Outcome Measures In Rehabilitation Research Articles

Comparing the WeeFIM and PEDI in neurorehabilitation for children with acquired brain injury: A systematic review

ABSTRACTIntroduction: We sought to compare the suitability of the Functional Independence Measure for Children (WeeFIM) and the Pediatric Evaluation of Disability Inventory (PEDI) as outcome measures in rehabilitation of children with acquired brain injury (ABI). Methods: We performed a systematic review of the evidence base using five databases. PRISMA guidelines were adhered to and the review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42015025370). Results: Twenty-six retrospective studies were included. Twelve studies utilized the PEDI, thirteen studies the WeeFIM, and one study included both. Statistically significant responsiveness was demonstrated for both the WeeFIM and PEDI, although significant ceiling effects were detected. Evidence of clinically significant responsiveness was limited to one center utilizing the PEDI. Conclusion: Although requiring licensing to use, the WeeFIM is more suitable for the inpatient setting, is quicker to administer and showed minimal ceiling effects compared to the PEDI counterpart.

Osseointegrated prosthesis for patients with an amputation : Multidisciplinary team approach in the Netherlands.

This article reviews the development of multidisciplinary osseointegration treatment in the Netherlands since its start in 2009. People experiencing limitations due to their socket prosthesis after a leg amputation present to the Radboud University Nijmegen Medical Centre for an osseointegration implant or “bone-anchored” prosthesis. In this article we share our experience with the first 100 patients regarding referral pattern, selection criteria, available osseointegration systems, preoperative planning, surgical treatment, the rehabilitation protocol, outcome measurement, revision surgery, and future developments.

難治性めまい患者に対する個別リハビリテーションの効果 (第2報)

In Japan there are few reports of vestibular rehabilitation for patients with dizziness being provided by physical therapists compared to other countries around the world. One of the most frequently used outcome measures for vestibular rehabilitation is the Dizziness Handicap Inventory (DHI) which is divided into 3 categories; physical, emotional and functional and consists of 25 questions. There are many reports that the total score of the DHI is used for evaluating outcomes, however, there are few reports about analyzing the individualized questions of the DHI. The purpose of this study was to investigate the effectiveness of vestibular rehabilitation for patients with dizziness using the DHI, and to analyze the individualized questions of the DHI after vestibular rehabilitation. Twenty-six patients who had suffered from dizziness for more than 3 months participated in this study. Postural stability and Japanese-DHI (J-DHI) were measured before and after 3 months of vestibular rehabilitation. The results showed that there were significant differences in postural stability and total scores of the J-DHI before and after vestibular rehabilitation. Five of nine J-DHI questions pertaining to physical activity and quick head movements did not improve; however, the J-DHI total score did improve. The results of this study indicate that vestibular rehabilitation may not be effective for physical activity and quick head movements. The exact amount of physical activity and quick head movements were not evaluated in this study and should be in future investigations.

Utility of the Neurobehavioral Symptom Inventory As an Outcome Measure: A VA TBI Model Systems Study.

To examine the utility of the Neurobehavioral Symptom Inventory (NSI)-a measure of postconcussion symptoms used within the Veterans Health Administration-as an index of rehabilitation outcome. Veterans Administration Polytrauma Rehabilitation Centers Traumatic Brain Injury (TBI) Model Systems program. A total of 159 Veterans (14% with mild TBI; 86% with moderate-severe TBI). Disability Rating Scale; Functional Independence Measure; Glasgow Outcome Scale-Extended; NSI; Participation Assessment with Recombined Tools-Objective; Posttraumatic Stress Disorder Checklist-Civilian Version; Satisfaction With Life Scale; Supervision Rating Scale. Correlations and exploratory factor analyses examined the interrelations among outcome measures. Hierarchical regression analyses were utilized to determine if the NSI predicted rehabilitation outcome measures after controlling for demographic variables, TBI severity, and time since injury. NSI reliable changes from pretreatment to 1-year follow-up were examined. Receiver operating characteristics curve analyses were conducted to evaluate the ability of changes in the NSI to predict meaningful change in functioning and employment status. The NSI correlated with psychological distress measures. The NSI administered prior to brain injury rehabilitation had limited predictive utility beyond satisfaction with life. A minority of patients (32%) demonstrated reliable changes on the NSI from baseline to 1-year follow-up. Changes on the NSI were not predictive of meaningful change in employment or functioning. The NSI was not useful for assessing meaningful change in a sample of mixed severity TBI patients.

Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

Use of outcome measures in stroke rehabilitation in the transition from hospital to home-based rehabilitation

Reabilitação baseada em movimento para melhora de dor e atividade em indivíduos com espondilólise ou espondilolistese: revisão sistemática

Introdução: Alterações em estrutura e função decorrentes de espondilólise/espondilolistese podem incluir dor lombar e/ou irradiada para membros inferiores com limitações de atividade. Objetivo: avaliar a eficácia de programas de reabilitação baseados em movimento para redução da dor e melhora de atividade em indivíduos com diagnóstico de espondilólise/espondilolistese. Método: Revisão sistemática de ensaios clínicos aleatorizados, cuja intervenção foi programa de reabilitação baseado em exercício. As medidas de desfecho foram dor e atividade. Resultados: Cinco estudos foram incluídos. Dois estudos investigaram a eficácia da intervenção experimental comparada a placebo/não-intervenção, encontrando resultados inconclusivos. Três estudos investigaram a eficácia da intervenção experimental em comparação ao tratamento cirúrgico, reportando superioridade do tratamento cirúrgico. Conclusão: Os resultados são inconclusivos em relação à eficácia da reabilitação baseada em movimento, e sugerem que é menos eficaz do que tratamentos cirúrgicos na redução da intensidade de dor e melhora de atividade de indivíduos com diagnóstico de espondilólise/espondilolistese.

Development of the Participation Measure–3 Domains, 4 Dimensions (PM-3D4D): A New Outcome Measure for Rehabilitation

ObjectivesTo describe the development of a participation measure that assesses 3 domains (productivity, social, and community) and 4 dimensions (frequency, diversity, desire for change, and perceived difficulty) of participation and to evaluate the initial psychometric properties in rehabilitation outpatients. DesignA mixed-method approach included a literature review, item selection, expert reviews, cognitive interviews, and field testing with rehabilitation outpatients. Confirmatory factor analysis (CFA) and Rasch analysis were used to validate the construct validity of the difficulty dimension of the instrument. SettingOutpatient rehabilitation programs. ParticipantsAn expert panel consisting of 12 rehabilitation and measurement experts contributed to measurement development; 20 rehabilitation outpatients participated in cognitive interviews; and a sample of rehabilitation outpatients (N=556) (average age, 61.36±23.62y; 53% men) participated in field testing. InterventionsNot applicable. Main Outcome MeasureThe Participation Measure–3 Domains, 4 Dimensions (PM-3D4D). ResultsA scoring method for each dimension of the PM-3D4D was established. The instrument displayed good overall model fit in the CFA and unidimensionality across 3 domains after removing and collapsing locally dependent items identified from a principal component analysis. However, considering the poor personal reliability of the social subscale and its high correlation with the community subscale, we decided to merge the 2 subscales into 1. The combined subscale showed improved reliability and good construct validity by demonstrating a good model fit (comparative fit index, .985; Tucker-Lewis Index, .982, root mean square error of approximation, .061) and item fit. ConclusionsThe PM-3D4D is a newly developed participation measure designed to assess multiple domains and dimensions of participation by rehabilitation patients. The psychometric analysis results supported the construct of the instrument and helped item revision. Further examination of the validity and reliability of the PM-3D4D will be conducted.

The Mayo Portland Adaptability Inventory-4 outcome measure is superior to UK FIM+FAM in a British military population

Objective: The aim of this study was to identify the most appropriate rehabilitation outcome measure for use in a young adult population with acquired brain injury.Methods: A 2-year prospective study of patients admitted to a UK military neuro-rehabilitation unit with acquired brain injury to compare the appropriateness of the Functional Independence Measure/Functional Assessment Measure (FIM+FAM) vs the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) in assessing outcomes. Patients were assessed at admission, discharge and at 4-month follow-up using FIM+FAM and MPAI-4.Results: The FIM+FAM total motor score showed a marked ceiling affect, 42% of patients scored the maximum on admission rising to 80% at discharge. The MPAI-4 did not show significant ceiling effects. The other sub-scales of FIM+FAM and MPAI-4 were generally comparable, no more than 17% achieved ceiling at follow-up.Conclusions: This is the first comparative study of FIM+FAM and MPAI-4 in a young adult military population following acquired brain injury. All patients showed improvements in both outcome measures following intensive inpatient rehabilitation. However, the MPAI-4 did not show ceiling effects in motor scores. This measure was, therefore, found to be more appropriate in the cohort.

