Objective. To examine diverse nonmotor neurobehavioral impairments (NBIs) that impact activities of daily living (ADL) task performance and to verify if such impairments can be viewed as one dimension when evaluated in an ecologically-relevant context. Methods. Rasch analysis was performed on data from 206 individuals diagnosed with dementia or cerebral vascular accident (CVA) who had been scored on 50 standardized NBIs from the A-ONE Neurobehavioral Impairment scale, based on naturalistic observation of ADL task performance. Evaluation of mean square (MnSq) infit and outfit values and principal components analysis (PCA) of residuals were used to evaluate unidimensionality of the items. Two evaluations were implemented: (1) to evaluate if there is a single global dimension common for persons with either dementia or CVA, and (2) to evaluate if the 50 NBIs are unidimensional, but comprised of different diagnosis-specific global hierarchies (dementia, left CVA, and right CVA). Results. The PCA indicated that 56.8% of variance was explained by the global measure (Rasch factor) of NBIs, with 4.9% of the unexplained variance explained by the first contrast. Four items showed outfit misfit to the common hierarchy. Developing diagnosis-specific global hierarchies resulted in improved PCA results for all 3 diagnostic groups (Rasch factor = 79.2% to 85.5%; unexplained variance in first contrast = 1.7% to 3.4%) after removal of 2 to 3 misfitting items. Conclusions. Nonmotor NBIs, when evaluated based on naturalistic performance of ADL, can be considered unidimensional, but the hierarchical structure of the dimension likely varies across diagnostic groups. Further study is needed with larger samples to verify these results.
Objective: The fact that different neurobehavioral impairments affect daily life task performance of clients with different neurological diagnoses currently restricts between-group comparisons in rehabilitation. The purpose of this study was to determine whether a single neurobehavioral impact scale could be constructed for use with different diagnostic groups. Methods and results. Rasch analysis of 422 clients (diagnosed with CVA and dementia) demonstrated that 29 of 55 items from the A-ONE Neurobehavioral Scale could be used to construct a short-form, Common Scale. Conclusions: While the use of different and longer diagnostic-specific scales versions may be more useful clinically, the short-form, Common Scale has the potential to be used in research focusing on comparison of groups. Further research will be needed to validate the common, short version.
OBJECTIVE.: The objective was to determine whether the School Version of the Assessment of Motor and Process Skills (School AMPS) is valid when used to evaluate students in different world regions.
METHOD.: Participants were 984 students, ages 3–13 yr, from North America, Australia and New Zealand, United Kingdom, and the Nordic countries, matched for age and diagnoses. We used FACETS many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant differential item functioning (DIF) and differential test functioning (DTF).
RESULTS.: Four School AMPS items demonstrated DIF but resulted in no DTF.
CONCLUSION.: This study provided support for occupational therapists using the School AMPS to evaluate students' quality of schoolwork task performances across regions because the School AMPS measures are free of bias associated with world region.
Aim: The purpose of this study was to use a variety of methods to evaluate and cross-validate the reliability estimates of the quality of schoolwork performance measures in the School Version of the Assessment of Motor and Process Skills (School AMPS)(1).
Methods: Split-half reliability was estimated based on School AMPS data from 6 194 students who had performed at least two school AMPS tasks. Two different split-half methods were used: splitting the School AMPS items vertically and splitting them horizontally. The Rasch equivalent of Cronbach’s alpha for the full School AMPS evaluation and standard error of measurement (SEm) were also considered.
Results: All three methods yielded high reliability coefficient estimates (r ≤ 0.70) and overall SEm was low.
Conclusions: From a practice perspective, the results of this study are of clinical importance as they provide evidence that occupational therapists can have confidence in the consistency of the School AMPS measures when they are used in the process of making decisions about individual students, planning interventions, and later performing followup evaluations to measure the outcome.
