The purpose of this study was to identify factors that facilitated or acted as a barrier to return to work (RTW) for stroke survivors. We applied 3 approaches to identify the factors. First, we conducted qualitative interviews with 10 stroke survivors about their RTW experience post stroke. Second, we surveyed 21 vocational specialists about barriers and facilitators of RTW based on their clinical practice. Last, we interviewed 7 employers who had experience in interviewing individuals with disabilities or had the authority to make hiring decisions. Descriptions of barriers and facilitators to RTW from these 3 perspectives were illustrated. Identified components were mapped based on the ICF framework. From stroke survivors' perspectives, factors affecting employment after stroke include neurological (motor, cognition, communication), social, personal, and environmental factors. Vocational specialists described similar barriers and facilitators of RTW as the stroke survivors but emphasized personal factors such as flexibility and being realistic in vocational goals. The employers explained that the candidate's disability plays no role in the hiring process and indicated that all applicants must meet the essential job requirements. Some employers described the benefits of having the support of vocational rehabilitation staff and being able to interact with the vocational rehabilitation specialists during the hiring process. The interaction allows the employer to gather initial information (consented to by the job applicant) about the applicants from the vocational rehabilitation service and to be educated about any specific needs related to the applicant's medical issues.

Objectives:The Center for Epidemiologic Studies Depression (CESD) scale has been useful in a broad spectrum of health research on patient and population outcomes. A brief version is used when depressive symptoms are not the primary focus. Rasch (item response) analysis previously demonstrated potential problems with positively worded items. We tested the 10-item CESD (CESD-10) scale and considered an 8-item version with both psychometric and Rasch analyses.Methods:This was a special sample of 2067 caregivers from three existing US databases. We describe item response patterns and internal constancy in addition to Rasch scale results.Results:There were few problems with missing data, and internal consistency was high (alpha = 0.86–0.88) for both CESD versions. Rasch analysis indicated that one of the positive items (“hopeful about future”) could be dropped.Conclusions:We partly confirmed prior work that suggested dropping positive items for the CESD-10. Among caregivers, item-level problems and scaling problems seem minimal. At present, there is not a strong rationale for dropping the CESD-10 positive items: the one poorly performing positive item might be explained by the special caregiver sample.

Abstract-Setting-specific outcome measures present a major barrier to monitoring patient progress across the continuum of care. This study demonstrated Rasch analysis for the creation of a crosswalk between the Functional Independence Measure (FIM), which is used in inpatient rehabilitation, and the Minimum Data Set (MDS), which is used in skilled nursing facilities. To create the crosswalk, we used data from a sample of 236 patients from four Department of Veterans Affairs' facilities who had had both the FIM and the MDS administered within 7 days. The combined FIM-MDS analysis showed good internal consistency (Cronbach alpha = 0.94), with 21 of the 26 items showing acceptable fit statistics. FIM and MDS raw scores correlated at -0.81 and the measures, corrected for scale direction, correlated at 0.78. Future validity testing will be necessary to determine the accuracy and applicability of the crosswalk.

Objective. To compare students' preferences for and academic performance using 2 different distance education course content delivery platforms. Methods. A randomized, crossover research design was used to compare traditional video with a 4-panel platform among learners on multiple campuses within 1 college of pharmacy.1 The outcomes were students' preferences for delivery platform and examination scores. Rasch analysis was used to assess unidimensionality and the difficulty of examination items. Hierarchical logistic and multiple regression models were used to assess students' preferences and academic performance.Results. The logistic model predicting preference for the 4-panel or traditional platform was not significant, but African-Americans and Hispanics were more likely to prefer the 4-panel platform than Caucasian and Asian students. The delivery platform did not impact students' academic performance. Students who did well on the semester's previous 2 examinations scored higher on the questions related to schizophrenia. Students with higher Pharmacy College Admission Test (PCAT) scores performed better on the bipolar questions than students who preferred the traditional video platform. Conclusion. The additional faculty time, effort, and cost invested in presenting the class material in a 4-panel platform, and the students' extra time and effort spent viewing the 4-panel platform did not produce a comparable benefit in student preference and performance.

Abstract-In this study, we performed a validation analysis of a crosswalk that converts Functional Independence Measure (FIM) scores to Minimum Data Set (MDS) scores and vice versa in order to achieve score compatibility. Data from 2,130 patients were obtained from the Department of Veteran Affairs' Austin Automation Center. The conversion algorithm was tested at the (1) individual patient level, (2) classification level, and (3) facility level. The validity testing resulted in mixed findings. The mean MDS-derived FIM (FIMc) scores were within 1.3 and 0.1 points of the mean actual FIM (FIMa) scores for the motor and cognition scales, respectively. Kappa statistics demonstrated a fair to substantial (0.37-0.66) strength of agreement between functional-related group classifications generated from the FIMa and FIMc scores. Four of the five facilities had an average point difference of 2.4 between the mean FIMa and FIMc scores. While the sample distributions were similar, individual score comparisons fell short of expectations. Only 37% to 67% of the FIMc scores were within 5 points of the FIMa scores. The crosswalk algorithm demonstrated a convenient way to achieve score comparisons across different rehabilitation settings. However, the effectiveness of a single measure or of crosswalk conversions may ultimately depend on the quality of the data.

Rasch analysis offers researchers an innovative method for developing and validating rehabilitation instruments. Despite the increased use of Rasch analysis by allied health researchers, this method continues to be underutilized by rehabilitation counseling professionals. In the rehabilitation counseling profession, vocational evaluators use various instruments, such as the Career Ability Placement Survey (CAPS), to determine client aptitudes and justify job placement recommendations. The purpose of this article is to introduce Rasch analysis as a method for analyzing vocational assessments by examining the psychometric properties of the Word Knowledge (WK) subtest of the CAPS. University undergraduate and graduate students ( n = 227) completed the WK subtest as part of a classroom exercise. The analysis determined item hierarchy, item gaps and redundancies, item-fit statistics (unidimensionality), and person reliability and separation statistics. Although the WK construct demonstrates good psychometric characteristics relating to unidimensionality and to person reliability and separation statistics, several items deviated from the expected ordering pattern. The reordering of items revealed potential item gaps and redundancies as well as poor person—instrument match. Adding and removing items will improve the validity and reliability of the WK subtest psychometrics.

This study examines 137 state vocational rehabilitation (VR) counselors' perceptions of the value of having the Certified Rehabilitation Counselor (CRC) credential. While almost 53% of this sample included persons who were certified, the majority who were not indicated that the two major reasons for not currently having this designation were: (a) it was not required to be employed as a state VR counselor and (b) they planned to get it. In terms of perceived encouragement by master's degree program faculty to pursue the CRC credential, results reveal that for this group of vocational rehabilitation counselors, this influence did not have a substantial impact on CRC obtainment. Implications for the rehabilitation counseling field/education are discussed.

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