Faculty Bibliography

BACKGROUND: The Dyspnea Management Questionnaire (DMQ) is a measure of the psychosocial and behavioral responses to dyspnea for adults with COPD. The research objectives were to evaluate the reliability and validity of an expanded DMQ item pool, as a preliminary step for developing a computer adaptive test. METHODS: The original 66 items of the DMQ were used for the analyses. The sample included 63 women and 44 men with COPD (n = 107) recruited from two urban medical centers. We used confirmatory factor analysis to test the factor structure of the DMQ and its underlying cognitive-behavioral theoretical base. The internal consistency and test-retest reliability, and breadth of coverage of the expanded DMQ item bank were also evaluated. RESULTS: Five distinct dyspnea domains were confirmed using 56 original items of the DMQ: dyspnea intensity, dyspnea anxiety, activity avoidance, activity self-efficacy, and strategy satisfaction. Overall, the breadth of items was excellent with a good match between sample scores and item difficulty. The DMQ-56 showed good internal consistency reliability (alpha = 0.85-to 0.96) and good preliminary test-retest reliability over a 3-week interval (ICC = 0.69-0.92). CONCLUSIONS: The DMQ demonstrated acceptable levels of reliability and validity for measuring multidimensional dyspnea outcomes after medical, psychological, and behavioral interventions for adults with COPD

OBJECTIVES: To investigate the patterns, predictors, and benefits associated with driving a modified vehicle for people with spinal cord injuries (SCIs). DESIGN: Cross-sectional retrospective survey design. SETTINGS: Sixteen Model SCI Systems (MSCISs) throughout the United States. PARTICIPANTS: People (N=3726) post-SCI from the National MSCIS Database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Driving, employment, and community reintegration post-SCI. RESULTS: The study found that 36.5% of the sample drove a modified vehicle after SCI. Significant predictors of driving a modified vehicle post-SCI included married at injury, younger age at injury, associate's degree or higher before injury, paraplegia, a longer time since the injury, non-Hispanic race, white race, male sex, and using a wheelchair for more than 40 hours a week after the injury (accounting for 37% of the variance). Higher activity of daily living independence (in total motor function) at hospital discharge also increased the odds of driving. Driving increased the odds of being employed at follow-up by almost 2 times compared with not driving postinjury (odds ratio, 1.85). Drivers tended to have higher community reintegration scores, especially for community mobility and total community reintegration. Driving was also associated with small health-related quality-of-life gains, including less depression and pain interference and better life satisfaction, general health status, and transportation availability scores. CONCLUSIONS: The associated benefits of driving and the relatively low percentage of drivers post-SCI in the sample provide evidence for the need to increase rehabilitation and assistive technology services and resources in the United States devoted to facilitating driving after SCI.

The purpose of this qualitative study was to analyse participants' perceptions of a pulmonary rehabilitation programme, which combined occupational therapy with physical therapy. Semi-structured interviews were used to collect data from four adults with chronic obstructive pulmonary disease (COPD) who attended an outpatient pulmonary rehabilitation programme in New York City. Features of the occupational therapy programme reported to be valuable were biofeedback and clinician support. Participants reported more control of dyspnoea, improved mental health and confidence in performing daily activities, less fatigue, more physically active lifestyles and hope for the future. Limitations of the study were that participants were interviewed only once and themes were not verified with participants. The study results also cannot be generalized. Further research is needed to evaluate the effectiveness of occupational therapy in promoting self-management and coping skills and restoring occupational performance in adults with COPD. Participants' responses provide additional support for developing cognitive-behavioural protocols in occupational therapy and measuring their effectiveness in relieving anxiety symptoms and promoting dyspnoea management.

PURPOSE: This paper reviews the strengths and weaknesses of two different approaches to assessing ICF concepts: coding versus quantitative scales. It illustrates the advantages of an alternative, integrative approach, called functional staging. METHOD: A prospective cohort study. A total of 516 subjects in the Rehabilitation Outcome Study. RESULTS: ICF codes provide a useful approach for classifying easy-to-interpret health-related information on individuals that can be incorporated into administrative records and databases. By minimizing measurement error, quantitative scales are well suited for synthesizing health-related data that can be used to compare the health states of groups of individuals across studies, conditions, and countries as well as to detect clinically meaningful change. A functional staging approach combines the attractive features of ICF coding and quantitative scales to help the user interpret the clinical meaningfulness of summary scores while retaining measurement reliability, validity and precision. CONCLUSIONS: A functional staging approach to assessing ICF concepts holds promise as a useful technique for measuring and interpreting the core concepts in the ICF framework.

OBJECTIVE: With the increased use of standardized outcome instruments in rehabilitation, questions frequently arise as to how to interpret the scores that are derived from these standardized outcome instruments. This article uses examples drawn from the Activity Measure for Post Acute Care to illustrate 4 different data analysis and presentation strategies that can be used to yield meaningful outcome data for use in rehabilitation research and practice. DESIGN: A prospective cohort study in patients recruited at the point of discharge from a large acute care hospital or on admission to 1 of 2 rehabilitation hospitals after discharge from an acute care hospital in the greater Boston, MA region. SAMPLE: A total of 516 subjects in the Rehabilitation Outcome Study. RESULTS: Four distinct approaches to analyzing and reporting outcome data are described to derive more meaningful outcome measurements: interpreting a single scale score; interpreting clinical significance of score changes; a percentile ranking method; and a functional staging approach. The first 3 methods focus on interpreting the numeric property of individual measurements and are best suited to assess individual outcomes and for detecting change. The fourth, a functional staging approach, provides an attractive feature of interpreting the clinical meaning provided by a particular quantitative score without sacrificing the inherent value of a quantitative scale for tracking change over time. CONCLUSION: Users are encouraged to consider the range of analysis and presentation strategies available to them to evaluate a standardized scale score, both from a quantitative and a content perspective.

STUDY OBJECTIVES: To study the short-term and long-term effects of combining activity training or lectures to exercise training on quality of life, functional status, and exercise tolerance. DESIGN: Randomized clinical trial. SETTING: Outpatient pulmonary rehabilitation center. PARTICIPANTS: Forty-three outpatients with COPD. INTERVENTIONS: Patients were randomized to one of three treatment groups: exercise training alone, exercise training plus activity training, and exercise training plus a lecture series. The mean treatment period was 10 weeks.Measurement: The Chronic Respiratory Disease Questionnaire, the modified version of the Pulmonary Functional Status and Dyspnea Questionnaire, and the COPD Self-Efficacy Scale were administered at baseline, and 6, 12, 18, and 24 weeks from the beginning of the rehabilitation program. The 6-min walk test was used to measure exercise tolerance. RESULTS: Benefits of activity training combined with exercise included less dyspnea (p < or = 0.04) and fatigue (p < or = 0.01), and increased activity involvement (p < or = 0.02) and total functional status (p < or = 0.02) in the short term compared to comparison treatment groups for comparatively older participants. Compared to the lecture series adjunct, the activity training adjunct resulted in significantly higher gains in total quality of life (p = 0.04) maintained at 24 weeks. Significantly worse emotional function and functional status resulted from the lecture series adjunct in the oldest participants (p < or = 0.03). Treatment groups did not differ significantly on exercise tolerance or self-efficacy. CONCLUSIONS: Evidence for additional benefits of activity-specific training combined with exercise was found. A behavioral method emphasizing structured controlled breathing and supervised physical activity was statistically significantly more effective than didactic instruction in facilitating additional gains and meeting participants' learning needs.