02898nas a2200409   4500008004100000245012300041210006900164260000800233300001000241490000700251520159700258653004701855653001001902653000901912653001901921653003101940653002601971653001101997653002902008653001102037653000902048653001602057653003902073653001402112653002502126653002702151653003002178653003202208653002802240653002202268100001502290700001602305700001702321700001602338700001502354856011902369       2005                        eng d00aMeasuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach0 aMeasuring physical function in patients with complex medical and  cOct  a741-80 v843 aOBJECTIVE: To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure--Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions. DESIGN: Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions. RESULTS: The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool. CONCLUSION: The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.10aActivities of Daily Living/*classification10aAdult10aAged10aCohort Studies10aContinuity of Patient Care10aDisability Evaluation10aFemale10aHealth Services Research10aHumans10aMale10aMiddle Aged10aPostoperative Care/*rehabilitation10aPrognosis10aRecovery of Function10aRehabilitation Centers10aRehabilitation/*standards10aSensitivity and Specificity10aSickness Impact Profile10aTreatment Outcome1 aSiebens, H1 aAndres, P L1 aPengsheng, N1 aCoster, W J1 aHaley, S M  uhttp://iacat.org/content/measuring-physical-function-patients-complex-medical-and-postsurgical-conditions-computer03703nas a2200481   4500008004100000245005200041210005200093300001200145490000700157520221100164653001902375653002902394653005802423653001002481653005302491653000902544653001102553653002502564653002602589653003302615653001102648653001002659653000902669653001602678653002402694653007402718653001802792653002902810653005802839653003102897653003202928653003602960653003202996100001503028700001603043700001603059700001603075700001003091700001403101700001803115700001503133856007303148       2004                        eng d00aActivity outcome measurement for postacute care0 aActivity outcome measurement for postacute care  aI49-1610 v423 aBACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual's execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72% of the variance: Applied Cognition (44%), Personal Care & Instrumental Activities (19%), and Physical & Movement Activities (9%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings.10a*Self Efficacy10a*Sickness Impact Profile10aActivities of Daily Living/*classification/psychology10aAdult10aAftercare/*standards/statistics & numerical data10aAged10aBoston10aCognition/physiology10aDisability Evaluation10aFactor Analysis, Statistical10aFemale10aHuman10aMale10aMiddle Aged10aMovement/physiology10aOutcome Assessment (Health Care)/*methods/statistics & numerical data10aPsychometrics10aQuestionnaires/standards10aRehabilitation/*standards/statistics & numerical data10aReproducibility of Results10aSensitivity and Specificity10aSupport, U.S. Gov't, Non-P.H.S.10aSupport, U.S. Gov't, P.H.S.1 aHaley, S M1 aCoster, W J1 aAndres, P L1 aLudlow, L H1 aNi, P1 aBond, T L1 aSinclair, S J1 aJette, A M  uhttp://iacat.org/content/activity-outcome-measurement-postacute-care04028nas a2200433   4500008004100000245012300041210006900164260000800233300001200241490000700253520252400260653001902784653002902803653005802832653001002890653000902900653002202909653002602931653003302957653001102990653001103001653000903012653001603021653007403037653003003111653003603141653005803177653003103235653004503266653004103311653003203352100001603384700001503400700001603415700001603431700001403447700001203461856012103473       2004                        eng d00aRefining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain0 aRefining the conceptual basis for rehabilitation outcome measure  cJan  aI62-1720 v423 aBACKGROUND: 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.10a*Self Efficacy10a*Sickness Impact Profile10aActivities of Daily Living/*classification/psychology10aAdult10aAged10aAged, 80 and over10aDisability Evaluation10aFactor Analysis, Statistical10aFemale10aHumans10aMale10aMiddle Aged10aOutcome Assessment (Health Care)/*methods/statistics & numerical data10aQuestionnaires/*standards10aRecovery of Function/physiology10aRehabilitation/*standards/statistics & numerical data10aReproducibility of Results10aResearch Support, U.S. Gov't, Non-P.H.S.10aResearch Support, U.S. Gov't, P.H.S.10aSensitivity and Specificity1 aCoster, W J1 aHaley, S M1 aAndres, P L1 aLudlow, L H1 aBond, T L1 aNi, P S  uhttp://iacat.org/content/refining-conceptual-basis-rehabilitation-outcome-measurement-personal-care-and-instrumental