Responsiveness of Mobility, Daily Living, and Instrumental Activities of Daily Living Outcome Measures for Geriatric Rehabilitation

Demers L, Desrosiers J, Nikolova R, Robichaud L, Bravo G. Responsiveness of mobility, daily living, and instrumental activities of daily living outcome measures for geriatric rehabilitation.

Objectives

To assess and compare the ability of the Timed Up & Go (TUG) and subscales of the Functional Autonomy Measurement System (SMAF) to detect change in people undergoing geriatric rehabilitation in inpatient geriatric rehabilitation units (GRUs) and day hospitals.

Design

Longitudinal design with repeated measures obtained at admission and discharge from rehabilitation and at 2 follow-up interviews.

Setting

Inpatient and outpatient hospital-based settings.

Participants

Subjects (N=237, age 80±7y) had data at admission and discharge from rehabilitation (changing time frame), and of these, 160 had data at 2 subsequent follow-ups (stable time frame).

Interventions

Not applicable.

Main Outcome Measures

The TUG was used to estimate basic mobility, and subscales of the SMAF were used to estimate general mobility (SMAF-mobility), basic activities of daily living (SMAF-ADL), and instrumental activities of daily living (SMAF-IADL). Professionals' perception of change was used as a criterion.

Results

The TUG generated large values for the standardized response mean (SRM) and Guyatt's responsiveness index in GRUs (.98 and 1.12) and day hospitals (.89 and 1.85). Professionals' perception of change in mobility was explained by a perceptible change in the TUG in day hospitals (15%) but not in GRUs. The SMAF-mobility, SMAF-ADL, and SMAF-IADL were associated with large values of SRM and Guyatt's responsiveness index in GRUs (.97-2.17) and with small to moderate values in day hospitals (.29-.54). Moderate to large portions in the professionals' perceptions of change for mobility (20%, 17%), basic ADLs (10% and 14%), and IADLs (23% and 19%) were associated with the respective change scores of the subscales of the SMAF in both GRUs and day hospitals.

Conclusions

Progress of older adults in the areas of mobility, basic ADLs, and IADLs can be captured using the TUG, SMAF-mobility, SMAF-ADL, and SMAF-IADL in both GRUs and day hospitals. The results support their use in settings of high- and low-intensity rehabilitation, thus suggesting their adequacy for use in these 2 settings.     

Reliability and Responsiveness of the Activities of Daily Living Computerized Adaptive Testing System in Patients With Stroke

Objective

To examine the intrarater reliability, interrater reliability, and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system (ADL CAT) in patients with stroke.

Design

One repeated-measures design (at an interval of 7d) was used to examine the intrarater reliability and interrater reliability of the ADL CAT. For the responsiveness study, participants were assessed with the ADL CAT at admission to the rehabilitation ward and at discharge from the hospital.

Setting

Eight rehabilitation units.

Participants

Three different (nonoverlapping) groups of patients (N=157) were recruited. Fifty-five and 42 outpatients with chronic stroke participated in the intrarater and interrater reliability studies, respectively; 60 inpatients who had recently had a stroke participated in the responsiveness study.

Interventions

Not applicable.

Main Outcome Measure

ADL CAT.

Results

The intraclass correlation coefficient values were .94 and .80 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The classical test theory–based minimal detectable change values were 6.5 and 9.5 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The Kazis' effect size and standardized response mean of the ADL CAT were moderate (.62–.73).

Conclusions

The ADL CAT has good intrarater reliability and interrater reliability in outpatients with chronic stroke, and sufficient responsiveness in inpatients with stroke undergoing inpatient rehabilitation. Further investigations on the responsiveness of the ADL CAT in outpatients are needed to obtain more evidence on the utility of the ADL CAT.     

Repeatability and validity of a modified Activities of Daily Living (ADL) index in studies of chronic disability

In order to measure disability in a randomised controlled trial of different intensities of rehabilitation following stroke, a modification of existing methods has been developed; it makes use of 17 items of activities of daily living (ADL) which are rated on a three-point scale, and it has been subjected to tests of repeatability and validity. While some activities (e.g. use of taps, ascending or descending stairs) are either redundant or repetitive, others provide independent measures of disability. There was no significant inter-observer variability; the assessors disagreed on 78 (3.7%) out of a total of 2,125 paired observations. In a study of short-term within-patient variability, different scores were assigned on 49 (14.4%) out of a total of 340 observations made on two separate occasions. Minor differences (mainly in activities involving equipment e.g. cookers) emerged when scores obtained in hospital were compared with those obtained at home, but the two sets of scores were still highly correlated (r = 0.962). There was, however, considerable discrepancy between the hospital scores and those derived from the patients' own estimates of their activities at home, the latter falling below actual capabilities as indicated by the hospital scores. A clinical validation of the index showed a significant association between the hospital ADL scores and the extent of cerebral lesions determined by the number of neurological deficits. This modified ADL index is sufficiently repeatable and valid for the assessment of patients with moderate disability as a result of stroke and other chronic diseases; in most circumstances, it can probably be simplified to include only five or six items.     

