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Article ; Online: Five Functional Classes Identified Among Patients Hospitalized for Pneumonia Characterized by Activity Limitations With Mobility and Self-Care Tasks.

Edelstein, Jessica / Kinney, Adam R / Hoffman, Amanda / Graham, James E / Malcolm, Matthew P

Archives of rehabilitation research and clinical translation

2024 Volume 6, Issue 1, Page(s) 100323

Abstract: Objective: Latent class analysis was used to identify functional classes among patients hospitalized for pneumonia. Then, we determined predictors of class membership and examined variation in distal outcomes among the functional classes.: Design: An ...

Abstract	Objective: Latent class analysis was used to identify functional classes among patients hospitalized for pneumonia. Then, we determined predictors of class membership and examined variation in distal outcomes among the functional classes. Design: An observational, cross-sectional study design was used with retrospectively collected data between 2014 and 2018. Setting: The study setting was a single health system including 5 acute care hospitals. Participants: A total of 969 individuals hospitalized with the primary diagnosis of pneumonia and receipt of an occupational and/or physical therapy evaluation were included in the study. Interventions: Not applicable. Main outcomes: The following 5 distal outcomes were examined: (1) occupational therapy treatment use, (2) physical therapy treatment use, (3) discharge to home with no services, (4) discharge to home with home health, and (5) institutional discharge. Results: Five functional classes were identified and labeled as follows: Conclusions: Five functional classes were identified among individuals hospitalized for pneumonia. Functional classes could be used by the multidisciplinary team in the hospital as a framework to organize the heterogeneity of functional deficits after pneumonia, improve efficiency of care processes, and help deliver targeted rehabilitation treatment.
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Journal Article
ISSN	2590-1095
ISSN (online)	2590-1095
DOI	10.1016/j.arrct.2024.100323
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Article ; Online: Response to "Relationships between Acute and Postacute Care Providers: Measurement and Estimation".

Graham, James E

Health services research

2017 Volume 52, Issue 5, Page(s) 1629–1630

MeSH term(s)	Humans ; Medicare ; Skilled Nursing Facilities ; Subacute Care ; United States
Language	English
Publishing date	2017-06-05
Publishing country	United States
Document type	Editorial ; Journal Article ; Comment
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.12707
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Article ; Online: Identification of Disability Subgroups for Patients After Ischemic Stroke.

Edelstein, Jessica / Kinney, Adam R / Keeney, Tamra / Hoffman, Amanda / Graham, James E / Malcolm, Matthew P

Physical therapy

2023 Volume 103, Issue 3

Abstract: Objective: The aims of this study were to identify disability subgroups among patients hospitalized for ischemic stroke and to determine the predictors and distal outcomes for the disability subgroups.: Methods: A retrospective, cross-sectional study ...

Abstract	Objective: The aims of this study were to identify disability subgroups among patients hospitalized for ischemic stroke and to determine the predictors and distal outcomes for the disability subgroups. Methods: A retrospective, cross-sectional study design was used. Data on patients after ischemic stroke were collected from the electronic health records at 5 hospitals within a single health system. Covariates included social and demographic factors. Disability was characterized according to the Activity Measure for Post-Acute Care assessment. Distal outcomes were physical therapist treatment use, occupational therapist treatment use, and discharge disposition. Latent class analysis was used to identify disability subgroups of patients hospitalized for ischemic stroke. Results: A total of 1549 patients were included in the analyses. Five disability subgroups were identified and labeled as follows: globally impaired (subgroup 1), impaired dynamic balance (subgroup 2), impaired self-care (subgroup 3), impaired mobility (subgroup 4), and independent (subgroup 5). Physical therapist treatment use (χ24 = 113.21 [P < .001]) and occupational therapist treatment use (χ24 = 122.97 [P < .001]) varied significantly across the disability subgroups. The globally impaired group had the highest probability of physical and occupational therapist treatment use. Similarly, discharge disposition varied across the subgroups (for home without services, χ24 = 246.61 [P < .001]; for home with home health care, χ24 = 35.49 [P < .001]; for institutional discharge, χ24 = 237.18 [P < .001]). The independent subgroup had the highest probability of discharge to home without services. Conclusion: Five disability subgroups were identified for patients after ischemic stroke. The disability subgroups provide a common language for clinicians to organize the heterogeneity of disability after stroke. Impact: Using the disability subgroups, the multidisciplinary team might be able to improve the accuracy and efficiency of care decisions. The number of current rehabilitation interventions is indeterminable; these subgroups may help to guide clinicians in selecting the most beneficial interventions for patients based on subgroup membership.
MeSH term(s)	Humans ; Ischemic Stroke/therapy ; Retrospective Studies ; Stroke Rehabilitation ; Cross-Sectional Studies ; Stroke/therapy
Language	English
Publishing date	2023-05-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.1093/ptj/pzad001
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Article ; Online: Assistive technology services for adults with disabilities in state-federal vocational rehabilitation programs.

