Improved tracking of mobility across care settings: a crosswalk between AM-PAC mobility '6-clicks' and GG Items.

Fundamento: La concordancia de las puntuaciones de los componentes físico y mental obtenida a través del SF- 36 y del SF-12 ha sido establecida en población general y muestras clínicas, pero todavía no ha sido valorada entre pacientes con adicción a drogas. Objetivo: Analizar como un instrumento breve del estado de salud, el SF-12, es comparable con su versión extendida, el SF-36, para valorar la calidad de vida relacionada con la salud de pacientes con trastornos adictivos en tratamiento con metadona. Pacientes, material y método: Se ha llevado a cabo un estudio transversal sobre una muestra aleatoria estratificada de 726 personas incluidas en Programas de Mantenimiento con Metadona del País Vasco. Se ha utilizado el cuestionario de salud SF-36 y se han calculado los índices sumarios físico (PCS) y mental (MCS) del SF-36 y SF-12. Se han utilizado Coeficientes de Correlación Intraclase (CCI) y modelos de regresión lineal para valorar la capacidad del componente sumario físico del SF-12 (PCS-12) para predecir los valores del PCS-36, así como los del MCS-12 para predecir las puntuaciones del MCS-36. Resultados: La concordancia entre el SF-12 y el SF-36, tanto respecto al componente físico (ICC=0,97) como mental (ICC=0,98) ha resultado alta, mostrando una relación lineal y positiva. Una alta proporción de la varianza del componente físico -PCS- (R2=0,88) y mental -MCS- (R2=0,91) del SF-36 es explicado por los correspondientes índices sumarios del SF-12. Conclusiones: El SF-12 reproduce las puntuaciones sumarias del SF-36 sin demasiada pérdida de información cuando es utilizada en pacientes en tratamiento con metadona. El SF-12 puede ser una alternativa eficiente al SF-36 para la valoración de la calidad de vida relacionada con la salud de pacientes con trastornos adictivos y su tratamiento.

The replicability of the physical and mental component summary scores of the Short Form (SF)-36 has been established using the SF-12 in selected patient populations but has yet to be assessed in stroke patients. If the summary scores of the SF-12 are highly correlated with those of the SF-36, the benefits of using a shorter health-status measure may be realized without substantial loss of information or precision. Both self-reported and proxy assessments were evaluated for replicability. Intraclass correlation coefficients (ICCs) and linear regression were used to assess the ability of the SF-12 physical component summary (PCS-12) scores to predict PCS-36 scores and the SF-12 mental component summary (MCS-12) scores to predict MCS-36 scores. Multivariate regression was used to explore the relationship between SF-12 and SF-36 scores. The MCS-12 and PCS-12 scores were strongly correlated with the corresponding SF-36 summary scores for surveys completed by proxy or self-report (ICCs ranged from 0.954 to 0.973). Regression analysis of the proxy assessments indicated that patient age was an important effect modifier in the relationship between MCS-12 and MCS-36 scores. The SF-12 reproduced SF-36 summary scores without substantial loss of information in stroke patients. Accordingly, the SF-12 can be used at the summary score level as a substitute for the SF-36 in stroke survivors capable of self-report. However, the mental health summary scores of proxy assessments are influenced by patient age, thereby limiting the replicability of the SF-36 by the SF-12 under these conditions.

