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The author reflects on the state of the supply and demand for physical therapists in the U.S., particularly the projections that the future demand for physical therapist services will outpace the growth in physical therapist professional education in the country.

The author offers observation on the incidence of Long Covid in various populations.

Objective: The aim of the study was to estimate the prevalence of late-life community disability for adults 65 yrs and older with cardiovascular disease versus those without. This study also investigated the contributions of environmental and individual risk factors on late-life community disability for persons with cardiovascular disease. Design: This is a secondary data analysis of the 2016 round of the National Health and Aging Trends Study. The study sample included community- dwelling Americans with cardiovascular disease (n = 1490) and without (n = 4819). Logistic regression was used to estimate associations between individual risk factors, environmental factors, and community disability for those with cardiovascular disease. Results: Individuals with cardiovascular disease had a significantly higher prevalence of late-life community disability than those without (44.8% vs. 29.0%). For persons with cardiovascular disease, lack of transportation, home modification, and needing assistance with mobility increased the odds of community disability. Younger age and lower comorbidity were associated with decreased odds of community disability. When accounting for environmental factors in multivariate analyses, sex, race, and education were not significantly associated with community disability. Conclusion: Late-life community disability is highly prevalent for persons aging with cardiovascular disease. Intervention strategies to deter late-life community disablement should focus on improving access to transportation and improving the community environment in which older adults live. [ABSTRACT FROM AUTHOR]

The authors discuss three strategies to identify potential bias in the results of clinical trials and protect against publication spin in such trials. Topics mentioned include spin as the distortion of the interpretation of a study result, the International Clinical Trials Registry Platform, and the use of confidence intervals around estimates in reporting clinical trial results in lieu of or in addition to reporting statistical significance.

Background: The intent of this study was to examine and compare the ability to detect change of two patient reported outcome (PRO) instruments that use a computerized adaptive test (CAT) approach to measurement. The Patient Reported Outcomes Measurement Information System (PROMIS®) Physical Function scale is a generic PRO, while the Osteoarthritis Computerized Adaptive Test (OA-CAT) is an osteoarthritis-specific PRO.Methods: This descriptive, longitudinal study was conducted in a community setting, involving individuals from the greater Boston area.Inclusion Criteria: age > 50, self-reported doctor-diagnosed knee osteoarthritis (OA) and knee pain. The PROMIS® Physical Function CAT and OA-CAT Functional Difficulty scale were administered at baseline and at the conclusion of a 6-week exercise program. Effect sizes (ES) were calculated for both measures, and bootstrap methods were used to construct confidence intervals and to test for significant ES differences between the measures.Results: The OA-CAT Functional Difficulty scale achieved an ES of 0.62 (0.43, 0.87) compared to the PROMIS® Physical Function CAT ES of 0.42 (0.24, 0.63). ES estimates for the two CAT measures were not statistically different.Conclusions: The condition-specific OA-CAT and generic PROMIS® Physical Function CAT both demonstrated the ability to detect change in function. While the OA-CAT scale showed larger effect size, no statistically significant difference was found in the effect size estimates for the generic and condition-specific CATs. Both CATs have potential for use in arthritis research.Trial Registration: This trial is registered with ClinicalTrials.gov on 6/21/11 (Identifier NCT01394874 ). [ABSTRACT FROM AUTHOR]

Objectives To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. Design Secondary analysis of the 2016 National Health and Aging Trends Study ( NHATS). Setting Standardized in-person home interviews. Participants Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. Measurements Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. Results Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. Conclusion Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks. [ABSTRACT FROM AUTHOR]

The article offers a perspective on health services research in the 21st century. It outlines emerging strategic priorities in health services research that are posed to contribute advanced in health care quality and efficiency, according to a 2018 workshop report from the National Academies of Medicine (NAM). It discusses data infrastructure advances and challenges and cites the access to rehabilitation datasets through the Center for Large Data Research and Data Sharing in Rehabiliation.

