Biomedical subjects

Stephen M Haley

Publications and source records attributed to Stephen M Haley.

At least 55 records · Page 3Linked to original sources

PubMed2003

Item-specific functional recovery in children and youth with acquired brain injury.

PURPOSE: The purpose of this study was to examine changes in item-specific functional activities and caregiver support in children and youths with acquired brain injury (ABI) in an inpatient setting using the Pediatric Evaluation of Disability Inventory (PEDI). METHODS: The PEDI was administered by therapy staff at admission and discharge to a consecutive sample of 94 children and youths with brain injury (62 males and 32 females; age range = one to 19 years of age) admitted to the inpatient service at Franciscan Children's Hospital and Rehabilitation Center during a two-year, 10-month period. Individual PEDI item scores were abstracted from the medical records. RESULTS: Using the Wilcoxon matched-pairs signed rank test (two-tailed), significant differences between admission and discharge scores were found for most mobility, self-care, and social activity item groups and for all domains of caregiver support. Patterns of activity-specific improvements were contrasted between children with traumatic ABI and those with nontraumatic ABI. CONCLUSIONS: Recovery in children with ABI can be detected during inpatient rehabilitation across many areas of functioning as represented by item content of the PEDI. Changes at the item level may serve as a guide for defining specific physical therapy goals for inpatient episodes. Item groups in which changes are not detected provide information about sections of the PEDI that are less relevant for hospital-based recovery of children with ABI.

Journal Article↗

PubMed2003

Is patient-reported function reliable for monitoring postacute outcomes?

OBJECTIVE: A major challenge in the development of a comprehensive measurement system to evaluate effectiveness across a broad range of postacute care settings is the stability and consistency of outcomes measures across respondents and settings. The objective of this study was to investigate the test-retest and subject-proxy reliability of activity scores for use in a new postacute care outcome instrument using an interview format across different care settings. DESIGN: Twenty-five subjects were randomly selected from a larger study of 485 individuals and were interviewed on two occasions within 1 to 4 days to assess self-reported test-retest reliability of summary scores of the Activity Measure-Post-Acute Care item pool. Proxy reliability was tested by interviewing the primary physical or occupational therapist or family member using an identical questionnaire in addition to the subject in 45 patients. RESULTS: Test-retest and subject-proxy reliability was acceptable for the three domains of the activity construct: physical and movement, personal and instrumental, and applied cognition with intraclass correlation coefficients of the summary scores of each of the three domains ranging between 0.91 and 0.97 for test-retest and 0.68 and 0.90 for subject-proxy. CONCLUSIONS: Reliability is adequate to justify use of these activity scales across respondents and settings.

Adult↗

PubMed2003

Comparison of functional status tools used in post-acute care.

There is a growing health policy mandate for comprehensive monitoring of functional outcomes across post-acute care (PAC) settings. This article presents an empirical comparison of four functional outcome instruments used in PAC with respect to their content, breadth of coverage, and measurement precision. Results illustrate limitations in the range of content, breadth of coverage, and measurement precision in each outcome instrument. None appears well-equipped to meet the challenge of monitoring quality and functional outcomes across settings where PAC is provided. Limitations in existing assessment methodology has stimulated the development of more comprehensive outcome assessment systems specifically for monitoring the quality of services provided to PAC patients.

Activities of Daily Living↗

PubMed2003

An assessment tool translation study.

Policymakers hoped to substitute a new, multi-purpose, functional assessment instrument, the minimum data set post-acute care (MDS-PAC), into the planned prospective payment system (PPS) for inpatient rehabilitation hospitals. PPS design requires a large database linking treatment costs with measures of the need for care, so the PPS was designed using the functional independence measure (FIM) database linked to Medicare hospital claims. An accurate translation from the MDS-PAC items to FIM--like items was needed to ensure payment equity under the substitution. This article describes the translation efforts and some of the problems that led policymakers to abandon the effort.

