is becoming clear that measures of abuser risk have an important role to play in both case assessment and in research.

Designing ergonomic interventions for EMS workers: concept generation of patient-handling devices.

Fire service personnel and private ambulance paramedics suffer musculoskeletal injuries as they lift and carry patients while performing emergency medical services (EMS). Engineering changes, such as the design of new EMS patient-handling devices, offer a potential intervention opportunity for combating this problem. The purpose of this qualitative descriptive study was to generate beginning ideas for the design of new EMS patient-handling devices that were framed within the contextual reality of the end user firefighter/paramedics. Guided by an ecological model of musculoskeletal injuries in the fire service, focus groups were conducted with 25 firefighter/paramedics from 13 suburban fire departments. Based on their availability, participants were assigned to one of three groups with each group focusing on a different EMS patient-handling scenario. Each group participated in two focus group sessions: one session to brainstorm ideas for devices and a second session to validate sketches of their design ideas. The sketches were professionally drawn by an industrial designer who attended all focus group sessions. Sketches, photos, videotapes, and written transcripts were content analyzed to describe the phenomena of interest. The ideas centered on EMS devices for lateral transfers, bed-to-stairchair transfers, and stair descent transport, and served as the starting point for the development of EMS devices in subsequent phases of a mixed method research study. The outcomes of this study were an improved understanding of the contextual issues that need to be considered in designing EMS patient handling devices and a set of industrial design sketches that served as a starting point for subsequent development of the devices. End user acceptance criteria for the devices included: affordability, portability/compactness, durability, operability including being quickly ready for use, and cleanability.

Designing ergonomic interventions for EMS workers, Part I: transporting patients down the stairs.

The objective of the current work was to test ergonomic interventions aimed at reducing the magnitude of trunk muscle exertions in firefighters/paramedics (FFPs) providing emergency medical services (EMS) when transporting patients down the stairs. The interventions, developed using focus groups, were a footstrap to prevent the patient from sliding down on the backboard, a change in the handle configuration on the stairchair, and 2 devices, the "backboard wheeler" and a tank tread-like device (descent control system, DCS) for a stretcher, that change the backboard and stretcher carrying tasks into rolling and sliding tasks. Eleven two-person teams transported a 75 kg dummy with each intervention and its corresponding control condition down a flight of steps. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant. Results showed that the backboard footstrap reduced the erector spinae (ERS) activity for the FFP in the "leader" role by 15 percent, on average. The change in handle configuration on the stairchair had no effect on the variables measured. The backboard wheeler reduced the ERS activity bilaterally in the FFP in the leader role and unilaterally for the FFP in the "follower" role, by 28 and 24 percent, respectively. The DCS reduced the 90th percentile ERS activity for both FFPs from 26 to 16 percent MVC, but increased the latissimus dorsi activity in the follower from 11 to 15 percent MVC. The DCS was the only intervention tested that resulted in a reduced rating of perceived exertion relative to the corresponding control condition. In summary, the hypotheses that the proposed interventions could reduce trunk muscle loading were supported for 3 of the 4 transport interventions tested.

Designing ergonomic interventions for EMS workers - part II: lateral transfers.

The objective of the current work was to test ergonomic interventions aimed at reducing the low back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) when performing lateral transfers between a bed and a stretcher or between a stretcher and a hospital gurney. The interventions, developed using focus groups, were a bridgeboard to reduce the frictional force resisting the lateral sliding of the patient, the use of rods along each side of the patient to facilitate the grasping and handling of the bedsheet on which the patient is typically transferred, and a single rod that, when rolled in the bedsheet, resulted in the task being changed from a lifting task to a pulling task. Eleven two-person teams laterally transferred a 75 kg dummy with each intervention between a bed and simulated stretcher. Two roles were defined. For the two-sided transfers, the FFP roles were termed "stretcher-side" and "bed-side." Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, kinetic data were obtained for the FFP in the stretcher-side role. Trunk flexion moments and Erector Spinae activity were reduced for the FFP in the stretcher-side role when using the bridgeboard and the single rod both individually and in combination. The single rod reduced the Erector Spinae activity in the FFP who typically would have been on the bed. For FFPs in both roles the single rod increased Latissimus Dorsi activation relative to the standard bedsheet transfer condition, although, this effect was moderated when the single rod was used in combination with the bridgeboard. Ratings of perceived exertion also supported the use of the single rod relative to the corresponding control condition.