Background: The physical impairments that affect participation in life roles among older adults have not been identified. Using the International Classification of Functioning Disability and Health as a conceptual framework, we aimed to determine the leg and trunk impairments that predict participation over 2 years, both directly and indirectly through mediation by changes in activities.Methods: We analyzed 2 years of data from the Boston Rehabilitative Impairment Study of the Elderly, a cohort study of 430 primary care patients with self-reported mobility limitation (mean age 77 years; 68% female; average of four chronic conditions). Frequency of and limitations in participation were examined using the Late-Life Disability Instrument. Baseline physical impairments included: leg strength, leg speed of movement, knee range of motion (ROM), ankle ROM, leg strength asymmetry, kyphosis, and trunk extensor endurance. Structural equation modeling with latent growth curve analysis was used to identify the impairments that predicted participation at year 2, mediated by changes in activities. Models were adjusted for baseline participation, age, and gender.Results: Leg speed and ankle ROM directly influenced participation in life roles during follow-up (βdirect = 1.39-4.53 and 4.70, respectively). Additionally, ankle ROM and trunk extensor endurance contributed indirectly to participation score at follow-up via effects on changes in activities (βindirect = -1.06 to -4.24 and 1.01 to 4.18, respectively).Conclusions: Leg speed, ankle ROM, and trunk extensor endurance are key physical impairments predicting participation in life roles in older adults. These results have implications for the development of exercise interventions to enhance participation. [ABSTRACT FROM AUTHOR]

The author reflects on the efforts to improve airline transportation accommodations in the U.S. for people with disabilities. Also cited are the mandate issued by Congress to the Access Board to study the feasibility of aircraft in-cabin wheelchair restraint systems to enhance the safety of said people when traveling by air, and the recommendations by the board to address the risks faced by people with disabilities in aircraft.

The author reflects on the potential benefits of developing and using profession-specific diagnostic labels to clarify the knowledge and diagnostic expertise of physical therapists about the movement system. Other topics include the proposal by experts like Doctor Shirley Sahrmann for the creation of profession-specific diagnostic labels to document the views of physical therapists on issues related to physical therapy.

Background. Patient-reported and performance-based measures (PBMs) are commonly used to measure physical function in studies of older adults. Selection of appropriate measures to address specific research questions is complex and requires knowledge of relevant psychometric properties.The aim of this study was to examine the predictive validity for adverse outcomes and responsiveness of a widely used patient-reported measure, the Late-Life Function and Disability Instrument (LLFDI), compared with PBMs. Methods. We analyzed 2 years of follow-up data from Boston RISE, a cohort study of 430 primary care patients aged >65 years. Logistic and linear regression models were used to examine predictive validity for adverse outcomes and effect size and minimal detectable change scores were computed to examine responsiveness. Performance-based functional measures included the Short Physical Performance Battery, 400-m walk, gait speed, and stair-climb power test. Results. The LLFDI and PBMs showed high predictive validity for poor self-rated health, hospitalizations, and disability.The LLFDI function scale was the only measure that predicted falls. Absolute effect size estimates ranged from 0.54 to 0.64 for the LLFDI and from 0.34 to 0.63 for the PBMs. From baseline to 2 years, the percentage of participants with a change > minimal detectable change was greatest for the LLFDI scales (46-59%) followed by the Short Physical Performance Battery (44%), gait speed (35%), 400-m walk (17%), and stair-climb power test (9%). Conclusions. The patient-reported LLFDI showed comparable psychometric properties to PBMs. Our findings support the use of the LLFDI as a primary outcome in gerontological research. [ABSTRACT FROM AUTHOR]

The author reflects on the feasibility of telerehabilitation in physical therapy, particularly during the COVID-19 pandemic. Also cited are a study on the use of telerehabilitation in conducting physical therapy interventions like therapeutic exercises, manual therapy, functional training, and electrotherapy, as well as the guidelines issued by the World Confederation for Physical Therapy (WCPT) on telerehabilitation.

The author discusses a report that estimates global prevalence of disability and years of life lived with disability and the need for rehabilitation. Topics mentioned include contribution of musculoskeletal conditions to the need for rehabilitation services among children, prevalence of disability in the Western Pacific region, and the integration of rehabilitation services at the primary care level.

In the article, the editor discusses the articles published by the journal on topics like the use of telehealth during the COVID-19 pandemic, severe acute respiratory syndrome (SARS), and treatment for adults with post-intensive care syndrome, as well as the 100th anniversary of the journal in 2021.

The authors reflect on the pros and cons of using evidence-based practice (EBP), particularly evidence hierarchies, in physical therapy and rehabilitation. Topics include how hierarchies could be detrimental in promoting EBP, the story of the Procrustean bed of Greek innkeeper Procrustes, and the evidence pyramid of randomized controlled trials (RCT), case reports and case-control studies.

The author reflects on the strategies to eliminate ineptitude in the 21st century rehabilitation practice through the facilitation of adoption of clinical research evidence into clinical practice. Topics include the recommendations by Atul Gawande to change the behavior of clinicians like the law-and-order strategy and the use of mentoring approach to overcome the resistance of physicians in adopting clinical innovations into their practice.

