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Current & Completed Projects

Pilot Projects

Prevalence and Correlates of School-based Medicaid-funded Services for Children with Autism Spectrum Disorder

Lucy Bilaver, PhD
Assistant Professor, Department of Pediatrics
Northwestern University Feinberg School of Medicine

Collaborator
Amol Karmarkar, PhD - UTMB

General Description
This project will examine the relationship between state and county-level Medicaid payment methodologies and the rates of service utilization and expenditures for school- based Medicaid funded health services for children with ASD.

Specific Aims

  1. To examine the effect of Medicaid payment methodologies on patterns of school-based service utilization among children with ASD.
  2. To examine the effect of Medicaid payment methodologies on patterns of school-based expenditures among children with ASD.

Diabetes Is Associated With Lower Limb Strength Decline in Hispanic Older Adults

Camille Brightwell, MS
PhD Student, Department of Neuroscience, Cell Biology, and Anatomy
University of Texas Medical Branch

General Description

Objectives: To compare changes in lower limb strength in Hispanic older adults with and without diabetes.

Dataset: Hispanic EPESE Frailty Study: (2006-2009)

The Influence of Rehabilitation-Intensive Discharge Destination on 30-day Rehospitalization Rates Among Older Adults Receiving Lumbar Spinal Fusion Surgery

Chad Cook, PhD, PT
Professor
Duke University

Collaborator
James Graham, PhD - UTMB

General Description
The proposed study will examine case mix characteristics and patient risk profiles across different hospital facilities in Medicare beneficiaries receiving spinal fusion. This study will utilize Medicare Provider and Analysis Review (MedPAR) files and asses the association of discharge destination with 30-day rehospitalization rates.

Specific Aims
This pilot project will explore, develop, and examine relationships of case mix characteristics, risk profiles, and discharge disposition categories. In addition, the project will examine the independent effects of rehabilitation-intensive discharge destination in existing risk-adjustment models for 30-day rehospitalization.

Positive Emotion, Cognition, and Disability in Activities of Daily Living Among Older Mexican Americans

Jessica Jarvis, PhD, MT-BC
Postdoctoral Fellow
Children’s Participation in Environment Research Lab
University of Illinois at Chicago

General Description

Objectives: To determine if positive emotion modifies the relationship between cognition and Activities of Daily Living (ADL) disability status over 10 years in Mexican American adults aged 75 years and older. To describe the process of utilizing large and publicly available data sets to accelerate rehabilitation research.

Dataset: Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) Disabling Process Study (2001-2002)

Frailty and Disability in Cardiovascular Disease: Predictors of 30-day Hospital Readmission

Tamra Keeney, DPT
Graduate Student
MGH Institute of Health Professions

Alan Jette, PhD
Professor
Boston University School of Public Health

Collaborator
Ken Ottenbacher, PhD, OTR- UTMB

General Description
The proposed study will utilize National Health and Aging Trends Study database as well as linked Medicare Claims Data to explore the relationship between frailty status, disability status, and 30-day readmission rate for individuals with cardiovascular disease.

Specific Aim
This pilot project will examine the comparative ability of measures of frailty and disability to predict risk of 30-day readmission in patients with cardiovascular disease.

Variation in Hospital-Based Rehabilitation Services in Joint Replacement and its Impact on Post- Acute Outcomes

Amit Kumar, PT, PhD, MPH
Postdoctoral Research Associate
Department of Health Services, Policy & Practice
Brown University, School of Public Health

Collaborator
Kenneth J. Ottenbacher, PhD, OTR

Description
This study will generate evidence on the effectiveness of hospital-based rehabilitation services to improve quality of care, outcomes, and reduce costs. Furthermore, this study will explore variation in hospital-based rehabilitation services and the association between this variation and post-acute outcomes by performing secondary data analysis using Medicare claims data.