Designing ergonomic interventions for emergency medical services workers--part III: Bed to stairchair transfers.

The objective of the current work was to test interventions aimed at reducing the low-back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) that involve transferring a patient between a bed and a stairchair. The interventions, developed or selected using focus groups, were a prototype Drew People Movertrade mark, and a Transfer Sling. These interventions changed the coupling between the EMS worker and the patient. They were compared with an under-axilla lift. Eleven FFP teams transferred a 75kg dummy between a bed and a stairchair. Both interventions were tested using two-person transfers. In addition, the Transfer Sling was tested using a one-person transfer. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, ground reaction force data obtained from two forceplates were acquired for one member of each FFP team that was used to estimate directional spine moments using a 3D linked-segment model. In the two-person transfers, there was 19 degrees less trunk flexion (p=0.002) for the FFP on the patient's left side and a trend towards less motion for the FFP on the patient's right side (p=0.079) when using the interventions. Both FFPs showed reductions in the ipsilateral Erector Spinae activity using the Drew People Mover and the Transfer Sling that averaged approximately 9% MVC, which corresponds to a 21% decrease in the muscle activation levels. While the overall EMG was greater when performing a single-FFP transfer, the Transfer Sling reduced the bilateral Erector Spinae activity by approximately 20%. During the two-person transfers, the FFP on the forceplate to the right side of the patient showed a reduction in the forward bending moment using the Drew People Mover relative to the Sling and under-axilla conditions. During the single-person transfers, only the twisting moment was significantly reduced through use of the Transfer Sling. These objective measures, when combined with the subjective ratings of perceived exertion and the verbal feedback lead us to recommend the use of these interventions for bed to stairchair transfers.

Work-related musculoskeletal symptoms reported by female flight attendants on long-haul flights.

INTRODUCTION: Flight attendants working on long-haul international commercial airline operations exposed to ergonomic stressors are likely to experience work-related musculoskeletal symptoms (WMS). To date, however, no studies investigating the extent of WMS experienced by this specific population have been published. The purpose of this study was to identify the prevalence and severity (frequency, duration, and intensity) of WMS experienced by female flight attendants working on long-haul international flights for one major airline. METHODS: A cross-sectional, mailed survey was conducted with female flight attendants randomly selected from a union membership list. Inclusion criteria were female flight attendants who had worked at least one long-haul international flight in the prior 3 mo and had worked at least 75 flight hours in the prior month. A total of 185 eligible flight attendants returned completed questionnaires (63% response rate). WMS in nine body regions were measured by the Nordic Musculoskeletal Questionnaire and the National Institute for Occupational Safety and Health Symptom Survey. RESULTS: The prevalence of WMS by body region ranged from 50% to 86%. Almost all (97%) of the flight attendants in this study experienced some level of WMS during the past year. The WMS tended to involve more than one body region, and the lower back was the most commonly affected body region. DISCUSSION: Female flight attendants working on long-haul international flights at one major airline showed a high prevalence of WMS, suggesting the need for replication studies with other airlines and the need for investigation into the risk factors associated with this substantial problem.

Risk factors associated with work-related musculoskeletal disorders among female flight attendants: using a focus group to prepare a survey.

In preparation for surveying female flight attendants about work-related musculoskeletal disorder risk factors and symptoms, a focus group study was completed with members of the target population. The aims of this study were to ensure completeness of a previously developed list of physically strenuous job tasks performed by female flight attendants and assess the clarity, appropriateness, and applicability of existing self-reported measures to be used in the survey. Female flight attendants who worked one or more long-haul international flights in the prior 3 months and 75 or more hours in the prior month were recruited from the union membership. A trained moderator led a 2-hour discussion with the flight attendants. With use of a transcript-based analysis, a final list of 41 job tasks was created. Useful comments on a set of self-reported measures were obtained. The

Validation of the Full and Short-Form Self-Help Involvement Scale Against the Rasch Measurement Model.

