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Biomedical subjects

C V Granger

Publications and source records attributed to C V Granger.

At least 73 records · Page 4Linked to original sources
PubMed1994

Inter-rater agreement and stability of functional assessment in the community-based elderly.

The purpose was to examine the inter-rater agreement and test-retest stability of the Functional Independence Measure (FIM) and the Instrumental Activities of Daily Living Scale (IADL) from the Multidimensional Functional Assessment of Older Adults. These two instruments were administered to 20 older persons living in the community. Two experienced raters administered the assessment instruments over either a short (7-10 days) or long (4 to 6 week) interval. The intraclass correlation (ICC) was used to analyze the data. ICC values were computed for agreement between and within raters and across short and long intervals. ICC values for inter-rater agreement and stability ranged from 0.90 to 0.99. The relation between scores on the FIM and IADL scale was also examined. The analysis produced an r value of 0.85, suggesting a positive statistical relationship among the items assessed. The high ICC values indicate that the Functional Independence Measure Instrument and IADL scale of the Multidimensional Functional Assessment of Older Adults provide consistent information across two experienced raters and over time when used with a sample of elderly persons residing in the community.

Activities of Daily Living↗
PubMed1994

The structure and stability of the Functional Independence Measure.

The Functional Independence Measure (FIM) records the severity of disability of rehabilitation patients. The necessarily curvilinear relationship between the finite range of recorded FIM raw scores and the conceptually infinite range of additive disability measures is resolved through Rasch analysis. The analysis of admission and discharge FIM ratings of 14,799 patients shows that the 18 FIM items define two statistically and clinically different indicators. Thirteen items define disability in motor functions. Five items define disability in cognitive functions. Additive measures for each indicator have the same characteristics at admission and discharge, so that these measures can be used to assess change in patient status.

Activities of Daily Living↗
PubMed1993

Performance profiles of the functional independence measure.

The functional independence measure (FIM) is used to determine the degree of disability that patients experience and the progress that they make through programs of medical rehabilitation. Rasch analysis is a statistical technique for constructing interval measures from ordinal data that was applied to derive FIM measures. The major factors that are taken into account to produce FIM measures are the relative difficulty in performance of FIM items and the ability of the persons tested. Our analyses showed the relative difficulties that patients experienced in performing items in the FIM. There were two dominant patterns of difficulty, one for motor FIM items and the other for cognitive FIM items. The patterns were consistent across impairment groups, although not identical. Of the motor items, eating and grooming were easiest whereas stair climbing, tub/shower transfers and locomotion were most difficult. Of the cognitive items, expression and comprehension were easiest and problem solving was the most difficult. The patterns of difficulty in performing FIM items are illustrated by analysis of the following impairment groups: for motor items, orthopedic conditions, stroke with left hemiparesis and spinal cord dysfunction; for cognitive items, orthopedic conditions, brain dysfunction, stroke with right hemiparesis and spinal cord dysfunction. By understanding patterns of difficulty in performing FIM items according to types of impairment and levels of function, clinicians may more precisely design treatment programs, use services and predict outcomes of medical rehabilitation.

Activities of Daily Living↗
PubMed1993

Specificity of ICD-9-CM coding practices for stroke rehabilitation.

Designed for acute care classification, the 9th version of the International Classification of Disease, Clinical Modification (ICD-9-CM) is also used to describe the principal diagnosis in medical rehabilitation. ICD-9-CM (ICD-9) coding practices for all stroke cases found in two nationally representative databases were examined (sample sizes over 17,000 and over 2,000). Of the more than 100 codes selected, four were indicated for 67% and 72% of stroke cases in the two data sets, respectively. Codes 436 and 438 distinguish acute from late stroke effects; whereas code 434.9 identifies stroke, but not its duration. The most frequently used code in the larger database, 342.9, refers to the manifestation of hemiplegia rather than to diagnosis, and thus is not specific to stroke. Other less frequently selected ICD-9 codes are more specific to the underlying pathophysiology (e.g., thrombosis, embolus or hemorrhage). Results emphasize the need for more precise selection of etiologic ICD-9 codes for stroke rehabilitation so that they describe specific pathology.

Cerebrovascular Disorders↗
PubMed1993

Functional assessment scales: a study of persons after stroke.

The purpose of this study was to investigate disability in persons after stroke by using combinations of functional assessment item, subscale, domain, and full-scale scores, to predict (1) the burden of care measured in minutes of assistance provided per day by another person in the home, and (2) the subject's level of satisfaction with life in general. The Functional Independence Measure (FIM) and the Sickness Impact Profile (SIP) each contributed to prediction of the subject's physical care needs. A change in total FIM score of one point (range, 61 to 126) was equivalent to an average of 2.19 minutes of help from another person per day and a change in one point in the SIP physical dysfunction (SIPPHYS) score (range, 4.0% to 57.4%) was equivalent to an average of 3.32 minutes. Along with the Brief Symptom Inventory and a measure of visual ability, the FIM contributed to predicting the patient's general satisfaction as well. The burden of care and subjective satisfaction with life in general are important standards by which functional assessment instruments may be compared to reflect, in pragmatic terms, the impact of disability on the lives of individuals and on the human and economic resources of the community.

