TY - JOUR A1 - Peter, C. A1 - Schulenberg, S. E. A1 - Buchanan, E. M. A1 - Prodinger, Birgit A1 - Geyh, S. T1 - Rasch analysis of measurement instruments capturing psychological personal factors in persons with spinal cord injury JF - Journal of Rehabilitation Medicine N2 - Objective: To evaluate the metric properties of distinct measures of psychological personal factors comprising feelings, beliefs, motives, and patterns of experience and behaviour assessed in the Swiss Spinal Cord Injury Cohort Study (SwiSCI), using Rasch methodology. Methods: SwiSCI Pathway 2 is a community-based, nationwide, cross-sectional survey for persons with spinal cord injury (SCI) (n = 511). The Rasch partial credit model was used for each subscale of the Positive Affect Negative Affect Scale (PANAS), Appraisal of Life Events Scale (ALE), Purpose in Life test – Short Form (PIL-SF), and the Big Five Inventory-K (BFI-K). Results: The measures were unidimensional, with the exception of the positive affect items of the PANAS, where pairwise t-tests resulted in 10% significant cases, indicating multidimensionality. The BFI-K subscale agreeableness revealed low reliability (0.53). Other reliability estimates ranged between 0.61 and 0.89. Ceiling and floor effects were found for most measures. SCI-related differential item functioning (DIF) was rarely found. Language DIF was identified for several items of the BFI-K, PANAS and the ALE, but not for the PIL-SF. Conclusion: A majority of the measures satisfy the assumptions of the Rasch model, including unidimensionality. Invariance across language versions still represents a major challenge. KW - psychological factors KW - personality KW - affect KW - spinal cord injury KW - validity KW - reliability KW - psychometrics Y1 - 2016 UR - http://dx.doi.org/10.2340/16501977-2028 VL - 48 IS - 2 SP - 175 EP - 188 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Stamm, T. A1 - Petersson, D. A1 - Stucki, G. A1 - Tennant, A. T1 - Toward a standardized reporting of outcomes in hand osteoarthritis: Developing a common metric of outcome measures commonly used to assess functioning. JF - Arthritis Care & Research N2 - Objective Functioning is an important outcome in hand osteoarthritis (OA). The heterogeneity of patient‐reported outcome measures (PROMs) available challenges the direct comparability of information collected by these instruments. This study aimed to examine whether it is possible to achieve metric equivalence of PROMs commonly used to measure functioning in people with hand OA. Methods A secondary analysis of data from 253 persons who participated in the Vienna Hand Osteoarthritis Cohort Study was conducted applying the Rasch measurement model. Participants completed the Health Assessment Questionnaire, the Australian/Canadian Index for Hand Osteoarthritis, the Functional Index for Hand Osteoarthritis (FIHOA), and the Cochin Scale. The assumptions of stochastic ordering, local independence, unidimensionality, and invariance were tested for each scale independently before the scales were co‐calibrated onto a common metric. Results Except for the FIHOA, all measures indicated issues of local dependency in the initial analyses. After accommodating those with testlets, all scales satisfied the assumptions of the Rasch model (χ2 > 0.05). Marginal misfit in 2 items was found in the FIHOA, but this did not disturb person estimates. As the 4 scales form a common metric that satisfies the assumptions of the Rasch model, the scores can be equated. Conclusion The scores of the 4 hand function measures can be transformed to a common 0–100 metric, such that scores can be interchanged. A user‐friendly transformation table enables clinicians and researchers to have access to the common metric by simply adding up the total score for each instrument and identifying the corresponding transformed score on the common metric. KW - Osteoarthritis KW - Outcome measures KW - Cohort study Y1 - 2016 UR - https://doi.org/10.1002/acr.22816 VL - 68 IS - 8 SP - 1115 EP - 1127 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Reinhard, J.D. A1 - Selb, M. A1 - Stucki, G. A1 - Yan, T. A1 - Zhang, C. A1 - Li, J. T1 - Towards system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in routine practice: Developing simple, intuitive descriptions of ICF categories in the ICF Generic and Rehabilitation Set JF - Journal of Rehabilitation Medicine N2 - Objective: A national, multi-phase, consensus process to develop simple, intuitive descriptions of International Classification of Functioning, Disability and Health (ICF) categories contained in the ICF Generic and Rehabilitation Sets, with the aim of enhancing the utility of the ICF in routine clinical practice, is presented in this study. Methods: A multi-stage, national, consensus process was conducted. The consensus process involved 3 expert groups and consisted of a preparatory phase, a consensus conference with consecutive working groups and 3 voting rounds (votes A, B and C), followed by an implementation phase. In the consensus conference, participants first voted on whether they agreed that an initially developed proposal for simple, intuitive descriptions of an ICF category was in fact simple and intuitive. Results: The consensus conference was held in August 2014 in mainland China. Twenty-one people with a background in physical medicine and rehabilitation participated in the