Poster 4 Validation of the Utrecht Scale for Evaluation of Rehabilitation – Participation (USER-Participation)

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2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS

Poster Presentations Measurement Poster 1 Test-Retest Reliability of the Functional Mobility Assessment (FMA). Amit Kumar (Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, Division of Rehabilitation Science, University of Texas Medical Branch, Galveston, TX), Mark Schmeler, Amol Karmarkar, Diane Collins, Rosemarie Cooper, Rory Cooper, Hyekyoung Shin, Margo Holm. Disclosure: None disclosed. Objective: Functional mobility is necessary to perform activities of daily living and for community participation and requires reliable measurement of consumer satisfaction and functional changes. The Functional Mobility Assessment (FMA) instrument is a self-report outcomes tool, designed to measure effectiveness of Wheeled Mobility and Seating (WMS) interventions for people with disabilities (PWD). This study examined test-retest reliability of the FMA and stability of self-reported performance item. Design/Setting: A repeated-measures cohort study was conducted at the Centre for Assistive Technology (CAT). Participants: (n⫽41) completed an initial FMA questionnaire. The FMA was administered a second time, within 7-21 days. The study sample involved 20 participants who were Non- WMS users but in the process of being evaluated for a device and 21 participants who were existing WMS users. Intra-class correlation coefficients (ICC) were computed to determine agreement between the two scores. Results: Test-retest reliability scores for all items and participants were above the acceptable value for a clinical assessment tool (ⱖ 0.80). Existing WMS users had higher total ICC scores on the FMA than Non-WMS users. Conclusions: Results indicate that the FMA was a reliable and stable tool for assessing functional outcome performance of individuals who use or need WMS interventions. This study also demonstrated the applicability of FMA for measuring functional performance with users of other mobility devices including canes, crutches, walkers or prostheses. Key Words: Outcomes; Assistive device; Functional; Test-retest; Reliability; Rehabilitation. Poster 2 Responsiveness of Four Participation Measures for Outcomes of Outpatient Rehabilitation. Carlijn van der Zee (Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands), Marcel Post. Disclosure: None disclosed. Objective: To compare the responsiveness of four generic participation measures for outcomes of outpatient rehabilitation. Design: Longitudinal study with measurements at the start (t1) and the end (t2) of a multidisciplinary outpatient rehabilitation program, and at 4-months follow-up (t3). Setting: The outpatient clinics of five rehabilitation centers in The Netherlands. Participants: Consecutive, adult (age ⬎17 years), patients who were eligible for a multidisciplinary outpatient rehabilitation program with a duration of at least four weeks. Diagnosis was not a selection criterion, but patients who were not able to complete questionnaires due to cognitive deficits or language problems or who suffered a fast progressive condition were excluded. Interventions: Not applicable. Main Outcome Measures: The Frenchay Activities Index (FAI), the participation subtotal score of the ICF Measure of Participation and Activities-Screener (IMPACT-SP), the Participation Scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation). Responsiveness was assessed by the Effect Size (ES) and the Standardized Response Mean (SRM). Results: A total of 509 patients were included in the study, of whom 395 (77.6%) completed all three measurements. Mean age was 52.1 years (SD⫽13.6) and 46.6% were female. The largest diagnostic groups were Brain Injury (34.9%) and Arch Phys Med Rehabil Vol 92, October 2011

