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To describe the development of and quality measure scores for the cross-setting postacute care function process quality measure that requires the collection of standardized self-care and mobility data at admission and discharge and at least 1 function goal.Description of the development and implementation of the quality measure and the associated standardized self-care and mobility data elements. Descriptive analyses of quality measure scores for the first calendar year using data from the Minimum Data Set, the Inpatient Rehabilitation Facility Patient Assessment Instrument, the Long-Term Care Hospitals (LTCH) Continuity Assessment Record and Evaluation Data Set, and Outcome and Assessment Information Set.15,127 skilled nursing facilities (SNFs), 1129 inpatient rehabilitation facilities (IRFs), 414 LTCHs, and 10,352 home health agencies (HHAs) in the United States.In total there were 9,216,943 stays/quality episodes (N = 9,216,943), including 2,084,774 SNF Medicare fee-for-service patient stays, 493,209 IRF Medicare patient stays, 161,714 patient stays, and 6,477,246 Medicare and Medicaid quality episodes.Not applicable.Scores for the cross-setting postacute care function process quality measure.The mean process quality measure scores for SNFs, IRFs, LTCHs, and HHAs were 95.5%, 99.7%, 99.1%, and 95.8, respectively. The 10th percentile scores for SNFs, IRFs, LTCHs, and HHAs were 88.5%, 99.3%, 98.4%, and 89.4, respectively, indicating that at least 90% of postacute care providers submitted the standardized data for a large proportion of their patients. Mean quality measure scores did not vary by provider characteristics.Most SNFs, IRFs, LTCHs, and HHAs submitted the self-care and mobility data, resulting in high quality measure scores during the first year of implementation. The availability of the standardized self-care and mobility data across postacute care settings offers the opportunity to compare the characteristics and functional outcomes of patients treated in postacute care.

To describe the development, implementation and reliability and validity testing of the inpatient rehabilitation facility (IRF) Change in Self-Care and Change in Mobility quality measures.We describe the activities involved in developing and implementing the 2 facility-level quality measures, including public comment opportunities. We examined facility-level reliability using split-half testing and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICCAll 1117 IRFs in the United States with at least 20 Medicare stays that ended in 2017.Facility-level quality measure scores (N=1117) were derived from data from 427,517 (self-care) and 427,956 (mobility) Medicare fee-for-service and Medicare Advantage IRF patient stays in 2017.Not applicable.Facility-level Change in Self-Care and Change in Mobility quality measure scores and facility Disease-Specific Certification for Stroke Rehabilitation from The Joint Commission were used in validity analysis.The split-half quality measure scores showed strong, positive correlations for the facility-level self-care (Pearson=0.903, Spearman=0.884, ICC=0.903, P.0001) and mobility (Pearson=0.903, Spearman=0.884, ICC= 0.903, P.0001) quality measure scores, providing evidence of reliability. ICCs remained strong when stratifying by provider volume. IRFs with stroke certification had slightly higher mean and median quality measure scores than IRFs without certification, and IRFs with the higher quality measure scores tended to have a higher percentage of certified IRFs.Our analyses support the reliability and validity of the Change in Self-Care and Change in Mobility quality measure scores in IRFs.

To describe the exclusion criteria and updated risk adjustment model developed for the Change in Mobility quality measure in the inpatient rehabilitation facility (IRF) quality reporting program. Facility-level quality measures focused on patient outcomes usually require risk adjustment to account for varied admission characteristics of patients across facilities.This cohort study analyzed admission demographic and clinical factors associated with mobility change scores using the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data for Medicare patients discharged from IRFs in calendar year 2017.A total of 1129 IRFs in the United States.A total of 493,209 (N=493, 209) Medicare fee-for-service and Medicare Advantage IRF patient stays discharged in calendar year 2017.Not applicable.Mobility change scores using admission and discharge standardized assessment data from the IRF-PAI.Approximately 53% of patients in the study were female, 67% were aged 65-84 years, and nearly 80% were White. In the final risk adjustment model, 105 covariates were included, explaining 20% of variance in mobility change scores. Key risk adjusters included IRF primary diagnosis group, prior indoor ambulation functioning, age older than 90 years, and 14 of the comorbidities. The model showed good calibration across the range of deciles of predicted IRF mobility change scores; the ratio of the average expected to observed change scores ranged from 0.93-1.03, with all but 1 within ±0.03.The updated risk adjustment model uses IRF patients' demographic and clinical characteristics to predict their mobility change scores. The exclusion criteria and resulting risk model are used to calculate the risk adjusted Change in Mobility quality measure scores, enabling comparisons of Change in Mobility scores across IRFs.

