Evaluate Rehabilitation Outcomes Research Articles

From individualised treatment goals to personalised rehabilitation in osteoarthritis: a longitudinal prospective mapping study using the WHO international classification for functioning, disability and health

Background/Objective(s)/Introduction In clinical practice, treatment goals are often set up without exploring what patients really want. We, therefore, collected individualised treatment goals of patients with osteoarthritis (OA), categorised and mapped them to the World Health Organisation International Classification for Functioning, Disability and Health (ICF). Patients/Materials and Methods A longitudinal prospective cohort study was conducted (2019–2021). We used descriptive statistics and Chi2/Fisher’s Exact Tests, where appropriate, as well as Kruskal-Wallis-Tests for the mean score ranks of the patients’ goals. Results In total, 305 goals reported by 132 participants were analysed (267 women vs. 38 men). The top 3 ICF categories were sensation of pain (ICF:b280), mobility of joint (ICF:b710) and muscle power functions (ICF:b730). Overall, 51% of all individually reported functional goals were achieved after 3 months. Men were more likely to achieve their goals than women (p = 0.009). The majority of the “very important” goals (51%) and “very difficult” goals (57%) was not improved. Goals’ mean score ranks significantly differed between baseline and follow-up. Conclusion(s) As the human lifespan as well as the number of people affected by OA worldwide increase, there is a growing need to identify and evaluate rehabilitation outcomes that are relevant to people with OA. Key Messages Treat-to-target agreements between patients and health care providers present a step towards more personalised precision medicine, which will eventually lead to better reported functional and health outcomes. In patients with osteoarthritis, the Goal Attainment Scale instrument can be used to measure health outcomes at different time points and its content may be linked to ICF providing a unified language and conceptual scientific basis.

The Functional Independence Measure and the Functional Assessment Measure (FIM + FAM) as an effective tool for the evaluation of functional status in stroke rehabilitation

The Functional Independence Measure and Functional Assessment Measure (FIM + FAM) is an effective, efficient, and objective tool for tracking changes in the motor, cognitive, and psychosocial functions of patients over the entire treatment and rehabilitation period. It is estimated that in the Czech Republic (CR), stroke is the third most common cause of death and the most common cause of adult disability. To develop faster, better, and more cost‑effective stroke treatments and reduce or mitigate functional losses and restrictive situations, it is very important that patients be objectively evaluated, relative to their functional abilities, as soon as possible after a stroke. A critical part of stroke treatment is to calculate the length of in‑hospital treatment and estimate the length of the rehabilitation period after the stroke. Contemporary methods for evaluating and analyzing a patient’s condition are based on test results and evidence.The FIM offers a more sensitive rating scale compared to BI due to the presence of cognitive items and is used worldwide for assessment during the acute stage of the disease. Thus, it is an efficient instrument for setting therapy goals and evaluating the effects of rehabilitation. Not only can it assist the therapist in clinical decision making, but it also functions as a tool for evaluating rehabilitation outcomes. Based on this test, short‑term and long‑term rehabilitation plans can be determined. At the end of the rehabilitation process, assessing the patient’s functional condition helps to predict the specific long‑term rehabilitation services the patient will need as they return to society and regain their quality of life.

Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis.

This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. Three MSUS methods (grey scale, Doppler, strain elastography) and two acquisition techniques (long versus short axis; transducer on skin versus floating on gel) were examined in the forearm before and after rehabilitation treatment. For grey-scale, tissue thickness measures, intra- and inter-rater reliability were calculated (ICCs), and paired t-tests examined differences among techniques. Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable grey-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intra- and inter-rater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.

Relationship between late objective and subjective outcomes of holistic neurorehabilitation in patients with traumatic brain injury

