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To estimate Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) scores from FIM motor items. Secondary data analysis. Fourteen Spinal Cord Injury Model Systems (SCIMS) programs. Persons with traumatic spinal cord injury (SCI) discharged from inpatient rehabilitation at 14 SCIMS programs (N=1237). Not applicable. FIM motor items were matched to SCI-FI/AT domains and summary scores for each measure were developed. The kernel-based method was employed to develop a concordance table to estimate SCI-FI/AT domain summary scores from content-matched FIM motor item summary scores. We conducted analyses to compare agreement between actual SCI-FI/AT summary scores (actual SCI-FI/AT_S) and estimated SCI-FI/AT summary scores (est-SCI-FI/AT_S) for the total sample and for participants with different SCI injury categories. Nine FIM items matched SCI-FI/AT basic mobility and self-care domain content. Pearson correlations for actual and est-SCI-FI/AT_S scores (0.79) were adequate for using concordance linking methods. Intraclass correlation coefficient values (0.79; 95% confidence interval, 0.77-0.81) indicated moderate reliability. t tests revealed no significant differences between actual and est-SCI-FI/AT_S scores in the total sample. For almost 60% of the sample, actual and est-SCI-FI/AT_S score differences were <5 points (half of a SD). Greater differences between actual and est-SCI-FI/AT_S scores were noted for persons with tetraplegia American Spinal Injury Association Impairment Scales (AISs) A, B, and C. Despite differences between the FIM and SCI-FI/AT assessments, we developed a concordance table to estimate self-care and basic mobility SCI-FI/AT scores from content-matched FIM motor item scores. This concordance table allows researchers to merge FIM data with SCI-FI/AT data to analyze SCI functional outcomes at the group level. However, owing to greater differences between actual and estimated scores, the concordance table should be used with caution to interpret scores for those with cervical-level injuries AISs A, B, C. [ABSTRACT FROM AUTHOR]

To establish responsiveness of 3 Spinal Cord Injury–Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI). Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set. A total of 8 SCI Model Systems rehabilitation hospitals in the United States. Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418). In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures' responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness. The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only). In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P <.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65). The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use. [ABSTRACT FROM AUTHOR]

To evaluate the psychometric properties of the Spinal Cord Injury–Functional Index (SCI-FI) instruments in a community-dwelling sample. Cross-sectional study. Community setting. Individuals (N=269) recruited from 6 SCI Model Systems sites. Not applicable. Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity. Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms. Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals. [ABSTRACT FROM AUTHOR]

The article presents recommendations from the International Society of Physiotherapy Journal Editors on statistical inference through estimation:.

To expand an existing validated measure of basic mobility (Activity Measure for Post-Acute Care [AM-PAC]) for patients at the lowest levels of function. Item replenishment for existing item response theory (IRT) derived measure via (1) idea generation and creation of potential new items, (2) item calibration and field testing, and (3) longitudinal pilot test. Two tertiary acute care hospitals. Consecutive inpatients (N=502) ≥18 years old, with an AM-PAC Inpatient Mobility Short Form (IMSF) raw score ≤15. For the longitudinal pilot test, 8 inpatients were evaluated. Fifteen new AM-PAC items were developed, 2 of which improved mobility measurement at the lower levels of functioning. Specifically, with the 2 new items, the floor effect of the AM-PAC IMSF was reduced by 19%, statistical power and measurement breadth were greater, and there was greater measurement sensitivity in longitudinal pilot testing. Adding 2 new items to the AM-PAC IMSF lowered the floor and increased statistical power, measurement breadth, and sensitivity. • Few measures of function can be used longitudinally across all levels of function. • The Activity Measure for Post-Acute Care (AM-PAC) offers flexible administration across a broad range of function. • The 6-item AM-PAC Inpatient Mobility Short Form (IMSF) is widely used in hospitals. • Two new AM-PAC items improve measurement at very low levels of function. • The 8-item AM-PAC Expanded IMSF is recommended for use among patients with low function. [ABSTRACT FROM AUTHOR]

To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Older participants, those who were married, and men were more likely to be burned at work (P <.01). Burn survivors who were injured at work scored significantly lower on the Work and Employment scale score after adjusting for demographic and clinical characteristics (P =.01). All other domain scale scores demonstrated no significant differences between groups. Individuals with work-related injuries scored significantly worse on 6 of the 19 items within the Work and Employment scale (P <.05). These individuals were more likely to report that they were afraid to go to work and felt limited in their ability to perform at work. Burn survivors with work-related injuries report worse work reintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes. [ABSTRACT FROM AUTHOR]

To examine differences in long-term social reintegration outcomes for burn survivors with and without peer support attendance. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area (TBSA) or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Burn support group attendance was reported by 330 (55%) of 596 respondents who responded to this item. Attendees had larger burn size (43.4%±23.6% vs 36.8%±23.4% TBSA burned, P <.01) and were more likely to be >10 years from injury (50% vs 42.5%, P <.01). Survivors who attended at least 1 support group scored significantly higher on 3 of the scales: Social Interactions (P =.01), Social Activities (P =.04), and Work and Employment (P =.05). In adjusted analyses, peer support attendance was associated with increased scores on the Social Interactions scale, increasing scores by 17% of an SD (95% confidence interval, 1%–33%; P =.04). Burn survivors who reported peer support attendance had better social interaction scores than those who did not. This is the first reported association between peer support group attendance and improvements in community reintegration in burn survivors. This cross-sectional study prompts further exploration into the potential benefits of peer support groups on burn recovery with future intervention studies. [ABSTRACT FROM AUTHOR]

Validation of linking coefficients to transform Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI/AM) scores to adult Spinal Cord Injury-Functional Index (SCI-FI) scores. This cross-sectional study administered PEDI-SCI/AM and SCI-FI computerized adaptive tests (CATs) and short forms (SFs) to children with SCI and parents or caregivers. Hospitals, university, and rehabilitation institute. About 107 children with SCI and 96 parent or caregivers. Not applicable. Linking coefficients estimated SCI-FI (est-SCI-FI) scores from PEDI-SCI/AM scores for matched domains. Correlations between est-SCI-FI and actual SCI-FI scores were calculated. If correlations exceeded the criterion linking (0.866), the following analyses to compare est-SCI-FI and actual SCI-FI scores were conducted: paired t tests, intraclass correlation coefficients (ICCs 3, 1), percent of cases with absolute score differences at different thresholds. Two matched domains, PEDI-SCI/AM Daily Routine/SCI-FI Self-Care and PEDI-SCI/AM General Mobility/SCI-FI Basic Mobility, met the linking criterion for both respondent-types (parent and child) and administration modes (CAT and SF). PEDI-SCI/AM Daily Routine and SCI-FI Fine Motor Function did not meet linking criterion for respondent type or mode. The linking criterion was met for wheelchair domains (child SF and CAT) and ambulation domains (child SF only). Significant differences between est-SCI-FI and actual SCI-FI scores were noted for all matched domains except Daily Routine/Self-Care (child SF only; parent SF and CAT). ICC values showed excellent agreement (range=0.75-0.89). Absolute differences between est-SCI-FI and actual SCI-FI scores were less than 1 standard deviation (except wheelchair CAT child). Linking coefficients applied to PEDI-SCI/AM scores can provide valid SCI-FI estimates that vary by domain, mode, and respondent type. [ABSTRACT FROM AUTHOR]

To assess psychometric properties of the improved Work Disability Functional Assessment Battery (WD-FAB 2.0). Longitudinal study. Community. Three samples of working-age (21-66) adults (N=1006): (1) unable to work because of a physical condition (n=375); (2) unable to work because of a mental health condition (n=296); (3) general United States working age sample (n=335). NA. All samples completed the WD-FAB 2.0; the second administration came 5 days after the first. Construct validity was examined by convergent and divergent correlational analysis using legacy measures. Test-retest reliability was assessed by intraclass correlation coefficients (ICC 3,1). Standard error of the mean (SEM) and minimal detectable change (MDC 90) were calculated to measure scale precision and sensitivity. Physical function ICCs ranged from 0.69 to 0.77 in the general sample, and 0.66 to 0.86 in the disability sample. Mental health function scales ICCs ranged from 0.62 to 0.73 in the general sample, and 0.74 to 0.76 in the disability sample. SEMs for all scales indicated good discrimination; those for the physical function scales were generally lower than those for the mental health scales. MDC 90 values ranged from 3.41 to 10.55. Correlations between all WD-FAB 2.0 scales and legacy measures were in the expected direction. The study provides substantial support for the reliability and construct validity of the WD-FAB 2.0 among 3 diverse samples. Although initially developed for use within the Social Security Administration (SSA), these results suggest that the WD-FAB 2.0 could be used for assessment and measurement of work-related physical and mental health function in other contexts as well. [ABSTRACT FROM AUTHOR]

Purpose The Cerebral Palsy Profile of Health and Function (CP-PRO) Computerized Adaptive Tests (CAT) are quality of life measures developed specifically for use in children with cerebral palsy. This study examined the ability of the upper-extremity (UE) CP-PRO CAT to detect change in function after UE surgery compared with the Pediatric Outcomes Data Collection Instrument (PODCI), ABILHAND-Kids, and Box and Blocks test. Methods From 2009 to 2013, children with cerebral palsy who had UE musculoskeletal surgery completed the UE CP-PRO CAT, PODCI-UE, ABILHAND-Kids, and Box and Blocks tests before surgery (97 children) and at 3 postoperative intervals: 6 months (80 children), 12 months (73 children), and 24 months (52 children). Mean, SD, effect size (ES), and standardized response mean (SRM) values for each measure at each time interval and each level of the Manual Ability Classification System were calculated and compared. Finally, the minimal detectable change at the 90% confidence level was determined. Results Values for the ES (0.40) and SRM (0.53) for the UE CP-PRO CAT at baseline to 6 months were moderate and significantly greater than the PODCI-UE (ES, 0.18; SRM, 0.25). The ES and SRM for the PODCI-UE, ABILHAND-Kids, and Box and Blocks tests were not significantly greater than for the UE CP-PRO CAT at any period. From baseline to 6 months, the UE CP-PRO CAT detected a large and significant improvement for Manual Ability Classification System level II (SRM, 0.70; ES, 0.70). The minimal detectable change for the UE CP-PRO CAT was 5.20. Conclusions The UE CP-PRO CAT is significantly better in detecting change in UE function in the first 6 months after surgery and is comparable to other measures at 12 and 24 months. Type of study/level of evidence Diagnostic II. [ABSTRACT FROM AUTHOR]

Objective To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE). Design Cross-sectional. Setting Outpatient rehabilitation. Participants Adults (N=50) participating in physical therapy for musculoskeletal conditions. Interventions Not applicable. Main Outcome Measures Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient’s physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ability ratings in the Dynamic Strength, Position Tolerance, and Mobility subsections. Results Participating in the study were 50 patients with 1 or more conditions (shoulder, n=21; knee, n=16; low back, n=13; ankle/foot, n=10; neck, n=8; hip, n=7). The patient-based WD-FAB scores demonstrated moderate, statistically significant correlations with the provider proxy WD-FAB report ( R =.49-.65). The WD-FAB Upper Body Function scale scores demonstrated moderate strength relationships with the PWPE overall ratings. The Whole Body Mobility and Changing and Maintaining Body Position scales did not demonstrate statistically significant relationships with the PWPE overall ratings. Conclusions We found moderate evidence for validity for the WD-FAB Upper Body Function, Whole Body Mobility, and Changing and Maintaining Body Position scales relative to clinician report and varied evidence relative to the PWPE in this clinical sample. [ABSTRACT FROM AUTHOR]

Objective To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI). Design Multisite longitudinal (12-mo follow-up) study. Setting Nine SCI Model Systems programs. Participants Adults (N=165) with SCI enrolled in the SCI Model Systems database. Interventions Not applicable. Main Outcome Measures SCI-FI/AT computerized adaptive test (CAT) (Basic Mobility, Self-Care, Fine Motor Function, Wheelchair Mobility, and/or Ambulation domains) completed at discharge from rehabilitation and 12 months after SCI. For each domain, effect size estimates and 95% confidence intervals were calculated for subgroups with paraplegia and tetraplegia. Results The demographic characteristics of the sample were as follows: 46% (n=76) individuals with paraplegia, 76% (n=125) male participants, 57% (n=94) used a manual wheelchair, 38% (n=63) used a power wheelchair, 30% (n=50) were ambulatory. For individuals with paraplegia, the Basic Mobility, Self-Care, and Ambulation domains of the SCI-FI/AT detected a significantly large amount of change; in contrast, the Fine Motor Function and Wheelchair Mobility domains detected only a small amount of change. For those with tetraplegia, the Basic Mobility, Fine Motor Function, and Self-Care domains detected a small amount of change whereas the Ambulation item domain detected a medium amount of change. The Wheelchair Mobility domain for people with tetraplegia was the only SCI-FI/AT domain that did not detect significant change. Conclusions SCI-FI/AT CAT item banks detected an increase in function from discharge to 12 months after SCI. The effect size estimates for the SCI-FI/AT CAT vary by domain and level of lesion. Findings support the use of the SCI-FI/AT CAT in the population with SCI and highlight the importance of multidimensional functional measures. [ABSTRACT FROM AUTHOR]