To describe the abilities of Medicare patients in inpatient rehabilitation facilities (IRFs) at admission and discharge using the standardized self-care and mobility data elements and examine the validity of the data elements. These data are used in the Center for MedicareMedicaid's IRF payment and quality reporting programs.Descriptive study reporting IRF patients' self-care and mobility scores. We also examined content validity and the associations between admission scores and length of stay (LOS), discharge scores and discharge destination, and change scores and the number of comorbidities.Patients discharged from 1129 IRFs in 2017.IRF Medicare fee-for-service and Medicare Advantage patient stays (N = 493,209).Not applicable.Self-care and mobility item scores, IRF LOS, discharge destination, and categories of the number of comorbidities.For each self-care and mobility activity, patients in IRFs overall made substantial improvements in function between admission and discharge. For example, the percentage of patients independent with eating and toilet transfers increased from 29.04% to 66.68% and 0.80% to 39.87%, respectively, between admission and discharge. Activities represented in the standardized data elements are included in other functional assessment instruments addressing content validity. Analyses showed a monotonic relationship between admission scores and LOS and between discharge scores and discharge to community percentages with only a few exceptions. Self-care and mobility scale change scores decreased as the number of comorbidities increased across categories.Patients in IRFs overall show functional improvement across each of the activities as defined by the standardized self-care and mobility data elements. The results showing the associations between patient functioning and 3 metrics (LOS, discharge to community rates, and number of comorbidities) support the validity of the data elements measuring functional abilities in the IRF Medicare population.

Background Despite the recommendations to increase recruitment of participants into clinical trials, investigators face costly challenges in trials investigating work disability interventions for people with arthritis and rheumatological conditions. This study aims to evaluate the recruitment costs and outcomes from a randomized controlled trial of an arthritis work disability prevention program conducted between 2011 and 2015, to inform planning and monitoring recruitment in similar studies. Methods Data were obtained from enrollment and financial records pertaining to recruitment costs for each recruitment approach employed. The cost for each recruitment method was calculated for total cost and cost per number of participants screened, eligible, and enrolled in the trial. Then the yield of each possible recruitment method was also determined based on the ratio of the number of randomized participants divided by the number of people contacted through each recruitment method. Finally, the Results Recruitment rate was lower than projected. Community advertising, specifically newspapers, was the most successful method of recruitment in terms of numbers, but social media, specifically Craigslist, was the least costly method used to recruit. Some social media approaches, including Facebook and LinkedIn, yielded few if any participants. Recruitment efforts used successfully in the past are not always effective. Conclusions Costs to recruit large numbers of people with arthritis into clinical trials are high. Investigators are encouraged to monitor recruitment efforts and evaluate the costs and outcomes of their strategies throughout the study period. Close consideration to recruitment costs should be considered as part of the research fiscal resources prior to and during the study period for long-term outcomes like work disability. Trial registration ClinicalTrials.gov Identifier: NCT01387100, date: 06/01/2011.

To describe the exclusion criteria and risk-adjustment model developed for the quality measure Change in Self-Care. The exclusion criteria and risk adjustment model are used to calculate Change in Self-Care scores, allowing scores to be compared across inpatient rehabilitation facilities (IRFs).This national cohort study examined admission demographic and clinical factors associated with IRF patients' self-care change scores using standardized self-care data for Medicare patients discharged in calendar year 2017.A total of 1129 IRFs in the United States.A total of 493,209 (N=493,209) Medicare Fee-for-Service and Medicare Advantage IRF patient stays INTERVENTIONS: Not applicable.Self-care change scores using admission and discharge standardized assessment data elements from the Inpatient Rehabilitation Facility-Patient Assessment Instrument.Approximately 53% of patients were female, and 67% were between 65 and 84 years old. The final risk-adjustment model contained 93 clinically relevant risk adjusters and explained 23.1% of variance in self-care change scores. Risk adjusters that had the greatest effect on change scores and included IRF primary diagnosis group (ie, binary risk adjusters representing 13 diagnoses), prior self-care functioning, and age older than 90 years. When split by deciles of expected scores, the ratio of the average expected and observed change scores was within 2% of 1.0 across 8 groups and within 8% at the extremes, showing good predictive accuracy.The risk adjustment model quantifies the relationship between IRF patients' demographic and clinical characteristics and their self-care score changes. The exclusion criteria and model are used to risk-adjust the IRF Change in Self-Care quality measure.

Background/purpose Evidence suggests that more than 30% of patients post-total knee replacement (TKR) are living with participation restrictions, yet little is known about their perceptions of and factors contributing to these restrictions. The purpose of this study was to identify emergent or recurring themes behind participation restrictions after TKR. Methods Nineteen participants between 50 and 85 years old reporting participation restrictions 1 to 5 years post-TKR completed semistructured qualitative interviews about their participation experience after TKR. Participants provided background information in written questionnaires. Data collected from in-person interviews were analyzed qualitatively using a grounded theory approach. Results Participants discussed 3 major themes with regard to participation post-TKR: (1) limiting activities requiring long-distance walking due to continued knee impairments, (2) avoiding activities with negative or unknown outcome expectancies, and (3) using problem solving to identify strategies to participate in important activities. Conclusions An unknown or negative outcome expectancy, particularly with regard to activities requiring long-distance walking, may lead to participation restrictions in some patients post-TKR. As participants reported using self-efficacy and coping strategies to improve participation, further physical rehabilitation or interdisciplinary rehabilitation incorporating the identified strategies may be effective with some patients post-TKR.

