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Articles| Volume 85, ISSUE 12, P2030-2035, December 2004

Development of an applied cognition scale to measure rehabilitation outcomes

      Abstract

      Coster WJ, Haley SM, Ludlow LH, Andres PL, Ni PS. Development of an applied cognition scale to measure rehabilitation outcomes.

      Objective

      To examine the structure and content coverage of an item pool of new items based on the Activity categories from the International Classification of Functioning, Disability and Health and items from existing instruments to measure the applied cognition dimension of function.

      Design

      Prospective study.

      Setting

      Four postacute care rehabilitation settings (inpatient, transitional care, home care, outpatient) in an urban-suburban area of northeast United States.

      Participants

      Convenience sample of 477 patients (mean age, 62.7y) receiving rehabilitation services for neurologic, orthopedic, or complex medical conditions.

      Interventions

      Not applicable.

      Main outcome measures

      Participants were administered applied cognition items from the new Activity Measure for Post-Acute Care, the Medical Outcomes Study 8-Item Short-Form Health Survey, and an additional setting-specific measure: the FIM instrument (inpatient rehabilitation); the Minimum Data Set (skilled nursing facility); the Minimum Data Set–Post Acute Care (postacute settings); or the Outcome Assessment and Information Set (home care). Rasch (partial-credit model) analyses were conducted to examine item fit, item coverage, scale unidimensionality, and category difficulty estimates.

      Results

      The majority of items (46/59) could be located along a single continuum. Relatively few people were performing at the lower end of the difficulty scale, and about 25% were at ceiling.

      Conclusions

      The proposed definition of applied cognition dimension provides a useful guide for item development to measure this dimension. Further work is needed to determine how best to measure function in this domain for people at the upper and lower ends of the continuum.