Objective To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). Design Longitudinal observational study. Setting Participants' homes. Participants Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. Interventions Not applicable. Main Outcome Measures Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. Results Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels. Conclusions Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans. [ABSTRACT FROM AUTHOR]

Objective To develop self-reported short forms for the Life Impact Burn Recovery Evaluation (LIBRE) Profile. Design Short forms based on the item parameters of discrimination and average difficulty. Setting A support network for burn survivors, peer support networks, social media, and mailings. Participants Burn survivors (N=601) older than 18 years. Interventions Not applicable. Main Outcome Measures The LIBRE Profile. Results Ten-item short forms were developed to cover the 6 LIBRE Profile scales: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. Ceiling effects were ≤15% for all scales; floor effects were <1% for all scales. The marginal reliability of the short forms ranged from .85 to .89. Conclusions The LIBRE Profile-Short Forms demonstrated credible psychometric properties. The short form version provides a viable alternative to administering the LIBRE Profile when resources do not allow computer or Internet access. The full item bank, computerized adaptive test, and short forms are all scored along the same metric, and therefore scores are comparable regardless of the mode of administration. [ABSTRACT FROM AUTHOR]

Objective To examine the role of residential neighborhood characteristics in accounting for race disparities in participation among a large sample of community-living adults with chronic spinal cord injury (SCI). Design Secondary analysis of cross-sectional survey data from the national Spinal Cord Injury Model Systems (SCIMS) database linked with national survey and spatial data. Setting SCIMS database participants enrolled at 10 collaborating centers active in follow-up between 2000 and 2014. Participants The sample consisted of persons with SCI (N=6892) in 5441 Census tracts from 50 states and the District of Columbia. Intervention Not applicable. Main Outcome Measure The Craig Handicap Assessment and Reporting Technique was used to measure full participation across 4 domains: physical independence, mobility, occupation, and social integration. Results Racial minority groups had lower odds of reporting full participation relative to whites across all domains, suggesting that blacks and Hispanics are at risk for poorer community reintegration after SCI. Neighborhood characteristics, notably differences in socioeconomic advantage, reduced race group differences in the odds of full occupational and social integration, suggesting that the race disparities in community reintegration after SCI are partially attributable to variation in the economic characteristics of the places where people live. Conclusions This investigation suggests that addressing disadvantage at the neighborhood level may modify gaps in community participation after medical rehabilitation and provides further support for the role of the environment in the experience of disability. [ABSTRACT FROM AUTHOR]

Objective To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life. Design Longitudinal cohort study. Setting Research clinic. Participants Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry. Interventions Not applicable. Main Outcome Measures Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), range of motion (ROM) (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis). Results The largest effect sizes were found for baseline weaker leg strength (odds ratio [95% confidence interval]: 3.45 [1.72–6.95]), trunk extensor endurance (2.98 [1.56–5.70]), and slower leg velocity (2.35 [1.21–4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10–2.70], 1.83 [1.13–2.95], and 2.03 [1.24–3.35], respectively). Conclusions Older adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the groundwork for developing interventions aimed at optimizing rehabilitative care and disability prevention, and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance). [ABSTRACT FROM AUTHOR]

Objectives To develop functional ability levels for the Spinal Cord Injury Functional Index (SCI-FI) and to validate them using calibration and reliability samples. Design Three-phase strategy involved (1) performing quantitative synthesis of SCI-FI data to create item maps; (2) using a panel of experts to identify functional ability levels after the bookmarking and Delphi consensus-building process; and (3) performing quantitative analyses to examine demographic characteristics across 2 samples, assessing the distribution pattern across functional ability levels, and examining concurrent validity using the self-reported functional measure and the observer-rated FIM. Setting Inpatient and community settings. Participants People 18 years or older with traumatic spinal cord injury (N=1124) were recruited from the Spinal Cord Injury Model Systems programs and stratified by diagnosis, severity, and time since injury (n=855 and n=269 for calibration and reliability samples, respectively). Interventions Not applicable. Main Outcome Measure SCI-FI. Results Five functional ability levels were identified for all SCI-FI domains, except fine motor having 4 functional ability levels. Statistical test results indicated no significant differences in the distribution pattern across the 2 samples across functional ability levels for all domains except for ambulation. Known-group comparisons were able to discern the spinal cord injury population as expected. Basic mobility, self-care, and wheelchair mobility domains had a cluster of persons with paraplegia and incomplete lesions at higher functional ability levels and persons with tetraplegia and complete lesions at lower functional ability levels. For the ambulation domain, the distribution was skewed to the lower end, with a relatively small percentage of persons with incomplete lesions (paraplegia and tetraplegia) at higher functional ability levels. For the fine motor domain, the distribution was skewed to higher functional ability levels, with a high percentage of persons with paraplegia at the highest level (complete and incomplete lesions). Concurrent validity analyses revealed SCI-FI functional levels to be significantly ( P <.001) positively correlated with both the self-reported functional measure and the observer-rated FIM. Conclusions Clinicians can use functional ability levels to discuss patients' functional capabilities with them and their family. [ABSTRACT FROM AUTHOR]

Objective To assess the feasibility and psychometric properties of 8 scales covering 2 domains of the newly developed Work Disability Functional Assessment Battery (WD-FAB): physical function (PF) and behavioral health (BH) function. Design Cross-sectional study. Setting Community. Participants Adults (N=973) unable to work because of a physical (n=497) or a mental (n=476) disability. Interventions Not applicable. Main Outcome Measures Each disability group responded to a survey consisting of the relevant WD-FAB scales and existing measures of established validity. The WD-FAB scales were evaluated with regard to data quality (score distribution, percentage of “I don't know” responses), efficiency of administration (number of items required to achieve reliability criterion, time required to complete the scale) by computerized adaptive testing (CAT), and measurement accuracy as tested by person fit. Construct validity was assessed by examining both convergent and discriminant correlations between the WD-FAB scales and scores on same-domain and cross-domain established measures. Results Data quality was good, and CAT efficiency was high across both WD-FAB domains. Measurement accuracy was very good for PF scales; BH scales demonstrated more variability. Construct validity correlations, both convergent and divergent, between all WD-FAB scales and established measures were in the expected direction and range of magnitude. Conclusions The data quality, CAT efficiency, person fit, and construct validity of the WD-FAB scales were well supported and suggest that the WD-FAB could be used to assess PF and BH function related to work disability. Variation in scale performance suggests the need for future work on item replenishment and refinement, particularly with regard to the Self-Efficacy scale. [ABSTRACT FROM AUTHOR]

