Christine Glenny

Comparing the functional independence measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature.

BackgroundThe rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems.MethodsEnglish language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements.ResultsIn total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS.ConclusionAdditional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.

Inpatient versus home-based rehabilitation for older adults with musculoskeletal disorders: a systematic review

Objective: To review and summarize available evidence to compare the outcomes of home-based rehabilitation to inpatient rehabilitation for older patients with musculoskeletal conditions. Data sources: Relevant articles published prior to August 2011 were identified using MEDLINE, CINAHL and the Cochrane Central Register of Controlled Trials databases. Review methods: English-language articles that compared patient outcomes of home-based and inpatient rehabilitation for older adults were included. Outpatient care was not included as home-based or inpatient rehabilitation. Methodological quality of included studies was evaluated by two reviewers using the PEDro scale. Results: A systematic search yielded eight randomized controlled trials and four cohort studies. Older adults who received rehabilitation in the home had equal or higher gains than the inpatient group in function, cognition, and quality of life; they also reported higher satisfaction. Conclusion: Home-based rehabilitation may be an effective alternative for treating older patients with musculoskeletal conditions.

The use of electronic health information systems in home care: facilitators and barriers.

Electronic health information systems (EHIS) containing standardized assessment data (e.g., RAI-Home Care, Outcome and Assessment Information Set [OASIS]) hold considerable promise, but their potential has yet to be fully realized. Literature was searched for strategies on implementing and using EHIS, including barriers and facilitators of their use in home care. Results of this review will be discussed in terms of their implications for the future development and use of EHIS in home care, and for future research.

A multi-site study of the feasibility and clinical utility of Goal Attainment Scaling in geriatric day hospitals

Background: Goal Attainment Scaling (GAS) is an individualized goal-setting and measurement approach that is useful for patients with multiple, individualized health problems, such as those served by geriatric day hospitals (GDHs) and other specialized geriatric programmes. Purpose: To assess the feasibility and utility of GAS in a multi-site study of six GDH affiliated with the Regional Geriatric Programmes of Ontario. Method: Individualized GAS guides were developed for 15 consecutively admitted patients at each site [total n = 90; mean age: 76.2 SD 8.3; 58.9% female; mean attendances: 24.0 SD 10.3]. Staff members (n = 39) were surveyed on their experience with GAS. Results: Mean goals/patient ranged across sites from 2.1 to 4.3. Mean GAS discharge score was 52.3 SD 8.7, close to the theoretically expected values of 50 SD 10. Common goals included mobility, community reintegration, basic and instrumental activities of daily living, medical issues, cognition/communication, and home safety. Estimated mean time to develop a GAS guide ranged across sites from 15.3 to 43.8 min. Conclusion: Clients were often involved in goal setting; family involvement was less frequent. The staff survey identified challenges and benefits regarding the use of GAS. Study results are being used to inform a more consistent approach to the clinical and research use of GAS in GDH. Implications for Rehabilitation The geriatric day hospital (GDH) has had a long history as one element of a comprehensive system of specialized geriatric services with potential advantages including ongoing treatment and rehabilitation from an interdisciplinary team. Despite this history, the evidence for the effectiveness of GDHs in rehabilitation of older persons has been equivocal. We found that Goal Attainment Scaling (GAS) was able to detect clinically relevant change in this setting which can aid in demonstrating evidence for the utility and impact of GDHs. GAS was feasible in this setting and clinicians felt that GAS may have an effect on speeding up discharge, as a result of having a clearer focus on outcomes that are desired for each patient. Clinicians felt the involvement of clients and families in goals settings resulted in more meaningful outcomes for clients and GAS aided in identifying highly individual outcomes such as quality of life and community integration that are routinely difficult to measure with standardized tools.

