Concordance of four methods of disability assessment using performance in the home as the criterion method

Abstract

Objective. To determine the concordance of 4 methods of disability assessment with the criterion method. Performance testing in the home was selected as the criterion. Methods. The task performance of 57 community-dwelling older women (>70 years) with knee osteoarthritis was examined through self report, proxy report, clinical judgment based on impairment measures, performance testing in an occupational therapy clinic, and performance testing in participants' homes. The 26 tasks represented 4 domains of daily living activities: 5 functional mobility, 3 personal care, 14 cognitively oriented instrumental activities of daily living (IADL), and 4 physically oriented IADL. Results. In general, self reports and proxy reports had the highest concordance with in-home performance test results. Nonetheless, even for these methods, depending on task domain, the rate of discordance ranged from 31% to 54%, being least in personal care and greatest in the physically oriented IADL. Conclusion. Disability estimates based on self reports, proxy reports, clinical judgments, and hospital performance-based assessments are not interchangeable with in-home task performance.

Comparison of Older Adults' and Occupational Therapists' Awareness of Functional Abilities at Discharge from Rehabilitation with Actual Performance in the Home

“…However, OTs' awareness was better than patients' awareness for stair-climbing, meal preparation, telephone use, and medication management when percentage agreement was considered, and for stair-climbing, meal preparation, and medication management when in addition to percentage agreement values, kappas and tau-b were taken into account. Rogers et al (2003) reported a similar relationship between patients' and OTs' awareness of personal care, mobility, and instrumental ADLs, but with lower overall percentages.…”

“…No studies were found that assessed OT awareness for individual functional activities. However, in a study of older women with knee osteoarthritis, Rogers et al (2003) evaluated OTs' assessment of patients' performance on groups of functional activities (personal care, mobility, IADLs) in the clinic and compared this to the same performance-based test administered in patients' own homes. They found OTs' awareness to be somewhat lower than in our study: 57% for personal care, 73% for mobility, and 52% for IADLs.…”

“…Three studies have compared professionals' ratings with actual patient performance (Elam et al, 1991;Rogers et al, 2003;Sheikh et al, 1979), but none have focused on health professionals' awareness of patients' abilities to function at home at the time of discharge from inpatient rehabilitation. Understanding levels of awareness at discharge is critical, since health professionals' decisions regarding discharge plans are based on their perceptions of the patients' abilities to function safely in their home environments.…”

Association between computer use speed and age, impairments in function, and touch typing training in people with rheumatoid arthritis

“…There was a trend in the data that indicated that larger impairments in range of motion, as measured by the KHFI, were associated with faster typing and mouse use speeds, an unexpected result. Previous research on the association between impairments and task performance has suggested that there is not a consistently strong association (35)(36)(37). Instead of impairments in hand function, decreased capacity in contextspecific activity ability, as measured by the HAQ DI, was the arthritis-specific variable most often significantly associated with speed in all 14 models.…”

Instrumental Activities of Daily Living Performance and Role Satisfaction in People With and Without Mild Cognitive Impairment: A Pilot Project

“…Occupation-based assessments completed through clinical observation can more precisely define deficits in IADL subtasks than can gross measures of activity of daily living (ADL) ability that rely on self-or proxy report (Ciro, 2014). In particular, the Performance Assessment of Self-Care Skills (PASS) can distinguish among errors in Independence (cueing to initiate and complete), Safety, and Adequacy (quality) of IADL performance (Rogers et al, 2003(Rogers et al, , 2010Rogers, Holm, Beach, Schulz, & Starz, 2001). Of additional importance is the person's satisfaction with how he or she performs in life roles, which is a different construct from ADL performance and can help guide the occupational therapy process (AOTA, 2014).…”