Archives of physical medicine and rehabilitation, 2004
The number and sophistication of statistical procedures reported in medical rehabilitation resear... more The number and sophistication of statistical procedures reported in medical rehabilitation research is increasing. Application of the principles and methods associated with evidence-based practice has contributed to the need for rehabilitation practitioners to understand quantitative methods in published articles. Outcomes measurement and determination of reliability are areas that have experienced rapid change during the past decade. In this study, distinctions between reliability and agreement are examined. Information is presented on analytical approaches for addressing reliability and agreement with the focus on the application of the kappa statistic. The following assumptions are discussed: (1) kappa should be used with data measured on a categorical scale, (2) the patients or objects categorized should be independent, and (3) the observers or raters must make their measurement decisions and judgments independently. Several issues related to using kappa in measurement studies a...
Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI... more Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI) patient satisfaction with life and community services has been investigated, satisfaction with medical rehabilitation has not. Information submitted to the Uniform Data System for Medical Rehabilitation (1998-2001) by 134 hospitals/rehabilitation facilities in the United States (n = 6,205 patients with SCI) was examined. Predictors were sociodemographic variables, Case Mix Groupings (CMG) (401-505, 5001), length of stay, rehospitalization, follow-up therapy, and health maintenance. Satisfaction was assessed at a mean of 92.2 days (SD 11.9 days) postdischarge. Data were analyzed according to who reported the outcome (patient, n = 3,858 or family/other, n = 1,869). Statistical modeling was conducted using logistic regression. High overall satisfaction was reported (94%). Significant predictors for the patient report data were CMG and rehospitalization. Compared with CMG 5001 (short stay,...
Limited evidence exists about the role of education and own educational mobility on body weight t... more Limited evidence exists about the role of education and own educational mobility on body weight trajectory. A better understanding of how education influences long term weight gain can help us to design more effective health policies. Using random effects models, the association between i) highest education (n = 10 018) and ii) educational mobility over a 9 year period (n = 9 907) and weight gain was analysed using five waves of data (over 13 years) from the Australian Longitudinal Study on Women's Health 1973-78 cohort (from 18-23 years to 31-36 years). Highest educational attainment was inversely associated with weight at baseline and weight gain over 13 years. Compared to high educated women, those with a low (12 years or less) or intermediate (trade/certificate/diploma) education, respectively, weighed an additional 2.6 kg (95% CI:1.9 to 3.1) and 2.5 kg (95% CI:1.9 to 3.3) at baseline and gained an additional 3.9 kg (95% CI:2.6 to 5.2) and 3.1 kg (95% CI:2.6 to 3.9) over 13 ...
This study describes the rehabilitation length of stay (LOS), discharge destination and discharge... more This study describes the rehabilitation length of stay (LOS), discharge destination and discharge functional status of 149 patients admitted with traumatic brain injury (TBI) to an Australian hospital over a 5-year period. Hospital charts of patients admitted between 1993-1998 were reviewed. Average LOS over the 5-year time period was 61.8 days and only decreased nominally over this time. Longer LOS was predicted by lower admission motor FIM scores and presence of comorbidities. Mean admission and discharge motor FIM scores were 58 and 79, which represented a gain of 21 points. Higher discharge motor FIM scores were predicted by higher admission motor FIM scores and younger age. FIM gain was predicted by cognitive status and age. Most patients, 88%, were discharged back to the community, with 30% changing their living setting or situation. Changing living status was predicted by living alone and having poorer functional status on admission.
This study investigated the ability of client-, assistive technology (AT)- and intervention-relat... more This study investigated the ability of client-, assistive technology (AT)- and intervention-related factors to predict the post-discharge use of rails and bathing, toileting and dressing AT, which had been recommended by an occupational therapist during hospitalisation. A prospective correlational study involving interviews conducted pre and post discharge for those clients who required rails and bathing, toileting and dressing AT was used. Additionally, a direct logistic regression analysis with backwards elimination was performed to identify predictor variables. Variables found to predict AT use included participants' perceptions of the characteristics of the AT, the presence or absence of anxiety, and their ability to recall AT training. Additionally four other variables (intended post-discharge use of AT, negative perceptions about disability/illness, perceived benefit of the AT and having a choice during the AT selection process) were strongly related to AT use. Although these four variables were not included in the best final model they are nevertheless important and need to be considered when recommending AT. The findings suggest that occupational therapists need to ensure that AT is recommended using a client-centred approach, where clients' perceptions and opinions are considered along with their needs and goals. The Matching Person to Technology (MPT) Model is suggested as a useful framework to guide the process of recommending AT.
