Interrater reliability of the Personal Care Participation Assessment and Resource Tool (PC-PART) in a rehabilitation setting

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.     

Agreement Between Occupational Therapists and Clients with Stroke on Three Outcome Measures

In recent years, the occupational therapy profession has been under increased pressure to document the outcomes of interventions in order 10 improve the quality of client care and to provide evidence of the effectiveness and efficiency of services to recipients and sponsors. The literature to date has focused primarily on establishing therapy outcomes from a therapist perspective. However, attention must also be paid to the views of our consumers regarding the outcomes of therapy. The purpose of this study was to determine whether clients and therapists agree regarding client scores on three outcome measures. The study included 4 occupational therapists and 20 clients with stroke who rated clients' status in terms of personal activities of daily living, instrumental activities of daily living and quality of life, at admission of clients as well as discharge from rehabilitation. The results indicated that there was generally only moderate agreement between therapists' and clients' ratings at both admission and discharge. These findings suggest that therapists should continue to spend time exploring client status with their clients so that both parties have the best possible understanding of the clients' capabilities, and the outcome of therapy. The findings also suggest the need to administer client outcome assessments as well as to utilize client self-reports.     

The Relationship Between Cognition and Daily Activities in Cases of Mild Alzheimer's Disease

The purpose of this study was to investigate the relationship between cognitive functions, assessed by neuropsychological tests, and instrumental activities of daily living (IADL) ability, assessed by the Assessment of Motor and Process Skills (AMPS) in persons with mild Alzheimer's disease. Fifty-two participants were included in the study. We found significant relationships between the AMPS IADL process ability and Factors 1 (perceptual speed, visuoconstructive ability) and 4 (secondary memory). The AMPS IADL motor ability showed a significant relationship to Factors 1 and 3 (logical memory). The cognitive factors explained 24 26% of the variability in AMPS IADL ability. The results indicate that cognitive functions had a significant impact on IADL ability in this population. However, as 74–76% of the variability in the IADL ability was left unaccounted for by the cognitive functions, it is important to assess both cognitive functions and IADL ability when investigating persons with mild dementia. Further study of the complex interaction between a variety of influencing factors is needed to better understand the consequences of dementia on everyday life functioning.     

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.     

Examination of the change in Assessment of Motor and Process Skills performance in patients with acquired brain injury between the hospital and home environment

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.     

Inter-rater reliability of the original and modified Barthel Index,and a comparison with the Functional Independence Measure

The Barthel Index (BI), the Modified Barthel Index (MBI) and the Functional Independence Measure (FIM) are all widely used by occupational therapists as assessment tools for clinical decision-making and outcome measurement. All of these tools have demonstrated validity and the BI and the FIM have demonstrated inter-rater reliability. The MBI has been modified to increase sensitivity; however, there have been no publications on the inter-rater reliability of this tool following the changes. The purpose of this research was to examine the inter-rater reliability of two versions of the Barthel Index, and draw some comparisons between this assessment tool and the FIM. Twenty-five patients with neurological and orthopaedic conditions were assessed by three occupational therapists using the three tools. The method of analysis selected was percentage agreement and intraclass correlation coefficient. The results indicated that both the original and modified versions of the Barthel Index possess good inter-rater reliability. As all three tools have demonstrated adequate reliability and validity, it is suggested that clinicians select the most sensitive tool that best meets their clinical needs, and use this assessment tool in its standardized format.     

Examining the Effect of the First Wave of the COVID-19 Pandemic on Home Care Recipients’ Instrumental Activities of Daily Living Capacity