Specific Aims
  1. To estimate and identify sources of hospital-level variation associated with the utilization of hospital-based rehabilitation services after lower extremity joint replacement.
  2. To examine the association between hospital-based rehabilitation services and two post-acute outcomes: 1) discharge destinations and 2) hospital readmission.
Changes in cognitive ability and depression after stroke – a longitudinal study of three racial groups

Elsa Lee, PhD
Postdoctoral Fellow
Department of Rehabilitation Medicine
Icahn School of Medicine
Mount Sina

General Description

Objectives: To examine change in cognitive abilities and depression scores after stroke across racial groups

Dataset: Stroke Recovery in Underserved Populations (2004-2008)

Predictors of Lumbar Surgery in Patients with Low Back Pain

Jack Magel, PT, PhD
Research Assistant Professor
Department of Physical Therapy and Athletic Training
The University of Utah

Collaborator
James Graham, DC, PhD
Associate Professor, Division of Rehabilitation Sciences
University of Texas Medical Branch

Description
This study will leverage the combined power of two unique linked databases, the Utah Population Database (UPDB) and Utah’s All Payer Claims Database (APCD) to uncover social and economic determinants of health that play a role in the decision to have lumbar surgery for low back pain (LBP).

Specific Aims
  1. Examine the association between social and socioeconomic DoH and having lumbar surgery over a 1-year period following a new consultation with a health care provider for LBP.
  2. Examine the differences in DoH between patients who access a primary care or an emergency department provider for an initial consultation for LBP.

The Burden of Disease, Disability, and Functional Limitation for Ethnically Diverse Older Adults in the United States: Disability-Adjusted Life Years

Ryan McGrath, PhD
Postdoctoral Research Fellow
Physical Medicine & Rehabilitation
University of Michigan

Collaborators
Soham Al Snih, MD, PhD
Associate Professor, Division of Rehabilitation Sciences
University of Texas Medical Branch

Kyriakos S. Markides, PhD
Professor
Department of Preventive Medicine & Community Health
University of Texas Medical Branch

General Description
The purpose of this study is to determine the burden of 11 highly prevalent diseases and functional limitations in a nationally-representative sample of older adults in the United States by performing a secondary analysis of Health and Retirement Study data.

Specific Aims

  1. Determine how years a person has lived with a disease or disability (YLDs) and years of life lost (YLLs) contribute to the burden of 11 diseases and functional limitations as older adults become more advanced in age.
  2. Identify ethnic differences in the burden of 11 diseases and functional limitations.

Rehabilitation Services and Outcomes for Rural-residing Medicare Beneficiaries

Tracy Mroz, PhD, OTR/L
Assistant Professor
University of Washington

Collaborator
Amol Karmarkar, PhD- UTMB

General Description
The proposed study will utilize Medicare administrative data from 2011 to 2013 to describe rehabilitation service provision in home health for rural-residing, fee-for-service Medicare beneficiaries who undergo total hip and knee replacement by type of rural community and region of the U.S. The relationships between quality outcomes and the amount and mix or rehabilitation service provision will be examined, accounting for patient, home health agency, and community factors. Results will identify variation in service provision and outcomes of home health care for rural beneficiaries after total joint replacement and help to inform continued payment policy transformation and quality improvement strategies for post-acute care in rural areas.

Specific Aims
This study will attempt to determine:

  1. Whether or not rehabilitation service provision in home health vary by type or rural community and region
  2. If quality outcomes for rural home health care recipients are associated with the amount of rehabilitation services provided while accounting for patient, agency and community characteristics

Effect of Polypharmacy on Cognitive Function in Community-dwelling Older Adults by Age Group.

Efi Polychronopoulou, MSc
PhD Student
Division of Rehabilitation Sciences
University of Texas Medical Branch

General Description

Objectives: This study examined whether the association between polypharmacy and cognitive function in community-dwelling older adults varies with age.

