Generating Clinical Outputs for Self-Reports of Visual Functioning.

Generating Clinical Outputs for Self-Reports of Visual Functioning.

Optom Vis Sci. 2013 Jul 8;
Velozo CA, Warren M, Hicks E, Berger KA

Visual functioning questionnaires (VFQs) address patient-centered and evidenced-based practice. The purpose of this study was to investigate the psychometrics of the Self-Report Assessment of Functional Vision Performance (SRAFVP) and present Rasch-generated patient-level outputs.One hundred two patients were administered the 39-item SRAFVP that includes questions under the categories of reading, writing, money management, telephone usage, reading a timepiece, personal care, clothing care, meal preparation, leisure, and functional mobility. Dimensionality was determined using confirmatory factor analysis and principal components analysis of residuals. The Andrich rating (Rasch) model was used to determine rating scale qualities, item/person fit to the Rasch model, item-difficulty hierarchy, person-item match, and person separation. Keyform outputs were generated that present response patterns for individual patients.Whereas the confirmatory factor analysis confirmed reading and mobility dimensions, the principal components analysis indicated that the SRAFVP formed a single dominant measure. The original five-point rating scale showed disordered thresholds that were corrected by collapsing the three middle rating categories. Only two of 39 items showed high infit and outfit statistics and five of 39 items showed high outfit statistics. The items showed a logical item-difficulty order related to the visual ability necessary to accomplish activities of daily living. The SRAVFP separated the sample into 3.77 distinct strata, showing no ceiling or floor effects. Keyforms demonstrated distinct patterns of responses for individuals reporting different visual functioning ability.As with many VFQs, the SRAVFP shows good item-level psychometric qualities. The SRAVFP and other VFQs may provide the foundation for theory-based instrument calibration that should enhance our translation of measures across VFQs and improve our understanding of visual functioning. Rasch measurement provides a means to generate outputs that may prove to be useful in goal setting and treatment planning when providing low-vision rehabilitation. HubMed – rehab


Preoperative risk factors related to bladder cancer rehabilitation: a registry study.

Eur J Clin Nutr. 2013 Jul 10;
Jensen BT, Laustsen S, Petersen AK, Borre M, Soendergaard I, Ernst-Jensen KM, Lash TL, Borre M

INTRODUCTION:Patients diagnosed with (muscle-) invasive bladder cancer (IBC) are more likely to harbour comorbidities due to their advanced age at diagnosis. Under-nutrition is a predictor for postoperative morbidity and mortality in cancer patients, but under-reported in urology. Understanding the IBC patient profile before major surgery could facilitate and optimise outcome of the surgical patient.BACKGROUND/OBJECTIVES:To identify preoperative risk factors for early rehabilitation before radical cystectomy (RC).SUBJECTS/METHODS:A historical registry-based study of 76 patients referred for RC at Aarhus University Hospital, Denmark (DK) in 2009. Early rehabilitation was defined by length of stay (LOS) postoperatively with a cutoff ?11 days. High comorbidity was expressed by the charlson comorbidity index score (CCI) ?3. LOS was calculated by linking the unique Civil Registration Number with the National Patient Registry. Preoperative nutritional risk was identified using the screening tool, nutritional risk score 2002 (NRS) of the European Society of Clinical Nutrition and Metabolism. Multivariate analysis was used to identify risk factors for early rehabilitation.RESULTS:The proportion of patients at preoperative nutritional risk was 26% (95% confidence interval (CI): (95% CI: 17; 37) and 43% of patients held a high CCI (95% CI: 33; 55). Prolonged LOS was independently associated with female gender (P=0.02) and age ?70 years (P=0.04). NRS and CCI were not associated with LOS.CONCLUSIONS:Attention should be focused on women and elderly patients undergoing RC to optimise early rehabilitation and reduce LOS. It is still unknown whether preoperative nutritional risk and comorbidity are obstacles in early rehabilitation of RC patients.European Journal of Clinical Nutrition advance online publication, 10 July 2013; doi:10.1038/ejcn.2013.120. HubMed – rehab


Cardiac Rehabilitation Services in Low- and Middle-Income Countries: A Scoping Review.

J Cardiovasc Nurs. 2013 Jul 8;
Shanmugasegaram S, Perez-Terzic C, Jiang X, Grace SL

Despite the decreasing rate of cardiovascular disease-related mortality in developed nations, low- and middle-income countries (LMICs) are experiencing an increase. Cardiac rehabilitation (CR) successfully addresses this burden; however, the availability and nature of CR service delivery in LMICs are not well known.This scoping review examined the (1) presence and accessibility of CR services, (2) structure of CR services, and (3) effects of CR on patient outcomes in LMICs.Search criteria consisted of (1) nations considered to be low- or middle-income according to World Bank criteria, (2) CR, defined as programs including exercise and education, and (3) adults with cardiovascular diseases. Literature was identified through searching (a) the MEDLINE and EMBASE electronic databases, (b) proceedings from international cardiac conferences, (c) the grey literature and (d) through consulting experts in the field.Thirty peer-reviewed publications were identified. Grey literature, including Web sites for individual CR programs, revealed that CR is available in 32 (22.1%) LMICs. The most comprehensive data on accessibility stem from Latin America and the Caribbean, where 56% of institutions with cardiac catheterization facilities offered CR. Literature showed that some programs offered exercise, dietary advice, education, and psychological support, to assist patients to resume work and other activities of daily living. Fifteen peer-reviewed studies reported on CR outcomes, most of which were positive.Although patients similarly benefit from CR, few programs are available in LMICs. Policies need to be implemented to increase provision of tailored CR models at the global and national level, with evaluation. HubMed – rehab