Rasch Analysis and Functional Measurement in Post-Hospital Brain Injury Rehabilitation

Lewis, F. A.; Horn, Gordon J.

doi:10.5539/ijsp.v6n6p50

Cited by 3 publications

References 14 publications

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Effect of Compulsory Funding on Post-hospital Neurorehabilitation Outcomes and Length of Stay following Stroke

Lew,

Lewis,

Glenn

et al. 2024

Preprint

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Background and Purpose The American Stroke Association recommends post-stroke rehabilitation for those who qualify and have access to this service. Continued services at the post-hospital residential and outpatient rehabilitation levels of care result in further functional gains after acquired brain injury, including stroke, even when provided beyond 6-12 months post onset. Access to care remains a barrier to rehabilitation including third-party limits with funding and coverage restrictions. This study measured outcomes comparing those with state legislated Compulsory Funding (CF) vs. Restricted Funding (RF) for post-hospital neurorehabilitation. Methods There were a total of 402 participants across 14 states included in the study. The CF group had 201 and the RF group had 201 participants. The Mayo-Portland Adaptability Inventory (MPAI-4) was selected as the primary dependent measure. Results Post-hospital rehabilitation length of stay (LOS) was significantly shorter in the CF group, t(400) = 1.72, p < 0.05 (Cohen's d = 0.17). A Mixed 2x2 RM-MANCOVA revealed a significant main effect of time of testing, Pillai's Trace f(1,398) = 402.6, p < 0.001; power to detect = 0.99, partial eta2 = 0.50. The analysis also revealed significant between groups main effect f(1,398) = 12.8, p< 0.001, power to detect = 0.94, partial eta2 = 0.031. The results of Bonferroni post-hoc pairwise comparisons are presented. Conclusions This study examined the differences in rehabilitation outcomes and LOS for persons receiving CF post-acute neurorehabilitation with individuals receiving services in other states with RF. While both groups improved, the state legislated access to care CF group started post-hospital neurorehabilitation without delay, discharged more quickly thereby reducing cost, with a lower level of disability (MPAI-4 Indices) at discharge compared to the RF group.

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Effect of Compulsory Funding on Post-hospital Neurorehabilitation Outcomes and Length of Stay following Stroke

Lew,

Lewis,

Glenn

et al. 2024

Preprint

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Prediction of Functional Outcome in Post-Hospital Brain Injury Rehabilitation

Lewis¹,

Horn²

2019

JBBS

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Post-hospital brain injury rehabilitation programs are afforded limited time to reduce chronic disability resulting from acquired brain injury. Therefore, the purpose of this study was to identify deficit areas resulting from acquired brain injury that have the greatest impact on functional outcomes to enable greater efficiency in rehabilitation programming. Study participants were 1717 persons with acquired brain injury treated in residential post-hospital rehabilitation programs. Participants were assessed at admission and discharge on the MPAI-4. Functional status at discharge was evaluated based on T-scores derived from MPAI-4 discharge participation index items: initiation, self-care and residence. The database of 1717 was randomly divided into two subsets. Items from admission Abilities Index and select person variables were entered into stepwise multiple regression on subset one and then in a hierarchical multiple regression on subset two. Rash analysis demonstrated satisfactory construct validity and internal consistency of admission and discharge MPAI-4 evaluations (Person reliability ≥ 0.90, Item reliability = 0.99). Both regression analyses revealed that Mobility and Novel Problem Solving accounted for 40% of the variance in functional outcome, p < 0.001. Acquired brain injury results in a myriad of cognitive and physical impairments. Of the many possible deficits, the greatest gains in overall functional outcomes may be achieved by allocating additional treatments aimed at reducing disability in mobility and novel problem solving.

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Traumatic Brain Injury and Cerebral Vascular Accident: Application of Rasch Analysis to Examine Differences in Disability and Outcome in Post-Hospital Rehabilitation

Lewis¹,

Horn²

2018

OJS

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The purpose of this study was to demonstrate an application of Rasch analysis to identify differences in disability profiles resulting from traumatic brain injury (TBI) and cerebral vascular accident (CVA) and to examine outcome differences between the two groups following post-hospital residential rehabilitation. Participant data were collected from 32 facilities in 16 states. From 2990 neurologically impaired individuals with consecutive admissions from 2011 through 2017, 874 met inclusion criteria: TBI (n = 687) or CVA (n = 187), 18 years or older, minimum length of stay of one month, and maximum chronicity of 1 year. Participants were evaluated at admission and discharge on the Mayo Portland Adaptability Inventory-Version 4 (MPAI-4). Rasch analysis was performed to establish item reliability, construct validity and item difficulty. A Repeated Measures Multivariate Analysis of Covariance (RM MANCOVA) determined group differences and improvement from admission and discharge. Rasch Analysis demonstrated satisfactory construct validity and internal consistency (Person reliability > 0.90, Item reliability > 0.98 for admission and discharge MPAI-4s). Both groups showed significant improvement on the MPAI-4 (p < 0.0005). The TBI group was more impaired on the adjustment scale at both admission and discharge (p < 0.001). Rasch analysis identified two distinct impairment patterns. CVA participants exhibited deficits characteristic of focal impairment while the TBI group presented with deficits reflective of diffuse impairment. Rehabilitation was shown to be beneficial in reducing disability following neurologic injury in both groups. Importantly, Rasch Analysis accurately produced unique disability profiles that differentiated the treatment groups.

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Rasch Analysis and Functional Measurement in Post-Hospital Brain Injury Rehabilitation

Cited by 3 publications

References 14 publications

Effect of Compulsory Funding on Post-hospital Neurorehabilitation Outcomes and Length of Stay following Stroke

Effect of Compulsory Funding on Post-hospital Neurorehabilitation Outcomes and Length of Stay following Stroke

Prediction of Functional Outcome in Post-Hospital Brain Injury Rehabilitation

Traumatic Brain Injury and Cerebral Vascular Accident: Application of Rasch Analysis to Examine Differences in Disability and Outcome in Post-Hospital Rehabilitation

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