Facilitator s Manual to the Interactive Performance Oriented Mobility Assessment (ipoma)

Transcription

1 Facilitator s Manual to the Interactive Performance Oriented Mobility Assessment (ipoma) November 2005

2 Facilitator s Manual to the Interactive Geriatric Assessment Lite Modules Table of Contents Description and Purpose... 3 Learning Objectives... 3 Target Audience... 3 Procedures for Implementation... 4 Prerequisites... 4 Required Resources... 5 Evaluation... 7 Relationship to Other Materials... 7 Citation... 7 Copyright... 7 References... 8 Feedback Form... 9 Page 2 of 9

3 Description and Purpose The Interactive Performance Oriented Mobility Assessment (POMA) is based on the fall risk assessment tool developed by M. Tinetti (1). This tool has been used to assess fall risk in a wide variety of settings including outpatient, acute, home and long term care (2). The instrument has been modified over the years in order to measure usual function rather than standard function; the maneuvers included are based on the position changes and gait activities used during daily activity. Hence this particular instrument includes some maneuvers designed to measure the individual s function in the individual s most natural setting, his home, as opposed to the laboratory or the clinical setting (3). The inter-rater reliability for this instrument has been determined at around 83% (4). In a group of community dwelling elderly, the sensitivity and specificity was 70% and 52% respectively (3). This particular version has a greater number of maneuvers with a wider spectrum of difficulty in order to increase the sensitivity of the instrument. The maximum number of points that can be achieved is 35. The lower the score, the higher the fall risk, but there are no predetermined cut-off points. The score can be used as a baseline prior to implementing a therapeutic intervention for a particular individual. The maneuvers measured are likely to improve with a therapeutic intervention. The individual can be tested again at the end of the intervention to assess response to therapy. The POMA can be administered in minutes. The computer-based training module was created as a reusable learning object, and is available in CD ROM and web-based versions Learning Objectives Basic Level Describe the general characteristics, indications, validity, and reliability of the Performance Oriented Mobility Assessment. Describe the components of the balance and gait tests Determine when it is appropriate to perform the POMA on an individual Advanced level To administer and score the Performance Oriented Mobility Assessment safely and accurately. Target Audience Nurses Medical students Internal Medicine and Family Medicine residents Geriatrics fellows Physical therapists Page 3 of 9

4 Procedures for Implementation Module Creation This training module was developed in 2004 by GeriU, the Online Geriatrics University, at the Stein Gerontological Institute. Expertise was provided by faculty members from the University of Miami School of Medicine, and the Miami VA, including Drs. J. Ruiz G. Morel, S. Hernandez, A. Juan, O. Rodriguez (geriatricians) and V. Ribera (physical therapist). How This Module Will Help Trainees Learn The module has been divided into several sections; each section starts with a title, learning objectives, tutorial, key points and considerations, and practice exercises for that section. Some of the practice exercises include video clips of actual patients and/or standardized patients in order to make the learning object as interactive and realistic as possible. For each step of the POMA, you will see instructions on how to administer and score it, and descriptions and videos of patients with diverse gait or balance performances. At the end of the module, you can use the self-test with videos to practice scoring. Time for Completion: About 30 minutes Instructional Use In order to provide a complete experience and achieve the specified learning objectives, educators who use this learning object should use it in conjunction with preceptor assisted instructional activities such as lectures, workshops, or small group discussions as part of a blended learning strategy. The interactive gait and balance assessment learning object can be used in the following ways: Self-instruction: The learner can review the Tinetti gait and balance assessment at his or her own pace in anticipation of the preceptor assisted learning or activity. The tutorial can later be used to reinforce the knowledge or skills or as refresher for information and practice. Workshops or small groups: As part of the demonstration of the tool, the tutorial can be used to illustrate and demonstrate the steps of the procedure. Trainee Performance Support System TPSS (at the point of care): The tutorial can be used as a refresher for learners in the clinical environment immediately before performing this assessment in the clinic or at the bedside. Geriatrics educators at the University of Miami School of Medicine are currently using a similar learning object with 2 nd and 3 rd year medical students as part of the longitudinal theme in geriatrics. It has been evaluated (level one evaluation) with this group (5). Prerequisites Knowledge of the definition of falls. Page 4 of 9