Objective To characterize the manner of functional status difficulties with age across multiple functional domains: lower extremity function, upper extremity function, and cognitive/social function. Construct validity of a functional status measure composed of these domains was assessed as part of this goal. Design Cross-sectional survey of the community-dwelling civilian population in the United States. Setting Community. Participants Community-dwelling adults aged 60 years and older (N=7968). Interventions Not applicable. Main Outcome Measures Model fit of a 20-item functional status measure to a confirmatory factor analysis model was assessed with the root mean square error of approximation and the root mean square residual. Functional status benchmarks for age were developed with curves plotting activity difficulty percentiles versus age for the general U.S. population. Results The 20-item activity difficulty index modeled as a 3-factor construct had a root mean square error of approximation of .045 and a root mean squared residual of .052, indicating good fit. Benchmarks based on percentiles show that the median activity difficulty score is quite low for the full range studied but that there is a steady increase with increasing age. The domain regarding cognition and social function appeared to be less sensitive than the upper and lower extremity skills domains to increasing age. Conclusions A broad measure of difficulty with functional activities can be meaningfully treated as a 3-domain construct. The scores represented by the index measuring this construct can be used to compare patients to a national sample of age-matched individuals to assess functional status using normative values. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify the neuromuscular attributes that are associated with self-reported mobility status among older primary care patients. Design: Cohort study. Setting: Metropolitan-based health care system. Participants: Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks resulting from underlying health conditions. Interventions: Not applicable. Main Outcome Measures: Basic and Advanced Lower Extremity Function as measured by the Late Life Function and Disability Instrument. Results: We constructed multivariable linear regression models evaluating both outcomes. For Basic Lower Extremity Function, leg strength, leg velocity, trunk extensor muscle endurance, and ankle range of motion (ROM) were statistically significant predictors (P<.001, R 2=.21). For Advanced Lower Extremity Function, leg strength, leg strength asymmetry, leg velocity, trunk extensor muscle endurance, and knee flexion ROM were statistically significant predictors (P<.001, R 2=.39). Sensitivity analyses conducted using multiple imputations to account for missing data confirmed these findings. Conclusions: This analysis highlights the relevance and importance of 5 categories of neuromuscular attributes: strength, speed of movement, ROM, asymmetry, and trunk stability. It identifies novel attributes (leg velocity and trunk extensor muscle endurance) relevant to mobility and highlights that impairment profiles vary by the level of mobility assessed. These findings will inform the design of more thorough and potentially more effective disability prevention strategies. [Copyright &y& Elsevier]

Abstract: Objective: To use item response theory (IRT) data simulations to construct and perform initial psychometric testing of a newly developed instrument, the Social Security Administration Behavioral Health Function (SSA-BH) instrument, that aims to assess behavioral health functioning relevant to the context of work. Design: Cross-sectional survey followed by IRT calibration data simulations. Setting: Community. Participants: Sample of individuals applying for Social Security Administration disability benefits: claimants (n=1015) and a normative comparative sample of U.S. adults (n=1000). Interventions: None. Main Outcome Measure: SSA-BH measurement instrument. Results: IRT analyses supported the unidimensionality of 4 SSA-BH scales: mood and emotions (35 items), self-efficacy (23 items), social interactions (6 items), and behavioral control (15 items). All SSA-BH scales demonstrated strong psychometric properties including reliability, accuracy, and breadth of coverage. High correlations of the simulated 5- or 10-item computer adaptive tests with the full item bank indicated robust ability of the computer adaptive testing approach to comprehensively characterize behavioral health function along 4 distinct dimensions. Conclusions: Initial testing and evaluation of the SSA-BH instrument demonstrated good accuracy, reliability, and content coverage along all 4 scales. Behavioral function profiles of Social Security Administration claimants were generated and compared with age- and sex-matched norms along 4 scales: mood and emotions, behavioral control, social interactions, and self-efficacy. Using the computer adaptive test-based approach offers the ability to collect standardized, comprehensive functional information about claimants in an efficient way, which may prove useful in the context of the Social Security Administration's work disability programs. [Copyright &y& Elsevier]

Abstract: Objectives: To develop a broad set of claimant-reported items to assess behavioral health functioning relevant to the Social Security disability determination processes, and to evaluate the underlying structure of behavioral health functioning for use in development of a new functional assessment instrument. Design: Cross-sectional. Setting: Community. Participants: Item pools of behavioral health functioning were developed, refined, and field tested in a sample of persons applying for Social Security disability benefits (N=1015) who reported difficulties working because of mental or both mental and physical conditions. Interventions: None. Main Outcome Measure: Social Security Administration Behavioral Health (SSA-BH) measurement instrument. Results: Confirmatory factor analysis (CFA) specified that a 4-factor model (self-efficacy, mood and emotions, behavioral control, social interactions) had the optimal fit with the data and was also consistent with our hypothesized conceptual framework for characterizing behavioral health functioning. When the items within each of the 4 scales were tested in CFA, the fit statistics indicated adequate support for characterizing behavioral health as a unidimensional construct along these 4 distinct scales of function. Conclusions: This work represents a significant advance both conceptually and psychometrically in assessment methodologies for work-related behavioral health. The measurement of behavioral health functioning relevant to the context of work requires the assessment of multiple dimensions of behavioral health functioning. Specifically, we identified a 4-factor model solution that represented key domains of work-related behavioral health functioning. These results guided the development and scale formation of a new SSA-BH instrument. [Copyright &y& Elsevier]

Abstract: Objectives: To develop and test an instrument to assess physical function for Social Security Administration (SSA) disability programs, the SSA-Physical Function (SSA-PF) instrument. Item response theory (IRT) analyses were used to (1) create a calibrated item bank for each of the factors identified in prior factor analyses, (2) assess the fit of the items within each scale, (3) develop separate computer-adaptive testing (CAT) instruments for each scale, and (4) conduct initial psychometric testing. Design: Cross-sectional data collection; IRT analyses; CAT simulation. Setting: Telephone and Internet survey. Participants: Two samples: SSA claimants (n=1017) and adults from the U.S. general population (n=999). Interventions: None. Main Outcome Measures: Model fit statistics, correlation, and reliability coefficients. Results: IRT analyses resulted in 5 unidimensional SSA-PF scales: Changing & Maintaining Body Position, Whole Body Mobility, Upper Body Function, Upper Extremity Fine Motor, and Wheelchair Mobility for a total of 102 items. High CAT accuracy was demonstrated by strong correlations between simulated CAT scores and those from the full item banks. On comparing the simulated CATs with the full item banks, very little loss of reliability or precision was noted, except at the lower and upper ranges of each scale. No difference in response patterns by age or sex was noted. The distributions of claimant scores were shifted to the lower end of each scale compared with those of a sample of U.S. adults. Conclusions: The SSA-PF instrument contributes important new methodology for measuring the physical function of adults applying to the SSA disability programs. Initial evaluation revealed that the SSA-PF instrument achieved considerable breadth of coverage in each content domain and demonstrated noteworthy psychometric properties. [Copyright &y& Elsevier]