Activities of Daily Living↗

PubMed2003

Measuring functional change in children with acquired brain injury (ABI): comparison of generic and ABI-specific scales using the Pediatric Evaluation of Disability Inventory (PEDI).

BACKGROUND AND PURPOSE: The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. SUBJECTS: Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1-20) with ABI during inpatient rehabilitation admissions were included. METHODS: Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. RESULTS: Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. DISCUSSION AND CONCLUSION: The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.

Activities of Daily Living↗

PubMed2003

Establishing minimal clinically important differences for scores on the pediatric evaluation of disability inventory for inpatient rehabilitation.

BACKGROUND AND PURPOSE: Standardized pediatric assessment tools such as the Pediatric Evaluation of Disability Inventory (PEDI) numerically quantify changes during rehabilitation through test scores, but they are unable to provide client-specific information regarding important changes in function. The purpose of this study was to identify the smallest change in PEDI scores during inpatient rehabilitation that was considered to be a minimal clinically important difference (MCID) by physical therapists and other clinicians. SUBJECTS AND METHODS: A retrospective review was done of the medical charts of 53 children and youth (1-19 years of age) discharged from an inpatient rehabilitation hospital. Fifteen clinicians (5 physical therapists, 6 occupational therapists, and 4 speech and language pathologists) who were masked to the PEDI scores provided ratings of the magnitude of functional changes during inpatient rehabilitation using a Likert scale and a visual analog scale (VAS). Ratings by clinicians were reduced to 4 categories, including the MCID, and compared with PEDI change scores. RESULTS: The MCIDs ranged from 6 to 15 points (X=11.5, 95% confidence interval= +/- 2.8) for all PEDI scales. Likert scale and VAS ratings were correlated (tau =.73-.80). DISCUSSION AND CONCLUSION: Across all scales, PEDI change scores on the order of about 11% (0-100 scale) appear to be meaningful to clinicians during a child's or adolescent's inpatient rehabilitation. These data can serve as a starting point for interpreting group and individual changes on the PEDI during physical therapy intervention in inpatient rehabilitation.

Activities of Daily Living↗

PubMed2002

Classifying mobility recovery in children and youth with brain injury during hospital-based rehabilitation.

PRIMARY OBJECTIVE: This article describes mobility recovery for children and youth with traumatic and non-traumatic brain injury during hospital-based rehabilitation. RESEARCH DESIGN: A retrospective, descriptive pre-test/post-test design was used. METHODS AND PROCEDURES: One hundred and fifty-seven individuals with brain injury who were admitted for rehabilitation over a 5-year period were enrolled in this study. The Paediatric Evaluation of Disability Inventory (PEDI) was used to document functional mobility at admission and discharge from the rehabilitation programme. The PEDI mobility classification system consisting of seven discrete levels of mobility was developed to provide clinically relevant and succinct outcome information. MAIN OUTCOMES AND RESULTS: The majority of children with brain injury (69%) improved one or more mobility classification levels. Children in the traumatic brain injury group made greater changes (p = 0.001) in mobility recovery than children in the non-traumatic group. CONCLUSIONS: Information about recovery using a well-defined functional classification system may assist with programme evaluation and facilitate optimal service delivery.

Adolescent↗

PubMed2002

Developing a responsive measure of change for paediatric brain injury inpatient rehabilitation.

PRIMARY OBJECTIVE: To describe conceptual and methodological issues to be addressed in developing a responsive clinical performance measure for paediatric brain injury inpatient rehabilitation. Selected statistical approaches used to examine responsiveness of two functional activity scales (daily and social behavioural activity) of a prototype measure are presented to illustrate these issues. RESEARCH DESIGN: Retrospective chart review. METHODS AND PROCEDURES: Data on 65 children, aged 6 months to 18 years (X = 9.5 years) were collected during 1998 and 1999 from eight sites in the USA. Responsiveness was examined using effect sizes and a number of parametric and non-parametric tests. MAIN OUTCOMES AND RESULTS: Significant improvements from admission to discharge were found on all item and scale scores (p < 0.001). Moderate significant relationships were found between activity scale change scores and external ratings of change. CONCLUSIONS: Findings provide evidence that the activity scales have the potential to be responsive and point to issues that will need to be addressed in future measurement development.