ObjectiveTo examine the effect of the pandemic on, and factors associated with, change in home care (HC) recipients’ capacity for instrumental activities of daily living.DesignRetrospective cohort study.Setting and participantsHC recipients in Ontario, Canada, between September 1, 2018, and August 31, 2020, who were not totally dependent on others and not severely cognitively impaired at baseline.MethodsData were collected with the interRAI Home Care assessment. Outcomes of interest were declines in instrumental activities of daily living. Factors hypothesized to be associated with declining function were entered as independent variables into multivariable generalized estimating equations, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Those significant at P < .01 were retained in the final models.ResultsThere were 6786 and 5019 HC recipients in the comparison and pandemic samples, respectively. Between baseline and follow-up for the 2 groups, 34.1% and 42.1% of HC recipients declined in shopping, whereas 25.2% and 30.5% declined in transportation capacity in the comparison and pandemic sample, respectively. For shopping, those with cognitive impairment (OR 0.83, 95% CI 0.76-0.89) and receiving formal care (OR 0.72, 95% CI 0.62-0.85) were less likely to decline, whereas those who were older (OR 1.91, 95% CI 1.69-2.16) and had unstable health (OR 1.31, 95% CI 1.16-1.48) were more likely. For transportation, those receiving informal (OR 0.71, 95% CI 0.61-0.81) or formal care (OR 0.56, 95% CI 0.47-0.67) were less likely to decline, whereas those who were older (OR 1.81, 95% CI 1.58-2.07) and had unstable health (OR 1.35, 95% CI 1.119-1.54) were more likely.Conclusions and implicationsThe pandemic was associated with a decline in HC recipients’ capacity for shopping and transportation. HC recipients who are older and have unstable health may benefit from preventive strategies.     

An interrater reliability study of the revised elderly persons' disability scale

The aim of this study was to investigate the interrater reliability of the Revised Elderly Persons' Disability Scale (REPDS). In a correlational design four raters assessed 15 subjects all over the age of 65, and diagnosed as having dementia of varying stages of severity. All subjects attended day hospital facilities and were assessed by the raters. The raters comprised two staff nurses, one occupational therapist and one occupational therapy helper. Kendall's coefficient of concordance (W) was used to determine the overall interrater reliability of the REPDS as well as the seven subsections which make up this assessment tool. It was found that all of the subsections and the overall scale obtained significant values of W at the p < 0.05 level. The Spearman rank order correlation coefficient (r_s) was used to compare the raters' scores individually, which suggested that the qualified members of the staff achieved slightly higher levels of interrater reliability in comparison to an unqualified staff member.     

Reliability and Validity of the Milliken Activities of Daily Living Scale

Development of a self-report measure of activity limitation that combines measures of ability with necessity is described. The history of the Milliken Activities of Daily Living Scale (MAS) is traced, and the current measure is described. The test-retest reliability and concurrent validity of the MAS is studied. The MAS is found to have excellent reliability and good validity. The utility of the instrument to guide clinical practice is described, with a discussion of the importance of client-centered self-report measures of activity limitation.     

Occupational Therapy Intervention: Effects on Self-Care,Performance, Satisfaction,Self-Esteem/Self-Efficacy,and Role Functioning of Older Hispanic Females with Arthritis

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.     

The Assessment of Motor and Process Skills as a measure of ADL ability in schizophrenia

Background: Functional impairments in schizophrenia are substantial, complex, and persistent. Objective measurement of ADL ability, functional capacity and performance is needed for effective intervention planning and outcome evaluation. Objective: To evaluate ADL ability in people with schizophrenia using the Assessment of Motor and Process Skills (AMPS) and to determine the utility of using the AMPS to predict levels of assistance required for successful community living. Method: In a retrospective audit, AMPS ADL measures of a consecutive sample of 64 people with schizophrenia admitted to a mental health facility were compared with normative data and with recommended “cut-off” measures for competency to live independently in the community. Results: Substantial difficulties were measured in both ADL motor (mean z = –1.5) and ADL process ability (mean z = –2.1). AMPS ability measures did not predict problems with independent living for 62.5% of the patients. Conclusion: People with schizophrenia admitted to an inpatient rehabilitation facility experienced significant difficulty performing ADL tasks. AMPS is a useful measure of ADL ability but should be used in conjunction with measures of functional performance in order to plan interventions and supports for people with schizophrenia that reflect the complexity of factors affecting community functioning.     

Consensus Statements on Driving for Persons with Dementia

The presence of dementia can have a profound effect on a person's capacity for driving, and will lead to eventual cessation of driving and reliance on alternative transportation options. This paper offers evidence and discussion that affirm eight consensus statements related to drivers with dementia and the impact of dementia on the driving task. These statements offer guidance for occupational therapy practitioners when addressing driving and community mobility, a valued instrumental task of daily living.     

