Activities of daily living instruments: optimizing scales for neurologic assessments. (Lindeboom, Vermeulen, Holman, & De Haan, 2003)

Lindeboom, R., Vermeulen, M., Holman, R., & De Haan, R. J. (2003). Activities of daily living instruments: optimizing scales for neurologic assessments. Neurology, 60(5), 738-742.

Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.

The ability to perform activities of daily living (ADL) is an important part of assessment in neurologic patients. A literature search was carried out to identify multi-item ADL scales developed for the assessment of neurologic patients, comparing item content, range, and detail of ADL scales. Of the 113 ADL scales identified, 27 (24%) were designed for use in neurology. In the basic ADL (BADL) domains (basic mobility and self-care), individual items were present in 44% to 81% of instruments. In the extended ADL (EADL) domains (e.g., outdoor mobility, housekeeping), items were present in up to 67% of the instruments identified. A typical trade-off was observed between the range, the detail (number of items), and hence the practicality of a scale. In general, scales focus on either BADL or EADL domains or, on occasion, some of both, rather than measuring the full range of functioning. There are many ADL scales in neurology, with much overlap in item content, leading to redundancy. New scales developed with the traditional methods will not solve the existing difficulties associated with range and detail, ordinal scale scores, and cross-instrument comparability. The possibilities of a modern psychometric method known as item response theory that was designed to solve these problems are discussed.

http://www.ncbi.nlm.nih.gov/pubmed/12630419
http://www.neurology.org/cgi/content/full/60/5/738?cookietest=yes&eaf

My Notes

Functional outcome measure

1. Basic activities of daily living (BADL) contains item domains
   
   1. Basic mobility (e.g., transfers, walking in door)
   2. Self-care activities (toilet, hygiene, dressing, and feeding)
2. Extended ADL (EADL)—House keeping or shopping
   
   1. Househod activities (cleaning, laundry, meals)
   2. Community activities (shop, transportation)
   3. Social/recreational activities (sports, clubs, outings
   4. Cognitive activities (communicate, paperwork, finances)

The authors of this paper examined the redundancy and adequacy of neurologic ADL scales.

1. Redundancy refers to the overlap in item contents among scales
2. Adequacy refers to the comprehensiveness of a scale in term of the number of domains included.

The authors located 113 scales and retained only 27 scales that were originally developed and evaluated in the field of neurology for conditions such as stroke, dimension, dystonia, MS and brain trauma. Check the table for the reviews and comparisons for the 27 scales.

The "bandwidth fidelity problem" refers to a trade-off between the range, the detail and the practicality of a scale.

After the authors did a review on existing scales, they tried to ran analyses using Rasch model using information captured in an item bank containing 190 items to generate estimates for the item difficulties and individual ability.

Lindeboom and his associates (2003) conducted a study to examine the redundancy and adequacy of neurological ADL scales. In this study, redundancy refers to the overlaps between item contents while adequacy has to do with the comprehensiveness of the scale or the range of the symptoms the scale covers. Among the 113 ADL scales they identified through the literature, 27 of them were designed and evaluated for the field of clinical neurology. Their review found a lot of overlaps in the item contents for both the BADL (ADL) and EADL (IADL) domains, which resulted in redundancy. On the other hand, since different perspectives of functioning are more important for patients with different diagnosis, the gain in "fidelity" is often at the expense of comprehensiveness-- the "bandwidth fidelity problem." Later in this paper, the authors spoke of the promise of Item Response Theory and CAT.