Self-care Subscale Research Articles

Measuring Functional Change in Children With Acquired Brain Injury (ABI): Comparison of Generic and ABI-Specific Scales Using the Pediatric Evaluation of Disability Inventory (PEDI)

The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1-20) with ABI during inpatient rehabilitation admissions were included. Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.

A comprehensive analysis of verbal fluency deficit in geriatric schizophrenia

Deficits in verbal fluency are common in schizophrenia and may provide keys to some of the abnormalities in the semantic system in schizophrenia. While a number of studies have outlined the severity and implications of verbal fluency deficits in younger schizophrenia patients, these findings have not yet been extended to older patients with schizophrenia. In this study, 392 older (age≥50) patients with schizophrenia were administered phonological and semantic (i.e., category) fluency examinations, as well as tests of learning, memory, language, and praxic skills, and rated for clinical symptoms and functional status. When compared to normative standards, 82% of the patients were impaired in semantic fluency and 83% were impaired in phonological fluency. Both semantic and phonological fluency impairment were significantly correlated with other cognitive variables, total scores on the functional status measure, and with the social and self-care subscales. Scores were uncorrelated with the severity of psychosis, but were correlated with the severity of negative symptoms. Furthermore, the severity of poverty of speech (a clinical measure of verbal underproductivity) was moderate in magnitude and failed to enter as a predictor of verbal fluency, indicating that impaired fluency scores are not simply an artifact of general underproductivity or mutism. The findings support conclusions from studies with younger schizophrenia patients that suggest that verbal fluency impairment is a consequence of a disorganized semantic system. Verbal fluency impairment remains common and functionally relevant in schizophrenia patients in late life.

Correspondence of the functional independence measure (FIM) self-care subscale with real-time observations of dementia patients' ADL performance in the home.

To determine if caregivers of dementia patients can validly report (a) the level of patient activities of daily living (ADL) dependence and (b) the amount of time they spend providing ADL assistance. Seven ADLs were assessed through caregiver report using the Functional Independence Measure (FIM) and then videotaped. Videotapes were coded using a computer-assisted data collection system that documented the nature and duration of caregiver assistance provided during ADLs. The study took place in the homes of the caregiver-patient dyads. Twenty-one people with dementia and their primary caregivers participated in the study. Data analysis examined (a) the degree to which caregiver-reported FIM scores corresponded to FIM scores derived from the observational data and (b) the extent to which caregivers' estimates of ADL assistance time corresponded to the assistance time observed during ADL interactions. For all ADLs, caregiver-reported FIM scores were correlated significantly with observation-derived FIM scores (r(s) values ranged from 0.620 to 0.909), and means were similar. Assistance durations were also significantly correlated for some ADLs, but means were significantly different, indicating poor correspondence. Although caregivers of dementia patients can describe the nature of their ADL assistance with reasonable accuracy, they consistently overestimate their ADL assistance time, suggesting that caregiver reports of ADL assistance duration be used with caution. Additionally, the degree to which the assistance provided corresponds to the assistance actually needed needs to be addressed in future studies.

The Relationship Between the Allen Cognitive Level Test and the Life Skills Profile

Abstract Objectives. The purpose of this study was to further evaluate the validity of the Allen Cognitive Level Test (ACL-90) as a measure of the construct of “adaptive functioning” and to determine its effectiveness in discriminating between persons who live in the community and persons who are institutionalized. Method. Forty-one persons with schizophrenia living in the community and 17 persons with schizophrenia living in a long-term psychiatric hospital were assessed with the ACL-90 and the Life Skills Profile (LSP). Scores on the two measures were compared, as was the effectiveness of the two measures in discriminating between the participant groups. Results. The ACL-90 scores correlated moderately with the LSP total r (56) = .54, p < .01, and Self-Care Subscale, r (56) = .53, p < .01. Only the Nonturbulence subscale of the LSP discriminated between the community and institutionalized participant groups. The behavior of the participants living in the community was less turbulent than that of the participants who were institutionalized, F(1,54) = 15.24, p < .001. Conclusion. Although the moderate correlations between the ACL-90 and the LSP measures support the ACL as a measure of adaptive functioning and reflect its theoretical perspective, additional information is needed to predict the community functioning and support needs of persons with schizophrenia.

