Psychometric Evaluation of an ICF-Based Instrumental Activities of Daily Living Assessment With Older Adults With Cognitive Decline.

IMPORTANCE: Identifying cognitive or physical limitations that contribute to difficulties in instrumental activities of daily living (IADLs) is critical for adequate intervention with community-dwelling older adults with cognitive decline. OBJECTIVE: To establish the validity and responsiveness of an IADL scale based on the International Classification of Functioning, Disability and Health (the ICF-IADL) with respect to both cognitive and physical limitations. DESIGN: Cross-sectional study. SETTING: Multiple community care and senior centers. PARTICIPANTS: Eighty-two older adults. INTERVENTION: Combination of physical exercise and cognitive training. MEASURES: Five criterion measures-Lawton IADL Scale, Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSS), Word Lists Test (WLT), and Timed Up and Go Test (TUG). RESULTS: The ICF-IADL's three summary scales-Disability Index (DI), Cognitive Disability Index (CDI), and Physical Disability Index (PDI)-had good concurrent validity with the Lawton IADL Scale. The DI and CDI had moderate to good associations with the MoCA. The DI's and CDI's predictive validity for scores on the Lawton IADL Scale, MoCA, and TUG was moderate to good and that of the PDI was fair. Responsiveness was large for the DI, moderate for the CDI, and small for the PDI. CONCLUSIONS AND RELEVANCE: The ICF-IADL can be used to measure disability in IADLs related to cognitive and physical limitations. The DI and CDI were better than the PDI in predicting outcomes in general cognitive function and dynamic balance and were more responsive to change after intervention than the PDI. WHAT THIS ARTICLE ADDS: The ICF-IADL addresses both cognitive and physical limitations and can be a valid assessment of IADLs. Occupational therapists can use it to determine difficulties in IADLs and causes of those difficulties, guide treatment planning, and monitor intervention effectiveness with community-dwelling older adults with cognitive decline.

Longitudinal Trends of Participation in Relation to Mental Health in Children with and without Physical Difficulties.

Children with physical disabilities (PD) are known to have participation restrictions when in inclusive settings alongside typically developing (TD) children. The restrictions in participation over time may affect their mental health status. This study aimed to investigate the longitudinal relationship between independence in activities (capability) and frequency of attendance in activities, in relation to perceived mental health status in children with and without PD. The participants were a convenience sample of parents of 77 school children with PD and 94 TD children who completed four assessments with a one-year interval between each assessment. Parents of these children were interviewed with the Functioning Scale of the Disability Evaluation System-Child version (FUNDES-Child). Three dimensions of mental health problems-loneliness, acting upset, and acting nervous-were rated by parents with the Child Health Questionnaire (CHQ). Linear trend was tested by repeated-measure ANOVA. The results revealed different longitudinal patterns of independence and frequency of attendance over time for children with PD and TD. Frequency of attending activities may be more important than independence in performing activities for experiencing fewer mental health problems. The findings highlight the need for supporting children's actual attendance in daily activities which may benefit their later mental health.

Validation of the Chinese version of the Assessment of Preschool Children's Participation for children with physical disabilities.

PURPOSE: To examine the psychometric properties of the Chinese version of the Assessment of Preschool Children's Participation (APCP-C). METHOD: The APCP, a measure of participation in play, skill development, active physical, and social activities of preschool children, was translated into Traditional Chinese. Data on 94 Taiwanese children with physical disabilities aged 2 to 6 years were analyzed. RESULTS: Internal consistency (Cronbach's α = 0.85 and 0.86) and test-retest reliability (ICCs = 0.79) were excellent for total scores, and varied from excellent to poor for activity type scores. Items were generally relevant to the Taiwanese culture. Correlations between scores for the APCP-C and the Chinese version of the Pediatric Evaluation of Disability Inventory Mobility and Social Functioning scales in general supported convergent validity (r = 0.33-0.68) but less support for discriminant validity. CONCLUSIONS: The results provide evidence of reliability, cross-cultural validity, and limited support for construct validity of the APCP-C in measuring participation of children with physical disabilities.

Validity and Responsiveness of the Revised Nottingham Sensation Assessment for Outcome Evaluation in Stroke Rehabilitation.

OBJECTIVE: This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke. METHOD: The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA-S) and motor subscale (FMA-M) and the Nottingham Extended Activities of Daily Living (NEADL) scale. RESULTS: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA-M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51-.83). CONCLUSION: This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.

Predictors of participation change in various areas for preschool children with cerebral palsy: a longitudinal study.