The author discusses a presentation at the 2019 Spinal Cord Injury Model System Project Directors Meeting by K. Bell and T. Earland from Thomas Jefferson University about the importance of collecting information on the lesbian, gay, bisexual, and transgender population in rehabilitation research. Topics mentioned include the health-specific barriers facing transgender people, and the importance of updating sexual orientation and gender identity data.

America is about to experience a demographic shift of enormous magnitude: increasing longevity, declining fertility, and the aging of the baby boomers, which are triggering an enormous "age wave." We are facing the challenge of limited access to health care services by millions of our citizens, and unsustainable cost escalation. In response, health care is changing fundamentally. In the 2012 McMillan Lecture, Jette discusses 3 critical "system skills" that physical therapists must develop to practice successfully in a changing health care environment. First, therapists must become interested in data Second, they must become skilled in the ability to devise solutions for the system problems that data and experience uncover. Third, the physical therapy profession must develop the ability to implement at scale-the ability to get therapists along the entire chain of care functioning in concert, in collaboration. Jette discusses the American Physical Therapy Association's Vision 2020 as it relates to these challenges and the degree to which he believes physical therapists are equipped with the system skills needed to function within effective health care systems to identify what works in physical therapy, for what conditions, under what circumstances, and at what cost. Jette articulates a revised vision for physical therapy that includes being a leader in teaching systems skills to practice successfully in interconnected heath care teams; being a recognized national leader in implementing evidence-based strategies; using standardized collection, analysis, and dissemination of intervention and outcomes data as a regular part of practice to determine what interventions best improve the health of individuals and society; and being a profession that is a central player in devising, evaluating, and implementing cost-effective health care innovations for communities as well as for individuals. [ABSTRACT FROM AUTHOR]

Background. Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity. Methods. Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death. Results. Across definitions, the prevalence of healthy aging ranged from 3.3% to 35.5%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as “healthy” were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions. Conclusions. Moving across the conceptual continuum—from a more to less rigid definition of healthy aging—markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes. [ABSTRACT FROM PUBLISHER]

The article discusses reports published within the issue including one on randomized controlled trials of interventions to reduce disability, another on the complexity of identifying factors that contribute to disability in people with painful conditions, and another one on the impact that personal factors have on participation.

The article offers information on the research conducted by the authors related to telerehabilitation intervention for people with spinal cord dysfunction. It states that the pressure ulcers and depression are common conditions secondary to spinal cord dysfunction, which can be prevented. It mentions the development of an automated telephone calling system named Care Call, to empower and motivate people with spinal cord dysfunction to improve their treatment for depression and skin care.

In this article the author discusses aspects of the "International Classification of Functioning, Disability and Health (ICF)," by R. Escorpizo and colleagues and its use in physical therapist practice documentation. The author cites ideas and proposals outlined in the ICF regarding its implementation and shares both his thoughts on the feasibility of adopting the system. A response by the authors is included.

Background: There is limited evidence supporting the hypothesized environment–disability link. The objectives of this study were to (a) identify the prevalence of community mobility barriers and transportation facilitators and (b) examine whether barriers and facilitators were associated with disability among older adults with functional limitations. Methods. Four hundred and thirty-five participants aged 65+ years old with functional limitations were recruited from the Multicenter Osteoarthritis Study, a prospective study of community-dwelling adults with or at risk of developing symptomatic knee osteoarthritis. Presence of community barriers and facilitators was ascertained by the Home and Community Environment survey. Two domains of disability, (a) daily activity limitation (DAL) and (b) daily activity frequency (DAF), were assessed with the Late-Life Disability Instrument. Covariates included age, gender, education, race, comorbidity, body mass index, knee pain, and functional limitation. Multivariable logistic regression was used to examine adjusted associations of community factors with presence of DAL and DAF. Results. Approximately one third of the participants lived in a community with high mobility barriers and low transportation facilitators. High mobility barriers was associated with greater odds of DAL (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2–3.1) after adjusting for covariates, and high transportation facilitators was associated with lower odds of DAL (OR = 0.5, 95% CI 0.3–0.8) but not with DAF in adjusted models. Conclusion. People with functional limitations who live in communities that were more restrictive felt more limited in doing daily activities but did not perform these daily activities any less frequently. [ABSTRACT FROM PUBLISHER]

The author discusses issues concerning the translation of evidence-based practice (EBP) into clinical practice in the field of physical therapy. He cites researcher C. D. Naylor's four distinct phases of EBP adoption in physical therapy. He also discusses the priority of the U.S. National Institutes of Health for translational research and the types of implementation research interventions.

