A short measure of balance in multiple sclerosis: validation through Rasch analysis

Ambulatory patients with multiple sclerosis (MS) frequently present with poor balance. Neither static nor dynamic posturography explore balance during self-paced movements in real-life activities, when fall is most probable. Behavioural item-response scales can easily represent these activities. However, testing many items can easily cause fatigue in MS patients, thus distorting their scores. On the other hand, the lower the number of items, the lower the precision of the cumulative score and its reliability. A new short instrument: was derived from existing ones (the Tinetti and the Berg balance scales). A preliminary 10-item version encompassed sit/stand manoeuvres, standing with eyes open and closed, standing with eyes closed and head extended, leaning forward while standing, picking up an object from floor, resisting nudges on the sternum, turning around, tandem stance. The instrument was administered 1-3 times to 55 MS patients (103 observations overall), all of them able to walk autonomously for at least 20 metres. The Rasch Analysis was adopted to explore the psychometric validity of the scale. Two items (Stand-to-sit and Standing with eyes open) were deleted, as they were too easy and thus uninformative. The remaining 8 items made up a scale (called EQUISCALE) complying with the requirements of unidimensionality and reliability. The item scores remained stable in a sub-sample of 24 patients tested before and after ten 1-hour exercise sessions, thus supporting the homogeneity of the items

The FIMTM instrument in the United States and Italy: A comparative study

Objective: To compare FIMTM instrument ratings between Italy and the United States. Design: This study utilized 169,835 United States and 4,536 Italian FIM instrument records for stroke with the left side of the body affected, stroke with the right side of the body affected, and orthopedic conditions. Results: Case-mix, patient age, and admission and discharge FIM instrument scores were similar. The delays between onset of disability and admission to rehabilitation and lengths of stay in rehabilitation were 2-4 times longer in Italy. In Italy, some 88-95% of the subjects were discharged to the community vs. 74-88% in the United States. Hierarchies of FIM instrument ratings across the motor and cognitive items were similar, but there were interesting differences. The hierarchical patterns showed that dressing, bathing, perineal hygiene, and tub or shower transfer were relatively more difficult in Italy compared with the Unites States, whereas walking was easier in Italy compared to the United States. Conclusion: The Italian health care payment system offers less incentive for early discharges from acute care and rehabilitation. In Italy, nursing homes are less accessible, whereas family support is more available. Apparently less intensive treatment is applied in Italy, where a minimum time per day for rehabilitation services is not mandatory for payment. Occupational therapy is not used in Italy and the focus is more on physical therapy

Inpatient Rehabilitation Units: Age and Comorbidities Are Not Relevant if Admission Fits the Mission

The aging and disability epidemics are pressing the health-care system for the appropriate allocation of resources for the expensive inpatient rehabilitation. The key point is deciding whether old age and the associated comorbidities should determine the assignment to \u201cgeriatric\u201d or \u201cgeriatric rehabilitation\u201d units or to nursing homes provided with some rehabilitation services, rather than to specific hospital rehabilitation units. An extensive international epidemiologic research, based on sophisticated models of case-mix classification including demographic, biomedical, and disability indexes, showed that age and comorbidities are, themselves, not major determinants of the outcome in rehabilitation units. However, the core aspect is the admission policy. In the reality, admissions at rehabilitation units require a prognosis for (a) functional improvement in the short midterm (1\u201312 months) and (b) need and tolerance for specific motor, cognitive, and visceral-sphincteric exercise treatments. Units can be differentiated in order to fit the needs of long stay-low-tolerance cases of any age, yet retaining their rehabilitation identity. Downstream a correct admission, elderly/comorbid patients may benefit from specific rehabilitation units not less than younger patients