Dataset: Well Elderly Study 2 (2004-2008)

TBI: Trauma-Rehabilitation Merger Database—Expansion, Validation, and Clinical Research Utilization

Amy Wagner, MD
Associate Professor
University of Pittsburgh

Collaborator
Ken Ottenbacher, PhD, OTR - UTMB

General Description
The purpose of this study is to validate and further expand the TBI: Trauma-Rehabilitation Merger Database (TBI-TRMD). This database was created using a previously developed algorithm that matched subject data from the National Trauma Databank (NTDB) and the TBI Model System (TBIMS).

Specific Aims
This project will:

  1. Validate the previously published algorithm using an independent local trauma registry and TBIMS population.
  2. Update the TBI-TRMD by grooming, matching and incorporating newly available 2013-2014 data from the NTDB with recent data from the TBIMS
  3. Develop a no-TBI trauma matched database as a comparator group for the TBI-TRMD to assess difference in presentation, acute complications and procedures between populations
  4. Use the TBI-TRMD to evaluate the relationship between ECI severity and HAP/Sepsis frequency while controlling for relevant covariates affecting TBI severity among survivors receiving inpatient rehabilitation at a TBIMS center.
  5. Evaluate the impact of ECI severity, HAP, and sepsis on acute (e.g. complication-relevant) procedures and length of stay (LOS), subsequent health care utilization (rehab LOS, functional improvement, acute rehospitalization), and long-term multidimensional outcome.
  6. Evaluate Sepsis/HAP as moderating/mediating relationships between ECI severity and healthcare utilization and long-term multi-dimensional outcomes

The Impact of a Medicaid Managed Care Program on Health Services Utilization and Cost among Adults with Psychiatric Disabilities

Xioalong Xiang, PhD
Postdoctoral Fellow
Northwestern University

PI: Randal Owen, PhD
Research Assistant Professor
University of Illinois

Collaborator
Amol Karmarkar, PhD -UTMB

General Description
The purpose of this project is to evaluate the effect of the Illinois Integrated Care Program (ICP) on health services utilization and cost for adults with psychiatric disabilities.

Specific Aims
This project will:

  1. Assess the effects of the ICP on health services utilization and cost for adults with psychiatric disabilities
  2. Investigate whether patterns of physical-psychiatric comorbidities moderate the impact of the ICP on health services utilization and cost

Pilot Projects

Frailty Transitions and Frailty-Free Life Expectancy Among Older Mexican Americans - Gender Differences

Soham Al Snih, MD, PhD
Assistant Professor
Department of Rehabilitation Sciences
University of Texas Medical Branch

Collaborator
Ken Ottenbacher, PhD, OTR - UTMB

General Description
This pilot project explores transitions in frailty and years of frailty-free life and life expectancy in older Mexican Americans using data from the Hispanic Established Populations Epidemiologic Study of the Elderly.

Frailty is considered as a state of high vulnerability for adverse health outcomes such as disability, falls, hospitalization, institutionalization, and mortality in older adults. Prevalence of frailty in older Mexican Americans has been reported to be 17% in men and 20% in women. Previous research has shown that frailty is a dynamic process, with frequents transitions between frailty states over time. Currently, little is known about the probability of transitions between the different frailty states over time among older Mexican Americans.

The specific aims of this pilot study are:

  1. Describe transition rates through frailty states and associated factors by gender.
  2. Estimate the total life-expectancy and pre-frail/frail free life expectancy by gender.
  3. Estimate the disability-free life expectancy by baseline frailty status and gender.
  4. Determine the percent of frailty index components that are added from the previous follow-up for each interval of follow-up by gender.

Administrative Data Linkage to Examine Outcomes after Inpatient Rehabilitation

Janet Prvu Bettger, ScD
Assistant Professor
Duke University

Collaborator
James Graham, PhD, DC - UTMB

General Description
The objective of this project is to examine the degree to which patient and health-system characteristics are associated with the total number of days spent at home within 180 days of the index acute hospital admission ("home-time") for the highest users of IRF care: patients with stroke or hip fracture. Investigators will link data from administrative claims, provider and assessment files for 100% of the Medicare fee-for-service population for 2007-2009.

