Evidence Based Practice Symposium - McMaster University

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The ICF code that was most frequently linked to participant responses was d850 (Remunerative employment), with 44.7% of participants reporting a response linked to this code. The code for Family relationships (d760) was the second most commonly occurring code, with 30.0% of participants reporting challenges linked to this code. The third, fourth and fifth most commonly linked codes were d920 (Recreation and leisure), d9201 (Sports) and d5701 (Maintaining diet and fitness), respectively. Chapter 9 (Community, Social and Civic Life), had the highest frequency of linked codes (see figure one). Participants reported challenges which were linked to codes across 8 of the 9 Activity and Participation chapters; the most common code within each chapter is listed in table 1. Figure 1. Number of participant responses linked to codes within each Activities and Participation chapter. d1 – Learning and Applying Knowledge; d2 – General Tasks and Demands; d3 – Communication; d4 – Mobility; d5 – Self-Care; d6 – Domestic Life; d7 – Interpersonal Interactions and Relationships; d8 – Major Life Areas; d9 – Community, Social and Civic Life Table 1. Most frequently linked ICF code in each Activities and Participation chapter Chapter ICF Code Frequency d1 d170 (Writing) 4 d2 N/A N/A d3 d3601 (Using writing machines) 14 d4 d450 (Walking) 26 d5 d5701 (Managing diet and fitness) 86 d6 d660 (Assisting others) 80 d7 d760 (Family relationships) 121 d8 d850 (Remunerative employment ) 180 d9 d920 (Recreation and leisure) 99 Discussion The results of this study revealed participants experienced a wide range of occupational issues following DRF. The activity limitations and participation restrictions indicated as affected involved all areas of occupation, including self-care, productivity and leisure. The social implications of DRF were highly evident in this study, particularly related to the following chapters in the ICF: Community, Social and Civic Life, and Interpersonal Interactions and Relationships. Social implications of physical injuries have been demonstrated in past research, and social abilities are key aspects of health related quality of life (Beaton & Schemitsch, 2003). Past research has indicated that social relationships can be highly important and meaningful; therefore it is important to further understand how these are affected by DRF and what services may help address these challenges. Another major finding was the effect that DRF has on work related engagements. Work is a key aspect of health related quality of life, has been seen as a key aspect of personal and social identities, plays a significant role in community participation and meeting psychosocial needs, and can affect physical and mental health (COT, 2010). These findings combined with the previously demonstrated importance of work, indicate the need for services to improve engagement and facilitate more rapid return to work for this population. Domestic life was another area that was indicated to be highly affected by participants. This signifies the attention that is required to address these specific activities, particularly for females, as they are almost 4x more likely to experience DRF than males, and are often more involved in domestic life tasks (Thompson, Taylor, & Dawson, 2004). Conclusion The results of this study suggest that the experience of a DRF can result in activity limitations and participation restrictions across each of the domains of self-care, productivity and leisure. Paramount was the finding that a large number of participants indicated restrictions in their social and community lives. Given that research in this area has primarily focused on the physical implications of DRF, this is an important finding because it highlights, for the first time, the social implications of this injury. References Beaton, D.E. & Schemitsch, E. (2003). Measures of health-related quality of life and physical function. Clinical orthopaedics and related research, 413, 90-105. Cieza, , A., Geyh, S., Chatterji, S., Kostanjsek, N., Ustun, B., & Stucki, G. (2005). ICF linking rules: An update based on lessons learned. Journal of Rehabilitation Medical, 37, 212-218. College of Occupational Therapists. (2010). Working for health: Occupational therapy and how it can benefit your organization. Retrieved from: http://www.cot.co.uk/sites/default/files/marketing_materials/public/w orking-for-health-leaflet.pdf Dekkers, M., & Soballe, K. (2004). Activities and impairments in the early stage of rehabilitation after Colles’ fracture. Disability and Rehabilitation, 26(11), 662-668. Harris, J. E., MacDermid, J. C., Roth, J. (2005). The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study. Health and Quality of Life Outcomes, 3(73). MacDermid, J. C. (2008). Development and validation of a brief- patient specific participation scale. MacDermid, J., Richards, R., & Roth, J. (2001). Distal radius fractures: A prospective outcome study of 275 patients. Journal of Hand Therapy, 14(2), 154-164 MacDermid, J., Roth, J., & Richards, R. (2003). Pain and disability reported in the year following a distal radius fracture: A cohort study. BMC Musculoskeletal Disorders, 4(24). Squitieri, L., Reichert, H., Kim, H. M., Chung, K. C. (2010). Application of the Brief International Classification of Functioning, Disability, and Health Core Set as a conceptual model in distal radius fractures. Journal of Hand Surgery, 35A, 1795-1805. Thompson, P. W., Taylor, J., & Dawson, A. (2004). The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in dorset, UK. Injury, 35(5), 462-466. World Health Organization. (2001). International Classification of Functioning, Disability and Health: ICF. Geneva: Switzerland.
