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A revised activities of daily living/instrumental activities of daily living instrument increases interpretive power: theoretical application for functional tasks exercise.

Fieo, R., Watson, R., Deary, I.J. and Starr, J.M. (2009) A revised activities of daily living/instrumental activities of daily living instrument increases interpretive power: theoretical application for functional tasks exercise. Gerontology , Published Online December 23 2009. ISSN 1423-0003

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Abstract

Background: As the number of adults in older age groups expands, difficulty performing usual activities of daily life is a rising health concern. A common exercise regimen employed to attenuate functional decline and disability has been resistance strength training. However, recent evidence suggests that functional tasks exercise may be more effective in preventing disability.

Objective: Activities of Daily Living (ADL) measures are one of the most widely used tools in gerontology, and yet the full sensitivity of these instruments is often not realized. The purpose of this study is to enhance the interpretive power of ADL by formally confirming a hierarchy of decline, assessing discriminatory power, and examining option characteristic curves. Theoretically, a revised ADL instrument can improve the efficacy of functional tasks training programs.

Methods: This was a cross-sectional study that employed Item Response Theory (IRT) to interpret ADL outcomes. Participants consisted of community-dwelling older adults (n = 548, aged 79) living in Scotland. Results: A Mokken scale with rho = 0.77 was obtained, indicating good reliability, and satisfying the IRT assumption that a single unidimensional scale is present. The set H coefficient of 0.48 indicated that the scale may be ordered by decreasing difficulty, with the 'Cut your own toe-nails?' item being the most difficult and 'Tie a good knot in a piece of string?' being the least difficult. Discriminatory and option characteristic parameters revealed 'Get on a bus?' to be the task most closely related to the latent construct and that item options can be used to ascertain critical thresholds for prevention type strategies.

Conclusions: Examining parameters relating to difficulty, discriminatory power, and option characteristics facilitated the identification of ADL/Instrumental ADL items that may serve to enhance functional task training in community-dwelling older adults. These analyses demonstrated that functional tasks have differing levels of discriminatory power, and that a task's discriminatory power is likely to change with varying levels of disability. This observation reinforces the notion that exercises based on functional tasks may differ significantly in their therapeutic effect. Lastly, this study was able to highlight statistically meaningful cut-points relating to when older adults should begin 'prehabilitation' interventions.

Item Type: Article
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Nursing and Midwifery (Sheffield)
Depositing User: Miss Anthea Tucker
Date Deposited: 22 Feb 2010 16:10
Last Modified: 01 Mar 2010 16:02
Published Version: http://dx.doi.org/10.1159/000271603
Status: Published
Publisher: Karger
Identification Number: 10.1159/000271603
URI: http://eprints.whiterose.ac.uk/id/eprint/10416

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