Managing activity difficulties at home: a survey of Medicare beneficiaries

Dudgeon BJ, Hoffman JM, Ciol MA, Shumway-Cook A, Yorkston KM, Chan L. Managing activity difficulties at home: a survey of Medicare beneficiaries.

Objective

To describe assistance from helpers and use of assistive technology and environmental modification by community-dwelling people with difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Design

Cross-sectional study using the 2004 Medicare Current Beneficiary Survey.

Setting

Community.

Participants

Nationally representative sample of 14,500 Medicare beneficiaries (mean age, 71.5y; 55% female; 49% currently married; 68% living with others; 84% white).

Interventions

Not applicable.

Main Outcome Measures

Self-reported difficulty with ADLs and IADLs; uses of help, assistive technology, and/or environmental modification.

Results

Difficulties were reported most frequently for heavy housework, walking, and shopping; money management, shopping, and light housework were reported as activities most often needing a helper. Walking, bathing, and toileting were activities most often needing uses of assistive technology. Bathroom modifications were the most commonly reported environmental modification. Results from a logistic regression showed that advancing age was the primary factor associated with increasing use of helpers and assistive technology or both for difficult activities.

Conclusions

Uses of helpers, assistive technology, and environmental modification are common but vary by type of ADL and/or IADL and age. Focused studies regarding uses of help and access to assistive technology and environmental modification appear needed to support community living. Public education about methods and types of accommodations appears needed and may substitute for or augment guidance from care providers.     

A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders

Vandervelde L, Dispa D, Van den Bergh PY, Thonnard J-L. A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders.

Objective

To investigate the agreement between the self-reported and examiner-reported difficulties of patients with neuromuscular disorders (NMDs) in performing daily activities at home.

Design

A comparison between 2 methods of administering a measurement instrument.

Setting

Neuromuscular reference center in a university hospital.

Participants

Adult patients (N=57) with diagnosed NMDs living at home.

Interventions

Not applicable.

Main Outcome Measure

The ACTIVLIM questionnaire.

Results

The intraclass correlation coefficient, model 2,1 (ICC_2,1), between the measures was very good (ICC_2,1=.87), indicating a good agreement between self-perceived and observed measures.

Conclusions

The use of ACTIVLIM as a self-reporting questionnaire is a valid method for assessing activity limitations in patients with NMD.     

Rehabilitation setting and associated mortality and medical stability among persons with amputations

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations.

Objective

To estimate the differences in outcomes across postacute care settings—inpatient rehabilitation, skilled nursing facility (SNF), or home—for dysvascular lower-limb amputees.

Design

Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997.

Setting

Postacute care after amputation.

Participants

Dysvascular lower-limb elderly amputees (N=2468).

Interventions

Not applicable.

Main Outcome Measures

Mortality, medical stability, reamputations, and prosthetic device acquisition.

Results

The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%).

Conclusions

Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.     

Gait Analysis in Patients With Parkinson's Disease Off Dopaminergic Therapy

Švehlík M, Zwick EB, Steinwender G, Linhart WE, Schwingenschuh P, Katschnig P, Ott E, Enzinger C. Gait analysis in patients with Parkinson's disease off dopaminergic therapy.

Objective

To compare time-distance, kinematic, and kinetic gait parameters in patients with idiopathic Parkinson's disease (PD) off dopaminergic therapy with a group of healthy control subjects.

Design

A group-comparison study.

Setting

Gait analysis laboratory.

Participants

Patients with PD (n=20) and healthy age-matched controls (n=20).

Interventions

Not applicable.

Main Outcome Measures

Time-distance, kinematic, and kinetic gait variables.

Results

PD patients walked slower with shorter stride-length, comparable cadence, and longer double support times. Kinematics showed a reduction of the range of motion in the hip, knee, and ankle joints. Maximum hip extension and the ankle plantar flexion were significantly reduced. Kinetic gait parameters showed reduced push-off ankle power and lift-off hip power generation. Strong correlations between these important body advancement mechanisms and the walking velocity were observed.

