1

March 28, 2012

TO: Kathy Bryant, Pam West

FROM: Ann Meadow, DOTPA project officer

SUBJECT: Information from Section I of the CARE tool being used in DOTPA

You requested information from the DOTPA project so far pertaining to the information in Section I of

the CARE tool being used by participants. First, this memo summarizes the major observations from the

data we have tabulated. Then I provide a little or ientation to the data we have tabulated. I then focus

on responses to Section I of the tool , which is the section containing the ICF rubrics

.

I. G ENERAL S UMMARY

The ICF data are organized on the CARE

- C and CARE

- F instruments in the same way: three

subsecti ons, each containing a list of items. The subsections are: function, body structures, and

activities/participation

. In general, providers volunteering for DOTPA reported no difficulty completing the ICF page

. Overall, only 79 of the 4197 assessments tabu lated here (1.9%) did not fill out any of the three

subsections. However, the item non

- response rate did vary across disciplines (in settings where

discipline

- specific data are available). In general, response rates were higher for PT assessments

than for OT or SLP assessments.

Responses to the functional subsection were provided on 95.7% of assessments, overall, and

on:

 97.1% of PT assessments

 95% of OT assessments

 82.6% of SLP assessments

Responses to the body structure subsection were provided on 90.4% of assessments, overall,

and on:

 91.6% of PT assessments

 84.2% of OT assessments

 63.8% of SLP assessments

Responses to the activity and participation subsection were provided on 91.6% of

assessments, overall, and on:

 91.6% of PT assessments

 84.2% of OT as sessments

 63.8% of SLP assessments

These results suggest that additional training for SLP providers, or a modification of the ICF domains

that were used on the CARE tool, might be needed to describe the status of patients receiving SLP

services.

For the plurality of patients, therapists reported impairments for three or more body functions, 2 or

more body structures, and 3 or more activities.2

II. B ACKGROUND STATISTICS

The number of assessments the DOTPA project received and entered into files as of March 15

, 2012, is

4,197, representing 3,924 individual beneficiaries. We expect to have approximately 7,700 patients in

the data from 174 providers by the end of June 2012, when data collection will end. Therefore, the data

here represent approximately one

- hal f of the final data we expect.

The assessments came from providers in 30 states and the District of Columbia. All regions of the

country are represented, although less than 1% came from the Mountain States. By Census Division,

nearly three

- quarters cam e from the Middle Atlantic, East North Central, and South Atlantic. See Table

1 for the regional breakdown

.

Table 1: Distribution of a ssessments r eceived , by Census Division

.

Assessment data in DOTPA are collected from hospital outpatient departments (HOPDs) (some of which

are classified for purposes of DOTPA as day rehabilitation facilities) Nursing Facilities (S/NFs),

Comprehensive Outpatient Rehabilitation Facilities (CORFs), Outpatient Rehabilitation Facilities (ORFs),

and private office practices (PPs). Each of t hese settings may provide a combination of physical therapy,

occupational therapy, and speech and language pathology services. Some participating facilities provide

only one or two types of therapy. Others provide all three types of therapy.

The data ar e collected in two separate research instruments: CARE

- C and CARE

- F.

CARE

- C is collected in DOTPA by community settings: HOPDs, PPs, CORFs, ORFs, and ALFs

. In

general, participating providers were asked to have a separate assessment done by each

discip line responsible for a plan of care for the patient; thus, we have more assessments than

patients in the CARE

- C data. New England 358 9%

Middle Atlantic 1107 26%

East North Central 997 24%

West North Central 293 7%

South Atlantic 984 23%

East South Central 211 5%

West South Central 137 3%

Mountain 11 0%

West 99 2%

4,197 100%3

CARE

- F is collected in DOTPA by residential settings: nursing facilities and “day rehabilitation

programs”, which are intensive outpatient rehab programs run by HOPDs. A single CARE

- F

assessment combining input from all therapy disciplines involved in the patient's care is

collected from S/NFs and Day Rehabilitation programs.

