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Mixed Conditions: (Harmon, 2023a; n = 1,645, age ¡Ý 18, median age (IQR) = 71 (60-80), male = 51.3%, Observational quality improvement project at a single acute IRF)

• A Section GG score of ¡Ü51 can be used to identify patients at higher risk of falling during inpatient rehabilitation.
  (Sensitivity: 0.747, Specificity: 0.566, Youden¡¯s Index: 0.313, 45.4% of patients)
• A Section GG Self-Care score of ¡Ü20 can be used to identify patients with reduced independence who are more likely to fall.
  (Sensitivity: 0.660, Specificity: 0.632, Youden¡¯s Index: 0.292, 38.6% of patients)
• A Section GG Mobility score of ¡Ü28 can be used to identify patients at greater fall risk due to limited mobility. (Sensitivity: 0.690, Specificity: 0.595, Youden¡¯s Index: 0.285, 42.4% of patients)

Mixed Conditions: (Deutsch, 2016; n = 2,922, Skilled Nursing Facility Residents; summary report prepared by RTI International for the Centers for Medicare & Medicaid Services  )

Mean Admission, Discharge, and Change in Self-Care by Skilled Nursing Facility Resident Characteristics: Fee-for-Service Medicare Beneficiaries, Post-Acute Care Payment Reform Demonstration (n = 2,922) 

Self-Care at Admission Mean

Self-Care at Discharge Mean

Change in Self-Care Mean

n

%

Total Average

24.51

32.55

8.04

2,922

Age

   <35

¡ª

¡ª

¡ª

¡ª

¡ª

   35-44

¡ª

¡ª

¡ª

¡ª

¡ª

   45-54

25.72

34.09

8.37

47

1.61

   55-64

25.87

33.47

7.60

137

4.69

   65-74

25.76

34.43

8.67

629

21.53

   75-84

24.81

33.08

8.27

1,179

40.35

   85-90

23.12

31.03

7.91

649

22.21

   90+

22.45

28.56

6.11

265

9.07

Surgical Diagnosis

   No

23.63

30.46

6.83

1,491

51.03

   Yes

25.42

34.73

9.31

1,431

48.97

Prior Functioning: Indoor Ambulation

   Independent

25.72

34.54

8.82

2,256

77.21

   Dependent, Some Help

20.82

26.30

5.48

506

17.32

   Not Applicable

17.47

22.14

4.67

70

2.4

   Unknown/Missing

20.40

25.97

5.57

90

3.08

Prior Functioning: Self-Care

   Independent

26.06

35.08

9.02

2,020

69.13

   Some Help

21.92

28.19

6.27

727

24.88

   Dependent

14.73

18.27

3.54

101

3.46

   Unknown/Missing

21.04

26.08

5.04

73

¡ª

Presence of Severe Pressure Ulcer

   No

24.60

32.71

8.11

2,873

98.32

   Yes

19.12

23.29

4.17

49

1.68

Stage 2 Pressure Ulcer

   No

24.75

32.8

8.05

2,745

93.94

   Yes

20.81

28.67

7.86

177

6.06

Cognitive Abilities: BIMS score

   Intact or Borderline

26.01

34.77

8.76

1,938

66.32

   Moderately Impaired

23.84

31.50

7.66

562

19.23

   Severely Impaired

18.63

23.88

5.25

397

13.59

   Not Assessed

16.84

21.92

5.08

25

0.86

Moderate to Severe Communication Impairment

   No

25.22

33.56

8.34

2,682

91.79

   Yes

16.53

21.32

4.79

240

8.21

Bladder Incontinence

   Always Continent, Stress   Incontinent, No Urine Output

26.27

34.87

8.60

2,145

73.41

   Less Than Daily, Daily, Always

19.64

25.87

6.23

612

20.94

   Not applicable (NA)

19.75

27.15

7.40

165

5.65

Bowel Incontinent

   Always Continent, No bowel movement, or NA

25.71

34.31

8.60

2,485

85.04

   Always Incontinent

13.99

17.56

3.57

145

4.96

   Less Than Daily or Daily

19.50

25.06

5.56

292

9.99

Prior Mobility Device/Aid: Walker

   No

25.32

33.61

8.29

1,586

54.28

   Yes

23.55

31.30

7.75

1,336

45.72

Prior Mobility Device/Aid: Prosthetics

   No

24.52

32.55

8.03

2,904

99.38

   Yes

23.61

32.22

8.61

18

0.62

Prior Mobility Device/Aid: Wheelchair

   No

25.08

33.5

8.42

2,484

85.01

   Yes

21.25

27.19

5.94

438

14.99

Prior Mobility Device/Aid: Mechanical Lift

   No

24.60

32.68

8.08

2,898

99.18

   Yes

13.92

16.88

2.96

24

0.82

Swallowing Ability: Modified Food

   No

24.76

32.86

8.10

2,766

94.66

   Yes

20.03

27.14

7.11

156

5.34

Swallowing Ability: Tube Feeding

   No

24.59

32.67

8.08

2,898

99.18

   Yes

14.25

18.29

4.04

24

0.82

Mean Admission, Discharge, and Change in Mobility Score by Skilled Nursing Facility Resident Characteristics (n = 2,938)

