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Biomedical subjects

M E Segal

Publications and source records attributed to M E Segal.

7 recordsLinked to original sources
PubMed1994

Determining functional/health status and its relation to disability in stroke survivors.

BACKGROUND AND PURPOSE: Determining the functional/health status of stroke survivors poses special difficulties because of cognitive impairments that frequently result from stroke. A possible means of assessing the status of stroke survivors who are cognitively impaired is getting proxy responses from a family member or other caregiver. Proxy agreement was evaluated for two measures of functional/health status, the Frenchay Activities Index (FAI) and the Health Status Questionnaire (HSQ), and a measure of disability, the Functional Independence Measure (FIM). METHODS: Thirty-eight stroke survivors were administered the measures at follow-up (median time since the stroke, 6 months). Caregivers were instructed to answer as proxies for the stroke survivors in their care. Demographics on age, sex, race, marital status, educational level, side of lesion, and relation of stroke survivor to caregiver were collected. RESULTS: Proxy agreement was excellent for the FAI (intraclass correlation, .85) and the FIM (.87), but poor for the HSQ scales (average proxy agreement, .32). Patients' scores were low and positively skewed for the FAI but high and negatively skewed for the FIM. Although Spearman rho coefficients between the measures were fairly high for both stroke survivors and proxy respondents, the correlation of scores was substantially weaker when the group of less severely impaired survivors (as established by FIM ratings) was considered separately. CONCLUSIONS: The FAI and the FIM are useful for assessing the functional/health status of stroke survivors because answers can be obtained by proxy. Future studies should examine the relations between disability and functional/health status, with explicit attention paid to variations in the level of disability in the stroke survivors.

Activities of Daily Living↗
PubMed1993

Interinstitutional agreement of individual functional independence measure (FIM) items measured at two sites on one sample of SCI patients.

Individual items of the Functional Independence Measure (FIM) were analyzed for interinstitutional agreement using a sample of 57 spinal cord injured (SCI) patients at discharge from an acute care rehabilitation setting (ACRS) and at admission to an ongoing rehabilitation setting (ORS). The two FIM ratings were performed within 6 days of each other. The reliability coefficient for total FIM scores was good: 0.83. Individual items were classified into four groups: (1) above average reliability coefficient, above average proportion agreement, which included the feeding items and items from the mobility category; (2) above average reliability coefficient, below average agreement, which included the majority of items in the selfcare category; (3) below average reliability coefficient, above average agreement, which included items in the sphincter control and communication categories; and (4) below average reliability coefficient, below average agreement, which included items in the social cognition category. Patients received significantly higher ratings on most selfcare items in the ACRS, and significantly higher ratings on social cognition items in the ORS. Implications of these results are discussed in terms of using individual FIM items for research purposes. Reliability coefficients were acceptably high for subgroups of complete and incomplete paraplegics and for complete quadriplegics, ranging from 0.74 to 0.87, but low for incomplete quadriplegics, r = 0.49. However, these sample sizes were small, ranging from 9 to 17 patients. Data collection will continue in order to increase sample size and permit further analysis of these subgroups.

Disability Evaluation↗
PubMed1975

A rapid test for sickle hemoglobin.

Vigorous shaking of oxygenated sickle hemoglobin (Hb S) in solution causes precipitation of the hemoglobin. This unusual property of Hb S forms the basis of a simple test for the presence of Hb S. Comparison of results of this test with those from cellulose acetate electrophoresis in blood samples from 599 patients showed no false-positive or false-negative results. The group tested included 55 persons with sickling disorders and 47 others with unusual hemoglobin patterns. This test may be used to confirm the presence of Hb S or to establish the diagnosis of sickling disorders rapidly in the clinic or at the bedside.

Anemia, Sickle Cell↗
PubMedDate not supplied

Assessing handicap of stroke survivors. A validation study of the Craig Handicap Assessment and Reporting Technique.

Proxy agreement and internal structure of the Craig Handicap Assessment and Reporting Technique are documented, and the measure is compared with the Functional Independence Measure for a sample of stroke survivors. Thirty-eight former rehabilitation patients were assessed at follow-up (average time post-stroke was 6 mo) with the Craig Handicap Assessment, which was also answered separately under proxy instructions by caregivers (relatives or friends) who accompanied patients to the interview. Proxy instructions were for caregivers to answer as if they were the stroke survivor. Proxy agreement for the Craig Handicap total score was good (intraclass correlation was 0.77) and adequate for most of its scales. The physical independence, mobility, and occupation scales were highly intercorrelated, with low intercorrelations for social integration and economic self-sufficiency. Correlation between the handicap and Functional Independence Measure disability scores was around 0.50; when the handicap economic self-sufficiency scale was removed, this increased to 0.70. These findings are discussed within the context of the interrelationships among the educational level of the patients and both measures. With some modification, the Craig Handicap Assessment and Reporting Technique appears to be a useful tool for assessing outcomes in terms of the handicap status of stroke survivors.

Adult↗
PubMedDate not supplied

Telephone and in-person proxy agreement between stroke patients and caregivers for the functional independence measure.

This study examined patient/proxy agreement for telephone administration of the Functional Independence Measure (FIM) to a sample of 25 community-living stroke patients 18 mo post-stroke and their caregivers. Patients had all received in-patient rehabilitation for stroke. Because use of the FIM is increasing for follow-up purposes, it is important to document whether it is appropriate to administer a telephone version to proxy caregivers in situations in which patients cannot answer for themselves. Proxy agreement results were then compared with those obtained for in-person administration of the FIM to the same sample 1 yr earlier. Overall, proxy agreement for telephone administration was excellent for total scores (intraclass correlation was 0.91) and the physical dimension (0.94) and lower for the cognitive dimension (0.52), closely paralleling results obtained for the earlier in-person administration. Reasons for lower agreement on the cognitive dimension are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Modeling case mix adjustment of stroke rehabilitation outcomes.

Case mix adjustment models for long-term stroke rehabilitation outcomes should be developed (1) to facilitate equitable comparisons of outcomes across treatment settings, thereby reducing disincentives for treating complex cases, (2) to improve triage into the most appropriate level of rehabilitative care after discharge from acute care, and (3) to confirm that case mix factors are equated in treatment effectiveness studies and by random assignment across conditions in clinical trials. Case mix adjustment is necessary for valid quality improvement processes. A conceptual model of case mix adjustment of long-term rehabilitation outcomes is presented that (1) is diagnosis-specific, (2) includes demographic variables as important case mix factors, (3) encompasses triage into rehabilitation as well as treatment processes as aspects of quality of rehabilitative care, (4) contains outcomes measuring functional status as well as mortality and morbidity, and (5) keys timing of outcomes to onset of conditions requiring rehabilitation rather than discharge from rehabilitation. The number of potential interactions among case mix indicators requires a sophisticated analytic framework. Random factors in the model illustrate that case mix adjustment can never be perfect. Nevertheless, it is essential. A brief review of the stroke literature on prediction of long-term outcomes suggests that additional work is needed to specify relevant case mix indicators.

Activities of Daily Living↗