This study was designed to evaluate whether the level of occupational engagement is relatedto life satisfaction among the oldest-old. The study was performed as part of a cross-sectionalstudy of individuals 85 years and older in northern Sweden. The results revealed significantcorrelations between life satisfaction and engagement in both leisure and activities of daily living,and the effect sizes were interpreted as medium. This study adds some support to earlierfindings that a higher level of task performance is related to a higher level of life satisfaction.The results also give some clinical evidence to support a client-centered approach that includesconsideration of leisure tasks a person is motivated to perform.
This study elucidates the oldest olds’ leisure repertoire and how this repertoire varies due to gender, where they live, and cognitive status. A validated 20-item leisure interest checklist with four subscales was used to measure leisure participation and investigate the leisure repertoire among participants. The oldest old were most likely to be interested in, perform, be motivated for, and perceive well-being from social activities, cultural activities, and TV/video/movies. The respondents were least likely to be interested in, perform, be motivated for, and perceive well-being from equipment sports and ball games. Some gender, geographic differences, and differences in cognitive status were found. The oldest old were more likely to endorse the same activities across all subscales of the checklist, but the linear magnitude varied across sub-scales. The relationships between performance and the other subscales suggested that a sense of engagement or participation is related to actual performance.
Chronic heart failure (CHF) is a common condition among Europe's aging population. Findings indicate that CHF patients must make significant changes in many aspects of daily life. Previous studies of older primary health-care participants and their activities of daily living (ADL)-ability are rare. The aim of this study was to describe ADL-ability in older people with CHF syndrome. The factors considered were dependence on others, perceived strain, quality of performance, and the association between The New York Heart Association classification (NYHA) and ADL-ability. The participants, recruited from a primary health-care centre, had symptoms indicating CHF and were diagnosed by a cardiologist. Forty persons over 65 years (mean age 81), participated in the study and self-reported co-morbidity was frequent. The Assessment of Motor and Process Skills (AMPS) and the Staircase of ADL were used to describe ADL-ability. Most participants were independent with respect to personal activities of daily living (PADL), and 75% were dependent in one or more instrumental activities of daily living (IADL), usually shopping. Most participants perceived strain, and only three could perform all ADL without strain. Age had a significant impact on ADL performance (motor measures: OR 7.11, CI 1.19-42.32, p = 0.031 and process measures: OR 8.49, CI 1.86-38.79, p = 0.006). However, participants showed lower ADL motor and process ability in AMPS compared with well persons of the same age. Participants in NYHA III/IV (adjusted for age), had significantly increased effort (under motor cut-off) when performing ADL-tasks (OR: 15.5, CI 2.40-100.1, p = 0.004) compared to those in NYHA I/II. Older persons in primary health care with CHF exhibit a high amount of dependence, perceived strain and increased effort during performance of ADL. There is an association between NYHA class III/IV and a decreased ADL-ability (AMPS motor ability) even when adjusted for age.
Fatigue had a negative impact on ADL mainly from physical rather than from mental causes. Improved energy conservation strategies to reduce the consequences of fatigue are needed.
Aim:
The aim of this study was to describe experiences of limitations in occupational performance and strategies for managing daily activities among the elderly with chronic heart failure (CHF).
Methods:
Ten participants from primary healthcare with a confirmed diagnosis of CHF were interviewed. The interviews were analysed using qualitative content analysis.
Results: The first theme, "Redefining an active life, aware of one's impaired body", was based on four sub-themes: realizing one's limited activity ability; striving to preserve an active life; focusing on meaningful activities; and changing vs. not changing habits and roles. The second theme, "Planning activities and balancing the degree of effort", was based on three sub-themes: limiting, organizing, and rationalizing activities; adjusting activities to today's ability; and using technology and adapting the environment.
Conclusions:
Elderly people with CHF are struggling with an ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability. This highlights a need for information on strategies from a holistic perspective and client-centred occupational therapy interventions.
AIM: The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF).
METHODS: The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed.
RESULTS: The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice.
CONCLUSIONS: This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.