Impact of Cognition on Burn Inpatient Rehabilitation Outcomes

BackgroundA significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied. ObjectiveTo assess how cognitive function affects rehabilitation outcomes in the burn injury population. DesignRetrospective study. SettingInpatient rehabilitation facilities in the United States. ParticipantsA total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011. Methods or InterventionsMultivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates. Main Outcome MeasurementsFIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency. ResultsCognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days (P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting. ConclusionsCognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population. Level of EvidenceII

Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation

Introduction Despite the increased interest in telerehabilitation (TR), virtual reality (VR) and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and identify the most common outcome measures used in TR. For this review, we conducted a systematic search of the literature that reports outcome measures used in TR or VR for stroke rehabilitation. Our specific objectives included: 1) to identify the outcome measures used in TR and VR studies; and 2) to describe which parts of the International Classification of Functioning are measured in the studies. Methods We conducted a comprehensive search of relevant electronic databases (e.g. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PSYCOINFO, The Cochrane Central Register of Controlled Trial and the Physiotherapy Evidence Database). The scoping review included all study designs. Two reviewers conducted pilot testing of the data extraction forms and independently screened all the studies and extracted the data. Disagreements about inclusion or exclusion were resolved by consensus or by consulting a third reviewer. Results In total, 28 studies were included in this scoping review. The results were synthesized and reported considering the implications of the findings within the clinical practice and policy context. Discussion This scoping review identified a wide range of outcome measures used in VR and TR studies and helped identify gaps in current use of outcome measures in the literature. The review also informs researchers and end users (i.e. clinicians, policymakers and researchers) regarding the most appropriate outcome measures for TR or VR.

Trauma-related amputations in war and at a civilian major trauma centre—comparison of care, outcome and the challenges ahead

The Afghanistan conflict has resulted in a large number of service personnel sustaining amputations. Whilst obvious differences exist between military and civilian trauma-related amputations both settings result in life changing injuries. Comparisons offer the potential of advancement and protection of the knowledge gained during the last 12 years.This paper compares the military and civilian trauma-related amputee cohorts’ demographics, management and rehabilitation outcomes measures.The UK military Joint Theatre Trauma Registry and a civilian major trauma centre database of trauma-related amputees were analysed.255 military and 24 civilian amputees were identified. A significant difference (p>0.05) was seen in median age (24, range 18–43, vs. 48, range 24–87 years), mean number of amputations per casualty (1.6±SD 0.678 vs. 1±SD 0.0), mean ISS (22±SD 12.8 vs. 14.7±SD 15.7) and gender (99% males vs. 78%). Rehabilitation outcome measures recorded included the Special Interest Group in Amputee Medicine score where the military group demonstrated significantly better scores (91% Grade E+ compared to 19%).Differences in patients underlying physiology and psychology, the military trauma system and a huge sustained investment in rehabilitation are all contributing factors for these differing outcomes. However the authors also believe that the use of a consultant-led MDT and central rehabilitation have benefited the military cohort in the acute rehabilitation stage and is reflected in the good short-term outcomes.

Role of "Rehabilitation Outcome Measures" in Rehabilitation Medical Services and Development Status

Role of "Rehabilitation Outcome Measures" in Rehabilitation Medical Services and Development Status

TUG and 2MWT: Important Functional Outcome Measures for Acute Rehabilitation and the Post-op Cardiac Population

Functional outcome measures are tools frequently used to quantify a patient’s functional capacity. Since 2012, Kessler Institute for Rehabilitation (KIR), an acute rehabilitation hospital, has required physical therapists (PTs) to administer both the Timed Up and Go (TUG) and the Two Minute Walk Test (2MWT) upon admission and discharge for all cardiac patients. These assessments were selected in attempt to more specifically measure functional capacity other than using the Functional Independence Measure (FIM) in cardiac patients. Thus, the objectives of this study was to determine if there was an independent association between the TUG and 2MWT, as compared to the FIM, discharge destination and/or length of stay (LOS). We hypothesize that there would be a positive change in the scores (pre and post standard care) and that the assessments were not correlated to the FIM.

Successful outcomes following neurorehabilitation in military traumatic brain injury patients in the United Kingdom.

