The Life Impact Burn Recovery Evaluation (LIBRE) Profile was developed using Item Response Theory... more The Life Impact Burn Recovery Evaluation (LIBRE) Profile was developed using Item Response Theory methods to assess social participation after a burn injury. The LIBRE Profile measures six areas of social participation: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. It can be administered through a computerized adaptive test or through fixed short forms. The goal of this study was to further examine the psychometric properties of the LIBRE Profile, including reliability and validity. We examined the validity of the LIBRE Profile by administering the six LIBRE Profile scales as well as legacy measures that assessed similar constructs. We calculated the Pearson correlations between the LIBRE Profile scales and the scores on the same-domain and cross-domain legacy measures to evaluate convergent and divergent validity. We then administered the LIBRE Profile scales a second time, seven to ten days after the first administration, to a sample of adult burn survivors to evaluate test-retest reliability. We calculated repeatability coefficients, standard error of measurement, and minimal detectable change to establish the threshold beyond which the amount of change observed across an episode of care cannot be explained as measurement error. For reliability, the repeatability coefficients ranged from 7.31 to 9.27 and SEMs ranged from 2.62 to 3.39 for all six scales. MDC values ranged from 6.08 to 7.86 points, and MDC values ranged from 7.26 to 9.40 points. All correlations between the LIBRE Profile scales and legacy measures are significant (p<0.05) and in the expected directions for both convergent and divergent validity. This study provided evidence for the reliability and validity of the LIBRE Profile, one of the first tools that measures exclusively the social participation after a burn injury.
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 4, 2018
The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used ... more The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations. We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The minimal clinically important difference for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement, and the minimal detectable change with 90% confidence. Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditio...
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 4, 2018
The Short Physical Performance Battery (SPPB) is advocated as a screening tool in geriatric care ... more The Short Physical Performance Battery (SPPB) is advocated as a screening tool in geriatric care for predicting future disability. We aimed to identify the leg neuromuscular attributes to be targeted in rehabilitative care among older adults with poor SPPB scores. Boston Rehabilitative Impairment Study of the Elderly (Boston RISE) participants (n = 430) underwent assessment of neuromuscular attributes (leg strength, leg velocity, trunk extensor endurance, knee flexion range of motion [ROM], ankle ROM, and foot sensation). Linear regression models examined association between each neuromuscular attribute and SPPB, adjusting for age, race, gender, comorbidity, body mass index, depression, cognition, and other neuromuscular attributes. Participants with 1 SD unit higher leg strength, leg velocity, and trunk extensor endurance had 0.52, 0.30, and 0.52 points higher SPPB total score. Participants with ankle ROM impairment and foot sensory loss had 0.43 and 0.57 lower SPPB total score com...
BackgroundAssessing functioning and disability among individuals with mental and behavioral healt... more BackgroundAssessing functioning and disability among individuals with mental and behavioral health disorders has historically relied on deriving accurate psychiatric diagnoses and assessing symptoms. However, growing empirical evidence suggests that this approach is inadequate to determine real world performance, particularly with respect to work.ObjectiveWe examined a performance-based approach to the assessment of work functioning and its relationship to mental and behavioral health status.MethodsA cross-sectional study was conducted at two mental health programs. Trained employment providers conducted performance-based assessments of work function and ratings of mental and behavioral health while study participants self-reported their mental/behavioral health functioning. We hypothesized that participant and provider ratings of mental/behavioral health would be at moderately correlated and with performance-based assessments of work function.ResultsWe found no significant correlat...
Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effectiv... more Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical ...
Pragmatic studies have gained popularity, thus emphasizing the need for patient-reported outcomes... more Pragmatic studies have gained popularity, thus emphasizing the need for patient-reported outcomes (PRO) to be integrated into electronic health records. This study describes the development of a customized short form from the Boston University Osteoarthritis Functional Assessment PRO (BU-OA-PRO) for a specific pragmatic clinical trial. A Functional Pain Short Form was created from an existing item bank of deidentified data in the BU-OA-PRO. Item response theory (IRT) methods were used to select items. Reliability was measured with the Cronbach alpha, then with IRT simulation methods. To examine validity, ceiling and floor effects, correlations between the short-form scores and scores from the BU-OA-PRO and the Western Ontario McMasters University Osteoarthritis Index (WOMAC) Pain and Difficulty subscales, and the area under the curve (AUC) were calculated. A minimum detectable change at 90% confidence (MDC90) was calculated based on a calibration sample. The BU-OA-PRO was reduced fr...
