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Poster 15 Self Reported Functional Outcome Measure in the Field of Prosthesis: A Systematic Review
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2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
Poster 15 Self Reported Functional Outcome Measure in the Field of Prosthesis: A Systematic Review. Pallavi Sood (University of Pittsburgh, Pittsburgh, PA), Diane Collins, Mark Schmeler, Amit Kumar, Harry Browne, Amol Karmarkar. Disclosure: None disclosed. Objective: The consumer’s feedback is critical for decision making during recommendation of prosthetic provision and predicting the outcome of the treatment. A systematic literature review was conducted to assess and analyze various functional outcome measure instruments used in field of prosthetics. The instruments considered were specifically self-reported outcome measure tools to be completed by individuals with lower limb amputations. Design: A systematic literature review was conducted to compare various self-reported functional Outcome Measure Instrument (OMI) with reference to their psychometric properties and the life domains in published articles from the following databases: MEDLINE and University of Pittsburgh Health Sciences Library System, CINAHL-EBSCO, GOOGLE SCHOLAR, SCOPUS, OVID, and PUBMED (1990 to 2010). Articles were included and excluded according to criterion determined by the author. Setting, Participants and Interventions: Not Applicable. Results: Twenty articles which met the inclusion criterion were analyzed on their psychometric properties, and clinical recommendations were made based on this analysis. The strengths and weaknesses of psychometric properties of various outcome measurement tools were described including reliability, validity and reliability. The overall results suggested that Locomotor Capability Index (LCI) was the only instrument which presented strong validity, reliability and low ceiling effect with some degree of sensitivity. Amputee Activity Scale (AAS) on the other hand had fair to average reliability and further research was indicated to analyze validity and sensitivity. Conclusions: This systematic literature review suggested that most of the outcome measurement tools lacked sensitivity to changes in clinical status. Future research and outcome tool development is recommended to acquire more appropriate outcome tools for prosthetic users. Key Words: Functional outcome measures; Lower extremity amputation; Prosthetics; Reliability and validity; Rehabilitation.
Neurorehabilitation Poster 16 Progress in Four Postacute Brain Rehabilitation Program Types Compared through the MPAI-4 Outcome Info System. James Malec (Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN), Vicki Eicher, Mary Pat Murphy, Thomas Murphy. Disclosure: None disclosed. Objective: Compare progress in 4 post-acute program types. Design: Observational cohort study. Setting: Community and residential. Participants: 604 individuals with acquired brain injury. Interventions: Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and communitybased rehabilitation (“intensive outpatient”; n⫽235), intensive residential rehabilitation (“intensive residential”; n⫽78), long-term residential supported living (“residential supported living”; n⫽246), and long-term community-based supported living (“community supported living”; n⫽45). Using MPAI-4 Outcome Info system data, progress was examined on two consecutive assessments. Main Outcome Measures: Mayo-Portland Adaptability Inventory (MPAI-4). Results: Program types differed in participant age (F⫽17.77, p⬍.001), sex (2⫽22.38, p⬍.001), time from first to second assessment (F⫽26.707, p⬍.001), initial MPAI-4 score (F⫽6.89, p⬍.001), and chronicity (F⫽13.432, p⬍.001). However, only initial MPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, residential supported living participants were 9.1 years post-injury compared to Arch Phys Med Rehabil Vol 92, October 2011
5.1 years for intensive residential, 6.0 years for intensive community, and 6.8 years for community supported living programs. Intensive residential participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F⫽5.141, p⫽.002). Both the intensive outpatient and the intensive residential programs resulted in significant functional improvement across assessments. In contrast, both the residential supported living and the community supported living programs demonstrated relatively stable MPAI-4 scores. Conclusions : Results are consistent with stated goals of the programs, that is, intensive programs resulted in functional improvements; whereas, supported living programs produced stable functioning. Further studies using the large, multi-provider OutcomeInfo measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain jury programs. Key Words: Brain injury; Rehabilitation; Outcome measurement. Poster 17 Comprehensive Care in Multiple Sclerosis—From Theory to Practice. Ben Thrower (Shepherd Center, Atlanta, GA), Andrew C. Carlos. Disclosure: None disclosed. Objective: To define comprehensive care in multiple sclerosis (MS) and identify evidence that such care has positive effects on clinical outcomes or leads to more cost effective care. Design: A literature search was performed looking for (1) Models of comprehensive care in health conditions other than MS; i.e. diabetes mellitus; (2) Models or definitions of comprehensive care in MS; and (3) Studies examining the effects of comprehensive care on clinical outcomes or cost of care. Setting: Not applicable. Participants: Not applicable. Interventions: Not applicable. Results: In 2008, $2.1 trillion was spent in the U.S. on medical care. 75% of that was for the treatment of chronic diseases, such as MS. Improved clinical outcomes have been demonstrated for comprehensive programs such as the Model Spinal Cord Care Systems. A study of coordinated care for moderately disabled patients with MS, cerebral palsy, spinal cord injury or traumatic brain injury showed a reduction in costs per admission and shorter lengths of stay. MS may result in a wide variety of motor, sensory and cognitive symptoms emphasizing the need for a comprehensive management approach. Quality indicators for comprehensive care may include relapses, spasticity, speech, swallowing, mood, fatigue, mobility, skin integrity, bladder/bowel function and cognitive function.The National MS Society 2008 Trend Report survey revealed that more than two-thirds of managed care organization respondents agreed or strongly agreed that a disease management program for MS patients improves outcomes and adherence, reduces disability, and contains costs. However, only 10% of these same respondents had a fully developed MS disease management program. The majority of surveyed patients did not get care through a comprehensive program. Conclusions: Research suggests that a comprehensive care approach to MS management may result in better clinical outcomes and lower costs. Standardized definitions for such care have been proposed. Comprehensive MS programs are likely underutilized by both patients and managed care organizations. Key Words: Multiple sclerosis; Comprehensive care; Managed care organization; Rehabilitation. Poster 18 Early Impaired Self-Awareness is Associated with Age and Depression in Acquired Brain Injury. Shannon Juengst (University of Pittsburgh, Pittsburgh, PA), Emily Grattan, Elizabeth Skidmore. Disclosure: None disclosed. Objective: To examine the associations between early impaired selfawareness, age, depression, apathy, executive functioning, and disability in adults with Acquired Brain Injury. Design: Secondary analysis of clinical data. Setting: Inpatient Rehabilitation. Participants: Adults with Acquired Brain Injury. Main Outcome Measures: We used the Self Awareness of Deficits Interview (SADI) to measure self-aware-
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
Poster 15 Self Reported Functional Outcome Measure in the Field of Prosthesis: A Systematic Review. Pallavi Sood (University of Pittsburgh, Pittsburgh, PA), Diane Collins, Mark Schmeler, Amit Kumar, Harry Browne, Amol Karmarkar. Disclosure: None disclosed. Objective: The consumer’s feedback is critical for decision making during recommendation of prosthetic provision and predicting the outcome of the treatment. A systematic literature review was conducted to assess and analyze various functional outcome measure instruments used in field of prosthetics. The instruments considered were specifically self-reported outcome measure tools to be completed by individuals with lower limb amputations. Design: A systematic literature review was conducted to compare various self-reported functional Outcome Measure Instrument (OMI) with reference to their psychometric properties and the life domains in published articles from the following databases: MEDLINE and University of Pittsburgh Health Sciences Library System, CINAHL-EBSCO, GOOGLE SCHOLAR, SCOPUS, OVID, and PUBMED (1990 to 2010). Articles were included and excluded according to criterion determined by the author. Setting, Participants and Interventions: Not Applicable. Results: Twenty articles which met the inclusion criterion were analyzed on their psychometric properties, and clinical recommendations were made based on this analysis. The strengths and weaknesses of psychometric properties of various outcome measurement tools were described including reliability, validity and reliability. The overall results suggested that Locomotor Capability Index (LCI) was the only instrument which presented strong validity, reliability and low ceiling effect with some degree of sensitivity. Amputee Activity Scale (AAS) on the other hand had fair to average reliability and further research was indicated to analyze validity and sensitivity. Conclusions: This systematic literature review suggested that most of the outcome measurement tools lacked sensitivity to changes in clinical status. Future research and outcome tool development is recommended to acquire more appropriate outcome tools for prosthetic users. Key Words: Functional outcome measures; Lower extremity amputation; Prosthetics; Reliability and validity; Rehabilitation.
