Treating Physician vs Independent Medical Evaluator

2021 ◽  
Vol 26 (4) ◽  
pp. 8-8
Author(s):  
Steven D. Feinberg ◽  
Christopher R. Brigham
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Medical Examination ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Functional Activities ◽  
Patient Advocate ◽  
Independent Medical Examination

Abstract Who is in the better position to evaluate, the treating physician or an independent medical examination (IME) physician? A treating physician has a patient-advocate role because he or she has a doctor-patient relationship with the patient/claimant. Unlike the treating physician, an IME physician does not have a doctor-patient relationship, and can, therefore, provide an impartial evaluation necessary to assess the extent to which the patient/claimant is impaired or disabled from functional activities of daily living.

Who cares? Provision of Care and Assistance Among Older Persons in the Philippines

2018 ◽  
Vol 30 (10) ◽  
pp. 1536-1555 ◽  
Author(s):  
Jeofrey B. Abalos ◽  
Yasuhiko Saito ◽  
Grace T. Cruz ◽  
Heather Booth
Keyword(s):  
Activities Of Daily Living ◽  
Older Women ◽  
Daily Living ◽  
Older Persons ◽  
Older Men ◽  
The Philippines ◽  
Regression Analyses ◽  
Functional Activities ◽  
Provision Of Care ◽  
Experience Difficulty

Objective: This study aims to examine the provision of assistance among older persons in the Philippines who experience difficulty with activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Method: Data for this research are drawn from the 2007 Philippine Study on Aging (PSOA). Cross-tabulations and regression analyses are used to identify who provides assistance to older Filipinos. Results: The study shows that the Filipino family, particularly spouse and daughters, plays an important role in providing assistance to older Filipinos who need help in carrying out functional activities. This provision of caregiving, however, follows a gendered pattern. Specifically, the spouse provides assistance to older men, whereas daughters provide assistance to older women. Grandchildren and noncoresident family members, to some extent, are also active in providing care to older Filipinos. Discussion: The Filipino family remains faithful to its filial duty toward older persons, but who provides care and the way it is provided are likely to change due to the demographic changes and values shifts that have swept the country.

scholarly journals Longitudinal Declines in Instrumental Activities of Daily Living in Stable and Progressive Mild Cognitive Impairment

2014 ◽  
Vol 39 (1-2) ◽  
pp. 12-24 ◽  
Author(s):  
Julia J. Hsiao ◽  
Po H. Lu ◽  
Joshua D. Grill ◽  
Edmond Teng
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Disease Progression ◽  
Daily Living ◽  
Cross Sectional ◽  
Functional Deficits ◽  
Functional Activities ◽  
Instrumental Activities ◽  
Cross Sectional Studies

Background: Previous cross-sectional studies suggest that assessments of instrumental activities of daily living (IADLs) may be useful for operationalizing the differences in functional deficits seen in mild cognitive impairment (MCI) and dementia. However, their utility for longitudinal changes in IADLs in the transition between MCI and dementia remains unclear. Methods: We analyzed longitudinal IADL data with the Functional Activities Questionnaire (FAQ) in stable (MCI-S; n = 1,318) or progressive (MCI-P; n = 1,108) MCI patients. Results: Larger increases in FAQ scores were seen in the MCI-P group across a 14.5-month interval, but overlapping distributions in the two groups yielded poorer discriminatory power than prior cross-sectional reports. Conclusion: Our findings emphasize the difficulties in operationalizing the criterion of ‘essentially intact' IADLs in MCI, which may complicate the interpretation of disease progression in MCI treatment trials. © 2014 S. Karger AG, Basel

The Reliability and Validity of the Safety Assessment of Function and the Environment for Rehabilitation (SAFER Tool)

1998 ◽  
Vol 61 (3) ◽  
pp. 127-132 ◽  
Author(s):  
Lori Letts ◽  
Sheri Scott ◽  
Jill Burtney ◽  
Linda Marshall ◽  
Martha McKean
Keyword(s):  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Safety Assessment ◽  
Reliability And Validity ◽  
Predictive Ability ◽  
Retest Reliability ◽  
Functional Activities ◽  
Limited Variation ◽  
Test Retest Reliability