5 Required Resources System Requirements (CD ROM) Windows PC Intel Pentium processor (Pentium II or higher is recommended) 256-color monitor capable of 800 x 600 resolution Windows 95, 98, 2000, XP, Windows NT 4 (Service Pack 3) or Windows ME 64 MB or more of available RAM or higher is recommended Macintosh Intel Pentium II processor (or higher) 256-color monitor capable of 800 x 600 resolution Mac OS 8.5, 8.6, 9.0 and 9.1 (For OS X, we recommend running as Classic) 64 MB or more of available RAM (with virtual memory on) System Requirements (viewing on web) Windows OS: Internet Explorer 6.0 and above, Netscape Navigator 7.0 and above Macintosh OS: Mozilla 1.0 and above (which uses the same engine as Netscape) Flash 6.0 or higher Accessing the Module (CD-ROM version) Windows PC 1. Place the CD-ROM into the CD drive on your computer. 2. The CD-ROM will automatically start if Autorun is enabled on your computer. 3. If the CD-ROM does not automatically start, go to the taskbar on the bottom of your screen, click on <"Start>," then click <"Run...>". Type in "D: Dementia_Training_PC.exe", where D is the letter of the CD drive on your computer. Macintosh 1. Place the CD-ROM into the CD drive on your computer. 2. The CD-ROM will automatically start if Autorun is enabled on your computer. 3. If the CD-ROM does not automatically start, and double-click on the "DT.exe" file within the CD-ROM folder on your desktop. Page 5 of 9

6 For more details, see the readme.htm file on the CD-ROM. Going Through the Module Each page in the module shows information on the POMA, and presents controls for going through the module. You can go through the module one page at a time, or you can jump from page to page or section to section. Many pages have multimedia elements such as videos. Click on the appropriate item to view them. Click to go to a different section Click to watch videos Click to go to another page Moving between Pages Viewing Videos Moving between Sections Use the arrow buttons in the lower right corner of the screen to move backwards and forwards through the tutorial. To view the videos corresponding to each performance score, click on the numbered description. Click on the menu at the left to go to a different section. Page 6 of 9

7 Evaluation Phancao F, Katz A, Smith M, Rodriguez O, van Zuilen MH, Juan A, Paniagua M, McEntire A, Mintzer MJ, Ruiz JG. Blended Learning for Medical Students in the Performance-Oriented Mobility Assessment. Proceedings of the 58th Gerontological Society of America Annual Meeting, November 18-22, 2005, Orlando, FL Complete data was gathered from 95 second-year medical students. Self-efficacy ratings (on a 5-point scale) increased from 3.4 before the tutorial to 4.2 after the online tutorial (t = 6.86, p <.001). Self-efficacy ratings after the tutorial were significantly correlated with the online quiz score (r =.391, p <.001), indicating genuine increases in students capabilities. Students rated their overall experiences as good, and the tutorial as easy to use. Relationship to Other Materials Ruiz JG, Granville LJ, Ribera V, Kai T, Smith M, van Zuilen MH, Roos BA. Interactive gait and balance training (CD-ROM program). GeriU, the Online Geriatrics University, Stein Gerontological Institute, Katz A, and Ruiz JG. Geriatric Assessment Lite (CD-ROM program). GeriU, the Online Geriatrics University, Stein Gerontological Institute, 2005 Citation Referencing this work: Ruiz JG, Morel G, Phancao F, Smith M, Rodriguez O, McEntire A, Hernandez S, Juan A, van Zuilen MH, and Mintzer MJ. Interactive Performance Oriented Mobility Assessment {ipoma} (CD-ROM program). GeriU, the Online Geriatrics University, Stein Gerontological Institute, 2004 Copyright All material in this module was produced by the Stein Gerontological Institute. All further reproduction rights are given through written permission only. Page 7 of 9

8 References 1. Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34(2): Raiche M, Hebert R, Prince F, Corriveau H. Screening older adults at risk of falling with the Tinetti balance scale. Lancet. 2000;356(9234): Tinetti ME, Gottschalk M. Performance Oriented Mobility Assessment., ed. New Haven; 2004 (Personal Communication). 4. Topper AK, Maki BE, Holliday PJ. Are activity-based assessments of balance and gait in the elderly predictive of risk of falling and/or type of fall? J Am Geriatr Soc. 1993;41(5): Ruiz J, Granville L, Ribera V, Kai T, Smith M, van Zuilen R, MH R, BA. Computer-Assisted Training in Gait and Balance Assessment. J Am Geriatr Soc. 2002;50:S73. Page 8 of 9

9 Feedback Form Please tell us what you think of this training material. Your feedback will help us improve the training materials we develop. Please complete this questionnaire, and fax it to (305) , or mail it to: GeriU Coordinator Stein Gerontological Institute 5200 NE 2 nd Ave Miami, FL Alternately, you may visit and fill out the questionnaire on-line. 1. How was your overall experience with the training material? Excellent Good Fair Inadequate Bad 2. How appropriate was the level of the content? Much too advanced Too advanced At the right level Too basic Much too basic 3. Do you feel the materials were effective at enabling you to meet the learning objectives specified? Very effective Effective Neither effective nor ineffective Ineffective Very ineffective 4. How easy or difficult was it to use the training material? Very easy Easy Neither easy nor difficult Difficult Very difficult 5. Did you have any technical problems when viewing the material on your computer or DVD player? Yes No If Yes, please specify: 6. Please indicate which best describes your use of the material: I am using the material as part of self-directed learning to improve my care providing skills. I am using the material to help teach others better care providing skills. Other (please specify): 7. Do you have any other comments about this training material? Page 9 of 9