Journal of burn care & research : official publication of the American Burn Association, Jan 4, 2018
Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. ... more Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. Burn injury may also lead to serious psychosocial challenges that have not been adequately studied and addressed. Specifically, there has been limited research into the associations of burn injury on community reintegration based on gender. This work analyzed data from 601 burn survivors who completed field testing of a new measure of social participation for burn survivors, the Life Impact Burn Recovery Evaluation (LIBRE) Profile. Differences in item responses between men and women were examined. Scores on the six LIBRE Profile scales were then compared between men and women using analysis of variance and adjusted linear multivariate regression modeling. Overall, men scored significantly better than women on four of the six LIBRE Profile scales: Sexual Relationships, Social Interactions, Work & Employment, and Romantic Relationships. Differences were not substantially reduced after adju...
Archives of physical medicine and rehabilitation, Jan 9, 2018
To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB)... more To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE). Cross-sectional. Outpatient rehabilitation. Adults (N=50) participating in physical therapy for musculoskeletal conditions. Not applicable. Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient's physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ...
Archives of physical medicine and rehabilitation, Jan 11, 2018
To explore the accuracy of rehabilitation service use reports by older adults as well as variatio... more To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). Longitudinal observational study. Participants' homes. Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. Not applicable. Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (appr...
The purpose of this study was to investigate the cultural and semantic equivalence of the Activit... more The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese. This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis. Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI-adjusted conversion table was ge...
The Importance of Dose of a Rehabilitation Intervention R ehabilitation professionals have long u... more The Importance of Dose of a Rehabilitation Intervention R ehabilitation professionals have long understood that dose is a critical yet complex element that contributes to the effectiveness of the therapeutic interventions they deliver to their patients. Parameters that contribute to the dose of a rehabilitation intervention include frequency, intensity, duration, and timing.
To examine racial differences in the use of rehabilitation services and functional improvement du... more To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. Secondary analysis of the 2016 National Health and Aging Trends Study (NHATS). Standardized in-person home interviews. Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial dif...
The Life Impact Burn Recovery Evaluation (LIBRE) Profile was developed using Item Response Theory... more The Life Impact Burn Recovery Evaluation (LIBRE) Profile was developed using Item Response Theory methods to assess social participation after a burn injury. The LIBRE Profile measures six areas of social participation: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. It can be administered through a computerized adaptive test or through fixed short forms. The goal of this study was to further examine the psychometric properties of the LIBRE Profile, including reliability and validity. We examined the validity of the LIBRE Profile by administering the six LIBRE Profile scales as well as legacy measures that assessed similar constructs. We calculated the Pearson correlations between the LIBRE Profile scales and the scores on the same-domain and cross-domain legacy measures to evaluate convergent and divergent validity. We then administered the LIBRE Profile scales a second time, seven to ten days after the first administration, to a sample of adult burn survivors to evaluate test-retest reliability. We calculated repeatability coefficients, standard error of measurement, and minimal detectable change to establish the threshold beyond which the amount of change observed across an episode of care cannot be explained as measurement error. For reliability, the repeatability coefficients ranged from 7.31 to 9.27 and SEMs ranged from 2.62 to 3.39 for all six scales. MDC values ranged from 6.08 to 7.86 points, and MDC values ranged from 7.26 to 9.40 points. All correlations between the LIBRE Profile scales and legacy measures are significant (p<0.05) and in the expected directions for both convergent and divergent validity. This study provided evidence for the reliability and validity of the LIBRE Profile, one of the first tools that measures exclusively the social participation after a burn injury.
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 4, 2018
The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used ... more The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations. We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The minimal clinically important difference for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement, and the minimal detectable change with 90% confidence. Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditio...
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 4, 2018
The Short Physical Performance Battery (SPPB) is advocated as a screening tool in geriatric care ... more The Short Physical Performance Battery (SPPB) is advocated as a screening tool in geriatric care for predicting future disability. We aimed to identify the leg neuromuscular attributes to be targeted in rehabilitative care among older adults with poor SPPB scores. Boston Rehabilitative Impairment Study of the Elderly (Boston RISE) participants (n = 430) underwent assessment of neuromuscular attributes (leg strength, leg velocity, trunk extensor endurance, knee flexion range of motion [ROM], ankle ROM, and foot sensation). Linear regression models examined association between each neuromuscular attribute and SPPB, adjusting for age, race, gender, comorbidity, body mass index, depression, cognition, and other neuromuscular attributes. Participants with 1 SD unit higher leg strength, leg velocity, and trunk extensor endurance had 0.52, 0.30, and 0.52 points higher SPPB total score. Participants with ankle ROM impairment and foot sensory loss had 0.43 and 0.57 lower SPPB total score com...