Abstract: Objectives: To build a comprehensive item pool representing work-relevant physical functioning and to test the factor structure of the item pool. These developmental steps represent initial outcomes of a broader project to develop instruments for the assessment of function within the context of Social Security Administration (SSA) disability programs. Design: Comprehensive literature review; gap analysis; item generation with expert panel input; stakeholder interviews; cognitive interviews; cross-sectional survey administration; and exploratory and confirmatory factor analyses to assess item pool structure. Setting: In-person and semistructured interviews and Internet and telephone surveys. Participants: Sample of SSA claimants (n=1017) and a normative sample of adults from the U.S. general population (n=999). Interventions: Not applicable. Main Outcome Measure: Model fit statistics. Results: The final item pool consisted of 139 items. Within the claimant sample, 58.7% were white; 31.8% were black; 46.6% were women; and the mean age was 49.7 years. Initial factor analyses revealed a 4-factor solution, which included more items and allowed separate characterization of: (1) changing and maintaining body position, (2) whole body mobility, (3) upper body function, and (4) upper extremity fine motor. The final 4-factor model included 91 items. Confirmatory factor analyses for the 4-factor models for the claimant and the normative samples demonstrated very good fit. Fit statistics for claimant and normative samples, respectively, were: Comparative Fit Index=.93 and .98; Tucker-Lewis Index=.92 and .98; and root mean square error approximation=.05 and .04. Conclusions: The factor structure of the physical function item pool closely resembled the hypothesized content model. The 4 scales relevant to work activities offer promise for providing reliable information about claimant physical functioning relevant to work disability. [Copyright &y& Elsevier]

Abstract: Objective: To determine the impact of postacute care site on stroke outcomes. Design: Prospective cohort study. Setting: Four northern California hospitals that are part of a single health maintenance organization. Participants: Patients with stroke (N=222) enrolled between February 2008 and July 2010. Intervention: Not applicable. Main Outcome Measure: Baseline and 6-month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC), a test of self-reported function in 3 domains: Basic Mobility, Daily Activities, and Applied Cognition. Results: Of the 222 patients analyzed, 36% went home with no treatment, 22% received home health/outpatient care, 30% included an inpatient rehabilitation facility (IRF) in their care trajectory, and 13% included a skilled nursing facility (but not IRF) in their care trajectory. At 6 months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a skilled nursing facility in all 3 domains and in 2 of 3 functional domains compared with those who received home health/outpatient care. Conclusions: Patients with stroke may make more functional gains if their postacute care includes an IRF. This finding may have important implications as postacute care delivery is reshaped through health care reform. [Copyright &y& Elsevier]

Abstract: Objectives: To describe the methods of a longitudinal cohort study among older adults with preclinical disability. The study aims to address the lack of evidence guiding mobility rehabilitation for older adults by identifying those impairments and impairment combinations that are most responsible for mobility decline and disability progression over 2 years of follow-up. Design: Longitudinal cohort study. Setting: Metropolitan-based health care system. Participants: Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks because of underlying health conditions. Interventions: Not applicable. Main Outcome Measures: Late Life Function and Disability Instrument (LLFDI) (primary outcome); Short Physical Performance Battery and 400-m walk test (secondary outcomes). Results: Among 7403 primary care patients identified as being potentially eligible for participation, 430 were enrolled. Participants have a mean age of 76.5 years, are 68% women, and have on average 4.2 chronic conditions. Mean LLFDI scores are 55.5 for Function and 68.9 and 52.3 for the Disability Limitation and Frequency domains, respectively. Conclusions: Completion of our study aims will inform development of primary care–based rehabilitative strategies to prevent disability. Additionally, data generated in this investigation can also serve as a vital resource for ancillary studies addressing important questions in rehabilitative science relevant to geriatric care. [Copyright &y& Elsevier]

Abstract: Tulsky DS, Jette AM, Kisala PA, Kalpakjian C, Dijkers MP, Whiteneck G, Ni P, Kirshblum S, Charlifue S, Heinemann AW, Forchheimer M, Slavin MD, Houlihan B, Tate DG, Dyson-Hudson T, Fyffe D, Williams S, Zanca J. Spinal Cord Injury-Functional Index: item banks to measure physical functioning in individuals with spinal cord injury. Objectives: To develop a comprehensive set of patient-reported items to assess multiple aspects of physical functioning relevant to the lives of people with spinal cord injury (SCI), and to evaluate the underlying structure of physical functioning. Design: Cross-sectional. Setting: Inpatient and community. Participants: Item pools of physical functioning were developed, refined, and field tested in a large sample of individuals (N=855) with traumatic SCI stratified by diagnosis, severity, and time since injury. Interventions: None. Main Outcome Measure: Spinal Cord Injury-Functional Index (SCI-FI) measurement system. Results: Confirmatory factor analysis (CFA) indicated that a 5-factor model, including basic mobility, ambulation, wheelchair mobility, self-care, and fine motor function, had the best model fit and was most closely aligned conceptually with feedback received from individuals with SCI and SCI clinicians. When just the items making up basic mobility were tested in CFA, the fit statistics indicated strong support for a unidimensional model. Similar results were demonstrated for each of the other 4 factors, indicating unidimensional models. Conclusions: Though unidimensional or 2-factor (mobility and upper extremity) models of physical functioning make up outcomes measures in the general population, the underlying structure of physical function in SCI is more complex. A 5-factor solution allows for comprehensive assessment of key domain areas of physical functioning. These results informed the structure and development of the SCI-FI measurement system of physical functioning. [ABSTRACT FROM AUTHOR]