Mobility at Admission  Mean

Mobility at Discharge  Mean

Change in Mobility  Mean

n

%

Total Average

34.19

55.18

21

2,938

¡ª

Age

   <35

¡ª

¡ª

¡ª

¡ª

¡ª

   35-44

¡ª

¡ª

¡ª

¡ª

¡ª

   45-54

33.94

54.77

20.83

48

1.63

   55-64

37.04

54.32

17.28

141

4.80

   65-74

35.64

59.24

23.60

633

21.55

   75-84

34.51

56.47

21.96

1,185

40.33

   85-90

32.64

52.27

19.63

649

22.09

   90+

31.55

47.68

16.13

266

9.05

Surgical Diagnosis

   No

34.05

51.05

17.00

1,499

51.02

   Yes

34.33

59.49

25.16

1,439

48.98

Prior Functioning: Indoor Ambulation

   Independent

35.41

59.02

23.61

2,272

77.33

   Some Help

31.77

44.38

12.61

439

14.94

   Dependent

26.09

39.07

12.98

68

2.31

   Not Applicable

23.00

30.30

7.30

70

2.38

   Unknown/Missing

29.73

42.38

12.65

89

3.03

Prior Functioning: Stairs

   Independent

36.30

61.95

25.66

1,623

55.24

   Some Help

34.01

50.42

16.41

384

13.07

   Dependent

29.18

44.31

15.13

55

1.87

   Not Applicable

30.59

45.96

15.37

660

22.46

   Unknown/Missing

30.90

43.75

12.85

216

7.35

Prior Functioning: Functional Cognition

   Independent

35.75

59.89

24.14

1,979

67.36

   Some Help

31.36

46.36

15.00

606

20.63

   Dependent

27.91

39.76

11.85

192

6.54

   Not Applicable

37.57

50.77

13.20

47

1.60

   Unknown/Missing

31.30

48.15

16.85

114

3.88

Presence of Severe Pressure Ulcer

   No

34.32

55.52

21.20

2,888

98.30

   Yes

26.54

35.60

9.06

50

1.70

Stage 2 Pressure Ulcer

   No

34.53

55.69

21.16

2,761

93.98

   Yes

28.84

47.27

18.43

177

6.02

Cognitive Abilities: BIMS score

   Intact or Borderline

35.67

59.02

23.35

1,954

66.51

   Moderately Impaired

33.47

52.57

19.1

564

19.20

   Severely Impaired

28.46

41

12.54

396

13.48

   Not Assessed

24.88

38.71

13.83

24

0.82

Communication Impairment

   No Impairment

35.31

58.28

22.97

2,319

78.93

   Mild

32.52

47.98

15.46

377

12.83

   Moderate to Severe

25.81

36.53

10.72

230

7.83

   Unable to Assess

30.45

37.64

7.19

11

0.37

Bladder Incontinence

   Always Continent, Stress Incontinent, No Urine Output, or NA

35.70

58.44

22.74

2,328

79.24

   Less Than Daily, Daily, Always

28.40

42.77

14.37

610

20.76

Bowel Incontinent

   Always Continent, No bowel movement, or NA

35.60

58.40

22.80

2,503

85.19

   Always Incontinent

22.60

28.72

6.12

144

4.9

   Less Than Daily or Daily

27.79

40.58

12.79

291

9.9

History of Falls

   No

35.80

57.44

21.64

1,695

57.69

   Yes

31.98

52.1

20.12

1,243

42.31

Prior Mobility Device/Aid: Walker

   No

35.46

57.78

22.32

1,599

54.42

   Yes

32.67

52.08

19.41

1,339

45.58

Prior Mobility Device/Aid: Prosthetics

   No

34.21

55.20

20.99

2,920

99.39

   Yes

30.39

53.33

22.94

18

0.61

Prior Mobility Device/Aid: Wheelchair

   No

35.08

57.41

22.33

2,501

85.13

   Yes

29.08

42.43

13.35

437

14.87

Prior Mobility Device/Aid: Mechanical Lift

   No

34.29

55.41

21.12

2,914

99.18

   Yes

21.29

27.46

6.17

24

0.82

Usual Swallowing Ability: Tube Feeding

   No

34.25

55.34

21.09

2,914

99.18

   Yes

26.67

36.58

9.91

24

0.82

Major Treatments During Assessment Period: Total Parenteral Nutrition Recode

   No

34.19

55.19

21.00

2,933

99.83

   Yes

¡ª

¡ª

¡ª

¡ª

¡ª

Mixed Conditions: (Li, 2022; n = 408,491, mean age = 70 (14.4), female = 53.2%, diagnoses: stroke (29.8%), orthopedic disorders (27.3%), neurologic conditions (17.4%), brain dysfunction (14.5%), and debility (11.1%); analysis of 2017 Uniform Data System for Medical Rehabilitation)

