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Validation and responsiveness of the late-life function and disability instrument computerized adaptive test in community-dwelling stroke survivors

Background: Follow-up of stroke survivors is important to objectify activity limitations and/or participations restrictions. Responsive measurement tools are needed with a low burden for professional and patient. Aim: To examine the concurrent validity, floor and ceiling effects and responsiveness of both domains of the Late-Life Function and Disability Index Computerized Adaptive Test (LLFDI-CAT) in first-ever stroke survivors discharged to their home setting. Design: Longitudinal study. Setting: Community. Population: First ever stroke survivors. Methods: Participants were visited within three weeks after discharge and six months later. Stroke Impact Scale (SIS 3.0) and Five-Meter Walk Test (5MWT) outcomes were used to investigate concurrent validity of both domains, activity limitations, and participation restriction, of the LLFDI-CAT. Scores at three weeks and six months were used to examine floor and ceiling effects and change scores were used for responsiveness. Responsiveness was assessed using predefined hypotheses. Hypotheses regarding the correlations with change scores of related measures, unrelated measures, and differences between groups were formulated. Results: The study included 105 participants. Concurrent validity (R) of the LLFDI-CAT activity limitations domain compared with the physical function domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.46 respectively. R of the LLFDI-CAT participation restriction domain compared with the participation domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.41 respectively. A ceiling effect (15%) for the participation restriction domain was found at six months. Both domains, activity limitations and participation restrictions, of the LLFDI-CAT, scored well on responsiveness: 100% (12/12) and 91% (12/11) respectively of the predefined hypotheses were confirmed. Conclusions: The LLFDI-CAT seems to be a valid instrument and both domains are able to detect change over time. Therefore, the LLFDI-CAT is a promising tool to use both in practice and in research. Clinical rehabilitation impact: The LLFDI-CAT can be used in research and clinical practice.

[Review of: Mark W. Wiggins, Thomas Loveday (2015) Diagnostic Expertise in Organizational Environments]

Integrating data, knowledge, and expertise for policy advice: understanding the practices of Dutch organized crime control professionals

Current research on data in policy has primarily focused on street-level bureaucrats, neglecting the changes in the work of policy advisors. This research fills this gap by presenting an explorative theoretical understanding of the integration of data, local knowledge and professional expertise in the work of policy advisors. The theoretical perspective we develop builds upon Vickers’s (1995, The Art of Judgment: A Study of Policy Making, Centenary Edition, SAGE) judgments in policymaking. Empirically, we present a case study of a Dutch law enforcement network for preventing and reducing organized crime. Based on interviews, observations, and documents collected in a 13-month ethnographic fieldwork period, we study how policy advisors within this network make their judgments. In contrast with the idea of data as a rationalizing force, our study reveals that how data sources are selected and analyzed for judgments is very much shaped by the existing local and expert knowledge of policy advisors. The weight given to data is highly situational: we found that policy advisors welcome data in scoping the policy issue, but for judgments more closely connected to actual policy interventions, data are given limited value.