title: An ADL measure for spinal cord injury.
abstract: Occupational therapists do not have a comprehensive, objective method for measuring how persons with tetraplegia perform activities of daily living (ADL) in their homes and communities, because SCI ADL performance is usually determined in rehabilitation. The ADL Habits Survey (ADLHS) is designed specifically to address this knowledge gap by surveying performance on relevant and meaningful activities in homes and communities. After a comprehensive task analysis and pilot development, 30 activities were selected that emphasize a broad range of hand and wrist, reaching, and grasping movements in compound activities. A sample of 49 persons with cervical spinal cord injuries responded to items. The sample was predominantly male, median age was 41 years, and ASIA motor classification levels ranged from C2 through C8/T1 with majority concentration in C4, C5, or C6 (68%). Each participant report was rated by an occupational therapist using a seven category rating scale, and the item by participant response matrix (30 X 49) was analyzed with a Rasch model for rating scales. Results showed excellent participant separation (>4) and very high reliability (>.95), and both item and participant fit values were adequate (STANDARDIZED INFIT less than absolute value of 3). With only two exceptions, all participants fit the Rasch rating scale model, and only one item "Light housekeeping" presented significant fit issues. Principal Components Analysis an analysis of item residuals did not reveal serious threats to unidimensionality. A between group fit comparison of participants with more versus less movement found invariant item calibrations, and ANOVA of participant measures found statistically significant differences across ASIA motor classification levels. These ADLHS results offer occupational therapists a new method for measuring ADL that is potentially more sensitive to functional changes in tetraplegia than most instruments in common use. Accommodation of step disorder with a three category rating scale did not diminish measurement properties.
authors.affiliation: Case Western Reserve University, The Cleveland FES Center at MetroHealth Medical Center, H601 2500 MetroHealth Drive, Cleveland, Ohio 44109-1998 USA. amb31@case.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Bryden
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Bezruczko
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014481:United States