Development of a measure of receptivity of the physical environment

Purpose. New models of disability identify the importance of measuring the influence of the environment (environmental barriers) on the performance of persons with disabilities. The objective of this paper is to present a new measure of the receptivity of the physical environment for persons with mobility impairments and to offer preliminary information about its psychometric properties.

Methods. The measure, The Community Health Environment Checklist (CHEC), was developed and validated in a community setting with a group of persons with mobility impairments. Sixty-three destinations (buildings, recreational areas or facilities) were assessed using the CHEC.

Results. Using Cronbach's alpha, the CHEC was found to have an internal consistency reliability of 0.95. The content validity of the CHEC was assured by the development procedure.

Conclusion. The CHEC offers a brief, easily administered measure of receptivity of the physical environment for persons with mobility impairments that is psychometrically sound.     

Development and validation of a movement and activity in physical space score as a functional outcome measure

Herrmann SD, Snook EM, Kang M, Scott CB, Mack MG, Dompier TP, Ragan BG. Development and validation of a Movement and Activity in Physical Space score as a functional outcome measure.

Objective

To develop and validate a functional measure, the Movement and Activity in Physical Space (MAPS) score, that encompasses both physical activity and environmental interaction.

Design

Observational matched-pair cohort with 2-month follow-up.

Setting

General community under free-living conditions.

Participants

Adult participants (N=18; n=9 postsurgical, n=9 matched control; mean age ± SD, 28.9±12.0y) were monitored by an accelerometer and global positioning system receiver for 3 days within 1 week (4.1±2.8d) after knee surgery (T=0) and 2 months later (T+2). The healthy controls were matched for age, sex, smoking, perceived physical activity level, and occupation of a postsurgical participant. Correlation, t test (with Bonferroni adjustment: α=.05/2), analysis of variance, and intraclass correlation coefficient were used to establish validity and reliability evidence.

Interventions

Not applicable.

Main Outcome Measure

MAPS scores.

Results

MAPS scores were moderately correlated with the Knee Injury and Osteoarthritis Outcome Score (P<.05). There was a significant group difference at T = 0 for MAPS (t_9.9=–3.60; P=.01). Analysis of variance results for the MAPS indicated a time and group interaction (F_1,12=4.60, P=.05). Reliability of 3 days of MAPS scores ranged from 0.75 to 0.81 (postsurgical and control), and 2-month test-retest reliability in the control group was 0.94.

Conclusions

The results provide a foundation of convergent and known-group difference validity evidence along with reliability evidence for the use of MAPS as a functional outcome measure.     

Psychometric properties of a Chinese version of the home environment measure for motor development

Purpose.?This study examined the psychometric properties of the Chinese version of the Affordance in the Home Environment for Motor Development – Toddler version (AHEMD-Toddler-C) for children developing typically (DT) or having motor delays (MD).

Methods.?This was a methodology study. Parent–child dyads with DT (n == 106, mean age of 27.9 months) and with MD (n == 45, 23.6 months) were enrolled. For test-retest reliability, parents completed AHEMD-Toddler-C twice within 2 weeks. For convergent validity, correlations were analysed between AHEMD-Toddler-C and Home Observation for Measurement of the Environment Inventory (HOME), and between AHEMD-Toddler-C and family variables.

Results.?Test-retest reliabilities for AHEMD-Toddler-C were adequate except for Variety of Stimulation (VS) subscale. For convergent validity, the correlation coefficients between AHEMD and HOME were 0.44 (p <0.05). Two subscales of motor toys of AHEMD demonstrated convergent validity with Learning Material subscale of HOME and some family variables in children with MD. Inside Space subscale of AHEMD correlated with family variables. Outside Space (OS) subscale of AHEMD was not significantly correlated with HOME or family variables.

Conclusion.?AHEMD-Toddler-C is a new measure option to explore the relationships between home environment and motor development in Chinese-speaking countries. Nevertheless, VS and OS subscales should be used cautiously.     

