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As dental hygienists, we are always searching for the appropriate, evidence-based interventions for our patients. (1) Instead of skipping straight to the solutions, let's start with the questions and determine [...]

Objective. The aims of this study were to (1) evaluate the suitability of newly developed items for calibration into 2 item banks for stroke upper extremity (SUE) and stroke lower extremity (SLE) physical function (PF) patient-reported outcome measures (PROMs) and to (2) assess score reliability and validity and PROM administration efficiency based on computerized adaptive testing (CAT). Methods. A retrospective longitudinal study involving patients poststroke who were treated in outpatient rehabilitation clinics and responded to 28 and 25 region-specific candidate items addressing tasks related to upper or lower extremity PF, respectively, was conducted. Item response theory (IRT) model assumptions of unidimensionality, local independence, item fit, and presence of differential item functioning were evaluated. CAT-generated scores were assessed for reliability, validity, and administration efficiency, and 10-item short forms were assessed for reliability. Results. Cohorts consisted of 2017 patients with stroke involving the upper extremity and 2107 patients with stroke involving the lower extremity (mean age [SD]: SUE = 62 [14] and SLE = 63 [14]; range = 14-89). Two solutions (SUE: 28-item; SLE: 24-item) supported unidimensionality and fit to the IRT model, with reliability estimates >0.93 for all administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways, with better outcomes observed for patients who were younger, were male, had less chronicity, and had fewer comorbidities. The SUE and SLE, respectively, had 1 and 0.3% floor effects and 4.3 and 1.1% ceiling effects. Change score effect sizes were 0.5 (SUE) and 0.6 (SLE). Simulated CAT scores required an average of 6 (SUE) and 5.6 (SLE) items (median = 5). Conclusion. The stroke upper extremity and stroke lower extremity PROM scores were reliable, valid, and efficient and had moderate change effect sizes for assessing PF as perceived by patients poststroke with upper and lower extremity impairments. Scores had negligible floor and acceptable ceiling effects. Based on these results, the stroke PROMs are suitable for research and routine clinical practice. Impact. As IRT-based measures, these PROMs support clinical practice guideline recommendations for the use of outcome measures in neurologic physical therapy and the administration of condition-specific functional questions with low response burden for patients. The 10-item short forms offer a feasible alternative administration mode when CAT administration is not available. Keywords: Item Response Theory, Lower Extremity, Patient-Reported Outcome Measures, Physical Function, Stroke, Upper Extremity, Introduction On average, every 40 seconds, someone in the USA has a stroke. (1) Reliable and valid measures of physical function (PF) can provide valuable information for poststroke management. Patient-reported [...]

Common assessment tools for determining therapeutic success in rehabilitation typically focus on task--based outcomes. Task--based outcomes provide some understanding of the individual's functional ability and motor recovery; however, these clinical outcomes may have limited translation to a patient's functional ability in the real world. Limitations arise because (1) the focus on task--based outcome assessment often disregards the complexity of motor behavior, including motor variability, and (2) mobility in highly variable real-world environments requires movement adaptability that is made possible by motor variability. This Perspective argues that incorporating motor variability measures that reflect movement adaptability into routine clinical assessment would enable therapists to better evaluate progress toward optimal and safe real-world mobility. The challenges and opportunities associated with incorporating variability--based assessment of pathological movements are also discussed. This Perspective also indicates that the field of rehabilitation needs to leverage technology to advance the understanding of motor variability and its impact on an individual's ability to optimize movement. Impact. This Perspective contends that traditional therapeutic assessments do not adequately evaluate the ability of individuals to adapt their movements to the challenges faced when negotiating the dynamic environments encountered during daily life. Assessment of motor variability derived during movement execution can address this issue and provide better insight into a patient's movement stability and maneuverability in the real world. Creating such a shift in motor system assessment would advance understanding of rehabilitative approaches to motor system recovery and intervention. Keywords: Adaptability, Capacity Testing, Coordination, Motor Variability, Movement Assessment, Introduction Physical therapists are responsible for evaluating a patient's movement system to determine recovery potential, progress, and need for continued skilled rehabilitation. (1) Optimizing movement requires a focus on functional [...]