Conclusions

In addition to previously described dysfunctional kinematics, abnormal kinetic parameters play an important role in the characterization of gait in PD patients off therapy. Hence, these parameters could be used to document treatment effects of parkinsonian gait disorders.     

Relationship Between Diabetes Codes That Affect Medicare Reimbursement (Tier Comorbidities) and Outcomes in Stroke Rehabilitation

Graham JE, Ripsin CM, Deutsch A, Kuo Y-F, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.

Objectives

To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.

Design

Secondary data analysis.

Setting

Inpatient rehabilitation facilities (N=864) across the United States.

Participants

Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.

Intervention

None.

Main Outcome Measures

Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.

Results

Mean ± standard deviation age of the sample was 70.4±13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.

Conclusions

The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age.     

A Chinese version of Iowa Infant Feeding Attitude Scale: reliability and validity assessment

Background

To achieve the goal of increasing the proportion and duration of breastfeeding in Taiwan, it is essential to assess the role of attitudes in determining which method of infant feeding will be chosen. Understanding maternal attitudes toward infant feeding methods may have utility in the development and implementation of public health policy and interventions facilitating increasing breastfeeding rates. However, no validated instrument to assess breastfeeding attitudes is available in Chinese for use in Taiwan.

Objective

To translate the Iowa Infant Feeding Attitude Scale (IIFAS) into Chinese and assess its psychometric properties among Taiwanese breastfeeding women.

Design

Methodological study.

Setting

One public hospital in Taichung city, Taiwan.

Participants

A convenience sample of 140 in-hospital breastfeeding women was recruited.

Methods

The IIFAS was translated into Chinese using forward translation, back-translation, semantic equivalence, and pilot testing. Predict validity and internal consistency was assessed. The final sample consisted of 120 women (14% attrition) that were interviewed by telephone at 6 weeks postpartum to record the breastfeeding duration and infant feeding method.

Results

One item was modified to better reflect the item content. In-hospital IIFAS scores significantly predicted breastfeeding duration as well as exclusive breastfeeding at 6 weeks postpartum. The Cronbach's alpha coefficient for internal consistency was 0.74.

Conclusions

This study provides evidence that the Chinese version of the IIFAS can be considered valid and reliable scale for assessing attitudes toward breastfeeding among breastfeeding women in Taiwan.     

The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients

Objectives

To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

Design

Cross-sectional, correlation study.

Setting

Orthopaedic outpatient setting in a tertiary hospital.

Participants

One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

Measures

Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

Results

The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

Conclusions

This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.     

Gait Patterns After Total Hip Arthroplasty and Surface Replacement Arthroplasty

Nantel J, Termoz N, Vendittoli P-A, Lavigne M, Prince F. Gait patterns after total hip arthroplasty and surface replacement arthroplasty.

Objective

To compare gait patterns in patients with total hip arthroplasty (THA) and surface hip arthroplasty.

Design

Observational study.

Setting

Outpatient biomechanical laboratory.

Participants

Two groups of 10 surface hip arthroplasty and THA patients and 10 control subjects participated in the study (N=30). The patients were volunteers recruited from a larger randomized study.

Interventions

Not applicable.

Main Outcomes Measures

Gait patterns, hip abductor muscle strength, clinical outcomes, and radiographic analyses were compared between groups.

Results

In the sagittal plane, the THA group showed a larger flexor moment and larger mechanical work in H2S and K3S power bursts compared with surface hip arthroplasty and control subjects. In the frontal plane, both THA and surface hip arthroplasty patients had smaller hip abductor muscles energy generation (H3F) than the control group. No difference was found for the hip abductor muscles strength.

Conclusions

In the THA group, the larger energy absorption in H2S and K3S would be a cost-effective mechanical adaptation to increase stability. The surface hip arthroplasty characteristics could allow the return to a more normative gait pattern compared with THA. The modification in the frontal plane in surface hip arthroplasty and THA would be related to the hip abductor muscles strength.     

The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey

Background

Social support is a crucial coping resource in the development of a strong sense of coherence. However, little is known about which components of social support are most important for the positive development of sense of coherence.

Objectives

The aim of this study is to investigate the ability of the six social provisions in Weiss's theory of social support to predict the positive development of sense of coherence among people with mental health problems.