Activities of Daily Living↗

PubMed2002

Late life function and disability instrument: I. Development and evaluation of the disability component.

BACKGROUND: Efforts to evaluate the effectiveness of clinical and community-based interventions designed to impact late-life disability have been hindered significantly by limitations in current instrumentation. More conceptually sound and responsive measures of disability are needed. METHODS: Applying Nagi's disablement model, we wrote questionnaire items that assessed disability in terms of frequency and limitation in performance of 25 life tasks. We evaluated their validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 and older who had a range of functional limitations, using factor analysis and Rasch analytic techniques to examine and refine the instrument. RESULTS: Our analyses resulted in a 16-item disability component with two dimensions, one focused on frequency of performance and the other addressing limitation in performance of life tasks, with two disability domains within each dimension. The frequency dimension consisted of a personal and a social role domain, and the limitation dimension consisted of an instrumental and a management role domain. Expected differences in summary scores of known-functional limitation groups support the validity of this instrument. Test-retest intraclass correlations of the reproducibility of each overall dimension summary score were moderate to high (intraclass correlation coefficients .68-.82). CONCLUSIONS: The Late-Life Function and Disability Instrument has potential to assess meaningful concepts of disability across a wide variety of life tasks with relatively few items.

Activities of Daily Living↗

PubMed2002

Late Life Function and Disability Instrument: II. Development and evaluation of the function component.

BACKGROUND: Self-reported capability in physical functioning has long been considered an important focus of research for older persons. Current measures have been criticized, however, for conceptual confusion, lack of sensitivity to change, poor reproducibility, and inability to capture a wide range of upper and lower extremity functioning. METHODS: Using Nagi's disablement model, we wrote physical functioning questionnaire items that assessed difficulty in 48 common daily tasks. We constructed the instrument using factor analysis and Rasch analytic techniques and evaluated its validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 years and older who had a range of functional limitations. RESULTS: Our analyses resulted in a 32-item function component with three dimensions--upper extremity, basic lower extremity, and advanced lower extremity functions. Expected differences in summary scores of known-functional limitation groups support its validity. Test-retest stability over a 1- to 3-week period was extremely high (intraclass correlation coefficients =.91 to.98). CONCLUSIONS: The Late-Life Function and Disability Instrument has potential to assess activity concepts related to upper and lower extremity functioning across a wide variety of daily physical tasks and individual levels of physical functioning.

Activities of Daily Living↗

PubMed2002

Functional changes during inpatient rehabilitation for children with musculoskeletal diagnoses.

PURPOSE: The purpose of this study was to describe functional self-care and mobility changes of children with musculoskeletal diagnoses during inpatient rehabilitation. METHODS: A retrospective record review was completed for 50 children and youth aged three to 20 years admitted to inpatient rehabilitation after a traumatic musculoskeletal injury or after orthopedic surgery because of a preexisting musculoskeletal or neuromuscular disorder. Admission to discharge changes in summary scaled scores on the Pediatric Evaluation of Disability Inventory's (PEDI) Functional Skills and Caregiver Assistance Self-Care and Mobility scales for the total group and two diagnostic subgroups were examined using paired t tests and effect-size coefficients. Independent t tests were used to determine differences between change scores for the subgroups. RESULTS: Mean PEDI Functional Skills Self-Care and Mobility scaled scores were significantly higher at discharge for the total group. For the subgroups, both Functional Skills and Caregiver Mobility scaled scores were significantly higher at discharge, but only the trauma group made a significant change in Self-Care, on the Caregiver Assistance scale. Effect-size coefficients ranged from 0.23 to 1.76. The trauma group demonstrated significantly greater changes than the postsurgical group on both scales in both domains. CONCLUSIONS: During inpatient rehabilitation, children with musculoskeletal diagnoses demonstrated significant functional improvements. Children with traumatic injuries made greater gains than children with preexisting conditions after orthopedic surgery. These results support the PEDI as a responsive measure of change during inpatient rehabilitation for children with musculoskeletal diagnoses.

