Structural validity and internal consistency of an ecological observation-based assessment, the Activities of Daily Living Profile.

INTRODUCTION: Direct observation of everyday task performance is considered the most accurate measure of independence for individuals with executive function impairments. However, few observation-based measures have been shown to have sound psychometric qualities and be clinically applicable. The objective of this study was to investigate the Activities of Daily Living (ADL) Profile's structural validity using exploratory factor analyses and internal consistency in order to identify the minimum set of tasks required to achieve reliable scores in each of three ADL environments (personal, home and community). METHODS: Ninety-one persons with a severe traumatic brain injury aged 16-40 years (convenience sample) were recruited from a university affiliated level 1 trauma hospital. The 17 observation-based tasks of the ADL Profile were administered by one of five occupational therapists, either in the hospital or in the subjects' home and community environments. This measure of independence considers goal formulation, planning, carrying out and verifying goal attainment. RESULTS: Exploratory factor analysis indicated the unidimensionality of the 17 tasks of the ADL Profile. A single factor explained more than 80% of the common variation, which in this case is the concept of independence. Internal consistency of task scores is very high (0.955), suggesting redundancy of the tasks. Approaches used to reduce the number of items, and to optimise the clinical applicability of the tool, showed that a minimum of two tasks per each of three environments (personal, home, community) is required to obtain reliable results that respect the tool's internal structure. Each assessment should contain both simple and familiar and more novel and complex tasks. CONCLUSIONS: Findings show that the ADL Profile is a valid and clinically applicable observation-based measure of independence that considers four important task-related components: goal formulation, planning, carrying out and verifying goal attainment.

How do assessments of activities of daily living address executive functions: A scoping review.

Executive functions (EF) allow persons to adapt to situations arising in daily life and can be affected following acquired brain injury (ABI). Measuring the impact of EF impairments on the accomplishment of activities of daily living (ADL) requires specific assessment tools, but choosing the right tool may be difficult. PURPOSE: To conduct a scoping review on how assessments of ADL address EF and EF impairments in persons with ABI. METHOD: A scoping review of literature (peer-reviewed and grey literature) published until August 2014 was conducted. Using a systematic procedure, literature was selected, results were charted, and tools were analysed with respect to their goals, underlying models, psychometric properties and applicability. The analysis also included how tools considered components of EF according to Lezak's model. RESULTS: 12 tools, developed either to assess EF in ADL, independence in ADL considering EF or ADL capacities, were identified and analysed according to multiple criteria. CONCLUSIONS: This review provides important information about existing tools to assist in tool selection and clinical decision-making related to ABI and EF.

Home Assessment of Person-Environment Interaction (HoPE): content validation process.

The purpose of this paper is to present the content validation, including a pilot test, of the Home Assessment of the Person-Environment Interaction (HoPE). The HoPE fills a gap for evaluating issues related to home adaptation. Using qualitative methods, a two-phase study was conducted: an expert consultation and a pilot test. The expert consultation was conducted via focus groups with occupational therapists (n = 20), and individual interviews with adults who had undergone home adaptation (n = 5). The pilot test was undertaken using a multiple case study design of four adults awaiting home adaptation. Data were audio-recorded, transcribed, and analyzed using NUD.IST software. In phase 1, experts agreed with the content of HoPE and suggested minor changes. In phase 2, HoPE enabled occupational therapists to identify handicap-creating situations. After both phases, the final version of HoPE is more comprehensive than other current tools and addresses the complex experiences of clients with whom occupational therapists work which suggests a new approach for practice regarding home adaptation.

A generalizability study of the instrumental activities of daily living profile.

OBJECTIVE: To establish generalizability estimates of the Instrumental Activities of Daily Living (IADL) Profile when administered to persons with a moderate or severe traumatic brain injury (TBI) within their home and community environment. DESIGN: Generalizability theory was used to estimate generalizability and dependability coefficients as well as the relative contribution of identified sources of measurement error to total measurement error. Decision studies were used to enable the investigators to determine the optimal measurement design. SETTING: The IADL Profile was administered in subjects' homes and community environments. PARTICIPANTS: Convenience sample of adults with a moderate or severe TBI (N=30, aged 16-65y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: IADL Profile scores include 6 factor scores (going to the grocery store/shopping for groceries, having a meal with guests/cleaning up, putting on outdoor clothing, obtaining information, making a budget, and preparing a hot meal) and 1 total score. RESULTS: The greatest sources of measurement error were the subject-item interactions (3-random-facet design) and the subject-rater interactions (2-random-facet design). One hundred percent of generalizability coefficients of factor scores indicated acceptable to excellent reliability. Indices of dependability confirmed that 1 evaluator could reliably score the tool on a single occasion after having received a 3-day training workshop. CONCLUSIONS: The IADL Profile administered to persons with a moderate or severe TBI provides occupational therapists with a reliable set of measures of IADL independence capable of both capturing and analyzing the complex interactions between personal and environmental factors.