2024 MAY 18 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on clinical research have been published. According to news [...]

2024 MAY 11 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on non-small cell lung cancer is now available. According [...]

2024 FEB 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Cancer. According to news reporting originating in [...]

2024 FEB 10 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cancer have been published. According to news reporting [...]

Objective. Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. Methods. Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. Results. Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness overtime (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. Conclusion. Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. Impact. This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes. Keywords: Hip Fractures, Mobility, Outcome Assessment (Health Care), Introduction Hip fractures are common, with over 300,000 occurring each year in the United States (1) and 75,000 in the United Kingdom (2) and a rising incidence globally. They reduce [...]

2023 SEP 2 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Brain Diseases and Conditions - Brain Metastasis are presented [...]

Interpreting change is a requisite component of clinical decision making for physical therapists. Physical therapists often interpret change using minimal detectable change (MDC) values. Current MDC formulas are informed by classical test theory and calculated with group-level error data. This approach assumes that measurement error is the same across a measure's scale and confines the MDC value to the sample characteristics of the study. Alternatively, an item response theory (IRT) approach calculates separate estimates of measurement error for different locations on a measure's scale. This generates a conditional measurement error for someone with a low, middle, or high score. Error estimates at the measure-level can then be used to determine a conditional MDC (cMDC) value for individual patients based on their unique pre- and post-score combination. cMDC values can supply clinicians with a means for using individual score data to interpret change scores while providing a personalized approach that should lower the threshold for change compared with the MDC and enhance the precision of care decisions by preventing misclassification of patients. The purpose of this Perspective is to present how IRT can address the limitations of MDCs for informing clinical practice. This Perspective demonstrates how cMDC values can be generated from item-level psychometrics derived from an IRT model using the patient-reported Activities-specific Balance Scale (ABC) commonly used in stroke rehabilitation and also illustrates how the cMDC compares to the MDC when accounting for changes in measurement error across a scale. Theoretical patient examples highlight how reliance on the MDC value can result in misclassification of patient change and how cMDC values can help prevent this from occurring. This personalized approach for interpreting change can be used by physical therapists to enhance the precision of care decisions. Keywords: Balance, Measurement: Applied, Stroke, Introduction Precision rehabilitation requires that physical therapists accurately interpret a patient's change over time to make appropriate clinical decisions such as whether an intervention is efficacious. Standardized measurement tools can [...]

2023 JUL 1 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in ulcerative colitis. According to news reporting from [...]

2023 JUN 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New study results on cancer have been published. According to news originating [...]

2023 JUN 24 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators discuss new findings in Musculoskeletal Diseases and Conditions - Myositis. According [...]

2023 JUN 17 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on Drugs and Therapies - Radiation Therapy is the subject [...]

2023 JUN 10 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on pharmacology is the subject of a new report. According [...]

Objective. Involving parents in the evaluation of their child with cerebral palsy (CP) is associated with enhanced neurode-velopmental outcomes. The pediatric outcomes data collection instrument (PODCI) is a patient-reported outcome measure primarily used to assess motor function following orthopedic surgical intervention or for older children with more independent motor function. The PODCI expectations scale has infrequently been reported in previous studies. This study aims to determine the relationship between parent-reported motor performance using the PODCI and motor capacity assessed by pediatric therapists for young children with CP across all ability levels and to explore the use of the PODCI expectations scale for quantifying therapy-related parent expectations. Methods. This prospective cohort study included 108 participants with CP, 2 to 8 years of age, gross motor function classification systems (GMFCS) levels I to V. Measures included the PODCI, gross motor function measure (GMFM), and GMFCS. Results. There were moderate (r =0.513) to large (r =0.885) relationships between PODCI and GMFM scores. PODCI scores were significantly different across GMFCS levels. Weak, significant relationships (r = -0.28) were found between function expectations scores and measures of function. Conclusion. The PODCI, GMFM, and GMFCS provide different, but strongly related, information about the abilities of young children. The GMFM measures motor capacity. Parents report daily function and health-related quality of life for their child using the PODCI. Parent expectations for intervention outcomes may relate to a child's motor function. Impact. These study results are consistent with those for older children with greater independent mobility, indicating an opportunity for expanded use of the PODCI for measuring motor performance for younger children with CP across all ability levels. A strategy is provided for using the PODCI expectations scale to quantify parent therapy-related expectations in future research and clinical settings. Therapy-related expectations may relate to child outcomes. Keywords: Cerebral Palsy, Child, Gross Motor Function Measure, Parent, Patient-Reported Outcomes Measures, Pediatric Outcome Data Collection Index, Introduction Cerebral palsy (CP) is the most common motor disorder of childhood, occurring in 2 to 3 per 1000 live term births. (1) CP is a neurodevelopmental disorder characterized by [...]