Design

The study has a prospective design including a baseline assessment and one-year follow-up.

Settings

The community mental health care system in a large city in Norway.

Participants

The sample comprised 107 people with mental health problems. The inclusion criteria were: 18-80 years of age, living at home, mental health problems considered relatively stable, able to engage in dialogue, reliant on the mental health services and/or an activity centre, good orientation, mastery of the Norwegian language and no alcohol and/or drug problems. A total of 92 completed both measures.

Methods

Sense of coherence was measured by the Sense of Coherence questionnaire, mental symptoms by the revised Symptom Checklist-90-R and social support by The Social Provision Scale (all Norwegian versions).

Results

The results show that while social support predicted change in sense of coherence (standardized beta coefficient for social support was 0.32, P = 0.016), mental symptoms did not (standardized beta coefficient −0.07, P = 0.621). The social provision of opportunity for nurturance contributed most to the prediction (standardized beta coefficient 0.24, P = 0.019).

Conclusions

The results indicate that improving social support with special emphasis on opportunity for nurturance might provide important opportunities for increasing sense of coherence among people with mental health problems.     

Effects of two hospital bed design features on physical demands and usability during brake engagement and patient transportation: A repeated measures experimental study

Background

Work-related musculoskeletal disorders (WMSDs) are prevalent among healthcare workers worldwide. While existing research has focused on patient-handling techniques during activities which require direct patient contact (e.g., patient transfer), nursing tasks also involve other patient-handling activities, such as engaging bed brakes and transporting patients in beds, which could render healthcare workers at risk of developing WMSDs.

Objectives

Effectiveness of hospital bed design features (brake pedal location and steering-assistance) was evaluated in terms of physical demands and usability during brake engagement and patient transportation tasks.

Design

Two laboratory-based studies were conducted. In simulated brake engagement tasks, three brake pedal locations (head-end vs. foot-end vs. side of a bed) and two hands conditions (hands-free vs. hands-occupied) were manipulated. Additionally, both in-room and corridor patient transportation tasks were simulated, in which activation of steering-assistance features (5th wheel and/or front wheel caster lock) and two patient masses were manipulated.

Participants

Nine novice participants were recruited from the local student population and community for each study.

Methods

During brake engagement, trunk flexion angle, task completion time, and questionnaires were used to quantify postural comfort and usability. For patient transportation, dependent measures were hand forces and questionnaire responses.

Results

Brake pedal locations and steering-assistance features in hospital beds had significant effects on physical demands and usability during brake engagement and patient transportation tasks. Specifically, a brake pedal at the head-end of a bed increased trunk flexion by 74-224% and completion time by 53-74%, compared to other pedal locations. Participants reported greater overall perceived difficulty and less postural comfort with the brake pedal at the head-end. During in-room transportation, participants generally reported “Neither Low nor High” physical demands with the 5th wheel activated, compared to “Moderately High” physical demands when the 5th wheel was deactivated. Corridor transportation was similarly reported to be easier when a steering-assistance feature (the 5th wheel or front caster lock) was activated.

Conclusions

Braking and steering-assistance features of hospital beds can have important effects on task efficiency and physical demands placed on healthcare workers. Selection of specific designs may thus be able to improve productivity and contribute to a reduction in WMSDs risk among healthcare workers.     

Relatives' Criticism Influences Adjustment and Outcome After Traumatic Brain Injury

Weddell RA. Relatives' criticism influences adjustment and outcome after traumatic brain injury.

Objectives

To apply some of the methods developed to study the effects of relatives' expressed emotion (EE) on psychiatric relapse rates and to test the prediction that relatives' criticism and psychiatric distress would be associated with outcome and emotional distress after traumatic brain injury (TBI).

Design

Retrospective cohort design with correlational analyses of quantitative and qualitative measures of TBI outcomes.

Setting

The author interviewed participants in the hospital. The research assistant interviewed close relatives at home.

Participants

Participants and relatives (N=78) were interviewed 34.3±15.2 months (mean ± SD) after a severe TBI.

Interventions

None.