Journal Article↗

PubMed2002

Functional recovery in pediatric traumatic brain injury during inpatient rehabilitation.

OBJECTIVE: To examine changes in functional status of children with traumatic brain injury by identifying the pattern and amount of change between and within the domains of self-care, mobility, and social function during inpatient rehabilitation and to examine the relationships of age and injury severity to functional recovery. DESIGN: Retrospective descriptive study. Seventy-nine children and adolescents with traumatic brain injury were assessed at inpatient rehabilitation hospital admission and discharge by using the Pediatric Evaluation of Disability Inventory's (PEDI) functional skills and caregiver assistance domains of self-care, mobility, and social function. RESULTS: Admission self-care functional levels were significantly greater than mobility and social function for both PEDI scales. At discharge, significant improvement was noted within all three domains and the amount of change between domains was significantly greater for the mobility domain on both scales. Age was not related to the amount of recovery. Admission functional status was moderately negatively correlated to the change in PEDI scores (ranging from r = -0.432 to -0.681). CONCLUSIONS: Variations exist in the recovery of self-care, mobility, and social function capability and independence during inpatient rehabilitation. Self-care was the least affected. Participants showed significant improvement in all domains, with the most recovery in mobility. Children with greater functional deficits demonstrated greater functional gains.

Activities of Daily Living↗

PubMed2002

Clinical findings and resource use of infants and toddlers dependent on oxygen and ventilators.

Medical records were reviewed to describe characteristics, report clinical and resource measures, and determine if differences exist between the diagnostic groups of prematurity and multiple congenital anomalies/neurologic conditions for initial admissions of 37 infants and toddlers to an inpatient pulmonary rehabilitation program. More than 75% of the children had a tracheostomy at admission and discharge. Forty-six percent of the sample was admitted requiring only oxygen, whereas 51% were discharged requiring only oxygen and not mechanical ventilation. Thirty percent of the children weaned to a less invasive mode of ventilation while just under half of the children were discharged home. Between-group comparisons indicated statistically significant differences for nutritional support at discharge (p < or = 0.05) and discharge disposition (p = 0.04). Complete weaning of oxygen or ventilator support during an initial inpatient pulmonary rehabilitation admission occurred less frequently than weaning to a less invasive mode of ventilation. This is an important consideration for referring children to rehabilitation programs, for clinical program improvement activities, and for setting realistic expectations for referral sources, patients and families, clinical staff, and payers. Further study is recommended using clinical data in program planning, in program improvements, and for setting outcome expectations for infants and toddlers dependent on pulmonary technology.

Child, Preschool↗

PubMedDate not supplied

Participation readiness at discharge from inpatient rehabilitation in children and adolescents with acquired brain injuries.

OBJECTIVE: To describe the extent of readiness for participation in home, school and community life at discharge from inpatient rehabilitation and selected factors associated with participation readiness in children and adolescents with acquired brain injuries. METHODS: Staff from eight sites used retrospective review to complete a prototype clinical performance measure on up to 10 of their most recent discharges. Data were obtained on 65 children and adolescents, aged 6 months to 18 years (X = 9.5 years). The extent of participation readiness was analysed descriptively. Associations between selected variables and participation readiness were examined using correlation and multiple regression analyses. RESULTS: Only 3-27% of the children were deemed ready for age-expected participation at discharge in 15 domains of home, school and community life. Social behavioural activity performance at discharge explained 74% of the variance associated with participation readiness at discharge. CONCLUSIONS: The low percentage of children deemed ready for age-expected participation has implications for post-discharge programming, since 82% of the children were discharged home. Participation readiness may not be an easily achievable goal or may not be fully addressed during inpatient rehabilitation. Preliminary findings suggest that social-behavioural activity performance is a key variable to be considered in efforts to promote participation readiness.

