Do Environmental Factors Predict Home and Community Participation Postacute Care?

E21 Poster 60 Do Environmental Factors Predict Home and Community Participation Postacute Care? Janet Prvu Bettger (Boston University, Boston, MA), Julie Keysor, Wendy Coster, Alan Jette. Disclosure: None Objective: To examine if home and community environmental barriers and mobility, communication, and transportation facilitators predict home and community participation at 1 and 6 months postacute care. Design: Cohort study. Setting: Postacute care. Participants: 345 adults age 18 or older with complex medical, orthopedic, and neurologic diagnoses were enrolled from acute care and rehabilitation facilities. Interventions: Not applicable. Main Outcome Measures: Home and community participation assessed by the Participation Measure for Post-Acute Care. Results: Participants’ mean age was 68⫾14.4 years; 50% were women and 92% were white. Adjusting for age, sex, race, educational attainment, functional activity, and applied cognition, more home barriers were associated with less home participation (t⫽⫺2.70, P⬍.01), whereas more community barriers were associated with more home participation (t⫽2.55, P⬍.01) at 1 month; more community mobility barriers were associated with less community participation (t⫽⫺2.16, P⬍.05) and more transportation facilitators were related to more community participation (t⫽1.89, P⬍.05). At 6 months postacute care, no environmental factors predicted home or community participation. Conclusions: Home and community mobility barriers and transportation facilitators predict home and community participation at 1 month postacute care but do not predict participation 6 months after acute care. Key Words: Environment; Outcomes assessment (health care); Rehabilitation. Poster 61 Feasibility and Interrater Reliability of Clinical Tests of Dual-Task Performance After Acquired Brain Injury. Karen L. McCulloch (Division of Physical Therapy, University of North Carolina, Chapel Hill, NC). Disclosure: None declared. Objective: To evaluate the feasibility and interrater reliability of clinical tests of dual-task performance during walking for adults with acquired brain injury. Design: Experimental, sample of convenience. Settings: Community-based rehabilitation and postacute residential. Participants: 18 ambulatory adults (5 women) with subacute or chronic acquired brain injury; 3 subjects used a cane or walker during testing. Interventions: Subjects performed 3 dualtask clinical tests of walking, designed for use with older adults: (1) stops while talking test (SWWT); (2) walking while talking test (WWTT), which requires self-selected walking while repeating the alphabet and alternate letters of the alphabet; and (3) walking and remembering test (WART), which tests speeded walking on a narrow path while performing a working memory task. All tests were observed and scored by 2 raters simultaneously for 12 subjects. WWTT and WART order was counterbalanced. Main Outcome Measures: Reliability data were derived from dichotomous scores for SWWT; walking time and cognitive task accuracy in single- and dual-task conditions for WWTT and WART. Step accuracy was also recorded for WART. Test feasibility and ability to elicit dual-task costs was also examined. Results: Raters agreed perfectly on the SWWT. Intraclass correlation coefficients for timed measures and cognitive accuracy on the WWTT and WART exceeded .95. Raters agreed perfectly on step accuracy for 76% of WART trials. Dichotomous agreement (on/off) improved to 85%, with a .33 steps/trial absolute difference. All subjects were able to complete the SWWT, but all ratings were negative. Dual-task costs in walking speed and cognitive performance were elicited with the WWTT and the WART. 67% of subjects were unable to do the

more difficult WWTT cognitive task error-free while seated, and errors increased dramatically during walking. All subjects could complete the WART cognitive task, but 3 subjects had difficulty with the walking task as a result of visual deficits (n⫽1) and severe hemiparesis (n⫽2). Conclusions: The SWWT was not useful in identifying dual-task performance problems in this population. Both the WWTT and WART were safely and reliably administered and expected dual-task costs were observed. The cognitive task difficulty for the WWTT cannot be adjusted for people with acquired brain injury, and the motor task for the WART is difficult for some subjects to complete. Clinicians should consider cognitive and motor task difficulty in relation to patient deficits when selecting clinical dual-task performance measures. Key Words: Brain injuries; Attention; Walking. Poster 62 Use of the Capabilities of an Upper-Extremity Questionnaire to Evaluate Changes in Upper-Extremity Function During Inpatient Rehabilitation After Spinal Cord Injury. Ralph Marino (Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA). Disclosure: None declared. Objective: To determine the ability of the Capabilities of an UpperExtremity (CUE) questionnaire, a functional limitation measure, to detect change in capacity of people with tetraplegia. Design: Longitudinal convenience sample. Setting: Inpatient rehabilitation unit of a Model Spinal Cord Injury Systems center. Participants: 38 subjects with traumatic tetraplegia: 13 motor complete and 25 motor incomplete. Interventions: Not applicable. Main Outcome Measures: CUE; Upper-Extremity Motor Score (UEMS); and self-care subscale of FIM instrument at admission and discharge from rehabilitation. Results: Subjects were mostly men (n⫽30) and white (n⫽28). Mean age was 45 (range, 16 – 87) years. Most common etiologies were automobile collisions (n⫽14) and falls (n⫽13). During rehabilitation, mean UEMS increased from 20.1⫾12.4 to 28.0⫾12.4, FIM self-care from 9.8⫾5.7 to 22.6⫾10.3, and CUE scores from 98.9⫾52.2 to 134.3⫾56.8. At admission and discharge, CUE scores had moderate to good correlations with UEMS (Spearman ␳ range, .75–.74) and FIM self-care (␳ range, .62–.68), suggesting that the CUE measures related but different constructs than the other 2 instruments. The effect size of change ([final mean ⫺ initial mean]/SD of initial mean) was .68 for CUE, .64 for UEMS, and 2.2 for FIM self-care. Conclusions: The responsiveness of the CUE is similar to the UEMS in acute tetraplegia but evaluates a different construct, functional limitations. Key Words: Rehabilitation; Spinal cord injuries; Outcome assessment (health care). Poster 63 Who Receives Inpatient Rehabilitation After Traumatic Brain Injury? A Population-Based Study. Angela Colantonio (University of Toronto/Toronto Rehabilitation Institute, Toronto, ON, Canada), Audrey LaPorte, Ruth Croxford, Peter Coyte. Disclosure: None Disclosure Objectives: To examine sociodemographic and health predictors of inpatient rehabilitation for adults with traumatic brain injury (TBI) by using a population-based data set for an entire Canadian province and to examine trends over time. Design: Prospective. Setting: Province of Ontario. Participants: All persons aged 16 years of age and over who were discharged from a tertiary care hospital with International Classification of Diseases, 9th Revision codes for TBI (800⫹, 801⫹, 803⫹, 804⫹, 850⫺854⫹) were identified through a provincial discharge abstract database for the years 1992 to 2001 (N⫽69,733). Interventions: Not applicable. Main Outcome Measures: Health and demographic characteristics were also accessed through this database. Arch Phys Med Rehabil Vol 86, October 2005