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Test-Retest Reliability of a Measure of Independence in Everyday Activities: The ADL Profile 时间:2017-07-22 23:03   来源:未知   作者:admin   点击: 次 Abstract:Background. Very few performance-based measures used in occupational therapy have established test-retest reliability coefficients. Objectives of Study. This study presents the test-retest reliability of the task and operation scores of a performance-based measure of independence in everyday activities called the ADL Profile. Methods. 20 adults with severe traumatic brain injury (mean age 28.4 years; SD 9.9) were tested on two occasions with the 17 tasks (personal care, home, and community) of the ADL Profile. Kappa coefficients were calculated on both task and operation scores (formulating goal, planning, executing, and goal attainment). Findings. Test-retest reliability was moderate to almost perfect on task and operation scores of all 17 tasks. The three tasks with only moderate agreement were more novel and complex (e.g., making a budget) for the participants. Relevance to Clinical Practice. Use of measures that are stable over time is essential for treatment planning and research. Repeat testing is crucial with clients that require long periods of treatment (acute care, rehabilitation, and community integration) and multiple measurements of ADL independence. Limitations. The small sample size is a limit of the study. Recommendations for Further Research. Alternate versions of the three tasks with only moderate agreement would need to be developed and other psychometric properties established.
1. Introduction
  Documenting the effect of treatment interventions requires the use of stable measures to ensure that changes pre-post intervention in client functioning deemed to be a result of specific treatments are not a measurement error caused by an unstable tool. Most frequently used outcome measures in rehabilitation are generally measures of everyday activities. Much literature has shown the importance of considering the impact of executive functions on independence in everyday activities and the need for such measures to be administered in a real-world context [1]. For these measures to be sensitive to the impact of executive function deficits on independence, the latter must include elements of novelty and complexity [2]. The challenge of using such measures on two separate occasions with the same individual, such as when tests are administered before and after an intervention, is that evaluation measures are no longer novel on the second administration of the test, directly impacting its stability [3]. Hence, unstable tests can lead to erroneous positive treatment effect conclusions as the person is found to improve on the test without any assurance that improvements are not related to the person having learned the test rather than them having fundamentally improved.
  A recent study by Poulin et al. [4] showed that very few performance-based measures of executive functions used in occupational therapy with a stroke population have established test-retest reliability coefficients. In fact, out of 19 tests examined, only two, the Assessment of Motor and Process Skills [5, 6] and the Virtual Environment Technology based cognitive assessment program [7], had demonstrated test-retest reliability. However, test-retest reliability study of the Assessment of Motor and Process Skills with a traumatic brain injury population was completed on only two of the numerous tasks included within this test and the delay between the two administration instances was a single day, thus weakening the findings of the study [8].
The present study examined the test-retest reliability of the task and operation scores of a performance-based measure of independence in everyday activities called the Activities of Daily Living (ADL) Profile [9]. This measure was specifically developed to consider the impact of executive deficits on independence in everyday activities, with a particular emphasis having been given to the consideration of such fundamental abilities as goal formulation and planning. The ADL Profile was developed with the intent of offering occupational therapists a measure that would guide the elaboration of therapeutic objectives and monitor longitudinal change. It is meant to be first administered in acute care where the focus is more on personal Activities of Daily Living, then in rehabilitation, and, finally, in the community. Hence, as the test can and should be repeated over time to evaluate changes in performance, documenting the test-retest reliability of the test is of utmost importance.