Patient-Staff Agreement on Barthel Index Scores at Admission and Discharge in a Sample of Elderly Stroke Patients.

Abstract

To investigate the congruence and influence of lesion side on staff and patient ratings of activity limitations. Study Design: Retrospective study of activity limitations at admission and discharge using the Rasch model and rating scale analysis. Participants: One-hundred twenty elderly stroke patients. Setting: Outpatient geriatric rehabilitation center. Main Outcome Measure: Barthel Index (BI). Results: High patient-staff agreement was found with the lowest agreement on the bathing item of the BI. Although staff rated the degree of activity limitations significantly higher than patients, the effect size was low at admission and discharge. The discrepancy between patient and staff reports did not change during rehabilitation and was equivalent between patients with right and patients with left hemisphere lesions. Conclusion: Patients with a stroke slightly overestimated their competency compared with rehabilitation staff and remained consistent during rehabilitation.

Agreement of patient and physician ratings on mobility and self-care in neurological diseases

“…At the group level, these differences generally indicate that the proxies give a more negative assessment of the patient's condition [2,[17][18][19]. The effect sizes of these differences are slight to moderate and often lie between 0.10 and 0.50 [15,16]. Some studies (e.g., [20]) find a varying extent and at times different directions of discrepancies, depending on the content of the items.…”

“…The use of a uniform scale of measurement ensures a higher degree of validity of measurement and thus a better basis for analyzing agreement. This is all the more important as the results of previous studies of this topic are often inconsistent and heterogenous (e.g., [16]). …”

“…Some studies (e.g., [2,26]) find a greater degree of agreement at the end of treatment, which can be explained for example by the fact that the providers are more familiar with the patient or that the patient's condition becomes more stable; other studies [16,19] find no change in agreement. The agreement between patient and proxy regarding change scores is low for van der Linden et al [19], with ICCs between 0.30 and 0.42.…”

Development and validation of the Rasch-based depression screening (DESC) using Rasch analysis and structural equation modelling

“…The Rasch model is one of the IRT models that holds some particularly beneficial attributes, e.g., interval scale level of model parameters, sample free test calibration, and item free person measurement (for an introduction to Rasch analysis, see Bond & Fox, 2001;Gauggel et al, 2004). With the Rasch model, calibrated item banks can be built which is the necessary prerequisite for CAT applications.…”

Integration of patient and provider assessments of mobility and self-care resulted in unidimensional item-response theory scales

“…[15,16]) treat the corresponding patient and provider items not as different items to be calibrated jointly in one scale, but as two measurements of one and the same item. The advantage of the approach chosen for this study is that, if integration is successful, because of the properties of the 1-p IRT model (cf.…”