Validity of Functional Independence Staging in Patients Receiving Rehabilitation in Skilled Nursing Facilities

Jette, Diane U.; Warren, Reg L.; Wirtalla, Christopher

doi:10.1016/j.apmr.2004.11.035

Cited by 15 publications

(13 citation statements)

References 21 publications

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“…31,32 Intended to reflect older community-dwelling people who might be seen as outpatients or in-home care rather than as rehabilitation inpatients, Activity Limitation Stages differ from FI stages by characterizing person- (self- or proxy-) reported rather than clinician-rated functional information. The use of self- or close proxy-report recognizes growing emphasis on person-centered care and self-reported ratings as being valid and important.…”

Section: Theoretical Foundationsmentioning

confidence: 99%

Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

Stineman

Henry-Sánchez

Kurichi

et al. 2012

American Journal of Physical Medicine &Amp; Rehabilitation

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Objective This study aimed to describe the conceptual foundation and development of an activity limitation and participation restriction staging system for community-dwelling people 70 yrs or older according to the severity and types of self-care (activities of daily living [ADLs]) and domestic life (instrumental ADLs (IADLs)) limitations experienced. Design Data from the second Longitudinal Study of Aging (N = 9447) were used to develop IADL stages through the analyses of self- and proxy-reported difficulties in performing IADLs. An analysis of activity limitation profiles identified hierarchical thresholds of difficulty that defined each stage. IADL stages are combined with ADL stages to profile status for independent living. Results IADL stages define five ordered thresholds of increasing activity limitations and a “not relevant” stage for those who normally have someone else do those activities. Approximately 42% of the population experience IADL limitations. To achieve a stage, a person must meet or exceed stage-specific thresholds of retained functioning defined for each activity. Combined ADL and IADL stages de-fine 29 patterns of activity limitations expressing the individual’s potential for participating in life situations pertinent to self-care and independent community life. Conclusions ADL and IADL stages can serve to distinguish between groups of people according to both severity and the types of limitations experienced during home or outpatient assessments, in population surveillance, and in research.

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Section: Theoretical Foundationsmentioning

confidence: 99%

Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

Stineman

Henry-Sánchez

Kurichi

et al. 2012

American Journal of Physical Medicine &Amp; Rehabilitation

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“…18-20 The complex and simple ADL staging systems would primarily be appropriate for outpatient use and may help clinicians screen patients at risk for various adverse outcomes and with increasing needs for assistive devices or home modifications to allow them to maintain independence.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Complex Versus Simple Activity of Daily Living Staging: Validation of Simple Stages

Schussler-Fiorenza

Xie

Pan

et al. 2013

Archives of Physical Medicine and Rehabilitation

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OBJECTIVE To compare simple activities of daily living (ADL) staging with complex ADL staging and to assess the face, construct and predictive validity of simple ADL stages. Activities of Daily Living (ADL) staging is an innovative, partially hierarchical approach to ADL difficulty measurement. Initial staging validation studies used four-level responses to ADL difficulty questions to derive stages (complex ADL staging). Simple ADL stages are based on two-level responses to ADL difficulty questions. DESIGN Analysis of the second Longitudinal Study of Aging, a prospective cohort study, using descriptive statistics and logistic regression. SETTING United States PARTICIPANTS 9,447 community dwelling persons ≥ age 70 years in 1994. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES Agreement & Face Validity: Baseline simple ADL stage Construct Validity: Baseline health, difficulty and need characteristics Prognostic Comparison (determined at the Wave 2 interview): Primary: nursing home use and/or death; Secondary: death RESULTS The systems showed good agreement (kappa = 0.75). The simple ADL stages stratified people into distinct groups and reflected the expected step-wise increases from Stage 0 to Stage IV in health and need characteristics, such as the prevalence of home-related challenges (2.9% to 84.5%) and perceived need for home modifications (2.1% to 33.6%). In comparing the prognostic ability using the primary outcome, the complex system model demonstrated slightly increased discrimination between milder stages and a slightly higher C-statistic (0.666 vs. 0.664) CONCLUSION Although complex staging appears slightly better at classifying people into distinct prognostic strata with respect to nursing home use and/or death at Wave 2, simple ADL stages demonstrate strong, clinically relevant associations with health and need characteristics.

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“…This information is commonly extracted and used in different studies to assess patient outcome and used as a marker of poor health status [17][18][19]. Similarly, our review showed that the predictive model based on hospital readmission had better sensitivity and specify than the other models.…”

Section: Comparison With Previous Studiesmentioning

confidence: 90%

“…Predictive models based on FIM score and FIS staging had limited applicability for National and International comparison of functional outcome as observed in previous studies [19]. In general hospitals, there are no regulations to record ADL [14].…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Systematic Review of the Use of Hospital Administrative Data to Assess Functional Decline

Av¹,

Suliman²,

Vuik³

et al. 2016

J Aging Sci

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Validity of Functional Independence Staging in Patients Receiving Rehabilitation in Skilled Nursing Facilities

Cited by 15 publications

References 21 publications

Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

Staging Activity Limitation and Participation Restriction in Elderly Community-Dwelling Persons According to Difficulties in Self-Care and Domestic Life Functioning

Comparison of Complex Versus Simple Activity of Daily Living Staging: Validation of Simple Stages

Systematic Review of the Use of Hospital Administrative Data to Assess Functional Decline

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