consensus process. Four ICF categories achieved consensus in vote A, 16 in vote B, and 8 in vote C. Discussion: This process can be seen as part of a larger effort towards the system-wide implementation of the ICF in routine clinical and rehabilitation practice to allow for the regular and comprehensive evaluation of health outcomes most relevant for the monitoring of quality of care. KW - Disability and health KW - Health information systems KW - International classification of functioning KW - Practicing standards Y1 - 2016 UR - https://doi.org/10.2340/16501977-2066 VL - 48 IS - 6 SP - 508 EP - 514 ER - TY - JOUR A1 - Li, J. A1 - Prodinger, Birgit A1 - Reinhard, J. D. A1 - Stucki, G. T1 - Toward the system-wide implementation of the International Classification of Functioning, Disability and Health in routine clinical practice: Lessons from a pilot study in China JF - Journal of Rehabilitation Medicine N2 - In 2011 the Chinese leadership in rehabilitation, in collaboration with the International Classification of Functioning, Disability and Health (ICF) Research Branch, embarked on an effort towards the system-wide implementation of the ICF in the healthcare system in China. We report here on the lessons learned from the pilot phase of testing the ICF Generic Set, a parsimonious set of 7 ICF categories, which have been shown to best describe functioning across the general population and people with various health conditions, for use in routine clinical practice in China. The paper discusses whether classification and measurement are compatible, what number of ICF categories should be included in data collection in routine practice, and the usefulness of a functioning profile and functioning score in clinical practice and health research planning. In addition, the paper reflects on the use of ICF qualifiers in a rating scale and the particularities of certain ICF categories contained in the ICF Generic Set when used as items in the context of Chinese rehabilitation and healthcare. Finally, the steps required to enhance the utility of system-wide implementation of the ICF in rehabilitation and healthcare services are set out. KW - Functional status KW - ICF KW - Psychomatrics KW - Rasch analysis KW - Sensitivity to change Y1 - 2016 UR - https://doi.org/10.2340/16501977-2067 VL - 48 IS - 6 SP - 502 EP - 507 ER - TY - JOUR A1 - Hopfe, M. A1 - Stucki, G. A1 - Marshall, R. A1 - Twomey, C. A1 - Üstün, T.B. A1 - Prodinger, Birgit T1 - Capturing patients' needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems JF - BMC Health Services Research N2 - Background Contemporary casemix systems for health services need to ensure that payment rates adequately account for actual resource consumption based on patients’ needs for services. It has been argued that functioning information, as one important determinant of health service provision and resource use, should be taken into account when developing casemix systems. However, there has to date been little systematic collation of the evidence on the extent to which the addition of functioning information into existing casemix systems adds value to those systems with regard to the predictive power and resource variation explained by the groupings of these systems. Thus, the objective of this research was to examine the value of adding functioning information into casemix systems with respect to the prediction of resource use as measured by costs and length of stay. Methods A systematic literature review was performed. Peer-reviewed studies, published before May 2014 were retrieved from CINAHL, EconLit, Embase, JSTOR, PubMed and Sociological Abstracts using keywords related to functioning (‘Functioning’, ‘Functional status’, ‘Function*, ‘ICF’, ‘International Classification of Functioning, Disability and Health’, ‘Activities of Daily Living’ or ‘ADL’) and casemix systems (‘Casemix’, ‘case mix’, ‘Diagnosis Related Groups’, ‘Function Related Groups’, ‘Resource Utilization Groups’ or ‘AN-SNAP’). In addition, a hand search of reference lists of included articles was conducted. Information about study aims, design, country, setting, methods, outcome variables, study results, and information regarding the authors’ discussion of results, study limitations and implications was extracted. Results Ten included studies provided evidence demonstrating that adding functioning information into casemix systems improves predictive ability and fosters homogeneity in casemix groups with regard to costs and length of stay. Collection and integration of functioning information varied across studies. Results suggest that, in particular, DRG casemix systems can be improved in predicting resource use and capturing outcomes for frail elderly or severely functioning-impaired patients. Conclusion Further exploration of the value of adding functioning information into casemix systems is one promising approach to improve casemix systems ability to adequately capture the differences in patient’s needs for services and to better predict resource use. KW - Functioning information KW - DRG KW - Casemix KW - Systematic Review KW - Ressource utilization Y1 - 2016 UR - https://doi.org/10.1186/s12913-016-1277-x VL - 16 SP - 40 ER - TY - JOUR A1 - Dorjbal, D. A1 - Cieza, A. A1 - Gmünder, H.