Shirley Ryan AbilityLab, Outcomes Management: Systems & Analytics, Chicago, Illinois.
Shirley Ryan AbilityLab, Center for Rehabilitation Outcomes Research, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Arch Phys Med Rehabil. 2021 Jan;102(1):97-105. doi: 10.1016/j.apmr.2020.08.021. Epub 2020 Oct 6.
To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation.
Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT).
Freestanding inpatient rehabilitation hospital in the Midwestern United States.
Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions.
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.
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 d =1.13; Cohen d.=0.91) greater than the FIM self-care items (d.=0.94; d .=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.
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.
开发并评估一种在住院康复期间用于观察临床医生和患者自理功能的测量方法。
使用验证性因子分析（CFA）和多维项目反应理论（MIRT）对治疗师收集的自理评估进行回顾性分析。
美国中西部的独立住院康复医院。
患有中风、创伤性脑损伤、脊髓损伤、神经疾病和肌肉骨骼疾病的住院患者（N=7719）。
不适用。
共 19 项由临床医生选择的自理措施，包括 FIM 以及患者自理、临床医生评定的平衡、上肢功能、力量、改变体位和吞咽能力。临床医生在入院时和至少 1 次中期评估时完成评估。
对 3 组患者（按平衡能力最高水平分为坐、站、行走）进行了 CFA。我们减少了 47.5%的项目数量，同时保持了可接受的内部一致性；每个项目组的一维性需要开发测验组。递归分析定义了一种自理测量方法，其敏感性（Cohen d=1.13；Cohen d=0.91）大于 FIM 自理项目（d=0.94；d=0.83）。CFA 模型提供了良好到可接受的拟合度（近似均方根误差 0.03-0.06）。在入院时 FIM 自理评定为完全辅助的 338 例患者中（88%，297 例），有 26%（78 例）的患者在 FIM 上没有发现变化，219 例（78%）的患者在 MIRT 自理测量上的改善超过了 FIM。剩余的 74%（219 例）在 MIRT 基础测量上的改善平均比 FIM 提前 14 天。
与 FIM 相比，这种基于 MIRT 的自理测量方法具有更好的测量特性，特别是对于接近其下限或上限的患者。该方法确保了多维性和高敏感性。这种自理测量方法有可能改善自理的监测，并在住院康复期间有效地管理治疗。
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