Abstract: Jette AM, Tulsky DS, Ni P, Kisala PA, Slavin MD, Dijkers MP, Heinemann AW, Tate DG, Whiteneck G, Charlifue S, Houlihan B, Williams S, Kirshblum S, Dyson-Hudson T, Zanca J, Fyffe D. Development and initial evaluation of the Spinal Cord Injury-Functional Index. Objectives: To describe the calibration of the Spinal Cord Injury-Functional Index (SCI-FI) and report on the initial psychometric evaluation of the SCI-FI scales in each content domain. Design: Cross-sectional survey followed by calibration data simulations. Setting: Inpatient and community settings. Participants: A sample of participants (N=855) with traumatic spinal cord injury (SCI) recruited from 6 SCI Model Systems and stratified by diagnosis, severity, and time since injury. Interventions: None. Main Outcome Measure: SCI-FI instrument. Results: Item response theory analyses confirmed the unidimensionality of 5 SCI-FI scales: basic mobility (54 items), fine motor function (36 items), self-care (90 items), ambulation (39 items), and wheelchair mobility (56 items). All SCI-FI scales revealed strong psychometric properties. High correlations of scores on simulated computer adaptive testing (CAT) with the overall SCI-FI domain scores indicated excellent potential for CAT to accurately characterize functional profiles of adults with SCI. Overall, there was very little loss of measurement reliability or precision using CAT compared with the full item bank; however, there was some loss of reliability and precision at the lower and upper ranges of each scale, corresponding to regions where there were few questions in the item banks. Conclusions: Initial evaluation revealed that the SCI-FI achieved considerable breadth of coverage in each content domain and demonstrated acceptable psychometric properties. The use of CAT to administer the SCI-FI will minimize assessment burden, while allowing for the comprehensive assessment of the functional abilities of adults with SCI. [ABSTRACT FROM AUTHOR]

Abstract: Norweg A, Ni P, Garshick E, O''Connor G, Wilke K, Jette AM. A multidimensional computer adaptive test approach to dyspnea assessment. Objectives: To develop and test a prototype dyspnea computer adaptive test (CAT). Design: Prospective study. Setting: Two outpatient medical facilities. Participants: A convenience sample of adults (N=292) with chronic obstructive pulmonary disease (COPD). Interventions: Not applicable. Main Outcome Measure: We developed a modified and expanded item bank and CAT for the Dyspnea Management Questionnaire (DMQ), an outcome measure consisting of 4 dyspnea dimensions: dyspnea intensity, dyspnea anxiety, activity avoidance, and activity self-efficacy. Results: Factor analyses supported a 4-dimensional model underlying the 71 DMQ items. The DMQ item bank achieved acceptable Rasch model fit statistics, good measurement breadth with minimal floor and ceiling effects, and evidence of high internal consistency reliability (α=.92–.98). With the use of CAT simulation analyses, the DMQ-CAT showed high measurement accuracy compared with the total item pool (r=.83–.97, P<.0001) and evidence of good to excellent concurrent validity (r=–.61 to –.80, P<.0001). All DMQ-CAT domains showed evidence for known-groups validity (P≤.001). Conclusions: The DMQ-CAT reliably and validly captured 4 distinct dyspnea domains. Multidimensional dyspnea assessment in COPD is needed to better measure the effectiveness of pharmacologic, pulmonary rehabilitation, and psychosocial interventions in not only alleviating the somatic sensation of dyspnea but also reducing dysfunctional emotions, cognitions, and behaviors associated with dyspnea, especially for anxious patients. [Copyright &y& Elsevier]

Summary: Background: The Dyspnea Management Questionnaire (DMQ) is a measure of the psychosocial and behavioral responses to dyspnea for adults with COPD. The research objectives were to evaluate the reliability and validity of an expanded DMQ item pool, as a preliminary step for developing a computer adaptive test. Methods: The original 66 items of the DMQ were used for the analyses. The sample included 63 women and 44 men with COPD (n = 107) recruited from two urban medical centers. We used confirmatory factor analysis to test the factor structure of the DMQ and its underlying cognitive-behavioral theoretical base. The internal consistency and test–retest reliability, and breadth of coverage of the expanded DMQ item bank were also evaluated. Results: Five distinct dyspnea domains were confirmed using 56 original items of the DMQ: dyspnea intensity, dyspnea anxiety, activity avoidance, activity self-efficacy, and strategy satisfaction. Overall, the breadth of items was excellent with a good match between sample scores and item difficulty. The DMQ-56 showed good internal consistency reliability (α = 0.85–to 0.96) and good preliminary test–retest reliability over a 3-week interval (ICC = 0.69–0.92). Conclusions: The DMQ demonstrated acceptable levels of reliability and validity for measuring multidimensional dyspnea outcomes after medical, psychological, and behavioral interventions for adults with COPD. [ABSTRACT FROM AUTHOR]

Abstract: Norweg A, Jette AM, Houlihan B, Ni P, Boninger ML. Patterns, predictors, and associated benefits of driving a modified vehicle after spinal cord injury: findings from the National Spinal Cord Injury Model Systems. Objectives: To investigate the patterns, predictors, and benefits associated with driving a modified vehicle for people with spinal cord injuries (SCIs). Design: Cross-sectional retrospective survey design. Settings: Sixteen Model SCI Systems (MSCISs) throughout the United States. Participants: People (N=3726) post-SCI from the National MSCIS Database. Interventions: Not applicable. Main Outcome Measures: Driving, employment, and community reintegration post-SCI. Results: The study found that 36.5% of the sample drove a modified vehicle after SCI. Significant predictors of driving a modified vehicle post-SCI included married at injury, younger age at injury, associate''s degree or higher before injury, paraplegia, a longer time since the injury, non-Hispanic race, white race, male sex, and using a wheelchair for more than 40 hours a week after the injury (accounting for 37% of the variance). Higher activity of daily living independence (in total motor function) at hospital discharge also increased the odds of driving. Driving increased the odds of being employed at follow-up by almost 2 times compared with not driving postinjury (odds ratio, 1.85). Drivers tended to have higher community reintegration scores, especially for community mobility and total community reintegration. Driving was also associated with small health-related quality-of-life gains, including less depression and pain interference and better life satisfaction, general health status, and transportation availability scores. Conclusions: The associated benefits of driving and the relatively low percentage of drivers post-SCI in the sample provide evidence for the need to increase rehabilitation and assistive technology services and resources in the United States devoted to facilitating driving after SCI. [Copyright &y& Elsevier]

Objective: To develop and evaluate a prototype measure (OA-DISABILITY-CAT) for osteoarthritis research using item response theory (IRT) and computer-adaptive test (CAT) methodologies.Study Design and Setting: We constructed an item bank consisting of 33 activities commonly affected by lower extremity (LE) osteoarthritis. A sample of 323 adults with LE osteoarthritis reported their degree of limitation in performing everyday activities, and completed the Health Assessment Questionnaire-II (HAQ-II). We used confirmatory factor analyses to assess scale unidimensionality and IRT methods to calibrate the items and examine the fit of the data. Using CAT simulation analyses, we examined the performance of OA-DISABILITY-CATs of different lengths compared with the full-item bank and the HAQ-II.Results: One distinct disability domain was identified. The 10-item OA-DISABILITY-CAT demonstrated a high degree of accuracy compared with the full-item bank (r=0.99). The item bank and the HAQ-II scales covered a similar estimated scoring range. In terms of reliability, 95% of OA-DISABILITY reliability estimates were over 0.83 vs. 0.60 for the HAQ-II. Except at the highest scores, the 10-item OA-DISABILITY-CAT demonstrated superior precision to the HAQ-II.Conclusion: The prototype OA-DISABILITY-CAT demonstrated promising measurement properties compared with the HAQ-II, and is recommended for use in LE osteoarthritis research. [ABSTRACT FROM AUTHOR]