This article presents the author's views on disablement among older patients and language use in its related field of study. The author supports the development and use of a language model from World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF). The author also discusses classification frameworks for disability and the components of the ICF model.

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]

Background. This study applied item response theory (IRT) and computer adaptive testing (CAT) methodologies to develop a prototype function and disability assessment instrument for use in aging research. Herein, we report on the development of the CAT version of the Late-Life Function and Disability Instrument (Late-Life FDI) and evaluate its psychometric properties. Methods. We used confirmatory factor analysis, IRT methods, validation, and computer simulation analyses of data collected from 67 1 older adults residing in residential care facilities. We compared accuracy, precision, and sensitivity to change of scores from CAT versions of two Late-Life FDI scales with scores from the fixed-form instrument. Score estimates from the prototype CAT versus the original instrument were compared in a sample of 40 older adults. Results. Distinct function and disability domains were identified within the Late-Life FDI item bank and used to construct two prototype CAT scales. Using retrospective data, scores from computer simulations of the prototype CAT scales were highly correlated with scores from the original instrument. The results of computer simulation, accuracy, precision, and sensitivity to change of the CATs closely approximated those of the fixed-form scales, especially for the 10- or 15-item CAT versions. In the prospective study, each CAT was administered in <3 minutes and CAT scores were highly correlated with scores generated from the original instrument. Conclusions. CAT scores of the Late-Life FDI were highly comparable to those obtained from the full-length instrument with a small loss in accuracy, precision, and sensitivity to change. [ABSTRACT FROM AUTHOR]

The article focuses on the development of an outpatient Adaptive Short Forms based on the Basic Mobility and Daily Activities domains of the Activity Measure for Post-Acute Care item bank. Items chosen for inclusion on the form are based on functional content, range of item coverage, measurement precision, item exposure rate, and data collection burden. Adaptive Short Forms provide the efficient capability to monitor the functional outcomes of patients with orthopedic impairments. They can also facilitate the eventual transformation to computerized adaptive testing applications that are more acceptable to the rehabilitation community.

Background and Purpose The purpose of this study was to prospectively evaluate the practical and psychometric adequacy of the Activity Measure for Post-Acute Care (AM-PAC) "item bank" and computerized adaptive testing (CAT) assessment platform (AM-PAC-CAT) when applied within orthopedic outpatient physical therapy settings. Method This was a prospective study with a convenience sample of 1,815 patients with spine, lower-extremity, or upper-extremity impairments who received outpatient physical therapy in 1 of 20 outpatient clinics across 5 states. The authors conducted an evaluation of the number of items used and amount of time needed to complete the CAT assessment; evaluation of breadth of content coverage, item exposure rate, and test precision; as well as an assessment of the validity and sensitivity to change of the score estimates. Results Overall, the AM-PAC-CAT's Basic Mobility scale demonstrated excellent psychometric properties while the Daily Activity scale demonstrated less adequate psychometric properties when applied in this outpatient sample. The mean length of time to complete the Basic Mobility scale was 1.9 minutes, using, on average, 6.6 items per CAT session, and the mean length of time to complete the Daily Activity scale was 1.01 minutes, using on average, 6.8 items. Background and Conclusion Overall, the findings are encouraging, yet they do reveal several areas where the AM-PAC-CAT scales can be improved to best suit the needs of patients who are receiving outpatient orthopedic physical therapy of the type included in this study. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented, including one by Paolo Pedersini et al on the impact of the COVID-19 epidemic in Italy on physical therapy practice, another by Vanessa Alpalhão on how physical therapist practice in Portugal responded to the COVID-19 crisis and one by Alan Lee on the recommendations on advancing digital physical therapist practice and telehealth in the wake of COVID-19.

The author discusses the complex elements that constitute the practice of rehabilitation interventions and their role in the reporting of randomized controlled clinical trials for rehabilitation. Topics discussed include the development of the Template for Intervention Description and Replication checklist to improve intervention reporting, the relationship between clinician actions and treatment results, and the principle of the Rehabilitation Treatment Specification System.