The specific aim of this pilot study is to identify factors associated with the total number of days spent at home within 180 days of acute hospital admission ("home-time") for stroke and hip fracture patients who received IRF care.

Sex Differences in Acquired Brain Injury Profiles and Outcomes in a National Rehabilitation Sample

Angela Colantonio, PhD, OTR
Senior Scientist
Toronto Rehabilitation Institute

Collaborator
Ken Ottenbacher, PhD - UTMB

General Description
The objective of this project is to examine sex differences in profiles and outcomes of patients with acquired brain injury (ABI) in a population based province wide rehabilitation sample. This project will lay the foundation for a larger program of research examining sex differences in different types of comorbidities. Sleep disorder will be examined in detail. The Discharge Abstract Database (DAD) and the National Rehabilitation Reporting System (NRS) will be used.

The specific aims of this pilot study will determine the:

  1. Number and demographic, clinical, and environmental/social characteristics of adult ABI patients in inpatient rehabilitation by age groups and sex.
  2. Number and type of comorbidities of adult ABI patients in inpatient rehabilitation at admission and discharge by age groups and sex.
  3. Number of adults coded with psychiatric and/or sleep disorder by age groups and sex.
  4. Independent influence of sex and type and number of comorbidities on rehabilitation outcomes.

Comparison of Rehabilitation Outcomes of Veterans and Medicare Beneficiates

Diane M. Collins, PhD
Assistant Professor
Department of Rehabilitation Sciences
University of Pittsburgh

Collaborator
Amol Karmarkar, PhD UTMB

General Description
This pilot project examines the impact of assistive devices on functional status in veterans and civilians post-stroke, using the Veteran Affairs' Functional Status Outcomes Database and National Patient Prosthetic Database and comparing these databases with outcomes data of Medicare beneficiaries. This pilot project will generate systematic evidence to support development of healthcare policy that improves access to and equitable provision of assistive technology devices (ATDs) for persons with disability. To study a more homogenous Medicare-age population, the study focus is on the Veterans and civilians who are inpatient for acute post-stroke treatment.

The research questions addressed are:

  • Research Question 1.a: How do the demographic characteristics of post-stroke Veterans who received ATD from the Department of Veterans Affairs (VA) compare with the demographic characteristics of post-stroke civilians who received ATD from Medicare?
  • Research Question 1.b: How do the demographic characteristics of post-stroke Veterans who did not receive ATD from the VA compare with the demographic characteristics of post-stroke civilians who did not receive ATDs from Medicare?
  • Research Question 2.a: How does the functional status of post-stroke Veterans who received ATD from the VA compare with the functional status of post-stroke civilians who received ATD from Medicare?
  • Research Question 2.b: How does the functional status of post-stroke Veterans who did not receive ATDs from the VA compare with the functional status of post-stroke civilians who did not receive ATD from Medicare?

Cognitive Aging and Health among Older Adults with Traumatic Brain Injury

Kristen Dams-O'Connor, PhD
Assistant Professor
Mount Sinai School of Medicine

Collaborator
Ken Ottenbacher, PhD, OTR- UTMB

General Description
This pilot study will identify factors that influence long-term functioning and overall health in individuals with history of TBI. Previous research in the general cognitive aging literature has identified a host of factors that may accelerate or protect against cognitive decline. The extent to which these same factors (or others) are associated with long-term outcomes among individuals with a history of TBI is not well known. Of particular relevance to the field of rehabilitation is the identification of factors that may be modifiable.

The specific aims of this pilot study are to:

  1. Examine change in cognitive functioning over time and identify factors that may contribute to cognitive change among adults with a lifetime history of TBI.
  2. Examine change in overall health over time and identify factors that contribute to health decline among adults with and without a lifetime history of TBI.
  3. Identify risk factors for dementia among people with TBI.