Summary data for Section GG (scores recalibrated on a 0-100% scale) 

n

Mean (SD)

Median (Q1, Q3)

Skewness 

Kurtosis

Admission

  Self-Care

291,836

44.8 (17.4)

45.7 (34.3, 57.1)

-0.1663354

- 0.0815881

  Transfer

258,234

42.2 (18.7)

43.3 (30, 56.7)

-0.1308249

0.06177814

Discharge 

  Self-Care

348,357

77.8 (23.6)

82.9 (62.9, 100)

- 0.972366

0.22010802

  Transfer

291,424

77.8 (25.7)

86.7 (60, 100)

- 1.0738632

0.34142441

Change 

  Self-Care

265,572

32.6 (18.4)

34.3 (20, 45.7)

- 0.1515634

0.0762552

  Transfer

200,369

35.9 (20.6)

40 (20, 50)

- 0.1314327

0.01459547

Mixed Conditions: (Deutsch, 2022a; n = 1,117, Inpatient Rehabilitation Facilities with ¡Ý20 Medicare stays in 2017)

• Excellent interrater reliability for Self-Care quality measure scores by provider volume quartile (ICC = 0.836 - 0.965)
• Excellent interrater reliability Mobility quality measure scores by provider volume quartile (ICC = 0.833 - 0.969) 

Mixed Conditions: (Deutsch, 2023; n = 1,117, Inpatient Rehabilitation Facilities with ¡Ý20 Medicare stays in 2017)

• Excellent interrater reliability for mobility quality measure scores overall and when stratified by provider volume (ICC = 0.898 and from 0.806 ¨C 0.965, respectively (P < .001)
• Excellent interrater reliability for self-care quality measure scores overall and when stratified by provider volume (ICC = 0.886 and from 0.793 ¨C 0.964, respectively (P < .001)

Mixed Conditions: (Smith, 2012b; n = 450, report by RTI International/Brookings Institution for Centers for Medicare & Medicaid Services)

• Substantial (weighted kappa = 0.61¨C0.80) to Almost Perfect (weighted kappa =  0.81¨C1.00) interrater reliability was found for core Self-Care and Mobility items. (Wheel 150 feet, Wheel 100 feet, and Wheel 50 feet were not included due to low sample size.)
  • Self-Care item weighted kappa scores (which do not consider not attempted, unavailable, or refused scores) ranged between 0.798 (Eating) to 0.869 (Upper-Body Dressing)
  • Mobility item weighted kappa scores ranged between 0.855 (Lying to Sitting on Side of Bed) to 0.901 (Sit to Stand and Chair/Bed to Chair Transfer).
• Lower levels of interrater reliability were observed for inpatient rehabilitation facilities (IRFs) and Long-term Care Hospitals (LTCHs) compared to Acute Care, Home Health Agencies (HHAs), and Skilled Nursing Facilities (SNFs).

Mixed Conditions: (Smith, 2012a; report by RTI International/Brookings Institution for Centers for Medicare & Medicaid Services that assessed the interrater reliability of the CARE tool throughout video reliability testing)

• Significantly higher level of interrater agreement for Section GG items when clinicians were assessing patients with higher independence. This pattern held across provider types, disciplines, and most functional assessment items (with the exception of lower body dressing and wheelchair use).

Proportion of agreement for selected functional items by dependency level of patients

Item

Agreement on low-function patients n (%)

Agreement on high- function patients n (%)

t

Eating

32 (42.7%)

130 (90.9%)

778.51*

Oral hygiene

102 (54.0%)

95 (83.3%)

583.37*

Toilet hygiene

35 (46.7%)

164 (88.2%)

666.30*

Upper body dressing

74 (62.7%)

169 (90.9%)

571.26*

Lower body dressing

105 (89.0%)

133 (71.5%)

?398.04*

Lying to sitting on side of bed

163 (86.2%)

161 (86.6%)

9.04*

Sit to stand

40 (53.3%)

174 (93.6%)

666.37*

Chair/bed-to-chair transfer

135 (71.4%)

142 (76.3%)

108.42*

Toilet transfer

65 (86.7%)

162 (87.1%)

9.29*

Wheelchair use

73 (97.3%)

175 (94.1%)

?127.53*

Walk in room once standing

51 (68%)

51 (71.8%)

50.50*

Wash upper body

126 (66.7%)

56 (78.9%)

205.55*

Roll left and right

67 (56.8%)

33 (76.74%)

252.87*

Sit to lying

21 (48.8%)

