The development and validation of a screening instrument to identify hospitalized medical patients in need of early functional rehabilitation assessment.
The purpose of this study was to develop a scale that identifies hospitalized patients in need of physical therapy (PT) and/or occupational therapy (OT) assessments. Preliminary scale items were tested for reliability among 52 patients and remaining items were then administered to 299 patients and items that were associated with the concept of 'need for an assessment' on multivariate analyses were selected as final scale items. The concept of need was based on the clinical judgment of physical and occupational therapists. Receiver operator characteristic (ROC) curves were constructed to determine a cut-off score and the predictive ability of this score in determining length of stay and utilization of services was evaluated among 200 patients. The final scale contains two components. The PT component addresses ambulation, falls, breathing, and activities of daily living (ADL). The OT component addresses swallowing, ADL and instrumental activities of daily living (IADL). The area under the ROC curves of the PT and OT components were 0.71 and 0.72, respectively. Both components predicted length of stay and utilization (p < 0.05). In summary, this scale provides a mechanism for targeting patients for early PT and OT assessment and provides a basis for testing the effectiveness of early PT and OT interventions.
Division of General Internal Medicine, Joan and Sanford I. Weill Medical College, Cornell University, New York, NY, USA. Cboutin@mail.med.cornell.edu
Carla Boutin
CB
Foster
Delia
D
Gorga
Carolyn
C
Padial
Ann Marie
AM
Feretti
Debra
D
Berenson
Robin
R
Kline
Rhonda
R
Belue
Mary E
ME
Charlson
D000203:Activities of Daily Living; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020380:Needs Assessment; D009519:New York City; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity