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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.  相似文献   

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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.  相似文献   

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Background:  The Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART), assesses the domains of clothing, hygiene, nutrition, mobility, safety, residence and supports.
Aim:  To examine the interrater reliability of the PC-PART in a rehabilitation setting.
Methods:  Assessments made by the researcher were compared to the interdisciplinary rehabilitation team. The research and standard assessments occurred within three working days. Raters were blind to each other's scores. Sample participants were a consecutive case-series of rehabilitation clients with varied diagnoses, activity limitations and participation restrictions. Of 66 consecutive patients seen during the a priori determined enrolment period, 25 were included in the study (nine males and 16 females, aged 44–85 years). The remaining 41 patients did not meet the inclusion criteria.
Conclusion:  The PC-PART has good interrater reliability. Clinicians, administrators and researchers can be reassured about this aspect of the validity of the tool.  相似文献   

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Background/Aim:  The Assessment of Living Skills and Resources (ALSAR) measures instrumental activities of daily living in the older population and has some established reliability estimates. The study aimed to examine the interrater reliability of the original ALSAR in an Australian context and develop revised scoring criteria that were examined in a second interrater reliability study.
Method:  Seven occupational therapists rated a total of 20 clients over 65 years of age, with 10 clients in each study.
Results:  Using the original criteria, the ALSAR had relatively low interrater reliability across all scores (ICC range 0.253–0.756). The revised version yielded improved interrater reliability on all scores (ICC range 0.541–0.896).
Conclusion:  Detailed scoring criteria increased the interrater reliability of the ALSAR, enhancing its usefulness for clinical practice and research.  相似文献   

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The need of a standardized evaluation tool for clinical practice is acknowledged by occupational therapists worldwide. The purpose of this study was to examine the inter-rater and test-retest reliabilities of the Taiwanese Rehabilitation Functional Scale (TaRFS) developed in Taiwan. Seventy-five subjects with varying diagnoses were recruited to participate in the study. They came from an inpatient re-habilitation unit within a university-affiliated hospital. All participants were tested on a functional measure of their independence on activities of daily living and cognitive-social tasks, and of their sense of well-being. The Activity of Daily Living (ADL) and CognitiveSocial Skills (CSS) subscales of the TaRFS were found to be reliable across raters and times. But individual items on the Subjective Well Being subscale were not stable across time. The results indicated that the ADL subscale as well as most items in the CSS subscale of the TaRFS can be utilized reliably in clinical practice. The SWB subscale of the TaRFS may need further revision in order to be used stably across time. The development of the TaRFS and future revision of the scale can be beneficial for occupational therapists in Taiwan to provide evidence of their intervention efficacy.  相似文献   

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Objectives

The aim of this study was to assess the nutritional status and functional capacity of 144 community-dwelling elderly in three rural ethnic groups, namely, the Oy, the Brau and the Lao, of southern Laos.

Methods

The Mini nutritional assessment (MNA) questionnaire and Determine Your Nutritional Health checklist were used to assess nutritional status. The Barthel Activities of Daily Living questionnaire and Lawton and Brody’s Instrumental Activities of Daily Living questionnaire were used to assess the functional capacity of the respondents.

Results

The MNA score results indicated that 92.5 % of Oy respondents, 85.4 % of Brau respondents and 60 % of Lao respondents were malnourished. Analysis of variance tests showed that the MNA scores of the Oy and Lao ethnic groups and of the Brau and Lao ethnic groups were significantly different ( both p < 0.01), but that there was no significant difference between the MNA scores of the Oy and Brau ethnic groups (p > 0.05). In terms of functional capacity, 47.2 % of Oy respondents, 43.9 % of Brau respondents and 20 % of Lao respondents had limitations in their activities of daily living, whereas 98.1 % of Oy respondents, 97.6 % of Brau respondents and 86 % of Lao respondents had limitations in their instrumental activities of daily living. Body mass index, reduced appetite, number of meals consumed daily and presence of common diseases predicted nutritional status in all three ethnic groups; the remaining factors differed by ethnicity. This result implies that ethnic differences and other factors, such as location of the village, services, resources within the village and respondents’ lifestyles, can affect nutritional status.