The author discusses a report on the fundamental roles that physical therapists can play in the examination, evaluation, and treatment of patients with heart failure (HF). Topics mentioned include participation of individuals with HF in some sort of physical activity, the problem of a culture of physical inactivity among U.S. adults, and an increase in time spent on sedentary activity between 2007-2008 and 2015-2016.

Within physical therapy, the disablement model has proven useful as a language to delineate the consequences of disease and injury. This perspective provides an update on the changing language of disablement, reviews selected contemporary disablement models, and discusses some challenges that need to be addressed to achieve a universal disablement language that can be used to discuss physical therapy research and clinical interventions. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework has the potential of becoming a standard for disablement language that looks beyond mortality and disease to focus on how people live with their conditions. If widely adopted, the ICF framework could provide the rehabilitation field with a common, international language with the potential to facilitate communication and scholarly discourse across disciplines and national boundaries, to stimulate interdisciplinary research, to improve clinical care, and ultimately to better inform health policy and management. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of a workshop hosted by the National Academies of Sciences, Engineering, and Medicine Forum on Drug Discovery, Development, and Translation in late 2018. Topics covered include opportunities for a new generation of virtual clinical trials, how virtual trials can boost participant access and geographic representation, and operational, regulatory, and management challenges facing virtual clinical trials according to workshop participants.

The author discusses a report about the application of population health to physical therapist practice, research, and education. Topics covered include the classic definition of population health, the definition of social determinants of health by the World Health Organization, and how the emergence of large-scale genome studies and precision medicine initiatives might offer a means to improve population health.

In this article, we review the limitations of traditional rehabilitation functional outcome instruments currently in use within the rehabilitation field to assess Activity and Participation domains as defined by the International Classification of Function, Disability, and Health. These include a narrow scope of functional outcomes, data incompatibility across instruments, and the precision vs feasibility dilemma. Following this, we illustrate how contemporary measurement techniques, such as item response theory methods combined with computer adaptive testing methodology, can be applied in rehabilitation to design functional outcome instruments that are comprehensive in scope, accurate, allow for compatibility across instruments, and are sensitive to clinically important change without sacrificing their feasibility. Finally, we present some of the pressing challenges that need to be overcome to provide effective dissemination and training assistance to ensure that current and future generations of rehabilitation professionals are familiar with and skilled in the application of contemporary outcomes measurement. [ABSTRACT FROM AUTHOR]

Objective: To develop and pilot test the Home and Community Environment instrument (HACE), a self-report measure designed to characterize factors in a person's home and community environment that may influence level of participation. Design: A cross-sectional survey. Subjects: Sixty-two adults recruited from community organizations and an outpatient rehabilitation center. Methods: Six environmental domains were assessed: (i) home mobility; (ii) community mobility; (iii) basic mobility devices; (iv) communication devices; (v) transportation factors; and (vi) attitudes. Descriptive statistics, Kappa statistics and Kruskal-Wallis tests were used to ascertain whether persons were capable of assessing characteristics of their environment, could do so reliably and whether the distribution of environmental factors differed by type of living situation. Results: Participants were capable of characterizing their home environment and most aspects of their community with acceptable reliability. The median percent agreement of the 6 environmental domains ranged from 75% to 100% (median Kappa values ranged from 0.47 to 1.0). Percent agreement for individual HACE items ranged from 58% to 100%. The lowest reliability values were observed in the community mobility domain. As hypothesized, individuals who lived in private homes characterized home and community mobility factors differently from those who lived in multi-unit complexes; evidence of HACE's validity. Conclusion: HACE is a promising self-report instrument for assessing characteristics of an individual's home and community environments. Additional research is needed to assess its utility for rehabilitation research. [ABSTRACT FROM AUTHOR]

