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Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties.

ABSTRACT:

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Background

Older adults experience activity and participation limitations that are associated with ageing. Activity and participation limitations affect an older adult's ability to engage in meaningful daily activities and valued life roles. Occupational therapists provide interventions to reduce such limitations and monitor client change to ensure that interventions are effective. Client change should be measured through the use of valid and reliable assessments. Yet occupational therapists can favour the use of non-standardised assessments leading to inaccurate reflections of client change and difficulties in comparing the effectiveness of interventions. A number of reasons have been suggested as to why therapists may favour non-standardised assessments, including a lack of knowledge (of assessments and their properties) and lack of skill.

Methods/design

This paper describes the systematic review protocol that will be used to identify functional assessments used in randomised trials of occupational therapy interventions for older adults (?70 years of age). Interventions will focus on enhancing functional independence for either older adults transitioning from hospital to home, or community dwelling older adults. We will search Medline, EBSCO and OTseeker using a pre-determined search strategy to identify Functional assessments. These assessments will be recorded and, in phase two, their measurement properties analysed.

Discussion

This protocol provides a comprehensive guideline for conducting the proposed systematic review. The results of this systematic review will provide a thorough and unbiased identification and evaluation of measurement properties of functional assessment tools used in randomised trials to evaluate occupational therapy intervention. This information can be used to determine which assessment has superior measurement properties and will inform occupational therapy practice.

SUBMITTER: Wales K

PROVIDER: S-EPMC3582570 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties.

Wales Kylie K Clemson Lindy L Lannin Natasha A NA Cameron Ian D ID

Systematic reviews 20121015

<h4>Unlabelled</h4><h4>Background</h4>Older adults experience activity and participation limitations that are associated with ageing. Activity and participation limitations affect an older adult's ability to engage in meaningful daily activities and valued life roles. Occupational therapists provide interventions to reduce such limitations and monitor client change to ensure that interventions are effective. Client change should be measured through the use of valid and reliable assessments. Yet ...[more]

PMID: 23067564

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Project description:IntroductionThe use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults.ObjectiveTo identify and appraise the properties of assessments used to evaluate functional abilities in older adults.MethodsA systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria.ResultsTwenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population.ConclusionsThe Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary.

Project description:ObjectiveThe Keele Assessment of Participation (KAP) questionnaire measures person-perceived participation in 11 aspects of life. Participation allows fulfilment of valued life activities and social roles, which are important to older adults. Since we aimed to use the KAP in a larger Dutch cohort, we examined the measurement properties of KAP in a Dutch sample of older adults with joint pain and comorbidity.DesignCohort study.SettingA community-based sample in Amsterdam, the Netherlands and North Staffordshire, UK.ParticipantsParticipants were aged 65 years and over, had at least two chronic diseases (identified through general practice consultation) and reported joint pain on most days (questionnaire). The Dutch cohort provided baseline data (n=407), follow-up data at 6 months (n=364) and test-retest data 2 weeks after 6 months (n=122). The UK cohort provided comparable data (n=404).Outcome measuresThe primary outcome was person-perceived participation, as measured with the KAP. The measurement properties examined were the following: structural validity (factor analysis), internal consistency (Cronbach's ?), reliability (intraclass correlation coefficients; ICC), construct validity (hypothesis testing), responsiveness (hypothesis testing and area under the curve) and cross-cultural validity (differential item functioning; DIF).ResultsFactor analysis revealed two domains: KAPd1: 'participation in basic activities' and KAPd2: 'participation in complex activities', with Cronbach's ? of 0.74 and 0.57 and moderate test-retest reliability: ICC of 0.63 and 0.57, respectively. Further analyses of KAPd1 showed poor construct validity and responsiveness. Despite the uniform DIF in item 'interpersonal relations', the total KAPd1 score seemed comparable between the Dutch and UK sample.ConclusionsOnly KAP domain 'participation in basic activities' showed good internal consistency and sufficient reliability. KAPd2 lacks sufficient measurement properties for application in studies, although items may be used as single items. Further development of the concept 'participation' may help the development and validation of instruments to measure participation.

Project description:BACKGROUND:Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples' oral health, in order to provide recommendations for practice, policy, and research. METHODS:A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to 'oral health assessments', 'non-dental healthcare professionals' and 'older people (60+)' were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using "The Consensus-based Standards for the selection of health Measurement Instruments" (COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate). RESULTS:Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene. CONCLUSION:Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain.

