Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database

This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p 1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity

Provider Expectations for Recovery Scale: Refining a measure of provider attitudes

OBJECTIVE: The purpose of this study was to refine and test the psychometric properties of a scale to measure provider attitudes about recovery. METHODS: This was a secondary data analysis that combined survey data from 1,128 mental health providers from 3 state hospitals, 6 community mental health centers, and 1 VA Medical Center. Rasch analyses were used to examine item-level functioning to reduce the scale to a briefer, unidimensional construct. Convergent validity was assessed through correlations with related measures. RESULTS: The Provider Expectations for Recovery scale had strong internal consistency, was related to education and setting in expected ways, and was associated with lower levels of burnout and higher levels of job satisfaction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A 10-item scale of Provider Expectations for Recovery appears to be a useful tool to measure an important construct in recovery-oriented care. The process of refining the measure also highlights potential factors in how providers view recovery

Pragmatic characteristics of patient-reported outcome measures are important for use in clinical practice

OBJECTIVES: Measures for assessing patient-reported outcomes (PROs) that may have initially been developed for research are increasingly being recommended for use in clinical practice as well. Although psychometric rigor is essential, this article focuses on pragmatic characteristics of PROs that may enhance uptake into clinical practice. STUDY DESIGN AND SETTING: Three sources were drawn on in identifying pragmatic criteria for PROs: (1) selected literature review including recommendations by other expert groups; (2) key features of several model public domain PROs; and (3) the authors' experience in developing practical PROs. RESULTS: Eight characteristics of a practical PRO include: (1) actionability (i.e., scores guide diagnostic or therapeutic actions/decision making); (2) appropriateness for the relevant clinical setting; (3) universality (i.e., for screening, severity assessment, and monitoring across multiple conditions); (4) self-administration; (5) item features (number of items and bundling issues); (6) response options (option number and dimensions, uniform vs. varying options, time frame, intervals between options); (7) scoring (simplicity and interpretability); and (8) accessibility (nonproprietary, downloadable, available in different languages and for vulnerable groups, and incorporated into electronic health records). CONCLUSION: Balancing psychometric and pragmatic factors in the development of PROs is important for accelerating the incorporation of PROs into clinical practice

The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory

OBJECTIVES: To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention. METHODS: Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings. PARTICIPANTS: Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings. MAIN MEASURES: MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement. RESULTS: Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement. CONCLUSIONS: 5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID

Moment Methods for Advection on Networks and an Application to Forest Pest Life Cycle Models

This paper develops low-dimensional moment methods for advective problems on networks of domains. The evolution of a density function is described by a linear advection-diffusion-reaction equation on each domain, combined via advective flux coupling across domains in the network graph. The PDEs' coefficients vary in time and across domains but they are fixed along each domain. As a result, the solution on each domain is frequently close to a Gaussian that moves, decays, and widens. For that reason, this work studies moment methods that track only three degrees of freedom per domain -- in contrast to traditional PDE discretization methods that tend to require many more variables per domain. A simple ODE-based moment method is developed, as well as an asymptotic-preserving scheme. We apply the methodology to an application that models the life cycle of forest pests that undergo different life stages and developmental pathways. The model is calibrated for the spotted lanternfly, an invasive species present in the Eastern USA. We showcase that the moment method, despite its significant low-dimensionality, can successfully reproduce the prediction of the pest's establishment potential, compared to much higher-dimensional computational approaches.Comment: 31 pages, 14 figure

