Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients?

Objectives: To assess the validity, sensitivity to change, and responsiveness of 3 self-report and 4 performance-based measures of physical function: activity measure for postacute care (AM-PAC) Physical Mobility and Personal Care scales, the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function scale (SF-36 PF), the Physical Functional Performance test (PFP-10), the Short Physical Performance Battery (SPPB), a 4-meter gait speed, and the six-minute walk test (6MWT).

Design: A prospective observational study of patients after a hip fracture. Assessments were performed at baseline and 12 weeks postenrollment.

Adaptive short forms for outpatient rehabilitation outcome assessment.

Objective: To develop outpatient Adaptive Short Forms for the Activity Measure for Post-Acute Care item bank for use in outpatient therapy settings.

Design: A convenience sample of 11,809 adults with spine, lower limb, upper limb, and miscellaneous orthopedic impairments who received outpatient rehabilitation in 1 of 127 outpatient rehabilitation clinics in the United States. We identified optimal items for use in developing outpatient Adaptive Short Forms based on the Basic Mobility and Daily Activities domains of the Activity Measure for Post-Acute Care item bank.

Computer and internet use by persons after traumatic spinal cord injury.

Objective: To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI.

Design: A multicenter cohort study.

Setting: Twenty-six past and current U.

An exploratory analysis of functional staging using an item response theory approach.

Objectives: To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non-IRT-based staging system developed for the FIM instrument.

Design: Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation.

Setting: Follow-up interviews conducted in patients' homes.

Achieving meaningful measurements of ICF concepts.

Purpose: This paper reviews the strengths and weaknesses of two different approaches to assessing ICF concepts: coding versus quantitative scales. It illustrates the advantages of an alternative, integrative approach, called functional staging.

Method: A prospective cohort study.

Did the 1997 balanced budget act reduce use of physical and occupational therapy services?

Objective: To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA).

Design: Data from the nationally representative Medicare Current Beneficiary Survey (MCBS) were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973).

Physician-based physical activity counseling for middle-aged and older adults: a randomized trial.

Sedentary behavior among older adults increases risk for chronic diseases. Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients. The Physically Active for Life (PAL) project was a randomized, controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels.

Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes.

Objectives: To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness.

Design: Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later.

Setting: Follow-up interviews conducted in patient's home setting.

Relationship between self-reported function and disability and balance performance measures in the elderly.

This study evaluated the reliability and validity of the Hebrew version of the Late-Life Function and Disability Instrument (LLFDI). Fifty-five older adults (mean age 79.7 +/- 5.

Interpreting rehabilitation outcome measurements.

Objective: With the increased use of standardized outcome instruments in rehabilitation, questions frequently arise as to how to interpret the scores that are derived from these standardized outcome instruments. This article uses examples drawn from the Activity Measure for Post Acute Care to illustrate 4 different data analysis and presentation strategies that can be used to yield meaningful outcome data for use in rehabilitation research and practice.

Design: A prospective cohort study in patients recruited at the point of discharge from a large acute care hospital or on admission to 1 of 2 rehabilitation hospitals after discharge from an acute care hospital in the greater Boston, MA region.

Blending activity and participation sub-domains of the ICF.

Objective: The objective of the study was to test the supposition that distinct Activity and Participation sub-domains of the International Classification of Functioning, Disability, and Health (ICF) could be identified using physical function questionnaire items drawn from the Activity and Participation Measures for Post Acute Care.

Design: A cross-sectional survey design was employed. Subjects.

Predictors of basic and instrumental activities of daily living performance in persons receiving rehabilitation services.

Objective: To examine the relations among cognitive and emotional function and other patient impairment and demographic variables and the performance of daily activities.

Design: Cohort.

Setting: Acute inpatient rehabilitation, skilled nursing facilities, home care, and outpatient clinics.

Prospective evaluation of the AM-PAC-CAT in outpatient rehabilitation settings.

Background And Purpose: The purpose of this study was to prospectively evaluate the practical and psychometric adequacy of the Activity Measure for Post-Acute Care (AM-PAC) "item bank" and computerized adaptive testing (CAT) assessment platform (AM-PAC-CAT) when applied within orthopedic outpatient physical therapy settings.

