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Measuring quality of occupational performance based on self-report and observation: development and validation of instruments to evaluate ADL task performance
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background People with rheumatic or neurologic conditions are commonly referred for occupational therapy because of decreased ability to perform ADL tasks. Upon referral, occupational therapists use a client-centred, occupationfocused approach when evaluating a person's perceived and observed quality of ADL task performance to clarify the nature and extent of the person’s problems, plan interventions and determine effectiveness of interventions. Evaluation of the extent of problems and change following intervention require the use of linear measures of ADL. The aim of this doctoral thesis was to develop and validate linear measures of perceived and observed quality of ADL task performance for occupational therapy clinical praxis and research.

Methods To develop linear measures of observed quality of ADL task performance based on Rasch measurement methods, clients with ABI (n=70) were evaluated using a 3-category rating scale and the ADL Taxonomy. Similarly, to develop linear measures of perceived quality of ADL task performance women with rheumatic diseases (n=118) reported their ability on a questionnaire and in an interview based on the ADL Taxonomy and a 4- category rating scale. To further validate the ADL ability measures of the Assessment of Motor and Process Skills (AMPS) data were collected in two samples. In a sample of women with chronic widespread pain (CWP) or fibromyalgia (FM) (n=50) the ADL ability measures were validated with regard to discrimination, stability and sensitivity to changes. Discrimination was examined by comparing AMPS data from women with CWP/FM to those of healthy women. Stability and sensitivity to change were examined based on repeated AMPS observations pre and post intervention. In addition, sensitivity to change was examined in a sample of clients with ABI (n=36) using a pre- and post-test design. Finally, the validity of the AMPS ADL ability measures in relation to perceived ADL ability was examined in women with rheumatic diseases (n=118) and women with CWP/FM (n=50).

Results Based on the results of the four studies in this thesis, we were able to conclude that it was possible to obtain linear measures of observed quality of ADL task performance based on a revised version of the ADL Taxonomy (ADL-O). It was also possible to obtain linear measures of perceived quality of ADL task performance based on revised versions of the ADL Taxonomy using the formats of questionnaires (ADL-Q) and interviews (ADL-I). Moreover, it was possible to establish further evidence of validity of the ADL ability measures of the AMPS. Thus, the AMPS ADL ability measures could discriminate between women with CWP/FM and healthy women. The ADL ability measures of remained stable when no intervention was provided and the ADL motor ability measures were sensitive to change among women with CWP/FM. Moreover, the ADL ability measures were sensitive to change among clients with low ADL ability following ABI. Finally, only low to moderate correlations were found between measures of perceived and observed ADL ability.

Conclusions Rasch analyses of revised versions of the ADL Taxonomy suggest that the majority of the ADL tasks and rating scales focused on quality of ADL task performance can be used to obtain linear measures of quality of ADL task performance based on methods of questionnaire, interview or observation. Furthermore, the studies provided evidence of validity of the ADL ability measures of the AMPS in relation to discrimination, stability and sensitivity to change and relation to perceived ADL ability. The results may, therefore, enhance the use of ADL instruments that provide linear measures of perceived and observed quality of ADL task performance in occupational therapy clinical praxis and research.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2010. , 93 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1349
Keyword [en]
activities of daily living, acquired brain injury, ADL evaluation, ADL task performance, chronic disease, chronic widespread pain, interview, observation, occupational therapy, observation-based evaluation, questionnaire, Rasch measurement, rheumatic diseases
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
URN: urn:nbn:se:umu:diva-33848ISBN: 978-91-7264-993-4 (print)OAI: oai:DiVA.org:umu-33848DiVA: diva2:318271
Public defence
2010-05-28, Aulan, Vårdvetarhuset, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2010-05-07 Created: 2010-05-07 Last updated: 2010-05-07Bibliographically approved
List of papers
1. Developing linear ADL ability measures based on the ADL taxonomy: a Rasch analysis
Open this publication in new window or tab >>Developing linear ADL ability measures based on the ADL taxonomy: a Rasch analysis
2009 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 16, no 3, 159-171 p.Article in journal (Refereed) Published
Abstract [en]

Purpose. The aim of this pilot study was to explore the possibility of developing linear measures of ADL ability based on the ADL Taxonomy and a three-category rating scale.