Conclusions

Because predictors of nutritional status varied by ethnicity, there is a need for area-specific interventions aimed at improving the quality of life of the elderly in these areas.  相似文献   

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SUMMARY

The aim of this study was to identify client factors that may influence physicians' decision to refer individuals with multiple sclerosis (MS) to occupational therapy (OT). Study participants were seen in an MS clinic in which a physician referral was required prior to receipt of OT services. The symptoms and functional impairments of 40 individuals with MS who were either seen or not seen for OT services were compared. Findings show that individuals with MS who were referred to OT reported more difficulties with speaking or swallowing, hand tremors, uncontrolled urinary urgency, weakness of the legs, and performing functional activities than individuals with MS who did not receive OT services. Results also suggest that difficulties in functional mobility, work, community mobility and meal preparation were more likely to prompt OT referral and subsequent therapy for individuals who had attended the MS Clinic than any specific sign or symptom.  相似文献   

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This paper examines the healthcare needs of community‐dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi‐square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home‐care program. There was a high number rated as “severe dementia,” “fully dependent,” “severely or fully dependent in the activities of daily living (ADL),” and “severe frailty.” There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well‐structured home‐care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality‐integrated interventions, including the emotional and psychological balance of the caregiver.  相似文献   

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ABSTRACT

The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.  相似文献   

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Objective: Human ‘functioning’ is about how people live on a day‐to‐day basis. This paper sets out the case for adopting a common language about functioning that would improve population health information and information sharing across health and community service systems. Approach: Modern health systems recognise the importance of human functioning in addition to diagnosis and disease prevention. ‘Functioning’ is important in the context of chronic disease, mental health, healthy ageing, and the right of people with disabilities and their carers to participate in society. We outline major directions in the health system and their relationship to the concept of functioning. Conclusions and implications: The concept of functioning has not been used explicitly and consistently in Australian health and human service systems, which nevertheless deal with the 20% of the population who experience difficulties in functioning. The International Classification of Functioning, Disability and Health (ICF) is the international standard for definition, classification, information and measurement of functioning. While it has been partially implemented in Australia, it should be used more broadly, across health and community services, as the basis for information on functioning. This is an intended parallel to the use of the ICD as the standard classification and code list for disease monitoring and related health information systems. Monitoring health status and planning interventions and resources require information about people's functioning in their daily lives as well as their diseases. Such information should be based on the international standards developed for this purpose.  相似文献   

13.
ABSTRACT

The purposes of this study were to compare dexterity, visual perception, and abilities to carry out activities of daily living (ADL) in persons with different multiple sclerosis (MS) subtypes and to determine what relationships exist between the three variables. Fifty-six persons with MS were administered tests of dexterity, visual perception, and ADL ability. Demographic variables and scores on Kurtzke's Expanded Disability Status Scale were also collected. Scores from the chronic-progressive group were significantly higher than those of the benign and progressive-relapsing groups for the Nine-Hole Peg Test–Left Hand, Grooved Peg Test, and Functional Status Index (except Functional Status Index–Pain). There were no differences between the MS groups for any demographic variables except on the Expanded Disability Status Scale. Visual perception did not correlate with dexterity or ADL ability, and only dexterity scores for the left hand correlated with ADL ability. Persons with the severer subtype of MS were significantly impaired compared with the least severe group for dexterity and ADL ability. Decreased dexterity was associated with needing more assistance and having more perceived difficulty with ADL.  相似文献   

