Psychometric evaluation of the Decision Support System (DSS) for municipal nurses encountering health deterioration among older adults.

BACKGROUND: A valid and reliable tool is crucial for municipal registered nurses (RNs) to make quick decisions in older adults who show rapid signs of health deterioration. The aim of this study was to investigate the psychometric properties of the Decision Support System (DSS) among older adults in the municipal healthcare system. METHODS: Firstly, we utilized the Rasch dichotomous model to analyze the DSS assessments (n=281) that were collected from municipal RNs working with older adults in the municipal healthcare system. We examined the properties of the DSS in terms of its unidimensionality, item fit, and separation indices. Secondly, to investigate inter-rater agreement in using the DSS, four experienced municipal RNs used the DSS to assess 60 health deterioration scenarios presented by one human patient simulators. The 60 DSS assessments were then analyzed using the ICC (2,1), percentage agreement, and Cohen κ statistics. RESULTS: The sample of older adults had a mean age of 82.8 (SD 11.7). The DSS met the criteria for unidimensionality, although two items did not meet the item fit statistics when all the DSS items were analyzed together. The person separation index was 0.47, indicating a limited level of separation among the sample. The item separation index was 11.43, suggesting that the DSS has good ability to discriminate between and separate the items. At the overall DSS level, inter-rater agreements were good according to the ICC. At the individual DSS item level, the percentage agreements were 75% or above, while the Cohen κ statistics ranged from 0.46 to 1.00. CONCLUSIONS: The Rasch analysis revealed that the psychometric properties of the instrument were acceptable, although further research with a larger sample size and more items is needed. The DSS has the potential to assist municipal RNs in making clinical decisions regarding health deterioration in older adults, thereby avoiding unnecessary emergency admistion and helping.

Person-centred care in nursing homes during the COVID-19 pandemic: a cross sectional study based on nursing staff and first-line managers' self-reported outcomes.

BACKGROUND: COVID-19 has presented many difficulties in providing person-centred care (PCC) in nursing homes (NH). Factors such as organisational support, work condition and leadership may play a crucial role in supporting the performance of PCC during COVID restrictions. The study aim was to evaluate nursing staff and manager perceptions of the opportunities to perform person-centred care during the COVID-19 pandemic. METHODS: Nursing staff (NS) (n = 463) and First Line Managers (FLM) (n = 8) within all NHs in one community filled in the SVENIS questionnaire which consists of five areas: perceived organizational support, work climate, person-centred care, work conditions and leadership. A Kruskal-Wallis test was used to perform inter-group comparisons and standard multiple regression was used to investigate which factor contributed most to perform PCC. RESULTS: The comparison analyses indicate that staff from nursing homes for persons with dementia had the highest opportunities to perform PCC during the pandemic. The day shift staff had more opportunities to perform PCC than night shift staff. The results from the standard multiple regression show that a NA's current nursing home was the most significant variable affecting the opportunities to perform PCC. The analyses of both the comparison analyses and the regression suggest that day shift staff from nursing homes for persons with dementia had the highest opportunities to perform PCC during the pandemic. The same group also rated the importance of leadership as high for performing PCC. CONCLUSION: Despite the COVID-19 restrictions and all the criticism directed against the care of older people; the day staff felt that they conducted PCC. Staff in nursing homes for dementia had the highest opportunities for PCC and this may be because they are better prepared to provide care for the individual in NH. The importance of leadership was also evident, which means that investment in FLMs is seen as necessary.

Safe transport of children with disabilities and medical conditions: Caregiver experiences.

BACKGROUND: Road vehicle transportation is essential to support community access and participation for all children. However, little is known about the transport patterns of children with disabilities and medical conditions and their caregivers' experiences supporting them to be transported safely in road vehicles in Australia. AIM: To understand the transport needs of children with disabilities and medical conditions and the transport needs of their caregivers. MATERIALS AND METHODS: A large-scale national survey was undertaken online to explore the experiences and perspectives of 193 caregivers, identifying the challenges and needs associated with providing and supporting safe road transportation for their children. RESULTS: Caregivers believed their child was missing out on participating in everyday life due to their transportation needs, with caregivers experiencing multiple challenges and barriers to transporting their child safely. CONCLUSIONS AND SIGNIFICANCE: There is a need to provide knowledge and support to caregivers who are primarily responsible for the safe transportation of their children with disabilities and medical conditions.

A Study Protocol for Persons With Neurological Diseases: Linking Rehabilitation Goals to the International Classification of Functioning, Disability and Health With a Focus on Assistive Technology for Cognition and Its Effects.