BACKGROUND: Substance use disorders (SUDs) are one of the nation's most costly problems in terms of dollars, disability, and death. Self-help programs are among the varied recovery support options available to address SUD, and evaluation of these programs depends on good measurement. There exists an unmet need for a psychometrically sound, brief, efficient measure of self-help involvement for individuals with SUD that is valid across different substances and age-groups. METHODS: Using data from 2,101 persons presenting for SUD treatment, the full 21-item Global Appraisal of Individual Needs Self-Help Involvement Scale (SHIS) and a newly developed 11-item short-form version were validated against the Rasch measurement model and each other. Differential item functioning (DIF) was assessed by primary substance and age. RESULTS: Both versions met Rasch psychometric criteria. The full scale had minor misfit with no DIF for alcohol, marijuana, or opioids but a few instances of DIF for amphetamine and cocaine users as well as for age, in that youth tended to endorse several easier items more frequently than did adults. The 11-item short form had neither misfit nor DIF by substance and only minor DIF by age was highly correlated with the full version and was relatively more efficient. Criterion-related validity was supported for both. CONCLUSIONS: Both the long and short versions of SHIS are psychometrically sound measures of a more comprehensive conceptualization of self-help involvement for SUDs that can be used as part of an in-depth assessment or as a short measure that lessens respondent burden.

Evaluating the physical demands when using sled-type stair descent devices to evacuate mobility-limited occupants from high-rise buildings.

The physical demands on evacuators were investigated when using different types of sled-type stair descent devices designed for the emergency evacuation of high rise buildings. Twelve firefighters used six sled-type stair descent devices during simulated evacuations. The devices were evaluated under two staircase width conditions (1.12, and 1.32 m). Dependent measures included electromyographic (EMG) data, heart rates, Borg Scale ratings, and descent velocities. All stair descent speeds were below those reported during pedestrian egress trials. With the exception of the inflatable device, the devices operated by two evacuators had higher descent speeds than those operated by a single evacuator. High friction materials under the sleds facilitated control and reduced the muscle demands on stairs but increased physical demands on the landings. Usability assessments found devices with shorter overall lengths had fewer wall contacts on the landing, and handles integrated in the straps were preferred by the evacuators.

Evaluating the physical demands on firefighters using track-type stair descent devices to evacuate mobility-limited occupants from high-rise buildings.

The physical demands on firefighting personnel were investigated when using different types of track-type stair descent devices designed for the emergency evacuation of high rise buildings as a function of staircase width and evacuation urgency. Twelve firefighters used five track-type stair descent devices during simulated urgent and non-urgent evacuations. The devices were evaluated under two staircase width conditions (1.12, and 1.32 m), and three devices were also evaluated under a narrower staircase condition (0.91 m). Dependent measures included electromyographic (EMG) data, spine motion, heart rates, Borg Scale ratings, task durations and descent velocities. Stair descent speeds favored the devices that had shorter fore/aft dimensions when moving through the landing. EMG results indicated that there were tradeoffs due to design features, particularly on the landings where the physical demands tended to be greater. On the landings, devices that could be rolled on four wheels reduced the deltoid and bicep activation levels.

An introduction to Rasch measurement for scale development and person assessment.

This article: a) outlines some of the limitations of True Score Theory, b) discusses some advantages of Rasch measurement, and c) compares the results of Rasch and factor analytic techniques applied to a common data set. Using a mail survey, 206 female members of a national nursing association completed Ryckman's (1982) Perceived Physical Ability Scale. Exploratory factor analysis identified one factor with a Cronbach alpha of .78. Rasch fit statistics also identified one dimension with a person reliability of .76. Rasch methods were also used to investigate the rating scale functioning, additional construct validity issues, and person diagnosis. Discrepancies between the two estimates of internal consistency are discussed and differences in the utility of the two methodologies are reviewed.

