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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2012 September;48(3):443-54
Predicting the need for institutional care shortly after admission to rehabilitation: Rasch analysis and predictive validity of the BRASS Index
Panella L. 1, La Porta F. 2, Caselli S. 2, Marchisio S. 3, Tennant A. 4 ✉
1 Department of Rehabilitation Medicine, ASL Vercelli, Vercelli, Italy;
2 Rehabilitation Medicine Unit, AUSL Modena, Modena, Italy;
3 Quality Improvement Unit, ASL Vercelli, Vercelli, Italy;
4 Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
BACKGROUND: Effective discharge planning is increasingly recognised as a critical component of hospital-based Rehabilitation. The BRASS index is a risk screening tool for identification, shortly after hospital admission, of patients who are at risk of post-discharge problems.
AIM: To evaluate the internal construct validity and reliability of the Blaylock Risk Assessment Screening Score (BRASS) within the rehabilitation setting.
DESIGN: Observational prospective study.
SETTING: Rehabilitation ward of an Italian district hospital.
POPULATION: One hundred and four consecutively admitted patients.
METHODS: Using classical psychometric methods and Rasch analysis (RA), the internal construct validity and reliability of the BRASS were examined. Also, external and predictive validity of the Rasch-modified BRASS (RMB) score were determined.
RESULTS: Reliability of the original BRASS was low (Cronbach’s alpha=0.595) and factor analyses showed that it was clearly multidimensional. A RA, based on a reduced 7-BRASS item set (RMB), satisfied model’s expectations. Reliability was 0.777. The RMB scores strongly correlated with the original BRASS (rho=0.952; P<0.000) and with FIM™ admission scores (rho=-0.853; P<0.000). A RMB score of 12 was associated with an increased risk of nursing home admission (RR=2.1, 95%CI=1.7-2.5), whereas a score of 17 was associated to a higher risk of length of stay >28 days (RR=7.6, 95%CI=1.8-31.9).
CONCLUSION: This study demonstrated that the original BRASS was multidimensional and unreliable. However, the RMB holds adequate internal construct validity and is sufficiently reliable as a predictor of discharge problems for group, but not individual use.
CLINICAL REHABILITATION IMPACT: The application of tools and methods (such as the BRASS Index) developed under the biomedical paradigm in a Physical and Rehabilitation Medicine setting may have limitations. Further research is needed to develop, within the rehabilitation setting, a valid measuring tool of risk of post-discharge problems at the individual level.