Development and initial validation of the Northwick Park Therapy Dependency Assessment
Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and p...
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| Published in | Clinical rehabilitation Vol. 23; no. 10; pp. 922 - 937 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
London, England
SAGE Publications
01.10.2009
Sage Publications Ltd |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0269-2155 1477-0873 1477-0873 |
| DOI | 10.1177/0269215509337447 |
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| Abstract | Objectives: To describe the development and initial validation of the Northwick Park
Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in
neurorehabilitation.
Design: An iterative development process, followed by comparison with systemic
prospective activity analysis, and parallel application of prospective and
retrospective scores
Setting: A tertiary specialist inpatient neurorehabilitation service
Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with
complex neurological disability in two consecutive cross-sectional cohorts.
Methods: The NPTDA was developed and refined over 18 months, together with an
algorithm that converts ordinal scores to estimated therapy hours/week.
NPTDA-estimated hours were compared with ‘actual’ therapy hours/week, identified from
activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores
(reflecting intended levels of intervention) were compared with retrospective NPTDA
scores (actual interventions).
Results: NPTDA-estimated therapy hours/week were strongly correlated with those
identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001),
and also for all five subdomains for direct (hands-on) intervention (rho 0.70—0.93,
P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z
=3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this
bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied
total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although
intended levels of intervention were higher than those actually delivered (Wilcoxon z
=3.30, P<0.001), the differences corresponded to real deviations from intended
practice.
Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA
provided acceptable estimate of therapy interventions. Further evaluation is now
required in other populations and settings. |
|---|---|
| AbstractList | To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation.OBJECTIVESTo describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation.An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores.DESIGNAn iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores.A tertiary specialist inpatient neurorehabilitation service.SETTINGA tertiary specialist inpatient neurorehabilitation service.A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts.PARTICIPANTSA total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts.The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with 'actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions).METHODSThe NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with 'actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions).NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70-0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice.RESULTSNPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70-0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice.In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings.CONCLUSIONIn this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores Setting: A tertiary specialist inpatient neurorehabilitation service Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with ‘actual’ therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70—0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores. Setting: A tertiary specialist inpatient neurorehabilitation service, Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross- sectional cohorts. Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with 'actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70-0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P 0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores Setting: A tertiary specialist inpatient neurorehabilitation service Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with "actual" therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70--0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. [PUBLICATION ABSTRACT] To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores. A tertiary specialist inpatient neurorehabilitation service. A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with 'actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70-0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores Setting: A tertiary specialist inpatient neurorehabilitation service Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with ‘actual’ therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70—0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores Setting: A tertiary specialist inpatient neurorehabilitation service Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with 'actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P<0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70--0.93, P<0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z =3.9, P<0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z =1.4 P =0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P<0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z =3.30, P<0.001), the differences corresponded to real deviations from intended practice. Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. [Reprinted by permission of Sage Publications Ltd., copyright holder.] Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in neurorehabilitation. Design: An iterative development process, followed by comparison with systemic prospective activity analysis, and parallel application of prospective and retrospective scores Setting: A tertiary specialist inpatient neurorehabilitation service Participants: A total of 37 patients (M:F 21:16, mean age 41.8 (SD 14.7) years) with complex neurological disability in two consecutive cross-sectional cohorts. Methods: The NPTDA was developed and refined over 18 months, together with an algorithm that converts ordinal scores to estimated therapy hours/week. NPTDA-estimated hours were compared with ‘actual' therapy hours/week, identified from activity analysis. In a subsequent cohort analysis, prospectively rated NPTDA scores (reflecting intended levels of intervention) were compared with retrospective NPTDA scores (actual interventions). Results: NPTDA-estimated therapy hours/week were strongly correlated with those identified from activity analysis, for total scores (Spearman rho 0.77, P < 0.0001), and also for all five subdomains for direct (hands-on) intervention (rho 0.70–0.93, P < 0.0001). The initial test algorithm overestimated therapy hours (Wilcoxon z = ⊟3.9, P < 0.001). After adjustment, reanalysis using a revised algorithm showed this bias to be removed (Wilcoxon z = ⊟1.4 P = 0.15). Prospective and retrospectively applied total NPTDA scores were strongly correlated (rho 0.61, P < 0.0001). Although intended levels of intervention were higher than those actually delivered (Wilcoxon z = ⊟3.30, P < 0.001), the differences corresponded to real deviations from intended practice. Conclusion: In this initial evaluation, after revision of the algorithm, the NPTDA provided acceptable estimate of therapy interventions. Further evaluation is now required in other populations and settings. |
| Author | Rose, Hilary Shaw, Asa Turner-Stokes, Lynne Law, Janet |
| Author_xml | – sequence: 1 givenname: Lynne surname: Turner-Stokes fullname: Turner-Stokes, Lynne email: Lynne.turner-stokes@dial.pipex.com organization: King's College London, School of Medicine, Department of Palliative Care, Policy and Rehabilitation and Regional Rehabilitation Unit, Northwick Park Hospital – sequence: 2 givenname: Asa surname: Shaw fullname: Shaw, Asa organization: Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, UK – sequence: 3 givenname: Janet surname: Law fullname: Law, Janet organization: Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, UK – sequence: 4 givenname: Hilary surname: Rose fullname: Rose, Hilary organization: Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/19779007$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1111_scs_12018 crossref_primary_10_1177_1460408619871801 crossref_primary_10_1371_journal_pone_0132275 crossref_primary_10_3109_09638288_2014_998779 crossref_primary_10_1016_j_orhc_2012_08_001 crossref_primary_10_1080_02699052_2017_1406989 crossref_primary_10_1177_02692155231158475 crossref_primary_10_1177_0269215511417467 crossref_primary_10_1136_bmjopen_2021_052728 crossref_primary_10_12968_ijtr_2017_0139 crossref_primary_10_4103_ijprm_JISPRM_000166 crossref_primary_10_1177_14782715241242509 crossref_primary_10_1111_dmcn_13648 crossref_primary_10_3109_09638288_2012_670033 |
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| ContentType | Journal Article |
| Copyright | The Author(s), 2009. SAGE Publications © Oct 2009 The Author(s) 2009. Published by SAGE. All rights reserved. SAGE Publications 2009 The Author(s) |
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Therapy Dependency Assessment (NPTDA) as a measure of therapy... Objectives: To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy... To describe the development and initial validation of the Northwick Park Therapy Dependency Assessment (NPTDA) as a measure of therapy interventions in... |
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| SubjectTerms | Adult Algorithms Assessment Clinical medicine Dependency Disability Evaluation Electronic Health Records Female Hospitals Humans Inpatient care Intervention Interventions Male Middle Aged Multidisciplinary teams Nervous System Diseases - rehabilitation Neurology Nursing Observer Variation Occupational therapy Outcome Assessment, Health Care Patients Physical therapy Rehabilitation Workload |
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| Title | Development and initial validation of the Northwick Park Therapy Dependency Assessment |
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