Cardiovascular risks in firefighters: implications for occupational health nurse practice.

Limited cardiovascular risk data are available for firefighters. This cross sectional study of data collected during annual physical examinations described the prevalence of cardiovascular risk factors among firefighters (N = 200) and examined relationships between body mass index (BMI) and other cardiovascular risk factors. Evidence based guidelines were used to determine prevalence of cardiovascular risk factors and Framingham risk scoring was used to estimate probability of coronary heart disease (CHD). Firefighters ranged in age from 22 to 64 with a mean of 41. The prevalence of obesity, elevated total cholesterol, and elevated blood pressure in firefighters exceeded Healthy People 2010 targets. In addition, their prevalence of obesity, low high density lipoprotein (HDL), high low density lipoprotein (LDL), and high total cholesterol levels was higher relative to the general population. Elevated body mass index (BMI) values had positive significant (p < or = .01) associations with elevated blood pressures, triglycerides, and glucose levels, and a negative significant (p < .05) association with lower HDL cholesterol levels. Fire department worksite health and fitness policies and programs should proactively target firefighters' cardiovascular risks. Future firefighter related intervention research will benefit from considering not only the individual determinants of cardiovascular disease, but also the ecological framework that includes the influences of workplace and external environmental factors.

Evaluating the physical demands on firefighters using hand-carried stair descent devices to evacuate mobility-limited occupants from high-rise buildings.

The physical demands on firefighting personnel were investigated when using different types of hand-carried stair descent devices designed for the emergency evacuation of high rise buildings as a function of staircase width and evacuation urgency. Twelve firefighters used three hand-carried stair descent devices during simulated urgent and non-urgent evacuations. The devices were evaluated under three staircase width conditions (0.91, 1.12, and 1.32 m). For comparison, an urgent manual carry was also performed on the 1.12 m wide stairs. Dependent measures included electromyographic (EMG) data, heart rates, Borg Scale ratings, task durations and descent velocities. Results indicated that the stair chair with extended front handles, which allows the front person to descend the stairs facing forward, reduced the time integrated back muscle EMG by half and showed a descent velocity that was 1.8 times faster than the other stair descent devices in the study. There were no differences across staircase widths.

Dimensionality, hierarchical structure, age generalizability, and criterion validity of the GAIN's Behavioral Complexity Scale.

This study used Rasch measurement model criteria and traditional psychometric strategies to examine key psychometric properties of the Behavioral Complexity Scale (BCS), a widely used measure of externalizing disorders that focuses on attention deficit, hyperactivity, and conduct disorders. With a sample of 7,435 persons being screened for substance use disorders, the BCS was found to (a) be unidimensional, (b) have a hierarchical severity structure, (c) be generalizable to both youths and adults, and (d) meet hypothesized correlations with criterion variables. The BCS performed well as a unidimensional measure. The Rasch severity hierarchy of attention deficit to hyperactivity to conduct disorders provided a perspective that suggested that a dimensional measure could be used as an alternative and, in some ways, as an improvement to categorical diagnosis and common dimensional approaches. The finding of 3 low-severity conduct disorder items also supported a revision of categorical criteria, especially in substance use disorders.

Validation of the Crime and Violence Scale (CVS) against the Rasch measurement model including differences by gender, race, and age.

In assessing criminality, researchers have used counts of crimes, arrests, and so on, because interval measures were not available. Additionally, crime seriousness varies depending on demographic factors. This study examined the Crime and Violence Scale (CVS) regarding psychometric quality using item response theory (IRT) and invariance of the crime seriousness hierarchy for gender, age, and racial/ethnic groups on 7,435 respondents. The CVS is a useful measure of criminality, though some items could be improved or dropped. Differential item functioning (DIF) analysis revealed that crime seriousness varies by age and gender. IRT shows promise in assessing and adjusting for demographic variations in crime seriousness.