Hilary Siebens

Correlates and consequences of eating dependency in institutionalized elderly

Loss of independent eating capacity is a major problem for the institutionalized elderly. Few studies have examined the factors associated with loss of functional eating capacity. The authors cross‐sectionally studied 240 residents of a skilled nursing facility, classified their functional eating status, identified correlated deficits, and followed these residents for six months. Information was gathered through questionnaires, chart review, and physical examinations. Residents were stratified into independent (68%, N = 264) and dependent (32%, N = 76) eating status groups according to the need for physical assistance during meals. Dependency status did not correlate with age (P = .88) or weight loss (P = .27). Loss of independence in eating was associated with impaired mobility (P =.0001), impaired cognition (P =.0001), modified consistency diets (P = .0001), upper extremity dysfunction (P = .0001), abnormal oral‐motor examinations (P = .0002), absence of teeth and dentures (P = .002), behavioral indicators of abnormal oral and pharyngeal stages of swallowing (P = .0001), and increased mortality within six months (P = .0001). Eating dependency is therefore associated with multiple impairments and early mortality.

A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults.

OBJECTIVE: Older adults hospitalized for nondisabling diagnoses can lose functional ability. Lack of exercise or physical activity during the acute illness and recovery may be contributory. This study evaluated whether increased exercise in hospital and afterward would shorten length of stay and improve physical function at 1 month.

Computerized Adaptive Testing for Follow-Up After Discharge From Inpatient Rehabilitation: II. Participation Outcomes

OBJECTIVES To measure participation outcomes with a computerized adaptive test (CAT) and compare CAT and traditional fixed-length surveys in terms of score agreement, respondent burden, discriminant validity, and responsiveness. DESIGN Longitudinal, prospective cohort study of patients interviewed approximately 2 weeks after discharge from inpatient rehabilitation and 3 months later. SETTING Follow-up interviews conducted in patients home setting. PARTICIPANTS Adults (N=94) with diagnoses of neurologic, orthopedic, or medically complex conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation domains of mobility, domestic life, and community, social, & civic life, measured using a CAT version of the Participation Measure for Postacute Care (PM-PAC-CAT) and a 53-item fixed-length survey (PM-PAC-53). RESULTS The PM-PAC-CAT showed substantial agreement with PM-PAC-53 scores (intraclass correlation coefficient, model 3,1, .71-.81). On average, the PM-PAC-CAT was completed in 42% of the time and with only 48% of the items as compared with the PM-PAC-53. Both formats discriminated across functional severity groups. The PM-PAC-CAT had modest reductions in sensitivity and responsiveness to patient-reported change over a 3-month interval as compared with the PM-PAC-53. CONCLUSIONS Although continued evaluation is warranted, accurate estimates of participation status and responsiveness to change for group-level analyses can be obtained from CAT administrations, with a sizeable reduction in respondent burden.

Surrogate Decision-Makers' Satisfaction with the Placement of Feeding Tubes in Elderly Patients

Objective: To assess the satisfaction of surrogate decisionmakers with the decision to place feeding tubes in elderly patients with impaired decision‐making capacity.

Measuring physical function in patients with complex medical and postsurgical conditions: A computer adaptive approach

Siebens H, Andres PL, Pensheng N, Coster WJ, Haley SM: Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach. Am J Phys Med Rehabil 2005;84:741–748. Objective:To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure–Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions. Design:Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM™), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions. Results:The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool. Conclusion:The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.

Musculoskeletal problems as comorbidities

Siebens HC: Musculoskeletal problems as comorbidities. Am J Phys Med Rehabil 2007;86(Suppl):S69–S78. Musculoskeletal comorbidities increasingly are prevalent and present specific research challenges and opportunities. Several definitions for musculoskeletal comorbidities exist depending on the patient population and research approach. Population studies document that musculoskeletal problems, defined as arthritis, are the most prevalent condition in the population as a whole and therefore a frequent comorbidity. As adults with disabilities age and as the population as a whole ages, musculoskeletal comorbidities will become increasingly common. Multiple research studies have begun examining the relationships of musculoskeletal conditions to other health conditions in pediatric, middle-aged, and older adults. Multiple specific research approaches are needed to understand predisposing risk factors, prevention, progression, consequences, and treatment strategies for these conditions.

Research agenda for geriatric rehabilitation.

ABSTRACTHoenig H, Siebens H: Research agenda for geriatric rehabilitation. Am J Phys Med Rehabil 2004;83:858–866. The Research Agenda Setting Process is a joint endeavor by the American Geriatrics Society and the Hartford Foundation to increase geriatric expertise in the surgical and related specialties. This article provides the results of the Research Agenda Setting Process project on research needs in geriatric rehabilitation, which included a systematic review of the literature and a group consensus process. Explicit research questions and methodologies were developed for three cross-cutting research needs in geriatric rehabilitation and for the rehabilitation of eight specific conditions affecting older individuals.

Agreement in functional assessment: graphic approaches to displaying respondent effects.

Haley SM, Ni P, Coster WJ, Black-Schaffer R, Siebens H, Tao W: Agreement in functional assessment: graphic approaches to displaying respondent effects. Am J Phys Med Rehabil 2006;85:747–755. Objective:The objective of this study was to examine the agreement between respondents of summary scores from items representing three functional content areas (physical and mobility, personal care and instrumental, applied cognition) within the Activity Measure for Postacute Care (AM-PAC). We compare proxy vs. patient report in both hospital and community settings as represented by intraclass correlation coefficients and two graphic approaches. Design:The authors conducted a prospective, cohort study of a convenience sample of adults (n = 47) receiving rehabilitation services either in hospital (n = 31) or community (n = 16) settings. In addition to using intraclass correlation coefficients (ICC) as indices of agreement, we applied two graphic approaches to serve as complements to help interpret the direction and magnitude of respondent disagreements. We created a “mountain plot” based on a cumulative distribution curve and a “survival-agreement plot” with step functions used in the analysis of survival data. Results:ICCs on summary scores between patient and proxy report were physical and mobility ICC = 0.92, personal care and instrumental ICC = 0.93, and applied cognition ICC = 0.77. Although combined respondent agreement was acceptable, graphic approaches helped interpret differences in separate analyses of clinician and family agreement. Conclusions:Graphic analyses allow for a simple interpretation of agreement data and may be useful in determining the meaningfulness of the amount and direction of interrespondent variation.

Strengthening Information Capture in Rehabilitation Discharge Summaries: An Application of the Siebens Domain Management Model

To increase relevant information capture in inpatient rehabilitation discharge summaries.

Outcomes and Weight-bearing Status During Rehabilitation After Arthroplasty for Hip Fractures

To examine the association of weight‐bearing status with patient‐related variables and outcomes of inpatient rehabilitation after hip arthroplasty for acute hip fracture.