Objective Older adults with knee osteoarthritis (OA) who live in environments with mobility barriers may be at greater risk of developing participation restrictions, defined as difficulties in engagement in life situations. We investigated the risk of participation restriction over 5 years due to self-reported environmental features among older adults with knee OA. Methods Participants from the Multicenter Osteoarthritis (MOST) Study self-reported participation at baseline, 30 months, and 60 months using the instrumental role subscale of the Late Life Disability Index (LLDI). Data on self-reported environmental features were from the Home and Community Environment questionnaire administered in the MOST Knee Pain and Disability study, an ancillary study of MOST. The relative risks (RRs) of developing participation restriction at 60 months, indicated by an LLDI score

Objective To systematically rate the evidence on the measurement properties of work functioning instruments for people with arthritis and other rheumatologic conditions. Methods A systematic review was conducted through a structured search to identify the quality of articles describing studies of assessment development and studies of their psychometric properties. The Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to appraise the included studies. Finally, an evidence synthesis was performed to combine findings. Results Nine arthritis-specific work outcome assessments were identified; 17 articles examining the psychometric properties of these instruments were identified and their quality was reviewed. Quality of studies was highly variable. The evidence synthesis showed that the Work Limitations Questionnaire had the strongest quality evidence of internal consistency and content validity (including structural validity and hypothesis testing), followed by the Work Instability Scale. None of the instruments had strong quality evidence of criterion validity or responsiveness. Conclusion Considering the high variability and the low quality of the literature, we recommend that instrument developers integrate a full psychometric assessment of their instruments, including responsiveness and criterion validity, and consult guidelines (i.e., COSMIN) in reporting their findings.

BACKGROUND People with arthritis are at risk of work disability. Job accommodation and educational programs delivered before imminent work loss can minimize work disability, yet are not currently being widely implemented. The Work-It Study is a randomized controlled trial testing the efficacy of a problem solving program delivered by physical and occupational therapy practitioners to prevent work loss over a two-year period among people with arthritis and rheumatological conditions. OBJECTIVE The purpose of this paper is to describe the protocol of the randomized controlled trial, and describe the baseline characteristics of the subjects and their work outcomes. METHODS 287 participants were recruited from the Boston area in Massachusetts, USA. Eligible participants were aged between 21-65, self-reported a physicians' diagnosis of arthritis, rheumatic condition, or chronic back pain, reported a concern about working now or in the near future due to your health, worked at least 15 hours a week, had plans to continue working, and worked or lived in Massachusetts. Subjects were recruited through community sources and rheumatology offices. Participants in the experimental group received a structured interview and an education and resource packet, while participants in the control received the resource packet only. The baseline characteristics and work related outcomes of the participants were analyzed. CONCLUSIONS To our knowledge, the Work-It Study is the largest and most diverse randomized controlled trial to date aiming to identify and problem solve work-related barriers, promote advocacy, and foster work disability knowledge among people with chronic disabling musculoskeletal conditions. Despite advances in medical management of arthritis and other rheumatological and musculoskeletal conditions, many people still have concerns about their ability to remain employed and are seeking strategies to help them sustain employment.

Objective Participation restriction, common among people with knee osteoarthritis (OA), may be influenced by positive and negative affect. We examined the risk of incident participation restriction over 84 months conferred by positive and negative affect among people with knee OA. Methods Participants are from the Multicenter Osteoarthritis Study and had or were at high risk of knee OA. Participation restriction and positive and negative affect were measured with the Late Life Disability Index, Instrumental Role Limitation subscale and the positive affect and depressed mood subscales of the Center for Epidemiological Studies Depression Scale, respectively. Robust Poisson regression was used to calculate risk of incident participation restriction over 84 months conferred by combinations of low and high positive and negative affect, adjusting for covariates. Results Of 1810 baseline participants (mean: 62.1 years, 56% female), 470 (26%) had incident participation restriction over 84 months. Participants with low positive affect had 20% greater risk of incident participation restriction than those with high positive affect; participants with high negative affect had 50% greater risk of incident participation compared to those with low negative affect. Participants with both low positive and high negative affect had 80% greater risk of incident participation restriction compared to other combinations of positive and negative affect. Conclusion Low positive and high negative affect, both alone and in combination, increase risk of participation restriction among adults with knee OA. Efforts aimed at preventing participation restriction in this population should consider these mood states. This article is protected by copyright. All rights reserved.