A total of 119 providers contributed the 4,197assess ments to DOTPA though March 15, 2012. Five out

of six of the providers were in types of settings assigned to use the CARE

- C (see T able 2 ), with the

remainder in settings assigned to use the CARE

- F. About six out of seven assessments were CARE

- C

assessme nts, in part because of the multiple assessments contributed for some CARE

- C patients by

different disciplines.

Table 2: Number of providers and assessments, by assessment type

Assessment type Number of providers Number of assessments

Total CARE

- C 97 3567

Total CARE

- F 22 630

TOTAL 119 4197

T able 3 shows a finer breakdown of the number of providers and assessment types they contributed

. These counts are not meant to be proportional to the universe of billing providers. Our aim was to

ensure that all settings that bill Part B outpatient therapy are represented in DOTPA.

Table 3: Breakdown of providers and assessments, by type of provider and assessment type

` Form Number of providers Admission Assessments

HOPD CARE

- C 26 1367

Day Rehab CARE

- F 4 128

S/NF CARE

- F 18 502

ALF CARE

- C 5 273

CORF CARE

- C 2 18

ORF CARE

- C 21 519

Private Practice CARE

- C 43 1390

TOTAL 119 4197

III. S ECTION I STATISTICS

Both CARE

- F and CARE

- C have three sets of items derived from the ICF. The items are used by the

assessing clinician to identify the “primary reason for therapy.” The items comprise a high level

classification of body function, body structure, and activi ties/participation.4

The body function item set classifies functions under 21 headings that represent a selection of the ICF

function chapter rubrics and second

- level domains. The instructions say to “check all that apply.”

Approximately 95% of the as sessments have identified at least one functional problem; for the

remainder, the response was missing. Over all assessments (CARE

- C and CARE

- F), approximately three

quarters of the assessments have three or fewer functional problems identified as the pri mary reason

for therapy. T able 4 shows the distribution of assessments according to the total number of items

checked by the assessing clinician:

Table 4: Number of assessments according to the total number of functional problems , entire sample

For the CARE

- C, it is possible to break down the number of functional problems according to the

discipline completing the assessment. The vast majority of CARE

- C assessments came from PT (3,001),

followed by OT (417) and, finally, SLP (149). Table 5 sh ows each discipline’s CARE

- C assessments

according to number of functional problems identified as the primary reason for therapy. The table

indicates that assessments for PT patients tend to have on average slightly more functional problems

identified tha n assessments for OT. For OT, the shares of total assessments for 1, 2 or 3 functional

problems is fairly even, whereas for PT , the share of assessments increases between 1 and 3 problems.

For SLP, the pattern was quite different: half of the assessme nts identified only 1 problem. It appears Number of functional problems

1 function 814 19.4%

2 functions 1141 27.2%

3 functions 1159 27.6%

4 functions 644 15.3%

5 functions 148 3.5%

6 functions 55 1.3%

7 functions 19 0.5%

8 functions 18 0.4%

9 functions 7 0.2%

10 functions 6 0.1%

11+ functions 7 0.2%

TOTAL NUMBER OF

ASSESSMENTS IDENTIFYING AT

LEAST ONE FUNCTIONAL

PROBLEM 4018 96%

TOTAL NUMBER OF

ASSESSMENTS WITH NO

RESPONSE FOR BODY

FUNCTIONS 179 4%5

from these data that for the lion’s share of the clinicians up to four functional problems will account for

most of the functional issues they treat, because of the dominance of PT in the OP therapy benefit.

