Effectiveness of Reablement: A Systematic Review.

The ageing of the population and the increasing need for long-term care services are global issues. Some countries have adapted homecare programs by introducing an intervention called reablement, which is aimed at optimizing independence. The effectiveness of reablement, as well as its different service models, was examined. A systematic literature review was conducted using MEDLINE, CINAHL, PsycINFO and EBM Reviews to search from 2001 to 2014. Core characteristics and facilitators of reablement implementation were identified from international experiences. Ten studies comprising a total of 14,742 participants (including four randomized trials, most of excellent or good quality) showed a positive impact of reablement, especially on health-related quality of life and service utilization. The implementation of reablement was studied in three regions, and all observed a reduction in healthcare service utilization. Considering its effectiveness and positive impact observed in several countries, the implementation of reablement is a promising avenue to be pursued by policy makers.

Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates.

Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO(2)), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO(2) at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.

Content identification of the IWQOL-Lite with the International Classification of Functioning, Disability and Health.

INTRODUCTION: The identification of the content of a measure could ensure that the most appropriate measure is chosen to meet a particular objective. Mapping the Impact of Weight on Quality Of Life (IWQOL-Lite) to the International Classification of Functioning, Disability and Health (ICF) will improve the understanding of its structure and aid in the interpretation of the results. METHODS: A mapping exercise was performed by 21 raters using the Delphi technique to identify the ICF codes that best describe the content of the items of the IWQOL-Lite. Both French and English versions were linked to validate the French translation. The results were validated on a sample of 122 participants and were also compared to the mapping performed by another group. RESULTS: Most of the content of the IWQOL-Lite was identified. All five components of the ICF were represented in the IWQOL-Lite. The mapping differed across languages. The results of the mapping were similar to those obtained by another group. CONCLUSIONS: The content of the IWQOL-Lite is compatible with the ICF. The measure has good content validity. The content could be improved by the addition and the specification of some terms. The French translation of some items should be revised.

Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke.

OBJECTIVE: To determine whether a separate comorbidity index is needed to predict functional outcome after stroke, we compared the predictability of the Charlson Comorbidity Index (CMI) and the Functional Comorbidity Index (FCI) to that of a stroke-specific comorbidity index with function quantified with a measure developed with a Rasch model as outcome. DESIGN: Two prospective inception cohort studies, in 1996 through 1998 and in 2002 through 2005, with up to 9 months of follow-up. SETTING: Participants enrolled in 2 studies were recruited from acute care hospitals in the Montreal area. PARTICIPANTS: For study one, 1027 persons with a first stroke discharged into the community were eligible; the 437 who were interviewed a second time at 6 months were included in the analysis. In study two, 235 of 262 patients with stroke were enrolled. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To predict recovery, we developed 3 stroke-specific comorbidity algorithms based on the estimated strength of association between comorbidities and stroke function. The various indices were compared on the basis of their predictive ability with a c statistic. RESULTS: In study 1, the c statistics were .758, .763, .766, and .763 for the stroke-specific algorithms 1, 2, and 3 and the CMI, respectively. In study 2, the c statistics were .680, .700, .704, .714, and .714 for the algorithms 1, 2, and 3, the CMI, and the FCI, respectively. CONCLUSIONS: For purposes of case-mix adjustment, the CMI seems to be more than adequate.