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

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.

[1]  G S Rubin,et al.  Assessing functional status: correlation between performance on tasks conducted in a clinic setting and performance on the same task conducted at home. The Salisbury Eye Evaluation Project Team. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[2]  J. Fleiss,et al.  The assessment of self-care capacity in geriatric psychiatric patients by objective and subjective methods. , 1976, Journal of clinical psychology.

[3]  Mary Edwards,et al.  The Reliability and Validity of Self-Report Activities of Daily Living Scales , 1990 .

[4]  N C Dunham,et al.  Measurement of Activities of Daily Living in Hospitalized Elderly: A Comparison of Self‐Report and Performance‐Based Methods , 1992, Journal of the American Geriatrics Society.

[5]  G. Sinoff,et al.  The Barthel Activities of Daily Living Index: Self‐Reporting Versus Actual Performance in the Old‐Old (≥ 75 years) , 1997, Journal of the American Geriatrics Society.

[6]  S. Zimmerman,et al.  Proxy reporting in five areas of functional status. Comparison with self-reports and observations of performance. , 1997, American journal of epidemiology.

[7]  E. Taal,et al.  Opinions of patients with rheumatoid arthritis about their own functional capacity: how valid is it? , 1992, Annals of the rheumatic diseases.

[8]  R. Wolf,et al.  Repeatability and objectivity of various measurements in rheumatoid arthritis. A comparative study. , 1976, Arthritis and rheumatism.

[9]  D Shinar,et al.  Reliability of the activities of daily living scale and its use in telephone interview. , 1988, Archives of physical medicine and rehabilitation.

[10]  A. Feinstein,et al.  High agreement but low kappa: II. Resolving the paradoxes. , 1990, Journal of clinical epidemiology.

[11]  P. Gertman,et al.  Measuring health status in arthritis. The arthritis impact measurement scales. , 1980, Arthritis and rheumatism.

[12]  H. Chui,et al.  The Modified Mini-Mental State (3MS) examination. , 1987, The Journal of clinical psychiatry.

[13]  G J Wijlhuizen,et al.  Measuring disability, the agreement between self evaluation and observation of performance. , 1999, Disability and rehabilitation.

[14]  C. Goldsmith,et al.  Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. , 1988, The Journal of rheumatology.

[15]  J. Kellgren,et al.  Radiological Assessment of Osteo-Arthrosis , 1957, Annals of the rheumatic diseases.

[16]  S. Studenski,et al.  Functional reach: a new clinical measure of balance. , 1990, Journal of gerontology.

[17]  B Bell,et al.  Self-care skills: behavioral measurement with Klein-Bell ADL scale. , 1982, Archives of physical medicine and rehabilitation.

[18]  H. Holman,et al.  Measurement of patient outcome in arthritis. , 1980, Arthritis and rheumatism.

[19]  M. Tinetti Performance‐Oriented Assessment of Mobility Problems in Elderly Patients , 1986, Journal of the American Geriatrics Society.

[20]  D. Wade,et al.  The Barthel ADL Index: a reliability study. , 1988, International disability studies.

[21]  B. Santos-Eggimann,et al.  Functional status of elderly home care users: do subjects, informal and professional caregivers agree? , 1999, Journal of clinical epidemiology.

[22]  M J Graney,et al.  Comparison of subjective ratings of function with observed functional ability of frail older persons. , 1991, American journal of public health.

[23]  G. Kinsella,et al.  Repeatability and validity of a modified activities of daily living (ADL) index in studies of chronic disability. , 1979, International rehabilitation medicine.

[24]  Sati Mazumdar,et al.  Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale , 1992, Psychiatry Research.

[25]  R. H. Jebsen,et al.  An objective and standardized test of hand function. , 1969, Archives of physical medicine and rehabilitation.

[26]  A. Jette,et al.  Validity of self-report measures of functional disability , 1986 .

[27]  R. Levine,et al.  Self-Care: A Comparison of Patients' Institutional and Home Performance , 1987 .

[28]  J. Stewart,et al.  Stroke recovery: he can but does he? , 1979, Rheumatology and rehabilitation.

[29]  L. Rubenstein,et al.  Systematic biases in functional status assessment of elderly adults: effects of different data sources. , 1984, Journal of gerontology.

[30]  W J MacLennan,et al.  The accuracy of self and informant ratings of physical functional capacity in the elderly. , 1992, Journal of clinical epidemiology.

[31]  Jh. Kellgren Radiological assessment of osteoarthrosis , 1957 .

[32]  K Kroenke,et al.  Functional Assessment of the Elderly: A Comparison of Standard Instruments With Clinical Judgment , 1987 .

[33]  R. Reitan Validity of the Trail Making Test as an Indicator of Organic Brain Damage , 1958 .

[34]  Are hospital assessments of daily living activities valid? , 1979, International rehabilitation medicine.

[35]  V. Leirer,et al.  Development and validation of a geriatric depression screening scale: a preliminary report. , 1982, Journal of psychiatric research.

[36]  J. Osberg,et al.  Program evaluation of physical medicine and rehabilitation departments using self-report Barthel. , 1986, Archives of physical medicine and rehabilitation.

[37]  R. Devellis,et al.  The modified health assessment questionnaire difficulty scale. A health status measure revisited , 1990 .

[38]  P J Holliday,et al.  Functional performance measures: are they superior to self-assessments? , 1993, Journal of gerontology.

[39]  R. Schulz,et al.  Task independence, safety, and adequacy among nondisabled and osteoarthritis-disabled older women. , 2001, Arthritis and rheumatism.