Method. Data were obtained from medical records of adults with moderate to severe brain injury. The participants were rated on the ADL taxonomy, and recorded on the ADL Taxonomy Circle, based on direct observations. By applying the Rasch rating scale model, we examined the possibility of converting the raw ordinal scores into equal-interval estimates of the participants’ ADL ability.

Results. The data analysis indicated that the rating scale used in this study displays sound psychometric properties. Items from the ADL taxonomy defined one construct after 10 actions were removed, but retention of all items did not disrupt the measurement system. Except for one item in each of five different activity domains, the item difficulty hierarchy was the same as in the hierarchy originally published, supporting reliability of the item difficulty estimates. The ADL taxonomy discriminated well between different levels of ability in this sample of persons with brain injury.

Conclusion. This preliminary study indicates that the ADL taxonomy has potential to become a linear measure of a person's ability to perform ADL tasks.

Place, publisher, year, edition, pages
Informa Healthcare, 2009
Keyword
Assessment, occupational therapy, observation, outcomes, psychometric properties
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-33844 (URN)10.1080/11038120802483080 (DOI)18949630 (PubMedID)
Available from: 2010-05-07 Created: 2010-05-07 Last updated: 2017-12-12Bibliographically approved
2. Differences between questionnaire- and interview-based measures of ADL ability and their association to observed ADL ability in women with rheumatiod arthritis, knee osteoarthritis and fibromyalgia
Open this publication in new window or tab >>Differences between questionnaire- and interview-based measures of ADL ability and their association to observed ADL ability in women with rheumatiod arthritis, knee osteoarthritis and fibromyalgia
Show others...
(English)Article in journal (Other academic) Submitted
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-33846 (URN)
Available from: 2010-05-07 Created: 2010-05-07 Last updated: 2010-05-18Bibliographically approved
3. Observation-based assessment of ADL ability among women with chronic widespread pain
Open this publication in new window or tab >>Observation-based assessment of ADL ability among women with chronic widespread pain
(English)Article in journal (Other academic) Submitted
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-33847 (URN)
Available from: 2010-05-07 Created: 2010-05-07 Last updated: 2010-05-18Bibliographically approved
4. Improving quality of ADL performance after rehabilitation among people with acquired brain injury
Open this publication in new window or tab >>Improving quality of ADL performance after rehabilitation among people with acquired brain injury
2007 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 14, no 4, 250-257 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate whether people with brain injury show improvements in quality of performance of activities of daily living (ADL) after rehabilitation. A retrospective pre- and post-test design with no control group was used. Subjects received interdisciplinary rehabilitation consisting of restorative and compensatory strategies. Thirty-six adults with moderate to severe disability following acquired brain injury were evaluated using the Assessment of Motor and Process Skills (AMPS), an observational evaluation of the quality of ADL task performance. Paired t-tests revealed significant increase in ADL ability after intervention; effect sizes were medium. Improvements occurred across ages, within all diagnostic groups, and with no relation to time post-injury. It was concluded that people with moderate to severe disability following acquired brain injury improved in ADL ability after participating in an intensive, interdisciplinary rehabilitation programme. Although lack of a control group prevented a conclusively conclusion that the changes were due to the intervention provided, the fact that the subjects had shown slow spontaneous recovery and minimal improvements before the study was implemented supports the likelihood that their gains were largely the result of the intervention.

Keyword
Activities of Daily Living, Adolescent, Adult, Aged, Brain Injuries/*rehabilitation, Denmark, Disability Evaluation, Female, Humans, Male, Middle Aged, Motor Skills, Recovery of Function, Retrospective Studies, Treatment Outcome
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-10227 (URN)10.1080/11038120601182974 (DOI)17852966 (PubMedID)
Available from: 2008-07-03 Created: 2008-07-03 Last updated: 2017-12-14Bibliographically approved

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