Table 5: Percent of assessments according to number of functional problems , by discipline: CARE

- C

CAR E

- C

PT OT SLP

N=3001 N=417 N=149

Number of

functional problems

1 function 15.7% 24.7% 48.3%

2 functions 27.5% 24.0% 26.2%

3 functions 30.2% 22.8% 6.7%

4 functions 17.7% 13.9% 1.3%

5 functions 3.6% 6.2% 0.0%

6 functions 1.0% 2.9% 0.0%

7 functions 0.5% 0.2% 0.0%

8 functions 0.5% 0.2% 0.0%

9 functions 0.2% 0.0% 0.0%

10 functions 0.2% 0.0% 0.0%

11+ functions 0.1% 0.0% 0.0%

Sum of percents 97% 95% 83%

Percent of

assessments with no

response 3% 5% 17%6

Table 5 data indicate that the missing rate was relatively high for speech therapists completing the CARE

– C (17%). It is not clear why the speech therapy discipline lef t this item blank so frequently. During

training of the participating providers, there was very little focus needed on the items in Section I, based

on the responses the team observed in training sessions. We intend to cross

- tabulate the primary

reason for therapy against the Section H responses to learn about possible reasons for SLPs having high

missing data rates. For example, perhaps the categories available do not match SLPs perception of

reasons for therapy.

For the CARE

- F, of the 630 CARE

- F asses sments received so far, about 80 percent came from nursing

facilities, with the remainder coming from day rehabilitation programs (see Table 6 ). For the CARE

- F

patients in day rehab programs, a significant share of assessments (17%) indicates four functio nal

problems comprise the primary reason for therapy. This may not be surprising, because these programs

are d esigned to serve heavy

- care community

- dwelling patients. By contrast, among the nursing facility

assessments, 80 percent of the assessments are accounted for by 1, 2, or 3 problems.

Table 6: Percent of assessments according to number of functional problems , by setting: CARE

- F

CARE

- F

Nursing Facility Day Rehabilitation Program

N=502 N=128

Number of functional problems

1 function 28.9% 18.8%

2 functions 29.7% 21.9%

3 functions 21.7% 29.7%

4 functions 6.4% 17.2%

5 functions 2.0% 3.1%

6 functions 2.2% 2.3%

7 functions 0.4% 1.6%

8 functions 0.0% 1.6%

9 functions 0.0% 0.0%

10 functions 0.2% 0.0%

11+ functions 0.8% 0.0%

Sum of percents 92% 96%

Percent of assessments with no

response 8% 4%7

The 21 specific functional problems from the ICF rubrics and used in Section I are listed in Table 7. The

table also shows the number of times a given functional problem was checked , as a percent of each

category of assessments (e.g., the category for all CAR E

- C assessments from physical therapists). As a

result of clinicians having the option to check more than one problem, the percents sum to more than

100%.

By far, the most common problems identified by PT in the CARE

- C were related to functions of musc le,

joints and bones, pain, and movement. Each of these was mentioned on half or more of the

assessments. With the exception of vestibular, proprioceptive and touch, and cardiovascular functional

problems, all of the other categories were mentioned in fe wer than 2% of the assessments. With OT

assessments, muscle, joints and bones, pain, and movement also dominated the problem list, but the

types of problems are less concentrated in these four categories; for example, pain was mentioned in

less often (in one

- third of the assessments), and specific mental problems was mentioned in nearly one

in five assessments. In contrast to the relatively varied problems in OT, in SLP, only two problems,

specific mental problems and voice and speech, dominated the prob lems identified, and pain, so

common in PT and OT, was not listed as a functional problem for any of the SLP reasons for therapy.

Among the CARE

- F assessments, there was generally less concentration of problems in a few areas

compared to the CARE

- C PT ass essments, and the problem list for day rehab assessments was more

varied than the list for nursing patient assessments. The uncommon use of several types of problems

regardless of assessment type is notable: in particular, hair and nails and genital and r eproductive were

mentioned on less than 10 assessments apiece. Several other categories also have relatively small

numbers of mentioned. These categories might be candidates for deletion from any list of suggested

categories CM might want to publish for purposes of describing the Middle Class Tax Relief Act

requirements.8

Table 7: Percent of assessments according to specific functional problem mention ed, by discipline or