BackgroundAssessing functioning and disability among individuals with mental and behavioral healt... more BackgroundAssessing functioning and disability among individuals with mental and behavioral health disorders has historically relied on deriving accurate psychiatric diagnoses and assessing symptoms. However, growing empirical evidence suggests that this approach is inadequate to determine real world performance, particularly with respect to work.ObjectiveWe examined a performance-based approach to the assessment of work functioning and its relationship to mental and behavioral health status.MethodsA cross-sectional study was conducted at two mental health programs. Trained employment providers conducted performance-based assessments of work function and ratings of mental and behavioral health while study participants self-reported their mental/behavioral health functioning. We hypothesized that participant and provider ratings of mental/behavioral health would be at moderately correlated and with performance-based assessments of work function.ResultsWe found no significant correlat...
Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effectiv... more Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical ...
Pragmatic studies have gained popularity, thus emphasizing the need for patient-reported outcomes... more Pragmatic studies have gained popularity, thus emphasizing the need for patient-reported outcomes (PRO) to be integrated into electronic health records. This study describes the development of a customized short form from the Boston University Osteoarthritis Functional Assessment PRO (BU-OA-PRO) for a specific pragmatic clinical trial. A Functional Pain Short Form was created from an existing item bank of deidentified data in the BU-OA-PRO. Item response theory (IRT) methods were used to select items. Reliability was measured with the Cronbach alpha, then with IRT simulation methods. To examine validity, ceiling and floor effects, correlations between the short-form scores and scores from the BU-OA-PRO and the Western Ontario McMasters University Osteoarthritis Index (WOMAC) Pain and Difficulty subscales, and the area under the curve (AUC) were calculated. A minimum detectable change at 90% confidence (MDC90) was calculated based on a calibration sample. The BU-OA-PRO was reduced fr...
Journal of burn care & research : official publication of the American Burn Association, Jan 4, 2018
Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. ... more Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. Burn injury may also lead to serious psychosocial challenges that have not been adequately studied and addressed. Specifically, there has been limited research into the associations of burn injury on community reintegration based on gender. This work analyzed data from 601 burn survivors who completed field testing of a new measure of social participation for burn survivors, the Life Impact Burn Recovery Evaluation (LIBRE) Profile. Differences in item responses between men and women were examined. Scores on the six LIBRE Profile scales were then compared between men and women using analysis of variance and adjusted linear multivariate regression modeling. Overall, men scored significantly better than women on four of the six LIBRE Profile scales: Sexual Relationships, Social Interactions, Work & Employment, and Romantic Relationships. Differences were not substantially reduced after adju...
Archives of physical medicine and rehabilitation, Jan 9, 2018
To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB)... more To examine the validity of the self-report Work-Disability Functional Assessment Battery (WD-FAB) physical function scales relative to clinician ratings of function and a performance-based functional capacity evaluation called the Physical Work Performance Evaluation (PWPE). Cross-sectional. Outpatient rehabilitation. Adults (N=50) participating in physical therapy for musculoskeletal conditions. Not applicable. Patients completed the PWPE and the WD-FAB physical function scales including Changing and Maintaining Body Position, Whole Body Mobility, Upper Body Function, and Upper Extremity Fine Motor. The physical therapist also answered the WD-FAB questions on the patient's physical functioning. The WD-FAB computer-adaptive test version administered up to 10 items for each scale. The PWPE produces ratings from 0 to 5 indicating overall Level of Work ability: 0 (unable to work); 1 (sedentary); 2 (light); 3 (medium); 4 (heavy); 5 (very heavy). The PWPE also produces Level of Work ...
Archives of physical medicine and rehabilitation, Jan 11, 2018
To explore the accuracy of rehabilitation service use reports by older adults as well as variatio... more To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). Longitudinal observational study. Participants' homes. Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. Not applicable. Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (appr...
The purpose of this study was to investigate the cultural and semantic equivalence of the Activit... more The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese. This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis. Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI-adjusted conversion table was ge...
The Importance of Dose of a Rehabilitation Intervention R ehabilitation professionals have long u... more The Importance of Dose of a Rehabilitation Intervention R ehabilitation professionals have long understood that dose is a critical yet complex element that contributes to the effectiveness of the therapeutic interventions they deliver to their patients. Parameters that contribute to the dose of a rehabilitation intervention include frequency, intensity, duration, and timing.
To examine racial differences in the use of rehabilitation services and functional improvement du... more To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. Secondary analysis of the 2016 National Health and Aging Trends Study (NHATS). Standardized in-person home interviews. Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial dif...
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Papers by Alan Jette