Rehabilitation and Restorative Care
Hammondcare leads or partners in a range of rehabilitation and restorative care research projects. A selection of current and completed project are described below.
Analysis of a converted ICF based ADL outcome measure and its comparison to FIM
The International Classification of Functioning, Disability and Health (ICF) is a globally agreed classification system that provides a common language for describing a patient¹s health status. This HammondCare project investigates the development and application of an ICF outcome measure for patients in a rehabilitation ward and compares the use of ICF with the Functional Independence Measure (FIM), which is the current gold standard in clinical practice.
The feasibility of using an ICF based MAT to measure change in mobility of patients on a rehabilitation ward
This HammondCare project assesses the feasibility of using an ICF based Mobility Assessment Tool (MAT) to record the change in mobility of rehabilitation patients . This tool previously has been used to assess mobility in lower limb amputee patients and is being tested here for it its applicability in other rehabilitation settings. Investigators will use to the tool to score a patient’s mobility on admission and after discharge using the Functional Independent Measure (current ‘gold standard’) and the MAT. Variation between the two scoring tools will be assessed.
Validation and confirmation of reliability and sensitivity of the ICF brief core set in stroke patients
This HammondCare project aims to determine the sensitivy to change of the Brief ICF core sets for stroke in patients in acute and sub-acute settings. In this project, researchers will undertaken a chart review and assess patients who have a had a stroke at four different time points to describe and analyse any agreement between the scores determined at the different time points.
The HIHO Rehabilitation Study
The HIHO Rehabilitation study investigates whether inpatient rehabilitation is necessary after total knee replacement. Specifically, this project aims to determine whether 10 days of post-acute inpatient rehabilitation followed by a home-based rehabilitation program is more effective than a home-based program alone. This collaborative project is being undertaken and supported by the Sydney South West Local Health District.
Subacute casemix classification for stroke rehabilitation in Australia
How well does AN-SNAP v2 explain variance in outcomes? This study sought to determine the best predictors for length of stay, discharge destination and functional improvement for inpatients undergoing rehabilitation following a stroke and compared these predictors against AN-SNAP v2. The best explanatory variable in our inpatient rehabilitation service is the admission motor FIM whereas AN-SNAP v2 classification is a less effective explanatory variable. This needs to be taken into account when using AN-SNAP v2 classification for clinical or funding purposes. To read more about this project, please click here.
Developing core sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning
The functional impairments caused by amputation include mobility, activities of daily living, body image and sexuality. Classification, measurement and comparison of the consequences of amputations has been impeded by the limited availability of internationally, multiculturally standardised instruments in the amputee setting. In 2001, the World Health Assembly introduced the International Classification of Functioning, Disability and Health to assess, describe and compare function and disability. Outcomes: This international collaborative project showed that the Brief ICF Core Set may facilitate international studies and studies comparing the consequences of different conditions. The Comprehensive ICF Core Set can be used in the clinic as a checklist to assess patient¹s needs, to formulate rehabilitation goals and to evaluate progress. After a consensus conference, which will integrate evidence from preparatory studies, validation of the ICF core sets will follow with field-testing. To read more about this project, please click here.
Agreement of functional independence measure item scores in patients transferred from one rehabilitation setting to another
Classification and payment systems that incorporate a functional measure used in routine clinical practice can only be as accurate as the underlying functional measure. The test retest reliability in clinical practice of the individual item scores of the Functional Independence Measure (FIM), a functional measure used in classification and payment systems has been investigated. The aim of this collaborative project was to analyse paired measurements of FIM item scores carried out in routine clinical practice for patients transferred from one Rehabilitation Unit to another, and to determine the interrater reliability using standard measures of agreement and bias. Using data collected from 143 rehabiliation patients, researchers found that agreement between paired score for each FIM item was low and postulated that this lack of agreement may be due to a number of reasons including: incomplete FIM training of some staff, insufficient attention to accurate scoring, actual clinical changes, differences between patient performance in different settings, and variation in scoring because of the large number of staff involved in scoring the FIM in the multidisciplinary team within the settings. Given that this study indicated only a fair inter-rater reliability of these scores in clinical practice, caution needs to be exercised when utilising the FIM individual item scores in clinical practice as part of clinical or funding classifications or in benchmarking. To read more about this project, please click here and here.