The Psychometric Properties of the MacHANd Performance Assessment (MPA) Elizabeth Landman BHSc, MScOT(c) & Annemarie Muhic BA, MScOT(c) Abstract This measurement study examined reliability and validity of the MacHANd Performance Assessment (MPA) with a hand-injured population. The MPA is a standardized assessment under development that uses everyday functional tasks to examine the grasp and pinch patterns of the hand. Purpose: To determine if the MPA is a reliable and valid measure of function to be used with individuals following hand injury. Methods: Participants receiving therapy following hand trauma or surgery (n=41) were recruited from hand therapy clinics throughout the Hamilton/Niagara Region. At baseline visit, two raters simultaneously observed and scored the MPA, the Jebsen- Taylor hand assessment, Patient Rated Wrist and Hand Evaluation and grip/ pinch strength dynamometry. Available participants also repeated the assessments again within one week of baseline. Results: The MPA demonstrates good to high inter-rater reliability and excellent test-retest reliability. Item-total correlations were very strong at a=0.95. Preliminary explorations of construct and criterion validity confirmed hypothesized relationships between MPA scores and other measures. The MPA is an easy to use functional assessment for individuals with hand injuries based on performance of everyday tasks. This study provides initial estimates of the psychometric properties of the MPA in patients with hand injuries. Introduction Across the healthcare landscape, there is a strong movement towards routine utilization of outcome measures in clinical practice. In hand therapy, few performance-based hand assessments, which examine participation and activity limitations, have been developed explicitly for traumatic hand injuries, and data on the psychometric properties is of varied quality, or nonexistent (Van de Ven-Stevens et al., 2009). The Ahuja Hand Performance Assessment (AHPA), is a standardized test battery developed in Hamilton by a hand therapist over 25 years ago. It was pilot-tested for a heterogeneous population of hand function problems with promising results; however, this data was never published. The MacHANd Performance Assessment (MPA) was created as an adaptation of the AHPA in 2010. The concepts of the assessment are identical but implemented differently for reproducibility and face validity. The scoring has been reworded and common everyday items have replaced the original test kit. The clinical experience of therapists using the MPA in clinical practice has demonstrated it has potential utility both for description and evaluation of hand function; two of the three purposes for selection of a measurement instrument (Rudman & Hannah, 1998). In the absence of another reliable and valid performancebased assessment, this test was evaluated for the hand trauma and post-surgical population served by the Hand Therapy Clinic at HHS and other community facilities. Literature Review A review of the literature on hand assessments revealed two systematic reviews. The first, a systematic review published in 2009 (Van de Ven-Stevens et al) reviewed 23 instruments but found no performance-based measures of hand function that met all the criteria for sound clinimetric evaluation properties. They identified that a need exists for: “…reliable and validated instruments to evaluate changes and, if possible, to predict the outcomes of different interventions.” ( p.152) A similar systematic review of activity and participation measurement tools examined 15 tools, including both self-report and performance based tests (Schoneveld, Wittink, and Takken, 2009). They reported on 5 performance tests designed for all types of hand injuries but felt clinimetric data was weaker overall for the performance tests, specifically in the area of validity. Purpose The purpose of the study is to determine if the MPA is a reliable and valid method of assessing hand performance in persons after hand trauma or reconstructive surgery of the hand. Key Questions: • Does the MPA demonstrate acceptable levels of interrater and test-retest reliability? • Does the MPA represent a single construct (hand performance/ hand function) and how well do the items relate to that construct? • How does hand function as measured by the MPA compare to hand function as measured by the Jebsen- Taylor Hand Function Test (JTHFT) (Jebsen, Taylor, Trieschmann, Trotter & Howard; 1969), the selfreported upper extremity pain and disability as measured by the Patient Rated Wrist and Hand Evaluation (PRWHE) (MacDermid & Tottenham, 2004), and grip and pinch strength? Methods Design Participants with hand injury or reconstructive surgery were asked to undergo a battery of assessments for the purpose of comparing the results of the assessment across limbs, across raters, across different methods of measurement, and across time. On a baseline visit, 2 different raters simultaneously observed and scored the MPA, which was completed with both the affected and unaffected hands. Additionally, the participant completed the Jebsen-Taylor Hand Function Test (JTHFT) with the affected hand only, as well as bilateral testing of grip strength using the JAMAR dynamometer, and lateral pinch strength using the pinch strength dynamometer. Participants were also asked to complete a self-report questionnaire of pain and disability, the Patient Rated Wrist and Hand Evaluation (PRWHE). At the end of the baseline visit, participants
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Page 3 and 4: Transition to Adulthood with Cyberg
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Page 7 and 8: LOOKING AT CHILD BEHAVIOUR MEASURES
Page 9 and 10: Participation in Children and Youth
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Page 25 and 26: Abstract Mild Cognitive Impairments
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Page 31: Activity Limitations and Participat
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