Test–retest reproducibility of the Assessment of Motor and Process Skills for school-aged children with acquired brain injuries

Background Persistent impairments resulting from childhood acquired brain injury (ABI) can impact performance of activities of daily living (ADL). Objective and reliable measures of ADL skills are required for treatment planning and research. Aim To evaluate test–retest reproducibility of the Assessment of Motor and Process Skills (AMPS) for children with ABI. Methods Twenty-eight children with ABI (mean age 11 years 7 months, SD 2 years 4 months; males?=?11) were recruited. Two AMPS tasks were performed over two consecutive days, as per standardized AMPS procedures. Intraclass correlation coefficients (ICC; 2,1), standard error of measurement (SEM), smallest detectable difference (SDD), and 95% limits of agreement (Bland–Altman) were calculated. Results Test–retest reliability was fair to good for AMPS ADL motor (ICC 0.55) and ADL process (ICC 0.58) measures. The SEM was 0.36 and 0.34 logits for AMPS ADL motor and ADL process measures respectively. The SDD was 1.0 (motor) and 0.93 logits (process) measures. A learning effect was evident. Conclusion Test–retest reproducibility of the AMPS was fair to good for children with ABI, which is poorer than previously published data. Administration of the AMPS in an unfamiliar environment, fatigue, and the small time interval between testing sessions may have contributed to poorer results. The AMPS remains a useful measure of ADL, contributing to our understanding of task execution processes.     

Associations Of Physical Activity And Body Mass Index With Activities Of Daily Living In Older Adults

Research reports about the associations of leisure-time physical activity (LPA) and Body Mass Index (BMI) with activities of daily living (ADL) - or instrumental activities of daily living (IADL)-dependent disability in older adults are inconclusive. Data were obtained from the 2000 Missouri Older Adult Needs Assessment Survey. Logistic regression was used to examine the associations of LPA and BMI with ADL-or IADL-dependent disability, while controlling for factors known to be associated with LPA, BMI, ADL and IADL. ADL-or IADL dependency decreased with LPA and increased with BMI regardless of each other’s level, presence of functional limitation, education, gender, race-ethnicity, and health care coverage. Physically active individuals were less likely than inactive ones to be ADL- or IADL-dependent. BMI was modestly associated with ADL- or IADL-dependency and this relationship was confounded by LPA. If confirmed by well designed longitudinal studies, LPA and BMI independent associations with ADL- or IADL-dependent disability lends supports to a strategy for improving older adult quality of life through improved physical activity. Etiological studies on the associations between risk factors and quality of life outcomes in older adults should consider the joint confounding effect of LPA and BMI.Eduardo J. Simoes, MD, Prevention Research Centers Program; Rosemarie Kobau, MPH and Lynda Anderson, PhD, Health Care and Aging Studies Branch; Ali Mokdad, PhD, Behavior Surveillance Branch, all at Coordinating Center for Health Promotion, NCCDPHP-DACH, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., MS-K45. Atlanta, GA 30341,USA; Julie Kapp, PhD and Brian Waterman, MPH, Waterman Research Solutions, 5145 Shaw Ave., St. Louis, MO 63110, USA.     

Validity of the Kohlman Evaluation of Living Skills (KELS) with Israeli elderly individuals living in the community

The Kohlman Evaluation of Living Skills (KELS) was developed to evaluate Activities of Daily Living (ADL) and Instrumental ADL (IADL) in a psychiatric population. Later the KELS was assessed and adapted for a geriatric population. The purpose of this study was to determine the validity of the KELS with elderly individuals living in the community in Israel. The subjects included 92 elderly people living in the community, in protected housing facilities for the elderly, and those living in the community and attending day care. Instruments included the Mini-Mental State Examination (MMSE) to determine cognitive function, the Functional Independent Measure (FIM) to determine performance in ADL, and the Routine Task Inventory (RTI) as a measure of IADL to determine criterion validity. Results showed high correlations between the KELS and the RTI (r = 0.895) and the FIM (r = 0.70). The KELS was also found to be highly sensitive to the differences between all three groups, supporting construct validity. Furthermore, the KELS was found to be more sensitive to these differences than the other instruments used in the study. In conclusion, the results show the KELS to be valid and appropriate for use by occupational therapists with the Israeli elderly population, similar to the US population. The study's small sample size limits the generalizability of the findings. It is recommended that further research be done on the KELS with larger and more diverse elderly populations.