CARE

- F setting: CARE

- C and CARE

- F

All

assess

ments

CARE

- C

PT CARE

- C

O T CARE

- C

SLP CARE

- F

NF CARE

- F

Day

Rehab

Specific

functional

problems N=4197 N=3001 N=417 N=149 N=502 N=128

Global Mental 2.6% 1.2% 5.0% 10.1% 7.0% 3.9%

Specific Mental 7.2% 1.5% 18.9% 54.4% 11.4% 30.5%

Seeing & Related 1.6% 0.6% 7.2% 0.7% 0.8% 9.4%

Hearing 0.6% 0.3% 1.0% 1.3% 1.2% 3.9%

Vestibular 4.7% 5.7% 2.9% 0.0% 2.6% 1.6%

Proprioceptive &

Touch 6.6% 6.9% 10.6% 0.0% 3.8% 7.0%

Other Sensory 0.5% 0.1% 0.5% 0.7% 2.8% 0.0%

Pain 46.2% 56.2% 33.6% 0.0% 16.5% 21.9%

Voice & Speech 1.9% 0.1% 0.5% 35.6% 2.2% 7.0%

Cardiovascular 3.4% 3.4% 2.4% 0.0% 4.4% 6.3%

Immunological &

Hematological 0.3% 0.1% 1.2% 0.0% 1.0% 0.0%

Respiratory 1.9% 1.5% 0.7% 5.4% 4.8% 1.6%

Digestive 1.2% 0.0% 0.0% 8.1% 7.6% 0.0%

Metabolism &

Endocrine 0.5% 0.4% 0.0% 0.0% 1.6% 0.0%

Urinary 0.7% 0.5% 1.7% 0.0% 1.6% 0.8%

Genital &

Reproductive 0.1% 0.1% 0.0% 0.0% 0.2% 0.8%

Joints & Bones 52.8% 60.8% 43.6% 0.7% 35.5% 24.2%

Muscle 74.6% 79.5% 71.0% 4.0% 65.9% 87.5%

Movement 46.2% 48.0% 42.2% 5.4% 46.0% 64.8%

Skin 1.7% 0.9% 5.8% 0.0% 3.8% 2.3%

Hair & Nails 0.1% 0.0% 0.0% 0.0% 0.8% 0.0%9

The relatively high frequencies for muscles, joints and bones, pain, and movement funct ional problems

led us to examine how often they co

- occur on the assessments. The results are in the following T able 8

. The joint, muscle, and movement combinations are shown in the top panel, and the pain, joint, muscle,

and movement combinations are shown in the bottom panel.

More than three

- quarters of the assessments, with the except ion of SLP, cited either muscles, joints

and bones, or movement in Section I as a primary reason for therapy. This is no surprise and raises

questions about the utility o f the information if it were collected routinely (that is, the appearance of

these problems is highly predictable) without also requiring information about the body structures

involved

. Alternatively, in the absence of such a requirement, p erhaps a more

- d etailed level of the ICF

rubric should be required in the underlying documentation

.10

Table 8: Percent of assessments with common combinations of functional problem s
, by discipline or CARE

- F setting: CARE

- C and CARE

- F

All assessments CARE

- C

PT CARE

- C

O T CARE

- C

SLP CARE

- F

NF CARE

- F

Day Rehab

N=4197 N=3001 N=417 N=149 N=502 N=128



## J OINT



## , MUSCLE 

## & MOVEMENT COMBINATION S

joint & muscle & movement 1076 25.6% 29.5% 18.0% 0.0% 18.9% 17.2%

joint & muscle 1951 46.5% 54.0% 35.3% 0.0% 30.3% 23.4%

muscle & movement 1709 40.7% 43.0% 36.2% 1.3% 37.6% 60.2%

joint & movement 1114 26.5% 30.4% 18.2% 0.7% 20.5% 17.2%

joint OR muscle OR

movement 3586 85.4% 90.3% 85.1% 8.1% 77.9% 93.0%



## P AIN COMBINATIONS

pain & joint & muscle &

movement 643 15.3% 18.9% 9.1% 0.0% 6.2% 5.5%

pain & joint 1312 31.3% 38.6% 22.1% 0.0% 10.0% 8.6%

pain & muscle 1596 38.0% 46.4% 27.8% 0.0% 12.5% 20.3%

pain & movement 872 20.8% 24.9% 14.4% 0.0% 9.0% 16.4%

pain & not joint, muscle or

movement 181 4.3% 5.3% 2.2% 0.0% 2.4% 0.8%11

Data from t he body structures subsection of Section I are shown in the following Table 9

. Four in ten

assessments cited only one body structure as the primary reason for therapy, and a major ity of

assessments are accounted for by either one or two body structures. The structure subsection of

Section I had a higher missing rate, 10%, than the function subsection (4%, see Table 4 ).