Main Outcome Measures

Dependent variables in a series of hierarchical linear regression models were participants' scores on the Zung Depression Scale, Spielberger Trait Anxiety Inventory, State-Trait Anger Expression Inventory, an Anger Towards Relative questionnaire constructed for this study, and Extended Glasgow Outcome Scores. Participant-independent variables were social class, posttraumatic amnesia, Wechsler Memory Scale-Delayed Recall score, WAIS-R intelligence quotient, and a short version of the Smell Identification Test. Relative independent variables were the number of critical comments directed toward participants in the interview and psychiatric distress as measured by the General Health Questionnaire.

Results

The contributions of variance associated with relative independent variables (predominantly criticism) were significant in stage 2 of most hierarchical regression analyses after the adjustments for variance associated with participant independent variables made in stage 1.

Conclusions

Future application of EE research methods is warranted. If the present results are replicated, then evidence-based family interventions developed by EE researchers to reduce criticism might also improve TBI outcomes.     

Immediate and Long-Term Effects of Hippotherapy on Symmetry of Adductor Muscle Activity and Functional Ability in Children With Spastic Cerebral Palsy

McGibbon NH, Benda W, Duncan BR, Silkwood-Sherer D. Immediate and long-term effects of hippotherapy on symmetry of adductor muscle activity and functional ability in children with spastic cerebral palsy.

Objectives

To investigate the immediate effects of 10 minutes of hippotherapy, compared with 10 minutes of barrel-sitting, on symmetry of adductor muscle activity during walking in children with cerebral palsy (CP) (phase I). To investigate the long-term effects of 12 weeks of hippotherapy on adductor activity, gross motor function, and self-concept (phase II).

Design

Pretest/posttest randomized controlled trial plus clinical follow-up.

Setting

Outpatient therapy center.

Participants

Children with spastic CP (phase I: n=47; phase II: n=6).

Interventions

Phase I: 10 minutes of hippotherapy or 10 minutes of barrel-sitting; phase II: 12 weekly hippotherapy sessions.

Main Outcome Measures

Phases I and II: adductor muscle activity measured by surface electromyography. Phase II: gross motor function and self-perception profiles.

Results

Phase I: hippotherapy significantly improved adductor muscle asymmetry (P<.001; d=1.32). Effects of barrel-sitting were not significant (P>.05; d=.10). Phase II: after 12 weeks of hippotherapy, testing in several functional domains showed improvements over baseline that were sustained for 12 weeks posttreatment.

Conclusions

Hippotherapy can improve adductor muscle symmetry during walking and can also improve other functional motor skills.     

Psychometric Properties of the Community Integration Questionnaire Adjusted for People With Aphasia

Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia.

Objectives

To describe the feasibility of the Community Integration Questionnaire (CIQ) adjusted for use in people with aphasia and to report its psychometric properties in people with aphasia (internal consistency, factor analysis, test-retest reliability, convergent validity).

Design

A cross-sectional, interview-based psychometric study. Test-retest reliability was evaluated in 20 people (minimal to severe aphasia) by 2 different interviewers within a 2-week period.

Setting

Community.

Participants

In total 490 stroke survivors with (minimal to severe) aphasia were approached, of which 165 (34%) participants returned the answering letter. Participants (N=150) agreed to take part and were interviewed using a structured interview format.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire (CIQ), Frenchay Aphasia Screening Test, Barthel Index, Dartmouth Coop Functional Health Assessment Charts (COOP)-World Organisation of Family Doctors (WONCA) Charts, Life Satisfaction Questionnaire.

Results

A total of 150 stroke survivors with aphasia completed the CIQ adjusted for people with aphasia. The CIQ adjusted for people with aphasia was a feasible instrument. Results showed good internal consistency for the CIQ total (standardized Cronbach α=.75), excellent test-retest reliability (intraclass correlation coefficient=.96), moderate correlations with the Barthel Index, the COOP-WONCA, and the Life Satisfaction Questionnaire with regard to construct validity. Significant relations were found with regard to age and aphasia severity.

Conclusions

The CIQ adjusted for people with aphasia seems to be an adequate instrument to assess participation in people with aphasia.     

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.

