Gesundheit
Institut für Pflege
Accurate Assessment Instruments in Rehabilitation
Best practices and realities / Workshop 12.06.2014
S. Suter-Riederer, MScN , RN / Prof. J. Schwarz, Dr. sc. ETH / Prof. Dr. H. Petry, PhD, RN
Health condition
(disorder or disease)
Body Functions &
Structures
Environmental Factors
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Activities
Participation
Personal Factors
Categorising Patient Outcomes
• «clinical»
patient’s responses to intervention
•
improvement or decline in physical
functioning
«functional»
• «financial»
cost and length of stay
•
patient satisfaction
«perception»
«functional»
improvement or decline in physical
functioning
(Doran, 2011)
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Extended Barthel Index (EBI)
 Sum score 64 points = max. independence
 16 Items
 3-5 point Likert scale (0-4)
 Time exposure 20-30 minutes
 Reliability 0.96 -0.99
 Validity
Jansa et al., (2004), Marolf et al., (1996), Prosiegel et al., (2004), Schädler et al., (2012)
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Outcome Oriented Nursing Assessment
AcuteCare (ePA_AC)
 Selfcare Index (SPI) 40 points = max. self care
competencies
 10 categories 52 items
 4 point Likert scale (1-4)
 Time exposure 30 – 40 minutes
 Reliability 0.42-1.0
 Validity
Fiebig & Hunstein, (2006), Hunstein, (2009)
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Objectives
• Is there a causal relationship between the variables of ePA_AC
and the variables of EBI?
• Could the items and sum score of EBI be generated from the
ePA_AC?
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Method
• Design
– Quantitative – retrospective
• Data collection n=126 stroke
– Data anonymised 2011 / 2012
– Measuring point: T0=admission / T3=discharge
• Statistical Analysis
– Linear regression analysis with 10 constructs y=ß0+ß1x
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Construct Development
Outcome Oriented Nursing Assessment
Extended Barthel Index
Mobility: activity / movement
mobility / change of body position
Mobility: transfer to wheel chair / downstairs
upstairs / mobility level surface
Personal hygiene:
upper / lower part of the body
Personal hygiene: face, combing, shaving /
wash oneself
Dress / undress:
upper / lower part of the body
Personal hygiene: dress / undress
Carry out:
urinary excretion / stool output
Excretion: toilet use
Ingestion: food / drinking
Eat & drink
Control: urinary excretion
Excretion: control urinary excretion
Control: stool output
Excretion: stool output
Cognition: consciousness, vigilance /
orientation / gain knowledge / vision
Cognition: problem solving / vision, neglect /
memory, gain knowledge, orientation
Communication: communication
Language: understanding, articulation
Communication / activities due to
professional advice
Language: social interaction
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Results
Sample Size n=126
Variable
Age
Length of stay
Duration of disease
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Years
Mean
66
SD
± 14.3
Days
Weeks
41.2
16.6
± 20.5
± 76.3
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Results Regression 1
Item
Mobility
T0
(entry)
.345**
standadisierte
Koeffizienten
ß1
(.899)
ß2
R2 adj
.807
Hygiene
ß1
.645**
(.815)
ß2
R2 adj
.661
Dress
ß1
1.223**
(.803)
ß2
R2 adj
.641
Toilet Use
ß1
1.125**
(.828)
ß2
R2
.683 standadisierte
Item
T0 adj
(entry)
Eat&drink
ß1
.975**
(.711)
Koeffizienten
ß2
Mobility
ß1
.345**
R2 adj
.501 (.899)
ß2 control ß1
Urinary
.731**
(.861)
R2 adj
.807
ß2
R2 adj
.740
Stool control
ß1
.713**
(.700)
ß2
R2 adj
.485
Cognition
ß1
.436**
(.741)
ß2
R2 adj
.546
Communication ß1
.233**
(.701)
ß2
R2 adj
.487
Social
ß1
1.517**
(.445)
interaction
ß2
R2 adj
.191
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effect
size f2
4.181
1.950
1.786
2.155
effect size
f2
1.004
4.181
2.846
0.942
1.203
0.949
0.236
T3
(discharge)
.774**
-.030**
.820
.996**
-.021
.872
3.233**
-.425**
.835
2.708**
-301**
.809
T3
2.660**
(discharge)
-.290**
.774**
.748
-.030**
1.306**
.820
-.187**
.736
1.408**
-.208*
.708
1.487**
-.057**
.634
.901**
-.061**
.764
3.767*
-1.002
.097
standadisierte
Koeffizienten
effect
size f2
(1.936)
(-1.074)
6.406
(1.196)
(-.268)
6.813
(2.530)
(-1.683)
5.061
(1.973)
(-1.092)
standadisierte 4.236
effect
(1.751)
Koeffizienten
(-.951)
(1.936)
(-1.074)
(2.143)
(-1.311)
size f2
2.968
6.406
2.788
(1.630)
(-.802)
2.425
(1.948)
(-1.221)
1.732
(2.422)
(-1.624)
3.237
(1.196)
(-.900)
0.107
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Results Regression 2
• Mobility admission
• Linear relationship
• Significance p = .000
• Variance R2 adj = 80.7%
• Effect Size f2 = 4.18
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Results Regression 3
Mobility discharge squared
• Curvilinear
• Significance p=.000
• Variance R2 adj = 82%
• Effect Size f2=6.41
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Conclusions
• EBI could be generated from ePA_AC
• Items comparable
• Sum score not comparable
• Algorithm for sum score
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Literature
•
Cohen, J. (1992). A Power Prime. Psychological Bulletin, 112(1), 155-159.
•
Doran, D. M. 2003. Functional Status. In: DORAN, D. M. (ed.) Nursing-Sensitive Outcomes: State of the Science. Sudbury,
MA: Jones and Bartlett.
•
Fiebig, M. & Hunstein, D. 2006. Testung der Interrater-Reliabilität des ergebnisorientierten PflegeAssessments AcuteCare©
(ePA_AC©).
•
Hunstein, D. & Fiebig, M. 2006. Klinische Testung des ePA-AC©: erste Ergebnisse. Wiesbaden: ePA-Competence-Center.
•
Jansa, J., Pogacnik, T., & Gompertz, P. (2004). An evaluation of the Extended Barthel Index with acute ischemic stroke
patients. Neurorehabil Neural Repair, 18(1), 37.41.
•
Marolf, M. V., Vaney, C., Prosiegel, M., & König, N. (1996). Evaluation of disability in multiple sclerosis patients: A comperative
study of the functional independence measure, the extended barthel index and the expanded disability status scale. Clin
Rehabil, 10, 309-313.
•
Prosiegel, M., Böttiger, S., Schenk, T., König, N., Marolf, M., Vaney, C., Garner, C. & Yassouridis, A. 1996. Der erweiterte
Barthel-Index (EBI): eine Skala zur Erfassung von Fähigkeitsstörungen bei neurologischen Patienten. Neurologie &
Rehabilitation, 1, 7-13.
•
Schädler, Kool, Lüthi, Marks, Pfeffer, Oesch, & Wirz. (2006). Selbständigkeit im Alltag: Erweiterter Barthel Index (EBI)
Assessments in der Neurorehabilitation (pp. 59-70). Bern: Huber.
•
Suter-Riederer, S. Schwarz, J. Imhof, L. Petry, H. (2014). Vergleichbarkeit von ergebnisorientiertem Pflegeassessment
(ePA_AC) und Erweitertem Barthel Index (EBI). Neurologie & Rehabilitation, 1, 24-30.
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Thank you for your attention
[email protected]
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