Reliability of the Functional Independence Measure with Occupational Therapists

This paper reports an inter-rater reliability study on the Functional Independence Measure (FIM). The FIM measures inpatient burden of care, as reflected in 18 self care items, rated on a seven point scale from dependent to independent. The subjects were 40 occupational therapists, divided according to experience with the FIM and randomly assigned to a FIM training or non-training group. Subjects rated video tapes of four stroke patients on transfers, bathing, dressing, grooming, toileting and eating items from the FIM. Rater consensus was calculated using the intraclass correlation coefficient (ICC), percentage agreement and a measure of disagreement. Rating accuracy was measured by comparisons with an expert rater. Ratings were most reliable when done by clinicians with no prior FIM experience, from the FIM training group. It is strongly recommended that all clinicians undergo FIM training before using this tool to ensure acceptable reliability.     

A Process for Translating and Validating Model of Human Occupation Assessments in the Danish Context

The aim of the study was to validate the Danish translation of The Assessment of Communication and Interaction Skills (ACIS) and The Occupational Self-Assessment (OSA). The validation process followed four research steps where pilot versions were tested by occupational therapists in practice, peer-reviewed, and back-translated. The result of the study was two validated assessment tools based on the Model of Human Occupation (MOHO) available for Danish occupational therapy practice, education, and research. Future studies should enlighten how to maintain the validity and reliability of assessments when translations are made into other languages.     

Validity and reliability of the Japanese version of the FIM + FAM in patients with cerebrovascular accident

Background and aim: The study aim was to investigate the validity and reliability of the Functional Independence Measure and Functional Assessment Measure (FIM?+?FAM), which is unfamiliar in Japan, by using its Japanese version (FIM?+?FAM-j) in patients with cerebrovascular accident (CVA).

Material and methods: Forty-two CVA patients participated. Criterion validity was examined by correlating the full scale and subscales of FIM?+?FAM-j with several well-established measurements using Spearman’s correlation coefficient. Reliability was evaluated by internal consistency (tested by Cronbach’s alpha coefficient) and intra-rater reliability (tested by Kendall’s tau correlation coefficient).

Results: Good-to-excellent criterion validity was found between the full scale and motor subscales of the FIM?+?FAM-j and the Barthel Index, National Institutes of Health Stroke Scale, modified Rankin Scale, and lower extremity Brunnstrom Recovery Stage. High internal consistency was observed within the full-scale FIM?+?FAM-j and the motor and cognitive subscales (Cronbach’s alphas were 0.968, 0.954, and 0.948, respectively). Additionally, good intra-rater reliability was observed within the full scale and motor subscales, and excellent reliability for the cognitive subscales (taus were 0.83, 0.80, and 0.98, respectively).

Conclusion and significance: This study showed that the FIM?+?FAM-j demonstrated acceptable levels of validity and reliability when used for CVA as a measure of disability.     

The Barthel Index and ADL Evaluation in Stroke Rehabilitation in Australia, Japan, the UK and the USA

At present many of the activities of daily living indices used in Australia lack essential characteristics of an index yielding desirable results. This study argues that the Barthel Index as modified by Shah, Vanclay and Cooper (1989a) is robust and has the required biometric and psychometric qualities. It presents evidence in support of the use of the Barthel Index as a preferred measure of the activities of daily living function to report therapeutically meaningful and valid information of patient care and stroke rehabilitation outcomes in Australia. It also presents the functional performance on the modified Barthel Index and the outcome of all 258 first stroke patients admitted for inpatient rehabilitation in Brisbane, Australia. Using the Barthel Index as a measure of activities of daily living functions, the study then compares the performances and outcomes of stroke patients between Australia, Japan, the United Kingdom and the United States of America.     

