CIMIT FORUM AGENDA
November 6, 2007
4:00 – 6:00 PM
4:00PM How Are
You Really Doing? Innovations
in Functional Outcomes Measurement in Rehabilitation
Presenter: Alan M. Jette, PT, PhD,
FAPTA, Professor of Health Policy & Management, Boston University School of
Public Health; Director, Health & Disability Research Institute, BU;
Research Director, New England Regional Spinal Cord Injury Center, BUMC;
Director, Post Doctoral Research Fellowship in Rehabilitation Outcomes and
Effectiveness Research, BU, ajette@bu.edu
Moderator: Kenneth L. Minaker, MD, Chief,
Geriatric Medicine Unit, Associate Professor of Medicine, MGH Senior Health,
kminaker@partners.org
Rehabilitative care is a major part of the U.S. healthcare system, and from
the hospital to the home, clinicians and other caregivers depend on metrics to
gauge each patient’s progress. These
measurements promote speedy rehabilitation by providing information that can
help guide therapy, but at the moment, there may be too many metrics to choose
from. Most measuring instruments are
designed for one setting, but today, one episode of rehabilitative care usually
cuts across multiple settings, perhaps from an inpatient facility to a rehab
center to the patient’s home. The
healthcare system needs new outcome assessment instruments, and these should cover
a broad functional range without sacrificing precision.
Researchers led by Alan M. Jette,
PhD, of the Boston University School of Public Health have created a new
metric, known as the Activity Measure for Post-Acute Care (AM-PAC), to assess
outcomes based on item response theory.
The new metric consists of questions posed by focus groups, care
providers, and the scientific literature.
The questions, or items, have been correlated with one another based on
the responses of over one thousand trial subjects. Each item measures a patient’s ability to
perform one of 269 functional tasks, and the tasks are divided into three
sub-domains: daily activities, mobility, and applied cognitive skills.
AM-PAC is a computer-adaptive test, so it is fairly easy to administer. Not all questions in the battery of 269 items
are asked to each patient. Each new
question is based on the patient’s previous response. The computer is able to quickly assess the
general area of the scale on which the patient falls, and then it asks
questions designed to obtain a precise measure of the patient’s functional
abilities. Because the computerized test
tailors itself to each individual patient, a caregiver can obtain measurements
in all three AM-PAC sub-domains in around five minutes, yet the test is broad
enough to be applicable in many settings.
Despite the advantages of the AM-PAC system, there are still
obstacles to be overcome. The test
requires computer platforms that are not available everywhere, and it can
present IT challenges. In some settings,
care providers are legally required to use other metrics, and few providers are
willing to do “extra” tests. Finally,
the test itself still needs to be made more intuitively interpretable to
clinicians. Nevertheless, computer-adaptive
testing seems to be the technology of the future for outcome assessment. View
this video
5:00PM Three Big Risks For Older Adults: Walking, Climbing Stairs and Rising
from a Chair - Evidence-based Rehabilitative Care for Older Adults
Presenter: Jonathan Bean, MD, MS, MPH. Assistant Professor,
Director, Research Training and Education, Department PM&R, Harvard Medical
School; Medical Director, Spaulding Cambridge Outpatient Center,
jfbean@partners.org
Moderator: Bette Ann Harris, DPT, Clinical Professor, Special Assistant
to the President for New Initiatives, MGH Institute of Health Professions,
baharris@partners.org
Impaired mobility is a major health concern for older adults, affecting fifty
percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb
stairs, and to rise from a chair, they become completely disabled. The problem
cannot be ignored because people over 65 constitute the fastest growing segment
of the
Therapy designed to improve mobility
in elderly patients is usually built around diagnosing and treating specific
impairments, such as reduced strength or poor balance. It is appropriate to compare older adults
seeking to improve their mobility to athletes seeking to improve their split
times. People in both groups perform
best when they measure their progress and work toward specific goals related to
strength, aerobic capacity, and other physical qualities. Someone attempting to improve an older
adult’s mobility must decide what impairments to focus on, and in many cases, there
is little scientific evidence to justify any of the options.
Today, many caregivers choose to
focus on leg strength and balance.
Growing evidence, however, supports the view that limb velocity and core
strength are also important factors in mobility. Power, after all, is the product of force
(strength) and velocity, and exercise physiologists have long stressed
that strong abdominal and back muscles are important to athletic performance.
It is still relatively difficult to
measure limb velocity and core strength.
Ideally, measures of these factors should be inexpensive, reliable,
broadly applicable, and easy for the one being tested to perform. A newly thought-up stair-climbing test of
power is slightly less reliable than more expensive tests, but so far, it has
worked relatively well. Measures of core
strength, too, are being developed. As
clinically feasible ways of measuring limb velocity and core strength are
found, these considerations may become a more important part of the care
received by patients with impaired mobility.