„Selbständigkeits-Index für die Neurologische und Geriatrische Rehabilitation (SINGER)“ – Entwicklung und Validierung eines neuen Assessment-Instruments

Abstract

In the context of developing and testing a procedure for "Outcome-oriented payment for rehabilitation after stroke", we found that the instruments commonly used to measure the outcomes of rehabilitation after stroke (e. g., Barthel-Index or FIM) were not meeting the special requirements of the new payment system. Therefore the "Scores of Independence for Neurologic and Geriatric Rehabilitation" (SINGER) was developed as a new assessment instrument. This instrument is based on the ICF and measures 20 aspects of "independence in activities of daily living". The characteristic feature of the SINGER is, above all, the way all items are graded in 6 steps: the gradation does not refer to the degree of disability but to the kind and amount of help required for the respective activity, i. e.: 0 = totally dependent on professional help; 1 = professional contact help needed; 2 = contact help by (instructed) lay persons sufficient; 3 = preparation or supervision by lay persons still needed; 4 = independent with assistive device or still slow; 5 = independent without assistive device. For experienced personnel in neurologic rehabilitation, these gradations are "intuitively plausible". A manual moreover describes each grade in detail for each item so that the instrument can be used in rehabilitation facilities without extensive training. The SINGER has been tested and validated in a pilot study (n = 100) and in 2 subsequent studies with large case numbers in neurologic rehabilitation (n = 1058 and n = 700 patients after stroke in all categories of severity). Factor analyses showed that the instrument contains 2 dimensions which can be interpreted as "physical activities" and "activities of communication and cognition". Each of these 2 dimensions can be split into 2 sub-dimensions that can be assigned to the tasks of therapeutical professions in care/Occupational Therapy, physiotherapy, logopedics, and neuro- psychology. The test criteria of reliability, sensitivity, convergent validity, floor and ceiling effects as well as sensitivity to change show good to very good results. Particular emphasis can be given to the high degree of interrater reliability and the wide range of possible applications in clinical practice as well as in research. A limitation of the instrument to be taken into account is the fact that the SINGER has not yet been tested and validated in geriatric rehabilitation facilities.

Teilhabe nach Schlaganfall: Ergebnisse einer multizentrischen Katamnesestudie in der ambulanten Neurorehabilitation (Teil 1)

“…Daher ist der kombinierte Einsatz von verschiedenen Instrumenten zu empfehlen [19]. Als sinnvolle Ergänzung zum IMET eignet sich der von Gerdes, Funke et al entwickelte Selbstständigkeits-Index für die neurologische und geriatrische Rehabilitation (SINGER) [21,22]. Der SINGER misst als Fremdbeurteilungsinstrument mit klarem ICF-Bezug die Selbstständigkeit in den wichtigen Belangen des täglichen Lebens von neurologischen und geriatrischen Patienten [23].…”

Participation after Stroke and Traumatic Brain Injury: Results of a Pilot Study in Outpatient Neurorehabilitation in Vorarlberg

“…The Index for Measuring Restrictions on Participation (IMET) is a self-assessment instrument for recording patient participation [14,18]. The SINGER, as a third-party assessment instrument, gathers data on independence in important aspects of daily life [16,[19][20][21]. In addition, the phase to which rehabilitants belong can be determined using the SINGER total score model, a system established firmly in the Phase model [23] of neurorehabilitation of the Association of German Pension Insurances (now Deutsche Rentenversicherungsbund) [24].…”

“…In a German multicentric project in a near-home ambulatory rehabilitation centre [6,[13][14][15][16][17], the combined use of different measuring instruments enabled adequate recording and evaluation of participation-related effects. Of particular relevance were, among others, the interdisciplinary index for the measurement of restrictions on participation (IMET) [18] and the independent index for neurological and geriatric rehabilitation (SINGER) [19][20][21]. At the same time, the results published to date clearly indicate positive and lasting effects of outpatient neurological rehabilitation in Germany.…”

Das Hessisch Oldendorfer ICF-Assessment (HOIA)

“…Further studies on the usability of HOIA are recommended aufweisen, z. B. im Hinblick auf die Änderungssensitivität [11]. Als pragmatischer Zugang zur ICF eignen sich Core-Sets.…”

“…B. aus der BDH-Klinik Elzach [3], die die ICF als Bezugsrahmen für die Dokumentation interdisziplinären Teambesprechungen implementiert hat. Als weiteres Beispiel ist der "Selbstständigkeits-Index für die Neurologische und Geriatrische Rehabilitation" (SINGER) zu nennen [11]. Der SINGER stellt einen Assessmentvorschlag für die ICF-konforme Dokumentation der Selbstständigkeit in den Aktivitäten des täglichen Lebens dar, zumal die gebräuchlichen Instrumente (Barthel-Index, Functional Independence Measure -FIM) methodisch Limitationen Rollnik JD.…”