The IADL profile: development, content validity, intra- and interrater agreement.

BACKGROUND: Occupational therapists are frequently asked to document the interplay between individuals' neuropsychological deficits and the requirements of their daily lives. PURPOSE: The present study was designed to develop and validate a measure of independence in everyday functioning that considers recent advances in research regarding the ecological assessment of executive functions. METHOD: Experts (n=8) judged the IADL Profile's content validity and the tool was pilot tested with the target population (n=8). To document the tool's reliability, 30 patients aged 16 to 65 with moderate or severe TBI were recruited. A trained examiner administered the IADL Profile, and three trained judges rated video recordings on two occasions. RESULTS: An eight-task (29-item) test was developed. Comparing ratings of four raters, 95 percent of kappa coefficients indicated moderate to almost perfect agreement, and 94% showed almost perfect intrarater agreement. IMPLICATIONS: The IADL Profile provides occupational therapists with a set of measures of IADL independence with strong preliminary evidence of reliability.

Factors affecting leisure participation after a traumatic brain injury: an exploratory study.

OBJECTIVE: To explore leisure participation by people with traumatic brain injury (TBI) and reasons underlying changes after the trauma. PARTICIPANTS: Twenty-six individuals with mild to severe TBI. MAIN MEASURE: Leisure Profile, a semi-structured questionnaire measuring involvement in leisure activities before and after TBI (frequency of activities, degree of interest, and desire to modify one's leisure activities), attitudes toward leisure, and difficulties that might influence leisure activities (impairments and environmental obstacles). RESULTS: Leisure participation was greatly disrupted after TBI, with 92% of the participants reporting a reduction posttrauma. Less severe injuries, more time since the injury, and the presence of social obstacles in the environment were positively correlated with leisure participation. Motor impairments had a negative impact on leisure participation. CONCLUSION: TBI has a significant negative effect on leisure participation. Leisure activities should be evaluated and included in a therapy program designed to promote reintegration into society and work.

The criterion-related validity of the IADL Profile with measures of executive functions, indices of trauma severity and sociodemographic characteristics.

PRIMARY OBJECTIVE: To examine relationships between classical measures of executive functions (EF) and indices of traumatic brain injury (TBI) severity with the IADL Profile, a new performance-based measure of independence in instrumental activities of daily living (IADL) based on EF. This study hypothesized the presence of correlations between classical tests of EF and the IADL Profile, as the latter aims to establish whether the subject's main difficulties pertain to goal formulation, planning, carrying out the task and/or attaining the initial task goal; all important components of EF. METHODS AND PROCEDURES: One hundred subjects with a moderate/severe TBI aged 16-65 years (convenience sample) were recruited. Subjects were tested with the IADL Profile and three measures of EF within their home environment. Data was analysed using Pearson correlations, t-tests and multiple stepwise regressions. RESULTS: Post-traumatic amnesia and working memory emerged as the major determinants of IADL Profile scores. Together, indices of injury severity, measures of EF, education, age and environmental factors accounted for 12-28% of the variance in IADL Profile scores. CONCLUSIONS: This study has shown that the IADL Profile's non-structured approach permits the observation of a broad range of behaviours related to EF deficits and thus provides a closer approximation of the person's independence in IADL. Further study is required to demonstrate the IADL Profile's ability to inform more targeted treatment interventions.

Item analysis of the functional status assessment of seniors in the emergency department.

PURPOSE: To report some psychometric properties of the functional status assessment of seniors in the emergency department (FSAS-ED) at item level. This 40-item tool addresses the person's functional status prior to and following the decision to consult in ED. METHOD: A sample of 150 community-living elderly individuals who consulted the ED was recruited. Two evaluators administered the FSAS-ED in the ED and scored it independently. Three measurement properties were considered relevant for the item analysis: response distribution, inter-rater reliability and the ability to indicate a change between before and following the decision to consult ED. Criteria related to these properties were established to classify items as being excellent, acceptable or weak. RESULTS: The response distributions were excellent or acceptable for 36 items (90%). Results pertaining to inter-rater reliability showed 39 excellent or acceptable items (97.5%). Comparison of the responses between before and following the decision to consult to ED showed 24 (60%) excellent or acceptable items and 16 (40%) weak items; the latter were related to communication and cognitive skills. CONCLUSIONS: At the item level, the FSAS-ED provides reliable and clinically relevant information about the functional status of older adults consulting ED.

[The Profile of Leisure Activities, a promising instrument in occupational therapy]. / Le Profil du Loisir, un instrument prometteur en ergothérapie.