Mobility and Functional Outcomes from a National Spina Bifida Patient Registry

Brad Dicianno, MD
Associate Professor
University of Pittsburg

Collaborators
Amol Karmarkar, PhD - UTMB; Ken Ottenbacher, PhD - UTMB

General Description
Spina bifida (SB) is the most common birth defect that results in physical disability. The physical manifestations of SB include partial or complete paralysis of the lower limbs and/or trunk muscles and orthopedic deformities of the spine and limbs. Studies to date on functional outcomes in this population have been on small cohorts of individuals. This is the first study to examine functional status in a large, nationally representative sample. Results of this study will not only delineate the breadth of functional abilities within the different age groups and subtypes of SB, but will also inform clinicians of the comorbid conditions that may be related to impairments in function over the course of a lifetime.

The specific aims of this pilot study are:

  1. Describe transition rates through frailty states and associated factors by gender.
  2. Determine which medical, neurological, or demographic variables contribute significantly to functional ambulatory status.
  3. Determine if SB Severity Index Score is significantly associated with functional ambulatory status.

Physical Functioning as a Marker for 30-day Readmission

Steve Fisher, PhD, PT
Assistant Professor
Department of Physical Therapy
University of Texas Medical Branch

Collaborator
Soham Al Snih, MD, PhD - UTMB

General Description
This proposal will use an existing data set of 800 acutely hospitalized older adults to determine measures of physical functioning with the best predictive power for 30-day readmission. The data includes a variety of physical function measures (timed walking tests, standing balance, chair rise ability, accelerometry derived amount of walking, and self report ADLs), as well as 30-day readmission and medical record information.

The specific aims of this pilot study are:

  1. Identify preliminary functional forms and cut points for predicting 30-day readmission among measures of physical functioning collected during acute hospitalization.
  2. Calculate estimates of improved algorithm performance by adding the different function measures to known risk factor models.

Predictors of Functional Disparities among Individuals Living with Spinal Cord Injury

Denise Fyffe, PhD
Research Scientist
Spinal Cord Injury/Assessment & Outcomes Laboratory
Kessler Foundation Research Center

Collaborators
Anne Deutsch, PhD, CRRN - RIC;
Ken Ottenbacher, PhD, OTR - UTMB

General Description
This pilot project investigates demographic, sociocultural and clinical factors associated with disparities in functional outcomes among individuals living with spinal cord injury, using the National Spinal Cord Injury Model Systems database.

Although functional status is an important outcome after SCI injury, there has been little research attention focused on racial/ethnic group differences associated with the type of functional status over time as persons with SCI adjust to their impairment. Understanding the risk factors that affect changes in functional status after injury are essential to enhancing long-term rehabilitation efforts to promote community integration and quality of life for persons living with SCI. This pilot study will examine different types of functional gains, as measured by FIM subscale (i.e., self-care; sphincter control; motor/transfer; locomotion) scores, and functional gains observed over time in the NSCID.

The specific aims of this pilot study are:

  1. To identify the demographic, sociocultural and clinical characteristics associated with FIM subscale scores in the NSCID database.
  2. To determine if changes in FIM subscale scores are maintained over time across racial/ethnic and socioeconomic groups in the NSCID database.

Exploring the Influence of Neighborhood Characteristics and Functional Limitations on Physical and Social Participation Trajectories among Older Adults

Carri Hand, PhD
Assistant Clinical Professor
McMaster University

Collaborator
Bret Howrey, PhD - UTMB

General Description
The proposed study will examine how neighborhood characteristics, in interaction with individual characteristics, relate to participation in social and physical activities over time for older adults. The study will involve secondary analysis of Health and Retirement Study (HRS) data from 2008, 2010, 2012 combined with 2010 census data.

The specific aims of this pilot study are:

  1. Examine the effects of neighborhood social cohesion, neighborhood physical disorder, housing density, and land-use diversity on frequency of social participation in older adults.
  2. Examine the effects of neighborhood social cohesion, neighborhood physical disorder, housing density, and land-use diversity on frequency of physical participation in older adults.
  3. Compare six-year trajectories of frequency of social and physical participation between older adults living in neighborhoods with and without key age-friendly neighborhood characteristics and with and without key individual characteristics.