The Safety Assessment of Function and the Environment for Rehabilitation (SAFER Too)) was developed to assess people's abilities to manage functional activities safety within their homes. The results of a study to evaluate the instruments inter-rater and test-retest reliability and construct validity are reported. Reliability was evaluated using kappa for each dichotomous item. For inter-rater reliability, 59 of 66 items had acceptable reliability. For test-retest reliability, 63 of 70 items had acceptable kappa scores. For items where kappa could not be calculated because of limited variation between raters, percentage agreement was over 80%. For validity, higher SAFER Tool scores (that is, more safety problems) were hypothesised to be associated with less independence in activities of daily living (ADL) and instrumental activities of daily living (IADL) and more cognitive impairment. The correlation between SAFER Tool scores and cognitive impairment supported this hypothesis. The results of the correlations with ADL and IADL scores were less clear. This could be attributed to caregivers' assistance with activities which might have reduced risk, and generally limited variation in ADL scores. The reliability results from this study are positive. Further research to assure the SAFER Tools validity and predictive ability are needed.

Three-Dimensional Joint Co-Ordination Strategies of the Upper Limb during Functional Activities

1996 ◽  
Vol 210 (1) ◽  
pp. 17-26 ◽  
Author(s):  
T M Barker ◽  
A C Nicol ◽  
I G Kelly ◽  
J P Paul
Keyword(s):  
Activities Of Daily Living ◽  
Upper Limb ◽  
Shoulder Joint ◽  
Daily Living ◽  
Three Dimensional ◽  
Angular Motion ◽  
Joint Motion ◽  
Functional Activities ◽  
Quantitative Parameters ◽  
Two Parameters

A triaxial flexible electrogoniometer has been developed to measure the three-dimensional angular motion of the shoulder joint during simulated activities of daily living. The motion of the elbow, forearm and wrist were also recorded and angle-angle diagrams were mathematically analysed to provide quantitative parameters regarding the control and co-ordination of the joints of the normal and the arthritic upper limb. Two parameters (slope and movement area quotient) were derived and used in the interpretation of joint motion during different activities.

Comprehensive Evaluation of the Functional Activities Questionnaire (FAQ) and Its Reliability and Validity

Assessment ◽  
2021 ◽  
pp. 107319112199121
Author(s):  
David Andrés González ◽  
Mitzi M. Gonzales ◽  
Zachary J. Resch ◽  
A. Campbell Sullivan ◽  
Jason R. Soble
Keyword(s):  
Item Response Theory ◽  
Activities Of Daily Living ◽  
Item Response ◽  
Classification Accuracy ◽  
Daily Living ◽  
Response Theory ◽  
Functional Activities ◽  
Psychometric Analyses ◽  
Neurocognitive Measures ◽  
Normal Cognition

The Functional Activities Questionnaire (FAQ) is a collateral-report measure of difficulties in activities of daily living. Despite its widespread use, psychometric analyses have been limited in scope, piecemeal across samples, and limited primarily to classical test theory. This article consolidated and expanded psychometric analyses using tools from generalizability and item response theories among 27,916 individuals from the National Alzheimer’s Coordinating Center database who completed the FAQ. Reliability was evaluated with internal consistency, test–retest, and generalizability analyses. Validity was assessed via convergence with neurocognitive measures, classification accuracy with impairment stage, and confirmatory factor and item response theory analyses. Demographics did not impact scores and there was strong evidence for reliability (0.52-0.95), though coefficients were attenuated when restricted in range to diagnostic groups (e.g., normal cognition). There were strong correlations with neurocognitive measures ( rs: −.30 to −.59), strong classification accuracy (areas under the curve: .81-.99), and a single-factor model had excellent fit. All items evidenced strong item response theory discrimination and provided significant information regarding functional disability, albeit within a relatively restricted range. The FAQ is a reliable and valid measure of activities of daily living concerns for use in clinical/research settings. It best assesses mild levels of functional difficulty, which is helpful in distinguishing normal cognition from mild cognitive impairment and dementia.