33 (76.74%)

279.53*

Putting on/taking off footwear

145 (76.7%)

163 (87.6%)

279.12*

Total

1,784 (72.9%)

3,152 (82.2%)

1,095.66*

*p < 0.001

Mixed Conditions: (Deutsch, 2022c; n = 428,192, Descriptive study of 2017 Medicare and Medicare Advantage Patients)

• Excellent: Cronbach's alpha for admission and discharge self-care scores = 0.94*

Mixed Conditions: (Marino, 2024; n = 147, mean age = 77.4 (13.2), age range = 41-101, Long-Stay Nursing Home Residents)

• Excellent: Cronbach's alpha for all 16 Section GG items was 0.98*
• Excellent: Cronbach's alpha for the seven self-care items was 0.93*
• Excellent: Cronbach's alpha for the nine mobility elements was 0.98*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Predictive Validity:

Mixed Conditions: (Harmon, 2022a)

• Poor predictive validity of Section GG when predicting fall risk with Section GG Total Scores, AUC (95%CI) = 0.687 (0.638, 0.735) (P < 0.001)
• Poor predictive validity of Section GG when predicting fall risk with Section GG Self-Care Scores, AUC (95%CI) = 0.681 (0.629, 0.732) (P < 0.001)
• Poor predictive validity of Section GG when predicting fall risk with Section GG Mobility Scores, AUC (95%CI) = 0.666 (0.619, 0.712) (P < 0.001)

Concurrent Validity:

Mixed Conditions: (Li, 2022)

• Excellent correlation between Section GG and FIM scores at admission, discharge, and changes in scores (after removing discordant scores)

Correlation Between Section GG and FIM Scores (after removing discordant scores)

Section GG Score

n

Correlation (95% CI)

Admission Score

   Self-Care

291,836

0.87 (0.87, 0.87)

   Transfer

258,234

0.82 (0.81, 0.82)

Discharge Score

   Self-Care

348,357

0.95 (0.95, 0.95)

   Transfer

291,424

0.90 (0.90, 0.90)

Change Score

   Self-Care

265,572

0.80 (0.79, 0.80)

   Transfer

200,369

0.73 (0.73, 0.74)

• Substantive agreement between Section GG and FIM scores at admission and discharge (weighted kappa = 0.61-0.80) after removing discordant scores
• Moderate agreement between change scores for Section GG and FIM scores (weighted kappa = 0.41-0.60) after removing discordant scores

Agreement between Section GG and FIM scores (after removing discordant scores)

Section GG Score

n

Kappa (95 CI)

Weighted Kappa (95 CI)

Admission Score

   Self-Care

291836

0.49 (0.49, 0.50)

0.68 (0.68, 0.68)

   Transfer

258234

0.43 (0.43, 0.43)

0.62 (0.62, 0.62)

Discharge Score

   Self-care

348357

0.60 (0.60, 0.60)

0.76 (0.76, 0.76)

   Transfer

291424

0.52 (0.51, 0.52)

0.70 (0.70, 0.70)

Change Score

   Self-care

265572

0.40 (0.40, 0.40)

0.58 (0.58, 0.58)

   Transfer

200369

0.32 (0.31, 0.32)

0.49 (0.48, 0.49)

• By condition, patients with stroke had the strongest correlation and agreement, followed by brain dysfunction, and neurologic conditions

Convergent validity:

Mixed Conditions: (Marino, 2024)

• Adequate to Excellent  correlations between Section GG and its predecessor Section G, which employed opposite functional grading scales, ranged from r = -0.531 to -0.844
• Acceptable one- and two-construct solutions with Comparative Fit Index (CFI) (r = 0.986) and Tucker-Lewis Index (TLI) (0.984)

Mixed Conditions: (Deutsch, 2022b; n = 493,209, patients discharged from 1,129 inpatient rehabilitation facilities in 2017)

• Patients with higher discharge scores (from level 1 ¨C dependent to level 6 ¨C independent) were more likely to be discharged to the community This difference was observed for all self-care and mobility elements, with the exception of eating and picking up an object. When comparing more challenging mobility activities to less challenging, a higher percentage of patients were who were independent were discharged to the community.
• On average, patients with a lower number of comorbidities had higher changes in mobility and self-care scores from admission to discharge compared to patients with a higher number of comorbidities.

Mixed Conditions: (Toth, 2023; n = 1,458,579, 2017 Medicare Part A SNF patient stays)

• Higher percentages of patients with higher scores for self-care and mobility items were discharged to the community, with the exception of mobility items ¡°Walk 50 Feet with Two Turns¡± and ¡°Walk 150 Feet,¡± which had slightly higher ¡°Dependent¡± patients than ¡°Substantial/maximal assistance¡± patients discharged to the community. 