Remote measurement via the Internet of upper limb range of motion in people who have had a stroke

An Internet-based goniometer has recently been developed which can be used for the remote quantification of joint range of motion (ROM). We evaluated the validity and intra- and inter-rater reliability of this goniometer for the measurement of upper limb ROM in 10 people who had had a stroke. The movements on which the device was evaluated were shoulder flexion, shoulder abduction, elbow flexion, wrist flexion, wrist extension, forearm supination and forearm pronation. Measurements performed using the Internet-based goniometer were compared with measurements made using the most widely accepted clinical joint ROM measurement tool, the universal goniometer. The Internet-based goniometer was found to be a valid tool for the measurement of upper limb ROM, with the disagreement between the two measurement tools ranging from 1.1-2.4 degrees . The Internet-based goniometer was also shown to possess a high level of intra- and inter-rater reliability (all intra class correlation coefficients>0.93). The results suggest that therapists can confidently use the Internet-based goniometer to measure the upper limb ROM in people who have had a stroke.     

Reliability and validity of the fine motor scale of the Peabody Developmental Motor Scales-2

This study examined the test-retest reliability, inter-rater reliability, convergent validity and discriminant validity of the Fine Motor Scale of the Peabody Developmental Motor Scales-second edition (PDMS-FM-2). Participants included two groups of 18 children between the ages of 4 and 5 years with and without mild fine motor problems. The PDMS-FM-2 was administered twice to 12 children and rated by two occupational therapists. The PDMS-FM-2 results were compared with scores on the Movement Assessment Battery for Children (M-ABC). In addition, the scores of the children with and without fine motor problems were compared. For the test-retest reliability and the inter-rater reliability, correlation coefficients varied from r = 0.84 to r = 0.99. These results suggest that PDMS-FM-2 has excellent test-retest and inter-rater reliability. Convergent validity with the fine motor section of the M-ABC and discriminant validity have been confirmed. Only 39% of the children in the group with problems in fine motor activities had fine motor problems according to the PDMS-FM-2. This finding seems to indicate that the PDMS-FM-2 may not be sensitive enough for this population.     

Reliability and internal consistency of the Danish version of Loewenstein Occupational Therapy Cognitive Assessment 2nd Edition (LOTCA-II/D)

Abstract

Objective: To evaluate the intra-rater and inter-rater reliability and internal consistency of the Danish version of the Loewenstein Occupational Therapy Cognitive Assessment, second edition (LOTCA-II/D), an instrument designed to assess and evaluate cognitive functioning. Methods: A reliability study was conducted at neurological acute care and rehabilitation units at three Danish hospitals. Fifty-four neurological patients participated in the study. Patients were tested with LOTCA-II/D by occupational therapists, and video recordings were made for reliability assessments. Intra-rater assessments were performed at least two weeks after the first assessment, and all occupational therapists were blinded to previous assessments. Intra-rater and inter-rater reliability were evaluated using percentage agreement and weighted kappa. Internal consistency was evaluated using Cronbach’s alpha, and floor and ceiling effects were evaluated by calculating the proportion of observations in minimum and maximum categories of subtests. Results: The results showed a lack of intra-rater and inter-rater reliability and a large variation of agreement due to a substantial ceiling effect. Internal consistency was below the acceptable value in half of the cognitive areas. Conclusion: The study found that LOTCA-II/D is not reliable in acute clinical practice, and it could thus not be validated for use in this setting.     

The inter-rater and test–retest reliability of the Self-care and Transfer scales,and intra-rater reliability of all scales of the Swedish Translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S)

Abstract

Objective: The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) are used internationally to measure the outcomes of occupational therapy services across diagnoses, ages, and health care settings. This study reports on the inter-rater and test–retest reliability of the Self-care and Transfer scales as well as the intra-rater reliability of all scales of the Swedish (AusTOMs-OT-S) translation. Methods: Fifteen occupational therapists rated 11 case study clients on two occasions, separated by two weeks. Test–retest reliability and inter-rater reliability were calculated for the Self-care scale and Transfer scales. Moreover, intra-rater reliability was calculated for each of the 15 therapists across all 12 scales. Results: The inter-rater reliability intraclass correlation coefficients (ICCs) were all found to be high to very high, ranging from ICC 0.762 to 0.904; the intra-rater reliability coefficients were also very good with 11 of the 15 therapists achieving ICCs of 0.745 or over, and finally the test–retest ICCs were also found to be high, ranging from 0.705 to 0.920. Conclusions: Although further research is required to confirm reliability, preliminary reliability of the AusTOMs-OT Swedish translation has been demonstrated and therapists can have confidence when using the scales.     