Alshamrani, Khalid A / Roll, Marla C / Malcolm, Matt P / Taylor, Aryn A / Graham, James E

Disability and rehabilitation. Assistive technology

2023 Volume 19, Issue 4, Page(s) 1382–1391

Abstract: Purpose: Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, ...

Abstract	Purpose: Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, and there are apparent disparities in AT service utilization. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs. Recognizing potential disparities is the first step in improving equity in access to beneficial services. Materials and methods: This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration's Case Service Report from fiscal years 2017-2019. The sample included 788,173 cases that reported having a disability, were aged ≥18 years old, was deemed eligible for VR services, and had a complete set of data. Results: Less than 9% of VR clients received AT services. We ran a multiple logistic regression analysis to examine the independent effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. The following client characteristics were associated with a lower likelihood of receiving AT services: men, unemployed, minority, low income, significant disability, non-enrolled in post-secondary education, mental or cognitive disability, less education, and younger age (all Conclusion: The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities. Future research and implications are provided.
MeSH term(s)	Humans ; Self-Help Devices ; Male ; Adult ; Female ; Disabled Persons/rehabilitation ; Rehabilitation, Vocational ; Retrospective Studies ; Middle Aged ; United States ; Adolescent ; Young Adult ; Socioeconomic Factors
Language	English
Publishing date	2023-03-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2221782-4
ISSN	1748-3115 ; 1748-3107
ISSN (online)	1748-3115
ISSN	1748-3107
DOI	10.1080/17483107.2023.2181413
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Article ; Online: Inpatient Rehabilitation Facility Ownership Type Yields Mixed Performances on Quality Measures.

Edelstein, Jessica / Li, Chih-Ying / Meythaler, Jay / Weaver, Jennifer A / Graham, James E

Archives of physical medicine and rehabilitation

2023 Volume 105, Issue 3, Page(s) 443–451

Abstract: Objective: To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures.: Design: Cross-sectional, observational design.: Setting: We used 2 Centers for Medicare and Medicare ...

Abstract	Objective: To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures. Design: Cross-sectional, observational design. Setting: We used 2 Centers for Medicare and Medicare publicly-available, facility-level data sources: (1) IRF compare files and (2) IRF rate setting files - final rule. Data from 2021 were included. Participants: The study sample included 1092 IRFs (N=1092). Interventions: Not applicable. Main outcome measures: We estimated the effects of IRF ownership type, defined as for-profit and nonprofit, on 15 IRF-QRP measures using general linear models. Models were adjusted for the following facility-level characteristics: (1) Centers for Medicare and Medicaid census divisions; (2) number of discharges; (3) teaching status; (4) freestanding vs hospital unit; and (5) estimated average weight per discharge. Results: Ownership type was significantly associated with 9 out of the fifteen IRF-QRP measures. Nonprofit IRFs performed better with having lower readmissions rates within stay and 30-day post discharge. For-profit IRFs performed better for all the functional measures and with higher rates of returning to home and the community. Lastly, for-profit IRFs spent more per Medicare beneficiary. Conclusions: Ideally, IRF performance would not vary based on ownership type. However, we found that ownership type is associated with IRF-QRP performance scores. We suggest that future studies investigate how ownership type affects patient-level outcomes and the longitudinal effect of ownership type on IRF-QRP measures.
MeSH term(s)	Aged ; Humans ; United States ; Medicare ; Quality Indicators, Health Care ; Ownership ; Cross-Sectional Studies ; Inpatients ; Aftercare ; Rehabilitation Centers ; Patient Discharge
Language	English
Publishing date	2023-10-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2023.10.010
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Article: Association between divorce and access to healthcare services among married immigrants: propensity score approaches.