Objective. The main aims of this study were to (1) create a patient-reported outcome measure (PROM) item bank for measuring the impact of upper quadrant edema (UQE) on physical function by calibrating responses to newly developed items; and (2) assess reliability, validity, and administration efficiency of scores based on computerized adaptive test (CAT) and 10-item short-form (SF) administration modes. Methods. This was a retrospective study including data from patients treated in outpatient rehabilitation clinics for UQE that responded to all 27 candidate items at intake. Item response theory model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning were evaluated. UQE-CAT--and UQE-SF--generated scores were assessed for reliability, validity, and administration efficiency. Results. The total cohort included 3486 patients (mean [SD] age = 61 [13] years; range = 14-89 years). After removing 2 items, a 25-item solution was supported for its unidimensionality and fit to the item response theory model with reliability estimates of more than 0.93 for scores based on both CAT and SF administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways and were moderately responsive to change with negligible floor and acceptable ceiling effects. CAT scores were generated using an average of 5.6 items (median= 5). Conclusion. Scores on the UQE PROM were reliable, valid, and efficient for assessing perceived physical function of patients with upper quadrant edema; thus, the measure is suitable for research and routine clinical administration. Impact. The newly developed UQE PROM is reliable and valid and offers efficient administration modes for assessing perceived physical function of patients with UQE caused by lymphatic and venous disorders, both for research and routine clinical care in busy outpatient rehabilitation settings. As an item response theory--based measure, the UQE PROM allows administration of condition-specific functional questions with low response burden for patients. This study supports a transition to PROMs that are based on modern measurement approaches to achieve high accuracy and efficiency. Keywords: Computerized Adaptive Testing, Edema, Item Response Theory, Lymphedema, Patient-Reported Outcome Measures, Physical Function, Introduction Patient-reported outcome measures (PROMs) can provide valuable information for individuals with lymphatic and venous disorders that cause upper quadrant edema (UQE), translating the patient's experience of the edema load [...]

Objective. The longer-term impact of injury is increasingly recognized, but the early phases of recovery are less well understood. The best tools to measure early recovery of mobility and physical function following traumatic injury are unclear. The purpose of this study was to assess the clinical utility, validity, reliability, and responsiveness of 4 mobility and physical function measures in patients following traumatic injury. Methods. In this cohort, measurement-focused study (n =100), the modified Iowa Level of Assistance Score, Acute Care Index of Function, Activity Measure for Post-Acute Care "6 Clicks" short forms, and Functional Independence Measure were completed during first and last physical therapy sessions. Clinical utility and floor and ceiling effects were documented. Known-groups validity (early vs late in admission and by discharge destination), predictive validity (using 6-month postinjury outcomes data), and responsiveness were established. Interrater reliability was assessed in 30 patients with stable mobility and function. Results. Participants had a median age of 52 years (interquartile range = 33-68 years), and 68% were male. The modified Iowa Level of Assistance Score, Acute Care Index of Function, and "6 Clicks" short forms were quick to administer (an extra median time of 30 seconds-1 minute), but the Functional Independence Measure took much longer (extra median time of 5 minutes). At the last physical therapy session, ceiling effects were present for all measures except the Functional Independence Measure (18%-33% of participants). All had strong known-groups validity (early vs late in admission and by discharge destination). All were responsive (effect sizes >1.0) and had excellent interrater reliability (intraclass correlation coefficients =0.79-0.94). Conclusion. All 4 measures were reliable, valid, and responsive; however, their clinical utility varied, and ceiling effects were common at physical therapy discharge. Impact. This study is an important step toward evidence-based measurement in acute trauma physical therapy care. It provides critical information to guide assessment of mobility and physical function in acute trauma physical therapy, which may facilitate benchmarking across different hospitals and trauma centers and further progress the science and practice of physical therapy following traumatic injury. Keywords: Acute care, Mobility, Outcome Assessment (Health Care), Physical Therapists, Wounds and Injuries, Introduction Traumatic injury is a significant global public health problem, responsible for 9% of the world's total deaths annually and 6% of years lived with temporary or permanent disability. (1) [...]