Neurorehabilitation Poster 16 Progress in Four Postacute Brain Rehabilitation Program Types Compared through the MPAI-4 Outcome Info System. James Malec (Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN), Vicki Eicher, Mary Pat Murphy, Thomas Murphy. Disclosure: None disclosed. Objective: Compare progress in 4 post-acute program types. Design: Observational cohort study. Setting: Community and residential. Participants: 604 individuals with acquired brain injury. Interventions: Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and communitybased rehabilitation (“intensive outpatient”; n⫽235), intensive residential rehabilitation (“intensive residential”; n⫽78), long-term residential supported living (“residential supported living”; n⫽246), and long-term community-based supported living (“community supported living”; n⫽45). Using MPAI-4 Outcome Info system data, progress was examined on two consecutive assessments. Main Outcome Measures: Mayo-Portland Adaptability Inventory (MPAI-4). Results: Program types differed in participant age (F⫽17.77, p⬍.001), sex (2⫽22.38, p⬍.001), time from first to second assessment (F⫽26.707, p⬍.001), initial MPAI-4 score (F⫽6.89, p⬍.001), and chronicity (F⫽13.432, p⬍.001). However, only initial MPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, residential supported living participants were 9.1 years post-injury compared to Arch Phys Med Rehabil Vol 92, October 2011
5.1 years for intensive residential, 6.0 years for intensive community, and 6.8 years for community supported living programs. Intensive residential participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F⫽5.141, p⫽.002). Both the intensive outpatient and the intensive residential programs resulted in significant functional improvement across assessments. In contrast, both the residential supported living and the community supported living programs demonstrated relatively stable MPAI-4 scores. Conclusions : Results are consistent with stated goals of the programs, that is, intensive programs resulted in functional improvements; whereas, supported living programs produced stable functioning. Further studies using the large, multi-provider OutcomeInfo measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain jury programs. Key Words: Brain injury; Rehabilitation; Outcome measurement. Poster 17 Comprehensive Care in Multiple Sclerosis—From Theory to Practice. Ben Thrower (Shepherd Center, Atlanta, GA), Andrew C. Carlos. Disclosure: None disclosed. Objective: To define comprehensive care in multiple sclerosis (MS) and identify evidence that such care has positive effects on clinical outcomes or leads to more cost effective care. Design: A literature search was performed looking for (1) Models of comprehensive care in health conditions other than MS; i.e. diabetes mellitus; (2) Models or definitions of comprehensive care in MS; and (3) Studies examining the effects of comprehensive care on clinical outcomes or cost of care. Setting: Not applicable. Participants: Not applicable. Interventions: Not applicable. Results: In 2008, $2.1 trillion was spent in the U.S. on medical care. 75% of that was for the treatment of chronic diseases, such as MS. Improved clinical outcomes have been demonstrated for comprehensive programs such as the Model Spinal Cord Care Systems. A study of coordinated care for moderately disabled patients with MS, cerebral palsy, spinal cord injury or traumatic brain injury showed a reduction in costs per admission and shorter lengths of stay. MS may result in a wide variety of motor, sensory and cognitive symptoms emphasizing the need for a comprehensive management approach. Quality indicators for comprehensive care may include relapses, spasticity, speech, swallowing, mood, fatigue, mobility, skin integrity, bladder/bowel function and cognitive function.The National MS Society 2008 Trend Report survey revealed that more than two-thirds of managed care organization respondents agreed or strongly agreed that a disease management program for MS patients improves outcomes and adherence, reduces disability, and contains costs. However, only 10% of these same respondents had a fully developed MS disease management program. The majority of surveyed patients did not get care through a comprehensive program. Conclusions: Research suggests that a comprehensive care approach to MS management may result in better clinical outcomes and lower costs. Standardized definitions for such care have been proposed. Comprehensive MS programs are likely underutilized by both patients and managed care organizations. Key Words: Multiple sclerosis; Comprehensive care; Managed care organization; Rehabilitation. Poster 18 Early Impaired Self-Awareness is Associated with Age and Depression in Acquired Brain Injury. Shannon Juengst (University of Pittsburgh, Pittsburgh, PA), Emily Grattan, Elizabeth Skidmore. Disclosure: None disclosed. Objective: To examine the associations between early impaired selfawareness, age, depression, apathy, executive functioning, and disability in adults with Acquired Brain Injury. Design: Secondary analysis of clinical data. Setting: Inpatient Rehabilitation. Participants: Adults with Acquired Brain Injury. Main Outcome Measures: We used the Self Awareness of Deficits Interview (SADI) to measure self-aware-