Activities of Daily Living↗
PubMed1992

Hypothyroidism producing reversible dementia. A challenge for medical rehabilitation.

The evaluation of dementia for reversible causes should not be overlooked. Hypothyroidism is a reversible cause for dementia. Mental status is one of the important factors to be assessed prospectively to determine whether a patient is likely to benefit from intensive inpatient rehabilitation. Because of the negative effect of dementia on the learning process during intensive inpatient medical rehabilitation, it alone may be a sufficient reason to consider alternatives to intensive inpatient rehabilitation. On our rehabilitation unit, hypothyroidism causing confusion was recognized and corrected in two patients. The thyroid-stimulating hormone test is suggested as a screening tool.

Aged↗
PubMed1992

Discharge outcome after stroke rehabilitation.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the relations between host characteristics (age and side of body affected) and program variables (lengths of stay in acute care and rehabilitation, levels of functional ability at admission and discharge, and rates of community discharge). METHODS: A sample of 7,905 patients was drawn from medical rehabilitation facilities enrolled in the Uniform Data System for Medical Rehabilitation who were admitted and discharged for the first time between January 1988 and June 1989. Data were analyzed using either chi 2 tests or z normal tests of proportions, and analyses of variance (ANOVA) and/or t tests. Significance was set at p less than 0.05, and statistically significant F ratios were examined using Student-Newman-Keuls tests. RESULTS: The average age of patients was 70.7 years (24% less than 65 years, 53% 65-79 years, and 23% greater than 79 years). Lengths of stay in acute care and rehabilitation, admission and discharge functional independence ratings, and rates of community discharge were generally inversely related to patient age. Patients with bilateral paresis had lower rates of community discharge than those with unilateral paresis, although this distinction was not evident in the older group. CONCLUSIONS: Results showed that older age and bilateral paresis are negatively associated with levels of independence at admission and discharge and with rates of community discharge.

Activities of Daily Living↗
PubMed1990

Symptomatic atlantoaxial instability associated with medical and rehabilitative procedures in children with Down syndrome.

The Canadian College of Medical Genetics recently questioned the rationale for radiographic screening for atlantoaxial instability in Down syndrome. We report a case series of four children with Down syndrome with symptomatic atlantoaxial instability and followed for more than 5 years. In all cases a medical or rehabilitational procedure was associated with significant apnea, cardiopulmonary compromise, or severe neurological impairments. None of these patients were screened radiographically. The need for protocols to detect atlantoaxial instability in children with Down syndrome undergoing medical and rehabilitational procedures is highlighted by these cases.

Atlanto-Axial Joint↗
PubMed1990

Functional assessment scales: a study of persons with multiple sclerosis.

The purpose of this study was to investigate disability in persons with multiple sclerosis (MS) by using combinations of functional assessment scales and subscales to predict (1) the burden of care measured in minutes of assistance provided per day by another person in the home, and (2) the subject's level of satisfaction with life in general. The Functional Independence Measure (FIM), Incapacity Status Scale, Environmental Status Scale, and the Barthel Index had high intercorrelations with each other. Although each was predictive of the MS subject's physical care needs, the FIM was the most useful. A change in total FIM score of one point was equivalent to an average of 3.38 minutes of help from another person per day. With the Brief Symptom Inventory and the Environmental Status Scale, the FIM contributed to predicting the patient's general satisfaction as well. We propose that burden of care and subjective satisfaction with life be the standards by which functional assessment instruments are compared to reflect, in pragmatic terms, the impact of disability on the lives of individuals and on the human and economic resources of the community.

Activities of Daily Living↗
PubMed1989

The stroke rehabilitation outcome study: Part II. Relative merits of the total Barthel index score and a four-item subscore in predicting patient outcomes.

Part I of this series described the background of the study; the characteristics of the patient population; and their functional status before onset of stroke, at rehabilitation admission, at discharge, and at six months after discharge. Results at follow-up showed that patients with higher Barthel index scores living in the community were more likely to be satisfied with life in general, to have more person-to-person contacts, and to be more active in community affairs. Part II describes the utility of two sets of data derived from the admission Barthel index (combinations of independent performance of four basic items of the index vs the total score) in predicting the likely range of Barthel index scores at discharge and functional outcomes at six-month follow-up.

Activities of Daily Living↗
PubMed1988

Stroke rehabilitation outcome studies: comparison of a Japanese facility with 17 U.S. facilities.

A Japanese university hospital collaborated with a mixed group of 17 American hospitals in using common measures of functional status and outcomes for patients undergoing rehabilitation after stroke. Management protocols were similar for all facilities. Philosophies and operational factors concerning length of stay and discharge destinations varied among facilities. In Japan there was little pressure for discharge of rehabilitation patients. Japanese patients were kept in the hospital as long as they improved in their functional scores. The Japanese sample had fewer patients with bilateral involvement, patients were younger, were admitted after a longer period of time following the onset of the stroke, had less severe disability on admission, and had longer lengths of stay, and this may have accounted for higher Barthel score gains for the Japanese sample. These factors may have worked together with the family support system in Japan to account for higher discharge rate to the community for the Japanese sample.

Activities of Daily Living↗