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.     

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.     

The Relevance of Obesity for Activities of Daily Living in Geriatric Rehabilitation Patients

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0–100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps’ skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1–t2, t2–t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2–t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.     

社区脑卒中患者的日常生活能力与长期照料需求研究

目的了解脑卒中患者的日常生活能力与长期照料需求．为进一步在社区开展脑卒中患者的长期照料提供理论依据．方法选取经医院确诊为脑卒中、虹口区户籍的脑卒中存活患者作为对象,采用问卷调查的方法收集资料。结果共调查脑卒中患者1300名,17．08％的患者完全依赖,6．62％的患者严重依赖,8．08％的患者显著依赖。8．62％的患者功能有限独立,59．60％的患者功能完全独立。日常生活能力越好的患者对生活越满意,完全独立的患者39．19％对生活表示满意．有限独立的患者19．59％表示满意,显著依赖的患者15．22％表示满意,严重依赖的患者8．79％表示满意．生活完全依赖的患者5．67％对生活表示满意。日常生活能力情况和长期照料需求情况密切相关,生活能力独立情况越差,长期照料需求越高。结论脑卒中患者对生活满意度较低,长期照料需求与日常生活能力有关。应当根据患者生活能力情况提供相应的生活服务。     

贵阳市居家养老老年人日常生活能力影响因素研究?

目的调查贵阳市居家养老人群日常生活能力,分析其可能的影响因素,为老年人居家养老护理提供参考。方法采用多阶段分层整群随机抽样的方法,随机抽取8个居委会中年龄≥60岁的1 898名居家老年人进行日常生活能力调查;日常生活能力影响因素单因素分析采用t检验、F检验,两两比较采用LSD法,多因素分析采用多元线性回归。结果调查对象平均年龄为(71.4±5.9)岁。贵阳市居家老年人日常生活能力(ADL)总分为(14.91±3.88)分,躯体性日常生活能力(PADL)得分为(6.26±1.27)分,工具性日常生活能力(IADL)得分为(8.65±2.75)分。多元线性回归分析显示:对PADL、IADL和总的ADL有影响的因素及影响大小依次为年龄、是否参加体育锻炼、是否患慢性病和文化程度,差异均有统计学意义(P0.05)。结论贵阳市居家老年人日常生活能力总体水平较好,居家养老护理应重点关注高龄、患有慢性病和文化程度低的老年人。     

Dexterity,Visual Perception,and Activities of Daily Living in Persons with Multiple Sclerosis

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.     

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.     

Performance-Based Assessment of Instrumental Activities of Daily Living: Validation of the Sydney Test of Activities of Daily Living in Memory Disorders (STAM)

Objectives

The distinction between dementia and mild cognitive impairment (MCI) relies upon the evaluation of independence in instrumental activities of daily living (IADL). Self- and informant reports are prone to bias. Clinician-based performance tests are limited by long administration times, restricted access, or inadequate validation. To close this gap, we developed and validated a performance-based measure of IADL, the Sydney Test of Activities of Daily Living in Memory Disorders (STAM).

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.     

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.     

Association Between Plasma 25-hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study

ObjectivesA few studies of Western populations have found inconsistent results regarding the associations between vitamin D status and physical function. We explored the association between circulating vitamin D status [plasma 25-hydroxyvitamin D, 25(OH)D] and incident activities of daily living (ADL) disability among Chinese older adults.DesignCommunity-based longitudinal cohort study.Setting and ParticipantsA total of 2453 men and women (median age 84.0 years) in 7 Chinese longevity areas were included.MeasuresCox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident ADL, with adjustments for potential sociodemographic, and lifestyle confounders and biomarkers. Because there was a statistically significant interaction between plasma 25(OH)D and sex in relation to incident ADL, men and women were analyzed separately.ResultsThe median concentrations of plasma 25(OH)D were 46.6 nmol/L and 36.4 nmol/L for men and women, respectively. Compared with the lowest quartile in the fully adjusted model, the HR for incident ADL disability for the highest quartile was 0.55 (95% CI 0.36–0.85) for women; for men, a null association was indicated (HR_{highest vs lowest} 0.61, 95% CI 0.37–1.00). However, when using the recommended circulating 25(OH)D thresholds by the US Institute of Medicine, those with vitamin D sufficiency (≥50 nmol/L) had better ADL disability prognoses than those with vitamin D deficiency (<30 nmol/L) in both sexes (men HR 0.45, 95% CI 0.28–0.72; women HR 0.58, 95% CI 0.37–0.90).Conclusions and ImplicationsThe relationship between plasma 25(OH)D concentration and incident ADL disability was sex-specific among Chinese older adults. However, participants with recommended vitamin D sufficiency may have better disability prognoses in both sexes, suggesting that the recommended 25(OH)D concentration for bone health may extend to functional outcomes such as ADL disability in Chinese older adults.     

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.     

老年人日常生活活动能力评价及影响因素分析

以南京市城区６０岁以上老年人的健康状况与日常生活活动能力抽样调查资料为基础，综合分析评价老年人的日常生活活动能力及其影响因素。研究结果表明：老年人日常活动能力在不同年龄组间丧失率不同，男女性别的功能丧失率有显著性差异（Ｘ２＝７．７５，Ｐ＜Ｄ．０５）。非条件Ｌｏｇｉｓｔｉｃ回归分析显示：年龄、患慢性病种类、婚姻状况、体育锻炼，生活满意度为影响老年人日常生活活动能力的主要因素。     

Measuring the outcome of occupational therapy: Tools and resources

Current pressures to document outcomes and demonstrate the efficacy of occupational therapy intervention arise from fiscal restraints as much as from the humanitarian desire to provide the best quality health care to consumers. However, measuring outcomes is important in facilitating mutual goal setting, increasing the focus of therapy on the client, monitoring client progress, as well as demonstrating that therapy is valuable. The aims of this article are to provide the reader with an overview of what outcomes research is and to provide resources to aid the selection of outcomes assessments in a variety of practice areas. This article adopts the latest version of the World Health Organisation's health classification system (International Classification of Impairments, Activities and Participation), as an organizing framework, and promotes the use of this framework when undertaking outcomes research.     

Activities of Daily Living: An Area of Occupational Therapy Expertise

If occupational therapists are to provide services in the area of activities of daily living in such a way as to demonstrate their uniqueness and expertise, they must be clear in their own minds as to their uniqueness and the value of their contributions. They must also be able to communicate these effectively to others. This paper approaches the problem from two perspectives. Firstly, stimulated by the results of a survey of Royal Perth Hospital occupational therapists and a review of the literature, the authors describe a definition and classification of activities of daily living developed in order to standardise terminology and organise the content of treatment reports. Secondly, a professional model is presented to explain the uniqueness of occupational therapy in terms of activities of daily living. The use of these approaches in justifying occupational therapy intervention and communicating it to others is discussed.