Cross-diagnostic validity in a generic instrument: an example from the Functional Independence Measure in Scandinavia

BACKGROUND: To analyse the cross-diagnostic validity of the Functional Independence Measure (FIM™) motor items in patients with spinal cord injury, stroke and traumatic brain injury and the comparability of summed scores between these diagnoses. METHODS: Data from 471 patients on FIM™ motor items at admission (stroke 157, spinal cord injury 157 and traumatic brain injury 157), age range 11–90 years and 70 % male in nine rehabilitation facilities in Scandinavia, were fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM™ motor items was made prior to testing fit to the model. Categories were re-scored where necessary. Fit to the model was assessed initially within diagnosis and then in the pooled data. Analysis of Differential Item Functioning (DIF) was undertaken in the pooled data for the FIM™ motor scale. Comparability of sum scores between diagnoses was tested by Test Equating. RESULTS: The present seven category scoring system for the FIM™ motor items was found to be invalid, necessitating extensive rescoring. Despite rescoring, the item-trait interaction fit statistic was significant and two individual items showed misfit to the model, Eating and Bladder management. DIF was also found for Spinal Cord Injury, compared with the other two diagnoses. After adjustment, it was possible to make appropriate comparisons of sum scores between the three diagnoses. CONCLUSION: The seven-category response function is a problem for the FIM™ instrument, and a reduction of responses might increase the validity of the instrument. Likewise, the removal of items that do not fit the underlying trait would improve the validity of the scale in these groups. Cross-diagnostic DIF is also a problem but for clinical use sum scores on group data in a generic instrument such as the FIM™ can be compared with appropriate adjustments. Thus, when planning interventions (group or individual), developing rehabilitation programs or comparing patient achievements in individual items, cross-diagnostic DIF must be taken into account

Replication-biased genome organisation in the crenarchaeon Sulfolobus

<p>Abstract</p> <p>Background</p> <p>Species of the crenarchaeon <it>Sulfolobus </it>harbour three replication origins in their single circular chromosome that are synchronously initiated during replication.</p> <p>Results</p> <p>We demonstrate that global gene expression in two <it>Sulfolobus </it>species is highly biased, such that early replicating genome regions are more highly expressed at all three origins. The bias by far exceeds what would be anticipated by gene dosage effects alone. In addition, early replicating regions are denser in archaeal core genes (enriched in essential functions), display lower intergenic distances, and are devoid of mobile genetic elements.</p> <p>Conclusion</p> <p>The strong replication-biased structuring of the <it>Sulfolobus </it>chromosome implies that the multiple replication origins serve purposes other than simply shortening the time required for replication. The higher-level chromosomal organisation could be of importance for minimizing the impact of DNA damage, and may also be linked to transcriptional regulation.</p

CAN REHABILITATION IN THE HOME SETTING REDUCE THE BURDEN OF CARE FOR THE NEXT-OF-KIN OF STROKE VICTIMS? 1

Can rehabilitation in the home setting reduce the burden of care for the next-of-kin of stroke victims?. Background: More evidence of the efficacy of caregiver interventions is needed. The aim of this study was to evaluate whether counselling in the home setting reduces the care giver burden. Methods: Thirtysix patients after stroke, median age 53 years, with a close family member, were selected for an evaluation of the burden of care and 35 participated. They were part of a randomized controlled trial, comparing rehabilitation in the home setting with outpatient rehabili tation. In the home setting, counselling about the stroke and its consequences was included. Assessments with the Care giver Burden scale were made at 3 weeks, 3 months and one year after discharge. Results: The burden of the 2 groups did not differ. After the intervention, there was a tendency to a lower burden for the home setting. The burden for the home setting was then unchanged from 3 weeks to 1 year, while outpatient rehabilitation showed a reduced burden over time. For the home setting, significant correlations to activity level were seen after the intervention. Conclusion: A positive effect of counselling was seen, as the home setting burden tends to be lower after the intervention, while outpatient rehabilitation seems to adjust with time. The results suggest that counselling reduces burden and the remaining burden is associated with the patient&apos;s ability. Journal of Rehabilitation Medicin

Junctional Proteins and Ca(2+) Transport in the Rat Odontoblast-Like Cell Line MRPC-1

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42361/1/223-68-3-192_10680192.pd

A multicenter study on transfer, walking and stair climbing in persons with stroke admitted to specialized rehabilitation

Background: Walking on even surface and stair walking capacity are prerequisites for independence, and these capacities are often referred to as primary goals in rehabilitation after stroke

Specialized stroke rehabilitation services in seven countries

Background There is a lack of defined levels of rehabilitation, indicating possibly random content and access to specialized services. Aims and/or hypothesis The aim of the study was to perform a multinational descriptive study of specialized rehabilitation in persons with stroke, to elucidate what the different centers define as prerequisites for specialized rehabilitation, and to analyze whether these descriptions map to currently applied standards or constructs of specialized rehabilitation. A secondary aim was to look for similarities and differences between therapies and services for persons with stroke in the sub-acute stage in the different institutions. Methods Descriptive data of the collaborating centers regarding structure and processes of services were recorded and compared with the British Society of Rehabilitation Medicine and Specialized Services National Definitions sets. Results Comparisons of the definitions

Patient Reported Outcome Measures in Osteoarthritis: A systematic search and review of their use and psychometric properties

Introduction Patient Reported Outcome Measures (PROMs) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task. Methods The study included a systematic search for PROMs that have been in use over a 17 year-period (2000-2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion. Results 78 PROM’s were identified with psychometric evidence available. The domains of Pain, Selfcare, Mobility and Work dominated, whereas domains such as Cleaning & Laundry and Leisure, together with psychological and contextual factors were poorly served. The most frequently utilised PROMs included the WOMAC, the SF-36 and the KOOS which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence. Conclusion A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored

Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades

Introduction The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. Methods The study included a systematic search for PROMs that have been in use over the period 2000–2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. Results 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. Conclusion There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model