Increased Participation in Activities of Daily Living Is Associated With Lower Cholesterol Levels in People With Spinal Cord Injury

Hetz SP, Latimer AE, Martin Ginis KA, Buchholz AC, and the SHAPE-SCI Research Group. Increased participation in activities of daily living is associated with lower cholesterol levels in people with spinal cord injury.

Objective

To evaluate the relationships between activities of daily living (ADLs) participation and coronary heart disease (CHD) risk factors in people with spinal cord injury.

Design

Cross-sectional.

Setting

Community, university, hospital.

Participants

Participants (N=75) from the Study of Health and Activity in People With Spinal Cord Injury study (61 men, 14 women).

Interventions

Not applicable.

Main Outcome Measures

Physical Activity Recall Assessment for People With Spinal Cord Injury and CHD risk factor assessment including waist circumference, total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol, and triglycerides.

Results

Using generalized linear models, and controlling for leisure time physical activity and covariates, increased Mobility ADLs (transferring and wheeling) were associated with lower plasma total cholesterol and LDL. No other significant relationships emerged.

Conclusions

Mobility ADLs were associated with lower total cholesterol and LDL. However, neither Total ADLs nor Domestic ADLs were associated with CHD risk. Further investigation is needed to determine causality between Mobility ADLs and CHD risk.     

脑卒中家庭康复护理对日常生活活动能力的影响

目的 :研究脑卒中家庭康复护理干预对后遗症期患者日常生活活动能力的影响。方法 :将社区的 6 0例患者 ,随机分为干预组和对照组各 30例 ,由经培训的社区护士按“家庭康复护理干预方案”实施干预 ,分别于 1个月、3个月时评价日常生活活动能力。结果 :两组间在 1个月和 3个月时日常生活活动能力的得分、提高分和依赖度改变均有显著差异 (P <0 .0 1)。结论 :脑卒中家庭康复护理干预能提高后脑卒中遗症期患者日常生活活动能力     

早期康复对脑卒中后病人日常生活活动能力的影响

目的 :探讨脑卒中发病到康复开始的间隔时间(OAI)对病人日常生活活动(ADL)能力的影响。方法 :采用回顾性研究的方法 ,分析 2 2 5例脑卒中后ADL能力的变化及相关因素。结果 :OAI与ADL入院 值呈正相关 (r =0 .14 6,P =0 .0 2 87) ,与ADL增加 值呈负相关 (r =-0 .2 5 4,P =0 .0 0 0 1) ;OAI是ADL出院值的预测因素之一。结论 :早期康复有利于病人ADL能力的提高     

行为学习对提高阿尔茨海默病患者自理能力的探讨

目的 探讨行为学习训练能否提高阿尔茨海默病患的日常生活和认知能力，能否激发其思维活动，从而提高其生活质量。方法 选择住院的56例阿尔茨海默病患，随机分为实验组和对照组各28例，除进行常规治疗护理外，实验组再接受行为学习训练。以日常生活能力量表(ADL)和简易智力筛选量表(MMSE)为评定工具。结果 实验组经行为学习训练后ADL量表中(除洗澡和打电话两项外)，其余各项均P＜0．05，差异有显性；而对照组ADL各项均P＞0．05，差异无显性。实验组MMSE比较有6项P＜0．05，差异有显性，而对照组MMSE仅在语言理解和定向方面有改善，P＜0．05。结论 行为学习训练能提高阿尔茨海默病患的生活自理能力，有利于改善患的认知障碍及激发其思维活动和增强其社交能力，从而提高其生活质量。     