Objectives. The purpose of this study was to investigate the construct validity and overall appropriateness of test score interpretation of 4 shoulder-related patient-reported outcome (PRO) measures for use in a population of patients with head and neck cancer using Rasch analysis. Methods. One hundred eighty-two individuals who had received a neck dissection procedure within the past 2 weeks to 18 months were recruited for this cross-sectional psychometric study. Rasch methodologies were used to investigate scale dimensionality, scale hierarchy, response scale structure, and reliability of Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index (NDII). Results. DASH did not meet criteria for unidimensionality and was deemed inappropriate for use in this sample. The QuickDASH, SPADI, and NDII were all determined to be unidimensional. All scales had varying issues with person and item misfit, differential item functioning, coverage of ability levels, and optimal rating scale requirements. The NDII met most requirements. All measures were found to meet thresholds for person and item separation as well as reliability statistics. Conclusions. Rasch analysis indicates the NDII is the most appropriate measure studied for this population. The QuickDASH and SPADI are recommended with reservation, whereas the DASH is not recommended. Impact. This study demonstrates the use of objective methodologies, using Rasch analysis, to validate PRO recommendations provided by clinical experts in forums such as the Evaluation Database to Guide Effectiveness (EDGE) TaskForce, which are based upon a comprehensive literature review, consideration of published psychometric properties, and expert consensus. Use of Rasch methodologies demonstrates weaknesses in this model and provides opportunities to strengthen recommendations for clinicians. Keywords: Head and Neck Cancer, Patient-Reported Outcomes, Rasch Analysis, Shoulder Impairment, Introduction An individual with head and neck cancer (HNC) often requires a neck dissection procedure to remove lymph nodes from the neck. Damage to the spinal accessory nerve, and subsequent [...]

2023 MAY 20 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Opioids have been published. According to news reporting [...]

2023 MAY 20 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Obesity, Fitness and Wellness. According to news [...]

2023 MAY 13 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Musculoskeletal Diseases and Conditions - Myositis. According [...]

2023 MAY 13 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Oncology - Chondrosarcoma have been published. According to [...]

2023 MAY 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in clinical research. According to news reporting from [...]

2023 MAY 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- New research on drugs and therapies is the subject of a new [...]

2023 MAY 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on sickle cell anemia are presented in a new report. [...]

2023 APR 29 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Heart Disorders and Diseases - Heart Failure is [...]

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2023 MAR 18 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Drugs and Therapies - Cell Therapy. According [...]

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Objective. The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. Methods. In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect--Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. Results. In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect--Dutch Version). Conclusion. This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. Impact. Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice. Keywords: Nonspecific Low Back Pain, Physical Therapy, PROMs, Quality Indicators, Introduction Quality indicators based on health outcomes can be used as an implementation tool to improve quality of care by monitoring and evaluating treatment trajectories with patient-reported outcomes (.1-4 )Quality [...]