To assess the concurrent and predictive validity of the Late-Life Function and Disability Instrument (LLFDI). Cross-sectional. University-based human physiology laboratory. One hundred one men and women aged 80.8±0.4. A short physical performance battery (SPPB) and a self-paced 400-m walk (400-m W) were used as performance tests of lower extremity function. The LLFDI was used to assess self-reported function and physical disability. Partial correlations adjusted for age and body mass index were used to determine the concurrent and predictive validity of the LLFDI. Statistical significance was accepted at P< .004 using a testwise correction. LLFDI Overall Function scores were moderately associated with the SPPB ( r=0.65, P< .001), 400-m W gait speed ( r=0.69, P< .001), and measures of lower extremity function. Correlations of the two lower extremity subscores of the LLFDI (correlation coefficient ( r)=0.63–0.73, P< .001) were greater than for the LLFDI upper extremity subscores ( r=0.19–0.26, P>.004). Performance measures of function predicted disability limitations in the range of r=0.37–0.44 ( P< .001) and disability frequency in the range of r=0.16–0.20 ( P>.004). These findings support the concurrent and predictive validity of the LLFDI. Results support the use of the LLFDI scales as a substitute for physical performance tests when self-report is a preferred data-collection format. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that distinct Activity and Participation dimensions of the International Classification of Functioning, Disability, and Health could be identified using physical functioning items drawn from the Late Life Function and Disability Instrument. Design: A cross-sectional, survey design was employed. Subjects: The sample comprised 150 community-dwelling adults aged 60 years and older. Methods: Exploratory factor analysis was used to identify interpretable dimensions underlying 48 physical functioning questionnaire items. Results: Findings revealed that one conceptual dimension underlying these physical functioning items was not sufficient to adequately explain the data (X 2 = 2383; p < 0.0001). A subsequent solution produced 3 distinct, interpretable factors that accounted for 61.1% of the variance; they were labeled: Mobility Activities (24.4%), Daily Activities (24.3%), and Social/Participation (12.4%). All 3 factors achieved high internal consistency with coefficient alphas of 0.90 or above. Conclusion: Within physical functioning, distinct concepts were identified that conformed to the dimensions of Activity and Participation as proposed in the ICF. We believe this is the first empirical evidence of separate Activity and Participation dimensions within the International Classification of Functioning, Disability, and Health classification. [ABSTRACT FROM AUTHOR]

Presents a study which described a conceptual framework for the dissemination and utilization of information, along with examples of its use by the Boston University Roybal Center for Enhancement of Late Life Function in Massachusetts. Design and methods; Results; Implications.

Purpose: Enabling valuable research findings to be used by the field requires a strategic approach to dissemination and utilization rather than simply making constituencies aware of the information. This article describes a conceptual framework for the dissemination and utilization of information, along with examples of its use by the Boston University Roybal Center for Enhancement of Late Life Function. Design and Methods: The framework identifies dissemination/utilization goals of exposure, experience, expertise, and embedding (“4 E”) and relates each goal to strategies targeted for specific users. Results and Implications: The Boston University center exposed the field to information through presentations, print- and Web-based information, provided consumers and family members with new findings through motivational videotapes, developed expertise-level training programs, and embedded the new findings within organizations and systems. The 4 E framework can translate critical research outcomes into useful information to assist the field to better care and support available for individuals in late life. [ABSTRACT FROM AUTHOR]

Outcomes and effectiveness research is a category of health services research that gauges how well the health care needs of persons with disabilities are being met. Using Patrick’s Model of Health Promotion for people with disabilities as a framework for analysis, this article examines outcomes and effectiveness research related to the health care needs of persons with disabilities. The three most pressing research priorities are clear theoretical conceptualizations and qualitative research on health outcomes relevant to the needs of persons with disabilities; a systemic analysis of existing assessment instruments’ utility for disability outcomes research; and the development and testing of new outcome instruments. [ABSTRACT FROM AUTHOR]

Part II. Focuses on a study which examined the developmental and evaluation of the function component of Late-life Function and Disability Instrument. Methodology; Results of the study; Conclusions.

Part I. Focuses on a study which examined Late-Life Function and Disability Instrument designed to assess and be responsive to meaningful change in two distinct outcomes, function and disability. Methodology; Results of the study; Conclusions.

Evaluates the degree to which existing scientific evidence supports the claimed benefits of late-life exercise as of July 2001. Importance of exercise in improving the health and well-being of a person; Categories of exercise programs examined; Exercise effects on impairment, functional limitation and disability outcomes.

The Functional Status Questionnaire (FSQ) originally was developed to allow the comprehensive and efficient assessment of physical, psychosocial, social, and role functioning in ambulatory patients. It is a self-administered survey that takes approximately 15 min to complete and can be scored to produce a one-page report for clinicians to use in their practices. It has been translated into Swedish, French, and German. Since the FSQ was first published, it has been used in a variety of other settings, including assessment of the impact of variations in hospital practice patterns, the study of relationships between hospital processes of care and outcomes, and other applications, including randomized controlled trials of pharmaceuticals. In this paper we provide selected data on the reliability and validity of the FSQ in different populations. Many of the data are from previously published studies. However, because of the emphasis of this issue of Quality of Life Research , we also present new data from two large studies of persons over the age of 65. [ABSTRACT FROM AUTHOR]