Method: This was a prospective study with a convenience sample of 1,815 patients with spine, lower-extremity, or upper-extremity impairments who received outpatient physical therapy in 1 of 20 outpatient clinics across 5 states. The authors conducted an evaluation of the number of items used and amount of time needed to complete the CAT assessment; evaluation of breadth of content coverage, item exposure rate, and test precision; as well as an assessment of the validity and sensitivity to change of the score estimates.

Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort.

Objective: To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital.

Design: Cohort study.

Setting: Postacute care.

Development and initial psychometric evaluation of the participation measure for post-acute care (PM-PAC).

Objective: To evaluate a patient-reported participation measure constructed within the framework of the International Classification of Functioning, Disability, and Health.

Design: The Participation Measure for Post-Acute Care (PM-PAC) contains 51 items that assess participation in nine domains: mobility; role functioning; community, social, and civic life; domestic life/self-care; economic life; interpersonal relationships; communication; work; and education. Self-reported data were collected by interview with 395 noninstitutionalized rehabilitation patients.

Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank.

Background And Objective: Measuring physical functioning (PF) within and across postacute settings is critical for monitoring outcomes of rehabilitation; however, most current instruments lack sufficient breadth and feasibility for widespread use. Computer adaptive testing (CAT), in which item selection is tailored to the individual patient, holds promise for reducing response burden, yet maintaining measurement precision. We calibrated a PF item bank via item response theory (IRT), administered items with a post hoc CAT design, and determined whether CAT would improve accuracy and precision of score estimates over random item selection.

Measuring patient-reported outcomes after discharge from inpatient rehabilitation settings.

Objective: To examine the sensitivity of the Short Form Activity Measure for Post-Acute Care (AM-PAC) in comparison to the Functional Independence Measure (FIM) across a 12-month period after discharge from rehabilitation hospital.

Design: Prospective longitudinal study. Patients were recruited while receiving inpatient services from facilities in the north-east USA and interviewed 1, 6 and 12 months thereafter.

Rehabilitation Medicine Summit: Building Research Capacity--executive summary.

The advancement of medical science depends on the production, availability, and utilization of new information generated by research. A successful research enterprise depends not only on a carefully designed agenda that responds to clinical and societal needs but also on the research capacity necessary to perform the work. Research that is likely to enhance clinical practice presupposes the existence of a critical mass of investigators working as teams in supportive environments.

Rehabilitation medicine summit: building research capacity.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector.

Rehabilitation Medicine Summit: Building Research Capacity-Executive Summary.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector.

Toward a common language for function, disability, and health.

Within physical therapy, the disablement model has proven useful as a language to delineate the consequences of disease and injury. This perspective provides an update on the changing language of disablement, reviews selected contemporary disablement models, and discusses some challenges that need to be addressed to achieve a universal disablement language that can be used to discuss physical therapy research and clinical interventions. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework has the potential of becoming a standard for disablement language that looks beyond mortality and disease to focus on how people live with their conditions.

The effects of strength training on memory in older adults.

The authors examined whether resistance training has an effect on working memory span. Participants included 210 community-residing older adults with at least one disability from the Strong for Life program, a randomized controlled trial that examined the effects of home-based resistance exercise. Memory was assessed with the WAIS backward digit span at baseline and 3 and 6 months into the intervention.

Rehabilitation Medicine Summit: Building Research Capacity: executive summary.

The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector.

Feasibility of implementing the Strong for Life program in community settings.

Purpose: We describe the results of the dissemination of an efficacious, home-based exercise program called Strong for Life as it was implemented in a nationwide, volunteer caregiving program called Faith in Action, including training of volunteers who implemented the program, recruitment of older adult participants, exercise adherence, and attitudes and perceptions of program staff and participants.

Design And Methods: Frail, homebound older adults (N = 105) were recruited from 10 Faith in Action sites to participate in the Strong for Life exercise program. Volunteer trainers (n = 103) were trained by physical therapists to assist the older adults with the program.