ABSTRACTObjective: To explore the relation between objectively measured outcomes of neurorehabilitation and subjective self-appraisal of those outcomes in patients with traumatic brain injury (TBI).Methods: Forty-five adults (34 men; age at injury, mean ± SD, 30.1 ± 10.3 years) with chronic moderate-to-severe TBI (9.7 ± 5.5 years from injury; post-traumatic amnesia, 80% over one week) from two rehabilitation centres, in two countries. The subjects have had to resume working at various levels of competence following post-acute comprehensive neuropsychologically oriented neurorehabilitation, and experienced no functionally incapacitating, medical or psychological problems, for a minimum of six months after discharge. Objective outcome measure was the level of work competence attained post-rehabilitation transposed from the descriptions of the types of work attained by each subject into a number along a 10-point scale. Subjective outcome measure was the personal evaluations by ratings in six consequences of rehabilitation (effort during rehabilitation, meaning in life, productivity, acceptance, social life and intimate relationships) along a 10-point scale.Results: The attained work competence was statistically significantly related to the subjective self-appraisal of the ability to establish intimate relationships [odds ratio (OR), 1.79; 95% confidence interval (CI), 1.20–2.68; P = .005]. Otherwise, no association between subjective ratings and the levels of work was found. Of the patients, 67% attained competitive, 22% subsidized, and 11% volunteer or sheltered work. The subjective self-rated outcomes of the patients were relatively good [median, lower quartile (Q1) - upper quartile (Q3): 8 to 9, 7 to 8 – 8 to 9 out of 10]. The lowest ratings were observed for the ability to establish intimate relationships (8, 7–8 out of 10).Conclusions: The results support the need to evaluate rehabilitation outcomes involving both objective measures and subjective appraisals of them. The findings suggest that community functioning and satisfaction with that are distinct aspects of the subjects´ experience that must be considered in the evaluation of rehabilitation. It seems that comprehensive neurorehabilitation improve outcome, and patients with TBI with tailored placements were largely satisfied with the areas of wellness in their life. Additional larger controlled studies are needed to clarify how composition of neurorehabilitation and individualization in outcomes assessment might enhance the outcome of TBI rehabilitation.

Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake.

The 2008 Sichuan Earthquake resulted in many amputees, yet due to the rare incidence, few studies have explored the rehabilitation outcomes and quality of life of bilateral lower limb amputees after major natural disasters. To evaluate rehabilitation outcomes of 17 young and adult bilateral lower limb amputees under the StandTall rehabilitation programme and to identify factors associated with successful functional recovery of bilateral amputees after large-scale disasters. Cross-sectional study. Mobility (amputee mobility predictor), prosthesis use (Houghton Scale) and health-related quality of life (Trinity Amputation and Prosthesis Experience Scale, Short Form 12) were evaluated through questionnaires and performance-based assessments. Means of scores were compared using T-tests. Subjects with bilateral through-knee or transtibial amputations had less activity restriction ( p < 0.01) and higher mobility ( p = 0.03). Subjects using prostheses more than 50% waking time had better general adjustment ( p = 0.02) and less functional restriction ( p = 0.01). Exercise and education were associated with higher mobility ( p = 0.06) and mental quality of life, respectively ( p = 0.09). Amputation level and knee joint salvage, prosthesis use, exercise and education were associated with better rehabilitation outcomes including ambulation, adjustment and quality of life in bilateral lower limb amputees from the 2008 Sichuan Earthquake. The study examined a unique group of traumatic bilateral lower limb amputees who were young and healthy before having traumatic amputations from a single episode of natural disaster. The factors associated with better functional recovery after the earthquake were investigated and may support future development of post-disaster rehabilitation strategies for bilateral lower limb amputees.

Rehabilitation of Guillain-Barré syndrome patients: an observational study

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculopathy resulting in severe impairments of many body structures and functions with consequent limitations of activities and participation. The aim of our study was to evaluate rehabilitation outcome in these patients. Forty-five (20 women, 25 men) with GBS patients who had completed primary comprehensive rehabilitation were included in the study. Medical Research Council Scale for Muscle Strength was used for assessment of lower-limb function. Patients' activities were assessed using the Functional Independence Measure and two walking tests (6 min and 10 m). The patients were also described using an adapted International Classification of Functioning, Disability and Health checklist. Assessment was performed at admission and at discharge. Clinically important and statistically significant improvements were found in all outcome measures. Strong and significant correlations were found between the outcome measures. International Classification of Functioning, Disability and Health coding also clearly reflected the progress. Improvement in patients' activities increased statistically significantly with time for up to 3 months of rehabilitation. The outcome was not related to the time interval from establishing the diagnosis to the start of rehabilitation. Hence, multidisciplinary care for GBS patients is effective, because clinically important and statistically significant improvements regarding body functions and activities are achieved during relatively short inpatient rehabilitation.