Reliability and Validity of the Upper‐body Dressing Scale in Japanese Patients with Vascular Dementia with Hemiparesis

The purpose of this study was to examine the reliability and validity of the Upper‐body Dressing Scale (UBDS) for buttoned shirt dressing, which evaluates the learning process of new component actions of upper‐body dressing in patients diagnosed with dementia and hemiparesis. This was a preliminary correlational study of concurrent validity and reliability in which 10 vascular dementia patients with hemiparesis were enrolled and assessed repeatedly by six occupational therapists by means of the UBDS and the dressing item of the Functional Independence Measure (FIM). Intraclass correlation coefficient was 0.97 for intra‐rater reliability and 0.99 for inter‐rater reliability. The level of correlation between UBDS score and FIM dressing item scores was ?0.93. UBDS scores for paralytic hand passed into the sleeve and sleeve pulled up beyond the shoulder joint were worse than the scores for the other components of the task. The UBDS has good reliability and validity for vascular dementia patients with hemiparesis. Further research is needed to investigate the relation between UBDS score and the effect of intervention and to clarify sensitivity or responsiveness of the scale to clinical change. Copyright © 2014 John Wiley & Sons, Ltd.     

Reliability of an Upper-limb Assessment Tool for Acute Neurological Patients

Objective

Occupational therapists working within acute neurosciences assume a primary role in the identification of upper-limb impairments, and to achieve this, they require measurement tools, which are sensitive to small changes in patient function. The purpose of this study was to examine the psychometric properties of a newly developed upper-limb assessment tool (ULAT) for acute neurological patients.

Methods

Using a prospective study design, 30 patients with a confirmed neurological diagnosis completed the ULAT. Nonparametric statistics were then completed to examine the ULAT’s reliability.

Results

The ULAT exhibited strong intra- and inter-rater reliability and acceptable internal consistency across patients with various neurological diagnoses.

Conclusion

Evidence of the ULAT’s robust reliability supports its ongoing refinement and potential use in acute care neurological settings by occupational therapists.     

Improving the sensitivity of the Barthel Index for stroke rehabilitation

The Barthel Index is considered to be the best of the ADL measurement scales. However, there are some scales that are more sensitive to small changes in functional independence than the Barthel Index. The sensitivity of the Barthel Index can be improved by expanding the number of categories used to record improvement in each ADL function. Suggested changes to the scoring of the Barthel Index, and guidelines for determining the level of independence are presented. These modifications and guidelines were applied in the assessment of 258 first stroke patients referred for inpatient comprehensive rehabilitation in Brisbane, Australia during 1984 calendar year. The modified scoring of the Barthel Index achieved greater sensitivity and improved reliability than the original version, without causing additional difficulty or affecting the implementation time. The internal consistency reliability coefficient for the modified scoring of the Barthel Index was 0.90, compared to 0.87 for the original scoring.     

Mixed Model在脑卒中患者社区早期康复干预效果评价中的应用

目的应用MixedModel评价早期社区康复干预对脑卒中患者的效果。方法对符合纳入标准的32名脑卒中患者,在研究的第0,1,2,3、6月采用Barthel指数和Berg平衡量表进行社区康复干预评估。结果随着干预的进行,患者的Barthel指数和Berg评分呈逐渐上升趋势,并且不同时间之间Barthel指数和Berg评分差异均有统计学意义（P〈0．01）。对于Barthel指数,第0个月的Barthel指数的均数为54．38,康复干预6个月后增加到87．07,其差值为31．78（95％CI：24．21～39．36）。对于Berg评分,第0个月Berg评分均数为26．59,康复干预6个月后增加到46．62,其差值为18．66（95％CI：13．76～23．56）。结论社区早期康复干预对脑卒中患者恢复平衡能力和日常生活能力具有重要意义。     

Measurement Properties of the Barthel Index in Geriatric Rehabilitation

Objective

The Barthel index (BI) is a widely used observer-based instrument to measure physical function. Our objective is to assess the structural validity, reliability, and interpretability of the BI in the geriatric rehabilitation setting.

