Construct and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

This paper reports on the construct validity (scale design and convergent validity) and ecological validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST). The performance of 208 participants following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA-Geriatric version (LOTCA-G)) was compared. The OT-APST performance of the stroke sample was compared with a healthy normative sample (n = 356). The relationship between the OT-APST performance and the Functional Independence Measure (FIM) score of the participants following stroke was also examined. Factor analysis and internal consistency results supported the scale design of the OT-APST. Significant correlations between the performance of the participants following stroke on the OT-APST and the reference tool supported the convergent validity of the OT-APST. The ability of the OT-APST to separate the two participant groups provided further evidence of its construct validity. Significant correlations between OT-APST and FIM scores supported the ecological validity of this tool. This study shows that the OT-APST is an ecologically valid tool with demonstrated construct validity in the assessment of visual perception.     

Using the Assessment of Motor and Process Skills to measure functional change in adults with severe traumatic brain injury: A pilot study

Aim:  To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS).
Methods:  This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation.
Results:  Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation ( z = – 2.70 , p  =  0.01 ; z = – 2.81 , P =  0.01 , respectively).
Conclusions:  The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.     

Criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

This paper reports on the criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) including concurrent criterion validity and its sensitivity and specificity. The performance of 208 people following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA – Geriatric version (LOTCA-G)) was compared. The OT-APST subscale scores and performance outcome (intact or impaired) on related subscales of the reference tool was analyzed to evaluate the concurrent criterion validity of the OT-APST and its sensitivity and specificity at selected cut-off scores. Significant correlations were found between participants’ performance (intact or impaired) on the reference tool and scores on the OT-APST. The sensitivity and specificity of the OT-APST were analyzed at selected cut-off scores to explore the validity of decisions based on OT-APST performance when compared with the reference tool. This study shows that the OT-APST is a tool with demonstrated concurrent criterion validity for the assessment of visual perception.     

Criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)

This paper reports on the criterion validity of the Occupational Therapy Adult Perceptual Screening Test (OT-APST) including concurrent criterion validity and its sensitivity and specificity. The performance of 208 people following stroke on the OT-APST and a reference tool (either the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) or the LOTCA--Geriatric version (LOTCA-G)) was compared. The OT-APST subscale scores and performance outcome (intact or impaired) on related subscales of the reference tool was analyzed to evaluate the concurrent criterion validity of the OT-APST and its sensitivity and specificity at selected cut-off scores. Significant correlations were found between participants' performance (intact or impaired) on the reference tool and scores on the OT-APST. The sensitivity and specificity of the OT-APST were analyzed at selected cut-off scores to explore the validity of decisions based on OT-APST performance when compared with the reference tool. This study shows that the OT-APST is a tool with demonstrated concurrent criterion validity for the assessment of visual perception.     

Psychometric Development of the Individualized Retinopathy-Dependent Quality of Life Questionnaire (RetDQoL)

Objectives:  Psychometric development of the Retinopathy-Dependent Quality of Life (RetDQoL) questionnaire in a cross-sectional study of 207 German patients with diabetic retinopathy. Forty patients (19%) also had clinically significant macular edema.
Methods:  Principal component analyses identified factor structure, and Cronbach's alpha assessed internal consistencies. Construct validity was examined by testing the additional impact of macular edema and expected relationships of RetDQoL scores with visual impairment, stage of diabetic retinopathy, subscales of the SF-12, and scores of the Retinopathy Treatment Satisfaction Questionnaire (RetTSQ). Analyses were conducted using the RetDQoL's AWI score (average weighted impact of diabetic retinopathy on 26 life domains) and its two overview items (present QoL in general and retinopathy-specific QoL). Content validity was investigated using an open-ended question to identify any additional items needed.
Results:  A forced one-factor solution of the 26 specific weighted impact ratings showed all items except working life (applicable to 27%) to load >0.55, and Cronbach's alpha was 0.96, showing very high reliability. Greater impairment, worse diabetic retinopathy, and macular edema were associated with greater negative impact on scores. AWI correlated as expected more highly with retinopathy-specific QoL ( r  = 0.71, P  < 0.01) than with present QoL ( r  = 0.28, P  < 0.01). RetDQoL scores correlated moderately with SF-12 subscales ( r  = 0.22–0.51, P  < 0.01) and RetTSQ scores ( r  = 0.27–0.51, P  < 0.01). For six domains, >60% of patients reported no impact. No additional domains were needed.
Conclusions:  The RetDQoL is valid and reliable for patients with diabetic retinopathy with or without macular edema. It may be shortened if findings are confirmed cross-culturally.     