Bae, Suyeong / Graham, James E / Nam, Sanghun / Hong, Ickpyo

Archives of public health = Archives belges de sante publique

2022 Volume 80, Issue 1, Page(s) 81

Abstract: Background: While divorce is a social determinant of health among married immigrants in Korea, its association with access to healthcare services is unclear. Given the rapid increase in the number of married immigrants in Korea, research is needed to ... ...

Abstract	Background: While divorce is a social determinant of health among married immigrants in Korea, its association with access to healthcare services is unclear. Given the rapid increase in the number of married immigrants in Korea, research is needed to improve minority groups' access to healthcare services. Here, we examined healthcare service utilization among married immigrants. Methods: We retrieved 11,778 adults from the 2018 Korea National Multicultural Family Survey. We analyzed whether the sex of divorced immigrants is associated with healthcare access using multivariable logistic regression analysis. Further, we analyzed the association between divorce and access to healthcare services among married immigrants using propensity score matching methods. Results: There were 691 (5.8%) divorced immigrants in the data set. The married male immigrants had no association between divorce status and healthcare access (adjusted odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.55-2.03, p = 0.8620). Divorced immigrants were less likely to receive healthcare services than married immigrants (adjusted OR = 1.42, 95% CI = 1.07-1.88). Conclusion: Our findings revealed that divorce increases the risk of limited access to healthcare services among married immigrants. Policymakers and healthcare providers should be aware of these potential disparities in this vulnerable minority population.
Language	English
Publishing date	2022-03-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1117688-x
ISSN	2049-3258 ; 0778-7367 ; 0003-9578
ISSN (online)	2049-3258
ISSN	0778-7367 ; 0003-9578
DOI	10.1186/s13690-022-00840-3
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Article: Predicting Community Discharge for Occupational Therapy Recipients in the Neurological Critical Care Unit.

Malcolm, Matt P / Kinney, Adam R / Graham, James E

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

2021 Volume 76, Issue 1

Abstract: Importance: Occupational therapy in the neurological critical care unit (NCCU) may enable safe community discharge by restoring functional ability. However, the influence of patient characteristics and NCCU occupational therapy on discharge disposition ... ...

Abstract	Importance: Occupational therapy in the neurological critical care unit (NCCU) may enable safe community discharge by restoring functional ability. However, the influence of patient characteristics and NCCU occupational therapy on discharge disposition is largely unknown. Objective: To examine how patient factors and receipt of occupational therapy predict discharge disposition for NCCU patients. Design: Retrospective cross-sectional cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 30, 2015. Setting: NCCU in a large urban academic hospital. Participants: Adults age 18 yr or older (N = 1,134) admitted to the NCCU. Outcomes and Measures: Using logistic regression with discharge disposition as the dependent variable, we entered sex, age, length of stay (LOS), baseline Glasgow Coma Scale score, Elixhauser Comorbidity Index, and receipt of occupational therapy services as predictor variables. Results: Of NCCU patients, 39% received occupational therapy. Younger age, shorter LOS, lower comorbidity burden, and not receiving occupational therapy services increased the likelihood of discharge to the community. Men who received occupational therapy were less likely to be discharged to the community than men who did not receive occupational therapy. As age increased, differences in the probability of community discharge decreased between recipients and nonrecipients of occupational therapy services. Conclusions and relevance: Our results suggest that patients receiving occupational therapy services in the NCCU may have a lower likelihood of community discharge. However, these findings may result from therapist's consideration of the safest discharge location to ensure the greatest balance between independence and support. What This Article Adds: This study's findings suggest that receipt of occupational therapy in the NCCU is associated with higher likelihood for noncommunity discharge (i.e., to inpatient rehabilitation, skilled nursing, or long-term care). However, activity limitations and comorbidity burden may be greater for recipients of occupational therapy, and these NCCU patients are presumably less prepared for community discharge.
MeSH term(s)	Adolescent ; Adult ; Critical Care ; Cross-Sectional Studies ; Humans ; Length of Stay ; Male ; Occupational Therapy ; Patient Discharge ; Retrospective Studies
Language	English
Publishing date	2021-12-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	219403-x
ISSN	1943-7676 ; 0272-9490 ; 0161-326X
ISSN (online)	1943-7676
ISSN	0272-9490 ; 0161-326X
DOI	10.5014/ajot.2022.045450
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Article ; Online: Evaluating the Strength of Evidence in Favor of Rehabilitation Effects: A Bayesian Analysis.