Archives of Physical Medicine and Rehabilitation - ARCH PHYS MED REHABIL, 2004
Tooth LR, Ottenbacher KJ. The κ statistic in rehabilitation research: an examination. 2004;85:137... more Tooth LR, Ottenbacher KJ. The κ statistic in rehabilitation research: an examination. 2004;85:1371–6.The number and sophistication of statistical procedures reported in medical rehabilitation research is increasing. Application of the principles and methods associated with evidence-based practice has contributed to the need for rehabilitation practitioners to understand quantitative methods in published articles. Outcomes measurement and determination of reliability are areas that have experienced rapid change during the past decade. In this study, distinctions between reliability and agreement are examined. Information is presented on analytical approaches for addressing reliability and agreement with the focus on the application of the κ statistic. The following assumptions are discussed: (1) κ should be used with data measured on a categorical scale, (2) the patients or objects categorized should be independent, and (3) the observers or raters must make their measurement decision...
To analyse the stroke content in OTseeker in terms of the quantity of the research evidence, the ... more To analyse the stroke content in OTseeker in terms of the quantity of the research evidence, the quality of the randomised controlled trials (RCTs), and the types of interventions and outcome measures used. A survey of stroke-related content in the OTseeker database was conducted in 2007. The year of publication and intervention categories used in each stroke-related RCT and systematic review (SR) were recorded. The internal validity of RCTs using the PEDro scale (partitioned) and the outcome measures used were also recorded. Of the 4,369 articles indexed on OTseeker, 452 (10.3%) related to stroke were conducted between 1979 and 2006. The five most frequently studied intervention categories were movement training (43.2%), models of service delivery (31.2%), physical modalities/orthotics/splinting (30.1%), exercise/stretching/strength training (19.5%), and skill acquisition/training (9.3%). Random allocation (96.1%) was the most frequently satisfied internal validity criterion and therapist blinding (3.1%) was least often satisfied. The five most frequently used outcome measurement categories were basic and extended activities of daily living (70.1%), hand and upper limb function (56.1%), walking/gait (44.1%), movement/motor function (32.7%), and quality of life/general overall health (27.9%). The stroke-related content on OTseeker is useful for allied health professionals. This study highlights a need for better definitions of interventions and consensus about the best outcome measures. Few interventions or outcome measures were participation focused.
Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI... more Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI) patient satisfaction with life and community services has been investigated, satisfaction with medical rehabilitation has not. Information submitted to the Uniform Data System for Medical Rehabilitation (1998-2001) by 134 hospitals/rehabilitation facilities in the United States (n = 6,205 patients with SCI) was examined. Predictors were sociodemographic variables, Case Mix Groupings (CMG) (401-505, 5001), length of stay, rehospitalization, follow-up therapy, and health maintenance. Satisfaction was assessed at a mean of 92.2 days (SD 11.9 days) postdischarge. Data were analyzed according to who reported the outcome (patient, n = 3,858 or family/other, n = 1,869). Statistical modeling was conducted using logistic regression. High overall satisfaction was reported (94%). Significant predictors for the patient report data were CMG and rehospitalization. Compared with CMG 5001 (short stay, <3 days), patients in CMGs 401/2/3 and 501/2/3/4/5 had a 54% to 74% lower likelihood of being dissatisfied. Rehospitalized patients had a higher likelihood of dissatisfaction (odds ratio 2.3, 95% confidence interval 1.7 to 3.2). Significant predictors for the family/other report data were CMG (compared to CMG 5001, CMGs 401/2, 403, and 501/2 had a 70% lower likelihood of dissatisfaction), rehospitalization (odds ratio 1.7, 95% confidence interval 1.1-2.5), and marital status (married = 50% lower likelihood of dissatisfaction, 95% confidence interval 0.26-0.96). Satisfaction with medical rehabilitation services following SCI is related to functional abilities, rehospitalization, and marital status. Slightly different results were found for whether satisfaction was rated by the patient or family/other. The complex relationships among satisfaction, patient demographics, and functional status require continued examination.
