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Background:Functioning is, in addition to mortality and morbidity, one of the most important health indicators. Health indicators are important across all levels of the healthcare system: For clinical patient management on the micro level, for performance measurement and comparisons of clinics on the meso level, as well as for cantonal and national planning on the macro level. In particular in the field of rehabilitation, the focus lies on optimizing a person's functioning. However, the assessment and reporting of functioning information in practice is often not standardized and there exists a large variety of related clinical assessment instruments. This makes comparability and learning from functioning information in terms of continuous improvement at all levels of the health system difficult. Therefore, the aim of the NRP74 StARS project was the development of a Standardized Assessment and Reporting System (StARS) for functioning information in order to support targeted and high-quality rehabilitation. The project dealt with two application examples of a StARS: Part A) The Swiss national quality reports of the ANQ (National Association for Quality Development) in rehabilitation, Part B) Clinical decision-making in rehabilitation after spinal cord injury. In order to develop strategies together with relevant stakeholders on how a StARS can be implemented in the two application examples, a stakeholder dialogue including a stakeholder brief was carried out as part of the NRP74 StARS project implementation strategy. Methods:To inform stakeholders about a StARS for functioning information, a stakeholder brief, a short preparatory document, was developed and distributed amongst the participants of the stakeholder dialogue prior to the event. The stakeholder brief was designed to inform about the project, its findings and application areas in a user-friendly language. The stakeholder brief included SWOT (Strengths-Weaknesses-Opportunities-Threats) analyses for four application areas of a StARS in Switzerland and was developed based on nine key informant interviews. The stakeholder dialogue was designed to inform relevant stakeholders about the NRP74 StARS project and to mutually discuss and develop strategies for implementing a StARS for functioning information in different application areas in Switzerland. The stakeholders who participated in the one-day dialogue were identified in consultation with the project's advisory board. Both, the stakeholder brief and the stakeholder dialogue, were evaluated by the participating stakeholders through an anonymous online survey. Results:Twenty-four stakeholders participated at the NFP74 StARS stakeholder dialogue in November 2019. The participating stakeholders represented the federal offices of public health and statistics, health care departments of cantons, patients, rehabilitation clinics and health professionals, quality organizations, financing institutions, rehabilitation asso-ciations and research. The output of the stakeholder brief and stakeholder dialogue was an implementation agenda in which the stakeholders decided on the next steps for implementing the developed StARS, including three main points: i) The preparation of a final project report for the ANQ about the application of a StARS for functioning information with regards to all ANQ rehabilitation areas; ii) The clarification of financial possibilities in connection with the new national quality commission and the related new quality contracts; iii) the creation of a StARS consortium for further cooperation and exchange of the stakeholders. The online evaluation revealed that the stakeholders were satisfied with the brief and their involvement in the dialogue and that the related objectives were met. Conclusion:The NRP74 StARS stakeholder dialog, including the stakeholder brief as preparatory document, supported the development of strategies in the form of an implementation agenda together with relevant stakeholders for a possible implementation of a StARS for functioning in the four application areas in Switzerland. The participating stakeholders highly valued the opportunity for exchange and discussion with the other stakeholders and the research team and described the dialogue as meaningful, stimulating and interesting.

OBJECTIVE: Many different assessment tools are used to assess functioning in rehabilitation; this limits the comparability and aggregation of respective data. The aim of this study was to outline the development of an International Classification of Functioning, Disability and Health (ICF)-based interval-scaled common metric for 2 assessment tools assessing activities of daily living: the Functional Independence Measure (FIMTM) and the Extended Barthel Index (EBI), used in Swiss national rehabilitation quality reports. METHODS: The conceptual equivalence of the 2 tools was assessed through their linking to the ICF. The Rasch measurement model was then applied to create a common metric including FIMTM and EBI. SUBJECTS: Secondary analysis of a sample of 265 neurological patients from 5 Swiss clinics. RESULTS: ICF linking found conceptual coherency of the tools. An interval-scaled common metric, including FIMTM and EBI, could be established, given fit to the Rasch model in the related analyses. CONCLUSION: The ICF-based and interval-scaled common metric enables comparison of patients and clinics functioning outcomes when different activities of daily living tools are used. The common metric can be included in a Standardized Assessment and Reporting System for functioning information in order to enable data aggregation and comparability., + ID der Publikation: unilu_51149 + Sprache: Englisch + Bemerkungen: 1651-2081 Maritz, Roxanne Tennant, Alan Fellinghauer, Carolina Stucki, Gerold Prodinger, Birgit Journal Article Sweden J Rehabil Med. 2020 Jul 31;52(7):jrm00085. doi: 10.2340/16501977-2711. + Letzte Aktualisierung: 2020-12-17 16:21:49

