RehabWire - Volume 6, Number 1, January 2004

RehabWire for January examines "outcomes" research: Those projects that investigate the results of rehabilitation and the methods of measuring those results.

NIDRR Projects: Research in the New Millennium.

Development of an Assistive Technology Outcomes Measurement System Utilizing the International Classification of Functioning (ICIDH-2/ICF), University of Colorado Health Sciences Center (H133G030187) led by Cathy Bodine. David W. Keer, Project Officer.
Abstract: This project furthers the development of a secure, multi-site, web-based assistive technology (AT) outcomes system designed to capture data that enables the measurement of the impact of AT devices and services for children and adults with disabilities. THe project is designed for easy addition of data fields to support the ever-evolving schema for outcomes assessment in AT> Information gained leads to maximizing the full inclusion and integration into society, employment, independent living, family support, and economic and social self-sufficiency of individuals with disabilities, especially individuals with the most severe disabilities; and will lead to improved information and research on the effectiveness of AT devices and evidence-based practices.
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The impact of Interventions on Self-Determination and Adult Outcomes, University of Kansas (H133A031727) led by Michael Wehmeyer, PhD (University of Kansas) and Laurie Powers, PhD (Oregon Health Sciences University). Shelley Reeves, Project Officer.
Abstract: This project conducts three semi-longitudinal, national studies examining the impact of interventions to promote the self-determination of students with high incidence and low incidence disabilities, and students who are at-risk for poor adult outcomes on student self-determination, adult outcomes, and quality of life.
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Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes, Boston University (H133B990005) led by Alan M. Jette, PhD. Ruth Brannon, Project Officer.
Abstract: This Center develops new, more effective outcomes measurement tools and applies these tools to determine the effectiveness of medical rehabilitation effectiveness of medical rehabilitation interventions. Research components include: (1) identifying gaps in existing outcome measures and developing new instruments that address these gaps as part of a rehabilitation outcomes system; (2) critically evaluating the newly developed instruments gains tools currently in use; (3) implementing the newly developed outcome instruments across impairment groups and across rehabilitation settings to assess their feasibility, responsiveness, and validity; (4) investigating the extent to which specific rehabilitation interventions affect outcomes following the onset of a stroke; and (5) applying modern psychometric techniques to develop dynamic outcome instruments that can also be used with individual patients in a clinicla setting.
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woman receiving treatment from medical staff

Advancing Rehabilitation Research Training Center on outcomes and Intervention Effectiveness, University of Medicine & Dentistry of New Jersey (H133P020012) led by Mark V. Johnston, PhD. Theresa San Agustin, MD, Project Officer.
Abstract: This postdoctoral research training program develops researchers who advance knowledge of the impact of interventions - medical, activity-based, social-psychological, and environmental - on outcomes for persons with physical and neurological disabilities. Outcomes-related study topics include research on prognosis and severity adjustment, treatment guideliness, quality improvement strategies, and issues of health policy.
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Evaluating Independent Living Outcomes for Blind and Visually Impaired Older People: Development of a Nationally Standardized Minimum Dataset (NSMD) American Foundation for the Blind (H133G010183) led by Corine Kirchner, PhD and Alberta L. Orr, MSW. Bonnie Gracer, Project Officer.
Abstract: This Project develops and pilot tests a Nationally Standarized Minimum Dataset (NSMD), through which research can be conducted on the outcomes of services for older persons with visual impairments. The NSMD is piloted in several agencies throughout the country and includes: (1) pre-service consumer data, (2) a post-service consumer profile, (3) a functional outcomes assessment, and (4) a consumer satisfaction and perceived outcome survey.
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nurse reviews paperwork with older woman

Advancing Assistive Technology Outcomes, Duke University (H133A010401) led by Frank DeRuyter, PhD. Carol Cohen, Project Officer.
Abstract: Research activities of this project include: (1) performing a critical analysis of existing approaches to measurement and further developing instruments that are promising; (2) identifying unmet needs and assessing barriers to AT outcomes measurement; and (3) undertaking a prospective longitudinal study of factors associated with assistive device adoption, use, and discontinuance. Development activities include: (1) developing and evaluating independent electronic data collection or computer-assisted systems for the capture, analysis, and interpretation of AT outcomes information; (2) developing and evaluating improved methos and systems for communication of outcomes information among significant stakeholders; (3) automatic log file performance data-capturing for AT outcomes assesment; and (4) development of new or improved AT outcomes tools.
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ATOMS Project: Assistive Technology Outcomes Measurement System, University of Wisconsin/Milwaukee (H133A010403) led by Roger O. Smith, PhD. Carol Cohen, Project Officer.
Abstract: The ATOMS Project (Assistive Technology Outcomes Measurement System) targets the definitionand pre-development phases of a next-generation AT outcomes measurement system. A comprehensive needs assessment, prototype instrument development, and consensus building activitites frame an integrated set of research and development activities to address urgent needs to identify components of a future AT outcomes measurement system. In addition, these activities generate information about the relationships of AT outcomes factors that produce a better understanding of AT use and abandonment.
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television studio light indicating that a program is on the air
Join the staff of the RRTC on Measuring Outcomes online for a series of videotaped presentations on rehabilitation outcomes. Presentations will be available throughout February and March at Contact Mary Slavin, PhD at 617/353-1541 or for more information.

