Development and validation of the Utrecht Scale for Evaluation of Clinical Rehabilitation (USER)

Abstract

Objective: The Utrecht Scale for Evaluation of Rehabilitation (USER) is a measure of functional independence that covers physical functioning (mobility, self-care), cognitive functioning and additional domains of pain, fatigue and mood. USER is implemented in the Netherlands as a generic rehabilitation outcome measure. This article reports the development and psychometric characteristics of USER.

Design: (1) Inter-rater reliability study and (2) responsiveness study with measurements at admission and at discharge from clinical rehabilitation.

Setting: Three rehabilitation facilities in the Netherlands.

Patients: Rehabilitation inpatients (N = 319).

Interventions: Not applicable.

Main outcome measures: Effect size (ES) and standardized response mean (SRM) of USER scales were compared to those of the Barthel Index, Functional Independence Measure (FIM) and to relevant scales of the SF-36.

Results: Inter-rater reliability of USER was satisfactory to good. Strong correlations were found between the physical and cognitive functioning scores of USER, the Barthel Index and FIM (0.84—0.94). Correlations between USER pain, fatigue and mood scores and SF-36 scores were also strong (0.58—0.84). Responsiveness of USER physical functioning (1.0—1.2) was very good and slightly better than responsiveness of the Barthel Index (0.9—1.1) and the FIM motor score (0.8—1.1). Responsiveness of the USER cognitive score was below standard (0.2—0.3), but better than responsiveness of the FIM cognitive scores (0.1—0.2).

Conclusions: USER is a reliable, valid and responsive measure of functional independence that can be used as an alternative for the FIM. The pain, fatigue and mood scores were adapted after this study and need additional validation.

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References

Cohen ME , Marino RJ The tools of disability outcomes research functional status measures . Arch Phys Med Rehabil 2000; 81(suppl 2): S21-S29.

Keith RA Conceptual basis of outcome measures. Am J Phys Med Rehabil 1995; 74: 73-80.

Wade DT , de Jong BA Recent advances in rehabilitation. BMJ 2000 ; 320: 1385-88.

Heinemann AW Putting outcome measurement in context: a rehabilitation psychology perspective. Rehabil Psychol 2005 ; 50: 6-14.

Mahoney FI , Barthel DW Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 61-65.

Granger CV , Hamilton BB , Linacre JM , Heinemann AW , Wright BD Performance profiles of the functional independence measure. Am J Phys Med Rehabil 1993; 72: 84-89.

Haig R. , Tennant A. , Biering-Sorensen F. et al. The use of outcome measures in physical medicine and Rehabilitation within Europe. J Rehabil Med 2001; 33: 273-78.

Douglas H. , Swanson C. , Gee T. , Bellamy N. Outcome measurement in Austrailian rehabilitation environments. J Rehabil Med 2005; 37: 325-29.

Skinner A. , Turner-Stokes L. The use of standardized outcome measures in rehabilitation centres in the UK. Clin Rehabil 2006; 20: 609.

10.

Turner-Stokes L. Nyein K. , Turner-Stokes T. , Gatehouse C. The UK FIM+FAM: Development and evaluation Functional assessment measure. Clin Rehabil 1999; 13: 277-87.

11.

Söderback I. Effectiveness of rehabilitation. Crit

12.

Rev Phys Med Rehabil Med 1995; 7: 275-86. 12 Commissie Prestatie-indicatoren Revalidatie. Basisset Prestatie-indicatoren revalidatiecentra 2006. Utrecht, Revalidatie Nederland/Vereniging van Revalidatieartsen, 2006.

13.

Catz A. , Itzkovitch M. , Agranov E. , Ring H. , Tamir A. SCIM Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions. Spinal Cord 1997 ; 35: 850-56.

14.

Pollard CA Preliminary evidence validity study of the Pain Disability Index. Percept Mot Skills 1984; 59: 974.

15.

