Accurate Assessment Instruments in Rehabilitation

Transcription

1 Gesundheit Institut für Pflege Accurate Assessment Instruments in Rehabilitation Best practices and realities / Workshop 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 Activities Participation Environmental Factors Personal Factors

2 Categorising Patient Outcomes «clinical» patient s responses to intervention «functional» improvement or decline in physical functioning «financial» cost and length of stay «perception» patient satisfaction «functional» improvement or decline in physical functioning (Doran, 2011) 2

3 Extended Barthel Index (EBI) Sum score 64 points = max. independence 16 Items 3-5 point Likert scale (0-4) Time exposure minutes Reliability Validity Jansa et al., (2004), Marolf et al., (1996), Prosiegel et al., (2004), Schädler et al., (2012) 3

4 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 minutes Reliability Validity Fiebig & Hunstein, (2006), Hunstein, (2009) 4

5 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? 5

6 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=ß 0 +ß 1 x 6

7 Construct Development Outcome Oriented Nursing Assessment Mobility: activity / movement mobility / change of body position Personal hygiene: upper / lower part of the body Dress / undress: upper / lower part of the body Carry out: urinary excretion / stool output Ingestion: food / drinking Control: urinary excretion Control: stool output Cognition: consciousness, vigilance / orientation / gain knowledge / vision Communication: communication Communication / activities due to professional advice Extended Barthel Index Mobility: transfer to wheel chair / downstairs upstairs / mobility level surface Personal hygiene: face, combing, shaving / wash oneself Personal hygiene: dress / undress Excretion: toilet use Eat & drink Excretion: control urinary excretion Excretion: stool output Cognition: problem solving / vision, neglect / memory, gain knowledge, orientation Language: understanding, articulation Language: social interaction 7

8 Results Sample Size n=126 Variable Mean SD Age Years 66 ± 14.3 Length of stay Days 41.2 ± 20.5 Duration of disease Weeks 16.6 ±

9 Results Regression 1 Item T0 standadisierte effect T3 standadisierte effect (entry) Koeffizienten size f 2 (discharge) Koeffizienten size f 2 Mobility ß 1.345** (.899).774** (1.936) ß ** (-1.074) R 2 adj Hygiene ß 1.645** (.815).996** (1.196) ß (-.268) R 2 adj Dress ß ** (.803) 3.233** (2.530) ß ** (-1.683) R 2 adj Toilet Use ß ** (.828) 2.708** (1.973) ß 2-301** (-1.092) R 2 adj Item T0 (entry) standadisierte effect size T3 standadisierte effect Eat&drink ß 1.975** Koeffizienten (.711) 2.660** (1.751) Koeffizienten f ß 2 (discharge) size f ** (-.951) 2 Mobility ß 1.345** R 2 adj.501 (.899) **.748 (1.936) Urinary ß 2 control ß 1.731** (.861) -.030** 1.306** (2.143) (-1.074) R 2 adj.807 ß ** (-1.311) R 2 adj Stool control ß 1.713** (.700) 1.408** (1.630) ß * (-.802) R 2 adj Cognition ß 1.436** (.741) 1.487** (1.948) ß ** (-1.221) R 2 adj Communication ß 1.233** (.701).901** (2.422) ß ** (-1.624) R 2 adj Social interaction ß ** (.445) 3.767* (1.196) ß (-.900) R 2 adj

10 Results Regression 2 Mobility admission Linear relationship Significance p =.000 Variance R 2 adj = 80.7% Effect Size f 2 =

11 Results Regression 3 Mobility discharge squared Curvilinear Significance p=.000 Variance R 2 adj = 82% Effect Size f 2 =

12 Conclusions EBI could be generated from epa_ac Items comparable Sum score not comparable Algorithm for sum score 12

13 Literature Cohen, J. (1992). A Power Prime. Psychological Bulletin, 112(1), Doran, D. M Functional Status. In: DORAN, D. M. (ed.) Nursing-Sensitive Outcomes: State of the Science. Sudbury, MA: Jones and Bartlett. Fiebig, M. & Hunstein, D Testung der Interrater-Reliabilität des ergebnisorientierten PflegeAssessments AcuteCare (epa_ac ). Hunstein, D. & Fiebig, M 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), 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, Prosiegel, M., Böttiger, S., Schenk, T., König, N., Marolf, M., Vaney, C., Garner, C. & Yassouridis, A Der erweiterte Barthel-Index (EBI): eine Skala zur Erfassung von Fähigkeitsstörungen bei neurologischen Patienten. Neurologie & Rehabilitation, 1, Schädler, Kool, Lüthi, Marks, Pfeffer, Oesch, & Wirz. (2006). Selbständigkeit im Alltag: Erweiterter Barthel Index (EBI) Assessments in der Neurorehabilitation (pp ). 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,

14 Thank you for your attention 14