Understanding Traumatic Brain Injury in the Primary Care Setting

poster abstractBackground: TBI is being re-conceptualized as a chronic disease causative agent rather than as a single, acute event. This study examined how familiar family medicine physicians (PCPs) are with TBI and their level of confidence in treating TBI sequelae likely to be seen in primary care. We also examined PCP attitudes regarding care for post-acute mild TBI and moderate/severe TBI in primary care and how recently the respondent had cared for a mild TBI and/or moderate/severe TBI patient. Methods: The study featured a mixed methods study design. A survey was administered on paper and electronically. A semi-structured qualitative interview guide was developed based upon survey responses. Descriptive statistics were calculated. Results: Most respondents associated neurological symptoms/conditions as TBI sequelae: irritability, 100.0%, fatigue, 98.0%; insomnia, 88.2%, depression, 98.0%, headaches, 98.0%, anxiety, 80.4%. Two-thirds (66.7%) identified epilepsy as a condition associated with TBI. Just over one-half associated tinnitus (51.0%) or loss of libido (52.9%) with TBI while only one-third (33.3%) associated incontinence with TBI. Most physicians felt confident treating depression (84.0%), anxiety (82.4%), headache (80.4%) and insomnia (76.0%). Physicians felt less confident in treating fatigue (68.0%), irritability (68.0%), incontinence (51.2%) and loss of libido (50.0%). The least amount of confidence was claimed in treating epilepsy (37.5%) and tinnitus (36.4%). All respondents (100.0%) believed that a PCP can manage post-acute mild TBI (concussion) care while 52.0% agreed that a PCP can manage post-acute care for moderate/severe TBI. Only one respondent (2.0%) had never cared for a mild TBI patient. Most (70.6%) had cared for a moderate/severe TBI patient within the past two years while 5.9% had cared for one of these patients more than a year ago. Nearly twenty percent (19.7%) had never cared for a moderate/severe TBI patient and 3.9% were unsure if they had

The SPADE Symptom Cluster in Primary Care Patients with Chronic Pain

Objectives: Sleep disturbance, pain, anxiety, depression, and low energy/fatigue, the SPADE pentad, are the most prevalent and co-occurring symptoms in the general population and clinical practice. Co-occurrence of SPADE symptoms may produce additive impairment and negatively affect treatment response, potentially undermining patients’ health and functioning. The purpose of this paper is to determine: (1) prevalence and comorbidity (ie, clustering) of SPADE symptoms; (2) internal reliability and construct validity of a composite SPADE symptom score derived from the Patient-Reported Outcomes Measurement Information System (PROMIS) measures; and (3) whether improvement in somatic symptom burden represented by a composite score predicted subsequent measures of functional status at 3 and 12 months follow-up. Methods: Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study, a randomized trial of a collaborative care intervention for Veterans with chronic pain. Results: Most patients had multiple SPADE symptoms; only 9.6% of patients were monosymptomatic. The composite PROMIS symptom score had good internal reliability (Cronbach’s alpha=0.86) and construct validity and strongly correlated with multiple measures of functional status; improvement in the composite score significantly correlated with higher scores for 5 of 6 functional status outcomes. The standardized error of measurement (SEM) for the composite T-score was 2.84, suggesting a 3-point difference in an individual’s composite score may be clinically meaningful. Discussion: Brief PROMIS measures may be useful in evaluating SPADE symptoms and overall symptom burden. Because symptom burden may predict functional status outcomes, better identification and management of comorbid symptoms may be warranted

THE BUDDHIST AND CHRISTIAN PERSPECTIVES ON BUSINESS ETHICS IN LEADING CHINESE BUSINESS PRACTICES

The religious practices of ethnic Chinese business leaders make an interesting debate for exploring how leadership, ethics and perspective are seen because of the sharp distinction made between âbeforeâ and âafterâ. Business ethics applied to economics and business has a long tradition. While Buddhism focuses on experientially based ethical consciousness to develop the business with self-responsibility, Christian faith and reason intertwine to bring about principles, criteria, and guidelines for action and a set of virtues with relevance for business activity. Therefore, we then examine how such religious practices in both Buddhist and Christian improve their business leadership with related human values embedded strongly in terms of an old (conservative) and new (rebirth/born again) personhood and they do so within a challenging, highly corrupt and business context. This article introduces Buddhist and Christian ethics to show how these religious practices discursively deconstruct their âoldâ identities and construct their ânewâ aspirational identities to expand ethical understanding and practice in Chinese business. Since research on ethnic Chinese business typically investigates the dominance attributed to specific âChineseâ cultural values and strong intra-ethnic network, this paper provides different perspectives in order to make its contribution to the developments of both Buddhist and Christian ethics in the leading Chinese business practices as an âenhancerâ to increase expression in good business conduct

Sentence Processing in Aphasia: Dual-Task and Sentence Type Effects

Adults with aphasia or no brain damage completed a grammaticality judgment task alone and in competition with a tone discrimination task to determine whether (a) cognitive factors interact with stimulus parameters (i.e., syntactic complexity, number of propositions) known to influence sentence processing, and (b) material-specific limitations (grammaticality judgment in isolation), general cognitive abilities (cognitive test scores), or both are important predictors of dual-task outcomes. Accuracy, grammatical sensitivity, and reaction time findings were consistent with resource models of aphasia and underscore the theoretical and clinical importance of acknowledging and specifying interactions between language and cognition in normal and patient populations