Environmental influences on the cumulative structure of instrumental ADL: an example in osteoporosis patients in a Swedish rural district.
BACKGROUND
The ADL Staircase is a hierarchical instrument for the assessment of dependence/independence in personal and instrumental activities of daily living (P-ADL and I-ADL). Previous results indicated that environmental factors might affect assessment results, and revisions for use in rural areas have been tested with a gerontological population sample.


OBJECTIVE
To investigate further the cumulative structure of I-ADL in osteoporosis patients in a Swedish rural district.


METHODS
Patients were interviewed consecutively concerning their pre-injury dependence in P-ADL and I-ADL, using a revised version of the ADL Staircase (n = 276).


RESULTS
In contrast to results from urban areas, 'transportation' was the activity generating the most dependence among the respondents. In addition, different gender-specific cumulative orders among I-ADL were demonstrated. Guttman's scaling analysis confirmed the cumulativity of the revised scale (C of R = 0.94/0.97, C of S = 0.77/0.88).


CONCLUSIONS
Environmental factors influence the validity of instruments as well as the prevalence of disability.
Department of Community Health Sciences, Dalby/Lund, Lund University, Sweden.
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Iwarsson
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004777:Environment; D005260:Female; D005598:Fractures, Spontaneous / Q000534:rehabilitation; D006620:Hip Fractures / Q000534:rehabilitation; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology / Q000534:rehabilitation*; D010384:Pelvic Bones / Q000293:injuries; D012424:Rural Population; D016103:Spinal Fractures / Q000534:rehabilitation; D014186:Transportation