Mixed Conditions: (Deutsch, 2022a; n = 1,117, Inpatient Rehabilitation Facilities with ¡Ý20 Medicare stays in 2017)

• Significantly higher mean and median changes in Section GG Self-Care and Mobility scores at discharge centers with Stroke Rehabilitation Disease-Specific Certification Status (SRD-SCS) compared to the centers without the certification (P < 0.001) 

Mean and median change in self-care and mobility quality measure scores by stroke rehabilitation disease-specific certification status (CY2017) (n = 1,117)  

Measure

Stroke Rehabilitation Disease-Specific Certification Status (2017) = Yes (n = 176)

Stroke Rehabilitation Disease-Specific Certification Status (2017) = No (n = 941)

Change in Self-care Quality Measure Scores

   Mean (SD)

            12.1 (1.4)

            11.4 (1.7)

   Median (IQR)

            12.0 (1.6)

            11.3 (2.1)

Change in mobility quality measure scores

   Mean (SD)

            30.0 (3.9)

            28.0 (4.6)

   Median (IQR)

            29.9 (5.7)

            27.7 (6.3)

• Quintile groups based on Section GG scores with higher percentages of IRFs having certification status were associated with the highest changes in Mobility scores. This same pattern was seen with Self-Care except for groups 4 and 3, which respectively included 25% and 25.6% of IRFs with certification (P < 0.0001)

Mixed Conditions: (Deutsch, 2023; n = 1,117, Inpatient Rehabilitation Facilities with ¡Ý20 Medicare stays in 2017)

• Significantly higher mean and median Mobility and Self-Care scores on discharge at centers with the SRD-SCS certification compared to centers without the certification. (P < .001) 

Mean and median quality measure scores (CY2017) by stroke rehabilitation disease-specific certification status (2017) (n = 1,117)  

Measure

Stroke Rehabilitation Disease-Specific Certification Status (2017) = Yes (n = 176)

Stroke Rehabilitation Disease-Specific Certification Status (2017) = No (n = 941)

Discharge Mobility Quality Measure Score

   Mean (SD)

            56.4 (12.0)

            49.7 (14.9)

   Median (IQR)

            56.5 (19.4)

            49.4 (21.5)

Discharge Self-Care Quality Measure Score

   Mean (SD)

            61.5 (10.6)

            54.8 (14.5)

   Median (IQR)

            62.3 (13.6)

            54.7 (19.6)

• For quintile groups based on Section GG scores, higher discharge mobility and self-care scores were associated with a higher percentage of certified IRFs. Aside from groups 2 and 3, the opposite was observed with groups with lower quality measure scores on discharge¡ªwhich were associated with lower percentage of certified IRFs (P < 0.0001)

Discriminant validity 

Mixed Conditions: (Li, 2022)

• Patients with higher independence tended to have higher Section GG scores compared to their corresponding scores on the Functional Independence Measure (FIM). At admission, lower agreement between the two instruments was observed when evaluating patients lower average ability levels. Similar agreement was observed with higher functioning patients when evaluating changes in scores throughout an admission.

Mixed Conditions: (Harmon, 2023a)

• Significantly lower Section GG total, self-care, and mobility scores for patients who experienced a fall during their inpatient stay (P < 0.001)

Patient scores on Section GG and self-care/mobility subscales for fallers and non-fallers

Demographics

Total

Non-fallers

Fallers

Patients, n (%)

1,645

1,545 (93.9)

100 (6.1)

Section GG, median (IQR)

54 (40¨C66)

54 (41¨C67)

41 (31¨C52)

Self-Care

22 (18¨C26)

22 (18¨C26)

18 (13¨C23)

Mobility

31 (22¨C40)

31 (22¨C41)

24 (20¨C31)

IQR = interquartile range

Mixed Conditions: (Marino, 2024; n = 147, Long-Stay Nursing Home Residents)

• The following hierarchies, ordered from easiest to difficult were calculated utilizing Rasch Analysis
  • Self-Care: eating, oral hygiene, upper body dressing, toileting hygiene, lower body dressing, putting on/taking off footwear, and shower/bathe self
  • Mobility: roll left to right, sit to lying, lying to sitting on side of bed, chair/bed-to-chair transfer, sit to stand, toilet transfer, walk 10 feet, walk 50 feet with two turns, and walk 150 feet

Mixed Conditions: (Li, 2022)

• Adequate: Floor and ceiling effects for self-care (<2%) and transfer (<5%) elements at admission
• Adequate: Floor effect of <10% for self-care and transfer elements at discharge
• Poor: Ceiling effects for self-care and transfer elements at discharge were >20% and >40%, respectively

Stroke: (Herbold, 2023a; n = 1,051, mean age = 67.9 (13.6), male = 567 (53.8%);  retrospective, observational cohort study at one IRF of adults with stroke)

• A cut-off score of 33.5 can be used to discharge a patient to home when deciding between a discharge to home (with or without homecare) or to a skilled nursing facility
• A cut-off score of 36.5 can be used to discharge a patient to home when deciding between home with outpatient services or a skilled nursing facility