Objectives. Physical therapist intervention studies can be deemed ineffective when, in fact, they may not have been delivered as intended. Measurement of treatment fidelity (TF) can address this issue. The purpose of this study was to describe TF of a home-based intervention, identify factors associated with TF, and examine whether components of TF were associated with the outcome of change in 6-minute walk distance (A6MWD). Methods. This is a secondary analysis of community-dwelling hip fracture participants who completed standard therapy and were randomly assigned to the active intervention (Push). Push was 16 weeks of lower extremity strengthening, function, and endurance training. TF was defined as delivery (attendance rate, exercise duration) and receipt (progression in training load, heart rate reserve [HRR] during endurance training, and exercise position [exercise on floor]). The outcome was A6MWD. Independent variables included baseline (demographic and clinical) measures. Descriptive statistics were calculated; linear and logistic regressions were performed. Results. Eighty-nine participants were included in this analysis; 59 (66%) had attendance of 75% or greater. Participants walked for 20 minutes or more for 78% of sessions. The average training load increased by 22%; the mean HRR was 35%; and 61 (69%) participants exercised on the floor for at least 75% of sessions. Regression analyses showed that a higher body mass index and greater baseline 6MWD were related to components of TF; 4 out of 5 components of TF were significantly related to A6MWD. The strongest TF relationship showed that those who exercised on the floor improved by 62 m (95% CI = 31-93 m) more than those who did not get on the floor. Conclusions. Measures of TF should extend beyond attendance rate. This analysis demonstrates how measures of TF, including program attendance, progression in training load, endurance duration, and exercising on the floor were significantly related to improvement in 6MWD in participants post hip fracture. Impact. This careful analysis of treatment fidelity assured that the intervention was delivered and received as intended. Analysis of data from a large trial with participants after hip fracture showed that regular attendance, frequent endurance training for 20 minutes, increases in lower extremity training loads, and exercising on the floor were associated with improvements in the outcome of 6-minute-walk distance. The strongest association with improvement was exercising on the floor. Keywords: Exercise, Hip Fractures, Physical Therapists, Treatment Fidelity, Introduction Older adults demonstrate great heterogeneity in functional recovery following hip fracture. (1) Physical therapist interventions associated with hip fracture rehabilitation are complex behaviors that take time, physical effort, and [...]

Objective. The purpose of this study was to link Activity Measure for Post-Acute Care (AM-PAC) Mobility and Daily Activity scales to the PROMIS Physical Function (PF) allowing for a common metric across scales. Methods. Cross-sectional study of patients 18 years and older presenting to 1 of 8 outpatient rehabilitation clinics in southwestern Pennsylvania. Patients completed one survey with questions from the AM-PAC Daily Activity and Mobility short forms, and the PROMIS PF item bank. Using item response theory, 2 rounds of fixed-parameter calibration were performed. In the first, the AM-PAC Daily Activity and Mobility items were calibrated with 27 fixed item parameters from the PROMIS PF. Second, the AM-PAC Daily Activity items were calibrated with 11 PROMIS Upper Extremity fixed item parameters. This process uses the construct of physical function and equates AM-PAC items on the same underlying measurement scale for the PROMIS PF. Results. Both scales measured a wide range of functioning and demonstrated good calibration. Data were appropriate for a fixed-parameter item response theory-based crosswalk. AM-PAC Daily Activity and Mobility raw scores were mapped onto the PROMIS PF metric. AM-PAC Daily Activity scores were also mapped onto the PROMIS PF Upper Extremity metric. Conclusion. Question items from the AM-PAC Daily Activity, AM-PAC Mobility, and PROMIS PF similarly measure the construct of physical function. This consistency allows for a crosswalk of AM-PAC scores onto the PROMIS PF metric. Impact. Crosswalk tables developed in this study allow for converting scores from the AM-PAC Daily Activity and Mobility scales to the PROMIS PF metric. This will facilitate monitoring of longitudinal change in function over time and across settings. Keywords: Activities of Daily Living, Health-Related Quality of Life, Mobility, Patient-Reported Outcomes, Physical Function, Introduction With changing payment models and increasing attention on measuring the quality of interventions, there is a growing demand for routine collection of standardized outcome measures (.1,2 )Patient-reported outcomes (PROs) [...]

