Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability (Albertm et al., 2006)

Albertm, S. M., Bear-Lehman, J., Burkhardt, A., Merete-Roa, B., Noboa-Lemonier, R., & Teresi, J. (2006). Variation in sources of clinician-rated and self-rated instrumental activities of daily living disability. The Journal of Gerontology, 61A(8), 826-831.

Department of Behavioral and Community Health Sciences, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA. smalbert@pitt.edu

BACKGROUND: It is unclear how well self-reports and clinician ratings of performance in the instrumental activities of daily living (IADLs; household maintenance tasks) correspond and why they may differ.

METHODS: We assessed clinician-rated IADL performance using an occupational therapy protocol, the Assessment of Motor and Process Skills (AMPS). AMPS and self-rated IADL disability were compared in two groups of nondemented elderly persons without ADL limitation: a group with functional limitation only (self-reported difficulty in some area of upper or lower body function, n = 139) and a group that reported functional limitation plus IADL disability (difficulty in at least one IADL task, n = 49). Occupational therapists were blind to self-reports, and all assessments were conducted in respondent homes.

RESULTS: Self-rated IADL disability was significantly associated with the AMPS motor skill score (r = -.34, p <.001), but the motor skill score was only moderately sensitive (61%) and specific (67%) in identifying self-rated disability. In adjusted logistic regression models, clinician-rated performance and self-rated IADL disability shared some physical predictors, but only clinician-rated performance was related to cognitive status. AMPS process skill scores did not relate to self-rated IADL disability or physical or cognitive status.

CONCLUSIONS: In this sample of older adults without dementia or ADL disability, clinician ratings of IADL motor skill and self-rated IADL disability were correlated. Physical deficits appear to be more salient in self-ratings than is cognitive ability, because cognitive ability (in particular, verbal fluency) was associated only with clinician-rated IADL performance.

http://www.ncbi.nlm.nih.gov/pubmed/16912100

My Notes:

An important aspect of the AMPS is its use of a Rasch measurement model to separately estimate the parameters for the ability level and difficulty level/

What I really need from this study are the examples concerning the discordances between clinician reports and the self-reports of the patients. For instance, despite the low discriminability of self-reports on functional limitation, people reporting "difficulty carrying something as heavy as 10 lbs" are more likely to report having problems in IADLs and perform below the age norm. In addition, slower gait is found to be associated with higher risks in self-reported disability and poorer clinician-rated motor skill; for each second required in walking 4-meters increase 20% of the risk.

Another interesting finding of this study is that the gender and ethnic differences are observed in self-reported IADL disability but not in the rating of clinicians. The authors suggested that such a differential finding might have something to do with the response bias intrinsic to the self-reports.

I guess, when in dasein, it is just fairly inevitable for us to see our world as a dasein-defined world...

In addition, concerning the following quote:

"Physical deficits appear to be more salient in self-ratings than is cognitive ability"....

Well, believe me, it is much easier for me to use my head to tell that I could move less than 10 steps a time (physical deficits) than to figure out how delusional I am (mental deficits)....