      Key words

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      References

        • Duncan P.W.
        • Wallace D.
        • Lai S.M.
        • Johnson D.
        • Embretson S.
        • Laster L.J.
        The Stroke Impact Scale Version 2.0.
        Stroke. 1999; 30: 2131-2140
        • Hajek V.E.
        • Gagnon S.
        • Ruderman J.E.
        Cognitive and functional assessments of stroke patients.
        Arch Phys Med Rehabil. 1997; 78: 1331-1337
        • MacNeil S.E.
        • Lichtenberg P.A.
        Home alone.
        Arch Phys Med Rehabil. 1997; 78: 755-758
        • Fitzgerald J.F.
        • Smith D.M.
        • Martin D.K.
        • Freedman J.A.
        • Wolinsky F.D.
        Replication of multidimensionality of activities of daily living.
        J Gerontol. 1999; 48: S28-S31
        • Granger C.V.
        • Linn R.T.
        Biologic patterns of disability.
        J Outcome Meas. 2000; 4: 595-615
        • Barberger-Gateau P.
        • Fabrigoule C.
        • Rouch I.
        • Letenneur L.
        • Dartigues J.F.
        Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction of dementia.
        J Gerontol B Psychol Sci Soc Sci. 1999; 54: 293-303
        • Barberger-Gateau P.
        • Fabrigoule C.
        Disability and cognitive impairment in the elderly.
        Disabil Rehabil. 1997; 19: 175-193
        • Njegovan V.
        • Hing M.M.
        • Mitchell S.L.
        • Molnar F.J.
        The hierarchy of functional loss associated with cognitive decline in older persons.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M638-M643
        • Stineman M.G.
        • Maislin G.
        • Nosek M.
        • Fiedler R.
        • Granger C.V.
        Comparing consumer and clinician values for alternative functional states.
        Arch Phys Med Rehabil. 1998; 79: 1522-1529
        • World Health Organization
        International classification of functioning, disability and health.
        WHO, Geneva2001
        • Haley S.M.
        • Langmuir L.
        How do current post-acute functional assessments compare with the activity dimension of the international classification of functioning and disability (ICIDH-2)?.
        J Rehabil Outcome Meas. 2000; 4: 51-56
        • Haley S.M.
        • Coster W.J.
        • Andres P.
        • et al.
        Activity outcome measurement for post-acute care.
        Med Care. 2004; 42: I49-I61
        • Thomas V.S.
        • Rockwood K.
        • McDowell I.
        Multidimensionality in instrumental and basic activities of daily living.
        J Clin Epidemiol. 1998; 51: 315-321
        • Lawton M.P.
        • Brody E.M.
        Assessment of older people.
        Gerontologist. 1969; 9: 179-186
        • Haley S.M.
        • Coster W.J.
        • Andres P.L.
        • Kosinski M.
        • Ni P.S.
        • Jette A.M.
        Short-form Activity Measure for Post-Acute Care.
        Arch Phys Med Rehabil. 2004; 85: 649-660
        • Haley S.M.
        • Andres P.L.
        • Coster W.J.
        • Kosinski M.
        • Ni P.S.
        Score comparability of short forms and computerized adaptive testing.
        Arch Phys Med Rehabil. 2004; 85: 661-666
      1. Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM instrument), version 5.1.
        State Univ New York, Buffalo1997
        • Morris J.
        • Hawes C.
        • Fries B.
        • Phillips C.
        • Mor V.
        • Katz S.
        Designing the national resident assessment instrument for nursing homes.
        Gerontologist. 1990; 30: 293-297
        • Shaughnessy P.
        • Crisler K.
        • Schlenker R.
        Medicare’s OASIS: standardized Outcome and Assessment Information Set for home health care: Oasis-B.
        Center for Health Services and Policy Research, Denver1997
        • Rankin J.
        Cerebral vascular accidents in patients over the age of 60. II. Prognosis.
        Scot Med J. 1957; 2: 200-215
        • Ware J.
        • Kosinski M.
        • Dewey J.
        • Gandek B.
        How to score and interpret single-item health status measures.
        QualityMetric, Lincoln (RI)1999
        • Masters G.N.
        A Rasch model for partial credit scoring.
        Psychometrika. 1984; 47: 149-174
        • Wright B.D.
        • Masters G.N.
        Rating scale analysis.
        Mesa Pr, Chicago1982
        • Linacre J.
        • Wright B.
        A user’s guide to Winsteps.
        Mesa Pr, Chicago2001
        • Bond T.
        • Fox C.
        Applying the Rasch model.
        Lawrence Erlbaum, Mahwah2001
        • Wright B.
        • Stone M.H.
        Best test design.
        Mesa Pr, Chicago1979
        • Smith E.V.
        Detecting and evaluating the impact of multidimensionality using item fit statistics and PCA of residuals.
        J Appl Meas. 2002; 3: 205-231
      2. Holland P.W. Wainer H. Differential item functioning. Lawrence Erlbaum, Hillsdale1993
        • Haley S.M.
        • Jette A.M.
        • Coster W.J.
        • et al.
        Late Life Function and Disability Instrument: II. Development and evaluation of the function component.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M217-M222
        • Haley S.M.
        • Ludlow L.H.
        Applicability of the hierarchical scales of the Tufts Assessment of Motor Performance for school-aged children and adults with disabilities.
        Phys Ther. 1992; 72: 191-204
        • McHorney C.A.
        • Cohen A.S.
        Equating health status measures with Item Response Theory.
        Med Care. 2000; 38: 43-59
        • Seymour D.G.
        • Ball A.E.
        • Russell E.M.
        • Primrose W.R.
        • Garratt A.M.
        • Crawford J.R.
        Problems in using health survey questionnaires in older patients with physical disabilities.
        J Eval Clin Pract. 2001; 7: 411-418
        • Andres P.L.
        • Haley S.M.
        • Ni P.S.
        Is patient-reported function reliable for monitoring postacute outcomes?.
        Am J Phys Med Rehabil. 2003; 82: 614-621
        • Coster W.J.
        • Haley S.M.
        • Andres P.L.
        • Ludlow L.H.
        • Bond T.
        • Ni P.S.
        Refining the conceptual basis for rehabilitation outcome measurement.
        Med Care. 2004; 42: I162-I172