The Defence Medical Rehabilitation Centre Headley Court is the UK military rehabilitation unit. A pilot study identified the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as the most appropriate rehabilitation outcome measure in young military patients with acquired brain injury. MPAI-4 scores were prospectively recorded for patients on admission and discharge. At 4 months, independent living and employment status were recorded. Inclusion criteria were all new admissions with traumatic brain injury (TBI). Before injury, all patients were fully employed and lived independently. In a 3-year period from April 2011, there were 91 TBI patients with complete admission-discharge episodes: by US Department of Defense criteria, 21 were mild, 35 were moderate, and 35 were severe. There was a significant positive relationship between TBI severity and MPAI-4 score on admission (χ = 12.77, df = 2, p = 0.0017).Median age was 27 years, and median duration of admission was 63 days. Employment and independent living status were available for 79 patients at 4 months. Seventy-three patients (92%) were in community-based employment, with 64 (81%) employed in a competitive or transitional work; 6 (8%) were unemployed or in sheltered work. Sixty-nine (87%) were living independently, and 10 (13%) were living with support in their own home, with no one requiring institutional care.Complete MPAI-4 scores were available for 79 patients. There were statistically and clinically significant improvements in MPAI-4 scores between admission and discharge for the overall group: median admission T score was 40.0 (95% confidence interval, 36.0-42.0) and on discharge was 31.0 (95% confidence interval, 27.0-36.0), a nine-point change (Z = 6.53, p < 0.0001). These improvements with rehabilitation were sustained when patients were subdivided by TBI severity or MPAI-4 limitations. This study demonstrates significant functional improvements in military TBI patients following intensive inpatient multidisciplinary rehabilitation, which includes substantial vocational rehabilitation. At 4 months, 92% were employed, and 87% were living independently. Therapeutic study, level V; prognostic/epidemiologic study, level IV.

Feasibility of implementing rehabilitation outcomes on a specialist adult critical care unit

There is currently no gold standard rehabilitation outcome measure for Critical Care in the UK. Given the complex nature of these patients, it has been suggested that a 'battery' of outcome measures maybe more appropriate for this setting ([1]). Prior to August 2014 rehabilitation outcome measures were not routinely used on our Adult Liver Intensive Care Unit.

One-Legged Cycle Training for Chronic Obstructive Pulmonary Disease. A Pragmatic Study of Implementation to Pulmonary Rehabilitation.

In patients with chronic obstructive pulmonary disease (COPD), partitioned exercise training using one-legged cycling leads to greater improvements in peak oxygen uptake than conventional two-legged cycling. We evaluated the feasibility of incorporating one-legged cycling as the principal aerobic training modality for pulmonary rehabilitation in COPD. Physiotherapists underwent four teaching sessions about the principles and practical implementation of one-legged cycling training. Patients enrolled in a pulmonary rehabilitation program underwent 6-8 weeks of training in which one-legged cycling three times per week was the principal aerobic exercise activity. Participants cycled for 15 minutes with each leg, in each session. An incremental cardiopulmonary exercise test was completed before and after pulmonary rehabilitation along with standard pulmonary rehabilitation outcome measures. Participants and physiotherapists completed a satisfaction survey at the end of the program. A total of 22 out of 32 participants (14 male; mean [SD] age, 66 [7] years; FEV1% predicted, 32 [17]%; median [interquartile range] Medical Research Council dyspnea scale, 3.5 [3.0-4.3]) completed pulmonary rehabilitation. Peak oxygen uptake increased 1.1 (0.4-1.7) ml·min(-1)·kg(-1) (8%) from baseline (P<0.01). The mean (95% confidence interval) 6-minute-walk test distance improved by 72 (45-98) m (P=0.001). The change in the Chronic Respiratory Questionnaire total score of 1.6 (1.1-2.1; P<0.001) was achieved by improvement in all four domains above the clinically important difference. All the physiotherapists considered one-legged cycling safe and would continue to prescribe it; 75% of participants would recommend it to other patients. One-legged cycling was successfully implemented into a "real-life" pulmonary rehabilitation program, demonstrating improvements in cardiorespiratory fitness with associated improvement in function for patients with moderate/severe COPD. One-legged cycling should be recommended in professional pulmonary rehabilitation guidelines as an option for exercise training and be available in other pulmonary rehabilitation programs. Clinical trial registered with www.clinicaltrials.gov (NCT01930526).

Outcome Measurement in Adult Auditory Rehabilitation: A Scoping Review of Measures Used in Randomized Controlled Trials.

This review documented the range and nature of reported outcome measures in the context of adult auditory rehabilitative research. A scoping review conducted as a part of the development of a systematic review of the effect of interventions to improve hearing aid use. The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP; and additional sources for published and unpublished randomized control trials. The date of the search was November 6, 2013. Outcomes were grouped using a framework suggested by the Cochrane Effective Practice and Organization of Care group. Patient outcomes included adherence to hearing aid use, daily hours of aid use, hearing handicap, hearing aid benefit, quality of life, and communication and psychological outcome. Satisfaction and speech perception were frequent secondary outcomes. There was diversity in measures used to report patient outcomes. Outcome categories other than patient health status and behavior were rarely reported. The timing of outcome measurement was often short term (<12 weeks), with a relative lack of evidence on long-term outcomes (>1 year). This review has highlighted considerable diversity in patient-reported outcome measurements in randomized control trials in the context of adult auditory rehabilitation. In addition, there are gaps in the literature with respect to measurement of other outcome types of potential interest to stakeholders, including policymakers and commissioners. Long-term outcome assessment is rare.