Objectives. Individuals with distal radius fractures (DRF) may experience difficulty with gripping an object, painful wrist movements, sensorimotor difficulties, and swelling around the wrist and hand. A comprehensive review of the existing evidence concerning the measurement properties of common physical impairment measures can provide a valuable resource to guide hand therapy practice while managing DRF. The primary objective was to locate and assess the quality of literature on the measurement properties for the measures of physical impairment used in individuals with DRF. Methods. Two reviewers searched PubMed, CINAHL, and EMBASE. A combination of DRF, measurement properties, and physical impairments were used as keywords, and articles were independently assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool. Primary studies were included if they examined at least 1 of the following: reliability, validity, responsiveness, or indices of true and meaningful changes for measures of physical impairment in the DRF sample. A total of 19 articles were included in this review. The quality of the studies ranged from 46% to 92%. This review suggests that measures such as assessment of grip strength and supination and pronation range of motion (ROM), using various goniometric devices, showed good intrarater and interrater reliability, construct validity, and responsiveness in individuals with DRF. Conclusion. Acceptable reliability and responsiveness were reported in grip and wrist ROM assessments for measuring changes in wrist and hand function after DRF; however, wrist ROM assessed using traditional goniometric techniques were less reliable in individuals with DRF. Impact. This study provides insight into which objective tools might be better suited for measuring outcomes related to DRF. Keywords: Distal Radius Fracture, Measurement, Reliability, Responsiveness, Validity, Introduction Consequences related to distal radius fractures (DRF) are pain and functional limitations, which have been reported to occur in the acute and chronic phases of recovery. (1-3) Prior estimates [...]

Objective: To develop outcome measures that are more sensitive than current measures for evaluating primary or transitional care after hospitalizations, emergency department (ED) visits, or observation stays. Data Sources: Medicare claims data from January 1, 2015, to October 31, 2017, for 1 261 707 Medicare fee-for-service beneficiaries served by (a) primary care practices participating in Track 1 of the Comprehensive Primary Care Plus (CPC+) initiative, and (b) their matched comparison practices. Study Design: Given the poor statistical power in many studies to detect effects on readmissions, we developed two novel claims-based measures of unplanned acute care (UAC) following an index acute care event. The first measure assesses the proportion of hospitalizations followed by an unplanned readmission, ED visit, or observation stay within 30 days of discharge; the second assesses the proportion of ED visits and observation stays followed by a hospitalization, ED visit, or observation stay within 30 days. We calculate minimum detectable effects (MDEs) for both measures and for a conventional measure of 30-day unplanned readmissions, using CPC+ data. Principal Findings: Repeat UAC events are common among Medicare beneficiaries served by the CPC+ practices. In 2017, 22% of discharges and 21% of ED visits and observation stays had a UAC event within 30 days. Readmissions were the most common UAC event following discharge, whereas ED visits were most common following index ED visits or observation stays. MDEs are 25%-40% lower for the new measures than for the standard 30-day readmissions measure, indicating better statistical power to detect impacts of primary or transitional care interventions. Conclusions: This study introduces two new claims-based measures to assess quality of care during a patient's vulnerable period following acute care. The new measures complement existing measures, covering a broader range of UAC events than the standard 30-day readmissions measure, and yielding greater statistical power. KEYWORDS acute inpatient care, administrative data uses, ambulatory/outpatient care, hospitals, Medicare, primary care, program evaluation, quality of care/patient safety (measurement), 1 INTRODUCTION The period immediately following discharge from an acute care hospital admission has long been recognized as a period during which patients are vulnerable to preventable rehospitalizations due to [...]