To distinguish characteristics of Medicare beneficiaries who will have an acute inpatient admission for sepsis from those who have an inpatient admission without sepsis, and to describe their further trajectories during and subsequent to those inpatient admissions. Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project. All U.S. acute care hospitals, excepting federal hospitals (Veterans Administration and Defense Health Agency). Medicare beneficiaries, 2012-2018, with an inpatient hospital admission including one or more explicit sepsis codes. None. Prevalent diagnoses in the year prior to the inpatient admission; healthcare contacts in the week prior to the inpatient admission; discharges, transfers, readmissions, and deaths (trajectories) for 6 months following discharge from the inpatient admission. Beneficiaries with no sepsis inpatient hospital admission for a year prior to an index hospital admission for sepsis were nearly indistinguishable by accumulated diagnostic codes from beneficiaries who had an index hospital admission without sepsis. Although the timing of healthcare services in the week prior to inpatient hospital admission was similar among beneficiaries who would be admitted for sepsis versus those whose inpatient admission did not include a sepsis code, the setting differed: beneficiaries destined for a sepsis admission were more likely to have received skilled nursing or unskilled nursing (e.g., nursing aide for activities of daily living) care. In contrast, comparing beneficiaries who had been free of any inpatient admission for an entire year and then required an inpatient admission, acute inpatient stays that included a sepsis code led to more than three times as many deaths within 1 week of discharge, with more admissions to skilled nursing facilities and fewer discharges to home. Comparing all beneficiaries who were admitted to a skilled nursing facility after an inpatient hospital admission, those who had sepsis coded during the index admission were more likely to die in the skilled nursing facility; more likely to be readmitted to an acute inpatient hospital and subsequently die in that setting; or if they survive to discharge from the skilled nursing facility, they are more likely to go next to a custodial nursing home. Although Medicare beneficiaries destined for an inpatient hospital admission with a sepsis code are nearly indistinguishable by other diagnostic codes from those whose admissions will not have a sepsis code, their healthcare trajectories following the admission are worse. This suggests that an inpatient stay that included a sepsis code not only identifies beneficiaries who were less resilient to infection but also signals increased risk for worsening health, for mortality, and for increased use of advanced healthcare services during and postdischarge along with an increased likelihood of an inpatient hospital readmission.

Hypnosis in refractory alopecia areata significantly improves depression, anxiety, and life quality but not hair regrowth

Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7)

Falls are the leading cause of injury in older people. Rehabilitation services can assist individuals to improve mobility and function after sustaining a fall-related injury. However, the true effect of fall-related injury resulting in hospitalisation is often underestimated because of failure to consider sub-acute and non-acute care provided following the acute hospitalisation episode. This study aims to describe the sub-acute and non-acute health service use of individuals hospitalised in New South Wales (NSW), Australia for a fall-related injury during 2000-01 to 2008-09, to examine the burden of fall-related inpatient rehabilitation hospital admissions from 1998-99 to 2010-11 and to estimate future demand for fall-related inpatient rehabilitation admissions in NSW to 2020. Retrospective review of sub-acute and non-acute records linked to hospital admission records during 2001-02 to 2008-09 in NSW. Analysis of temporal trends from 1998-99 to 2010-11 and projections to 2020 for rehabilitation-related (ICD-10-AM: Z47, Z48, Z50, Z75.1) inpatient hospital admissions. There were 4317 individuals with a fall-related injury admitted to hospital and subsequently admitted for sub-acute and non-acute care; 84% of these were aged 65+ years; 70.4% were female and 27.2% had femur fractures. For the rehabilitation-related admissions, total mean functional independence measure (FIM) scores improved significantly (from 78.4 to 94.6; P<0.0001) between admission and discharge. Fall-related inpatient rehabilitation episodes increased by 9.1% each year between 1998 and 2011 for individuals aged 65 years and older and are projected to rise to 50000 admissions annually by 2020. This is the first study to provide an epidemiological profile of individuals using sub-acute and non-acute care in NSW using linked data. Improvements in data validity and reliability would enhance the quality of the sub-acute and non-acute care data and its ability to be used to inform resource use in this sector. The examination of temporal trends using only the inpatient hospital admissions provides a guide for resource implications for inpatient rehabilitation services. What is known about this topic? Fall-related injuries that result in inpatient hospital admissions are increasing in Australia. However, the extent of the effect of fall-related injuries in the sub-acute and non-acute sector remains unknown, due to data limitations. What does this paper add? Provides the first epidemiological profile of individuals who fall and go on to use sub-acute and non-acute care in NSW using linked data. It highlights where improvements in data quality in the sub-acute and non-acute care data could be made to improve their usefulness to inform resource use in this sector. What are the implications for clinicians? Fall injury prevention and healthy ageing strategies for older individuals remain a priority for clinicians. The current and projected future resource implications for inpatient rehabilitation and follow-up services provide an indication for clinicians of future demand in this area as the population ages. However, data quality needs to improve to provide clinicians with strongly relevant guidance to inform clinical practice.