Persons with neurological diseases often have some degree of cognitive impairment. They are in need of assistive technology for cognition (ATC) to compensate for cognitive impairments that affect their daily functioning. Goal setting in relation to cognitive deficits using ATC are common in clinical practice, and therapists often set several rehabilitation goals together with a patient. However, these rehabilitation goals are usually phrased differently, which limit the comparison of ATC and rehabilitation goals. It is thus valuable to link the goals to some standardized terminologies, such as the International Classification of Functioning, Disability and Health (ICF). Furthermore, goal achievement is seldom used to evaluate long-term effects of ATC in persons with neurological diseases and limited attention has been paid to the factors that predict goal achievement in using the ATC as cognitive support in persons with neurological diseases. The aim of the project is 3-fold. Firstly, we will use the ICF to link rehabilitation goals regarding the use of ATC in adults with neurological diseases. Secondly, we will evaluate effects of the ATC using goal achievement over a 5-year period. Thirdly, we will explore the variables that predict goal achievement in relation to the effects of ATC.

Adolescents with congenital limb reduction deficiency: Perceptions of treatment during childhood and its meaning for their current and future situation.

BACKGROUND: Children with congenital limb reduction deficiency live with the decisions made by their parents and healthcare professionals about treatments to be carried out during the first years of life. To understand better the meaning of treatment during childhood, it is necessary to listen to adolescents who have had this experience. The aim of this study was to investigate the perceptions of adolescents with congenital limb reduction deficiency concerning the treatment they received during childhood and what it meant to them currently and in the future. METHODS: A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with 10 adolescents (six girls and four boys) with upper and/or lower limb reduction deficiency, median age 17.5 years (range 16-19). The interview data were analysed using a phenomenographic approach. RESULTS: The treatment received during childhood had contributed to shaping the adolescents, as shown in the emerging description categories Creating opportunities, Choosing one's own path and Belonging in a context. Their current situation fell into three categories: A continuous journey, indicating that they still used the skills learned during childhood; Leaving the door open, indicating that they were not currently using the skills learned during childhood, but felt that there could be opportunities ahead; and Closing a chapter, indicating that they had stopped using their prosthesis or assistive devices and no longer needed those skills. Further, the adolescents' thoughts about the future are portrayed in the categories Uncertainty about the future and Confidence about the future. CONCLUSIONS: An understanding of the meaning of treatment received during childhood may help improve the delivery of treatment and continued support to meet the needs of children with congenital limb reduction deficiency in the short and long term.

Effect of multi-grip myoelectric prosthetic hands on daily activities, pain-related disability and prosthesis use compared with single-grip myoelectric prostheses: A single-case study.

OBJECTIVE: To evaluate the effect of multi-grip myoelectric prosthetic hands on performance of daily activities, pain-related disability and prosthesis use, in comparison with single-grip myoelectric prosthetic hands.  Design: Single-case AB design. PATIENTS: Nine adults with upper-limb loss participated in the study. All had previous experience of single-grip myoelectric prostheses and were prescribed a prosthesis with multi-grip functions. METHODS: To assess the changes in daily activities, pain-related disability and prosthesis use between single-grip and multi-grip myoelectric prosthetic hands, the Canadian Occupational Performance Measure, Pain Disability Index, and prosthesis wearing time were measured at multiple time-points. Visual assessment of graphs and multi-level linear regression were used to assess changes in the outcome measures.  Results: At 6 months' follow-up self-perceived performance and satisfaction scores had increased, prosthesis wearing time had increased, and pain-related disability had reduced in participants with musculoskeletal pain at baseline. On average, 8 of the 11 available grip types were used. Most useful were the power grip, tripod pinch and lateral pinch.  Conclusion: The multi-grip myoelectric prosthetic hand has favourable effects on performance of, and satisfaction with, individually chosen activities, prostheses use and pain-related disability. A durable single-grip myoelectric prosthetic hand may still be needed for heavier physical activities. With structured training, a standard 2-site electrode control system can be used to operate a multi-grip myoelectric prosthetic hand.

Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support.

