Competency-based assessments for healthcare professionals are critical for safe and effective client outcomes. Rehabilitation clinical skill competency assessments must be validated and revised to produce safe and ski...Competency-based assessments for healthcare professionals are critical for safe and effective client outcomes. Rehabilitation clinical skill competency assessments must be validated and revised to produce safe and skilled practitioners. The revised American Occupational Therapy Association (AOTA) Fieldwork Performance Evaluation (FWPE) instrument measures occupational therapy student performance to determine readiness for practice. The assessment includes thirty-seven competencies that address both profession specific clinical skills and general professional behavior skills. The objective of this study was to use Rasch methods to explore the use of the revised FWPE in actual fieldwork practice and to determine the instrument’s psychometric properties when separating the item components into two distinct subdomains: General Health Professions Competences and Occupational Therapy-Specific Competencies. Internal construct validity and test reliability were analyzed using data from 149 occupational therapy students after completing their initial Level II A fieldwork clinical internship. This study examined the item difficulty hierarchy, item fit, person-fit to model, person separation index, person separation reliability coefficient, strata, ceiling and floor effect, and unidimensionality of the FWPE instrument as a whole and as two separate domains. With the exception of not meeting the criteria for unidimensionality, the full FWPE instrument and the Occupational Therapy-Specific Competencies subdomain showed acceptable item-level psychometrics for reliability and precision. While the General Health Professions Competencies subdomain showed good item-level psychometrics, it was below the criterion for reliability and only separated the sample into two strata. Results support the validity, reliability, and clinical use of the revised FWPE full instrument and the Occupational Therapy-Specific Competencies subdomain to measure entry-level clinical skill competencies in practice.展开更多
Background and Purpose: This exploratory study focused on the assessment of stroke patients for musculoskeletal rehabilitation in the United Kingdom National Health Service. It was the first phase of research on devel...Background and Purpose: This exploratory study focused on the assessment of stroke patients for musculoskeletal rehabilitation in the United Kingdom National Health Service. It was the first phase of research on developing telerehabilitation for the assessment of patients who have had a stroke. The assessment of stroke patients for musculoskeletal rehabilitation is currently performed at the therapist’s discretion using different outcome measures. When looking at the Department of Health’s “National Clinical Guidelines for Stroke”, it is stated that there are a variety of outcome measures, yet no particular one is recommended. It is specified that each rehabilitation sector should select its own methodologies. Aim: The aim of this exploratory study was to understand physiotherapists’ and occupational therapists’ perspectives of the strengths and weaknesses of current rehabilitative assessment of stroke patients in the UK National Health Service. Methods: This study had 2 parts, non-participant observation with 2 therapists and 3 patients, and 10 semi-structured interviews with 5 physiotherapists and 5 occupational therapists to identify current practice, problem areas, and what types of improvements could be made. Interviews were transcribed and analyzed using thematic coding. Results: Seven emergent themes were identified portraying how outcome measures are currently not being used in a standardized way within National Health Service?hospitals. This means that the feedback provided to patients, therapists and healthcare commissioners is limited. Therapists are currently performing more informal assessments each time a patient begins therapy and concerns are shown with these methods of assessment, including subjectivity, standardization issues and time. Interviewed therapists were clear that they believed that change is required within this field. Conclusions: This study raises concerns about the methodologies used for the assessment of stroke patients for rehabilitative purposes in the United Kingdom National Health Service.展开更多
Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, und...Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.展开更多
目的:对游戏疗法干预脑性瘫痪(脑瘫)病人的系统评价进行再评价,为改进脑瘫病人康复运动策略提供参考。方法:通过计算机检索the Cochrane Library、Embase、PubMed、Web of Science、中国知网、中国生物医学文献数据库、维普及万方等中...目的:对游戏疗法干预脑性瘫痪(脑瘫)病人的系统评价进行再评价,为改进脑瘫病人康复运动策略提供参考。方法:通过计算机检索the Cochrane Library、Embase、PubMed、Web of Science、中国知网、中国生物医学文献数据库、维普及万方等中英文数据库,收集有关对比不同游戏疗法对脑瘫病人康复效果的系统评价/Meta分析,采用系统评价方法学质量评价工具AMSTAR 2对纳入研究的方法学质量进行评价,采用证据质量分级系统GRADE进行证据分级。结果:最终纳入28项系统评价/Meta分析,方法学质量评价结果显示,11个条目报告较完整,1个条目未报告。结论:游戏疗法有利于脑瘫病人运动功能、平衡功能以及上肢功能的恢复,虽然所纳入文献的方法学质量整体较高,但基于结局指标的证据等级均较低。展开更多