An evaluation of Therapy Outcome Measures (TOMs) in community rehabilitation

Background/Aims: This study considers the feasibility of using Therapy Outcome Measure (TOMs) in a community rehabilitation therapy team working with patients over 65 years of age. Methods: An action research approach was used. Data collection and analysis included completion of the outcome measure scores over a 22-week period through semi-structured individual interviews with the therapy team participants, group reflections and the researcher's reflections. Results: Sixty-seven patients were considered in this study, with 26 patient scores included. Nineteen (73%) of those scored for admission and discharge demonstrated sensitivity, with a difference of one score or more. However, the study participants agreed that the TOMs scales and descriptors did not best describe their patient group. They acknowledged that the study had included a small sample size. Conclusions: TOMs was agreed to be an ‘OK fit’ for community rehabilitation patients rather than a ‘best fit’. It should be used as part of a variety of outcome measures to evidence the multidimensional aspects of this speciality, where patients have complex needs and therefore require more complex interventions. This study also highlights the need for further research with a larger sample size.

Selecting Rehabilitation Outcome Measures for People with Multiple Sclerosis.

Despite the well-known benefits of using standardized outcome measures (OMs) in clinical practice, a variety of barriers interfere with their use. In particular, rehabilitation therapists lack sufficient knowledge in selecting appropriate OMs. The challenge is compounded when working with people with multiple sclerosis (MS) owing to heterogeneity of the patient population and symptom variability in individual patients. To help overcome these barriers, the American Physical Therapy Association appointed the Multiple Sclerosis Outcome Measures Task Force to review and make evidence-based recommendations for OM use in clinical practice, education, and research specific to people with MS. Sixty-three OMs were reviewed based on their clinical utility, psychometric properties, and a consensus evaluation of the appropriateness of use for people with MS. We sought to illustrate use of the recommendations for two cases. The first case involves a 43-year-old man with new-onset problems after an exacerbation. The second case pertains to an outpatient clinic interested in assessing the effectiveness of their MS rehabilitation program. For each case, clinicians identified areas that were important to assess and various factors deemed important for OM selection. Criteria were established and used to assist in OM selection. In both cases, the described processes narrowed the selection of OMs and assisted with choosing the most appropriate ones. The recommendations, in addition to the processes described in these two cases, can be used by clinicians in any setting working with patients with MS across the disability spectrum.

A systematic review protocol to evaluate the psychometric properties of measures of function within adult neuro-rehabilitation.

BackgroundSpasticity in the upper limb is common after acquired brain impairment and may have a significant impact on the ability to perform meaningful daily activities. Traditionally, outcome measurement in spasticity rehabilitation has focused on impairment, however, improvements in impairments do not necessarily translate to improvements in an individual’s ability to perform activities or engage in life roles. There is an increasing need for outcome measures that capture change in activity performance and life participation.Methods/DesignWe will conduct a systematic review of the psychometric properties of instruments used to measure upper limb functional outcomes (activity performance and participation) in patients with spasticity. Assessments (n = 27) will be identified from a recently published systematic review of assessments that measure upper limb function in neurological rehabilitation for adults with focal spasticity, and a systematic review of each assessment will then be conducted. The databases MEDLINE, CINAHL and EMBASE will be searched from inception. Search strategies will include the name of the assessment and the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) published search strategy for identifying studies of measurement properties. The methodological rigour of the testing of the psychometric quality of instruments will be undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. International Classification of Functioning, Disability and Health (ICF) definitions of impairment, activity and participation will be used for content analysis of items to determine the extent to which assessments are valid measures of activity performance and life participation. We will present a narrative synthesis on the psychometric properties and utility of all instruments and make recommendations for assessment selection in practice.DiscussionThis systematic review will present a narrative synthesis on the psychometric properties and utility of assessments used to evaluate function in adults with upper limb focal spasticity. Recommendations for assessment selection in practice will be made which will aid clinicians, managers and funding bodies to select an instrument fit for purpose. Importantly, appropriate assessment selection will provide a mechanism for capturing how applicable to everyday life the outcomes from individualised rehabilitation programs for the upper limb really are.Systematic review registrationPROSPERO CRD42014013190Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0076-5) contains supplementary material, which is available to authorized users.