This study identifies potential predictors of participation changes in various areas for preschool children with cerebral palsy (CP). Eighty children with CP (2-6 years) were enrolled. Seven potential predictors were identified: age; sex; socioeconomic status, CP subtype; cognitive function, Function Independence Measure for Children (WeeFIM), and motor composite variable from 5 motor factors (gross motor function classification system (GMFCS) level; bimanual fine motor function level; selective motor control score; Modified Ashworth Scale score; and Spinal Alignment and Range of Motion Measure). Outcome was assessed at baseline and at 6-month follow-up using the Assessment of Preschool Children's Participation (APCP) including diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation, social activities (SA), and total areas. Dependent variables were change scores of APCP scores at baseline and 6-month follow-up. Regression analyses shows age and sex together predicted for APCP-total, APCP-SD diversity and APCP-total intensity changes (r(2)=0.13-0.25, p<0.001); cognitive function and WeeFIM were negative predictors for APCP-SA and APCP-PA diversity changes, respectively. CP subtype, motor composite variable, and socioeconomic status predicted for APCP changes in some areas. Findings suggest that young boys with poor cognitive function and daily activity predicted most on participation changes.

Motor impairments screened by the movement assessment battery for children-2 are related to the visual-perceptual deficits in children with developmental coordination disorder.

This study was to examine to what extent the motor deficits of children with Developmental Coordination Disorder (DCD) verified by the Movement Assessment Battery for Children-2 (MABC-2) are linked to their visual-perceptual abilities. Seventeen children with DCD and seventeen typically developing children (TD) aged 5-10 years screened from a total of 250 children were recruited. The assessments included MABC-2, traditional test of visual perceptual skills (TVPS-R), and computerized test for sequential coupling of eye and hand as well as motion coherence. The results indicated that children with DCD scored lower than TD in MABC-2, and their total scores were highly correlated with manual dexterity component scores. DCD group also showed poor visual-perceptual abilities in various aspects. The visual discrimination and visual sequential memory from the TVPS-R, the sequential coupling of eye and hand, and the motion coherence demonstrated a moderate or strong correlation with the MABC-2 in the DCD rather than the TD group. It was concluded that the motor problems screened by MABC-2 were significantly related to the visual-perceptual deficits of children with DCD. MABC-2 is suggested to be a prescreening tool to identify the visual-perceptual related motor deficits.

Clinimetric properties of the Assessment of Preschool Children's Participation in children with cerebral palsy.

This study examines the criterion-related validity and clinimetric properties of the Assessment of Preschool Children's Participation (APCP) for children with cerebral palsy (CP). Eighty-two children with CP (age range, two to five years and 11 months) and their caregivers participated in this study. The APCP consists of diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation (AP), social activities (SA), and total areas. Tests were administered at baseline and at six-month follow-up. Concurrent and predictive validities were identified by assessing the strength of correlations between APCP scores and criterion-related measures--the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measure for Children (WeeFIM). Responsiveness was measured by standardized response mean (SRM). Minimal detectable change (MDC) at the 95% confidence level (MDC95) and minimal clinically important difference (MCID) were analyzed. The APCP with GMFM-66 and WeeFIM had fair to excellent concurrent validity (r=0.39-0.85) and predictive validity (r=0.46-0.82). The SRM values of the APCP diversity and intensity scales in all areas were 0.8-1.3. The MDC95 and MCID ranges for all areas (i.e., PA, SD, AP, SA, and total areas) were 0.1-0.7 and 0.4-1.2 points for intensity scores, respectively, and 4-17% and 10-19% for diversity scores, respectively. Therefore, the APCP scale was markedly responsive to change. Clinicians and researchers can use these clinimetric APCP data to determine whether a change score represents a "true" or clinically meaningful effect at post-treatment and follow-up.

Comparison between hospital-based and community-based services for the special health care needs of children with developmental delays.

BACKGROUND: Recognizing special health care needs (SHCN) is obligatory for children with developmental delay (DD). The purpose of this study was to compare hospital-based and community-based services for the SHCN of children with DD. METHODS: We collected 114 children with DD. An expert-designed questionnaire was used to measure the SHCN of children in either hospital-based or community-based services. The questionnaire included the children's characteristics, family ecology and SHCN, which encompassed four categories, team assessment and counseling, rehabilitation, complementary and alternative treatment, and home care. We compared the differences and needs between the two health care services. RESULTS: More children with DD in hospital-based services had disabled certificates, catastrophic illness certificates and multiple caregivers than community based services. More children with DD in community-based services had severe-disabled certificates than those in hospital-based services (p < 0.001). Children in hospital-based services had more SHCN for some items of team assessment and counseling, rehabilitation, and complementary and alternative treatment than those in community-based services (p < 0.05). The need for home care was not significantly different between the two services except for nutrition counseling (p = 0.048). CONCLUSION: SHCN in multiple aspects imply the necessity for team assessment and counseling, rehabilitation, complementary and alternative treatments and nutrition counseling in approaching children with DD in hospital-based services.