Abstract
BackgroundSince the number of persons diagnosed with multi-morbidity is increasing, there is a need for generic instruments to be able to assess, measure and compare ADL ability across diagnoses. Accordingly, the ADL-Interview (ADL-I) was developed to be used in rehabilitation research and clinical practice. The aim of this study was to investigate if the ADL-I can be used to provide valid and reliable ADL ability measures across gender and diagnostic groups.MethodsADL-I data were extracted from an existing research database on persons with chronic conditions including medical, rheumatological, oncological, neurological, geriatric and psychiatric diagnoses. Data were analysed based on Rasch Measurement methods to examine: the psychometric properties of the rating scale; ADL item and person fit to the Rasch model; if the difficulty of the ADL tasks differs across gender and diagnostic groups, and if the ADL-I provides precise and reliable measures of ADL ability.ResultsData on n = 2098 persons were included in the final analysis. Initial evaluation of the 0–3 rating scale revealed threshold disordering between categories 1 and 2. After removal of 16 underfitting items, the variance explained by the Rasch dimension increased from 54.3 to 58.0%, thresholds were ordered, but the proportion of persons with misfitting ADL-I measures increased slightly from 8.7 to 9.1%. The person separation index improved slightly from 2.75 to 2.99 (reliability = 0.90). Differential test function analysis, however, supported that the 16 underfitting items did not represent a threat to the measurement system. Similarly, ADL items displaying differential item functioning across gender and diagnoses did not represent a threat to the measurement system. The ADL items and participants were well distributed along the scale, with item and person measures well targeted to each other, indicating a small ceiling effect and no floor effect.ConclusionsThe study results overall suggest that the ADL-I is producing valid and reliable measures across gender and diagnostic groups among persons within a broad range of ADL ability, providing evidence to support generic use of the ADL-I.Trial registrationN/A.
Highlights
Since the number of persons diagnosed with multi-morbidity is increasing, there is a need for generic instruments to be able to assess, measure and compare activities of daily living (ADL) ability across diagnoses
The Barthel Index [3] and the Functional Independence Measure (FIMTM) [4] are examples of generic instruments that are wellknown and commonly used within rehabilitation. In both instruments the ability to perform Personal ADL (PADL) tasks independently is evaluated based on an ordinal rating scale and the interpretation is based on summed scores
Aim The overall aim was to examine the psychometric properties of the ADL-I applied among males and females living with various chronic conditions
Summary
Since the number of persons diagnosed with multi-morbidity is increasing, there is a need for generic instruments to be able to assess, measure and compare ADL ability across diagnoses. Within the field of rehabilitation, several instruments used to evaluate ADL ability have been developed. The Barthel Index [3] and the Functional Independence Measure (FIMTM) [4] are examples of generic instruments that are wellknown and commonly used within rehabilitation. In both instruments the ability to perform PADL tasks independently is evaluated based on an ordinal rating scale and the interpretation is based on summed scores. Decreased quality of ADL task performance may be indicated by increased effort, inefficient use of time and safety risk
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