Table 9: Number of assessments according to number of body structures, entire sample

Number of b o d y s t r u c t u r e s

1 structure 1749 41.7%

2 structures 694 16.5%

3 structures 429 10.2%

4 structures 236 5.6%

5 structures 219 5.2%

6 structures 176 4.2%

7 structures 111 2.6%

8 structures 42 1.0%

9 structures 26 0.6%

10 structures 24 0.6%

11+ structures 86 2.0%

TOTAL NUMBER OF

ASSESSMENTS IDENTIFYING AT

LEAST ONE STRUCTURE

PROBLEM 3792 90%

TOTAL NUMBER OF

ASSESSMENTS WITH NO

RESPONSE FOR BODY

STRUCTURES 405 10%12

T able 10 indicates that on the CARE

- C assessments, the discipline with the highest rate of missing

assessments was SLP, in which about one

- third did not identify a structural impairment as a primary

reason for therapy. About one in six OT assessments did not identify a structur al impairment. One, two,

or three structural impairments accounted for about three

- quarters of all PT assessments on the CARE

C, whereas up to three impairments accounted for roughly half of the OT assessments.

Table 10: Percent of assessments accordin g to number of body structures

, by discipline: CARE

- C

On the CARE

- F assessments (Table 11) , missing rates for body structures were comparable to missing

rates for functional problems. In day rehabilitation programs, about one in five assessments indicated

at least 11 structures were mentioned. After 1 structure (28%), this is the second

- most

- frequent total

mentioned for day rehab assessments. We are looking into the possible reasons why 20% cluster on 11+

structures

. Virtually all of the assessm ents with 11+ body structures came from a single provider, and

for that reason our current hypothesis is that an unusually thorough coding approach is at least partly

responsible. Nearly half of the nursing facility assessments had one or two structures i dentified, and

37% of the day rehab program assessments had two or less identified. Nearly 80% of the nursing facility

assessments were accounted for by up to 5 structures.

CARE

- C

PT OT SLP

N=3001 N=417 N=149

Number of b o d y

s t r u c t u r e s

1 structure 47.0% 23.7% 25.5%

2 structures 17.8% 12.2% 16.8%

3 structures 9.4% 16.5% 7.4%

4 structures 4.4% 7.7% 10.1%

5 structures 4.8% 2.9% 3.4%

6 structures 3.0% 10.8% 0.0%

7 structures 2.1% 6.7% 0.7%

8 structures 0.8% 2.2% 0.0%

9 structures 0.6% 0.0% 0.0%

10 structures 0.4% 0.0% 0.0%

11+ structures 1.3% 1.4% 0.0%

Sum of percents 92 % 84 % 6 4 %

Percent of

assessments with no

response 8% 16% 36%13

Table 11: Percent of assessments according to number of body structures, by setting : CARE

- F

The 31 specific structures identified as functional problems from the ICF rubrics and used in Section I

are listed in Table 12

. It should be noted that for structures beginning with “hip” and ending with

“fingers”, the form asks the clinician to indicate the si de of the body affected (left or right); the

information about side of the body isn’t tabulated here. Table 12 also shows the frequency with

which a given body structure was identified as being a primary reason for therapy, as a percent of each

catego ry of assessments (e.g., the category for all CARE

- C assessments from physical therapists). As a

result of clinicians having the option to check more than one structure, the percents sum to more than

100%.