文摘Competency-based assessments for healthcare professionals are critical for safe and effective client outcomes. Rehabilitation clinical skill competency assessments must be validated and revised to produce safe and skilled practitioners. The revised American Occupational Therapy Association (AOTA) Fieldwork Performance Evaluation (FWPE) instrument measures occupational therapy student performance to determine readiness for practice. The assessment includes thirty-seven competencies that address both profession specific clinical skills and general professional behavior skills. The objective of this study was to use Rasch methods to explore the use of the revised FWPE in actual fieldwork practice and to determine the instrument’s psychometric properties when separating the item components into two distinct subdomains: General Health Professions Competences and Occupational Therapy-Specific Competencies. Internal construct validity and test reliability were analyzed using data from 149 occupational therapy students after completing their initial Level II A fieldwork clinical internship. This study examined the item difficulty hierarchy, item fit, person-fit to model, person separation index, person separation reliability coefficient, strata, ceiling and floor effect, and unidimensionality of the FWPE instrument as a whole and as two separate domains. With the exception of not meeting the criteria for unidimensionality, the full FWPE instrument and the Occupational Therapy-Specific Competencies subdomain showed acceptable item-level psychometrics for reliability and precision. While the General Health Professions Competencies subdomain showed good item-level psychometrics, it was below the criterion for reliability and only separated the sample into two strata. Results support the validity, reliability, and clinical use of the revised FWPE full instrument and the Occupational Therapy-Specific Competencies subdomain to measure entry-level clinical skill competencies in practice.
文摘Background and Purpose: This exploratory study focused on the assessment of stroke patients for musculoskeletal rehabilitation in the United Kingdom National Health Service. It was the first phase of research on developing telerehabilitation for the assessment of patients who have had a stroke. The assessment of stroke patients for musculoskeletal rehabilitation is currently performed at the therapist’s discretion using different outcome measures. When looking at the Department of Health’s “National Clinical Guidelines for Stroke”, it is stated that there are a variety of outcome measures, yet no particular one is recommended. It is specified that each rehabilitation sector should select its own methodologies. Aim: The aim of this exploratory study was to understand physiotherapists’ and occupational therapists’ perspectives of the strengths and weaknesses of current rehabilitative assessment of stroke patients in the UK National Health Service. Methods: This study had 2 parts, non-participant observation with 2 therapists and 3 patients, and 10 semi-structured interviews with 5 physiotherapists and 5 occupational therapists to identify current practice, problem areas, and what types of improvements could be made. Interviews were transcribed and analyzed using thematic coding. Results: Seven emergent themes were identified portraying how outcome measures are currently not being used in a standardized way within National Health Service?hospitals. This means that the feedback provided to patients, therapists and healthcare commissioners is limited. Therapists are currently performing more informal assessments each time a patient begins therapy and concerns are shown with these methods of assessment, including subjectivity, standardization issues and time. Interviewed therapists were clear that they believed that change is required within this field. Conclusions: This study raises concerns about the methodologies used for the assessment of stroke patients for rehabilitative purposes in the United Kingdom National Health Service.
基金the Science and Technology Foundation of Shanghai Railway Bureau of China, No. B340406052
文摘Sixty elderly patients, viro cluffered from acute stroke and were admitted within a 1-year period to the Department of Geriatrics in the First Affiliated Hospital of School of Medicine, Zhejiang University, China, underwent early rehabilitation in combination with neuroprotective drug therapy. Limb movement, cognitive functions and daily life self-care ability in elderly patients upon admission and discharge were assessed using the Hunt-Hess scale, functional independence measures and mini-mental state examination. The mean duration of hospital stay among the 60 patients was 35 days. Upon discharge, 42 （75%） of the patients exhibited cognitive impairment to varying degrees, and 25 （45%） of the 56 stroke patients who underwent rehabilitation evaluation attained independence in daily living activities, 11 （20%） required intermittent supervision, and 20 （36%） required 24-hour constant supervision during performance of these activities. Results demonstrated that early rehabilitation treatment in combination with neuroprotective therapy for acute stroke was effective.
