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Introduction: This study clarifies why patients avoided the use of outpatient rehabilitation services covered by long-term care insurance during the COVID-19 pandemic. Method: Self-administered online questionnaires targeted 474 outpatient rehabilitation facilities under long-term care insurance in Fukuoka prefecture, Japan. Results: Main avoidance reasons were users avoiding contact with other users, families avoiding contact with users and other users, and users avoiding contact with staff. Users' physical and cognitive functions, motivation for activities, and assistance levels subsequently deteriorated. Conclusion: Methods for providing rehabilitation are needed in future pandemics to ensure patients maintain physical and cognitive functions and live independently. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To examine whether there was a racial disparity among Medicare beneficiaries in the likelihood of using outpatient physical therapy (PT) services following a hip fracture. * METHODS: Our retrospective descriptive cohort study analyzed administrative claims data for 51 781 Medicare beneficiaries post hip fracture. We examined the association between race and PT use within the first 6 months post fracture using hierarchical logistic regression, adjusting for demographics, medical complexity, and socioeconomic factors. We used Poisson regression to examine the association between race and the number of PT visits. * RESULTS: Only 31% of beneficiaries used outpatient PT after hip fracture with significant racial disparities. After controlling for demographics, medical complexity, and socioeconomic factors, Black beneficiaries had 42% lower odds of using PT (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI]: 0.51, 0.66) compared to White beneficiaries. Among PT users, Black beneficiaries received fewer visits than White beneficiaries (rate ratio [RR], 0.85; 95% CI: 0.82, 0.88) with this disparity persisting after adjustments (RR, 0.88; 95% CI: 0.85, 0.91). * CONCLUSION: Even after adjusting for demographic, medical, and socioeconomic factors, Black beneficiaries were less likely to use outpatient PT following hip fractures. Conditional on an initial PT evaluation, Black beneficiaries received fewer sessions. J Orthop Sports Phys Ther [ABSTRACT FROM AUTHOR]

This is a cross-sectional, observational study. The disability of the arm, shoulder and hand (DASH) questionnaire is an upper-extremity specific outcome measure commonly used in routine clinical care and clinical trials. Our purposes were to: (1) examine the psychometric properties of the DASH questionnaire using factor analysis, one- and two-parameter item response theory models, and (2) develop a functional staging map illustrating the relationships between the item difficulty hierarchy of the DASH items and the patient's DASH total score. Data from 2724 patients with orthopedic shoulder impairments seeking outpatient physical therapy in 79 clinics in the US were analyzed. Factor analysis supported a general factor, explaining 62.2% of the total variance. The coverage of DASH items was suitable for patients with shoulder impairments with no ceiling or floor effect. Endorsed items representing the most difficult items were related to feeling less capable, executing recreational activities with force or impact, and performing recreational activities in which you move your arm freely. Items with higher discriminating abilities were those related to do heavy household chores, garden/yard work, and change a light bulb overhead. With a separation index equaled to 4.94, the DASH can differentiate persons into at least 6 statistically distinct person strata. None of the DASH items exhibited differential item functioning by gender or symptom acuity, except two items by age group. Besides a total (summed) final score obtained from a specific measure, the keyform and functional staging plots/maps can be used to assist clinicians in clinical interpretation of the scores. Results supported the clinical usage of the DASH questionnaire in patients with orthopedic shoulder impairments seeking outpatient rehabilitation. • This study analyzed the psychometric properties of the DASH in patients with orthopedic shoulder impairments seeking outpatient rehabilitation services. • To the best of our knowledge, this is the first study to examine the psychometric properties of the DASH using both the 1-PL and 2-PL item response theory (IRT) models. • This is the first study to develop functional stages of the DASH. [ABSTRACT FROM AUTHOR]

The article presents a study on the effect of adding a single-item variable of fear-avoidance beliefs on physical activities of patients on a model which predicts risk-adjusted functional status (FS) outcomes. Determining this may allow patients with lumbar spine dysfunction to be managed properly. Methods involving models of discharge FS were used to compare fear-avoidance scores. It was shown that elevated fear-avoidance beliefs improve the FS outcomes of predictive model, but additional meaningful interpretation was minimal.

The article discusses research on the clinical interpretation of outcome measures in patients exhibiting foot/ankle impairments provided by computerized adaptive testing (CAT). It mentions that more and more clinical studies are using patient-reported outcomes (PRO) yet little evidence exists regarding the positive impact of PRO use on patient health. Results imply that CATs have the potential to hold clinical meaning in medical research once clinical interpretation is added to the CAT estimated functional measures.