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Development of a Multidimensional, Multigroup Measure of Self-Care for Inpatient Rehabilitation

Published:October 05, 2020DOI:https://doi.org/10.1016/j.apmr.2020.08.021

      Abstract

      Objective

      To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation.

      Design

      Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT).

      Setting

      Freestanding inpatient rehabilitation hospital in the Midwestern United States.

      Participants

      Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions.

      Interventions

      Not applicable

      Main Outcome Measures

      A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment.

      Results

      CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen dmax−min =1.13; Cohen dlast−first.=0.91) greater than the FIM self-care items (dmax−min.=0.94; dlast−first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM.

      Conclusions

      This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation.

      Keywords

      List of abbreviations:

      ARAT (Action Research Arm Test), BBS (Berg Balance Scale), BTA (Bilateral Task Assessment), CAT (computerized adaptive test), CFA (confirmatory factor analysis), FGA (Functional Gait Assessment), FIST (Function in Sitting Test), IRF (inpatient rehabilitation facility), IRT (item response theory), MASA (Mann Assessment of Swallowing Ability), MIRT (multidimensional item response theory), QI (quality indicator), UEF (upper-extremity function)
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