Comparing Individuals with and without Mental Illness Using the Daily Activities Checklist

This study of the Daily Activities Checklist examined an aspect of construct validity, distinguishing differences between groups, specifically investigating differences in activity engagement in individuals with different types of mental illness (schizophrenia and mood disorders) and individuals without mental illness. The Daily Activities Checklist includes subscales of self-care, community living skills, socialization, and quality of performance. Individuals with schizophrenia (N=19), individuals with mood disorders (N=16), and individuals without mental illness (N=20) completed the Daily Activities Checklist every day for a one-week period. An ANCOVA with age as a covariate was used to examine differences in scores across the three groups. Individuals with mental illness scored lower than individuals without mental illness on the total score and all but one subscale of the Daily Activities Checklist. There was no difference between individuals with schizophrenia and individuals without mental illness on the quality subscale scores. Individuals with schizophrenia scored lower than individuals with mood disorders on the self-care subscale and the total score. These results support the usefulness of the Daily Activities Checklist in evaluating engagement in daily activities.

A comparison of the characteristics of incontinent and continent stroke patients in a rehabilitation program.

The characteristics of incontinent stroke patients who regained continence by the time of their discharge from an acute rehabilitation program were compared with those of patients who remained incontinent. Of the 90 patients who met the inclusion criteria on admission to the program, 45 were continent at discharge. Compared with those who regained continence, the subjects who remained incontinent at discharge took longer to be transferred to the rehabilitation program after the onset of stroke, had lower total Functional Independence Measure (FIM) instrument scores at admission and discharge, had more episodes of urinary incontinence (UI) during the first 24 hours after their admission, and had smaller increases in functional scores during rehabilitation. When the time from the onset of stroke was controlled, a subsample of those who remained incontinent scored lower only on the social cognition subscale 14-18 days after the stroke, whereas 27-30 days after their stroke their scores on the sphincter control and self-care subscales were lower. UI was not associated with patients' destinations at discharge. The results of this study provide more information about UI after stroke and give direction for future research.

Outcome of a psychosocial rehabilitation program for persons with psychiatric disabilities

Objective: The study evaluated the outcome of a psychosocial rehabilitation program for persons with psychiatric disability who met DSM-III-R diagnostic criteria for disorders on Axis I and II. Study Design: Twenty-seven users of community mental health centers were admitted to training-on-the-job courses in productive environments. All subjects were interviewed with structured questionnaires (IEF, DAS, LSP, GAS) to evaluate symptomatology and social skills at baseline and at the end of the program. Results: Statistically significant results were detected by the DAS on the Hyperactivity item, dysfunction in social roles, work performance, interest in information, by the LSP on Communication and Self-care subscale. Conclusion: The study replicated some findings from research in this field and confirms the indication of rehabilitation programs for the treatments of the negative dimension of functional psychosis. © 1998 Elsevier Science Ireland Ltd. All rights reserved.

Predictors of Successful Prompted Voiding Among Incontinent Nursing Home Residents

To develop a simple, noninvasive assessment strategy that will enable nursing home staff to identify incontinent residents who respond well to prompted voiding. Incontinent nursing home residents underwent an extensive clinical and functional assessment and then 7 days of prompted voiding. Data from the assessment and the first 3 days of prompted voiding were used to predict responsiveness to the intervention. Seven nursing homes. A cohort of 191 incontinent, long-stay nursing home residents who passed a simple behavioral screen (able to state their name or reliably point to one of two named objects). Prompted voiding was carried out by trained research nurse's aides from 7 AM to 7 PM for 7 days. The intervention was maintained in responsive residents 5 days per week for an additional 9 weeks. Physical checks for wetness were done by research staff hourly from 7 AM to 7 PM for 3 days in a baseline condition, during days 5 through 7 of the 7-day prompted voiding intervention, and for 3 days at the end of 9 weeks of prompted voiding in the responsive group. Outcome measures were percentage of checks wet and response to prompted voiding, with "responders" defined as residents with an average of one or fewer wet episode per day on days 5 through 7 of prompted voiding. Seventy-eight (41%) of the residents were responders. Their wet percentage went from 26.7% to 6.4% at the end of 1 week and was maintained at 9.6% after 9 weeks of prompted voiding. The best predictors of responsiveness were the wet percentage and the appropriate toileting percentage during the first 3 days of prompted voiding, the self-care subscale score of the Multidimensional Observational Scale for the Elderly, and the ability to ambulate without human assistance. The best sensitivity and specificity in identifying responders was achieved when either the wet percentage was lower than 20% or the appropriate toileting percentage was higher than 66% during the first 3 days of prompted voiding (sensitivity, 87%; specificity, 69%). Those residents falsely identified as responders by these criteria still had a 46% relative reduction in wetness. A substantial proportion of nursing home residents respond well to prompted voiding. The most responsive residents can be easily identified using data collected during a 3-day trial of the intervention. The assessment strategy is consistent with federal guidelines and could be used to facilitate quality control by assessing changes in percentage of wetness from the expected norm.