Project description:BackgroundEvidence-based practice (EBP) is a complex process. To quantify it, one has to also consider individual and contextual factors using multiple measures. Modern measurement approaches are available to optimize the measurement of complex constructs. This study aimed to develop a robust measurement approach for constructs around EBP including practice, individual (e.g. knowledge, attitudes, confidence, behaviours), and contextual factors (e.g. resources).MethodsOne hundred eighty-one items arising from 5 validated EBP measures were subjected to an item analysis. Nominal group technique was used to arrive at a consensus about the content relevance of each item. Baseline questionnaire responses from a longitudinal study of the evolution of EBP in 128 new graduates of Canadian physical and occupational therapy programmes were analysed. Principles of Rasch Measurement Theory were applied to identify challenges with threshold ordering, item and person fit to the Rasch model, unidimensionality, local independence, and differential item functioning (DIF).ResultsThe nominal group technique identified 70/181 items, and modified Delphi approach identified 68 items that fit a formative model (2 related EBP domains: self-use of EBP (9 items) and EBP activities (7 items)) or a reflective model (4 related EBP domains: attitudes towards EBP (17 items), self-efficacy (9 items), knowledge (11 items) and resources (15 items)). Rasch analysis provided a single score for reflective construct. Among attitudes items, 65% (11/17) fit the Rasch model, item difficulties ranged from - 7.51 to logits (least difficult) to + 5.04 logits (most difficult), and person separation index (PSI) = 0.63. Among self-efficacy items, 89% (8/9) fit the Rasch model, item difficulties ranged from - 3.70 to + 4.91, and PSI = 0.80. Among knowledge items, 82% (9/11) fit the Rasch model, item difficulties ranged from - 7.85 to 4.50, and PSI = 0.81. Among resources items, 87% (13/15) fit the Rasch model, item difficulties ranged from - 3.38 to 2.86, and PSI = 0.86. DIF occurred in 2 constructs: attitudes (1 by profession and 2 by language) and knowledge (1 by language and 2 by profession) arising from poor wording in the original version leading to poor translation.ConclusionsRasch Measurement Theory was applied to develop a valid and reliable measure of EBP. Further modifications to the items can be done for subsequent waves of the survey.

Project description:BackgroundOccupational therapists who work in hospitals need to assess patients' home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients' home environments could be an innovative solution to allow better and more appropriate recommendations.ObjectiveThe aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients' home environments.MethodsOccupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients' homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient's occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews.ResultsEight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not.ConclusionsThe use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning.International registered report identifier (irrid)RR2-10.2196/11674.

Project description:BackgroundDefinitive evidence that exercise interventions that improve gait also reduce disability is lacking. A task-oriented, motor sequence learning exercise intervention has been shown to reduce the energy cost of walking and improve gait speed, but whether the intervention also improves activity and participation has not been demonstrated.ObjectiveThe objective of this study was to compare the impact of a task-oriented, motor sequence learning exercise (TO) intervention and the impact of an impairment-oriented, multicomponent exercise (IO) intervention on activity and participation outcomes in older adults with mobility limitations. The mediating effects of a change in the energy cost of walking on changes in activity and participation also were determined.DesignThis study was a single-blind, randomized controlled trial. Setting The study was conducted in an ambulatory clinical research training center.ParticipantsThe study participants were 47 older adults (mean age=77.2 years, SD=5.5) with slow and variable gait. Intervention The intervention was a 12-week, physical therapist-guided program of TO or IO.MeasurementsMeasures of activity (gait speed over an instrumented walkway; daily physical activity measured with an accelerometer; confidence in walking determined with the Gait Efficacy Scale; and physical function determined with the total, basic lower-extremity, and advanced lower-extremity components of the Late-Life Function and Disability Instrument [Late-Life FDI]) and participation (disability limitation dimension and instrumental role [home and community task performance] domain components of the Late-Life FDI) were recorded before and after the intervention. The energy cost of walking was determined from the rate of oxygen consumption during self-paced treadmill walking at the physiological steady state standardized by walking speed. An adjusted comparison of activity and participation outcomes in the treatment arms was made by use of an analysis of covariance model, with baseline and change in energy cost of walking added to the model to test for mediation. Tests were used to determine the significance of the mediating effects.ResultsActivity improved in TO but not in IO for confidence in walking (Gait Efficacy Scale; mean adjusted difference=9.8 [SD=3.5]) and physical function (Late-Life FDI basic lower-extremity component; mean adjusted difference=3.5 [SD=1.7]). Improvements in TO were marginally greater than those in IO for gait speed, physical activity, and total physical function. Participation improved marginally more in TO than in IO for disability limitations and instrumental role.LimitationsThe older adults were randomized to the intervention group, but differences in baseline measures had to be accounted for in the analyses.ConclusionsA TO intervention that improved gait also led to improvements in some activity and participation outcomes in older adults with mobility limitations.

Dataset Information

Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties.

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Background

Methods/design

Discussion

Publications

Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties.

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