Objective

To determine whether oxygen consumption (V˙o₂) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.

Design

Exploratory case-control study.

Setting

Medical school exercise physiology laboratory.

Participants

Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).

Intervention

None.

Main Outcome Measures

V˙o₂ on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).

Results

Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.

Conclusion

V˙o₂ on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.     

Analysis of muscle atrophy after hip fracture in the elderly

Ogawa H, Oshita H, Ishimaru D, Yamada K, Shimizu T, Koyama Y, Akaike A, Hori H. Analysis of muscle atrophy after hip fracture in the elderly.

Objectives

To examine the relationship between muscle atrophy, ambulatory ability, and fracture type, and to make a specific rehabilitation regimen for each fracture type.

Design

Observational study.

Setting

Public hospital.

Participants

Consecutive patients (N=53) with hip fracture (mean age, 83.6y) who underwent operative treatment.

Interventions

Not applicable.

Main Outcome Measures

The ambulatory ability score and the cross-sectional areas of lower-limb muscles as measured on computed tomography scans.

Results

Muscle atrophy was not related to fracture type. Although the mean ambulatory ability score decreased significantly from 4.5±0.3 points prior to injury to 3.0±0.6 points 1 month postadmission, the degree of muscle atrophy was not associated with the decrease in ambulatory ability.

Conclusions

It seems likely that other factors are more important than muscle atrophy and fracture type in determining recovery after surgical repair of a fracture and that there is no need for rehabilitation regimens based on fracture types.     

Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Berlowitz DR, Hoenig H, Cowper DC, Duncan PW, Vogel WB. Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?

Objectives

To examine the impact of comorbidities in predicting stroke rehabilitation outcomes and to examine differences among 3 commonly used comorbidity measures—the Charlson Index, adjusted clinical groups (ACGs), and diagnosis cost groups (DCGs)—in how well they predict these outcomes.

Design

Inception cohort of patients followed for 6 months.

Setting

Department of Veterans Affairs (VA) hospitals.

Participants

A total of 2402 patients beginning stroke rehabilitation at a VA facility in 2001 and included in the Integrated Stroke Outcomes Database.

Interventions

Not applicable.

Main Outcome Measures

Three outcomes were evaluated: 6-month mortality, 6-month rehospitalization, and change in FIM score.

Results

During 6 months of follow-up, 27.6% of patients were rehospitalized and 8.6% died. The mean FIM score increased an average of 20 points during rehabilitation. Addition of comorbidities to the age and sex models improved their performance in predicting these outcomes based on changes in c statistics for logistic and R² values for linear regression models. While ACG and DCG models performed similarly, the best models, based on DCGs, had a c statistic of .74 for 6-month mortality and .63 for 6-month rehospitalization, and an R² of .111 for change in FIM score.

Conclusions

Comorbidities are important predictors of stroke rehabilitation outcomes. How they are classified has important implications for models that may be used in assessing quality of care.     

The clinical learning environment and supervision instrument (CLES): validity and reliability of the Dutch version (CLES+NL)

Background

The clinical learning environment and supervision scale (CLES) is a valid and reliable tool that was developed to assess the quality of nursing students’ clinical placements.

Objectives

To obtain a reliable and valid Dutch version of the CLES that is in line with the Flemish culture and educational context.

Design

Scale validation study on data provided by a cross-sectional survey.

Settings

190 wards in 31 institutions for healthcare in Flanders, Belgium.

Participants

768 student nurses enrolled in the 3 year bachelor programme at University College Ghent, Faculty of Healthcare Vesalius.

Methods

Face and content validation was followed by data collection. Factor analysis was performed using varimax rotation. Subsequently, internal consistency reliability was tested on the total scale and its subdimensions using Cronbach's alpha.

Results

We gathered 768 questionnaires. Factor analysis revealed 5 subdimensions with an eigenvalue greater than 1, explaining 71.281% of the variance. The overall internal consistency and the consistency of the five subdimensions is high. Our data supports face, content and construct validity of the CLES + NL.

Conclusions

The CLES + NL is a valid and reliable instrument that can be used to evaluate the quality of nursing wards as learning environments in Flanders.