Predictors of successful prompted voiding among incontinent nursing home residents

<h3>Objective.</h3> —To develop a simple, noninvasive assessment strategy that will enable nursing home staff to identify incontinent residents who respond well to prompted voiding. <h3>Design.</h3> —Incontinent nursing home residents underwent an extensive clinical and functional assessment and then 7 days of prompted voiding. Data from the assessment and the first 3 days of prompted voiding were used to predict responsiveness to the intervention. <h3>Setting.</h3> —Seven nursing homes. <h3>Patients.</h3> —A cohort of 191 incontinent, long-stay nursing home residents who passed a simple behavioral screen (able to state their name or reliably point to one of two named objects). <h3>Intervention.</h3> —Prompted voiding was carried out by trained research nurse's aides from 7 AM to 7 PM for 7 days. The intervention was maintained in responsive residents 5 days per week for an additional 9 weeks. <h3>Main Outcome Measures.</h3> —Physical checks for wetness were done by research staff hourly from 7 AM to 7 PM for 3 days in a baseline condition, during days 5 through 7 of the 7-day prompted voiding intervention, and for 3 days at the end of 9 weeks of prompted voiding in the responsive group. Outcome measures were percentage of checks wet and response to prompted voiding, with "responders" defined as residents with an average of one or fewer wet episode per day on days 5 through 7 of prompted voiding. <h3>Results.</h3> —Seventy-eight (41%) of the residents were responders. Their wet percentage went from 26.7% to 6.4% at the end of 1 week and was maintained at 9.6% after 9 weeks of prompted voiding. The best predictors of responsiveness were the wet percentage and the appropriate toileting percentage during the first 3 days of prompted voiding, the self-care subscale score of the Multidimensional Observational Scale for the Elderly, and the ability to ambulate without human assistance. The best sensitivity and specificity in identifying responders was achieved when either the wet percentage was lower than 20% or the appropriate toileting percentage was higher than 66% during the first 3 days of prompted voiding (sensitivity, 87%; specificity, 69%). Those residents falsely identified as responders by these criteria still had a 46% relative reduction in wetness. <h3>Conclusions.</h3> —A substantial proportion of nursing home residents respond well to prompted voiding. The most responsive residents can be easily identified using data collected during a 3-day trial of the intervention. The assessment strategy is consistent with federal guidelines and could be used to facilitate quality control by assessing changes in percentage of wetness from the expected norm. (<i>JAMA</i>. 1995;273:1366-1370)