Development of a standardized occupational therapy screening tool for visual perception in adults

Occupational therapy assessment and treatment of visual perceptual impairments are integral to the rehabilitation of clients following stroke and other acquired brain injuries. Occupational therapists need to identify the nature of visual perceptual performance impairments in order to choose rehabilitation intervention strategies appropriate for remediation of specific problems or to compensate for limitations in daily function. This paper describes the variations in visual perception terminology and occupational therapy approaches to visual perceptual assessment. Limitations of existing assessment tools for visual perception are highlighted in terms of reliability, validity, normative information, length of time to administer, and comprehensiveness in screening for visual perceptual impairment. In response to these limitations, a battery of items, called the Occupational Therapy Adult Perceptual Screening Test (OT-APST) was selected to screen adults comprehensively for impairments of agnosia, visuospatial skills including body scheme and neglect, constructional skills, apraxia, and acalculia. It also includes a subtest to evaluate functional skills directly observed during screening. This new battery has established reliability, validity and age-stratified normative data for adults 16 to 97 years of age. The OT-APST is recommended for use in conjunction with observational assessment of activities of daily living for clients with stroke and acquired brain injury.     

Survey Assessment of Continuation of and Satisfaction with Pharmacological Treatment for Urinary Incontinence

Purpose:  To evaluate treatment satisfaction and compliance with pharmacologic therapy in urinary incontinence patients.
Materials and Methods:  An online survey was returned by 1447 individuals from a nationwide panel of adults who had previously reported treatment for incontinence symptoms and agreed to participate in survey research. Data on demographics, incontinence severity, treatment compliance, and satisfaction were obtained. Logistic regression was used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for characteristics associated with pharmacologic treatment dissatisfaction and discontinuation.
Results:  The sample was predominantly female (87%) and white (93%) with a mean age of 56 years. On average, patients urinated 10 times/day and experienced 16 wetting accidents in the week preceding survey. Overall, 25% reported being somewhat or very dissatisfied with treatment. Those who reported a severe effect of incontinence on their lives were most likely to be dissatisfied (OR = 2.82, 95% CI = 1.89–4.23). Discontinuation of drug treatment was reported by 45% of study subjects, with major reasons being poor efficacy (in 41.3% of discontinuations), side effects (22.4%), and cost (18.7%). Predictors for discontinuation included young age (OR = 1.8, 95% CI = 1.2–2.8), experiencing symptoms for 10 or more years (OR = 1.5, 95% CI = 1.1–2.0), and experiencing more than 16 wetting accidents in the last week (OR = 1.6, 95% CI = 1.3–2.1).
Conclusions:  This online survey of self-selected incontinence patients indicated that almost half of those who have received drug treatment for incontinence had discontinued primarily because of lack of efficacy, side effects, and cost concerns. Our findings suggest a substantial degree of unmet need from current therapy among those with incontinence.     

Development of a standardized occupational therapy screening tool for visual perception in adults

Occupational therapy assessment and treatment of visual perceptual impairments are integral to the rehabilitation of clients following stroke and other acquired brain injuries. Occupational therapists need to identify the nature of visual perceptual performance impairments in order to choose rehabilitation intervention strategies appropriate for remediation of specific problems or to compensate for limitations in daily function. This paper describes the variations in visual perception terminology and occupational therapy approaches to visual perceptual assessment. Limitations of existing assessment tools for visual perception are highlighted in terms of reliability, validity, normative information, length of time to administer, and comprehensiveness in screening for visual perceptual impairment. In response to these limitations, a battery of items, called the Occupational Therapy Adult Perceptual Screening Test (OT-APST) was selected to screen adults comprehensively for impairments of agnosia, visuospatial skills including body scheme and neglect, constructional skills, apraxia, and acalculia. It also includes a subtest to evaluate functional skills directly observed during screening. This new battery has established reliability, validity and age-stratified normative data for adults 16 to 97 years of age. The OT-APST is recommended for use in conjunction with observational assessment of activities of daily living for clients with stroke and acquired brain injury.     