BACKGROUND: Parents of children with congenital limb reduction deficiency have an essential role in making treatment decisions during their child's first years of life. Treatment options usually concern surgical and/or prosthetic treatment. To tailor treatment options to fit different family values and priorities, the family-centred approach indicates the importance of understanding the parental role in partnership with health care professionals. The aim of this study was to describe parents' experiences of their role in decision-making and treatment for children with congenital limb reduction deficiency. METHODS: A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with 17 parents (12 mothers and 5 fathers) of children with upper and/or lower limb deficiency (mean age 5.9 years). The interview data were analysed using qualitative content analysis with an inductive approach. RESULTS: Two major themes emerged from the data. The first theme, being a decision maker for someone else, was described as an ambivalent parental role, including collaboration within the family and with health care professionals. The second theme, becoming and being a treatment supporter in the child's everyday life, was made up of four categories: being a supporter of the child in everyday activities, mentoring the child to handle encounters with others, becoming a coordinator of information and being an 'extended arm' of the health care provision for the child. CONCLUSIONS: This study enhances our understanding of the parental role in decision-making and treatment for children with congenital limb reduction deficiency. The results may contribute to the continued development of the family-centred service approach by providing guidelines for treatment programmes, with the goal of improving decision support and broadening the support for parents during treatment for these children.

Risk of depression following traumatic limb amputation-a general population-based cohort study.

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics. Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression. Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62-4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57-4.08). Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

Long-term results of early myoelectric prosthesis fittings: A prospective case-control study.

BACKGROUND: Different recommendations exist regarding what age is best for first-time fitting of myoelectric hand prostheses in children. OBJECTIVES: To compare prosthetic skill, prosthetic use and risk for rejection over time between children fitted with myoelectric hand prostheses before or after 2½ years of age. STUDY DESIGN: Prospective case-control design. METHODS: The cases were nine children fitted with myoelectric hand prostheses before the age of 2½ years, whereas the controls were 27 children who were fitted with myoelectric hand prostheses after the age of 2½ years. The Skills Index Ranking Scale was used to classify prosthetic skill, and prosthetic use was categorised based on wearing time and pattern. Independent samples tests were used to compare data between groups. To estimate and compare the risk of prosthesis rejection between groups and over time, survival analysis was used. RESULTS: Cases showed prosthetic skill early, but controls had caught up by the age of 3½ years. Cases had a significant ( p = 0.046) decrease in prosthetic use at the age of 9 years. In the long term, cases had a higher percentage of prosthesis rejection. CONCLUSIONS: Considering young children's development of prosthetic skill and prosthetic use over time, this study shows no additional advantages from fitting a myoelectric hand prosthesis before 2½ years of age. Clinical relevance Children may be fitted with myoelectric hand prostheses to assist in daily tasks and to prevent future over-use problems. Most children fitted with myoelectric hand prostheses before 4 years of age become regular users. No advantages of fitting myoelectric hand prostheses before 2½ years of age were observed.

Relation between capacity and performance in paediatric upper limb prosthesis users.

BACKGROUND: The International Classification of functioning, disability and health refers capacity to what an individual can do in a standardised environment and describes performance as what an individual really does and whether the individual encounters any difficulty in the real-life environment. Measures of capacity and performance can help to determine if there is any gap between them that may restrict participation. The aim of this study was to explore the relationship between capacity scores obtained in a standardised clinical setting and proportional ease of performance obtained from a real-life environment. METHODS: The Assessment of Capacity for Myoelectric Control and the Prosthetic Upper Extremity Functional Index were used to assess capacity and performance in 62 prosthetic users (age 3-17). Spearman coefficient and generalised linear model were used to examine the association between these measures. RESULTS: A strong correlation (Spearman = 0.75) was found between the capacity scores and the ease of performance. In both unadjusted and adjusted models, capacity was significantly associated with proportional ease of performance. The adjusted model showed that, by 1 unit increase in the Assessment of Capacity for Myoelectric Control score, the ratio of proportional ease of performance increases by 45%. CONCLUSION: This implies that Assessment of Capacity for Myoelectric Control can be a predictor for ease of performance in real-life environment. Clinical relevance The ACMC scores may serve as an indicator to predict the difficulties that the children may encounter in their home environment. This prediction can help the clinician to make decisions, such that if the child requires more control training or is ready to move on to learn more complex tasks.

Is the Autism-Spectrum Quotient a Valid Measure of Traits Associated with the Autism Spectrum? A Rasch Validation in Adults with and Without Autism Spectrum Disorders.

The Autism-Spectrum Quotient (AQ) is among the most widely used scales assessing autistic traits in the general population. However, some aspects of the AQ are questionable. To test its scale properties, the AQ was translated into Swedish, and data were collected from 349 adults, 130 with autism spectrum disorder (ASD) and 219 without ASD, and analysed with Rasch. Several scale properties of the AQ were satisfactory but it did not meet the criterion of a unidimensional measure of autistic traits. The Rasch analysis showed that the 50-item AQ could be reduced to a 12-item subset with little loss of explanatory power, with the potential to efficiently measure the degree to which adults with and without ASD show autistic traits.

