Applying the Clinical Practice Improvement Approach to Stroke Rehabilitation: Methods Used and Baseline Results

Gassaway, Julie; Horn, Susan D.; DeJong, Gerben; Smout, Randall J.; Clark, Crystal T.; James, Roberta

doi:10.1016/j.apmr.2005.08.114

Cited by 94 publications

(58 citation statements)

References 25 publications

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“…PBE methodology uses detailed descriptive data on rehabilitation practices to examine relationships among patient characteristics, the content of therapy, and their effects on rehabilitation outcomes (65,67,68). In contrast to the interventional nature of the RCT and PCT, PBE is an observational approach that does not disrupt treatment.…”

Section: Evaluating Effectiveness Of Rehabilitationmentioning

confidence: 99%

“…The SCIRehab project team cautioned that many relevant details of interventions used in (SCI) rehabilitation are not documented adequately; medical records tend to focus on elements that are required by third-party payers and accreditors. The SCI clinicians agreed that the need to capture details of what rehabilitation specialists do on a daily basis is essential, and thus, POC documentation was incorporated as it had been in the earlier stroke and joint replacement rehabilitation PBE studies (68,74). An innovative point of departure from the two earlier rehabilitation PBE studies is that, rather than using paper forms, SCIRehab uses specialized software (PointSync Pro version 2.0; MobileDataforce, Boise, ID) on electronic handheld personal digital assistants (Hewlett Packard iPAQ hx2490b; Hewlett-Packard, Palo Alto, CA).…”

Section: Patient Enrollmentmentioning

confidence: 99%

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New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

Whiteneck

Gassaway

Dijkers³

et al. 2009

The Journal of Spinal Cord Medicine

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Background/Objective: Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury (SCI) rehabilitation; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions, medical procedures, patient education, or counseling. Given the problems of conducting randomized controlled trials (RCTs) in rehabilitation, practice-based evidence (PBE) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes, after controlling for patient differences. Using the PBE research methodology, the SCIRehab project attempts to ''open the black box'' of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making. Methods: The SCIRehab project includes 1,500 patients with acute SCI, consecutively admitted to 1 of 6 US inpatient rehabilitation facilities. Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in handheld personal digital assistants after sessions with their patients. Outcome data are abstracted from medical records (clinical outcomes data) and obtained from patient interviews at 6 and 12 months after injury. Extensive patient, injury, and other treatment characteristics are abstracted from medical records. SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. Results: SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. These findings are presented in a series of 9 articles. Conclusions: To date, SCIRehab's major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail. After data collection is complete, future manuscripts will relate those process elements to outcomes. The SCIRehab Project is an important step toward establishing outcomes-based guidelines for SCI rehabilitation.

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Section: Evaluating Effectiveness Of Rehabilitationmentioning

confidence: 99%

Section: Patient Enrollmentmentioning

confidence: 99%

New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

Whiteneck

Gassaway

Dijkers³

et al. 2009

The Journal of Spinal Cord Medicine

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“…5,6 A SW/CM taxonomy, which classifies the types of interventions provided during acute rehabilitation, was created for the SCIRehab Project; 7 clinicians collected data on the details of the main activities that are the focus of social workers/case managers in the acute rehabilitation setting and the amount of time the social worker/case manager spends on the patient's behalf in each topic area. The introductory paper to this series of SCIRehab Project articles 8 describes the study design, including use of PBE research methodology 5,6,[9][10][11][12] inclusion criteria, data sources, and the analysis plan. Briefly, the SCIRehab team included representatives of all rehabilitation clinical disciplines (including SW/ CM) from six inpatient rehabilitation facilities: Craig Hospital, Englewood, CO; Shepherd Center, Atlanta, GA; Rehabilitation Institute of Chicago, Chicago, IL; Carolinas Rehabilitation, Charlotte, NC; Mount Sinai Medical Center, New York, NY; and National Rehabilitation Hospital, Washington, DC.…”

Section: Methodsmentioning

confidence: 99%

Social work and case management treatment time during inpatient spinal cord injury rehabilitation