The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN)

BACKGROUND & AIMS: Nutrition screening tools (NST) identify individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutritional support. The aims of this study were to design, pilot and evaluate a NST based on four nutritional parameters (weight, height, recent unintentional weight loss and appetite) recommended by the British Association for Parenteral and Enteral Nutrition as the minimum required to identify patients with nutritional problems. METHODS: A dietitian assessed the nutritional status of 100 patients admitted to the general medical wards. Results from the study were used to design a NST. The concurrent validity of the screening tool was then assessed, by comparing it with a nutritional assessment by an experienced dietitian in 100 patients admitted to acute medical and elderly care wards. The inter-rater reliability of the screening tool was also assessed using three nurses and 26 acute medical patients. RESULTS: All four nutritional parameters were required to identify all at-risk patients. There was good agreement between the screening tool and the dietitian's assessment (kappa = 0.717) and inter-rater reliability was reasonable (mean kappa = 0.66). CONCLUSION: The screening tool was valid and reliable in identifying medical patients at risk of malnutrition and was quick and simple to use.     

第二受害者结局评估工具分析及启示

目的分析第二受害者结局评估工具的主要内容、信效度得分、特点，并对工具未来发展提出思考和建议。方法检索数据库获取相关文献。结果最终纳入6类评估工具:第二受害者经验与支持量表（SVEST）、西班牙第二受害者调查工具、第二受害者心理影响与恢复调查工具、第二受害者伤害影响因素评价调查工具、医生母亲双重角色(DR-MOM)第二受害者调查工具、第二受害者事件反应调查工具。其中，SVEST包括1种英文版和3种汉化版。各工具均采用自评方式进行，内容各有侧重。结论第二受害者结局评估工具的理论基础薄弱，未突出特色，未来有必要提高此类工具的科学性和特异性，并开发适合我国国情的第二受害者结局评估工具。     

Occupational Therapy Assessment of Potential Hazards in the Homes of Elderly People: an Inter-Rater Reliability Study

Falls and fractured hips in the elderly have often been attributed to home environmental factors. There is a lack of research evaluating occupational therapists' reliability in assessing the home environment for potential safety hazards. Twenty home visits were conducted by seven therapists with two occupational therapy raters present at each home visit. The kappa statistic was used to determine inter-rater reliability. Generally, therapists were able to reliably rate potential hazards in the home, however, some areas, such as the toilet area and shower rails had poor reliability. It is recommended that more objective criteria be developed for assessing potential hazards in the home.     

Psychiatric decision making in the 90's: the coming era of decision support

Guidelines for how mental health care is allocated form a pivotal point on the fulcrum balancing preservation of quality care and containment of costs. Advances in information system technology are creating new opportunities for research-based decision support tools in this area. Such tools can systematically and reliably scale the domains of evidence used in psychiatric assessment in order to more precisely describe the severity of impairment and point to appropriateness of care decisions. The first psychiatric decision support tools were introduced in the 1960s in response to changes in the mental health community, but research in this area tended to have limited inter-rater reliability or validity. More recently, several computerized decision support tools have been developed, with a stronger research base and consequently a wider application. These tools are reviewed, and one such tool is described in greater depth to illustrate the possibilities of computer technology and the direction in which decision support software is headed.     

Activity-based assessment (BIA)--inter-rater reliability and staff experiences

The BIA method, based on assessment of patients in activities, was developed to enable reliable assessment of clients' occupational functioning. The method evaluates the patient's ego functions and capacity for activity and participation. The aims of this study were to examine inter-rater reliability for the BIA method and to compare the experiences of staff working with the BIA with those of staff using standard assessment (SA). In SA, the patient's activity problems and capacities were assessed without using any structured protocol. Four staff members worked according to the BIA method and eight according to SA. The estimation of reliability was based on data from 14 patients who went through the BIA and were assessed by five staff members. These assessments resulted in all in about 400 statements, which were classified and compared for agreement between raters. In order to address the aim concerning staff experiences, a questionnaire was filled out anonymously by the staff. The inter-rater reliability of the nine ego functions varied from 0.76 to 1.00. The scale was deemed appropriate by the BIA staff and they had significantly higher median ratings on work satisfaction and appropriateness than the SA staff. In conclusion, the inter-rater reliability of the BIA was found to be good. The BIA method also seems to have a high degree of appropriateness, constituting a promising assessment tool when occupational functioning is addressed.