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. PARTICIPANTS: Adults (N=534) receiving services for neurologic (32.3%), lower-extremity orthopedic (42.7%), or complex medical (24.9%) conditions. Mean age was 63.8 years; 55% were women; 88.6% were white; and the time since condition onset ranged from 0.2 to 3.9 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Activity Measure for Post-Acute Care: applied cognitive, personal care and instrumental, and physical and movement scales; Mental Health Inventory-5 (MHI-5); and patient-identified problems (vision, grasp). RESULTS: Path analyses resulted in good model fit both for the total sample and 3 patient subgroups (chi(2) test, P>.05; comparative fit index >.95). There was a significant (P<.05) direct relation between the applied cognitive, grasp, and personal care and instrumental variables in all patient groups. There were also significant indirect relations between the MHI-5, visual impairment, and grasp problems with the personal care and instrumental scale through an association with the applied cognitive scale. Strength and significance of associations between age, sex, and physical and movement and personal care and instrumental scales varied more across patient groups. The model R(2) for the personal care and instrumental scale for the total sample was .60, with R(2) values of .10, .72, and .62 for the lower-extremity orthopedic, neurologic, and complex medical groups, respectively. CONCLUSIONS: Results suggest that variations in cognitive function, along with visual impairment and lower perceived well-being are associated with a patient's ability to complete daily activities. Rehabilitation professionals should consider cognitive and emotional factors as well as physical performance when planning treatment programs to restore daily activity function.     

A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge

van den Berg-Emons RJ, Bussmann JB, Haisma JA, Sluis TA, van der Woude LH, Bergen MP, Stam HJ. A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge.

Objectives

To assess the change over time in the physical activity level after a spinal cord injury (SCI), to explore its determinants, and to compare the physical activity level 1 year after discharge from the rehabilitation center with the level in able-bodied persons.

Design

Prospective cohort study. Measurements were obtained at the start of active rehabilitation, 3 months later, at discharge, 2 months after discharge, and 1 year after discharge.

Setting

Rehabilitation center in The Netherlands and the participant's home.

Participants

Persons (n=40) with SCI.

Interventions

Not applicable.

Main Outcome Measures

The physical activity level, as indicated by the duration of dynamic activities (ie, wheelchair driving, walking, cycling, noncyclic movement) per day, and the intensity of everyday activity; both were measured with an accelerometry-based activity monitor during 2 consecutive weekdays.

Results

Random coefficient analyses showed that the duration of dynamic activities and the intensity of everyday activity increased during inpatient rehabilitation at rates of 41% and 19%, respectively (P<.01). Shortly after discharge, there was a strong decline (33%; P<.001) in the duration of dynamic activities. One year after discharge, this decline was restored to the discharge level but was low in comparison with levels in able-bodied persons. The level of lesion and completeness of lesion were determinants of the change in the physical activity level after discharge.

Conclusions

The physical activity level increased during inpatient rehabilitation, but this increase did not continue after discharge, and the level 1 year after discharge was distinctly lower than the level in able-bodied persons. Subpopulations had a different change over time in the physical activity level after discharge.     

不同阶段作业治疗对脊髓损伤患者日常生活影响

目的探讨不同阶段作业治疗对汶川地震致脊髓损伤患者日常生活能力（ADL）的影响。方法对2008年7月-2011年6月收治于绵竹市人民医院康复科的26例地震致脊髓损伤患者进行为期3个月的第1阶段治疗和为期3周的第2阶段作业治疗,并以改良Barthel指数（MBI）作为评估ADL的指标。结果第1阶段治疗后MBI指数平均得分（65．714-19．30）分,第2阶段治疗后MBI指数平均得分（76．934-16．82）分,第2阶段MBI各项评分较第1阶段均有所提高,其中大便控制、小便控制、行走评分较第1阶段差异有统计学意义（P〈0．05）。结论早期、分阶段和持续性作业治疗,能显著提高地震致脊髓损伤患者ADL。     

Actual Reality: A New Approach to Functional Assessment in Persons With Multiple Sclerosis

Goverover Y, O'Brien AR, Moore NB, DeLuca J. Actual Reality: a new approach to functional assessment in persons with multiple sclerosis.

Objective

To examine the use of an innovative approach for assessing everyday life activities of people with multiple sclerosis (MS): Actual Reality. Actual Reality is a performance-based assessment approach that involves the use of the internet to perform real, everyday life activities.

Design

A between-subjects design.

Setting

Outpatient rehabilitation institute.

Participants

Persons (n=21) with clinically definite MS and healthy controls (HCs) (n=18) without any reported neurologic disabilities participated in this study. Participants were between the ages of 21 to 60 years, and the sample consisted of volunteer sample.

Interventions

Not applicable.

Main Outcome Measures

Participants were asked to access the internet to purchase airline tickets for a round trip flight and were administered the Minimal Assessment of Cognitive Functioning in Multiple Sclerosis. Participants also completed questionnaires to assess quality of life (Functional Assessment of Multiple Sclerosis), functional status (Functional Behavior Profile), and prior Internet experience.

Results

The MS group displayed significantly more difficulties than the HC group in accurately and independently completing the Actual Reality task primarily because of cognitive impairment. Self-report of quality of life and functional status were not correlated with Actual Reality performance in the group of people with MS. However, the self-report measures were significantly associated with affective symptomatology.