Cross-Cultural Validity and Differential Item Functioning of the Orthotics and Prosthetics Users' Survey With Swedish and United States Users of Lower-Limb Prosthesis.

OBJECTIVES: To investigate the cross-cultural validity of the Orthotics and Prosthetics Users' Survey (OPUS), to evaluate differential item functioning (DIF) related to country, sex, age, amputation level, and amputated side (unilateral, bilateral), and to determine known-group validity of the OPUS. DESIGN: Survey. SETTING: Outpatient clinics. PARTICIPANTS: The sample (N=321) consisted of Swedish (n=195) and U.S. (n=126) adults using lower-limb prostheses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Four OPUS modules were used: lower extremity functional status, client satisfaction with device (CSD), client satisfaction with services (CSS), and health-related quality of life. Rasch analysis was used to calculate measures for persons and items. RESULTS: The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of CSD and CSS needed adjustments, and the unidimensionality of CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for 2 out of 6 comparisons. CONCLUSIONS: This study supports the validity of OPUS measure comparisons between Sweden and the United States and between subgroups with different demographic characteristics. Some of the country-related DIF may reflect the different health care financing systems. The findings demonstrate that the OPUS can discriminate between certain patient groups. The results also challenge some of our preconceptions about persons with bilateral amputation, indicating that we might know these persons less well than we think.

Test-retest reliability and rater agreements of assessment of capacity for myoelectric control version 2.0.

The Assessment of Capacity for Myoelectric Control (ACMC) is an observation-based tool that evaluates ability to control a myoelectric prosthetic hand. Validity evidence led to ACMC version 2.0, but the test-retest reliability and minimal detectable change (MDC) of the ACMC have never been evaluated. Investigation of rater agreements in this version was also needed because it has new definitions in certain rating categories and items. Upper-limb prosthesis users (n = 25, 15 congenital, 10 acquired; mean age 27.5 yr) performed one standardized activity twice, 2 to 5 wk apart. Activity performances were videorecorded and assessed by two ACMC raters. Data were analyzed by weighted kappa, intraclass correlation coefficient (ICC), and Bland-Altman method. For test-retest reliability, weighted kappa agreements were fair to excellent (0.52 to 1.00), ICC2,1 was 0.94, and one user was located outside the limits of agreement in the Bland-Altman plot. MDC95 was less than or equal to 0.55 logits (1 rater) and 0.69 logits (2 raters). For interrater reliability, weighted kappa agreements were fair to excellent in both sessions (0.44 to 1.00), and ICC2,1 was 0.95 (test) and 0.92 (retest). Intrarater agreement (rater 1) was also excellent (ICC3,1 0.98). Evidence regarding the reliability of the ACMC is satisfactory and MDC95 can be used to indicate change.

Co-morbid depression and chronic illness related to coping and physical and mental health status.

A partial latent structural regression analysis was used to evaluate the role of coping resources, depression, diet and exercise on mental and physical health status. The sample consisted of 113 participants (59 females and 54 males) with a mean age of 59.38 years (SD = 10.52). Coping resources, depression and exercise explained 52 and 26% of the variance in mental and physical health status, respectively. Fewer coping resources predicted higher levels of depression and both predicted worse mental health. Only higher levels of depression predicted worse physical health status. There were also significant indirect effects of coping on mental and physical health status through depression. The development of cognitive, social and emotional coping strategies is important for managing depression and supporting positive mental health. These results highlight the important role of health psychologists in the care of individuals with chronic illness. Additionally, the management of depression is important in maintaining positive physical health.

Influence of standardized activities on validity of Assessment of Capacity for Myoelectric Control.

The Assessment of Capacity for Myoelectric Control (ACMC) is an observation-based clinical tool that evaluates ability to control a myoelectric prosthetic hand during bimanual activities. Two validity aspects were investigated: potential bias interaction between prosthesis users and activities performed during assessment, and potential bias interaction between activities and different user characteristics (sex or prosthetic side). Six activities were standardized for the ACMC. Upper-limb myoelectric prosthesis users (47 congenital, 11 acquired; 31 male, 27 female, average age 19.9 yr) performed three standardized activities, each on one occasion. Bias-interaction analysis in the many-facet Rasch model identified inconsistent patterns in the interactions of individual users and activity facets and between activities and user characteristics. The standardized activities had no significant influence on measures of user ability. The activities functioned similarly across both sexes (p-value greater than or equal to0.12) and across both prosthetic sides in persons with upper-limb reduction deficiency (p-value greater than or equal to0.50) and persons with acquired amputation (p-value greater than or equal to0.13). The results provide evidence for the validity of the ACMC across the standardized activities and support use of the ACMC in prosthesis users of both sexes and prosthetic sides. The newly standardized activities are recommended for future ACMC use.