만성폐쇄성폐질환자의 가정호흡재활 프로그램 효과에 대한 체계적 고찰: 무작위시험설계

Purpose: The purpose of this study was to review systematically the effects of home based pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients using qualitative synthesis. Methods: Studies designed randomized controlled trials were identified to extract data and to assess the quality of studies in 8 domestic and 3 foreign search engines, and hand search reference reviews. Results: A total of 9 studies met the inclusion criteria. Overall, the methodological quality of the studies ranged from average to poor. Home based pulmonary rehabilitation consisted of exercise, education, and psychosocial interventions. Several exercises such as aerobic, strength, respiratory muscle training, and flexibility were used in home based pulmonary rehabilitation for COPD patients. Upper muscle exercise and walking were the most frequently used exercises. The most common topics for education were 'knowledge of the illness' and 'drug management'. Walking distance test (WDT) and quality of life (QoL) were the most frequently measured as the dependent variables to evaluate rehabilitation outcomes, followed by pulmonary function test (PFT) and dyspnea. WDT was the most effective outcome, followed by dyspnea, QoL and PFT. Conclusion: This study informed about the details of scientific and effective home based rehabilitation programs in COPD patients for future researchers and clinicians. These findings can help expand the recognition and accessibility of home based rehabilitation in COPD patients.

Cochlear implant treatment of patients with single-sided deafness or asymmetric hearing loss. German version

The rehabilitation of patients with single-sided deafness (SSD) or asymmetric hearing loss can be achieved with conventional (bilateral) contralateral routing of signals ((Bi)CROS) hearing aids ((Bi)CROS-HA, (Bi)CROS), bone-anchored hearing systems (BAHS) or cochlear implants (CI). To date, only small case series have been published on treatment outcomes in SSD patients after CI surgery and there are only afew comparative studies evaluating rehabilitation outcomes. The aim of this study was to provide evidence of successful treatment of SSD and asymmetric hearing loss with aCI compared to the untreated monaural hearing condition and the BAHS and (Bi)CROS treatment options in alarge number of patients. In asingle-centre study, 45patients with SSD and 40patients with asymmetric hearing loss were treated with aCI after careful evaluation for CI candidacy. Monaural speech comprehension in noise and localisation ability were examined with (Bi)CROS-HA and BAHS devices (on atest rod) both preoperatively and at 12months after CI switch-on. At the same intervals, subjective evaluation of hearing ability was conducted using the Speech, Spatial and Qualities of Hearing Scale (SSQ). This report presents the first evidence of successful binaural rehabilitation with CI in arelatively large patient cohort and the advantages over (Bi)CROS and BAHS in smaller subgroups, thus confirming the indication for CI treatment. Moreover, patients with long-term acquired deafness (>10years) show a benefit from the CI comparable to that observed in patients with shorter-term deafness.

Examination of stride-to-stride independence of selected lower extremity kinematic and temporal variables during treadmill walking

The purpose of this study was to examine the nature of the intra-subject independence among strides during treadmill walking. We investigated the strength of the relationships among strides sampled in different ways from a population of observed strides. Eighteen asymptomatic subjects walked on a treadmill at 1.4±0.1m/s. Maximum angles and ranges of motion from the ankle, knee and hip joints, as well as stride duration were obtained and autocorrelation coefficients (AC) for 3 lags were calculated among 12 strides sampled consecutively (CS), in order but non-adjacently (NA), and randomly (RA). Ninety-nine percent of AC values were within Bartlett's 95% confidence interval limits and thus the strides were not considered significantly autocorrelated. The results support the hypothesis that strides obtained from an individual walking on a treadmill can be statistically independent. This supports the theoretical assumption that in some circumstances humans can be modeled as random sample generators due to inherent movement variability. The ability to assess statistically clinical intervention provides objective rigor for evaluating rehabilitation outcomes.

A prospective observational study of outcomes from rehabilitation of elderly patients with moderate to severe cognitive impairment