Education is accepted as a key component of cardiac rehabilitation for patients following myocard... more Education is accepted as a key component of cardiac rehabilitation for patients following myocardial infarction and bypass graft surgery. Recently, there has been a call for rehabilitation to be uniformly offered to partners and families of cardiac patients, and for the expanding boundaries of rehabilitation to include patients who undergo coronary angioplasty. This paper aims to highlight patient education strategies for cardiac patients and partners with a focus on assessment of their educational needs. The unique needs of patients undergoing coronary angioplasty and their partners will then be discussed with existing cardiac educational strategies expanded to encompass this group of patients.
The effect of a pre-coronary angioplasty education and counselling program on knowledge and psych... more The effect of a pre-coronary angioplasty education and counselling program on knowledge and psychological status of patients and on knowledge and quality of life/coping status of their spouses was evaluated. Forty patients and their spouses participated in a pre-coronary angioplasty education and counselling program and 40 served as controls. Knowledge, psychological status and quality of life/coping status were assessed prior to coronary angioplasty and at a mean of four and 11 months post-coronary angioplasty. At four months, improved knowledge and reduced anxiety were found for patients in the experimental group. At 11 months, spouses in the experimental group showed continued improvement in quality of life compared to those in the control group. It was concluded that pre-coronary angioplasty education and counselling can impact favourably upon knowledge in patients and quality of life in spouses.
ABSTRACT Enhancement of quality of life is central to occupational therapy philosophy. The purpos... more ABSTRACT Enhancement of quality of life is central to occupational therapy philosophy. The purpose of this study was to determine whether individuals with specific characteristics experience quality of life differently after angioplasty. Data on sociodemographic and psychosocial predictor variables were collected on 209 patients on the day before angioplasty. Data on the quality of life outcomes of functional capacity, life satisfaction, psychological well-being and return to work time were collected on 205 patients at a mean of 11 months after angioplasty. Multiple regression analyses revealed that previous exercise participation predicted functional capacity after angioplasty; social support, pre-angioplasty life satisfaction and pre-angioplasty psychological well-being predicted post-angioplasty life satisfaction; psychological well-being before angioplasty predicted psychological well-being after angioplasty; and having fewer dependents and a longer period of unemployment predicted return to work time. Consideration of individuals' social, psychological and employment status before angioplasty could assist occupational therapists in predicting prognosis and tailoring intervention to improve quality of life outcomes.
Archives of physical medicine and rehabilitation, 2004
The number and sophistication of statistical procedures reported in medical rehabilitation resear... more The number and sophistication of statistical procedures reported in medical rehabilitation research is increasing. Application of the principles and methods associated with evidence-based practice has contributed to the need for rehabilitation practitioners to understand quantitative methods in published articles. Outcomes measurement and determination of reliability are areas that have experienced rapid change during the past decade. In this study, distinctions between reliability and agreement are examined. Information is presented on analytical approaches for addressing reliability and agreement with the focus on the application of the kappa statistic. The following assumptions are discussed: (1) kappa should be used with data measured on a categorical scale, (2) the patients or objects categorized should be independent, and (3) the observers or raters must make their measurement decisions and judgments independently. Several issues related to using kappa in measurement studies a...
Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI... more Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI) patient satisfaction with life and community services has been investigated, satisfaction with medical rehabilitation has not. Information submitted to the Uniform Data System for Medical Rehabilitation (1998-2001) by 134 hospitals/rehabilitation facilities in the United States (n = 6,205 patients with SCI) was examined. Predictors were sociodemographic variables, Case Mix Groupings (CMG) (401-505, 5001), length of stay, rehospitalization, follow-up therapy, and health maintenance. Satisfaction was assessed at a mean of 92.2 days (SD 11.9 days) postdischarge. Data were analyzed according to who reported the outcome (patient, n = 3,858 or family/other, n = 1,869). Statistical modeling was conducted using logistic regression. High overall satisfaction was reported (94%). Significant predictors for the patient report data were CMG and rehospitalization. Compared with CMG 5001 (short stay,...
Limited evidence exists about the role of education and own educational mobility on body weight t... more Limited evidence exists about the role of education and own educational mobility on body weight trajectory. A better understanding of how education influences long term weight gain can help us to design more effective health policies. Using random effects models, the association between i) highest education (n = 10 018) and ii) educational mobility over a 9 year period (n = 9 907) and weight gain was analysed using five waves of data (over 13 years) from the Australian Longitudinal Study on Women's Health 1973-78 cohort (from 18-23 years to 31-36 years). Highest educational attainment was inversely associated with weight at baseline and weight gain over 13 years. Compared to high educated women, those with a low (12 years or less) or intermediate (trade/certificate/diploma) education, respectively, weighed an additional 2.6 kg (95% CI:1.9 to 3.1) and 2.5 kg (95% CI:1.9 to 3.3) at baseline and gained an additional 3.9 kg (95% CI:2.6 to 5.2) and 3.1 kg (95% CI:2.6 to 3.9) over 13 ...