scholarly journals Independent Medical Examinations: Facts and Fallacies

2009 ◽  
Vol 5;12 (5;9) ◽  
pp. 811-818
Author(s):  
Paul Ky
Keyword(s):  
The United States ◽  
Legal Framework ◽  
Patient Relationship ◽  
Injured Worker ◽  
Legal Process ◽  
Doctor Patient Relationship ◽  
Social Controversy ◽  
Independent Medical Examinations ◽  
Independent Medical Examination ◽  
Medical Examinations

Background: Independent Medical Examinations (IMEs) have protected the rights of workers in the United States since the first laws protecting employees were established in the early 1900s. There have been many social advancements and a great collective struggle over the last 100 years that have ultimately lead to justice for the injured or disabled worker. Objective: We describe the origins of the IME as well as the evolution of both medical and social processes that have provided the legal framework for the correct practice of IMEs. This article will summarize the current medical principles, legal process, and social controversy embodying the modern IME. Discussion: Medical professionals must adhere to the same principles of impartial and ethical conduct that they uphold in general patient care when dealing with IMEs. Although previously controversial, it is now clear following successful litigation of many physician examiners that at least a ‘limited doctor-patient relationship’ is created during an IME. Limitations: The limitations of this manuscript include a paucity of the literature, lack of IME updates, and certain conflicts with guidelines by various organizations. Conclusion: IMEs represent a valuable mechanism for determining alleged impairment and/or disability. In the current economic environment of declining reimbursement to physicians, IMEs exist outside the scope of traditional payment methods and offer competitive compensation. Key words: Independent Medical Examination, disability, impairment, worker’s compensation, injured worker, disabled worker, doctor-patient relationship

scholarly journals Subluxed Shoulders Need “TLC”: A Pilot Study of T-L-C Elastic Taping to Address Hemiplegic Shoulder Pain, Passive Range of Motion, and Sub-luxation

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sara J. Stephenson ◽  
Steven M. Frey ◽  
Mark P. Stumpf ◽  
Jacob D. Wright ◽  
Lauren B. Loges ◽  
...  
Keyword(s):  
Pilot Study ◽  
Activities Of Daily Living ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Daily Living ◽  
Evidence Based ◽  
Functional Activities ◽  
Neurological Conditions ◽  
Consistent Approach

Shoulder subluxation, abnormal tone, and hemiplegic shoulder pain are common sequelae for patients with neurological conditions. Therapists have used elastic taping to treat these consequential conditions in rehabilitation settings with inconsistent techniques and results. The use of elastic tape to treat shoulder subluxation, abnormal tone, and hemiplegic shoulder pain may result in increased participation in activities of daily living and functional activities; however, evidence-based approaches to guide taping are still emerging. An elastic taping method called the "T-L-C" method has been developed to establish a consistent approach for the assessment and taping to ensure patients are being treated with evidence-based techniques.

scholarly journals La atenuación pragmática como estrategia de acercamiento en el Español de la Salud: propuesta didáctica

2017 ◽  
Author(s):  
Marta Gancedo Ruiz
Keyword(s):  
Patient Communication ◽  
Medical Examination ◽  
Bad News ◽  
Pragmatic Competence ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Doctor Patient Communication ◽  
Medical Context ◽  
Giving Bad News

Resumen: El objetivo de este trabajo es aportar una nueva manera de desarrollar la competencia pragmática de los alumnos de Español de la Salud. Para ello, se propone introducir en el aula el trabajo con una estrategia pragmática concreta para facilitar las relaciones médico-paciente, la atenuación, a través de secuencias didácticas contextualizadas en tres situaciones comunicativas concretas del ámbito hospitalario: la exploración física, la transmisión de malas noticias y la reprobación de malas conductas con consejo médico.Palabras clave: Español con Fines Específicos, atenuación, competencia pragmática, relación médico-paciente. Abstract: The aim of this article is to provide a new way to develop the pragmatic competence in Spanish for Medical Purposes. In order to do this, it is suggested to introduce in the classroom the work with a specific pragmatic strategy, mitigation, in order to make easier the doctor-patient communication by using didactic sequences contextualised in three medical situations of the medical context: medical examination, giving bad news and rejection of misconduct.Keywords: Spanish for Specific Purposes, mitigation, pragmatic competence, doctor-patient relationship

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