Further Validation and Responsiveness Assessment of the Herpes Outbreak Impact Questionnaire and Herpes Symptom Checklist

Objective:  The Herpes Outbreak Impact Questionnaire (HOIQ) and Herpes Symptom Checklist (HSC) are patient-completed questionnaires for assessing genital herpes outbreaks. This report describes the validation of paper-and-pencil versions of the scales and responsiveness assessments in an Australian clinical trial.
Methods:  Acceptability of the language of the original UK versions was tested with Australians. The HOIQ and HSC were then field-tested with patients. The new versions were validated using patients' daily responses to the questionnaires in a famciclovir study.
Results:  The HOIQ and HSC were readily adapted into Australian English and were acceptable to patients. Psychometric sample: N = 151; 81 (54%) male; mean age 39.9 ± 11.6 years; mean outbreaks 5.1 ± 3.0 per year. Internal consistency was good (alphas at outbreak 1 ranged 0.84–0.90 HOIQ and 0.73–0.87 HSC). Rasch analysis showed item stability over time. Correlations between HOIQ and HSC ranged from 0.46 to 0.60. Both scales distinguished outbreak healing presence or absence at day 6 ( P  = 0.001), and the HOIQ scale distinguished between symptom severity groups ( P  < 0.001). Scale scores declined significantly over study duration, exhibiting large effect sizes.
Conclusions:  The paper-and-pencil HOIQ and HSC were reliable, valid, and responsive in a clinical trial setting. These instruments are recommended for use in clinical studies.     

Reliability of the original and revised versions of the Assessment of Living Skills and Resources

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.     

The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies

Background/aim:  Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor.
Methods:  Eight databases (1985–2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data.
Results:  Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls.
Cohort:  Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97–1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03–1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59–2.71) and institutional (OR = 1.77; 95% CI: 1.66–1.89) settings.
Conclusions:  Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.     

Validity, Responsiveness, and Minimal Important Difference for the SF-6D Health Utility Scale in a Spinal Cord Injured Population

Objective:  To determine the feasibility, acceptability, discriminative validity, responsiveness, and minimal important difference (MID) of the SF-6D for people with spinal cord injury (SCI).
Methods:  A total of 305 people with SCI completed the SF-36 health status questionnaire at baseline and at subsequent occurrence of a urinary tract infection (UTI) or 6-month follow-up. Normative SF-36 data were obtained from the Australian Bureau of Statistics. SF-36 scores were transformed to SF-6D utility values using Brazier's algorithm. We used UTI as the external criterion of clinically important change to determine responsiveness and two categories of the SF-36 transition question ("somewhat worse" and "somewhat better") as the external criterion to determine the MID. Derived SF-12 responsiveness was also assessed.
Results:  The mean SF-6D values were: 0.68 (SD 0.21, n = 305) all patients; 0.66 (SD 0.19, n = 167) tetraplegia; 0.72 (SD 0.26, n = 138) paraplegia; 0.57 (SD 0.15, n = 138) with UTI. The Australian normative SF-6D mean value was 0.80 (SD 0.14, n = 18,005). The SF-6D was able to discriminate between SCI and the Australian normative sample (effect size [ES] = 0.86), tetraplegia–paraplegia (ES = 0.23), and it was responsive to UTI (ES = 0.86 SF-36 variant, ES = 0.92 SF-12 variant). The MID for respondents who reported being somewhat worse or somewhat better at follow-up was 0.03 (SD 0.17, n = 108/305), while the MID for only those who were somewhat worse was 0.10 (SD 0.14, n = 58).
Conclusions:  The content of the SF-6D is more appropriate than that of the SF-36 for this physically impaired population. The SF-6D has discriminative power and is responsive to clinically important change because of UTI. The MID is consistent with published estimates for other disease groups.     