Gassaway¹,

Abeyta

Freeman

et al. 2011

The Journal of Spinal Cord Medicine

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Background: There is a lack of published evidence regarding the amount and type of social work and case management (SW/CM) services that an individual with traumatic spinal cord injury (SCI) receives during acute inpatient rehabilitation. Such information is needed to assist in resource planning, benchmarking, and research on interventions and outcomes. Methods: As part of the SCIRehab study social workers and case managers at six inpatient rehabilitation facilities documented details (including time spent) about the interventions provided to 600 patients with traumatic SCI during acute inpatient rehabilitation. Associations between patient and injury characteristics and time spent on these activities were examined. Results: Patients received a mean total of 10 hours of SW/CM services, with a mean of 72.8 total minutes per week. The majority of the patients received SW/CM time spent on interdisciplinary conferencing on the patient's behalf (96%), discharge planning and services (89%), financial planning (67%), community/inhouse services (66%), supportive counseling (56%), and initial assessment (54%). A minority of the patients received peer advocacy (12%), classes (24%), and education topics (30%). Total hours per stay and minutes per week varied by level of injury group. The most time per week was dedicated to patients with high tetraplegia ASIA Impairment Scale (AIS) A-C and the least to patients with C5-C8 AIS A-C. The patient and injury characteristics studied did not explain the variance seen in time spent on specific SW/CM services. Conclusions: These descriptive data may be helpful in resource planning to anticipate and address individual patient needs and to plan for department-level training and hiring. These data also may pave the way to studying relationships of interventions with patient outcomes.

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“…Practice based evidence studies require comprehensive and complex databases including detailed patient characteristics, reliable treatment care processes, and valid outcome measures. [28][29][30] Seven specific steps are required in order to facilitate PBE. 26 Horn and…”

Section: Introductionmentioning

confidence: 99%

Clinician’s ability to identify neck and low back interventions: an inter-rater chance-corrected agreement pilot study

Werneke

Hart²,

Deutscher

et al. 2011

Journal of Manual & Manipulative Therapy

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Objective: To estimate inter-rater agreement of physical therapists trained in MDT approach and participating in practice-based evidence (PBE) research to identify 72 physical therapy interventions in video demonstrations on a single model and clinical vignettes. PBE is a well designed observational study and demonstrating clinician observational consistency is an important step in conducting PBE research design. Methods: Two physical therapists volunteered to participate in pilot reliability testing and seven other physical therapists trained in McKenzie Mechanical Diagnosis and Therapy (MDT) methods volunteered for the inter-rater chance-corrected agreement study. All therapists identified interventions presented within 52 videos and 5 written clinical vignettes describing 20 more intervention techniques. Therapists independently identified all interventions. We assessed inter-rater chance-corrected agreement of therapists' ability to identify intervention techniques using Kappa coefficients with associated 95% confidence intervals and indices for bias and prevalence. Results: Of the 147 kappa coefficients estimated, 7% were (0.6, 10% were .0.6 and (0.8, and 83% were .0.8. Agreement was lowest for identifying cognitive behavioral techniques (median kappa50.79). The minimum and maximum prevalence and bias indices were 0.33 and 0.85 and 0 and 0.33, respectively suggesting kappa coefficient estimates were strong. Generalized kappa coefficients ranged from 0.73 to 1.00. Discussion: Results provide evidence that substantial to almost perfect inter-rater agreement could be expected when trained therapists identify physical therapy interventions used for patients with spinal impairments from staged videos and vignettes. This may be helpful to reassure clinicians of the quality of the reporting of intervention(s) performed when conducting multivariable analyses in future pragmatic PBE studies. Additional studies are needed to test whether these results can be validated using larger groups of therapists, trained and not trained in MDT methods, as well as examining different methods to examine inter-rater agreement for identifying diverse interventions commonly used for managing patients during routine practice.

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Applying the Clinical Practice Improvement Approach to Stroke Rehabilitation: Methods Used and Baseline Results

Cited by 94 publications

References 25 publications

New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

Social work and case management treatment time during inpatient spinal cord injury rehabilitation

Clinician’s ability to identify neck and low back interventions: an inter-rater chance-corrected agreement pilot study

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