Predictors of Community Participation Among Young Children who have Received Part C Early Intervention Services and are Entering Kindergarten

Mary Khetani, ScD, OTR
Assistant Professor
Department of Occupational Therapy
Joint Appointment Human Development and Family Studies
Colorado State University

Collaborator
James Graham, PhD, DC - UTMB

General Description
Promoting the participation of young children with disabilities in home and community activities is one of the primary service goals for families receiving Part C early intervention services, and is considered to be a key indicator of their full inclusion. Despite its importance, providers of early intervention services have been found to be less likely to address participation as a service-related outcome. There is a paucity of literature to draw upon to understand the impact of child, family, and environmental factors on the participation of young children with disabilities across a full range of home and community-based activities. Further study is needed to understand specific patterns with respect to young children's participation to better guide service planning efforts on this outcome in focused and feasible ways. This 1-year project involves secondary analysis of data from over 2,000 families of young children with disabilities who participated in the National Early Intervention Longitudinal Study (NEILS) that was completed between 1997-2007. We will analyze these data to examine what types of child, family, and environmental factors predict whether families experience participation restriction across a broad range of community activities. Study results will inform the design of a new parent-report survey of young children's participation and environment that is being developed for use in service planning with this population.

The specific aim of this pilot study is:

To determine the child, family and environmental factors that best differentiate between families who report difficulty and those who report no difficulty participating in excursions and outings, community-sponsored activities, and recreational activities.

Arthroplasty Type and Patient Age for Predicting Probability of Re-Operation After Arthroplasty For Displaced Femoral Neck Fractures

Sunny Kim, PhD
Associate Professor
University of California - Davis

Collaborator
Ken Ottenbacher, PhD, OTR- UTMB

General Description
Hip fractures are associated with osteoporosis and mostly caused by low-energy falls from standing heights. Due to the rapidly expanding elderly population, hip fractures are a growing burden in the U.S. and are one of the most challenging public health concerns. The goal of this study is to estimate the probability of undergoing re-operation after hemiarthroplasty (HA) or total hip arthroplasty (THA) on the basis of patient age, stratified by sex. Results will aid in our understanding of patient age in association with arthroplasty type and re-operation risk, and provide a validated probability table of re-operation after THA and HA by age group for men and women that could be used by care providers and patients in making informed decisions.

The specific aims of this pilot study are to:

  1. Evaluate the arthroplasty type, age, and sex of patients as a predictor (or confounder) for re-operation after arthroplasty for femoral neck fracture.
  2. Estimate the probability of re-operation after arthroplasty for femoral neck facture at three time points (within one year, three years, or five years) on the basis of the arthroplasty type and patient age, stratified by sex.

Modeling Functional Outcomes from Spinal Cord Injury and Traumatic Brain Injury Model Systems Databases with Individual Growth Models

Alan Kozlowski, PhD, PT
Post Doctoral Fellow
Center for Rehabilitation Outcomes
Research Rehabilitation Institute of Chicago

Collaborators
Anne Deutsch, PhD, CRRN - RIC, James Graham, PhD, DC - UTMB

General Description
This pilot project evaluates the functional independence measures (FIM) outcomes for persons living with spinal cord injury and for those with traumatic brain injury as represented in the Spinal Cord Injury and the Traumatic Brain Injury Model Systems databases respectively, using the individual growth models methodology. The proposed pilot project will focus on the evaluation of clinical rehabilitation outcomes in the form of functional independence measures (FIM) from the Traumatic Brain Injury and the Spinal Cord Injury Model Systems (TBI-MS and SCI-MS respectively) using the individual growth models (IGM) methodologies. Medium (two to five years post discharge) and long-term (fifteen to thirty years post discharge) outcomes for the individuals with SCI and TBI will be evaluated using the above method. The application of IGMs will enable the individual with SCI/TBI to be the primary level of analysis, by integrating time as a factor, and by examining non-linear growth functions for change in FIM outcomes, in the areas of mobility, cognition and self-care, over time.