Comparison of the Responsiveness of the FIM and the interRAI Post Acute Care Assessment Instrument in Rehabilitation of Older Adults

OBJECTIVE To compare the responsiveness of 2 major systems developed for rehabilitation settings--the FIM and the interRAI Post Acute Care (PAC) assessment--in older patients. DESIGN Trained raters assessed patients with both tools at admission and discharge. SETTING Musculoskeletal (MSK) and geriatric rehabilitation units (GRUs) in 2 rehabilitation hospitals. PARTICIPANTS Older adults receiving rehabilitation (N=208; mean age +/- SD, 78.5+/-9.3; 67% women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Responsiveness was evaluated using effect size (ES) and standardized response mean (SRM). RESULTS ES and SRM were somewhat higher for the FIM motor (GRU ES=1.68, SRM=1.31; MSK ES=2.12, SRM=2.25) than the PAC (GRU ES=1.64, SRM=1.29; MSK ES=1.57, SRM=1.89) in both patient groups. Both tools were more responsive in MSKs than GRUs. This may reflect the greater frailty and clinical complexity of GRU patients. CONCLUSIONS Both the FIM motor and the PAC were able to detect clinically relevant improvement in functional ability in older rehabilitation inpatients.

An Evidence-Based Guideline for the Frequency of Optometric Eye Examinations

Background: Visual impairment has been recognized as a global health problem. Periodic optometric eye examinations have long been recognized as the “backbone” of strategies to prevent vision loss and blindness. The purpose of this study was to develop a frequency of eye examinations guideline for typical optometric eye examinations in Canada using the best available evidence. Methods: Guideline development involved: (1) an online search to identify existing evidence-based eye examination guidelines; (2) a literature review to identify studies investigating eye examination frequency and visual outcomes, and eye disease and refractive error epidemiology; (3) critical evaluation of the available evidence; (4) development of a draft guideline; (5) a workshop for optometric experts to appraise (and revise, where necessary) the draft guideline; and (6) an external review of the guideline by optometric patients and experts. The AGREE II Instrument and the RAND/UCLA Appropriateness Method were used to guide the development process. Results: Through synthesis of the literature review, expert workshop, and external review, the following guideline is recommended: infants and toddlers should undergo their first eye examination between the ages of 6 and 9 months; preschool children should undergo at least one eye examination between the ages of 2 and 5 years; school children aged 6 to 19 years should undergo an eye examination annually; adults aged 20 to 39 years should undergo an eye examination every 2 to 3 years; adults aged 40 to 64 years should undergo an eye examination every 2 years, and; adults aged 65 years or older should undergo an eye examination annually. Conclusion: The purpose of this guideline is to inform individuals who are either asymptomatic or have symptoms they do not recognize as being eye-related. Therefore, this guideline is meant to aid in the early detection of visual disorders in order to prevent or reduce future vision loss. *Corresponding author: Barbara E. Robinson, PhD, School of Optometry and Vision Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, Tel: (519) 888-4567; Fax: (519)725-0784; E-mail: robinson@uwaterloo.ca Received June 04, 2012; Accepted August 01, 2012; Published August 03, 2012 Citation: Robinson BE, Mairs K, Glenny C, Stolee P (2012) An Evidence-Based Guideline for the Frequency of Optometric Eye Examinations. Primary Health Care 2:121. doi:10.4172/2167-1079.1000121 Copyright:

Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms.

BackgroundResources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment.MethodsWe applied two algorithms from machine learning and data mining ― the LASSO and the random forest ― to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada.ResultsAnalyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not.ConclusionsInconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice.

A comparison of two assessment systems in predicting functional outcomes of older rehabilitation patients

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A qualitative study of healthcare provider perspectives on measuring functional outcomes in geriatric rehabilitation

Objectives: To explore, from the perspective of healthcare providers, the barriers to and facilitators of using standardized outcome measures of physical function in geriatric rehabilitation settings. Methods: In-depth semi-structured interviews with medical doctors, nurses, physiotherapists and occupational therapists were conducted from three geriatric rehabilitation hospitals in Ontario. Qualitative content analysis through an inductive approach was used to identify barriers to and facilitators of outcome measurement in geriatric rehabilitation settings. Results: A total of 20 healthcare providers from different disciplines were interviewed. Barriers are standardized outcome measures that (1) cannot be used in isolation to inform clinical decision-making for older patients, (2) are difficult to complete and interpret in older complex patients, (3) may not be useful for all members of the clinical team and (4) are used for reasons unrelated to patient care. Facilitators are to (1) divide the standardized outcome measure into components that are useful for each team member’s practice, (2) encourage standardized outcome measures as tools for improving daily communication and (3) provide adequate education and support for their daily use. Conclusion: This study revealed important barriers to using standardized outcome measures in geriatric rehabilitation from the perspective of healthcare providers. However, it also identified multiple factors that may help facilitate their use.