Archives of Physical Medicine and Rehabilitation, Sep 1, 2007
Objective: To examine the early effects of the Centers for Medicare Services (CMS) criteria for e... more Objective: To examine the early effects of the Centers for Medicare Services (CMS) criteria for eligibility for rehabilitation following total knee (TKA) and hip (THA) arthroplasty on patient discharge dispositions and acute care length of stay (LOS) and hospital charges. Design: Retrospective, exploratory study. Setting: A tertiary care hospital and affiliated inpatient rehabilitation hospital. Participants: Patients with TKA and THA; clinical data repository information and medical records of patients from 2000 and 2006. Interventions: Not applicable. Main Outcome Measures: Discharge disposition location, acute care hospital charges, acute care LOS, and patient variables (demographics, insurance carrier, comorbidities). Results: Patient population demographics and profiles were similar in 2000 and 2006. In TKA, the acute care LOS increased from 3.68 days (range, 1Ϫ21d) to 4.16 days (range, 1Ϫ34d). Total daily acute care hospital charges increased from $7384 to $14,893. In 2000, 45.9% of TKA patients were discharged to inpatient rehabilitation compared with 29.3% in 2006. In THA, LOS increased from 4.1 days (range, 1Ϫ21d) to 4.5 days (range, 2Ϫ52d). Total daily acute care hospital charges increased from $7103 to $17,311. 10.5% of THA patients were discharged to inpatient rehabilitation in 2000, whereas 31.1% were discharged to rehabilitation in 2006. In both TKA and THA, more patients were being discharged to skilled nursing facilities and to home with home healthcare. Reimbursements were reduced by 29.7% and 24.0% in THA and TKA, respectively, from 2000 to 2006. Conclusions: Given the impending restrictions imposed by the CMS criteria, these preliminary data suggest that joint arthroplasty patients remain in acute care longer at a greater expense, and fewer TKA patients are discharged to inpatient rehabilitation. Patients referred to skilled nursing facilities or home with home healthcare may not receive the same concentration of rehabilitation needed for rapid restoration of function and mobility.
Journal of rehabilitation and assistive technologies engineering, 2020
Aim: This brief report provides an overview of the development and structure of the Health App Re... more Aim: This brief report provides an overview of the development and structure of the Health App Review Tool. Methods: The Health App Review Tool has been designed to assess smart phone health apps according to their compatibility to individuals within the Alzheimer's disease community. Specifically, app features and functions are characterized according to their appropriateness to the needs, abilities, and preferences of potential users. The Health App Review Tool is comprised of two components, the App and User Assessment; each component includes four complementary domains. Items in these domains can be compared between App and User assessments using a scoring key that will produce a match score. The score indicates the level of appropriateness in reference to the app's ability to meet the user's needs. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations.
American Journal of Physical Medicine & Rehabilitation, Jun 14, 2019
The aims of the study were to report the demographic characteristics and functional mobility for ... more The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type. Design: This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction. Results: The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0-1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01). Conclusions: Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.
Aim: The aims of this study were to adapt an adult wheeled mobility outcome measure, the Function... more Aim: The aims of this study were to adapt an adult wheeled mobility outcome measure, the Functional Mobility Assessment, for use with children (FMA-Family Centred) and establish the new measure's content validity, test-retest reliability, and internal consistency. Background: Although several tools exist to measure a child's ability to operate and move a wheeled mobility device, none focus on the ability of the wheeled mobility device to support children and their families as they perform daily activities. Methods: After adapting the FMA items with examples relevant to children aged 3-21, parent/caregiver and therapist stakeholder groups recommended adaptations relevant for families with children who cannot respond for themselves. Results: Six of the initial FMA items were retained with child-appropriate examples, and 4 new items were developed. Conclusion: The content validity of the FMA-Family Centred was strongly supported, and internal consistency and test-retest reliability met accepted psychometric standards.