Table 12 suggests a clear difference in the t ypes of structures addressed among CARE

- C assessments

according to whether the clinician discipline was PT, OT, and SLP: PT was concentrated in the lower body

structures; OT, in the upper body structures; and SLP, in the structures involved in voice, spee ch, and

swallowing. Among both settings contributing CARE

- F assessments, there is less concentration and an

appreciably more varied set of body structures identified. Notably, in CARE

- F assessments from nursing

facilities, more than 30% cite “general, n o specific body structure”, as a primary reason for therapy. The

clinical reasons fo r this remain to be firmed up but I imagine this could relate to treating patients who

have become weak from extended illness. CARE

- F

Nursing Facility Day Rehabilitation Program

N=502 N=128

Number of b od y s tr uc tur e s

1 structure 33.1% 28.1%

2 structures 14.1% 9.4%

3 structures 11.6% 7.0%

4 structures 10.0% 6.3%

5 structures 9.8% 7.8%

6 structures 6.2% 7.8%

7 structures 3.4% 1.6%

8 structures 1.2% 1.6%

9 structures 0.8% 2.3%

10 structures 1.0% 5.5%

11+ structures 3.0% 20.3%

Sum of percents 94% 98%

Percent of assessments with no

response 6% 2%14

Table 12: Percent of assessments according to specific body structure mentioned, by discipline or

CARE

- F setting: CARE C and CARE

- F

Specific structure

problems All

assessments

N=4197 CARE

- C

PT

N=3001 CARE C

OT

N=417 CARE

- C

SLP

N=149 CARE

F NF

N=502 CARE

- F

Day Reh

N=128

Structures

related to

movement General/no specific

body location 13.9% 10.9% 13.4% 12.8% 31.5% 18.8%

Head 1.8% 1.3% 1.0% 11.4% 2.8% 0.8%

Cervical Spine 8.3% 10.7% 2.6% 0.7% 2.0% 4.7%

Thoracic Spine 5.4% 7.0% 0.7% 0.0% 2.4% 2.3%

Lumbar Spine 21.8% 29.2% 2.4% 0.7% 4.8% 3.9%

Pelvic Girdle 6.3% 8.1% 1.0% 0.0% 3.4% 0.0%

Hip 24.7% 28.5% 5.5% 0.0% 19.3% 47.7%

Thigh 15.1% 17.2% 3.4% 0.0% 12.2% 32.8%

Knee 26.8% 31.0% 4.1% 0.0% 20.9% 57.8%

Calf 11.6% 12.9% 3.8% 0.0% 9.8% 25.8%

Foot 15.7% 17.1% 4.3% 0.0% 15.3% 40.6%

Toes 3.6% 3.7% 2.6% 0.0% 3.0% 12.5%

Shoulder 17.8% 16.2% 30.7% 0.0% 17.5% 35.9%

Arm 8.6% 3.6% 29.7% 0.0% 13.1% 48.4%

Elbow 6.7% 2.6% 25.7% 0.0% 11.0% 31.3%

Wrist 8.6% 2.7% 42.7% 0.0% 12.0% 32.8%

Hand 10.2% 2.5% 50.8% 0.0% 16.5% 45.3%

Fingers 8.7% 2.0% 46.0% 0.0% 13.3% 35.9%

Nose 0.6% 0.0% 0.0% 0.7% 4.4% 0.8%

Structures

involved in

voice,

speech, &

swallowing Mouth 4.4% 0.1% 0.0% 26.2% 25.5% 10.9%

Tongue 4.5% 0.0% 0.2% 30.9% 25.1% 12.5%

Pharynx 3.1% 0.0% 0.0% 22.1% 17.5% 7.0%

Larynx 2.7% 0.0% 0.2% 23.5% 13.1% 7.8%

Eye 0.8% 0.3% 3.1% 0.0% 0.6% 6.3%

Other

structures Ear 1.4% 1.7% 1.0% 0.7% 0.8% 0.0%

CNS 4.1% 3.5% 5.0% 5.4% 3.4% 16.4%

PNS 3.3% 3.2% 5.5% 2.7% 2.8% 3.1%

CV,Immune,Respiratory 2.2% 1.9% 2.2% 4.0% 3.0% 3.1%

Digestive, Metabolic,

Endocrine 0.5% 0.3% 0.0% 1.3% 2.0% 0.0%

Genitourinary &

Reproductive 0.2% 0.2% 0.0% 0.0% 0.8% 0.8%

Skin 0.9% 0.3% 3.1% 0.0% 2.4% 2.3%15

As with the functional problems, a few structures are rarely mentioned (e.g., genitourinary and

reproductive). More assessments mentioned “urinary” problems in the function list than mentioned