Objectives: To evaluate rehabilitation outcomes in patients with moderate to severe cognitive impairment. Design: Prospective observational cohort study. Setting: Rehabilitation unit for older people. Subjects: A total of 116 patients (70F) mean age (SD) 86.3 (6.4). Group 1: 89 patients with moderate cognitive impairment (Mini-Mental State Examination 11–20); and Group 2: 27 patients with severe cognitive impairment (Mini-Mental State Examination 0–10). Intervention: A personalised rehabilitation plan. Main measures: Barthel Activity of Daily Living score on admission and discharge, length of stay and discharge destination. Results: Of 116 patients, 64 (55.2%) showed an improvement in Barthel score. Mini-Mental State Examination was significantly higher in those who improved, 15.4 (SD 3.7) vs.13.2 (SD 5.1): p = 0.01. The mean Barthel score improved in both groups; Group 1 – 14.7 (SD 19.1) vs. Group 2 – 9.3 (SD 16.3): p = 0.17. Of 84 home admissions in Group 1, more patients returning home showed improvements of at least 5 points in the Barthel score compared with nursing/residential home discharges (32/37 – 86.5% vs. 10/28 – 35.7%: p = 0.0001). In Group 2 of 17 home admissions, 6/6 (100%) home discharges showed improvement compared with 3/7 (42.8%) discharges to nursing/residential home (p = 0.07). In Group 1, a discharge home was associated with significantly greater improvement in number of Barthel items than a nursing/residential home discharge (3.27 (SD 2.07) vs. 1.86 (SD 2.32): p = 0.007). A similar non-significant pattern was noted for severe cognitive impairment patients (3.5 (3.06) vs. 1.14 (1.06); p = 0.1). Conclusion: Patients with moderate to severe cognitive impairment demonstrated significant improvements in Barthel score and Barthel items showing that such patients can and do improve with rehabilitation.

Quality of life among older people with stroke in a developing country: a preliminary report

Results: During the 1st phase of the study, some issues related to semantic, idiomatic, experiential and conceptual equivalences arose. These issues were resolved by consensus among the expert committee meeting. The results from the field test of the Malay LIFE-H (3.1) demonstrated that the translated questionnaire was clear and appropriate for Malay speakers. The 2nd phase of the study showed that the Malay LIFE-H (3.1) had good test-retest reliability (ICC> .75) and average bias was <0.5. Further, the Malay LIFE-H (3.1) fairly correlated with Barthel Index (r= 0.55) andWHOQoL (r= 0.28–0.54). Conclusion(s):Malay LIFE-H (3.1) had good face validity and test-retest reliability. Barthel Index and WHOQol positively correlated with Malay LIFE-H, suggesting an acceptable concurrent validity. Implications: We validated a tool that is appropriate to evaluate the levels of social participation among Malay speakers. The tool would be beneficial to identify those are at risk of social restriction, to monitor progression, and to evaluate rehabilitation outcomes.

Goal Attainment Scaling in brain injury rehabilitation: Strengths, limitations and recommendations for future applications

There is increasing emphasis on the need to identify, work with and evaluate rehabilitation outcomes in ways that are personally relevant to individuals with brain injury, whether this be at a global or individual client level. This paper focuses on the use of one such method, Goal Attainment Scaling (GAS). It provides a general review of GAS and discusses what we found to be the strengths and limitations of using GAS to assess functional improvements in a rehabilitation study. Strengths included enabling the measurement of goal accomplishment on meaningful daily activities, capturing improvement on relevant functional tasks more effectively than broad measures of impairment, and facilitating collaborative goal-setting. Limitations included the time required to identify goals that could be broken down into five GAS outcome levels and defining the five levels, and compromised assessment of goal attainment due to poorly constructed GAS scales. Recommendations for minimising these potential limitations in future applications of GAS are also discussed. They include setting GAS baseline levels consistently across all scales, assigning GAS weights based on the client's ratings of importance, reviewing GAS weightings prior to each measurement phase, and using a suggested checklist to minimise the likelihood of poorly constructed scales.

Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH)

ObjectivesOur objectives were to evaluate rehabilitation outcome of aSAH survivors with severe disorders of consciousness (DOC) and to examine potential predictors of long-term outcome. Severe DOC includes patients in a vegetative state (VS) and in a minimally conscious state (MCS). Patients and methodsThis is a retrospective single-center cohort study of consecutive aSAH patients with severe and prolonged DOC upon admission to neurorehabilitation. Clinical assessments started right after discharge from ICU, a median of 26 days after the aSAH. Two different outcome criteria were used, one addressing the functional aspect (assessed by the Functional Independence Measure [FIM]) the other one addressing the level of consciousness (“behavioral outcome”, assessed by the Coma Remission Scale [CRS]). Improved outcome was defined by an increase in FIM scores of at least 22 points (minimal clinically important difference) or by reaching a full score of 24 points on the CRS. Separate least square linear regression models were calculated to examine potential predictors for functional and behavioral outcome. ResultsOut of 63 patients, 19.0% and 39.7% of the patients achieved an improved functional and behavioral outcome, respectively. Age and level of consciousness upon admission to neurorehabilitation were independent prognostic factors for both outcome definitions. Both groups reached the better outcome category after a median of 11 and 9 weeks, respectively. In an individual patient, the longest delay to achievement of improved functional outcome was 30 weeks and to favorable behavioral outcome was 22 weeks after rehabilitation admission. ConclusionAbout one-third of severely affected aSAH patients with DOC regained at least a favorable behavioral status during early neurorehabilitation. It is interesting to note that in our study population, the beginning of clinical improvement took up to 6 months after aSAH.