Poster 289: Achieving Tight Glycemic Control for the Diabetic Patient During the Inpatient Rehabilitation Admission

Intensive care unit survivors often have diminished health-related quality of life. To describe health-related quality of life of former intensive care patients and identify associated factors 6 months after hospital discharge. Six months after discharge, 193 patients from an intensive care unit completed the Short Form-36 Health Survey; measures of sleep; Intensive Care Experience Questionnaire; Depression, Anxiety and Stress Scales; and Posttraumatic Stress Disorder Checklist. Norm-based scores were calculated for the Short Form-36. Bivariate associations with Short Form-36 scores were tested by using the Pearson correlation. Multiple linear regression was used to identify independent associations with health-related quality of life. All scores on the Short Form-36 (physical component summary, 41.8; mental component summary, 48.2) were less than population norms. Bivariate associations with health-related quality of life (P < .05) were scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, awareness of surroundings and frightening experiences, depression, anxiety, stress, posttraumatic symptoms, and sleep quality at 2 and 6 months. In linear regression, scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, and sleep quality at 6 months were independently associated with Short Form-36 physical summary scores (P < .001); depression and stress were independently associated with mental summary scores (P < .001). Sleep, depression, and stress are potential targets for interventions to improve health-related quality of life and improve recovery.

Chronic kidney disease is the 10th leading cause of death among Filipinos. Those with chronic kidney disease are exposed to stressors which effect their daily lives. Therefore, assessment of health-related quality of life is important in these patients. The objective of the present study was to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) into Filipino and measure its validity and reliability. Translation and cultural adaptation began with two translations into Filipino, with reconciliation of the forward translators. Pretesting with 10 renal patients, review by experts (nephrologist, translator and dialysis nurse) and back-translation was also done. The final questionnaire was administered to 80 patients with chronic renal disease undergoing haemodialysis for at least 3 months, who could understand Filipino, and were without life-threatening or terminal conditions at the time of the test. A convenience sample of 30 patients from the group had a repeat test 10-14 days after to determine test-retest reliability. Test-retest reliability was assessed by intraclass correlation coefficient and internal consistency reliability was measured by determining the Cronbach's alpha value. Validity was measured using Pearson's correlation between the overall health rating scale and the items from the questionnaire. All of the items showed good test-retest reliability (intraclass correlation coefficient >0.40), ranging from 0.58 (social interaction) to 0.98 (role--emotional). Internal consistency reliability values were acceptable, with Cronbach's alpha ranging from 0.60 (cognitive function) to 0.80 (physical functioning and role--physical). Regarding construct validity, overall health rating in kidney disease-targeted scales was significantly correlated with symptoms/problems, effects of kidney disease and burden of kidney disease. All items in the SF 36 scales had significant correlation with overall health rating (P < 0.05) except for role--emotional. The Filipino version of the Kidney Disease Quality of Life--Short Form can be used to evaluate the health-related quality of life of Filipinos with chronic renal disease on haemodialysis.

PurposePituitary diseases severely affect patients’ health-related quality of life (HRQoL). The most frequently used generic HRQoL questionnaire is the Short Form-36 (SF-36). The shorter 12-item version (SF-12) can improve efficiency of patient monitoring. This study aimed to determine whether SF-12 can replace SF-36 in pituitary care.MethodsIn a longitudinal cohort study (August 2016 to December 2018) among 103 endoscopically operated adult pituitary tumor patients, physical and mental component scores (PCS and MCS) of SF-36 and SF-12 were measured preoperatively, and 6 weeks and 6 months postoperatively. Chronic care was assessed with a cross-sectional study (N = 431). Mean differences and agreement between SF-36 and SF-12 change in scores (preoperative vs. 6 months) were assessed with intraclass correlation coefficients (ICC) and limits of agreement, depicting 95% of individual patients.ResultsIn the longitudinal study, mean differences between change in SF-36 and SF-12 scores were 1.4 (PCS) and 0.4 (MCS) with fair agreement for PCS (ICC = 0.546) and substantial agreement for MCS (ICC = 0.931). For 95% of individual patients, the difference between change in SF-36 and SF-12 scores varied between −14.0 and 16.9 for PCS and between −7.8 and 8.7 for MCS. Cross-sectional results showed fair agreement for PCS (ICC = 0.597) and substantial agreement for MCS (ICC = 0.943).ConclusionsOn a group level, SF-12 can reliably reproduce MCS in pituitary patients, although PCS is less well correlated. However, individual differences between SF-36 and SF-12 can be large. For pituitary diseases, alternative strategies are needed for concise, but comprehensive patient-reported outcome measurement.