Neuromuscular Diseases (22.0%). Responsiveness parameters were largest during rehabilitation and negligible during follow-up. ES values were generally somewhat smaller than SRM values. Comparing scores at t1 and t2, the USER-Participation Restriction scale showed the highest SRM (0.54). Other scores ranged from 0.21 (USER-Participation Frequency scale) to 0.41 (FAI). Responsiveness parameters varied between diagnostic groups, with participants with Brain Injury showing the largest change and participants with Neuromuscular Diseases or Chronic Pain showing least change. Across the different diagnostic groups, the USER-Participation Restriction scale showed the best responsiveness. Conclusions: Over-all, the USER-Participation Restriction scale showed the best responsiveness. Key Words: Social participation; Outcome assessment; Rehabilitation. Poster 3 Evaluation of Patient and Proxy Responses on the Activity Measure for Post-Acute Care. Alan Jette (Boston University School of Public Health, Boston, MA), Pengsheng Ni, Elizabeth Rasch, Jed Appelman, M. Elizabeth Sandel, Leighton Chan. Disclosure: None disclosed. Objective: The objective of this study was to examine the concordance between patient and proxy-reported scores on the Activity Measure for Post-Acute Care (AM-PAC). Design: A trained interviewer administered the AM-PAC to each participant and proxy respondent. We examined agreement between patient and proxy summary scores in three functional domains: Daily Activity, Basic Mobility, and Applied Cognition. Setting: Patients and proxies completed the AM-PAC at acute hospital discharge and/or during one or more post-acute care settings (inpatient rehabilitation hospital, skilled nursing facility, home care, outpatient therapy). Participants: This study involved 67 patients with a diagnosis of stroke admitted to the inpatient hospital of Kaiser Permanente of Northern California. Interventions: Not applicable. Main Outcome Measures: The AM-PAC instrument uses a 4-point difficulty scale rating across 259 functional activities. In this study, the computer adaptive test (CAT) version of the AM-PAC which employs an iterative computer program that tailors item selection thereby eliminating questions that are too hard or too easy for a patient. Results: Findings support the validity of using proxy-reported data to generate AM-PAC scores across all three functional domains for patients who have had a stroke. The pattern of disagreement between patient and proxy was, on average, relatively small, not systematic, and not clinically meaningful. The degree of concordance between patient and proxy was lower for those with more severe strokes. Conclusions: Patient and proxy ratings on the AM-PAC CAT are valid with adequate agreement between patient and proxy. Use of the AM-PAC CAT using proxy respondents when necessary is encouraged to reduce selection bias in stroke research. Key Words: Rehabilitation; Functional recovery; Outcomes. Poster 4 Validation of the Utrecht Scale for Evaluation of Rehabilitation – Participation (USER-Participation). Marcel Post (De Hoogstraat, Utrecht, The Netherlands, Swiss Paraplegic Research, Nottwil, Switzerland), Carlijn van der Zee. Disclosure: None disclosed. Objectives: The Utrecht Scale for Evaluation of RehabilitationParticipation (USER-Participation) is a new generic participation measure, designed to measure both objective and subjective participation outcomes of outpatient rehabilitation in adults living in the community. The USER-Participation comprises 31 items in three scales: Frequency of participation, participation Restrictions and Satisfaction with participation. The aim of this study was to examine the validity of this measure. Design: Cross-sectional study. Setting: Five outpatient rehabilitation facilities

2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS

in the Netherlands. Participants: Consecutive series of rehabilitation outpatients (n⫽395). Interventions: Not applicable. Main Outcome Measures: In addition to the USER-Participation, the Frenchay Activities Index (FAI), ICF Measure of Participation and Activities Screener Participation subscale (IMPACT-SP), and the Participation Scale were included as reference measures. Results: Internal consistency of the USER-Participation scales was satisfactory (alpha 0.70 0.91). Spearman correlations between these scales were between 0.36 and 0.52. Concurrent validity was shown by strong correlations between the Frequency scale and the FAI (0.59), the Restrictions scale and the IMPACT-SP (0.75) and the Satisfaction scale and the Participation Scale (-0.73). Discriminant validity was shown by significant differences in USER-Participation scores between participants with different levels of independence and between participants with different health conditions. Conclusions: It is useful to distinguish between objective and subjective aspects of participation, as demonstrated by the moderate correlations between the Frequency, Restrictions, and Satisfaction scores of the USER-Participation. The USER-Participation appears to be a valid measure to rate objective and subjective participation in persons with physical disabilities. Key Words: Validation studies; Disabled persons; Questionnaires; Outcome assessment; Community participation; Rehabilitation. Poster 5 A Systematic Review of the Health-related Quality of Life Measures following Total Knee Arthroplasty. Saurabh Mehta (McMaster University, Hamilton, Ontario, Canada), Mary Law, JeanSébastien Roy. Disclosure: None disclosed. Objective: To perform systematic review and appraisal of common patient-reported outcomes (PROs) used in measuring aspects of health-related quality of life (HRQOL) following total knee arthroplasty (TKA). Especially, the study aimed to examine whether these common PROs assess the domains of HRQOL as described in the theoretical frameworks of the HRQOL. Design: A systematic review of the clinimetric properties of the selected HRQOL outcomes. Literature Search and Selecting Studies: A systematic literature search was performed to identify commonly used PROs for assessing HRQOL following TKA. The selection of the PROs was based on their frequency of use across studies deemed to be of the highest evidence such as the systematic reviews and randomized controlled trials. . Critical Appraisal: A critical appraisal was performed using standardized guidelines for examining the conceptual basis, reliability, validity, responsiveness, and administrative issues of selected PROs. Results: Six HRQOL outcomes were deemed eligible for this review and critical appraisal was performed. Four of these PROs were health status measures and two were the measures of functional ability following TKA. Critical appraisals had acceptable psychometric properties for use in TKA. Most of these PROs evaluate either health status or functional ability but none of them comprehensively assess the domains of the HRQOL described in the theoretical frameworks of the HRQOL. Conclusions: Since none of the PROs comprehensively assess HRQOL following TKA, the clinicians might be challenged while selecting an appropriate PRO for assessing HRQOL in these patients. In future, qualitative studies can be conducted to expand the knowledge of patient-relvant HRQOL domains following TKA. Moreover, there is a potential to amend the existing measures for increasing their relevance and applicability for the patients following TKA. Key Words: Health-related quality of life; Total knee arthroplasty; Patientreported outcomes; Clinimetric properties; Rehabilitation. Poster 6 Evaluation of Item Difficulty on the Coma Recovery Scale with Implications for Emergence Criteria. Shital Pavawalla (James A. Haley Veterans’ Hospital, Tampa, FL), Risa Nakase-Richardson, Stuart Yablon, Mark Sherer, Clea Evans, Scott Barnett. Disclosure: None disclosed.

