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 Activities Participation Environmental Factors Personal Factors
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
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) 3
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) 4
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
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
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
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 ± 76.3 8
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 2 -.030** (-1.074) R 2 adj.807 4.181.820 6.406 Hygiene ß 1.645** (.815).996** (1.196) ß 2 -.021 (-.268) R 2 adj.661 1.950.872 6.813 Dress ß 1 1.223** (.803) 3.233** (2.530) ß 2 -.425** (-1.683) R 2 adj.641 1.786.835 5.061 Toilet Use ß 1 1.125** (.828) 2.708** (1.973) ß 2-301** (-1.092) R 2 adj.683 2.155.809 4.236 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 2 -.290** (-.951) 2 Mobility ß 1.345** R 2 adj.501 (.899) 1.004.774**.748 (1.936) 2.968 Urinary ß 2 control ß 1.731** (.861) -.030** 1.306** (2.143) (-1.074) R 2 adj.807 ß 2 4.181.820 -.187** (-1.311) 6.406 R 2 adj.740 2.846.736 2.788 Stool control ß 1.713** (.700) 1.408** (1.630) ß 2 -.208* (-.802) R 2 adj.485 0.942.708 2.425 Cognition ß 1.436** (.741) 1.487** (1.948) ß 2 -.057** (-1.221) R 2 adj.546 1.203.634 1.732 Communication ß 1.233** (.701).901** (2.422) ß 2 -.061** (-1.624) R 2 adj.487 0.949.764 3.237 Social interaction ß 1 1.517** (.445) 3.767* (1.196) ß 2-1.002 (-.900) R 2 adj.191 0.236.097 0.107 9
Results Regression 2 Mobility admission Linear relationship Significance p =.000 Variance R 2 adj = 80.7% Effect Size f 2 = 4.18 10
Results Regression 3 Mobility discharge squared Curvilinear Significance p=.000 Variance R 2 adj = 82% Effect Size f 2 =6.41 11
Conclusions EBI could be generated from epa_ac Items comparable Sum score not comparable Algorithm for sum score 12
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. 13
Thank you for your attention susanne.suter-riederer@zhaw.ch 14