Development of the participation and environment measure for children and youth: conceptual basis

Purpose: The purpose of this paper is to describe the conceptual foundation of a new parent-report measure of the participation and environment of children and youth: the Participation and Environment Measure ? Children and Youth version (PEM-CY). Methods: The ICF-CY provided an initial conceptual framework. Results from a qualitative study to obtain parent perspectives and in-depth review of the literature were used to identify relevant dimensions, items and rating scales for measurement. Results: Life situations, defined as sets of activity categories, were identified for three settings: home, school and community. Participation was operationalized as a multidimensional construct with three measurement dimensions: frequency, extent of involvement and desire for change. Parallel sets of items examining environmental factors that are perceived to help or facilitate participation were defined in relation to the typical activities of each setting. Conclusions: The PEM-CY provides a new measure of participation and environment that reflects the perspectives of parents of children and youth. The instrument will facilitate research and professional practice to understand and support the participation of children and youth with and without disabilities.

Implications for Rehabilitation

• As defined by the International Classification of Functioning, Disability, and Health (ICF), participation and environment are multidimensional constructs that have been challenging to measure.

• A new parent-report survey measure has been developed that is feasible for use in large-scale studies of children and youth with and without disabilities.

• The instrument examines participation and environment of children and youth aged 5 to 17 years across three major settings: home, school and community.

     

Development of a PROMIS item bank to measure pain interference

This paper describes the psychometric properties of the PROMIS-pain interference (PROMIS-PI) bank. An initial candidate item pool (n = 644) was developed and evaluated based on the review of existing instruments, interviews with patients, and consultation with pain experts. From this pool, a candidate item bank of 56 items was selected and responses to the items were collected from large community and clinical samples. A total of 14,848 participants responded to all or a subset of candidate items. The responses were calibrated using an item response theory (IRT) model. A final 41-item bank was evaluated with respect to IRT assumptions, model fit, differential item function (DIF), precision, and construct and concurrent validity. Items of the revised bank had good fit to the IRT model (CFI and NNFI/TLI ranged from 0.974 to 0.997), and the data were strongly unidimensional (e.g., ratio of first and second eigenvalue = 35). Nine items exhibited statistically significant DIF. However, adjusting for DIF had little practical impact on score estimates and the items were retained without modifying scoring. Scores provided substantial information across levels of pain; for scores in the T-score range 50–80, the reliability was equivalent to 0.96–0.99. Patterns of correlations with other health outcomes supported the construct validity of the item bank. The scores discriminated among persons with different numbers of chronic conditions, disabling conditions, levels of self-reported health, and pain intensity (p < 0.0001). The results indicated that the PROMIS-PI items constitute a psychometrically sound bank. Computerized adaptive testing and short forms are available.     

Engendering a conducive environment for university students with physical disabilities: assessing availability of assistive facilities in Nigeria

Purpose: This study assessed awareness and availability of assistive facilities in a Nigerian public university.

Methods: Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university.

Results: Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30?years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university’s administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD.

Conclusion: Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required.

• Implications for Rehabilitation

• Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for students with disabilities.

• Awareness about assistive facilities in tertiary institutions for students with disability should be increased so that they can utilize the ones available and demand for such if non-existent.

• The design of buildings on university campus should be made disability friendly.

• A disability register should be open for SWD on campus.

     

Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers

OBJECTIVE: To develop and test a new instrument to assess environmental barriers encountered by people with and without disabilities by using a questionnaire format. DESIGN: New instrument development. SETTING: A rehabilitation hospital and community. PARTICIPANTS: Two convenience samples: (1) 97 subjects, 50 with disabilities and 47 without disability, and (2) 409 subjects with disabilities from spinal cord injury, traumatic brain injury, multiple sclerosis, amputation, or auditory or visual impairments. In addition, a population-based sample in Colorado of 2269 people (mean age, 44 y; 57% men) with and without disabilities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Item development; factor structure; test-retest, subject-proxy and internal consistency reliability; content, construct, and discriminant validity; and subscale and abbreviated version development. RESULTS: Panels of experts on disability developed items for the Craig Hospital Inventory of Environmental Factors (CHIEF). The instrument measured the frequency and magnitude of environmental barriers reported by individuals. Five subscales were derived from factor analysis measuring (1) attitudes and support, (2) services and assistance, (3) physical and structural, (4) policy, and (5) work and school environmental barriers. The CHIEF total score had high test-retest reliability (intraclass correlation coefficient [ICC]=.93) and high internal consistency (Cronbach alpha=.93), but lower participant-proxy agreement (ICC=.62). Significant differences were found in CHIEF scores among groups of people with known differences in disability levels and disability categories. CONCLUSIONS: The CHIEF has good test-retest and internal consistency reliability with evidence of content, construct, and discriminant validity resulting from its development strategy and psychometric assessments in samples of the general population and among people with a variety of disabilities.     