Supplemental material, sj-pdf-2-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching... more Supplemental material, sj-pdf-2-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching mobile apps to Alzheimer's populations (HART Match) by Julie Faieta, Brittany N Hand, Mark Schmeler, James Onate and Carmen Digiovine in Journal of Rehabilitation and Assistive Technologies Engineering
Supplemental material, sj-pdf-1-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching... more Supplemental material, sj-pdf-1-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching mobile apps to Alzheimer's populations (HART Match) by Julie Faieta, Brittany N Hand, Mark Schmeler, James Onate and Carmen Digiovine in Journal of Rehabilitation and Assistive Technologies Engineering
Telerehabilitation (TR) is a rehabilitation environment, in which the use of telecommunications t... more Telerehabilitation (TR) is a rehabilitation environment, in which the use of telecommunications technology provides rehabilitation and long-term support to people with disabilities in geographically-remote regions. Current wheelchair selection and evaluation processes are based on in-person assessment often not available to patients in underserved or rural areas due to lack of expertise by clinicians in wheeled mobility and seating (WMS) interventions. To improve current rehabilitation processes, technologists and clinicians have investigated the use of advanced telecommunications and infor
Disability and Rehabilitation: Assistive Technology, Mar 20, 2018
Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistiv... more Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities. Materials and Methods: This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements. Results: A total of 161 providers from 35 states within the USA consented to participation and completed the survey. Conclusions: This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces, and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities.
Introduction: A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The nee... more Introduction: A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development. Materials and Methods: This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions. Results: A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments. Conclusion: This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, humanmachine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.
Regardless of the field, agenda-setting processes are integral to establishing research and devel... more Regardless of the field, agenda-setting processes are integral to establishing research and development priorities. Beginning in 1998, the National Institute on Disability and Rehabilitation Research mandated that each newly funded Rehabilitation Engineering and Research Center (RERC) hold a state-of-the-science consensus forum during the third year of its 5-year funding cycle. NIDRR&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aim in formalizing this agenda-setting process was to facilitate the formulation of future research and development priorities for each respective RERC. In February 2001, the RERC on Wheeled Mobility, University of Pittsburgh, conducted one of the first such forums. The scope encompassed both current scientific knowledge and clinical issues. In preparation, expert interviews were carried out to establish the focus for the forum. Because a stakeholder forum on wheelchair technology had recently been held, opinion favored wheelchair seating as the focus and included the following core areas: seating for use in wheelchair transportation, seated postural control, seating discomfort, and tissue integrity management. The aim of this report is to present a summary of the workshop outcomes, describe the process, and increase awareness of this agenda-setting process in order to enhance future participation in a process that critically influences the field of wheeled mobility.
Official RESNA Position Papers articulate issues in assistive technology and rehabilitation engin... more Official RESNA Position Papers articulate issues in assistive technology and rehabilitation engineering important to researchers, practitioners, policy makers, and funding sources. These positions are based on a strong evidential foundation, supplemented by the authors’ extensive expertise and strengthened by input from others in the field. Development of these position papers follow specific guidelines, which are available on the RESNA website: http://www.resna.org/knowledge-center/position-papers-and-provision-guides.
Abstract Wheelchair and seating systems allow individuals with mobility impairments to actively p... more Abstract Wheelchair and seating systems allow individuals with mobility impairments to actively participate in all aspects of society. The quality of life of an individual is reflective of the overall effectiveness of the wheelchair and seating system when considering activities of daily living. Therefore, it is imperative that the multidisciplinary team of rehabilitation professionals considers the wheelchair not just within the clinic, but in the full context of an individual’s life. To do so, rehabilitation professionals must understand current technologies in assistive technology as well as best practices for service delivery, and execute a systematic approach to wheelchair assessment. Successful wheelchair outcomes occur when clinicians are well versed in available equipment, its intended application, and all seating and positioning parameters. Fitting, training, and follow-up are just as important as device selection and are essential to a successful match between patient and device.