Functional outcome reports for people with quadrilateral amputation are not common in the rehabilitation medicine literature. The literature describing functional outcomes that does exist focuses primarily on people with a single or bilateral lower limb amputation. This case report chronicles the interventions and outcomes in a single person with amputation of all 4 limbs during an inpatient rehabilitation admission. The patient was a 59-year-old woman who had a quadrilateral amputation after developing disseminated intravascular coagulation. Her medical history and initial physical therapist examination, along with preambulation interventions, gait training, and scores from the Functional Independence Measure (FIM), are described. The results of the 10-Meter Walk Test (10MWT) and the Six-Minute Walk Test (6MWT) illustrate her progress from novice ambulator to community ambulator over the course of 1 year. The patient achieved her goal of community ambulation with her prosthetic limbs. Her 10MWT and 6MWT results revealed significant improvement at the 1-year postdischarge follow-up. Despite the high energy levels necessary to ambulate with bilateral prosthetic limbs, the patient achieved 86% of the predicted distance for her age and sex in the 6MWT. In addition, she more than doubled her FIM motor score from inpatient acute rehabilitation admission to discharge. Closed-chain exercise and a focused approach to this patient's preprosthetic training were part of her success in becoming a community ambulator.

The purpose of this study was to test the reliability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" mobility and activity short forms between patients and therapist proxies. As a secondary aim, reliability was examined when patients completed their self-report before versus after the therapist evaluation. Patients being seen for an initial physical therapist (N = 70) or occupational therapist (N = 71) evaluation in the acute care hospital completed the "6-Clicks" mobility short form (if a physical therapist evaluation) or activity short form (if an occupational therapist evaluation). Whether patients completed their self-assessment before or after the evaluation was randomized. Patient- and therapist-rated "6-Clicks" raw scores were converted to AM-PAC T-scores for comparison. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and agreement was assessed with weighted kappa values. The ICCs for the "6-Clicks" mobility and daily activity short forms were 0.57 (95% CI = 0.42-0.69) and 0.45 (95% CI = 0.28-0.59), respectively. For both short forms, reliability was higher when the patient completed the self-assessment after versus before the therapist evaluation (ICC = 0.67, 95% CI = 0.47-0.80 vs ICC = 0.50, 95% CI = 0.26-0.67 for the mobility short form; and ICC = 0.52, 95% CI = 0.29-0.70 vs ICC = 0.34, 95% CI = 0.06-0.56 for the activity short form). Reliability of the "6-Clicks" total scores was moderate for both the mobility and activity short forms, though higher for the mobility short form and when patients' self-report occurred after the therapist evaluation. Reliability of the AM-PAC "6-Clicks" short forms is moderate when comparing scores from patients with those of therapists responding as proxies. The short forms are useful for measuring participants' function in the acute care hospital; however, it is critical to recognize limitations in reliability between clinician- and patient-reported AM-PAC scores when evaluating longitudinal change and recovery.

ObjectivesThe Short Form 36 (SF-36) questionnaire is increasingly being used to measure health-related quality of life (HRQoL) in Indonesia. However, evidence that it is valid for use in Indonesian adults is lacking. This study assessed the validity and reliability of the SF-36 in Indonesian middle-aged and older adults.MethodsAdults aged 46-81 years (n=206) in Yogyakarta, Indonesia completed the SF-36, another measure of HRQoL (the EuroQoL visual analogue scale [EQ-VAS]), and measures assessing their demographic characteristics. Fifty-four percent (n=121) completed the SF-36 measure again 1 week later. Confirmatory factor analysis was conducted to confirm the factor structure of the SF-36. Internal consistency reliability was estimated using Cronbach’s alpha, and test-retest reliability was assessed using intraclass correlations. Convergent and discriminant validity were assessed by computing correlations among SF-36 subscales, between subscales and the 2 component scores, and between component scores and EQ-VAS scores.ResultsMost scaling assumptions were met. The hypothetical factor structure fit the data poorly (root mean square error of approximation [RMSEA]=0.108) and modification was required for a good fit (RMSEA=0.060). Scores on all subscales demonstrated acceptable internal consistency (α>0.70) and test-retest reliability (r>0.70). Divergent validity was supported by weak to moderate interscale correlations (r=0.19 to 0.64). As expected, the 2 summary scores were moderately to strongly correlated with the EQ-VAS (r>0.60).ConclusionsThe findings adequately support the use of SF-36 in Indonesian middle-aged and older adults, although the optimal algorithm for computing component scores in Indonesia warrants further investigation.