终末期住院患者病房物理环境设计研究进展

就物理环境的定义、分类及其构成要素,终末期住院患者病房物理环境设计原则,终末期住院患者病房物理环境设计及其对患者的影响进行了综述,以期为设计促进终末期住院患者身心社灵舒适及优逝的病房物理环境提供参考,为构建国内安宁疗护病房提供理论依据和实践指导。     

Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men

Liang H, Tomey K, Chen D, Savar NL, Rimmer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men.

Objectives

To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI).

Design

A cross-sectional study.

Setting

Urban university.

Participants

Men with SCI (N=131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time.

Interventions

Not applicable.

Main Outcome Measures

Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score.

Results

Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR]=.19; 95% confidence interval [CI], .04–.80), metabolic syndrome (OR=.15; 95% CI, .03–.66) and high CRP (OR=.17; 95% CI, .04–.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR=.14; 95% CI, .04–.49) than their counterparts.

Conclusions

In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome, and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.     

Development of a brief survey to measure nursing home residents' perceptions of pain management

Persistent severe pain in nursing home residents remains an important public health problem. One major key to quality improvement efforts is the development of tools to assist in auditing and monitoring the quality of health care delivery to these patients. A qualitative synthesis of existing pain guidelines, and input from focus groups and an expert panel, were used to develop a 10-item instrument, the Resident Assessment of Pain Management (RAPM). The psychometric properties of the RAPM were examined in a sample of 107 (82% female, average age 85) cognitively intact nursing home residents living in six Rhode Island nursing homes. Reliability and internal consistency were evaluated with test–retest and Cronbach's alpha, respectively, and validity was examined against independent assessment of pain management by research nurses. After comparing the results of RAPM with the independent pain assessment and examining a frequency distribution and factor analysis, five of the 10 items were retained. Internal reliability of the final instrument was 0.55. The rate of reported concerns ranged from 8% stating that they were not receiving enough pain medication to 43% stating that pain interfered with their sleep. The median pain problem score (i.e., the count of the number of opportunities to improve) was 1, with 23% of residents reporting three or more concerns. Overall, RAPM was moderately correlated (Spearman correlation coefficient r = 0.43) with an independent expert nurse assessment of the quality of pain management. Evidence of construct validity for RAPM is based on the correlation of the pain problem score with nursing home resident satisfaction with pain management (r = 0.26), reported average pain intensity (r = 0.41), research nurse completion of the Minimum Data Set pain items (r = 0.52), and the quality of pain documentation in the medical record (r = 0.28). In conclusion, RAPM is a brief survey tool easily administered to nursing home residents that identifies important concerns with pain management. Although there is concern with the low internal consistency, RAPM demonstrates both criterion and construct validity that suggests its potential use in quality improvement efforts.     

Preparing students to competently measure blood pressure in the real-world environment: a comparison between New Zealand and the United Kingdom

This research sought to evaluate the contribution of simulation to the development of a fundamental nursing skill, blood pressure measurement. Year one nursing students at UCOL, New Zealand (n = 75) and the University of Huddersfield, England (n = 55) completed questionnaires about their confidence/competence levels in blood pressure measurement at the conclusion of the simulation sessions, and again after their first clinical placement. Registered nurses who worked with those students (n = 22 UCOL, n = 21 University of Huddersfield) also completed assessments of the students’ competence with both electronic and manual blood pressure during their placement.On completion of the simulation sessions 60% of the UCOL students considered themselves competent or confident/competent in blood pressure measurement compared with just 16% of those at the University of Huddersfield. Reports of registered nurse supervision of students undertaking blood pressure measurement on clinical placement varied, but it was clear that students often undertook blood pressure measurement without a registered nurse in attendance to check technique, or the accuracy of their recording.     