Archives of Physical Medicine and Rehabilitation, Sep 1, 2007
Objective: To examine the early effects of the Centers for Medicare Services (CMS) criteria for e... more Objective: To examine the early effects of the Centers for Medicare Services (CMS) criteria for eligibility for rehabilitation following total knee (TKA) and hip (THA) arthroplasty on patient discharge dispositions and acute care length of stay (LOS) and hospital charges. Design: Retrospective, exploratory study. Setting: A tertiary care hospital and affiliated inpatient rehabilitation hospital. Participants: Patients with TKA and THA; clinical data repository information and medical records of patients from 2000 and 2006. Interventions: Not applicable. Main Outcome Measures: Discharge disposition location, acute care hospital charges, acute care LOS, and patient variables (demographics, insurance carrier, comorbidities). Results: Patient population demographics and profiles were similar in 2000 and 2006. In TKA, the acute care LOS increased from 3.68 days (range, 1Ϫ21d) to 4.16 days (range, 1Ϫ34d). Total daily acute care hospital charges increased from $7384 to $14,893. In 2000, 45.9% of TKA patients were discharged to inpatient rehabilitation compared with 29.3% in 2006. In THA, LOS increased from 4.1 days (range, 1Ϫ21d) to 4.5 days (range, 2Ϫ52d). Total daily acute care hospital charges increased from $7103 to $17,311. 10.5% of THA patients were discharged to inpatient rehabilitation in 2000, whereas 31.1% were discharged to rehabilitation in 2006. In both TKA and THA, more patients were being discharged to skilled nursing facilities and to home with home healthcare. Reimbursements were reduced by 29.7% and 24.0% in THA and TKA, respectively, from 2000 to 2006. Conclusions: Given the impending restrictions imposed by the CMS criteria, these preliminary data suggest that joint arthroplasty patients remain in acute care longer at a greater expense, and fewer TKA patients are discharged to inpatient rehabilitation. Patients referred to skilled nursing facilities or home with home healthcare may not receive the same concentration of rehabilitation needed for rapid restoration of function and mobility.
Journal of rehabilitation and assistive technologies engineering, 2020
Aim: This brief report provides an overview of the development and structure of the Health App Re... more Aim: This brief report provides an overview of the development and structure of the Health App Review Tool. Methods: The Health App Review Tool has been designed to assess smart phone health apps according to their compatibility to individuals within the Alzheimer's disease community. Specifically, app features and functions are characterized according to their appropriateness to the needs, abilities, and preferences of potential users. The Health App Review Tool is comprised of two components, the App and User Assessment; each component includes four complementary domains. Items in these domains can be compared between App and User assessments using a scoring key that will produce a match score. The score indicates the level of appropriateness in reference to the app's ability to meet the user's needs. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations. Discussion: The Health App Review Tool was designed using available evidence and stakeholder preference data to ensure a user-centered design. The result was the development of a tool built on evidence and informed by the perceptions and preferences of those within and working with the Alzheimer's disease population. App and User domains include usefulness, complexity, accessibility, and external variables. This unique matching approach is anticipated to significantly impact individualized, client-centered care. We anticipate that this study will serve as a model for future development of technology matching tools for other diagnostic populations.
American Journal of Physical Medicine & Rehabilitation, Jun 14, 2019
The aims of the study were to report the demographic characteristics and functional mobility for ... more The aims of the study were to report the demographic characteristics and functional mobility for individuals accessing an academic medical center mobility device clinic and to compare functional mobility data across demographic characteristics and mobility device type. Design: This study used a retrospective, cross-sectional design. Demographic, mobility type, and patient-reported outcome measure data for 833 clients were analyzed. The Functional Mobility Assessment was used as the patient-reported outcome measure to determine satisfaction. Results: The mean (SD) baseline Functional Mobility Assessment score was 0.59 (0.25) on a 0-1 scale. Significant differences with the Functional Mobility Assessment scores were found across the mobility device types, with scooter and power wheelchair groups reporting higher satisfaction scores than those in the cane/crutch/walker or manual wheelchair groups. Device type, sex, and age were each found to be significant predictors of satisfaction scores (P < 0.01). Conclusions: Mobility device type is associated with satisfaction level. Mobility devices that offer higher levels of assistance are associated with increased satisfaction. The Functional Mobility Assessment, mobility device type, and demographic data provide baseline information for evaluating the effectiveness of an academic medical center mobility device clinic.
Aim: The aims of this study were to adapt an adult wheeled mobility outcome measure, the Function... more Aim: The aims of this study were to adapt an adult wheeled mobility outcome measure, the Functional Mobility Assessment, for use with children (FMA-Family Centred) and establish the new measure's content validity, test-retest reliability, and internal consistency. Background: Although several tools exist to measure a child's ability to operate and move a wheeled mobility device, none focus on the ability of the wheeled mobility device to support children and their families as they perform daily activities. Methods: After adapting the FMA items with examples relevant to children aged 3-21, parent/caregiver and therapist stakeholder groups recommended adaptations relevant for families with children who cannot respond for themselves. Results: Six of the initial FMA items were retained with child-appropriate examples, and 4 new items were developed. Conclusion: The content validity of the FMA-Family Centred was strongly supported, and internal consistency and test-retest reliability met accepted psychometric standards.