Stroke: (Herbold, 2023b; n = 1,087, male = 585 (53.8%) Retrospective cohort study of stroke patients at one IRF)

Section GG self-care and mobility scores at admission, discharge, and 90-day post-discharge follow-up

Self-Care (scale range = 7-42):

Time/Group 

n

Sample Range

Mean (SD)

Median (Q1, Q4)

Skewness (SE)

Admission:

   All

1087

7-35

16.8 (6.1)

17 (12, 21)

0.01 (0.07)

   Inpatient Only

817

7-35

16.7 (6.1)

17 (12, 17)

0.02 (0.09)

   Follow-Up

270

7-31

16.9 (6.1)

17 (12, 22)

-0.03 (0.15)

Discharge:  

   All

1087

7-42

30.1 (9.0)

30 (23, 38)

-0.34 (0.07)

   Inpatient Only

817

7-42

30.1 (9.2)

31 (23, 39)

-0.34 (0.09)

   Follow-Up

270

7-42

30.2 (8.5)

30 (24, 38)

-0.33 (0.15)

Post-Discharge Day 90 Follow-Up

270

7-42

34.1 (9.6)

40 (27, 42)

-0.94 (0.15)

Mobility (scale range = 15-90): 

Time/Group 

n

Sample Range

Mean (SD)

Median (Q1, Q4)

Skewness (SE)

Admission:

   All

1087

15-68

29.1 (10.4)

27 (21, 35)

0.73 (0.07)

   Inpatient Only

817

15-62

28.8 (9.9)

27 (21, 35)

0.64 (0.09)

   Follow-Up

270

15-68

29.8 (11.8)

27.5 (21, 36.3)

0.73 (0.15)

Discharge:  

   All

1087

15-90

57.3 (21.5)

60 (40, 76)

- 0.24 (0.07)

   Inpatient Only

817

15-90

57.0 (21.7)

60 (39, 76)

-0.25 (0.09)

   Follow-Up

270

15-90

58.3 (21.1)

60 (42.8, 78)

-0.23 (0.15)

Post-Discharge Day 90 Follow-Up

270

15-90

71.0 (22.0)

80 (57.8, 90)

-1.05 (0.15)

Stroke: (Harmon, 2023b; n = 1,296, mean age = 70 (14), female = 607 (46.8%), Retrospective cohort study at one IRF)

Median Section GG scores at admission and discharge 

Section GG Score 

Median (IQR)

   at Admission

61 (41-78)

   at Discharge

97 (81-121)

Stroke: (Harmon, 2024; n = 208, median age (IQR) = 70 (59-79), female = 90 (43.3%), Prospective observational cohort study at an IRF)

Median Section GG scores

Total Physical Functioning

   Admission median (IQR)

50 (33 to 65)

   Discharge median (IQR)

96 (72 to 119)

   Change median (IQR)

42 (24 to 55)

Self-Care

   Admission median (IQR)

19 (14 to 24)

   Discharge median (IQR)

32 (25 to 40)

   Change median (IQR)

13 (8 to 18)

Mobility

   Admission median (IQR)

29 (19 to 44)

   Discharge median (IQR)

65 (44 to 78)

   Change median (IQR)

29 (15 to 39)

IQR = interquartile range

Stroke: (Harmon, 2023b)

• Excellent: Cronbach's alpha for admission scores = 0.971*. After excluding patients with 7 (patient refusal), 9 (N/A), and 10 (not attempted because of environmental limitations) codes it was 0.973*
• Excellent: Cronbach's alpha for discharge scores = 0.983*.  After excluding patients with 7, 9, and 10 codes it was 0.985*

Stroke: (Harmon, 2024)

• Excellent: Cronbach's alpha for Total functioning, Self-Care, and Mobility scores were >0.95*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

Concurrent validity:

Stroke: (Harmon, 2023b)

• Excellent correlation between Section GG and the Functional Independence Measure Motor Subscale (FIMm) on admission (¦Ñ = 0.919), discharge (¦Ñ = 0.929), and when measuring patient gains throughout treatment (¦Ñ = 0.789)
  • After excluding patients with 7, 9, and 10 codes, ¦Ñ = 0.925, 0.931, and 0.788, respectively, for the categories listed above 

Stroke: (Harmon, 2024)

• Excellent correlations between Total physical function, Self-Care, and Mobility Section GG subscales scores and the modified Rankin Scale (mRS) at admission (¦Ñ < -0.67) and discharge (¦Ñ < -0.71)
• Adequate correlations between mRS and Total physical function (¦Ñ = -0.49), mobility (¦Ñ = -0.47), and self-care (¦Ñ = -0.36) score changes on Section GG (all p < 0.001)

Predictive validity:

Stroke: (Herbold, 2023a)