New Research: Selections from REHABDATA

Maag, E.M., Wittenburg, D.C. (2003) Real trends or measurement problems? Disability and employment trends from the survey of income and program participation. Naric Accession Number: O14781
Abstract: Article examines the reliability of data sources used to measure disability trends in general and specifically, whether the Survey of Income and Program Participation (SIPP) can be used to track employment trends of people with disabilities. Findings from the SIPP, which reconfirm the trend in declining employment rates for people with disabilities shown in studies using other data sources, directly address the major criticisms of using statistical data to track disability outcomes. Authors conclude that the different empirical results found by researchers are not caused by problems with the data but by assumptions researchers make when using the data.

Turnbull, H.R., III, Turnbull, A.P., Wehmeyer, M.L., Park, J. (2003). A quality of life framework for special education outcomes. Remedial and Special Education, 24(2), 67-74. NARIC Accession Number: J45627.
Abstract: Article examines the relationship between quality of life outcomes and four goals established by the Individuals with Disabilities Education Act (IDEA): equal opportunity, full participation, independent living, and economic self-sufficiency. Authors propose that the underlying goal of education should be to improve the quality of life for students with disabilities and that the four IDEA goals should guide the curriculum and assessment measures.

O-Hara, L., Langbehn, K., Petty, R., Stamper, D., Hughey, A., Heinsohn, D. (2003). What are we doing and how well are we doing it? Outcomes measurement and independent living: A national teleconference: Participant's manual. NARIC Accession Number: O14830.
Abstract: Provides materials for training teleconference on outcomes measurement and reporting for independent living (IL) centers. Topics covered include: problems with standard IL reporting, how outcomes measurement can clarify the IL vision and improve accountability, the benefits and challenges of developing a statewide reporting system, using data to evaluate progress in achieving program goals, and how to train staff in outcome measurement.

Bushnik, T., Hanks, R.A., Kreutzer, J., Rosenthal, M. (2003). Etiology of traumatic brain injury: Characterization of differential outcomes up to 1 year postinjury. Archives of Physical Medicine and Rehabilitation, 84(2), 255-262. NARIC Accession Number: J45032.
Abstract: Characterizes outcomes after TBI based on the cause of the injury for a sample of subjects enrolled in TBI Model Systems (TBIMS) project. Specificially, subjects were grouped according to whether the injury resulted from vehicular crashes, violence, falls, or other etiology. At rehabilitation discharge, outcome measures included the Rancho Los Amigos Levels of Cognitive Functioning Scale. Both at discharge and at one-year follow-up, primary residence, the Functional Independence Measure instrument and the Disability Rating Scale scores were examined. Additional measures at one year postinjury included employment status, marital status, occurrence of seizures, and the Community Integration Questionnaire (CIQ) scores. At rehabilitation discharge, tere were no functional differences between the four etiology groups. At 1-year follow-up, individuals with violence-related TBI had higher unemployment rates and lower CIQ scores; individuals in the vehicular crashes group reported the best functional and psychosocial outcomes.

Shah, S., Muncer, S.J. (2003) A comparison of rehabilitation outcome measures for traumatic brain injury. OTJR: Occupation, Participation and Health, 23(1), 2-9. NARIC Accession Number: J45151.
Abstract: Study compares the appropriateness, responsiveness, and predictive ability of the Modified Barthel Index (MBI), the Disability Rating Scale (DRS), the Barry Rehabilitation Inpatient Screening of Cognition (BRISC), and the Glasgow Coma Scale (GCS) for predicting the outcome of patients with TBI referred for inpation rehabilitation. Appropriateness was determined by examining means, standard deviation, coefficients of variation, and ceiling and floor effects. Responsiveness was determined by examining paired t-test results for admission and discharge scores, and on the basis of an effect size calculation. Predictive ability was determined by performing two stepwise regressions with length of rehabilitation and total length of stay in the hospital. The results indicate that although the DRS and GCS have some advantages, MBI is the most effective measure overall, particularly for prediction.

Kolitz, B.P., Vanderploeg, R.D., Curtiss, G. (2003) Development of the key behaviors change inventory: A traumatic brain injury behavioral outcome assessment instrument. Archives of Physical Medicine and Rehabilitation, 84(2), 277-284. NARIC Accession Number: J45035.
Abstract: Describes the development and initial validation of the Key Behaviors Change Inventory (KBCI), a neurobehavioral outcome measure for individuals with TBI. The domains to be assessed by the KBCI were identified through informal interviews with people with TBI, their family members, and caregivers, and through discussions with TBI rehabilitation specialists. Analysis resulted in the identification of eight domains: inattention, impulsivity, unawareness of problems, apathy, interpersonal difficulties, communication problems, somatic difficulties, and emotional adjustment. The KBCI was found to be both sensitive and specific to typical behavioral changes after TBI.