The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) is a standard shoulder assessment form, which is comprised of objective and subjective sections and prepared by shoulder and elbow surgeons. The purpose of this study was to translate the subjective part of the ASES into Turkish and establish its cultural adaptiveness and validity. The original version of the ASES was translated into Turkish in accordance with the stages recommended by Guillemin. Sixty-three patients (average age: 48.2±13.4; range: 18-74years) suffering from different shoulder complaints were included in the study. The ASES was completed twice at 3- to 7-day intervals for test-retest reliability. The intraclass correlation coefficient was used to calculate the test-retest reliability, and Cronbach's alpha was used for internal consistency. Patients were asked to complete the short form 36 (SF-36) and the Shoulder Pain and Disability Index (SPADI) for correlation. Validity was evaluated by external correlation of the ASES with the SPADI and SF-S6 questionnaire, which may also be defined as 'construct validity'. The results were analysed using Pearson's correlation test. The test-retest reliability of the ASES pain and function subscales and total ASES score were 0.95, 0.86 and 0.94, respectively. Cronbach's alpha coefficient for the total ASES was 0.88. The correlation between the total ASES and total SPADI score was -0.82; the correlation coefficient between the ASES pain subscale and SPADI pain subscale was -0.79 (p<0.000); and the correlation between the ASES and SPADI function subscales were -0.53 (p<0.000). The highest correlation was between ASES and SF-36 bodily pain, as well as ASES and SF-36 mental health (r=0.64, r=0.56, p<0.000), and the lowest correlations were between ASES and the SF-36 physical component score and between ASES and SF-36 social function (r=0.28, r=0.33 p<0.000). The Turkish version of the ASES is a valid and reliable shoulder assessment form that can be used for numerous shoulder disorders. III.

There are few objective measures of functional impairment to support clinical decision making in lumbar degenerative disc disease (DDD). We present the validation (and reliability measures) of the Timed Up and Go (TUG) test. In a prospective, 2-center study, 253 consecutive patients were assessed using the TUG test. A representative cohort of 110 volunteers served as control subjects. The TUG test values were assessed for validity and reliability. The TUG test had excellent intra- (intraclass correlation coefficient: 0.97) and interrater reliability (intraclass correlation coefficient: 0.99), with a standard error of measurement of 0.21 and 0.23 seconds, respectively. The validity of the TUG test was demonstrated by a good correlation with the Visual Analog Scale (VAS) back (Pearson's correlation coefficient [PCC]: 0.25) and VAS (PCC: 0.29) leg pain, functional impairment (Roland-Morris Disability Index [PCC: 0.38] and Oswestry Disability Index [PCC: 0.34]), as well as with health-related quality of life (Short Form-12 Mental Component Summary score [PCC: -0.25], Short Form-12 Physical Component Summary score [PCC: -0.32], and EQ-5D [PCC: -0.28]). The upper limit of "normal" was 11.52 seconds. Mild (lower than the 33rd percentile), moderate (33rd to 66th percentiles), and severe objective functional impairment (higher than the 66th percentile) as determined by the TUG test was <13.4 seconds, 13.4 to 18.4 seconds, and >18.4 seconds, respectively. The TUG test is a quick, easy-to-use, valid, and reliable tool to evaluate objective functional impairment in patients with lumbar degenerative disc disease. In the clinical setting, patients scoring a TUG test time of over 12 seconds can be considered to have functional impairment. BMI, body mass indexDDD, degenerative disc diseaseHRQOL, health-related quality of lifeICC, intraclass correlationLDH, lumbar disc herniationLSS, lumbar spinal stenosisODI, Oswestry Disability IndexOFI, objective functional impairmentPCC, Pearson's correlation coefficientPCS, Physical Component SummaryRMDI, Roland-Morris Disability IndexSF, Short FormVAS, visual analog scale.