Evaluation of a community-based weight management program for overweight and obese adolescents: The Loozit study

Aim:  To evaluate a community-based weight management program for overweight and obese adolescents aged 13–16 years.
Methods:  The present study was a group-based intervention over five months conducted in Australian community health centres. Program evaluation questionnaires were completed by adolescents and their parents. Seven semi-structured group sessions were held for adolescents: weekly for four weeks and then at two, four and five months. The program sessions focused on healthy eating, increasing physical activity, decreasing sedentary behaviour and increasing self-esteem. Adolescents' anthropometry, blood pressure and fasting blood biochemistry were measured. Adolescents completed validated questionnaires on diet, physical activity and self-esteem.
Results:  Twenty-two overweight and obese adolescents were recruited with a median body mass index (BMI) z-score 2.30. Recruitment strategies were identified and a high retention rate (91%) was achieved. The program was well received by adolescents. Parents reported their adolescents were making healthier food choices and increasing physical activity. At treatment end there were clinically significant improvements in self-perception scores for physical appearance and romantic appeal ( P  < 0.05), waist circumference (median 100.1 cm vs 97.1 cm; P  < 0.0001) and HDL cholesterol (median 1.10 mmol/L vs 1.20 mmol/L; P  = 0.02), but not BMI or BMI z-score.
Conclusions:  The Loozit weight management intervention is one of the first to involve adolescents in the evaluation of the program and to operate at a sustainable intensity in an accessible community setting. The present study provides valuable insights into the elements of a program that is acceptable to adolescents.     

Reliability of the Perceive, Recall, Plan and Perform System of Task Analysis: A criterion-referenced assessment

Objective:  To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury.
Methods:  Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency.
Results:  Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion (      –4.5%; 95% confidence interval for     : –10.67%→ 3.17%).
Conclusion:  The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury.     

Validity of the Health Profile-Types of the Spanish Child Health and Illness Profile-Adolescent Edition (CHIP-AE)

Objective:  To develop and validate a simplified, easy to interpret scoring system based on the health profile-types taxonomy for the Spanish version of the Child Health and Illness Profile-Adolescent Edition (CHIP-AE).
Methods:  The CHIP-AE was administered to a 1453 Spanish adolescents. Hierarchic and nonhierarchical cluster analyses, as well as conceptual considerations, were used to identify exhaustive, mutually exclusive health profile-types based in four CHIP-AE domain scores: Satisfaction, Discomfort, Resilience, and Risks. Validity of the health profile-types was assessed by testing expected differences among adolescents according to sex, age, socioeconomic status, and self-reported conditions. Logistic models were built.
Results:  A total of 13 health profile-types (10 that best fitted the data and three additional considered conceptually necessary) were identified. The largest group of adolescents was in the "Excellent health" or "Good health" types (43.4%), although 11.2% were in the "Worst health" profile. According to a priori hypotheses, being a girl (OR = 1.81; 95% CI = 1.26–2.60), older age (OR = 1.80; 1.26–2.57), and self-reported recurrent (OR = 2.49; 1.72–3.60) and psychosocial disorders (OR = 4.38; 2.92–6.56) were associated to the likelihood of a "Worst health" profile-type.
Conclusions:  The Spanish CHIP-AE health profile-types offer a simplified method to describe adolescents' patterns of health, which is valid and similar to the original US taxonomy. This can facilitate interpreting the instrument scores and using it for needs assessment, although additional research is required.     

Does maternal knowledge and parent education affect blood phenylalanine control in phenylketonuria?

Background  Metabolic control in phenylketonuria (PKU) may be influenced by parental ability because dietary treatment involves complex food choices. This is an observational study to compare maternal carer (MC) knowledge and parental education with phenylalanine concentrations in children with PKU.
Methods  Children ( n  = 46; 26 boys) aged 1–10 years (median age 6 years) on dietary treatment were recruited. Their median lifetime and median phenylalanine concentrations in the year prior to study were estimated. MC completed a questionnaire to assess dietary knowledge.
Results  Overall maternal knowledge on most aspects of diet was good and there was a correlation between annual median blood phenylalanine concentrations, but at the age of 5–6 years of age only, and higher maternal carer scores on PKU knowledge ( r  = −0.646; P  < 0.0001). Three of only four children (12%) with median phenylalanine concentrations above 500 μmol L⁻¹ in the year prior to study had both parents leave school without educational qualifications. Children who had median phenylalanine concentrations ( n  = 3; 7%) over the recommended ranges at 3 years of age or earlier continued to have poor control.
Conclusions  Blood phenylalanine control within the first 3 years of age, poor parental educational achievement at school level, and unsatisfactory maternal dietary knowledge may all influence longer-term blood phenylalanine control in children.     