Psychometric Analyses to Improve the Dutch ICF Activity Inventory

In the past, rehabilitation centers for the visually impaired used unstructured or semistructured methods to assess rehabilitation needs of their patients. Recently, an extensive instrument, the Dutch ICF Activity Inventory (D-AI), was developed to systematically investigate rehabilitation needs of visually impaired adults and to evaluate rehabilitation outcomes. The purpose of this study was to investigate the underlying factor structure and other psychometric properties to shorten and improve the D-AI. The D-AI was administered to 241 visually impaired persons who recently enrolled in a multidisciplinary rehabilitation center. The D-AI uses graded scores to assess the importance and difficulty of 65 rehabilitation goals. For high-priority goals (e.g., daily meal preparation), the difficulty of underlying tasks (e.g., read recipes, cut vegetables) was assessed. To reduce underlying task items (>950), descriptive statistics were investigated and factor analyses were performed for several goals. The internal consistency reliability and test-retest reliability of the D-AI were investigated by calculating Cronbach α and Cohen (weighted) κ. Finally, consensus-based discussions were used to shorten and improve the D-AI. Except for one goal, factor analysis model parameters were at least reasonable. Internal consistency reliability was satisfactory (range, 0.74 to 0.93). In total, 60% of the 65 goal importance items and 84.4% of the goal difficulty items showed moderate to almost perfect κ values (≥0.40). After consensus-based discussions, a new D-AI was produced, containing 48 goals and less than 500 tasks. The analyses were an important step in the validation process of the D-AI and to develop a more feasible assessment tool to investigate rehabilitation needs of visually impaired persons in a systematic way. The D-AI is currently implemented in all Dutch rehabilitation centers serving all visually impaired adults with various rehabilitation needs.

Low Vision Rehabilitation Plans Comparing Two Intake Methods

This qualitative study investigates possible differences in identified rehabilitation needs indicated by the usual intake procedures at a Multidisciplinary Rehabilitation Center (MRC) for visually impaired persons compared with those indicated by the use of a structured Dutch version [based on the International Classification of the Disability, Functioning and Health (ICF)] of the Activity Inventory (D-AI). Twenty patients who enrolled at the MRC received a D-AI assessment by telephone, in addition to the usual intake. All patients received usual care, based on rehabilitation needs identified by the usual intake procedure at the MRC. Rehabilitation needs identified at the MRC were obtained from patient files retrospectively and were compared with rehabilitation needs identified by the D-AI. The mean number of rehabilitation needs reported in the patient files was 6.9 (± 5.1) vs. 24.0 (± 11.2) using the D-AI. Only 22.6% (± 14.3) of the rehabilitation needs identified by the D-AI were present in the patient files; 79.3% (± 28.2) of the rehabilitation needs reported in the patient files were identified by the D-AI. Overall agreement corrected for chance between both intake methods revealed a fair Cohen kappa of 0.27. At the MRC, more needs were revealed using the D-AI compared with the usual intake procedure. The systematic character of the D-AI prevents important topics being overlooked. In the usual intake, it was not clear whether needs were investigated from the patient's perspective. This may hamper (medical) communication and shared decision making about the rehabilitation program that needs to be followed. Moreover, using the unstructured information from the patient files makes it difficult to evaluate rehabilitation outcomes. With the D-AI, although an extensive overview of rehabilitation needs is produced, it remains difficult to focus on the most relevant needs. However, after assessment with the D-AI, all aspects of the ICF, Disability, and Health scheme can be discussed in a process of shared decision making, which leads to the final determination of rehabilitation goals.

Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.