• Adequate ability of Section GG to predict discharge destination between home (with or without homecare) vs. skilled nursing facility, AUC (95%CI) = 0.82 (0.80, 0.85)
• Adequate ability of Section GG to predict discharge destination between home with homecare vs. skilled nursing facility, AUC (95%CI) = 0.79 (0.76, 0.82)
• Adequate ability of Section GG to predict discharge destination between   home with outpatient services vs. skilled nursing facility, AUC (95%CI) = 0.89 (0.86, 0.91)
• Poor ability of Section GG to predict discharge destination between  home with outpatient services vs. home with homecare, AUC (95%CI) = 0.67 (0.63, 0.71)
• Logistic regression indicated the presence of a caregiver is the most significant factor for discharge destination decision-making (P < 0.001). 

Logistic regression comparisons of discharge destinations with significant prediction variables and model assessment

Discharge Destination

Variable

Odds Ratio

(95% CI)

Nagelkerke

R2

Hosmer &

Lemeshow

(P)

Overall

Accuracy

of the Model

Percent

Correctly

Predicted

Home with or

without

Homecare

vs SNF*

Admission Section GG

1.13 (1.12-1.15)

0.40

.25

78.4%

87.5% (Home)

Caregiver Present

2.68 (1.87-3.83)

57.8% (SNF)

Sex

1.40 (1.02-1.93)

Home with OP* vs

Home with

Homecare

Admission Section GG

1.06 (1.05-1.08)

0.21

.15

72.6%

41.8% (Home with OP)

Caregiver Present

1.67 (1.12-2.51)

89.2% (Home with Homecare)

Age

0.96 (0.95-0.97)

Home with

Homecare vs

SNF*

Admission Section GG

1.12 (1.10-1.14)

0.34

.77

74.6%

80.6% (Home with Homecare)

Caregiver Present

2.58 (1.78-3.76)

65.5% (SNF)

Home with OP vs

SNF*

Admission Section GG

1.17 (1.14-1.20)

0.62

.29

84.2%

79.5% (Home with OP)

Caregiver Present

3.71 (2.12-6.50)

87.9% (SNF)

Age

0.96 (0.94-0.98)

*P < 0.001 for logistic regression

Stroke: (Harmon, 2023b)

• Bias towards higher scores on both admission (Bias = 2.3%, P < 0.001)  and discharge (Bias = 6.2%, P < 0.001), along with greater gains in function (Bias=3.9%, P < 0.001), especially with walking and stair usage (Bias = 3.71%, P < 0.001), were seen on Section GG when compared to the Functional Independence Measure Motor Subscale (FIMm). Similar bias was also seen in Section GG Admission (2.2%, P < 0.001), Discharge (6.1%, P < 0.001), and Change (3.9%, P < 0.001) in score data after removing 7, 9, and 10 codes.

Stroke: (Herbold, 2023a)

• Throughout one-way ANOVA, Herbold et al. found that age differed based on discharge destination, on average, younger patients were discharged to home with outpatient service compared to home with homecare or SNF discharge. Patients discharged to SNF also had the longest length of stays and the lowest Section GG scores at both admission and discharge. (P < 0.001)
• Significant main effect of discharge destination on admission Section GG scores, with scores decreasing as discharge setting became more dependent (F(2,2) = 50.8, P = 0.019), and a significant interaction between discharge destination and caregiver presence (F(2,1045) = 3.68, P = 0.025). Individuals living alone had higher admission Section GG scores than those with caregivers, regardless of discharge destination.

Mean (SD) and range of age, length of stay in inpatient rehabilitation unit, and Section GG scores at admission and discharge

Variable

Statistic

Aggregate Sample (n = 1051)  

Home with Outpatient Services (n = 249)

Home with Homecare (n = 480)

SNF (n = 322)

Age (y)

Mean (SD)

67.9 (13.6)

61.8a (13.6)

69.9a (13.3)

69.6a (12.6)

Range

22-101

22-93

25-101

32-95

Length of Stay (d)

Mean (SD)

21.1 (9.2)

16.4b (7.3)

20.5b (9.2)

25.5b (8.6)

Range

2-105

2-42

5-105

8-92

Admission Section GG Score

Mean (SD)

36.6b (12.7)

45.4b (10.7)

38.6b (11.1)

27.0b (9.7)

Range

16-67

16-67

16-65

16-63

Discharge Section GG Score

Mean (SD)

67.1b (21.3)

82.5b (14.7)

73.3b (16.7)

46.1b (14.9)

Range

16-96

20-96

19-96

16-90

aHome with outpatient services significantly different from home with homecare and SNF, P < 0.001

bAll groups had statistically significant differences from each other, P < 0.001

Stroke: (Harmon, 2023b)