“genitourinary and reproductive” in the body structures list. Other than the issue of possible coding

error, this apparent inconsistency m ay point to other issues to be considered in generating instructions

for the Middle Class Tax Relief requirements. One possibility is that clinicians are more confident in

judging functional problems than in tracing problems to specific body structures.

The final subsection of Section I elicits information about activities and participation, that is, it instructs

the assessing clinician to identify the “activity and participation reason(s) for which you are treating the

patient. ” As shown on Table 13 , the overall rate of nonresponse, 8%, is similar to the rate of

nonresponse for body structures (10%) (see Table 9 ). About three quarters of the assessments in the

entire sample were accounted for by one, two, three, or four activity/participation items. Equal shares

of the entire sample (one

- f ifth) had either one, two, or three activity/participation items cited.

Table 13: Number of assessments according to number of activities and participation items, entire

sample

Number of activities

1 activity 875 20.8%

2 activities 900 21.4%

3 activities 850 20.3%

4 activities 520 12.4%

5 activities 285 6.8%

6 activities 171 4.1%

7 activities 110 2.6%

8 activities 55 1.3%

9 activities 32 0.8%

10 activities 19 0.5%

11+ activities 29 0.7%

TOTAL NUMBER OF

ASSESSMENTS IDENTIFYING AT

LEAST ONE

ACTIVITY/PARTICIPATION ITEM 3846 92%

TOTAL NUMBER OF

ASSESSMENTS WITH NO

RESPONSE FOR

ACTIVITY/PARTICIPATION 351 8%16

Table 14 indicates that o n the CARE

- C assessments, the PT shares for number of activities affected

resemble the overall shares, because PT dominates the sample. For OT, 3 activities is the modal (most

common) number of activities mentioned; all other counts for activities are sma ller. With OT

assessments, one to five activities account for nearly three

- quarters of the assessments. The missing

rates for PT and OT are similar. In contrast, SLP has a nearly one in five rate of nonresponse.

Table 14: Number of assessments accor ding to number of activity/participation items, by discipline:

CARE

- C

On CARE

- F assessments, the nursing facility assessments’ activity list was concentrated among a smaller

number of items than the day rehab assessments’ list (Table 15) . However, the relatively smaller

number of providers in the day rehab category could be part of the reason why the there is more

variability in the number of activities mentioned on assessments from day rehab settings.

CARE

- C

PT OT SLP

N=3001 N=417 N=149

Number of activities

1 activity 20.7% 12.0% 21.5%

2 activities 21.5% 15.6% 14.1%

3 activities 21.9% 19.7% 15.4%

4 activities 12.9% 12.9% 11.4%

5 activities 6.5% 11.8% 8.1%

6 activities 3.6% 8.2% 6.7%

7 activities 2.4% 5.0% 2.0%

8 activities 1.0% 2.6% 1.3%

9 activities 0.7% 1.2% 0.7%

10 activities 0.3% 0.7% 0.7%

11+ activities 0.6% 1.4% 0.0%

Sum of percents 92% 91% 82%

Percent of

assessments with no

response 8% 9% 18%17

Table 15: Number of assessments according to number of activity/participation items, by discipline:

CARE

- F

Of the 21 specific activity/participation items, overall, “walking and moving around” was most

commonly listed (59% of all assessments) but by discipline the single most common item was unique for

each type (Table 16)

. For PT, “walking and moving around” was listed on 71% of assessments, and no

other activity was mentioned with a similar frequency. For OT, “self

- care” was the leading

activity/participation item (67%), with “carrying, handling, and moving objects” men tioned slightly less

frequently (60%). Also, on a majority of OT assessments (57%), “household tasks” was mentioned. On

SLP assessments, the leading item was “communication: expression ( 57% ), followed by “applying

knowledge (52%). No other activity/par ticipation issue was mentioned in a majority of SLP assessments

(bearing in mind that 18% had no response in the activity/participation subsection ).