Evaluating rehabilitation outcomes from the client's perspective by identifying the gap between current and preferred movement ability

Purpose. Examine the theoretical construct of a gap between people's perceived current and preferred movement abilities and its potential for evaluating rehabilitation outcomes against clients' desired goals.Method. A cross-section of 311 community-dwelling adults completed a 24-item movement ability measure (MAM) and a visual analog movement scale. In a nonrandomized pre–post design, two subsets of that population completed the measures again after 2 weeks: 35 clients undergoing outpatient physical therapy and 34 in a comparison group who were not undergoing physical therapy. Scores on the MAM were analyzed using item response theory methods.Results. The gap between current and preferred ability in the 311 adults represented one level difference on average out of six designated movement levels on both measures. Clients about to undergo physical therapy had gaps approximately twice the size of gaps in the 34-person comparison group on both measures (P < 0.001). Both the MAM and the movement scale showed a significantly narrower gap after 2 weeks for the group in physical therapy (P < 0.001) but no change for the comparison group.Conclusions. Assessing gaps between client-perceived current and preferred movement ability following intervention may help in the evaluation of rehabilitation outcomes from the client's perspective.

Quality of life as a measure of rehabilitation outcome in patients with multiple sclerosis.

A total of 43 patients with multiple sclerosis (MS) consecutively admitted to the Multiple Sclerosis Rehabilitation Hospital in Haslev completed a Danish version of the Laman & Lankhorst Questionnaire (LLQ) on quality of life (qol), and the Beck Depression Inventory (BDI). Twenty-one of the 43 pts completed the questionnaires at discharge as well. All patients received the standard multidisciplinary rehabilitative treatment. The purpose was to evaluate the LLQ as a measure of qol and as an outcome measure. The 43 MS-patients had low weighted qol scores on the following items: readily tired, fatigue, dependence on other people, worry about deterioration and walk. Correspondingly, the BDI showed high scores on fatigability, work difficulty and somatic preoccupation. The correlation between LLQ and BDI was statistically significant (0.54, p < 0002), but weak. ANOVA with repeated measures (LLQ and BDI at admission and discharge) was applied to evaluate rehabilitation outcome in 21 patients. LLQ: The patients experienced a significant reduction in disability on fatigue and mood; and in the importance of being able to climb stairs and to work. The weighted qol-scores increased significantly on physical endurance, work and mood. BDI scores showed a significant decrease on pessimism, irritability, loss of libido and total BDI-score. The changes measured by the LLQ were mainly on behavioral aspects. As the correlation coefficient was only 0.54, the LLQ and the BDI seem to address different aspects of quality of life.

The Impact of Cognitive Impairment on Rehabilitation Outcomes in Elderly Patients Admitted with a Femoral Neck Fracture

To evaluate the evidence of rehabilitation outcomes after the surgical repair of a hip fracture in older people with cognitive impairment. Systematic review. Searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register), ProQuest Dissertations, and Theses Database and bibliographies of extracted publications in the English language between 1990 and June 2007. Search terms included: dementia/Alzheimer disease/cognitive impairment, hip fracture, rehabilitation, outcome assessment/treatment outcome. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale, of the extracted articles. Only studies evaluating rehabilitation outcomes with data analysis specific for cognitive status were evaluated. Sackett's levels of evidence were used to summarize the main findings. Eleven studies met the inclusion criteria. Methodological quality of the studies ranged from fair to poor. The generalizability of study findings was limited by multiple rehabilitation settings in the acute and subacute phase postsurgery, multiple methods with varying thresholds for determining cognitive impairment and multiple functional outcome scales. There is some evidence that older adults with cognitive impairment who receive intensive inpatient rehabilitation after surgical repair of a hip fracture may be able to gain comparable benefit in physical function as cognitively intact patients. There is not enough information to guide recommendations of specific physical therapy interventions to optimize outcomes in this patient population. Further work is needed.

Latent Factors in Measures of Rehabilitation Outcomes After Traumatic Brain Injury

To determine whether there is a latent structure among measures used to evaluate rehabilitation outcomes for persons with traumatic brain injury and if the construct of participation is discernible within this structure. Exploratory factor analyses of 2 cross-sectional cohorts of rehabilitation patients who sustained a traumatic brain injury up to 5 years prior to assessment. Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Satisfaction With Life Scale (SWLS). Both factor analyses suggested a latent structure composed of 3 factors that were interpreted as representing the Activities and Participation dimensions of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), and a third representing Subjective Well-Being. Low to moderate correlations were found between factors. The World Health Organization's ICF excludes subjective well-being; however the factor analyses indicate that it is a distinct domain not incorporated into Activities and Participation. The SF-36, CIQ, and CHART can, in combination, evaluate all 3 domains, but not alone. The SF-36 appears to be sensitive to the affective, but not the cognitive, aspect of Subjective Well-Being. A measure of life satisfaction would be a useful supplement to traditional measures of rehabilitation outcome.