Objective: This article employs a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs in the United States. Data Sources: Patients and relevant parties, with pediatric antipsychotic oversight and treatment experience, completed a BWS experiment, including policymakers (n = 31), foster care alumni (n = 28), caseworkers (n = 23), prescribing clinicians (n = 32), and caregivers (n = 18). Study Design: Respondents received surveys with a scenario on antipsychotic monitoring programs and ranked 11 candidate claims-based outcomes as most and least important for program evaluation. Data Analysis: Stratified by respondent group, best-worst scores were calculated to identify the relative importance of the claims-based outcomes. A conditional logit examined whether candidate outcomes for safety, quality, and unintended consequences were preferred over reduction in antipsychotic treatment, the outcome used most often to evaluate antipsychotic monitoring programs. Principal Findings: Safety indicators (eg, antipsychotic co-pharmacy, cross-class polypharmacy, higher than recommended doses) ranked among the top three candidate outcomes across respondent groups and were an important complement to antipsychotic treatment reduction. Foster care alumni prioritized 'antipsychotic treatment reduction' and 'increased psychosocial treatment.' Caseworkers, prescribers, and caregivers prioritized 'increased follow-up after treatment initiation.' Potential unintended consequences of an antipsychotic monitoring program ranked lowest, including increased use of other psychotropic medication classes (as a substitute), increased psychiatric hospital stays, and increased emergency room utilization. Results of the conditional logit model found only caregivers significantly preferred other indicators over antipsychotic treatment reduction, preferring improvements in follow-up care (5.78) and psychosocial treatment (4.53) and reduction in prescriptions of higher than recommended doses (3.64). Conclusions: The BWS experiment supported rank ordering of candidate claims-based outcomes demonstrating the opportunity for future studies to align outcomes used in antipsychotic monitoring program evaluations with community preferences, specifically by diversifying metrics to include safety and quality indicators. KEYWORDS administrative data uses, child and adolescent health, evaluation design and research, Medicaid, pediatrics, program evaluation, state health policies, Survey Research and Questionnaire Design, 1 INTRODUCTION Over the last decade, academic research and federal funding initiatives have encouraged researchers to extend the concept of patient-centeredness from health care delivery, itself, to research. (1) Incorporating [...]

Objectives: To develop two practice-site-level measures of comprehensiveness and examine their associations with patient outcomes, and how their performance differs from physician-level measures. Data Sources: Medicare fee-for-service claims. Study Design: We calculated practice-site-level comprehensiveness measures (new problem management and involvement in patient conditions) across 5286 primary care physicians (PCPs) at 1339 practices in the Comprehensive Primary Care initiative evaluation in 2013. We assessed their associations with practices' attributed beneficiaries' 2014 total Medicare expenditures, hospitalization rates, ED visit rates. We also examined variation in PCPs' comprehensiveness across PCPs within practices versus between primary care practices. Finally, we compared associations of practice-site and PCP-level measures with outcomes. Principal Findings: The measures had good variation across primary care practices, strong validity, and high reliability. Receiving primary care from a practice at the 75th versus 25th percentile on the involvement in patient conditions measure was associated with $21.93 (2.8%) lower total Medicare expenditures per beneficiary per month (P Conclusions: More comprehensive primary care practices had lower Medicare FFS expenditures, hospitalization, and ED visit rates. Both PCP and practice-site level comprehensiveness measures had strong construct and predictive validity; PCP-level measures were more precise. KEYWORDS comprehensiveness, health services utilization and costs, Medicare, primary health care, quality measures, 1 INTRODUCTION Comprehensive primary care is the extent to which the patient's primary care provider (clinician, practice, or team) recognizes and meets the large majority of the patient's physical and [...]

Objective. The objective was to use the Activity Measure for Post-Acute Care "6-Clicks" scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). Methods. In this retrospective cohort study, initial "6-Clicks" Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility ([less than or equal to]40.78 vs >40.78) and Daily Activity ([less than or equal to]40.22 vs >40.22), accounting for patient and clinical characteristics. Results. Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80-0.81) and Daily Activity was 0.81 (95% CI = 0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores [less than or equal to]40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5-1.9]), SNF (OR = 7.8 [95% CI = 6.8-8.9]), and IRF (OR = 7.5 [95% CI = 6.3-9.1]), and the Daily Activity scores [less than or equal to]40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7-2.0]), SNF (OR = 8.9 [95% CI = 7.9-10.0]), and IRF (OR = 11.4 [95% CI = 9.7-13.5]). Conclusion. 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. Impact. Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination. Keywords: Activities of Daily Living, Acute Care, Case Management, Outcome Assessment (Health Care), Patient Discharge, Introduction Implementation of health care cost containment measures, such as the Inpatient Prospective Payment System (1) and Hospital Readmissions Reduction Program, (2) has forced inpatient facilities to optimize care and [...]

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