Jibby E Kurichi1, Joel E Streim2, Hillary R Bogner3, Dawei Xie3, Pui L Kwong3, Sean Hennessy4. 1. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jkurichi@mailmed.upenn.edu. 2. Geriatric Psychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; VISN 4 Mental Illness Research Education and Clinical Center (MIRECC), Philadelphia VA Medical Center, Philadelphia, PA, USA. 3. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Traditional ways of measuring disability include summary indices, binary expressions, or counts of limitations. However, counts of activity of daily living (ADL) or instrumental activity of daily living (IADL) limitations do not specify which activities are limited. Activity limitation staging systems within the ADL and IADL domains depict both the severity and types of limitations experienced and specify clinically meaningful patterns of increasing difficulty with self-care. OBJECTIVE: To compare the predictive value and utility of ADL and IADL stages based on dichotomous versus trichotomous responses to ADL and IADL questions based on "difficulty" and "receive help" responses. METHODS: Data were analyzed from the 2005, 2006, and 2007 Medicare Current Beneficiary Survey (MCBS) entry panels on 11,706 beneficiaries. This was a prospective cohort study that examined time to inpatient admission, all-cause mortality, skilled nursing facility (SNF) admission, and long-term care (LTC) facility admission based on dichotomous versus trichotomous stages. RESULTS: For both ADLs and IADLs, Akaike information criteria for most outcomes were lower (indicating better-performing models) for the trichotomous staging systems than the dichotomous staging systems. The hazard ratios (HRs) and 95% confidence intervals (CIs) of the dichotomous ADL staging system increased as disability increased, whereas the HRs of the other staging systems fluctuated. CONCLUSIONS: Both staging systems have strong associations with each outcome. The dichotomous staging system is more clinically relevant while the trichotomous staging system may provide utility for clinicians, health care organizations, and policy makers seeking to predict death or admission to a hospital, SNF, or LTC facility.
BACKGROUND: Traditional ways of measuring disability include summary indices, binary expressions, or counts of limitations. However, counts of activity of daily living (ADL) or instrumental activity of daily living (IADL) limitations do not specify which activities are limited. Activity limitation staging systems within the ADL and IADL domains depict both the severity and types of limitations experienced and specify clinically meaningful patterns of increasing difficulty with self-care. OBJECTIVE: To compare the predictive value and utility of ADL and IADL stages based on dichotomous versus trichotomous responses to ADL and IADL questions based on "difficulty" and "receive help" responses. METHODS: Data were analyzed from the 2005, 2006, and 2007 Medicare Current Beneficiary Survey (MCBS) entry panels on 11,706 beneficiaries. This was a prospective cohort study that examined time to inpatient admission, all-cause mortality, skilled nursing facility (SNF) admission, and long-term care (LTC) facility admission based on dichotomous versus trichotomous stages. RESULTS: For both ADLs and IADLs, Akaike information criteria for most outcomes were lower (indicating better-performing models) for the trichotomous staging systems than the dichotomous staging systems. The hazard ratios (HRs) and 95% confidence intervals (CIs) of the dichotomous ADL staging system increased as disability increased, whereas the HRs of the other staging systems fluctuated. CONCLUSIONS: Both staging systems have strong associations with each outcome. The dichotomous staging system is more clinically relevant while the trichotomous staging system may provide utility for clinicians, health care organizations, and policy makers seeking to predict death or admission to a hospital, SNF, or LTC facility.
Authors: Margaret G Stineman; Joel E Streim; Qiang Pan; Jibby E Kurichi; Sophia Miryam Schüssler-Fiorenza Rose; Dawei Xie Journal: PM R Date: 2014-05-02 Impact factor: 2.298
Authors: Margaret G Stineman; John T Henry-Sánchez; Jibby E Kurichi; Qiang Pan; Dawei Xie; Debra Saliba; Zi Zhang; Joel E Streim Journal: Am J Phys Med Rehabil Date: 2012-02 Impact factor: 2.159
Authors: Jibby E Kurichi; Joel E Streim; Dawei Xie; Sean Hennessy; Ling Na; Debra Saliba; Qiang Pan; Pui L Kwong; Hillary R Bogner Journal: Am J Phys Med Rehabil Date: 2017-07 Impact factor: 2.159
Authors: Ling Na; Sean Hennessy; Hillary R Bogner; Jibby E Kurichi; Margaret Stineman; Joel E Streim; Pui L Kwong; Dawei Xie; Liliana E Pezzin Journal: Disabil Health J Date: 2016-10-04 Impact factor: 2.554
Authors: Jibby E Kurichi; Liliana Pezzin; Joel E Streim; Pui L Kwong; Ling Na; Hillary R Bogner; Dawei Xie; Sean Hennessy Journal: Arch Gerontol Geriatr Date: 2017-05-18 Impact factor: 3.250
Authors: Jibby E Kurichi; Hillary R Bogner; Joel E Streim; Dawei Xie; Pui L Kwong; Debra Saliba; Sean Hennessy Journal: Arch Gerontol Geriatr Date: 2017-08-24 Impact factor: 3.250
Authors: Ling Na; Qiang Pan; Dawei Xie; Jibby E Kurichi; Joel E Streim; Hillary R Bogner; Debra Saliba; Sean Hennessy Journal: PM R Date: 2016-09-21 Impact factor: 2.298
Authors: Ling Na; Joel E Streim; Liliana E Pezzin; Jibby E Kurichi; Dawei Xie; Hillary R Bogner; Pui L Kwong; Steven M Asch; Sean Hennessy Journal: BMC Health Serv Res Date: 2017-03-29 Impact factor: 2.655