The nutritional intake supplied by enteral formulae used in older children (aged 7–12 years) on home tube feeds

Background:  In the UK, patients aged 6–12 years contribute more than one-third of children on home enteral tube feeds (HETF). Many enteral feeds are given to this age group. The present study aimed to investigate the formula with the best nutritional composition for children aged 7–12 years on HETF by comparing the nutrient intake of three feed types; a paediatric feed (PF) for 1–6 year olds, an adult feed (AF), and a feed for children (OCF) aged 7–12 years.
Methods:  Twenty-five HETF children aged 7–14 years (median 10 years) were given a 6.3 kJ mL⁻¹ enteral feed designed for 7–12 year olds (or weighing 21–45 kg) for 9 months. Nutrient intakes on the 7–12-year-old feed were compared with baseline feed (paediatric n  = 10; or adult n  = 15).
Results:  At baseline, the PF failed to meet 100% of the reference nutrient intake (RNI) for three of 19 (16%) of the nutrients studied, whereas AF provided in excess of 250% of the RNI for six of 19 (32%) of the nutrients. During the trial, the nutrients on the OCF were two of 19 (11%) <100% and four of 19 (21%) >250% of the RNI. Only seven of 10 (70%) children on a PF met at least 100% of the UK RNI for calcium, compared to 17 of 19 (89%) on the OCF.
Conclusions:  It is important to offer older children an enteral feed that provides an optimal level of nutrients to meet their nutritional requirements. Feeds designed for 7–12-year-old children more closely meet nutrient requirements than paediatric or adult formulae, but require further modification to fully meet the nutritional needs of this group.     

The Malnutrition Screening Tool is a useful tool for identifying malnutrition risk in residential aged care

Background:  The Malnutrition Screening Tool (MST) is a valid nutrition screening tool in the acute hospital setting but has not been assessed in residential aged care facilities. The aim of this secondary analysis was to determine whether the MST could be a useful nutrition screening tool when compared with a full nutrition assessment by Subjective Global Assessment (SGA) in the residential aged care setting.
Methods:  Two hundred and eighty-five residents (29% male; mean age 84 ± 9 years) from eight residential aged care facilities in Australia participated in the study. A secondary analysis of data collected during a nutrition intervention study was conducted. The MST consists of two questions related to recent weight loss and appetite. Although the MST was not specifically applied, weight loss and appetite information was available and an estimated MST score (0–5) was calculated. Nutritional status was assessed by a research assistant trained in using the SGA.
Results:  Malnutrition prevalence was 42.8% (122 malnourished out of 285 residents). Compared to the SGA, the MST was an effective predictor of nutritional risk (sensitivity = 83.6%, specificity = 65.6%, positive predictive value = 0.65, negative predictive value = 0.84).
Conclusions:  The components of the MST have acceptable sensitivity and specificity, suggesting that it can play a valuable role in quickly identifying the risk of malnutrition in the residential aged care setting. Further prospective research using the MST tool against a broader array of objective and subjective nutritional parameters is required to confirm its validity as a screening tool in aged care settings.     

Short stature: increased in children with severe learning disability

Introduction   'Health for all children' recommends that children should be screened for growth disorders at school entry with a 0.4th centile 'cut-off'. Following the diagnosis of growth hormone deficiency in four children attending local special schools, our aim was to compare the height distribution of children attending special schools with mainstream schools.
Methods   Children at two local special schools were measured using a Leicester height measurer and values converted to standard deviation scores (SDS). Children were categorized according to whether there were known factors that could affect height. The data were compared with those collected from local mainstream schools.
Results   In total, 242 children were registered at the two special schools and 192 children were measured. The mean height SDS of children in mainstream school ( n  = 2301) was similar to national standards at −0.09 (SD 1.02). The mean height SDS distribution of the 192 children in special schools (age range 3.2–18.4 years; median age 11.3 years) was −0.73; 95%CI −0.9 to −0.5. In those with no established diagnosis to explain altered growth ( n  = 120) this was −0.613; 95%CI −0.8 to −0.4. Both pre-pubertal ( n  = 37) and pubertal ( n  = 83) children were short and eight (6.7%) had a height less than the 0.4th centile.
Conclusions   Children attending special school with severe or profound learning disability were shorter than those attending mainstream school. This is still the case following the exclusion of children with a known cause for abnormal growth. This underlines the importance of each child being assessed by professionals with a refined knowledge of normal and abnormal growth.