The specific aims of this pilot study are to:

  1. Become familiar with the TBIMS and SCIMS databases and to identify the strengths and limitations inherent to secondary analysis as they apply to the MS databases
  2. Complete statistical educational workshops in hierarchical linear modeling (HLM), structural equation modeling (SEM), latent growth curve modeling, and item-response theory.
  3. Conduct longitudinal, non-linear IGM analyses of medium and long-term outcomes of the FIM mobility, self-care and cognitive subscales for persons living with SCI and TBI.
  4. Present findings of these analyses to relevant audiences, including CLDR researchers, and to researchers and clinical professionals of spinal cord injury and traumatic brain injury
  5. rehabilitation.
  6. Submit findings for publication in relevant peer-review journals.
  7. Submit a grant application to a federal agency for funding to extend this work, possibly in regard to generating individually predicted recovery curves to facilitate clinical decision-making within rehabilitation settings.

Physical Disability and Disparities in Health Care

Elham Mahmoudi, PhD
Postdoctoral Fellow
University of Michigan

Collaborator
Rebecca Wong, PhD - UTMB

General Description
This study will investigate factors associated with disability-related disparities in health care. Specifically, it will identify disparities that exist between adults with physical disabilities and non-disabled adults in three dimensions of health care system: 1) having no doctor visits, 2) having no usual source of care, and 3) having any unmet medical needs. This research will use data from three merged national datasets - the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the Area Resource File (ARF).

The specific aims of this project are to:

  1. Analyze the 10-year trends in disability-related disparities in use of/access to physician services and in unmet medical needs.
  2. Identify risk factors associated with disparities in use of/access to physician care and in unmet medical needs between adults with and without physical disabilities.

Examining contextual factors and community participation among older adults

Elizabeth Marfeo, PhD
Research Instructor
Boston University

Collaborators
Ken Ottenbacher, PhD - UTMB; James Graham, PhD, DC - UTMB

General Description
This project will investigate the association between contextual factors with participation in community-based instrumental activities of daily living and leisure activities among a national sample of community dwelling older adults. Data from the National Health and Aging Trends Study (NHATS) will be used. The study will examine the extent to which health condition, demographic, and contextual factors are associated with self-reported participation. Results from this study will provide important information that could be used to target future interventions aimed at improving health and functioning in this population.

The specific aims of this pilot study are to:

This project will investigate the association between contextual factors with participation in community-based instrumental activities of daily living and leisure activities among a national sample of community dwelling older adults. Data from the National Health and Aging Trends Study (NHATS) will be used. The study will examine the extent to which health condition, demographic, and contextual factors are associated with self-reported participation. Results from this study will provide important information that could be used to target future interventions aimed at improving health and functioning in this population.

Obesity Misclassification and Cardiometabolic Risk among Adults with Chronic Physical Disabilities

Mark Peterson, PhD
Research Assistant Professor
University of Michigan

Collaborators
Soham Al Snih, MD, PhD - UTMB; Ken Ottenbacher, PhD, OTR - UTMB

General Description
The prevalence of overweight and obesity in the U.S. has risen dramatically over the past several decades. This is alarming considering the evidence that links obesity with subsequent metabolic disturbances and chronic disease outcomes; however, statistics often fail to account for individuals with chronic physical disabilities, a population in which risk for overweight and obesity is significantly higher. The purpose of this study is to identify the extent of overweight and obesity misclassification, as well as cardiometabolic health status of adults with and without chronic motor-related disabilities. This project will utilize the National Health and Nutrition Examination Survey (NHANES).

The specific aims of this pilot study are:

  1. Estimate the degree of discrepancy regarding the classification of overweight and obesity among adults with and without chronic motor-related disabilities.
  2. Evaluate the cardiometabolic risk profile of non-obese individuals determined by BMI, but classified as obese by body fat (i.e. normal weight obesity), as well as the extent to which sedentary behavior (SB) plays a mediating role in this risk.