Activities of Daily Living↗

PubMedDate not supplied

Re-admissions to inpatient paediatric pulmonary rehabilitation.

OBJECTIVE: To describe re-admission rates, identify reasons for re-admission and examine characteristics of children requiring re-admission to inpatient pulmonary rehabilitation. METHODOLOGY: Retrospective record review of infants and toddlers (less than three years of age) requiring oxygen or ventilator support discharged from an inpatient paediatric pulmonary rehabilitation programme between 1992 and 1999. RESULTS: Forty-one initial admissions resulted in 45 readmissions with a mean re-admission rate of 1.1 (SD = 1.41) re-admissions per child. Children with re-admissions (n = 22, 54%) required significantly more ventilator support (p = 0.001) and nursing care (p = 0.001) and were transferred to acute care more frequently (p = 0.002) than children without re-admissions. One-half of the children re-admitted to inpatient pulmonary rehabilitation were re-admitted two or more times. CONCLUSIONS: Based on this cohort of children, dependence on supplemental oxygen and/or mechanical ventilation and medical complexity may be indicators that children will require re-admission to rehabilitation following a transfer back to acute care. Further examination of re-admission rates and reasons and children's clinical characteristics may have predictive value and provide practice improvement opportunities.

Boston↗

PubMedDate not supplied

Development of a disease-specific disability instrument for Pompe disease.

PURPOSE: The purpose of this study was to modify the Paediatric Evaluation of Disability Inventory (PEDI) to create a Pompe disease-specific disability instrument for use in clinical trials and natural history studies. METHODS: PEDI item content was revised to include self-care and mobility items appropriate for children and youth with Pompe disease. Data were collected on 30 individuals with Pompe disease (mean age 7.7+/-5.6 years; range 0.4-22.1 years) by parent proxy through telephone interviews. New items were merged with original PEDI items using Rasch rating scale methods. RESULTS: The Pompe-PEDI extended the content range and scoring precision of the original PEDI. Construct validity was demonstrated and test-re-test reliability was excellent. CONCLUSIONS: The Pompe-PEDI is a reliable and valid instrument to assess and monitor the functional changes of children and youth with Pompe disease.

Child↗

PubMedDate not supplied

Physical performance testing in mucopolysaccharidosis I: a pilot study.

OBJECTIVE: To develop and field-test a physical performance measure (MPS-PPM) for individuals with Mucopolysaccharidosis I (MPS I), a rare genetic disorder. METHODS: Motor performance and endurance items were developed based on literature review, clinician feedback, feasibility, and equipment and training needs. A standardized testing protocol and scoring rules were created. The MPS-PPM includes: Arm Function (7 items), Leg Function (5 items), and Endurance (2 items). Pilot data were collected for 10 subjects (ages 5-29 years). We calculated Spearman's rho correlations between age, severity and summary z-scores on the MPS-PPM. RESULTS: Subjects had variable presentations, as correlations among the three sub-test scores were not significant. Increasing age was related to greater severity in physical performance (r = 0.72, p<0.05) and lower scores on the Leg Function (r = -0.67, p<0.05) and Endurance (r = -0.65, p<0.05) sub-tests. The MPS-PPM was sensitive to detecting physical performance deficits, as six subjects could not complete the full battery of Arm Function items and eight subjects were unable to complete all Leg Function items. Subjects walked more slowly and expended more energy than typically developing peers. CONCLUSIONS: Individuals with MPS I have difficulty with arm and leg function and reduced endurance. The MPS-PPM is a clinically feasible measure that detects limitations in physical performance and may have potential to quantify changes in function following intervention.

Adolescent↗

PubMedDate not supplied

Evaluation of the nutrition counselling component of a fitness programme for children with disabilities.

OBJECTIVE: To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities. METHODS: Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented. RESULTS: No significant BMI changes were recorded for the entire group (n=28) or a sub-group with a goal to decrease BMI (n=8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar. CONCLUSION: Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.

Adolescent↗