用管理创造环境 以环境创造人才

人才是一种十分宝贵的人力资本.行业要发展,人才的竞争已是不争的事实.我们创造软环境,如舆论环境、学术环境、竞争环境,为人才成长打下良好基础.同时,注重环境对人才的作用,发挥环境对人才的感奋作用如实施护士长任期目标责任制,使她们感到了压力和动力.同时解决住房、电话,极大的方便了她们工作和生活.发挥环境对人才的趋向作用本着"人尽其才、才尽其用"的原则,对不同学历层次的人才,赋予不同的目标.发挥环境对人才的保障作用引进人才不容易、培养人才不容易,留住人才同样不容易.用良好的环境保障人才不流失,也需要管理手段与智慧.由于为人才提供了良好的精神生活保障,使人才心情舒畅、工作热情高涨,充分发挥了人才的积极性与能动作用.     

Development of the public information and communication technology assessment tool

Purpose. Public information and communication technologies, such as information kiosks, automated banking machines and ticket dispensers, allow people to access services in a convenient and timely manner. However, the development of these technologies has occurred largely without consideration of access by people with disabilities. Inaccessible technical features make operation of a public technology difficult and barriers in the environment create navigational challenges, limiting the opportunity of people with disabilities to use these devices and access the services they provide. This paper describes the development of a tool that individuals, disability advocacy groups, business owners, healthcare providers, and urban planners can use to evaluate the accessibility of public technologies and the surrounding environment. Evaluation results can then be used to develop recommendations and advocate for technical and environmental changes to improve access.

Methods. Tool development consisted of a review of the literature and key Canadian Standards Association documents, task analysis, and consultation with accessibility experts. Studies of content validity, tool usability, inter-rater and test-retest reliability were conducted in sites across Canada.

Results. Accessibility experts verified the content validity of the tool. The current version of the tool has incorporated the findings of a usability study. Initial testing indicated excellent agreement for inter-rater and test-retest reliability scores.

Conclusions. Social exclusion can arise when public technologies are not accessible. This newly developed instrument provides detailed information that can be used to advocate for more accessible and inclusive public information and communication technologies.     

医护人员对ICU物理环境因素认知的多中心调查

目的 了解医护人员对ICU物理环境因素的知识和态度,探索其影响因素,为优化ICU物理环境因素提供参考依据。方法 采用分层抽样的方法,使用自制问卷对福建省8所三级医院及14所二级医院的487名ICU医护人员进行问卷调查。结果 调查对象对物理环境因素的知识、态度得分分别为（33.25±7.14）分、（42.17±3.26）分。多元线性回归分析结果显示,文化程度、医院等级是ICU医护人员对物理环境因素知识水平的影响因素（P<0.01）,职称、行政职务和医院等级是ICU医护人员对物理环境因素态度的影响因素（P<0.01）。结论 ICU医护人员对ICU物理环境因素持积极态度,但相关知识有待提高。     

Transfer of spatial information from a virtual to a real environment in physically disabled children

A group of 10 severely physically disabled children explored a to-scale computer simulation of a real multi-storey building. Following exploration, their knowledge of the spatial properties of the real environment was assessed by asking them to point to fire apparatus that was not visible from the test site. Subjects in a control group were asked to complete the same assessment tasks, but without the opportunity to explore either the real building or the computer simulation. The estimates of the disabled children were superior to the control group indicating good transfer of spatial knowledge. Route finding and recognition reports provided support for the pointing data in indicating good transfer of spatial information.     

珠海海滨疗养环境质量分析

目的 通过调查珠海滨疗养环境质量情况，发掘本区疗养资源，促进疗养事业发展。方法 调查本区大气环境质量、声环境质量、水环境质量等环境资料，进行统计学处理并分析。结果 珠海海滨的气温、气湿、日照、空气负氧离子、噪声等方面优势明显，珠海海滨疗养区环境质量均达到或超过了国家统一标准。结论 珠海海滨的疗养环境优戟，适于各类人员的保健疗养和疾病疗养。