Individual Trajectories for Risk of Hospitalization Following Inpatient Rehabilitation

Christopher Pretz, PhD
Lead Biostatistician
National Data and Statistical
Center Craig Hospital

Collaborator
James Graham, PhD, DC - UTMB

General Description
This pilot will demonstrate the utility of applying advanced longitudinal analytic techniques to establish the existence of potential relationships between probability of rehospitalization over time and various demographic and clinical characteristics i.e. covariates. Results will provide detailed understanding of the manner in which probability of rehospitalization changes over time. Data files from the Center for Medicare and Medicaid Services will be used.

The specific aims of this pilot study are:

  1. Demonstrate the utility of advanced longitudinal statistical techniques for providing a comprehensive understanding of risk of rehospitalization following discharge from inpatient rehabilitation.
  2. Develop computer-based interactive tool that generates patient-level trajectories from the observed relationships between patient demographic / clinical characteristics and time-dependent probabilities of rehospitalization.
  3. Provide analytic training and pedagogical support for other rehabilitation and disability researchers. The project PI will travel to Galveston and organize/lead a workshop providing instruction and support for using advanced longitudinal analytic techniques.

Bounce-Back: Predicting Acute Readmissions from Inpatient Rehabilitation for Patients with Stroke

Pamela Roberts, PhD, OTR/L
Clinical Faculty
Cedars-Sinai Medical Center

Collaborator
Paulette Niewczyk, PhD - UDSMR

General Description
The purpose of this study is to identify both medical and functional health risk factors among rehabilitation patients admitted to an Inpatient Rehabilitation Facility (IRF) with primary diagnosis of stroke and subsequently discharged back to an acute care hospital directly from IRF before completion of an IRF program and risk factors for 30-day readmission post IRF discharge. The primary goal is to gain experience using large datasets to produce valuable information for understanding the association of medical and functional health risk factors with rehabilitation outcomes. Data files from the Center for Medicare and Medicaid Services will be used.

The specific aims of this pilot study are:

  1. Identify risk factors for discharge to an acute hospital before completion of an inpatient rehabilitation program. Risk factors examined will include medical variables, functional variables, and demographic variable (including geographic region).
  2. Identify risk factor for 30-day readmission post inpatient rehabilitation discharge (after completion of an IRF program). Similar risk factors as aim 1 will be examined.

Biopsychosocial Model of Improved Chronic Illness and Healthcare Utilization

Chia-Chang Wang
Assistant Professor
University of Buffalo

Collaborators
Soham Al Snih, MD, PhD - UTMB; Ken Ottenbacher, PhD, OTR - UTMB

General Description
The objective of this project is to systematically examine the associations between biopsychosocial factors and improved chronic illness of people age 50 or older and the consequences of improved chronic illness. The Health and Retirement Study (HRS) will be used to answer research inquires with the information about the improved chronic illness in five chronic diseases: diabetes, cancer, heart conditions, arthritis, and lung disease.

The specific aims of this pilot study are:

  1. Compare the biopsychosocial predictors of patient-reported improvement in chronic illness for people age 50 or older with arthritis, cancer, diabetes, heart conditions, lung disease, or multiple conditions.
  2. Compare the magnitude and significance of biopsychosocial predictors on outcomes of two age groups (50-64 vs. 65 or above).
  3. Test the proposed biopsychosocial model of improved chronic illness and healthcare utilization/cost for people age 50 or older with chronic diseases.

The Center for Large Data Research and Data Sharing in Rehabilitation involves a consortium of investigators from the University of Texas Medical Branch, Cornell University, and the University of Michigan. The CLDR is funded by NIH - National Institute of Child Health and Human Development, through the National Center for Medical Rehabilitation Research, the National Institute for Neurological Disorders and Stroke, and the National Institute of Biomedical Imaging and Bioengineering. (P2CHD065702).