Kinney, Adam R / Middleton, Addie / Graham, James E

Annals of physical and rehabilitation medicine

2021 Volume 65, Issue 1, Page(s) 101503

Abstract: Background: Relying solely on null hypothesis significance testing to investigate rehabilitation interventions may result in researchers erroneously concluding the presence of a treatment effect.: Objective: We sought to quantify the strength of ... ...

Abstract	Background: Relying solely on null hypothesis significance testing to investigate rehabilitation interventions may result in researchers erroneously concluding the presence of a treatment effect. Objective: We sought to quantify the strength of evidence in favour of rehabilitation treatment effects by calculating Bayes factors (BF Methods: We searched the Cochrane Database of Systematic Reviews for meta-analyses with "rehabilitation" as a keyword that evaluated a rehabilitation intervention. We extracted means, standard deviations, and sample sizes for treatment and comparison groups from individual findings within 175 meta-analyses. Investigators independently classified the interventions according to the Rehabilitation Treatment Specification System. We calculated t-statistics, P-values, effect sizes, and BF Results: We analysed 1935 rehabilitation findings. Across intervention types, 25% of significant findings offered only anecdotal evidence in favour of a treatment effect; only 48% indicated strong evidence. This pattern persisted within intervention types and when conducting robustness analyses. Smaller P-values and larger effect sizes were associated with stronger evidence in favour of a treatment effect. However, a notable portion of findings with P-value 0.01 to 0.05 (63%) or a large effect size (18%) offered anecdotal evidence in favour of an effect. Conclusions: For a substantial portion of statistically significant rehabilitation findings, the data neither support nor refute the presence of a treatment effect. This was the case among a notable portion of large treatment effects and for most findings with P-value>0.01. Rehabilitation evidence would be improved by researchers adopting more conservative levels of significance, complementing the use of null hypothesis significance testing with Bayesian techniques and reporting effect sizes.
Language	English
Publishing date	2021-11-14
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2480363-7
ISSN	1877-0665 ; 1877-0657
ISSN (online)	1877-0665
ISSN	1877-0657
DOI	10.1016/j.rehab.2021.101503
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Article: Participation Is Associated With Well-Being Among Community-Based Veterans: An Investigation of Coping Ability, Meaningful Activity, and Social Support as Mediating Mechanisms.

Kinney, Adam R / Graham, James E / Eakman, Aaron M

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

2020 Volume 74, Issue 5, Page(s) 7405205010p1–7405205010p11

Abstract: Importance: Occupational therapy practitioners can use therapeutic activity to promote veterans' well-being, but the mechanisms through which participation promotes well-being are poorly understood.: Objective: To examine whether coping ability, ... ...