Wade DT , Collin C.

The Barthel ADL Index: a standard measure of physical disability?

Int Disabil Stud 1988; 10: 64-67.

16.

Post MWM , Dallmeijer AJ , Angenot E. , van Asbeck FWA , van der Woude LHV . Duration and functional outcome of spinal cord injury rehabilitation in The Netherlands. J Rehabil Res Dev 2005; 42(3 suppl 1): 75-85.

17.

Dallmeijer AJ , Dekker J. , Roorda LD et al. Differential item functioning of the Functional Independence Measure in higher performing neurological patients . J Rehabil Med 2005 ; 37: 346-52.

18.

Streppel K. , Van Harten WH The Functional Independence Measure used in a Dutch rehabilitating stroke population; a pilot study to assess progress . Int J Rehabil Res 2002; 25: 87-91.

19.

Verhoef M. , Barf HA , Post MWM , van Asbeck FWA , Prevo AJH. Functional independence among young adults with spina bifida, in relation to hydrocephalus and level of lesion. Dev Med Child Neurol 2006; 48: 114-19.

20.

Van Bennekom CAM , Jelles F. , Lankhorst GJ , Bouter LM Responsiveness of the Rehabilitation Activities Profile and the Barthel Index. J Clin Epidemiol 1996; 49: 39-44.

21.

Kramer MS , Feinstein AR Clinical biostatistics LIV: the biostatistics of concordance. Clin Pharmacol Ther 1981; 29: 111-23.

22.

Ware JE , Sherbourne CD The MOS short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 1992; 30: 473-83.

23.

Aaronson NK , Muller M. , Cohen PD et al. Translation, validation and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998; 51: 1055-68.

24.

Nyein K. , McMichael L. , Turner-Stokes L.

Can a Barthel Index score be derived from the FIM?

Clin Rehabil 1999; 13: 56-63.

25.

Van der Putten JJ , Hobart JC , Freeman JA , Thompson AJ Measuring change in disability after the inpatient rehabilitation: comparison of the responsiveness of the Barthel Index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry 1999; 66: 480-84.

26.

Munro BH Statistical methods for health care research. Philadelphia , JB Lippincott Co., 1993.

27.

Wallace D. , Duncan PW , Lai SM Comparison of the responsiveness of the Barthel Index and the motor component of the Functional Independence Measure in stroke: the impact of using different methods for measuring responsiveness. J Clin Epidemiol 2002; 55: 922-28.

28.

Cohen J. Statistical power analysis for the behavioural sciences (swc ed). Hillsdale, NJ, Lawrence Erlbaum Associates , 1988, 24-27.

29.

Schepers VPM , Ketelaar M. , Visser-Meily A. , Dekker J. , Lindeman E. Responsiveness of functional health status measures frequently used in stroke rehabilitation . Disabil Rehabil 2006; 28: 1035-40.

30.

Houlden H. , Edwards M. , McNeil J. , Greenwood R. Use of the Barthel Index and the Functional Independence Measure during early inpatient rehabilitation after single incident brain injury. Clin Rehabil 2006; 20: 153-59.

31.

Cano SJ , O’Connor RJ , Thompson AJ , Hobart JC

Exploring disability rating scale responsiveness II: Do more response options help?

Neurology 2006; 67: 2056-59.

32.

Smeets R. , Vlaeyen JW , Hiding A. et al. Active rehabilitation for chronic low-back pain: Cognitive-behavioral, physical, or both? First direct post-treatment results from a randomised controlled trial. BMC Musculoskel Disord 2006; 7: 5.

33.

Van Drongelen S. , de Groot S. , Veeger HE et al. Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury. Spinal Cord 2006 ; 44: 152-59.

34.

Gagliese L. , Weizblit N. , Ellis W. , Chan VWS. The measurement of post-operative pan: a comparison of intensity scales in younger and older surgical patients. Pain 2005; 117: 412-20.