-P- A1 - Scheel-Sailer, A. A1 - Stucki, G. A1 - Üstün, T.B. A1 - Prodinger, Birgit T1 - Strengthening quality of care through standardized reporting based on the World Health Organization's reference classifications JF - International Journal of Quality in Health N2 - Quality issue Responding to person's health and related needs requires the availability of health information that reflects relevant aspects of a health condition and how this health condition impacts on a person's daily life. Initial assessment Health information is routinely collected at different time points by diverse professionals, in different settings for various purposes with varying methods. Consequently, health information is not always comparable, posing a challenge to the regular monitoring of quality. Choice of solution The World Health Organization's (WHO) International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI; under development) are complementary and serve as meaningful reference classifications for comparing data on persons’ health and related interventions across health systems. Implementation We developed a systematic approach of translating routinely collected information into a standardized report based on the three WHO reference classifications and the Rehab-Cycle®. Subsequently, we have demonstrated its application using five random case records of individuals attending a rehabilitation program. Evaluation All identified concepts were able to be linked to WHO's reference classifications. The ICF served as a tool to standardize information on rehabilitation goals and their achievement. The ICHI served as the basis for reporting the interventions that were documented in the case records, including the intervention targets that were derived from the ICF codes. Lessons learned Our experience shows that, it is possible to translate routinely collected information into standardized reports by linking existing narrative records with WHO's reference classifications. KW - International Classification of Diseases KW - International Classification of Functioning KW - Disability and health KW - Quality improvement KW - Rehabilitation Y1 - 2016 UR - https://doi.org/10.1093/intqhc/mzw078 VL - 28 IS - 5 SP - 626 EP - 633 ER - TY - JOUR A1 - Prodinger, Birgit A1 - Tennant, A. A1 - Stucki, G. A1 - Cieza, A. A1 - Üstün, T.B. T1 - Harmonizing routinely collected health information for strengthening quality management in health systems: requirements and practice JF - Journal of Health Services Research & Policy N2 - Objective Our aim was to specify the requirements of an architecture to serve as the foundation for standardized reporting of health information and to provide an exemplary application of this architecture. Methods The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) served as the conceptual framework. Methods to establish content comparability were the ICF Linking Rules. The Rasch measurement model, as a special case of additive conjoint measurement, which satisfies the required criteria for fundamental measurement, allowed for the development of a common metric foundation for measurement unit conversion. Secondary analysis of data from the North Yorkshire Survey was used to illustrate these methods. Patients completed three instruments and the items were linked to the ICF. The Rasch measurement model was applied, first to each scale, and then to items across scales which were linked to a common domain. Results Based on the linking of items to the ICF, the majority of items were grouped into two domains, Mobility and Self-care. Analysis of the individual scales and of items linked to a common domain across scales satisfied the requirements of the Rasch measurement model. The measurement unit conversion between items from the three instruments linked to the Mobility and Self-care domains, respectively, was demonstrated. Conclusions The realization of an ICF-based architecture for information on patients’ functioning enables harmonization of health information while allowing clinicians and researchers to continue using their existing instruments. This architecture will facilitate access to comprehensive and consistently reported health information to serve as the foundation for informed decision-making. KW - Decision making KW - Health classification KW - Health status measurement KW - Information standards KW - Quality management Y1 - 2016 UR - https://doi.org/10.1177/1355819616636411 VL - 21 IS - 4 SP - 223 EP - 228 ER - TY - JOUR A1 - Hinrichs, T. A1 - Prodinger, Birgit A1 - Brinkof, M.W. A1 - Gemperli, A. T1 - Subgroups in epidemiological studies on spinal cord injury: Evaluation of international recommendations in the Swiss Spinal Cord Injury Cohort Study JF - Journal of Rehabilitation Medicine N2 - Objective: To test subgroups of a community-based sample of individuals with spinal cord injury, categorized by the application of current recommendations by the International Spinal Cord Society. Design: Community survey. Participants: Individuals with traumatic and non-traumatic spinal cord injury residing in Switzerland. Methods: Recommended subgroups of age, gender, years since injury, severity of injury and aetiology were tested against the following criteria: (i) distribution of participants across categories; (ii) within- and between-group variability with regard to selected outcomes of functioning and quality of life. Results: Data-sets for 1,549 participants (28.5% women; mean age 52 ± 15 years) were available for analyses. There was a number of participants in