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Biomedical subjects

C V Granger

Publications and source records attributed to C V Granger.

At least 127 records · Page 7Linked to original sources
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Reliability of a brief outpatient functional outcome assessment measure.

The stability of the musculoskeletal form of the Medical Rehabilitation Follow Along (MRFA) instrument was examined in 47 patients receiving outpatient rehabilitation services. The MRFA instrument was designed to provide information on quality of daily living, including physical function, pain, satisfaction, and emotional/psychological well-being. The instrument consists of thirty questions and can be administered as an interview or a written questionnaire. The MRFA instrument was developed using Rasch analysis procedures and is an extension of previous research involving the Functional Assessment Screening Questionnaire. Forty-seven patients completed the musculoskeletal form of the MRFA on two occasions separated by an interval of 1 to 7 days. The stability of responses was examined using the intraclass correlation coefficient (ICC) and kappa. ICC values for the sections of the MRFA instrument examining quality of daily living and physical functioning ranged from 0.74 to 0.97. ICC values for items assessing pain and feelings of well-being were more variable, ranging from 0.36 to 0.93. The kappa values displayed a similar pattern. The overall stability of the MRFA instrument was found to be adequate for gathering screening information in outpatient settings. Additional research is necessary to confirm the findings of this investigation and extend the results to a larger outpatient population.

Activities of Daily Living↗
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Functional gain and length of stay for major rehabilitation impairment categories. Patterns revealed by function related groups.

This study evaluates the relationship of functional severity to patterns of functional gain and length of stay (LOS) for patients discharged from medical rehabilitation. It further compares differences in patterns between summed and Rasch transformed subscales of the Functional Independence Measure (FIM). Two different schemes of the FIM-Function Related Groups (FIM-FRGs) are used to define groups of patients who present with similar degrees of functional severity. The first scheme was developed using summed admission motor and cognitive FIM subscores (FIM-FRGs). The second scheme was developed by transforming these same motor and cognitive FIM subscores into logits (Logit FIM-FRGs), thus making FIM scores more equal-interval. The study included 32,494 patients who were discharged from 123 facilities that submitted data to the Uniform Data System for Medical Rehabilitation (UDSMR) and involved the separate evaluation of 18 different rehabilitation impairment categories. Motor FIM gain was calculated for each FRG in both schemes as the patient's discharge motor FIM score minus the admission motor FIM score. There were four patterns of motor FIM gain and two patterns of LOS across rehabilitation impairment. The most common pattern in both schemes was linear trend, for which median gains and LOS were highest for patients in the most disabled FRGs and lowest for patients in the least disabled FRGs. Gain patterns differed across impairment and across the two schemes. The motor FIM gain distributions provide clinicians with a range of typical functional outcomes for patients admitted to medical rehabilitation. This descriptive approach provides clinicians and administrators with a simple way to compare the motor FIM gain and LOS patterns of patients teated in local facilities with broad-based norms. This sample includes about one-quarter of rehabilitation facilities nationwide, thus representing population standards for facilities participating in the UDSMR. Suggestions are made on how to use these norms most appropriately for both facility and patient comparison.

Activities of Daily Living↗
PubMedDate not supplied

Validity of a brief outpatient functional assessment measure.

Aspects of validity are investigated with a brief functional assessment measure among outpatients undergoing rehabilitation for musculoskeletal problems. The Medical Rehabilitation Follow Along measure (MRFA) currently has screening, musculoskeletal, neurologic, and multiple sclerosis forms. In this study, the 31-item musculoskeletal form of the MRFA is compared with and contrasted to a measure of general health status, the Medical Outcomes Trust SF-36. Content, construct, and criterion validity are addressed using scale scores before (n = 94) and after (n = 48) outpatient rehabilitation. Scale scores are compared with therapists' ratings of improvement. The results provide support for the validity of inferences made from scale scores of the MRFA for persons with musculoskeletal problems. Applications of the MRFA, including screening, monitoring, and outcome assessment are discussed for clinical management, measuring treatment effectiveness, and program evaluation.

Adult↗
PubMedDate not supplied

A brief outpatient functional assessment measure: validity using Rasch measures.

The Medical Rehabilitation Follow Along (MRFA(TM)) is a brief outpatient functional assessment measure that was developed using Rasch analysis. The MRFA currently has musculoskeletal, neurologic, multiple sclerosis, cardiac, and pulmonary forms. Using Rasch scoring and selected scales, the 31-item musculoskeletal form of the MRFA was compared with and contrasted to a measure of general health status, the Medical Outcomes Trust SF-36. Content, construct, and criterion validity were addressed using scale scores before and after outpatient rehabilitation, as well as therapist ratings of improvement. The results supported the validity of inferences made from the MRFA scales using Rasch measures for persons with musculoskeletal problems. Rasch and raw scoring provided similar results with respect to the validity of the MRFA scales. Implications for the use of Rasch and raw scoring approaches with the MRFA are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Outcome, efficiency, and time-trend pattern analyses for stroke rehabilitation.

We present a series of pattern analysis techniques using inpatient medical rehabilitation as an example setting, stroke as a model diagnosis, and various versions of the Functional Independence Measure-Function Related Groups as a case mix adjuster. The pattern analytic approach uses severity-adjusted benchmarks to distinguish among groups of patients whose outcomes and resource use patterns are lower, typical, or higher than established ranges at set points in treatment. Changing outcome and resource use patterns were illustrated for 1990, 1992, and 1995 discharges (n=34,734). These pattern analytic approaches are applicable to any postacute care rehabilitation setting, assuming the availability of an appropriate case mix adjuster and a reliable patient information system. These techniques provide clinicians with tools to help maintain quality in this era of managed care.

Aged↗
PubMedDate not supplied

Functional assessment and care of children with neurodevelopmental disabilities.

OBJECTIVES: To determine the relationship between pediatric assessment scores and ratings by parents and teachers regarding the amount of assistance required to complete basic activities of daily living; and to examine the relationship among scores for three commonly used pediatric assessments. DESIGN: Prospective correlational study. 205 children with developmental disabilities. The children ranged in age from 11 to 87 mo and included 72 females and 133 males of diverse socioeconomic and ethnic backgrounds. The children were evaluated by using the Battelle Developmental Inventory Screening Test, Vineland Adaptive Behavior Scales, Functional Independence Measure for Children (WeeFIM instrument), and the Amount of Assistance Questionnaire. RESULTS: The test-retest reliability coefficients for items on the Amount of Assistance Questionnaire were found to range from 0.82 to 0.97. Correlations among subscale scores and amount of assistance ratings were highest for the WeeFIM instrument and Battelle Developmental Inventory Screening Test. The highest correlation was between WeeFIM total rating and total amount of assistance rating (r = 0.91). CONCLUSION: Total WeeFIM instrument ratings and severity of disability were the best predictors of amount of assistance ratings provided by parents and teachers.

Activities of Daily Living↗