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Objectives: The purpose of this study is to examine the item difficulty of neurobehavioral responses on the Coma Recovery Scale with implications for emergence criteria from a minimally conscious state. Design: Consecutive sample of neurorehabilitation admissions presenting with a disorder of consciousness and evaluated with serial examination by trained neuropsychologists. Setting: Free-standing rehabilitation hospital. Participants: Sixty-three participants with acute brain injury and a disorder of consciousness who were either in a vegetative state (54%) or a minimally conscious state on rehabilitation admission. Participants were primarily male (63.5%) with a median age of 22. Interventions: Not applicable. Main Outcome Measures: Coma Recovery Scale (CRS; Giacino, 1998). Results: Item difficulties were computed for the ability to exhibit CRS behaviors initially (first occurrence) and consecutively (i.e., twice in a row). Values ranged from 0 (most difficult) to 1.0 (easiest). A wide variety of item difficulties emerged across neurobehavioral responses. Differential item difficulty was observed across current emergence criteria (object manipulation ⫽ .60; accurate yes/no responses to 5 situational questions ⫽ .30), with intervening behaviors consistently falling in this range, such as repeatedly following commands (.60), object discrimination (.44), full arousal (.4), and verbalizations (.32). A similar profile was observed when neurobehavioral responses were observed consecutively; however, consistent demonstrations of verbalizations were rated as more difficult. Conclusions: Findings suggest that current emergence criteria behaviors are not comparable and that other behaviors such as repeatedly following commands, object discrimination, and other responses are relatively easier to demonstrate, especially in relations to yes/no accuracy. Data support reconsideration of the current emergence criteria with support for inclusion of alternative behaviors indicative of emergence. Key Words: Rehabilitation; Traumatic brain injury (TBI); Minimally conscious state (MCS). Poster 7 Normative Data for the Balance Error Scoring System in Community-Dwelling Adults. Grant Iverson (University of British Columbia, Vancouver, BC, Canada, Copeman Healthcare Centre, Vancouver, BC, Canada), Michael Koehle. Disclosure: None disclosed. Objective: The Balance Error Scoring System (BESS) is a brief, easily-administered test of static balance. The purpose of this study is to develop normative data for this test. Design: Cross-sectional, descriptive, cohort design. Setting: The sample was drawn from a population of clients taking part in a comprehensive preventive health screen at a multidisciplinary healthcare center. Participants: Community-dwelling adults (N⫽1,236) were administered the BESS within the context of a fitness evaluation. The average age of the sample was 49.5 years (SD⫽10.8; Range⫽20-69). There were 738 men (59.8%) and 496 (40.2%) women. The breakdown of participants by age group was as follows: 20-29⫽65, 30-39⫽172, 40-49⫽352, 50-59⫽420, and 60-69⫽225. The average body mass index (BMI) for men was 28.1 (SD⫽4.1, Range⫽16.2– 49.0) and for the women was 24.5 (SD⫽4.5, Range⫽15.9 – 45.8). They did not have significant medical, neurological, or lower extremity problems that might have an adverse effect on balance. Interventions: Not applicable. Main Outcome Measures: BESS normative reference values. Results: There was a significant positive correlation between BESS scores and age (r⫽.34). BESS performance was similar for participants between the ages of 20 and 49, and significantly declined between ages 50 and 69. Men and women performed similarly on the BESS. There was a small significant positive correlation between BESS scores and BMI (r⫽.17 for the total sample, r⫽.15 for men, and r⫽.26 for women). There was a small significant difference in BESS performance between obese and nonobese men (Cohen’s d⫽.16), and a medium significant difference between obese and non-obese women (d⫽.62). The BESS normative data are presented for the total sample and by age, sex, age by sex, and Arch Phys Med Rehabil Vol 92, October 2011