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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 05, 2020
Footnotes
Material from this article was presented to the American Congress of Rehabilitation Medicine on October 28, 2017, Atlanta, GA.
Disclosures: Dr Sliwa and Dr Bodine report a patent pending (US 2019/0096513 A1). The other authors have nothing to disclose.
Identification
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© 2020 by the American Congress of Rehabilitation Medicine