Conclusions

These results provide initial evidence supporting the use of the Actual Reality approach in assessing persons with MS performing everyday life activities. Actual Reality is a significant step forward in increasing the sensitivity, accessibility, and relevancy of functional assessments in people with cognitive and physical disabilities.     

Life Habits and Prosthetic Profile of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Life habits and prosthetic profile of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To assess performance of life habits among persons with lower-limb amputation at admission, at discharge, and 3 months after rehabilitation discharge and describe their prosthetic profile at discharge and follow-up.

Design

Case series.

Setting

Inpatient rehabilitation.

Participants

Unilateral persons with lower-limb amputation (N=19; 14 men; mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Life habits performance and prosthetic profile.

Results

In the daily activities subdomain, the lowest performances were observed for mobility and housing at all evaluation times. Within the social role subdomain, employment, recreation, and community life scores were the lowest for the 3 evaluations. Mean scores for all activities of daily living subdomain categories significantly increased (P<.05) during rehabilitation except for personal care and communication. Only community life (social roles subdomain) significantly increased during rehabilitation; life habits remained unchanged after discharge. Fifty-eight percent of patients at discharge versus 68.4% at follow-up used their prosthesis for more than 9 hours a day, and this increased significantly postdischarge (P=.017). Locomotor capability with prosthesis was similarly high at discharge and follow-up.

Conclusions

Among persons with lower-limb amputation, social role life habits appear to be more disturbed than those associated with activities of daily living. At discharge, prosthetic wear and locomotor capabilities with prosthesis were high and tended to improve on return to the community.     

Efficacy of Activities of Daily Living Retraining During Posttraumatic Amnesia: A Randomized Controlled Trial

Objective

To assess the efficacy of activities of daily living (ADL) retraining during posttraumatic amnesia (PTA) compared with ADL retraining commencing after emergence from PTA.

Self-Scoring Templates for Motor and Cognitive Subscales of the FIM Instrument for Persons With Spinal Cord Injury

Objective

To provide self-scoring templates for the FIM instrument's motor and cognitive scales that enable clinicians to monitor progress during rehabilitation using equal-interval Rasch-calibrated measures instead of ordinal raw scores.

Design

Secondary analysis of a prospective, observational cohort study.

Setting

Six geographically dispersed hospital-based rehabilitation centers in the United States.

Participants

Subset of consecutively enrolled individuals with new traumatic spinal cord injuries discharged from participating rehabilitation centers (N=1146).

Intervention

Not applicable.

Main Outcome Measures

Subscores of the FIM instrument, including a 13-item motor scale, a 5-item cognitive scale, an 11-item (without sphincter control items) motor scale, a 3-item transfer scale, a 6-item self-care scale, a 3-item self-care upper extremity scale, and a 3-item self-care lower extremity scale.

Results

KeyForms for the FIM instrument scales allow clinicians and investigators to estimate patients' functional status and monitor progress. In cases with no missing data, the look-up tables provide more accurate estimates of patients' functional status.

Conclusion

Clinicians can use KeyForms and look-up tables for FIM instrument subscales to monitor patients' progress and communicate improvement in equal-interval units.     

Measurement Properties of the Spinal Cord Injury-Functional Index (SCI-FI) Short Forms

Objective

To evaluate the psychometric properties of the Spinal Cord Injury-Functional Index (SCI-FI) short forms (basic mobility, self-care, fine motor, ambulation, manual wheelchair, and power wheelchair) based on internal consistency; correlations between short forms banks, full item bank forms, and a 10-item computer adaptive test version; magnitude of ceiling and floor effects; and test information functions.

Design

Cross-sectional cohort study.

Setting

Six rehabilitation hospitals in the United States.

Participants

Individuals with traumatic spinal cord injury (N=855) recruited from 6 national Spinal Cord Injury Model Systems facilities.

Interventions

Not applicable.

Main Outcome Measures

SCI-FI full item bank, 10-item computer adaptive test, and parallel short form scores.

Results

The SCI-FI short forms (with separate versions for individuals with paraplegia and tetraplegia) demonstrate very good internal consistency, group-level reliability, excellent correlations between short forms and scores based on the total item bank, and minimal ceiling and floor effects (except ceiling effects for persons with paraplegia on self-care, fine motor, and power wheelchair ability and floor effects for persons with tetraplegia on self-care, fine motor, and manual wheelchair ability). The test information functions are acceptable across the range of scores where most persons in the sample performed.

Conclusions

Clinicians and researchers should consider the SCI-FI short forms when computer adaptive testing is not feasible.