Supplemental material, sj-pdf-2-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching... more Supplemental material, sj-pdf-2-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching mobile apps to Alzheimer's populations (HART Match) by Julie Faieta, Brittany N Hand, Mark Schmeler, James Onate and Carmen Digiovine in Journal of Rehabilitation and Assistive Technologies Engineering
Supplemental material, sj-pdf-1-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching... more Supplemental material, sj-pdf-1-jrt-10.1177_2055668320938604 for Health App Review Tool: Matching mobile apps to Alzheimer's populations (HART Match) by Julie Faieta, Brittany N Hand, Mark Schmeler, James Onate and Carmen Digiovine in Journal of Rehabilitation and Assistive Technologies Engineering
Telerehabilitation (TR) is a rehabilitation environment, in which the use of telecommunications t... more Telerehabilitation (TR) is a rehabilitation environment, in which the use of telecommunications technology provides rehabilitation and long-term support to people with disabilities in geographically-remote regions. Current wheelchair selection and evaluation processes are based on in-person assessment often not available to patients in underserved or rural areas due to lack of expertise by clinicians in wheeled mobility and seating (WMS) interventions. To improve current rehabilitation processes, technologists and clinicians have investigated the use of advanced telecommunications and infor
Disability and Rehabilitation: Assistive Technology, Mar 20, 2018
Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistiv... more Purpose: The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities. Materials and Methods: This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements. Results: A total of 161 providers from 35 states within the USA consented to participation and completed the survey. Conclusions: This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces, and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities.
Introduction: A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The nee... more Introduction: A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development. Materials and Methods: This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions. Results: A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments. Conclusion: This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, humanmachine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.
Regardless of the field, agenda-setting processes are integral to establishing research and devel... more Regardless of the field, agenda-setting processes are integral to establishing research and development priorities. Beginning in 1998, the National Institute on Disability and Rehabilitation Research mandated that each newly funded Rehabilitation Engineering and Research Center (RERC) hold a state-of-the-science consensus forum during the third year of its 5-year funding cycle. NIDRR&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aim in formalizing this agenda-setting process was to facilitate the formulation of future research and development priorities for each respective RERC. In February 2001, the RERC on Wheeled Mobility, University of Pittsburgh, conducted one of the first such forums. The scope encompassed both current scientific knowledge and clinical issues. In preparation, expert interviews were carried out to establish the focus for the forum. Because a stakeholder forum on wheelchair technology had recently been held, opinion favored wheelchair seating as the focus and included the following core areas: seating for use in wheelchair transportation, seated postural control, seating discomfort, and tissue integrity management. The aim of this report is to present a summary of the workshop outcomes, describe the process, and increase awareness of this agenda-setting process in order to enhance future participation in a process that critically influences the field of wheeled mobility.
Official RESNA Position Papers articulate issues in assistive technology and rehabilitation engin... more Official RESNA Position Papers articulate issues in assistive technology and rehabilitation engineering important to researchers, practitioners, policy makers, and funding sources. These positions are based on a strong evidential foundation, supplemented by the authors’ extensive expertise and strengthened by input from others in the field. Development of these position papers follow specific guidelines, which are available on the RESNA website: http://www.resna.org/knowledge-center/position-papers-and-provision-guides.
Abstract Wheelchair and seating systems allow individuals with mobility impairments to actively p... more Abstract Wheelchair and seating systems allow individuals with mobility impairments to actively participate in all aspects of society. The quality of life of an individual is reflective of the overall effectiveness of the wheelchair and seating system when considering activities of daily living. Therefore, it is imperative that the multidisciplinary team of rehabilitation professionals considers the wheelchair not just within the clinic, but in the full context of an individual’s life. To do so, rehabilitation professionals must understand current technologies in assistive technology as well as best practices for service delivery, and execute a systematic approach to wheelchair assessment. Successful wheelchair outcomes occur when clinicians are well versed in available equipment, its intended application, and all seating and positioning parameters. Fitting, training, and follow-up are just as important as device selection and are essential to a successful match between patient and device.
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Papers by Mark Schmeler