Dually eligible individuals (i.e., eligible for Medicare and Medicaid) often have worse health and greater functional limitations than patients eligible for Medicare only. For dually eligible patients receiving inpatient rehabilitation services following a major illness or injury, improvement in function may be lower than for Medicare-only patients. To our knowledge, this is the first study to examine the relationship of dual eligibility on improvement in mobility for inpatient rehabilitation facility (IRF) patients by 13 primary diagnosis groups (e.g., Stroke, Amputation). Data was collected on the IRF-Patient Assessment Instrument at admission and discharge for all IRF patients discharged during 2017 (N = 428,631). A generalized linear model was run for each primary diagnosis group to examine the effect of dual eligibility on change in mobility during an IRF stay, adjusting for sociodemographic factors, clinical factors, and comorbidities. The proportion of patients who were dually eligible varied among primary diagnosis groups (9.6% for Hip/Knee Replacements, Fractures and Multiple Trauma to 21.7% for Amputation). Compared to patients who were non-dually eligible, dually eligible patients had lower improvement in mobility across all 13 diagnostic groups. The strongest effect of dual eligibility on lower improvement in mobility was among patients with hip and/or knee replacements (β: -1.99, p

Objective Work disability rates are high among people with rheumatic and musculoskeletal conditions. Effective disability preventive programs are needed. We examined the efficacy of a modified vocational rehabilitation approach delivered by trained occupational therapists and physical therapists on work limitation and work loss over two years among people with rheumatic and musculoskeletal conditions. Methods Eligibility criteria for this single-blind parallel-arm randomized trial included 21-65 years of age, 15 or more hours/week employment, self-reported doctor-diagnosed rheumatic or musculoskeletal condition, and concern about staying employed. The intervention consisted of a 1.5 hour meeting, an action plan, written materials on employment supports, and telephone calls at 3-weeks and 3-months. Control group participants received the written materials. The primary outcome was the Work Limitations Questionnaire (WLQ), Output Job Demand subscale. The secondary outcome was work loss. Intent to treat analyses were performed. This study is registered with ClinicalTrials. gov number NCT01387100. Results Between October 2011 and January 2014, 652 individuals were assessed for eligibility. 287 participants were randomized: 143 intervention and 144 control participants. 264 participants (92%) completed two-year data collection. There was no difference in the mean WLQ change scores from baseline to two year follow-up (-8.6 ± 1.9 intervention vs. -8.3 ± 2.2 control (p=.93)). Of the 36 participants who experienced permanent work loss at two years: 11 (8%) were intervention participants and 25 (18%) control participants (p=.03). Conclusion The intervention did not have an effect on work limitations but reduced work loss. The intervention can be delivered by trained rehabilitation therapists. This article is protected by copyright. All rights reserved.

Objective: The objective of this study is to identify features of the environment associated with community participation of older adults. Method: A systematic review of studies that examined associations between environment and community participation in older adults was conducted. Environmental features were extracted and grouped using the International Classification of Functioning, Disability, and Health’s environmental categories. Meta-analysis of environmental categories was conducted by calculating combined effect size (ES) estimates. Results: Significant, small to moderate, random ESs were found for six of seven environmental categories: neighborliness (ES = 0.52, 95% confidence interval [CI] = [0.18, 0.87]), social support (ES = 0.38, 95% CI = [0.13, 0.62]), land-use diversity (ES = 0.29, 95% CI = [0.16, 0.42]), transportation (ES = 0.29, 95% CI = [0.15, 0.43]), civil protection (e.g., safety; ES = 0.27, 95% CI = [0.0, 0.54]), and street connectivity/walkability (ES = 0.20, 95% CI = [0.15, 0.26]). Discussion: Community initiatives that address specific features of the social environment and street-level environment may increase community participation of older adults.

To systematically rate the evidence on the measurement properties of work functioning instruments for people with arthritis and other rheumatologic conditions.A systematic review was conducted through a structured search to identify the quality of articles describing studies of assessment development and studies of their psychometric properties. The Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist was used to appraise the included studies. Finally, an evidence synthesis was performed to combine findings.Nine arthritis-specific work outcome assessments were identified; 17 articles examining the psychometric properties of these instruments were identified and their quality was reviewed. Quality of studies was highly variable. The evidence synthesis showed that the Work Limitations Questionnaire had the strongest quality evidence of internal consistency and content validity (including structural validity and hypothesis testing), followed by the Work Instability Scale. None of the instruments had strong quality evidence of criterion validity or responsiveness.Considering the high variability and the low quality of the literature, we recommend that instrument developers integrate a full psychometric assessment of their instruments, including responsiveness and criterion validity, and consult guidelines (i.e., COSMIN) in reporting their findings.