Shirley Ryan AbilityLab, Chicago, Illinois (C.E.D., J.C., A.J.B., S.M.T., A.W.H., R.L.L., J.A.S.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (S.M.T.); Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Chicago, Illinois (A.W.H., R.L.L., J.A.S.); and Department of Biomedical Engineering, Northwestern University, Evanston, Illinois (R.L.L.).
J Neurol Phys Ther. 2021 Apr 1;45(2):101-111. doi: 10.1097/NPT.0000000000000354.
Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation.
For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills.
Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI.
The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).
住院康复机构（IRF）通过使用质量指标（QI）向医疗保险和其他付款人报告患者的功能状态。虽然 QI 对付款目的有用，但它的测量特性对于监测患者的进展有限。基于 QI 项目和其他标准化评估的移动性衡量标准可能会增强临床医生跟踪患者改善的能力。因此，我们开发了移动能力商数（Mobility AQ）来评估住院康复期间的移动能力。
对于 10036 名 IRF 住院患者，我们从电子健康记录中提取评估，使用验证性因子分析来定义移动性的子维度，然后应用多维项目反应理论（MIRT）方法来开发一个单一维度的结构。评估包括 QI 项目和移动性、运动表现、轮椅和转移技能的标准化测量。
验证性因子分析为 3 组产生了拟合良好的模型（接近均方根误差≤0.08，比较拟合指数和非标准化拟合指数≥0.95），这 3 组由预期的出院时主要移动方式定义：步行、轮椅推动或两者兼有。重新估计为多组 MIRT 模型，与 QI 移动性项目相比，得分更敏感（最后一次到第一次的 dlast-first 为 1.08 对 QI 的 0.60；QI 的 dmax-min 为 1.16 对 1.05）。真实分数均等分析表明，与 QI 相比，Mobility AQ 的上限更高，下限更低。
Mobility AQ 比 QI 移动性项目具有更高的敏感性。这种基于 MIRT 的移动性测量方法描述了接受 IRF 服务的患者的功能和进展情况，并且有可能减轻评估负担并改善关于患者功能状态的沟通。