BACKGROUND: Although the benefits of leisure activities are well known, few instruments have been specifically designed to measure a person's engagement in their leisure activities and to assess the personal or environmental factors affecting their capacity to participate in leisure activities. PURPOSE: The purpose of this paper is to present the steps leading to the development of the Profil du Loisir between 1990 and 2002. METHODS: The planning, construction, and validation of the tool were done according to the steps suggested by Benson and Clark (1982). The first versions were tested by occupational therapists on individuals with traumatic brain injuries. RESULTS: The validation led to the development of the final version (3.0). The inter-rater reliability of the instrument was rated from acceptable (kappa 0.21-0.4) to very good (0.61-0.80) and the test-retest reliability was rated from acceptable to moderate (0.41-0.60). CLINICAL IMPLICATIONS: The Profil du Loisir is a promising tool that invites occupational therapists to systematically consider and assess client leisure time in their practice.

[Description of the practice of occupational therapy in emergency rooms in Quebec]. / Description de la pratique des ergothérapeutes du Québec en salle d'urgence.

INTRODUCTION: Occupational therapists intervene in emergency departments, but the nature and scope of this practice is unknown. OBJECTIVE: To describe the professional practice of Quebec's occupational therapists in emergency departments. METHODS: Questionnaires covering the general context of practice, nature of interventions, assessment tools, models of practice and the satisfaction of working in emergency departments were sent by mail to the members of l'Ordre des ergothérapeutes du Québec. RESULTS: Occupational therapists have been working in emergency departments in several socio-administrative regions of Quebec and their work experience ranges from 1 to 11 years. They spend over 90% percent of their time with older adults and are members of interdisciplinary teams. They assess diverse areas of functioning and 75% of them use in-house assessment tools. The challenges encountered affect two thirds of the respondants who describe their satistaction level toward the practice as being neutral or unsatisfied. IMPLICATIONS FOR PRACTICE: The respondants have confirmed the emergence of occupational therapy in emergency departments and the need to develop better tools in order to address the problems met in their practice.

Test-Retest Reliability of a Measure of Independence in Everyday Activities: The ADL Profile.

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.

The PQRS-Montreal: a measure of patients' perceptions of the quality of rehabilitation services for persons with a traumatic brain injury.

Purpose To determine the factorial validity, internal consistency, criterion-related and concurrent validity of the Perception of Quality of Rehabilitation Services - Montreal (PQRS-Montreal) questionnaire for persons receiving traumatic brain injury (TBI) rehabilitation services. Design Cross-sectional study. Setting Seventeen facilities providing acute care and intensive inpatient and outpatient TBI adult rehabilitation. Participants Five-hundred thirty adults (GCS = 3-15; mean age = 41.5 ± 16.9 years) who received rehabilitation were administered the questionnaire during an interview near time of discharge. Subjects responded to the 61 PQRS-Montreal items (five-point scale of agreement) and to the Client Satisfaction Question (CSQ8). Results Exploratory and confirmatory factor analyses identified three potential subscales (one- and two-factor solutions) explaining 26.1-41% of the variance (ecological approach, quality of team, service organization). The subscales' internal structures were interpretable and their internal consistency varied from 0.51 to 0.90 (Cronbach's α). Rehabilitation phase significantly and positively impacted factor scores and all factor scores were significantly and moderately correlated with CSQ8 scores. Conclusions The PQRS-Montreal possesses adequate psychometric properties supporting its use as a valid tool to measure patients' perception of the quality of TBI rehabilitation services. This tool could help guide the development and monitoring of TBI rehabilitation service delivery. Implications for Rehabilitation The importance of measuring and monitoring quality of care is increasingly important in rehabilitation. Using the experiences and perceptions of care of service users is a valid way of assessing the quality of rehabilitation services. The PQRS-Montreal has adequate psychometric properties supporting its use as a valid tool to measure patients' perception of the quality of TBI rehabilitation services. This tool could help guide the development and monitoring of TBI rehabilitation service delivery.

[The importance of playfulness in occupational therapy with adult clients]. / L'importance de l'attitude ludique en ergothérapie avec une clientèle adulte.

BACKGROUND: As there is little documentation pertaining to playfulness in adults, its therapeutic potential remains uncertain. PURPOSE AND METHODOLOGY: A qualitative approach was used in order to develop a conceptual model of playfulness in adults and to discuss its potential uses in occupational therapy. RESULTS: The model identifies the influential sources and the consequences of playfulness in adults. The identified consequences support both the privileged intervention in occupational therapy, in other words, the meaningful activity, and the objectives of the intervention, those which include being the capacity to act, health and well-being. For these reasons, the proposed model presents interesting potential for occupational therapy intervention. CLINICAL IMPLICATIONS: This conceptual model presents a unique and innovative vision of playfulness in adults that could offer a new perspective on meaningful activity. It suggests that playfulness could become an important tool in occupational therapy in developing the capacity to act. Consequently, the model proposes an innovative client-based approach.