This study describes the rehabilitation length of stay (LOS), discharge destination and discharge... more This study describes the rehabilitation length of stay (LOS), discharge destination and discharge functional status of 149 patients admitted with traumatic brain injury (TBI) to an Australian hospital over a 5-year period. Hospital charts of patients admitted between 1993-1998 were reviewed. Average LOS over the 5-year time period was 61.8 days and only decreased nominally over this time. Longer LOS was predicted by lower admission motor FIM scores and presence of comorbidities. Mean admission and discharge motor FIM scores were 58 and 79, which represented a gain of 21 points. Higher discharge motor FIM scores were predicted by higher admission motor FIM scores and younger age. FIM gain was predicted by cognitive status and age. Most patients, 88%, were discharged back to the community, with 30% changing their living setting or situation. Changing living status was predicted by living alone and having poorer functional status on admission.
This study investigated the ability of client-, assistive technology (AT)- and intervention-relat... more This study investigated the ability of client-, assistive technology (AT)- and intervention-related factors to predict the post-discharge use of rails and bathing, toileting and dressing AT, which had been recommended by an occupational therapist during hospitalisation. A prospective correlational study involving interviews conducted pre and post discharge for those clients who required rails and bathing, toileting and dressing AT was used. Additionally, a direct logistic regression analysis with backwards elimination was performed to identify predictor variables. Variables found to predict AT use included participants' perceptions of the characteristics of the AT, the presence or absence of anxiety, and their ability to recall AT training. Additionally four other variables (intended post-discharge use of AT, negative perceptions about disability/illness, perceived benefit of the AT and having a choice during the AT selection process) were strongly related to AT use. Although these four variables were not included in the best final model they are nevertheless important and need to be considered when recommending AT. The findings suggest that occupational therapists need to ensure that AT is recommended using a client-centred approach, where clients' perceptions and opinions are considered along with their needs and goals. The Matching Person to Technology (MPT) Model is suggested as a useful framework to guide the process of recommending AT.
Archives of Physical Medicine and Rehabilitation - ARCH PHYS MED REHABIL, 2004
Tooth LR, Ottenbacher KJ. The κ statistic in rehabilitation research: an examination. 2004;85:137... more Tooth LR, Ottenbacher KJ. The κ statistic in rehabilitation research: an examination. 2004;85:1371–6.The number and sophistication of statistical procedures reported in medical rehabilitation research is increasing. Application of the principles and methods associated with evidence-based practice has contributed to the need for rehabilitation practitioners to understand quantitative methods in published articles. Outcomes measurement and determination of reliability are areas that have experienced rapid change during the past decade. In this study, distinctions between reliability and agreement are examined. Information is presented on analytical approaches for addressing reliability and agreement with the focus on the application of the κ statistic. The following assumptions are discussed: (1) κ should be used with data measured on a categorical scale, (2) the patients or objects categorized should be independent, and (3) the observers or raters must make their measurement decision...
To analyse the stroke content in OTseeker in terms of the quantity of the research evidence, the ... more To analyse the stroke content in OTseeker in terms of the quantity of the research evidence, the quality of the randomised controlled trials (RCTs), and the types of interventions and outcome measures used. A survey of stroke-related content in the OTseeker database was conducted in 2007. The year of publication and intervention categories used in each stroke-related RCT and systematic review (SR) were recorded. The internal validity of RCTs using the PEDro scale (partitioned) and the outcome measures used were also recorded. Of the 4,369 articles indexed on OTseeker, 452 (10.3%) related to stroke were conducted between 1979 and 2006. The five most frequently studied intervention categories were movement training (43.2%), models of service delivery (31.2%), physical modalities/orthotics/splinting (30.1%), exercise/stretching/strength training (19.5%), and skill acquisition/training (9.3%). Random allocation (96.1%) was the most frequently satisfied internal validity criterion and therapist blinding (3.1%) was least often satisfied. The five most frequently used outcome measurement categories were basic and extended activities of daily living (70.1%), hand and upper limb function (56.1%), walking/gait (44.1%), movement/motor function (32.7%), and quality of life/general overall health (27.9%). The stroke-related content on OTseeker is useful for allied health professionals. This study highlights a need for better definitions of interventions and consensus about the best outcome measures. Few interventions or outcome measures were participation focused.
Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI... more Retrospective. To predict satisfaction with medical rehabilitation. While spinal cord injury (SCI) patient satisfaction with life and community services has been investigated, satisfaction with medical rehabilitation has not. Information submitted to the Uniform Data System for Medical Rehabilitation (1998-2001) by 134 hospitals/rehabilitation facilities in the United States (n = 6,205 patients with SCI) was examined. Predictors were sociodemographic variables, Case Mix Groupings (CMG) (401-505, 5001), length of stay, rehospitalization, follow-up therapy, and health maintenance. Satisfaction was assessed at a mean of 92.2 days (SD 11.9 days) postdischarge. Data were analyzed according to who reported the outcome (patient, n = 3,858 or family/other, n = 1,869). Statistical modeling was conducted using logistic regression. High overall satisfaction was reported (94%). Significant predictors for the patient report data were CMG and rehospitalization. Compared with CMG 5001 (short stay, <3 days), patients in CMGs 401/2/3 and 501/2/3/4/5 had a 54% to 74% lower likelihood of being dissatisfied. Rehospitalized patients had a higher likelihood of dissatisfaction (odds ratio 2.3, 95% confidence interval 1.7 to 3.2). Significant predictors for the family/other report data were CMG (compared to CMG 5001, CMGs 401/2, 403, and 501/2 had a 70% lower likelihood of dissatisfaction), rehospitalization (odds ratio 1.7, 95% confidence interval 1.1-2.5), and marital status (married = 50% lower likelihood of dissatisfaction, 95% confidence interval 0.26-0.96). Satisfaction with medical rehabilitation services following SCI is related to functional abilities, rehospitalization, and marital status. Slightly different results were found for whether satisfaction was rated by the patient or family/other. The complex relationships among satisfaction, patient demographics, and functional status require continued examination.
Education is accepted as a key component of cardiac rehabilitation for patients following myocard... more Education is accepted as a key component of cardiac rehabilitation for patients following myocardial infarction and bypass graft surgery. Recently, there has been a call for rehabilitation to be uniformly offered to partners and families of cardiac patients, and for the expanding boundaries of rehabilitation to include patients who undergo coronary angioplasty. This paper aims to highlight patient education strategies for cardiac patients and partners with a focus on assessment of their educational needs. The unique needs of patients undergoing coronary angioplasty and their partners will then be discussed with existing cardiac educational strategies expanded to encompass this group of patients.
The effect of a pre-coronary angioplasty education and counselling program on knowledge and psych... more The effect of a pre-coronary angioplasty education and counselling program on knowledge and psychological status of patients and on knowledge and quality of life/coping status of their spouses was evaluated. Forty patients and their spouses participated in a pre-coronary angioplasty education and counselling program and 40 served as controls. Knowledge, psychological status and quality of life/coping status were assessed prior to coronary angioplasty and at a mean of four and 11 months post-coronary angioplasty. At four months, improved knowledge and reduced anxiety were found for patients in the experimental group. At 11 months, spouses in the experimental group showed continued improvement in quality of life compared to those in the control group. It was concluded that pre-coronary angioplasty education and counselling can impact favourably upon knowledge in patients and quality of life in spouses.
ABSTRACT Enhancement of quality of life is central to occupational therapy philosophy. The purpos... more ABSTRACT Enhancement of quality of life is central to occupational therapy philosophy. The purpose of this study was to determine whether individuals with specific characteristics experience quality of life differently after angioplasty. Data on sociodemographic and psychosocial predictor variables were collected on 209 patients on the day before angioplasty. Data on the quality of life outcomes of functional capacity, life satisfaction, psychological well-being and return to work time were collected on 205 patients at a mean of 11 months after angioplasty. Multiple regression analyses revealed that previous exercise participation predicted functional capacity after angioplasty; social support, pre-angioplasty life satisfaction and pre-angioplasty psychological well-being predicted post-angioplasty life satisfaction; psychological well-being before angioplasty predicted psychological well-being after angioplasty; and having fewer dependents and a longer period of unemployment predicted return to work time. Consideration of individuals' social, psychological and employment status before angioplasty could assist occupational therapists in predicting prognosis and tailoring intervention to improve quality of life outcomes.
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Papers by Leigh Tooth