every subgroup, yet numbers were relatively small in the group with the shortest time since injury (< 1 year; n = 23) and in the oldest age group (≥76; n = 94). A high variability in some outcomes was detected between categories. All variables were predictive for most of the endpoints investigated. Conclusion: Recommended categorization could well fit the present sample. A minor concern was the low numbers of participants in some subgroups. KW - Classification KW - Disability and health KW - Health survey KW - International classification of functioning KW - Spinal cord injury Y1 - 2016 UR - https://doi.org/10.2340/16501977-2029 VL - 48 IS - 2 SP - 141 EP - 148 ER - TY - JOUR A1 - Reinhardt, J. D. A1 - Zhang, X. A1 - Prodinger, Birgit A1 - Ehrmann-Bostan, C. A1 - Selb, M. A1 - Stucki, G. A1 - Li, J. T1 - Toward the system-wide implementation of the International Classification of Functioning, Disability and Health in routine clinical practice: Empirical findigns of a pilot study from Mainland China JF - Journal of Rehabilitation Medicine N2 - Objective: The aims of this study were to evaluate the feasibility of using the International Classification of Functioning, Disability and Health (ICF) Generic Set in routine clinical practice, and of creating a functioning score based on it, and, subsequently, to examine its sensitivity to change. Methods: In this prospective cohort study, data from 761 adult inpatients from 21 Chinese hospitals were analysed. Each patient was assessed at admission and discharge. Feasibility was evaluated by analysing mean assessment time. The Rasch model was used to create a metric of functioning. Sensitivity to change was analysed with mixed-effects regression and by calculating standardized effect size based on Cohen's f2. Results: Mean duration of assessment was 5.3 min, with a significant decrease between admission and discharge. After removal of the item remunerative employment, the remaining ICF Generic Set categories fitted the Rasch model well. With a mean improvement in functioning of 12.1 (95% confidence interval (95% CI): 11.5–12.6), this metric proved sensitive to change, both in terms of statistical significance (p < 0.001) and standardized effect size (Cohen's f2 = 2.35). Discussion: The ICF Generic Set is feasible for use in routine clinical practice and is promising to serve as the basis for the development of a functioning score that is sensitive to change. KW - Functional status KW - ICF KW - Psychomatrics KW - Rasch analysis Y1 - 2016 UR - https://doi.org/10.2340/16501977-2102 VL - 48 IS - 6 SP - 515 EP - 521 ER - TY - JOUR A1 - Dür, M. A1 - Steiner, G. A1 - Stoffer, M.A. A1 - Fialka-Moser, V. A1 - Kautky-Willer, A. A1 - Dejaco, C. A1 - Ekmekcioglu, C. A1 - Prodinger, Birgit A1 - Binder, A. A1 - Smolen, J. A1 - Stamm, T. A. T1 - Initial evidence for the link between activities and health: Associations between a balance of activities, functioning and serum levels of cytokines and C-reactive protein JF - Psychoneuroendocrinology N2 - Growing evidence shows interrelations of psychological factors, neurological and immunological processes. Therefore, constructs like a balance of activities, the so called “occupational balance”, could also have biological correlates. The aim of this study was to investigate potential associations between occupational balance, functioning, cytokines and C-reactive protein (CRP) in patients suffering from a chronic inflammatory disease like rheumatoid arthritis (RA) and healthy people. Moreover, we wanted to explore potential differences in gender and employment status. A descriptive study in patients with RA and healthy people was conducted using the Occupational Balance-Questionnaire (OB-Quest) and the Short-Form 36 Health Survey (SF-36). Serum levels of cytokines, such as interleukin 6 (IL-6) and 8 (IL-8), interferon alpha (INFα), tumour necrosis factor alpha (TNFα), rheumatoid factor (RF) and of CRP were measured. Descriptive statistics, as well as Mann-Whitney U tests and Spearmen's rank correlation coefficients (rs) were calculated. One-hundred-thirty-two patients with RA and 76 healthy people participated. Occupational balance was associated with functioning, cytokines and CRP. The strongest associations were identified in the unemployed healthy-people sample with cytokines and CRP being within the normal range. For example, the OB-Quest item challenging activities was associated with IL-8 (rs = − 0.63, p = 0.04) and the SF-36 sub-scale bodily pain was associated with IFNα (rs = − 0.69, p = 0.02). The items rest and sleep (rs = − 0.71, p = 0.01) and variety of different activities (rs = − 0.74, p < 0.01) correlated with the SF-36 sub-scale social functioning. Employed and unemployed people differed in their age and CRP levels. Additionally, gender differences were found in two OB-Quest items in that fewer women were able to adapt their activities to changing living conditions and fewer men were overstressed. In conclusion, we found preliminary biological evidence for the link between occupation and health in that the concepts encompassed in the construct of occupational balance were associated with functioning, cytokines and CRP. KW - Autoimmune disease KW - Psychoneuroendocrinology KW - Inflammatory markers KW - Occupational balance KW - Measure KW - Immunology Y1 - 2016 UR - https://doi.org/10.1016/j.psyneuen.2015.12.015 VL - 65 SP - 138 EP - 148 ER -