Development of a functional status assessment of seniors visiting emergency department.

The purpose of this paper is to describe the development and initial piloting of a Functional Status Assessment of Seniors in Emergency Department (FSAS-ED). The methodology of development of the tool included (1) specifying the underlying construct based on the conceptual framework of the International Classification of Functioning, Disability and Health (ICF), (2) deciding on an interview-based format appropriate for addressing functioning pre- and post-ED, (3) developing an initial 63-item pool and reviewing it through a consensus group with seven experts, (4) piloting the prototype with 23 subjects (mean age=76 years) and (5) subsequently revising its rating scales. The final 40 items tool consists of three theoretically derived components. First, activity and participation (n=23 items) address nine ICF domains using a 4-level scale combining levels of difficulty and help required. Second, body functions (n=10 items) cover eight ICF domains with a 3-level scale of impairment. And third, environmental factors (n=7 items) address four ICF domains assessed as facilitators or barriers. In conclusion, the FSAS-ED provides a clinical assessment of senior's functional status that is feasible to use in ED. It has potential utility for identifying unmet needs and obstacles for a safe return to the community.

The factorial validity and internal consistency of the Instrumental Activities of Daily Living Profile in individuals with a traumatic brain injury.

The objective of the study was to investigate the factorial validity and internal consistency of the Instrumental Activities of Daily Living (IADL) Profile. A group of 96 patients aged 16 to 65 years, with moderate to severe traumatic brain injuries, was recruited from 12 rehabilitation hospitals in Quebec. The IADL Profile was administered by an occupational therapist in each subject's home and community environment. Principal axis factoring and confirmatory factor analysis provide preliminary support for six correlated factors (F): (F1) going to grocery store/shopping for groceries, (F2) having a meal with guests/cleaning up, (F3) putting on outdoor clothing, (F4) obtaining information, (F5) making a budget, (F6) preparing a hot meal for guests. Total explained variance was 73.6%. Cronbach's alpha analysis revealed high to very high internal consistency for all scales ranging from .81 to .98; internal consistency of the total scale was very high (0.95). The findings suggest that the IADL Profile is a promising means of documenting both IADL independence and the repercussions of executive function deficits on everyday tasks in real-world environments.

Interpreting activity of daily living errors for treatment and discharge planning: the perception of occupational therapists.

OBJECTIVES: As clinician ratings of performance-based assessments of activities of daily living (ADL) require examiners to judge the appropriateness of actions within task context, this study sought to document occupational therapists' (OTs') ability to distinguish examples of potential ADL errors of healthy adults (HA) from those of individuals with frontal lobe lesions (FLL). METHOD: Eighty-two OTs were asked to identify the likely source population (HA/FLL) associated with 26 ADL errors. RESULTS: Only 50% of errors were related to the correct source population by more than 70% of OTs. CONCLUSION: Performance-based ADL assessments allowing for the documentation of context could enhance OTs' interpretation of ADL errors.

Training the next generation of researchers in work disability prevention: the Canadian Work Disability Prevention CIHR Strategic Training Program.

INTRODUCTION: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. METHODS: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. RESULTS: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. CONCLUSIONS AND SIGNIFICANCES: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow's research workforce.

Evaluating clients' perceptions of the quality of head injury rehabilitation services: development and validation of a questionnaire.

OBJECTIVE: The objective of this research was to develop a tool to assess clients' perception of the quality of head injury rehabilitation services. METHODS AND RESULTS: A questionnaire PQRS-Montreal 1.0 was developed in Montreal, Quebec using a standardized methodology that incorporated a new technique to reach consensus regarding the tool's contents. Five dimensions of care (i.e. ecological approach, client-centred approach, accessibility, quality of the service providers and continuity) and their corresponding standards were identified as pertinent to include in the tool and were subsequently validated by experts. A phase of item generation followed that led to the development of an 87-item prototype of the questionnaire. The questionnaire is to be administered during an interview and employs a 5-point rating scale. DISCUSSION AND CONCLUSION: The implications for the use of PQRS-Montreal 1.0 in the accreditation process of head injury rehabilitation services are discussed, as well as plans for future quantitative research in the development of the tool.

A critical review of assessment tools related to home adaptation issues.

For several decades now, occupational therapists have dealt with eliminating architectural barriers confronting persons using wheelchairs. The occupational therapist is usually a key resource person in the home care assessment team, but faces a penury of evaluation tools to carry out the task. Being often obliged to develop homemade instruments, the process tends to lack structure, uniformity and objectivity. A review of writings about assessment tools for occupational therapists has demonstrated the need for a specific tool dealing with the various factors involved in the home adaptation issue.