OBJECTIVE: To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric. DESIGN: Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets. SETTING: Swiss national public rehabilitation outcome quality reports on the clinic level. PARTICIPANTS: A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18047 patients. INTERVENTIONS: Neurological or musculoskeletal rehabilitation. MAIN OUTCOME MEASURES: Functional Independence Measure™ or Extended Barthel Index. RESULTS: Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric's content with ICF Core Sets suggests to include 'energy and drive functions' or 'maintaining a basic body position' to enhance the content of functioning as an indicator. CONCLUSIONS: A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS' ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation.

Background: The Extended Barthel Index (EBI), consisting of the original Barthel Index plus 6 cognitive items, provides a tool to monitor patients' outcomes in rehabilitation. Whether the EBI provides a unidimensional metric, thus can be reported as a valid sum-score, remains to be examined. Objective: To examine whether the EBI can be reported as unidimensional interval-scaled metric for neurological and musculoskeletal rehabilitation. Methods: Rasch analysis of a calibration sample of 800 cases from neurological or musculoskeletal rehabilitation in 2016 in Switzerland. Results: In the baseline analysis no fit to the Rasch Model was achieved. When accommodating local dependencies with a testlet approach satisfactory fit to the Rasch Model was achieved, and an interval scale transformation table was created. Conclusion: The results support the reporting of adapted EBI total scores for both rehabilitation groups by applying the interval scaled transformation table presented in this study., + ID der Publikation: unilu_51329 + Sprache: Englisch + Letzte Aktualisierung: 2020-12-17 14:42:28 Abstract auf Englisch und Deutsch

OBJECTIVE: Since the 1990s the Functional Independence Measure (FIM) was believed to measure 2 different constructs, represented by its motor and cognitive subscales. The practice of reporting FIM total scores, together with recent developments in the understanding of the influence of locally dependent items on fit to the Rasch model, raises the question of whether the FIM 18-item version can be reported as a unidimensional interval-scaled metric. DESIGN: Rasch analysis of the FIM using testlet approaches to accommodate local response dependency. PATIENTS: A calibration sample containing 946 cases of data from 11,103 patients undergoing neurological or musculoskeletal rehabilitation in Switzerland in 2016. RESULTS: Baseline analysis and the traditional testlet approach showed no fit with the Rasch model. When items were grouped into 2 testlets, fit to the Rasch model was achieved, indicating unidimensionality across all 18 items. A transformation table to convert FIM raw ordinal scores to the corresponding Rasch interval scaled values was created. CONCLUSION: This study provides evidence that FIM total scores represent a unidimensional set of items, supporting their use in clinical practice and outcome reporting when applying the respective transformation table. This provides a basis for standardized reporting of functioning., + ID der Publikation: unilu_46514 + Sprache: Englisch + Bemerkungen: Maritz, Roxanne Tennant, Alan Fellinghauer, Carolina Stucki, Gerold Prodinger, Birgit Sweden J Rehabil Med. 2019 Mar 13;51(3):193-200. doi: 10.2340/16501977-2525. + Letzte Aktualisierung: 2020-12-17 16:10:40

Appendix 1. Search terms for systematic literature reviw. Provides an overview of the search terms used for the systematic literature review for each database and country separately. (DOCX 13 kb)

Appendix 2 Interview guide NHS PROMs Programme. Shows the interview guide used for the interviews with experts related to the NHS PROMs Programme. (DOCX 14 kb)

797146_Suppplemental_Appendices_A_to_E for Linking occupational therapy models and assessments to the ICF to enable standardized documentation of functioning by Roxanne Maritz, Sue Baptiste, Susan W. Darzins, Susan Magasi, Chelsey Weleschuk, and Birgit Prodinger in Canadian Journal of Occupational Therapy

Appendix 3 Interview guide Swedish Hip or Knee Arthroplasty Registries. Shows the interview guide used for the interviews with experts related to the Swedish Hip or Knee Arthroplasty Registries. (DOCX 14 kb)