On the CARE

- F assessments from nursing facilities, there was no clear leading item. Three items

—
“changing and maintaining body position”, “walking and moving around,” and “self

- care” were

mentioned on approximately four in ten assessments. On the CARE

- F from day rehab programs, more

than three

- quarters of the assessments indicated “walking and moving around” was a primary activity

responsible for treatment. “Household tasks” (56%) and “self

- care” (52%) were mentioned in a

majority of assessments from day rehab programs. CARE

- F

Nursing Facility Day Rehabilitation

Program

N=502 N=128

Number of activities

1 activity 31.1% 11.7%

2 activities 30.7% 10.9%

3 activities 13.5% 16.4%

4 activities 8.4% 15.6%

5 activities 3.6% 7.8%

6 activities 1.2% 10.2%

7 activities 0.8% 8.6%

8 activities 0.8% 6.3%

9 activities 0.2% 2.3%

10 activities 0.0% 3.9%

11+ activities 0.8% 1.6%

Sum of percents 91% 95%

Percent of assessments with no

response 9% 5%18

Table 16: Percent of CARE assessments according to activity/participation item mentioned, by

discipline or CARE

- F setting: CARE

- C and CARE

- F

All

assess

ments CARE

- C

PT CARE

- C

O T CARE

- C

SLP CARE

- F

NF CARE

- F

Day Rehab

Specific activities N=4197 N=3001 N=417 N=149 N=502 N=128

Sensory Experience 2.3% 1.3% 6.0% 4.0% 4.8% 0.0%

Basic Learning 3.1% 1.0% 6.2% 15.4% 9.4% 3.1%

Applying Knowledge 7.2% 1.9% 19.7% 52.3% 10.0% 29.7%

General Tasks & Demands 10.9% 6.9% 26.9% 23.5% 13.3% 28.1%

Communication:

Reception 3.5% 0.9% 1.7% 46.3% 3.8% 19.5%

Communication:

Expression 4.2% 1.0% 2.9% 57.0% 4.8% 20.3%

Conversation & Use of

Communication Devices 1.6% 0.3% 1.2% 25.5% 2.8% 3.1%

Changing & Maintaining

Body Position 42.2% 46.3% 23.7% 2.7% 45.8% 39.1%

Carrying, Moving &

Handling Objects 38.8% 42.6% 60.0% 0.0% 11.2% 35.2%

Walking & Moving

Around 59.4% 70.6% 14.9% 1.3% 42.2% 75.8%

Moving Around Using

Transportation 8.2% 8.9% 5.0% 0.0% 5.0% 23.4%

Self Care 27.6% 19.9% 67.4% 6.0% 40.2% 52.3%

Acquisition of Necessities 2.3% 2.3% 5.5% 0.0% 0.4% 3.1%

Household Tasks 29.2% 30.0% 56.6% 0.7% 2.8% 56.3%

Caring for Household

Objects & Assisting

Others 10.6% 11.2% 23.0% 0.0% 0.4% 8.6%

General Interpersonal

Interactions 1.6% 1.2% 3.1% 6.0% 2.0% 0.8%

Particular Interpersonal

Interactions 1.0% 0.9% 0.7% 3.4% 0.8% 2.3%

Education 9.5% 9.2% 5.5% 6.0% 15.5% 9.4%

Work & Employment 2.8% 2.9% 5.5% 2.0% 0.0% 3.1%

Economic Life 0.5% 0.4% 1.7% 0.7% 0.0% 0.8%

Community, Social & Civic

Life 14.7% 16.5% 17.0% 6.7% 2.0% 21.9%