Restraint of children with additional needs in motor vehicles: knowledge and challenges of paediatric occupational therapists in Victoria, Australia.

AIM: This research project aimed to understand the challenges faced by occupational therapists when making recommendations regarding the restraint of children with additional needs in motor vehicles in Victoria, Australia. METHODS: A cross-sectional survey design was used to explore current practice in relation to the prescription of motor vehicle restraints in Victoria, Australia. An electronic survey was sent to occupational therapists working with children aged from birth to 18 years in early intervention services, hospitals, schools, community services or private practice. RESULTS: Challenges faced by occupational therapists related to a lack of knowledge of relevant standards and legal requirements, issues seating children with behavioural difficulties, families' inability to purchase recommended equipment and constraints as a result of funding issues. CONCLUSION: Further work is required to develop appropriate resources which support occupational therapists to make car seating recommendations for children with additional needs which comply with Australian legal requirements and standards.

Upper limb prosthetic outcome measures: review and content comparison based on International Classification of Functioning, Disability and Health.

The International Classification of Functioning, Disability and Health (ICF) has been recommended as a framework for evaluation of aspects of health. The aim of this study was to compare the contents of outcome measures for upper limb prosthesis users by using the ICF. Measurement focus and psychometric properties of these measures were also investigated. Outcome measures that used upper limb prosthesis users as subjects in their development and psychometric evaluations were selected. The psychometric studies (n = 14) were reviewed and scored and the items in the measures were linked to the ICF. One measure for all ages (ACMC), five paediatric measures (CAPP-FSI, CAPP-PSI, PUFI, UBET and UNB) and two adult measures (OPUS and TAPES) were selected. The concepts extracted (n = 393) were linked to 54 categories in the ICF. The ACMC, CAPP-FSI, UBET, UNB and PUFI measure categories mostly under the ICF component 'Activity and participation'. The TAPES and OPUS also measure ICF categories that describe the emotional and social status of a person. The main conclusion is that the use of a mixture of outcome measures would give a better picture on the aspects of our clients. Measures that focus on the social interaction in paediatric users are required.

A biopsychosocial model for depressive symptoms following acute coronary syndromes.

A partial latent structural regression analysis was used to evaluate the influence of perceived stress and coping resources on depression following acute coronary syndromes (ACS) in a sample of 113 participants (25 females and 88 males with a mean age of 57.61 years (SD = 12.63). Out of them, 55 participants were Australian born and 48 were born elsewhere, with 53 of the patients scoring in the mild to high depression range on the Beck Depression Inventory and the Cardiac Depression Scale. Perceived stress and coping resources, after controlling for age and smoking explained 89% of the variance in the latent variable depression. Higher perceived stress levels and fewer coping resources predicted higher levels of depression. Higher levels of perceived stress predicted fewer coping resources and fewer coping resources predicted higher levels of depression. There was a significant direct and indirect effect of perceived stress through coping on depression. Cognitive and physical coping resources were the best predictors of the depression construct. These results have potential implications for the treatment of depression post-ACS. In particular, cognitive and physical coping mechanisms and perceived stress reduction need to be addressed when treating depression post-ACS.

The role of coping in the relationship between depression and illness severity in chronic fatigue syndrome.

UNLABELLED: The self-regulatory model (SRM) proposes that both cognitive and emotional illness representations influence the coping processes adopted in response to an illness. AIM: This study used the SRM to explore the role of coping in the relationship between depression and self-appraisals of illness severity in a population of patients with chronic fatigue syndrome (CFS). METHODS: The sample comprised 156 participants, 34 men and 121 women, aged between 18 and 78 yrs, who had been medically diagnosed with CFS. Participants were asked to complete three questionnaires: the Cardiac Depression Scale, Ways of Coping Questionnaire, and Severity Subscale of the Illness Perceptions Questionnaire-Revised. RESULTS: Analyses revealed that almost 70% of the participants were moderately or severely depressed. Additionally, two particular subscales, social support seeking and positive reappraisals, emerged as positively contributing to self-appraisals of illness severity (beta = 0.20 [p < 0.05] and beta = 0.21 [p < 0.05], respectively), thereby supporting the SRM. Furthermore, results indicated that a combination of depression and coping was a better predictor of illness severity than depression alone, accounting for 22% of the variance compared with 8%, respectively. CONCLUSIONS: The findings suggest that focusing on depression, and particularly coping styles, during treatment interventions could have important implications for therapeutic interventions. This could lead to better treatment strategies for health professionals who work with patients with CFS.