Date of Award

Spring 3-15-2017

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Deborah A. DeLuca, JD

Committee Member

Genevieve Pinto-Zipp, Ed.D

Committee Member

Terrence F. Cahill, Ed.D

Keywords

Functional Outcome Measure, School Function Assessment, Timed Up and Go, Environment, modified-Emory Functional Ambulation Profile, Quality.

Abstract

Background The Patient Protection and Affordable Care Act of 2010 and the Middle Class Tax Relief and Job Creation Act of 2012 mandate patient centered, objective functional outcome reporting tied directly to limitations in mobility related to activity and participation in daily life (House of Representatives, 2009). These mandates apply to all persons, including children receiving therapy-based services. Literature on outcome measures in children has focused almost exclusively on capacity-based assessments that generally lack robust environmental context or demonstrate issues with objectivity. While constructs of the modified-Emory Functional Ambulation Profile (m-EFAP), a quantitative, objective outcome measure of functional mobility, support current standards of practice and meet federal regulations for quality and payment policies, studies supporting the validity of using the test in school-age children with disabilities have been sparse.

The aim of this dissertation is to evaluate the feasibility of using the m-EFAP in school-age children. It was hypothesized that total scores and subtasks on the m-EFAP would be correlated with the Activity Performance subsection of the School Function Assessment (SFA), which is a well-developed instrument used in the school setting. Results of this study will provide information regarding valid use of the m-EFAP as an alternative assessment tool of functional mobility that meets federal regulations for quality and effectiveness as well as practice standards, that is objective, timely, and cost efficient. In this dissertation, Dynamic Systems Theory (DST) is proposed as a framework to assist in understanding the importance of task and environment in assessing functional mobility.

Study Design Based on methodological studies, a quantitative, prospective correlational design was implemented to test the hypotheses. Using a sample of forty-four students ages 5-11; with Developmental Motor Delay (DD), data was collected from two private schools in North-Central New Jersey serving children with special needs. Data was collected using the m-EFAP and selected categories of the Activity Performance (AP) subsection of the SFA.

Results Statistical analysis using the Spearman Rho Correlational Coefficient revealed no significant relationship between the modified-Emory Functional Ambulation Profile and School Function Assessment Total Scores (α < 0.05). There was a significant relationship between a majority of the m-EFAP subtasks and AP categories of the SFA. A key finding was that the m-EFAP Timed Up and Go (TUG) subtask correlated with all of the SFA Performance categories except stairs (r-values ranging from -.298 to -.587; all p values < 0.05).

Conclusion Contrary to expectations, convergent validity of the m-EFAP with the SFA was not supported. However, these findings provide valuable information regarding the use of the TUG as a screening tool in a school-age population, and show that the TUG is more complex than previously assumed. Overall, this study prompts a revisiting of the topic of informed decision making for therapists, when selecting functional outcome measures. The results, clinical implications and future research are discussed.

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