@article {87,
	title = {Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain},
	journal = {Medical Care},
	volume = {42},
	number = {1 Suppl},
	year = {2004},
	note = {0025-7079Journal Article},
	month = {Jan},
	pages = {I62-172},
	abstract = {BACKGROUND: Rehabilitation outcome measures routinely include content on performance of daily activities; however, the conceptual basis for item selection is rarely specified. These instruments differ significantly in format, number, and specificity of daily activity items and in the measurement dimensions and type of scale used to specify levels of performance. We propose that a requirement for upper limb and hand skills underlies many activities of daily living (ADL) and instrumental activities of daily living (IADL) items in current instruments, and that items selected based on this definition can be placed along a single functional continuum. OBJECTIVE: To examine the dimensional structure and content coverage of a Personal Care and Instrumental Activities item set and to examine the comparability of items from existing instruments and a set of new items as measures of this domain. METHODS: Participants (N = 477) from 3 different disability groups and 4 settings representing the continuum of postacute rehabilitation care were administered the newly developed Activity Measure for Post-Acute Care (AM-PAC), the SF-8, and an additional setting-specific measure: FIM (in-patient rehabilitation); MDS (skilled nursing facility); MDS-PAC (postacute settings); OASIS (home care); or PF-10 (outpatient clinic). Rasch (partial-credit model) analyses were conducted on a set of 62 items covering the Personal Care and Instrumental domain to examine item fit, item functioning, and category difficulty estimates and unidimensionality. RESULTS: After removing 6 misfitting items, the remaining 56 items fit acceptably along the hypothesized continuum. Analyses yielded different difficulty estimates for the maximum score (eg, "Independent performance") for items with comparable content from different instruments. Items showed little differential item functioning across age, diagnosis, or severity groups, and 92\% of the participants fit the model. CONCLUSIONS: ADL and IADL items from existing rehabilitation outcomes instruments that depend on skilled upper limb and hand use can be located along a single continuum, along with the new personal care and instrumental items of the AM-PAC addressing gaps in content. Results support the validity of the proposed definition of the Personal Care and Instrumental Activities dimension of function as a guide for future development of rehabilitation outcome instruments, such as linked, setting-specific short forms and computerized adaptive testing approaches.},
	keywords = {*Self Efficacy, *Sickness Impact Profile, Activities of Daily Living/*classification/psychology, Adult, Aged, Aged, 80 and over, Disability Evaluation, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Outcome Assessment (Health Care)/*methods/statistics \& numerical data, Questionnaires/*standards, Recovery of Function/physiology, Rehabilitation/*standards/statistics \& numerical data, Reproducibility of Results, Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Research Support, U.S. Gov{\textquoteright}t, P.H.S., Sensitivity and Specificity},
	author = {Coster, W. J. and Haley, S. M. and Andres, P. L. and Ludlow, L. H. and Bond, T. L. and Ni, P. S.}
}
@article {187,
	title = {Development of an index of physical functional health status in rehabilitation},
	journal = {Archives of Physical Medicine and Rehabilitation},
	volume = {83},
	number = {5},
	year = {2002},
	note = {0003-9993 (Print)Journal Article},
	month = {May},
	pages = {655-65},
	abstract = {OBJECTIVE: To describe (1) the development of an index of physical functional health status (FHS) and (2) its hierarchical structure, unidimensionality, reproducibility of item calibrations, and practical application. DESIGN: Rasch analysis of existing data sets. SETTING: A total of 715 acute, orthopedic outpatient centers and 62 long-term care facilities in 41 states participating with Focus On Therapeutic Outcomes, Inc. PATIENTS: A convenience sample of 92,343 patients (40\% male; mean age +/- standard deviation [SD], 48+/-17y; range, 14-99y) seeking rehabilitation between 1993 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients completed self-report health status surveys at admission and discharge. The Medical Outcomes Study 36-Item Short-Form Health Survey{\textquoteright}s physical functioning scale (PF-10) is the foundation of the physical FHS. The Oswestry Low Back Pain Disability Questionnaire, Neck Disability Index, Lysholm Knee Questionnaire, items pertinent to patients with upper-extremity impairments, and items pertinent to patients with more involved neuromusculoskeletal impairments were cocalibrated into the PF-10. RESULTS: The final FHS item bank contained 36 items (patient separation, 2.3; root mean square measurement error, 5.9; mean square +/- SD infit, 0.9+/-0.5; outfit, 0.9+/-0.9). Analyses supported empirical item hierarchy, unidimensionality, reproducibility of item calibrations, and content and construct validity of the FHS-36. CONCLUSIONS: Results support the reliability and validity of FHS-36 measures in the present sample. Analyses show the potential for a dynamic, computer-controlled, adaptive survey for FHS assessment applicable for group analysis and clinical decision making for individual patients.},
	keywords = {*Health Status Indicators, *Rehabilitation Centers, Adolescent, Adult, Aged, Aged, 80 and over, Female, Health Surveys, Humans, Male, Middle Aged, Musculoskeletal Diseases/*physiopathology/*rehabilitation, Nervous System Diseases/*physiopathology/*rehabilitation, Physical Fitness/*physiology, Recovery of Function/physiology, Reproducibility of Results, Retrospective Studies},
	author = {Hart, D. L. and Wright, B. D.}
}