Abstract	Importance: Occupational therapy practitioners can use therapeutic activity to promote veterans' well-being, but the mechanisms through which participation promotes well-being are poorly understood. Objective: To examine whether coping ability, meaningful activity, and social support mediate the relationship between participation and two indicators of veterans' overall well-being: life meaning (psychological well-being) and life satisfaction (subjective well-being). Design: Explanatory cross-sectional design. We used two multiple mediation models to test whether coping ability, meaningful activity, and social support explained the relationship between participation and both life meaning and life satisfaction. Models were adjusted for demographic characteristics and service-related health conditions (e.g., posttraumatic stress disorder). Setting: Community. Participants: Three hundred eighty-nine community-based veterans attending college. Intervention: None. Outcomes and measures: Measures of participation, coping ability, meaningful activity, social support, life meaning, life satisfaction, and service-related health conditions. Results: Meaningfulness of activity partially explained the relationship between participation and both psychological well-being (B = 0.16, standard error [SE] = 0.04, 99% confidence interval [CI] [0.07, 0.27]) and subjective well-being (B = 0.14, SE = 0.03, 99% CI [0.07, 0.24]). Social support partially explained the relationship between participation and subjective well-being (B = 0.05, SE = 0.02, 99% CI [0.01, 0.11]). These findings persisted when symptoms of service-related health conditions were accounted for. Conclusions and relevance: Veterans' participation is associated with a greater sense of meaningful activity and social support, which in turn promotes psychological and subjective well-being. Occupational therapy practitioners may promote veterans' well-being by supporting engagement in activities that elicit meaning and enable social interaction, although further study is needed. What this article adds: This is among the first studies to test mechanisms underlying the relationship between veterans' engagement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans' well-being.
MeSH term(s)	Adaptation, Psychological ; Cross-Sectional Studies ; Humans ; Interpersonal Relations ; Social Support ; Stress Disorders, Post-Traumatic ; Veterans
Language	English
Publishing date	2020-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	219403-x
ISSN	1943-7676 ; 0272-9490 ; 0161-326X
ISSN (online)	1943-7676
ISSN	0272-9490 ; 0161-326X
DOI	10.5014/ajot.2020.037119
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Article ; Online: Novel Effect Size Interpretation Guidelines and an Evaluation of Statistical Power in Rehabilitation Research.

Kinney, Adam R / Eakman, Aaron M / Graham, James E

Archives of physical medicine and rehabilitation

2020 Volume 101, Issue 12, Page(s) 2219–2226

Abstract: Objective: First, to establish empirically-based effect size interpretation guidelines for rehabilitation treatment effects. Second, to evaluate statistical power in rehabilitation research.: Data sources: The Cochrane Database of Systematic Reviews ... ...

Abstract	Objective: First, to establish empirically-based effect size interpretation guidelines for rehabilitation treatment effects. Second, to evaluate statistical power in rehabilitation research. Data sources: The Cochrane Database of Systematic Reviews was searched through June 2019. Study selection: Meta-analyses included in the Cochrane Database of Systematic Reviews with "rehabilitation" as a keyword and clearly evaluated a rehabilitation intervention. Data extraction: We extracted Cohen's d effect sizes and associated sample sizes for treatment and comparison groups. Two independent investigators classified the interventions into 4 categories using the Rehabilitation Treatment Specification System. The 25th, 50th, and 75th percentile values within the effect size distribution were used to establish interpretation guidelines for small, medium, and large effects, respectively. A priori power analyses established sample sizes needed to detect the empirically-based values for small, medium, and large effects. Post-hoc power analyses using median sample sizes revealed whether the "typical" rehabilitation study was sufficiently powered to detect the empirically-based values. Post hoc power analyses established the statistical power of each test based on the sample size and reported effect size. Data synthesis: We analyzed 3381 effect sizes extracted from 99 meta-analyses. Interpretation guidelines for small effects ranged from 0.08 to 0.15; medium effects ranged from 0.19 to 0.36; and large effects ranged from 0.41 to 0.67. We present sample sizes needed to detect these values based on a priori power analyses. Post hoc power analyses revealed that a "typical" rehabilitation study lacks sufficient power to detect the empirically-based values. Post hoc power analyses using reported sample sizes and effects indicated the studies were underpowered, with median power ranging from 0.14 to 0.23. Conclusions: This study presented novel and empirically-based interpretation guidelines for small, medium, and large rehabilitation treatment effects. The observed effect size distributions differed across intervention categories, indicating that researchers should use category-specific guidelines. Furthermore, many published rehabilitation studies are underpowered.
MeSH term(s)	Data Interpretation, Statistical ; Guidelines as Topic ; Humans ; Rehabilitation Research/standards ; Sample Size ; Systematic Reviews as Topic
Language	English
Publishing date	2020-04-06
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2020.02.017
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