Abstract: Latham NK, Mehta V, Nguyen AM, Jette AM, Olarsch S, Papanicolaou D, Chandler J. Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients? Objectives: To assess the validity, sensitivity to change, and responsiveness of 3 self-report and 4 performance-based measures of physical function: activity measure for postacute care (AM-PAC) Physical Mobility and Personal Care scales, the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function scale (SF-36 PF), the Physical Functional Performance test (PFP-10), the Short Physical Performance Battery (SPPB), a 4-meter gait speed, and the six-minute walk test (6MWT). Design: A prospective observational study of patients after a hip fracture. Assessments were performed at baseline and 12 weeks postenrollment. Setting: Inpatient and outpatient rehabilitation facilities in Norway, the United Kingdom, Sweden, Israel, Germany, the United States, Denmark, and Spain. Participants: A sample of study participants (N=108) who had a hip fracture. Interventions: Not applicable. Main Outcome Measures: Assessments of validity (known-groups, concurrent, construct, and predictive), sensitivity to change (effect size, standardized response mean [SRM], SE of measure, minimal detectable change (MDC), and responsiveness (optimal operating cut-points and area under the curve) between baseline and 12-week follow-up. Results: All physical function measures achieved comparably acceptable levels of validity. Odds ratios in predicting patient Global Assessment of Improvement at 12 weeks were as follows: AM-PAC Physical Mobility scale, 5.3; AM-PAC Personal Care scale, 3.6; SF-36 PF, 4.3; SPPB, 2.0; PFP-10, 2.5; gait speed, 1.9; and 6MWT, 2.4. Effect sizes and SRM exceeded 1 SD for all 7 measures. Percent of patients who exceeded the MDC90 at week 12 were as follows: AM-PAC Physical Mobility scale, 90%; AM-PAC Personal Care scale, 74%; SF-36 PF, 66%; SPPB, 36%; PFP-10, 75%; gait speed, 69%; and 6MWT, 75%. When evaluating responsiveness using the area under receiver operating curves for each measure, all measures had acceptable responsiveness, and no pattern emerged of superior responsiveness depending on the type of measure used. Conclusions: Findings reveal that the validity, sensitivity, and responsiveness of self-report measures of physical function are comparable to performance-based measures in a sample of patients followed after fracturing a hip. From a psychometric perspective, either type of functional measure would be suitable for use in clinical trials where improvement in function is an endpoint of interest. The selection of the most appropriate type of functional measure as the primary endpoint for a clinical trial will depend on other factors, such as the measure''s feasibility or the strength of the association between the hypothesized mechanism of action of the study intervention and a functional outcome measure. [Copyright &y& Elsevier]

Abstract: Goodman N, Jette AM, Houlihan B, Williams S. Computer and internet use by persons after traumatic spinal cord injury. Objective: To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI. Design: A multicenter cohort study. Setting: Twenty-six past and current U.S. regional Model Spinal Cord Injury Systems. Participants: Patients with traumatic SCI (N=2926) with follow-up interviews between 2004 and 2006, conducted at 1 or 5 years postinjury. Interventions: Not applicable. Results: Results revealed that 69.2% of participants with SCI used a computer; 94.2% of computer users accessed the internet. Among computer users, 19.1% used assistive devices for computer access. Of the internet users, 68.6% went online 5 to 7 days a week. The most frequent use for internet was e-mail (90.5%) and shopping sites (65.8%), followed by health sites (61.1%). We found no statistically significant difference in computer use by sex or level of neurologic injury, and no difference in internet use by level of neurologic injury. Computer and internet access differed significantly by age, with use decreasing as age group increased. The highest computer and internet access rates were seen among participants injured before the age of 18. Computer and internet use varied by race: 76% of white compared with 46% of black subjects were computer users (P<.001), and 95.3% of white respondents who used computers used the internet, compared with 87.6% of black respondents (P<.001). Internet use increased with education level (P<.001): eighty-six percent of participants who did not graduate from high school or receive a degree used the internet, while over 97% of those with a college or associate''s degree did. Conclusions: While the internet holds considerable potential as a long-term treatment modality after SCI, limited access to the internet by those who are black, those injured after age 18, and those with less education does reduce its usefulness in the short term for these subgroups. [Copyright &y& Elsevier]

Abstract: Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach. Objectives: To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non–IRT-based staging system developed for the FIM instrument. Design: Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation. Setting: Follow-up interviews conducted in patients'' homes. Participants: Convenience sample of 516 patients (47% men; sample mean age, 68.3y) at baseline (retention at the final follow-up, 65%) with neurologic, lower-extremity orthopedic, or complex medical conditions. Interventions: Not applicable. Main Outcome Measures: AM-PAC basic mobility, daily activity, and applied cognitive activity stages; FIM executive control, mobility, activities of daily living, and sphincter stages. Stages refer to the hierarchic levels assigned to patients'' functioning performances. Results: We were able to define IRT-based staging definitions and create meaningful cut scores based on the 3 AM-PAC short forms. The IRT stages correlated as well or better to the criterion items than the FIM stages. Both the IRT-based stages and the FIM stages were sensitive to changes throughout the 6-month follow-up period. The FIM stages were more sensitive in detecting changes between baseline and 1-month follow-up visits. The AM-PAC stages were more discriminant in the follow-up visits. Conclusions: An IRT-based staging approach appeared feasible and effective in classifying patients throughout long-term follow-up. Although these stages were developed from short forms, this staging methodology could also be applied to improve the meaning of scores generated from IRT-based computerized adaptive testing in future work. [Copyright &y& Elsevier]

Abstract: Latham NK, Jette AM, Ngo LH, Soukup J, Iezzoni LI. Did the 1997 Balanced Budget Act reduce use of physical and occupational therapy services? Objective: To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design: Data from the nationally representative Medicare Current Beneficiary Survey (MCBS) were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings: Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings. Participants: Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions: Not applicable. Main Outcome Measures: Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting. Results: Multivariable logistic regression revealed no statistically significant differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.19−1.69) and 1995 to 2001 (OR=1.69; 95% CI, 1.39−2.05). For IRF and outpatient settings, a significant increase was observed between 1995 and 2001 (OR=1.71, OR=1.27, respectively). For OT, a statistically significant increase was observed for IRF and outpatient rehabilitation settings from 1995 to 2001. For SNF, the increase was statistically significant from 1995 to 1999 and 1995 to 2001. Mean total PT and OT units received also increased across all settings from 1995 to 2001 except for IRFs. Conclusions: Despite BBA mandates restricting postacute care expenditures, this nationally representative study showed no decreases in the percentage of Medicare beneficiaries with 5 common diagnoses receiving PT and/or OT across all settings and no decreases in units of PT and/or OT services received between 1995 and 2001 except for those in IRFs. This study suggests that the delivery of PT and OT services did not decline among persons with conditions for which rehabilitation services are often clinically indicated. [Copyright &y& Elsevier]