Serum albumin level as a predictor of geriatric stroke rehabilitation outcome

This study examined the value of serum albumin level as a predictor of medical complications and functional outcomes in 79 patients, age 65 years or older, who underwent comprehensive inpatient interdisciplinary rehabilitation for a first-time, unilateral, thromboembolic stroke. We recorded serum albumin levels at the time of admission to an inpatient rehabilitation unit, reports of the medical complications during rehabilitation, and Modifified Barthel Index (MBI) Scores on admission and discharge. The mean (±SD) serum albumin level for all patients was 3.3 ± 0.4g/dL. Forty-two patients (53%) had a total of 69 medical complications during rehabilitation. Mean serum albumin levels were 3.2 ± 0.4g/dL for the group with complications and 3.5 ± 0.3g/dL for the group without complications (t = −4.34, p < 0.001). Of the 37 patients with albumin levels ≥ 3.5g/dL, only 32% had complications; of the 28 patients with levels from 3.0 to 3.4g/dL, 68% had complications; of the 14 patients with levels ≤ 2.9g/dL, 79% experienced complications (χ2 = 12.4, p = 0.002). There were positive correlations between serum albumin levels and the discharge MBI Self-Care Subscores, Mobility Subscores, and Total Scores (p < 0.001). There were also correlations between serum albumin levels and the Mobility and Total MBI Improvement Scores (p = 0.002 and p = 0.008, respectively). The relationship between serum albumin levels discharge destination approached statistical significance. Neither age nor side of lesion were related to serum albumin level, medical complication rate, or functional outcomes. Serum albumin levels appear to be related to medical complication rate and functional outcome in geriatric stroke patients. This suggests that older stroke patients with hypoalbuminemia may warrant closer medical attention or therapeutic intervention before and during rehabilitation.

Rehabilitation Outcomes in Patients with Complete Thoracic Spinal Cord Injury

This paper describes the functional outcomes and lengths of stay of 184 patients discharged from comprehensive rehabilitation with complete thoracic traumatic spinal cord injuries. The 100-point modified Barthel Index (MBI) was used to assess functional abilities. There were statistically significant improvements in the mean total MBI score for the entire sample from 35.2 at rehabilitation admission to 71.0 at discharge. The mean lengths of stay were 46 days in acute care and 84 days in the rehabilitation facility. There were 79 patients with lesions between T1 and T6 ("high paraplegics") and 105 patients with lesions between T7 and T12 ("low paraplegics"). There were no significant differences in the mean MBI scores, self-care subscores, mobility subscores, acute lengths of stay or rehabilitation lengths of stay between high and low paraplegic patients. However, low paraplegic patients were more likely to walk than were the high paraplegic patients. Surgical stabilization was performed on 36% of the sample; total MBI scores were similar for surgically stabilized and nonsurgically stabilized patients. High and low thoracic paraplegic patients achieved significant functional gains during rehabilitation. These functional gains occurred in a setting which provided for the vocational, psychosocial and recreational needs of the individual, and which fostered independence, community participation and a return to a healthy and active lifestyle.

Rehabilitation outcomes in C6 tetraplegia.

This study reports on the rehabilitation outcome of 69 C6 tetraplegic patients admitted to the Rehabilitation Institute of Chicago during an 8 year period. All patients' last normal level was C6 bilaterally. A 100-point modified Barthel Index was used to obtain measures of functional independence in 15 self-care and mobility tasks. The population consisted of 54 males and 15 females with an average age of 29.2 years. The average number of days from injury to admission to the rehabilitation unit was 58.6 and the average length of rehabilitation stay was 108.4 days. The average Modified Barthel Index score increased from 16.6 on admission to 50.1 on discharge. The Self-Care Subscore increased from 12.8 to 32.2 and the Mobility subscore from 3.7 to 17.9. There were statistically significant increases in the number of patients able to perform all tasks except ability to don an orthosis and ability to walk 50 yards. This study documents a significant increase in function of C6 spinal cord injured patients during rehabilitation.

Rehabilitation outcomes in complete C5 quadriplegia.

Establishment of rehabilitation goals for spinal cord injury patients generally has been based on the degree of residual motor function. Despite extensive clinical experience with spinal cord injury rehabilitation, there have been no reports of the ability of C5 quadriplegic patients to perform self-care and mobility skills before and after rehabilitation. This study was designed to examine the rehabilitation outcomes of 63 patients with C5 complete quadriplegia, who completed an interdisciplinary inpatient rehabilitation program, using the 100-point modified Barthel Index as a means of rating functional status. There were statistically significant increases in the mean modified Barthel index scores from 7.1 on admission to 28.9 on discharge for the entire group of patients. The self-care subscore increased significantly from 6.5 on admission to 20.0 on discharge and the mobility subscore increased significantly from 0.5 on admission to 8.9 on discharge. Ability to perform self-care and mobility subscore tasks is described. This study documented significant improvements in function during comprehensive rehabilitation among patients with C5 spinal cord injury.