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Aim: The Assessment of Motor and Process Skills (AMPS) is a standardised, valid, reliable, observational assessment that is sensitive to change over time. This research aimed to examine the change in AMPS performance in patients discharged from a neurosurgical rehabilitation ward to a home‐based therapy programme over a four‐week time frame. Methods: A total of 15 individuals with acquired brain injury who were participating in rehabilitation were recruited to the study. The AMPS was conducted with each individual during the participant’s inpatient rehabilitation and again approximately four weeks later, while participating in home‐based rehabilitation. Assessment results were collated using the AMPS computer programme and entered into a statistics package from which data were analysed. Results: As a group, no statistically significant change in function was identified between the home and hospital environments; however, individual results did indicate a change in occupational performance for many of the participants. Conclusions: The AMPS was shown to reflect a change in occupational performance for many of the research participants. This research supports previous studies which indicate that some individuals’ motor and process skill abilities appear to be affected by the environment in which they perform. This suggests that occupational therapists wishing to know how an individual will perform activities of daily living should evaluate the individual’s performance in the environment in which they will be functioning.  相似文献   

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Objectives The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change. Methods Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management. Results The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends. Conclusion Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.  相似文献   

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Objective

To study instruments used and definitions applied in order to measure (instrumental) activities of daily living (I [ADL]) functioning and functional decline in hospitalized older medical patients.

Study Design

We systematically searched Medline, Embase, and the Cochrane Database of Systematic Reviews from 1990 to January 2010. Articles were included if they (1) focused on acute hospitalization for medical illness in older patients; (2) described the instrument used to measure functioning; and (3) outlined the clinical definition of functional decline. Two reviewers independently extracted data.

Results

In total, 28 studies were included in this review. Five different instruments were used to measure functioning: the Katz ADL index, the IADL scale of Lawton and Brody, the Barthel index, Functional Independence Measure, and Care Needs Assessment. Item content and scoring between and within the instruments varied widely. The minimal amount for decline, as defined by the authors, referred to a decrease in functioning between 2.4% and 20.0%.

Conclusion

This review shows there is a large variability in measuring (I)ADL functioning of older hospitalized patients and a large range of clinical definitions of functional decline. These conceptual and clinimetric barriers hamper the interpretation and comparison of functional outcome data of epidemiological and clinical studies.  相似文献   

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目的 观察基于加拿大作业表现量表(COPM)评估结果开展的作业治疗方案对全面性发育迟缓(GDD)儿童作业活动表现、满意度以及日常生活能力的影响,为GDD儿童作业治疗方案的制定提供临床实践参考。方法 选取2021年3月—2022年3月在唐山市妇幼保健院儿童康复科门诊接受康复治疗的GDD儿童69例,采用随机数字表法将其随机分对照组(n=35)和观察组(n=34),对照组给予常规康复治疗,观察组在此基础上将作业治疗替换为基于COPM结果的目标导向性的作业治疗方案,治疗时间持续3个月。分别于治疗前和治疗3个月后采用COPM评估儿童目标任务的作业表现及满意度,儿童功能独立性评定量表(WeeFIM)评估儿童日常生活能力。结果 治疗后,观察组和对照组COPM表现分均较治疗前显著改善,差异有统计学意义(t=21.845、7.533,P<0.05),且观察组优于对照组(t=2.551,P<0.05);观察组和对照组COPM满意度分较治疗前显著改善(t=22.240、8.329,P<0.05),且观察组优于对照组(t=2.300,P<0.05);观察组较对照组的COPM表现分有效性...  相似文献   

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Juvenile rheumatoid arthritis (JRA) is a frequent source of chronic illness and disability in childhood. Traditional clinical assessment of clients with JRA include measures of joint deformity, range of motion, duration of morning stiffness, pain and strength. In many instances, these traditional measures have little or no significance or relevance to paediatric clients and their parents whereas functional skills used in every day living are more likely to be meaningful. Reliable, valid and sensitive measures of function are an essential part of the holistic care and occupational therapy management of paediatric clients with JRA. Several self-report functional instruments are now available which measure a child's or adolescent's functional abilities. In this paper, the impact of JRA on functional development, JRA and functional assessment and specific types of functional measures that occupational therapy personnel can use with clients with JRA will be discussed. It is imperative to identify which functional measures can be effectively used in the clinical setting with paediatric clients diagnosed with JRA. Copyright © 1996 Whurr Publishers Ltd.  相似文献   

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