• Adequate: Floor effect at admission was 2.9%. After excluding patients with 7, 9, and 10 codes it was 3% (n = 35)
• Excellent: Ceiling effect at admission was 0%
• Adequate: Floor effect at discharge was 0.2%. After excluding patients with 7, 9, and 10 codes it was 0.3% (n = 3)
• Adequate: Ceiling  effect at discharge was 8.6%. After excluding patients with 7, 9, and 10 codes it was 9.1% (n = 106) 

Stroke: (Herbold, 2023b)

• Adequate: Floor effect for self-care elements at admission for all patients, inpatient only patients, and patients at follow up were 9.8%, 10.2%, and 9% respectively
• Excellent: Ceiling effect for self-care elements at admission for all patients, inpatient only patients, and patients at follow up were all 0%
• Adequate: Floor effect for self-care elements at discharge for all patients, inpatient only patients, patients at follow up, and patients at 90-day follow up were 0.3%, 0.2%, 0.4%, and 0.7% respectively
• Adequate: Ceiling effect for self-care elements at discharge for all patients, inpatient only patients, and patients at follow up were 11.2%, 12%, and 8.9% respectively
• Adequate: Floor effect for mobility elements at admission for all patients, inpatient only patients, and patients at follow up were 7.2%, 6.9%, and 8.1% respectively
• Excellent: Ceiling effect for mobility elements at admission for all patients, inpatient only patients, and patients at follow up were all 0%
• Adequate: Floor effect for mobility elements at discharge for all patients, inpatient only patients, patients at follow up, and patients at 90-day follow up were 0.5%, 0.5%, 0.4%, and 1.5% respectively
• Adequate: Ceiling effect for mobility elements at discharge for all patients, inpatient only patients, and patients at follow up were 4.6%, 4.9%, and 3.7% respectively
• Poor: Ceiling effect for self-care and mobility elements at 90-day follow up were 45.2% and 32.2% respectively 

Section GG Floor and Ceiling Effects for Self-Care and Mobility Scores at Admission, Discharge, and 90-day Post-Discharge Follow-up 

Self-Care:

Time/Group

n

Floor Effect n (%)

Ceiling Effect n (%)

Admission:

   All

1087

107 (9.8)

0 (0.0)

   Inpatient Only

817

83 (10.2)

0 (0.0)

   Follow-Up

270

24 (9.0)

0 (0.0)

Discharge:  

   All

1087

3 (0.3)

122 (11.2)

   Inpatient Only

817

2 (0.2)

98 (12.0)

   Follow-Up

270

1 (0.4)

24 (8.9)

Post-Discharge Day 90 Follow-Up

270

2 (0.7)

122 (45.2)

Mobility:

Time/Group 

n

Floor Effect n (%)

Ceiling Effect n (%)

Admission:

   All

1087

78 (7.2)

0 (0.0)

   Inpatient Only

817

56 (6.9)

0 (0.0)

   Follow-Up

270

22 (8.1)

0 (0.0)

Discharge:  

   All

1087

5 (0.5)

50 (4.6)

   Inpatient Only

817

4 (0.5)

40 (4.9)

   Follow-Up

270

1 (0.4)

10 (3.7)

Post-Discharge Day 90 Follow-Up

270

4 (1.5)

87 (32.2)

Stroke: (Herbold, 2023b)

• Large Standardized Response Means (SRM) for both self-care and mobility were observed from admission to discharge.
• A Moderate SRM was observed from discharge to 90-day follow-up for mobility.
• A Low SRM was observed from discharge to 90-day follow-up for self-care.

Standardized response means from admission to discharge and from discharge to 90-day post-discharge follow-up by group (all mean changes p < 0.001)

Time/Group 

Mean Change (SD)

Standardized Response Mean (SRM)

Self-Care

Admission to Discharge

   Inpatient 

13.4 (6.4)

2.09

   Follow-Up

13.3 (6.3)

2.11

Discharge to Post-Discharge Day 90

   Follow-Up

3.9 (8.5)

0.46

Mobility

Admission to Discharge

   Inpatient 

28.2 (16.1)

1.75

   Follow-Up

28.5 (15.5)

1.84

Discharge to Post-Discharge Day 90

   Follow-Up

12.7 (18.5)

0.68

Limb Loss and Amputation: (Chang, 2024; n = 156 (29 w/mean age = 62.4 (12.1); male = 21 (72.4%) readmitted to acute care and 137  w/mean age = 64.8 (13.4); male = 90 (70.9%) discharged to community), retrospective cohort study)

Section GG Mean (SD) Total Scores by Patient Status (n = 133)

Variable 

Readmission to acute care, n = 23

Discharge to community, n = 110

P value

Section GG score, mean (SD)

37.0 (14.7)

45.0 (14.4)

<0.00

Discriminant Validity:

Limb Loss and Amputation: (Chang, 2024)

• Significant ability of Section GG total scores to discriminate between patients readmitted to acute care and those discharged to the community (P < 0.001)