Abstract: Haley SM, Gandek B, Siebens H, Black-Schaffer RM, Sinclair SJ, Tao W, Coster WJ, Ni P, Jette AM. Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes. Objectives: To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness. Design: Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later. Setting: Follow-up interviews conducted in patient’s home setting. Participants: Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions. Interventions: Not applicable. Main Outcome Measures: Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53). Results: The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass correlation coefficient, model 3,1, .71–.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53. Conclusions: Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden. [Copyright &y& Elsevier]

Abstract: Coster W, Haley SM, Jette A, Tao W, Siebens H. 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 (χ2 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. [Copyright &y& Elsevier]

Abstract: Keysor JJ, Jette AM, Coster W, Bettger JP, Haley SM. Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort. Objective: To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital. Design: Cohort study. Setting: Postacute care. Participants: Adults (N=342) age 18 years or older with a diagnosis of complex medical, orthopedic, or neurologic condition recruited from acute care and inpatient rehabilitation facilities. The mean age ± standard deviation of participants was 68±14 years; 49% were women and 92% were white. Interventions: Not applicable. Main Outcome Measures: Participation in social, home and community affairs as assessed with the Participation Measure for Post-Acute Care. Results: Adjusting for covariates, 1 month after discharge a greater presence of home mobility barriers (P<.01) was associated with less social and home participation; whereas greater community mobility barriers (P<.01) and more social support (P<.001) were associated with greater participation. At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates. Conclusions: This study provides new empirical evidence that environmental barriers and facilitators do influence participation in a general rehabilitation cohort, at least in the short term. [Copyright &y& Elsevier]

Abstract: Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity. Executive summary. The general objective of the “Rehabilitation Medicine Summit: Building Research Capacity” was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were researchers; research culture, environment, and infrastructure; funding; partnerships; and metrics. Participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. Small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called for to pursue the agendas outlined in this report. [Copyright &y& Elsevier]

Abstract: Jette AM, Keysor J, Coster W, Ni P, Haley S. Beyond function: predicting participation in a rehabilitation cohort. Objectives: To monitor participation in a rehabilitation cohort and to identify determinants of change during a 12-month period posthospitalization following the onset of one of several major disabling conditions. Design: Cohort study. Setting: Postacute care rehabilitation settings. Participants: Adults (N=435) aged 18 years and older with complex medical, lower-extremity orthopedic, and major neurologic impairments. Interventions: Not applicable. Main Outcome Measures: At 1-, 6-, and 12-month follow-ups, community participation and social and home participation were assessed by personal interviews using the Participation Measure for Post-Acute Care. Information on potential determinants was abstracted from the medical chart and by personal interview using standardized instruments. Results: On average, rehabilitation patients achieved modest improvements in their levels of community participation during the first 6 months after acute hospitalization. In contrast, these same patients displayed a modest loss in social and home participation levels during the follow-up period. Activity limitations were the dominant factors that explained much of the variance in the extent of community participation achieved by patients. Personal and social environmental factors played a major role in predicting levels of social and home participation. Conclusions: The focus of rehabilitation interventions aimed at achieving posthospital participation requires careful consideration of the specific domain of participation that is being targeted. [Copyright &y& Elsevier]

Abstract: Ottenbacher KJ, Jette AM, Fuhrer MJ, Granger CV. Looking back and thinking forward: 20 years of disability and rehabilitation research. The National Center for Medical Rehabilitation Research recently celebrated its 20th Anniversary. The celebration included a symposium highlighting advances in rehabilitation science over the past 2 decades. The anniversary also reminds us of the challenges that remain in order to strengthen the foundation of disability and rehabilitation research. These challenges have been described in 3 reports published by the Institute of Medicine (IOM) in 1991, 1997, and 2007. Three areas of concern appear across the IOM reports. These include (1) the lack of a comprehensive disability monitoring program, (2) the need for better integration and coordination of federally supported disability research, and (3) funding levels that are inconsistent with the current and projected impacts of disability on individuals, families, and communities. In this commentary we examine the lack of progress in addressing the recommendations contained in the IOM reports. We conclude that renewed efforts by consumers, clinicians, educators, researchers, administrators, and policy makers are needed to achieve the promise of rehabilitation and disability science identified 20 years ago. [Copyright &y& Elsevier]

Objective To evaluate the impact of “My Care My Call” (MCMC), a peer-led, telephone-based health self-management intervention in adults with chronic spinal cord injury (SCI). Design Single-blinded randomized controlled trial. Setting General community. Participants Convenience sample of adults with SCI (N=84; mean time post-SCI, 9.9y; mean age, 46y; 73.8% men; 44% with paraplegia; 58% white). Interventions Trained peer health coaches applied the person-centered health self-management intervention with 42 experimental subjects over 6 months on a tapered call schedule. The 42 control subjects received usual care. Both groups received the MCMC Resource Guide . Main Outcome Measures Primary outcome—health self-management as measured by the Patient Activation Measure (PAM). Secondary outcomes—global ratings of service/resource use, health-related quality of life, and quality of primary care. Results Intervention participants averaged 12 calls over 6 months (averaging 21.8min each), with distinct variation. At 6 months, intervention participants reported a significantly greater change in PAM scores (6mo: estimate, 7.029; 95% confidence interval, .1018–13.956; P =.0468) compared with controls, with a trend toward significance at 4 months. At 6 months, intervention participants reported a significantly greater decrease in social/role activity limitations (estimate, −.443; P =.0389), greater life satisfaction (estimate, 1.0091; P =.0522), greater services/resources awareness (estimate, 1.678; P =.0253), greater overall service use (estimate, 1.069; P =.0240), and a greater number of services used (estimate, 1.542; P =.0077). Subgroups most impacted by MCMC on PAM change scores included the following: high social support, white persons, men, 1 to 6 years postinjury, and tetraplegic. Conclusions This trial demonstrates that the MCMC peer-led, health self-management intervention achieved a positive impact on self-management to prevent secondary conditions in adults with SCI. These results warrant a larger, multisite trial of its efficacy and cost-effectiveness. [ABSTRACT FROM AUTHOR]