Activities of daily living in persons with intellectual disability: Strengths and limitations in specific motor and process skills

Sound psychometric properties of a short new screening tool for patient safety climate: applying a Rasch model analysis

BACKGROUND

WHO recommends repeated measurement of patient safety climate in health care and to support monitoring an 11 item questionnaire on sustainable safety engagement (HSE) has been developed by the Swedish Association of Local Authorities and Regions. This study aimed to validate the psychometric properties of the HSE.

METHODS

Survey responses (n = 761) from a specialist care provider organization in Sweden was used to evaluate psychometric properties of the HSE 11-item questionnaire. A Rasch model analysis was applied in a stepwise process to evaluate evidence of validity and precision/reliability in relation to rating scale functioning, internal structure, response processes, and precision in estimates.

RESULTS

Rating scales met the criteria for monotonical advancement and fit. Local independence was demonstrated for all HSE items. The first latent variable explained 52.2% of the variance. The first ten items demonstrated good fit to the Rasch model and were included in the further analysis and calculation of an index measure based on the raw scores. Less than 5% of the respondents demonstrated low person goodness-of-fit. Person separation index > 2. The flooring effect was negligible and the ceiling effect 5.7%. No differential item functioning was shown regarding gender, time of employment, role within organization or employee net promotor scores. The correlation coefficient between the HSE mean value index and the Rasch-generated unidimensional measures of the HSE 10-item scale was r = .95 (p < .01).

CONCLUSIONS

This study shows that an eleven-item questionnaire can be used to measure a common dimension of staff perceptions on patient safety. The responses can be used to calculate an index that enables benchmarking and identification of at least three different levels of patient safety climate. This study explores a single point in time, but further studies may support the use of the instrument to follow development of the patient safety climate over time by repeated measurement.

Assessment of the Functional Level of Independence in Individuals with Mental Disabilities as Part of Special Education Diagnostics: Case Studies

In this study we focus on the application of standardized tests aimed at evaluating the functional degree of independence in children (client 1, WeeFIM test; and client 2, FIM test) in special education diagnostics. The target group consisted of two clients with a diagnosis of mental functional diversity (n = 2; client 1: mild mental retardation, according to ICD-10: F70, aged 6.5 years; and client 2: moderate mental retardation, according to ICD-10: F71, aged 13.4 years). Special pedagogical intervention was primarily applied to the clients, focusing on identified deficits in the areas of cognitive, motor, and social skills. The presented results demonstrate the importance of the application of these tests in special pedagogy. An improvement in the observed indicators of the given tests was demonstrated for both probands after the intervention. The aim of this article was to draw attention to the suitability of using functional independence tests in special pedagogical practices. The authors discuss the further implications of this application for future practice.

Pleiotropic predisposition to Alzheimer's disease and educational attainment: insights from the summary statistics analysis

Epidemiological studies report beneficial associations of higher educational attainment (EDU) with Alzheimer's disease (AD). Prior genome-wide association studies (GWAS) also reported variants associated with AD and EDU separately. The analysis of pleiotropic associations with these phenotypes may shed light on EDU-related protection against AD. We performed pleiotropic meta-analyses using Fisher's method and omnibus test applied to summary statistics for single nucleotide polymorphisms (SNPs) associated with AD and EDU in large-scale univariate GWAS at suggestive-effect (5 × 10-8 < p < 0.1) and genome-wide (p ≤ 5 × 10-8) significance levels. We report 53 SNPs that attained p ≤ 5 × 10-8 at least in one of the pleiotropic meta-analyses and were reported in the univariate GWAS at 5 × 10-8 < p < 0.1. Of them, there were 46 pleiotropic SNPs according to Fisher's method. Additionally, Fisher's method identified 25 of 206 SNPs with pleiotropic effects, which attained p ≤ 5 × 10-8 in the univariate GWAS. We showed that a large fraction of the pleiotropic associations was affected by a counterintuitive phenomenon of antagonistic genetic heterogeneity, which explains the increase, rather than decrease, of the significance of the pleiotropic associations in the omnibus test. Functional enrichment analysis showed that apart from cancers, gene set harboring the non-pleiotropic SNPs was characterized by late-onset AD and neurodevelopmental disorders. The pleiotropic gene set was characterized by a broad spectrum of progressive neurological and neuromuscular diseases and immune-mediated conditions, including progressive motor neuropathy, multiple sclerosis, Parkinson's disease, and severe AD. Our results suggest that disentangling genes harboring variants with and without pleiotropic associations with AD and EDU is promising for dissecting heterogeneity in biological mechanisms of AD.

A Novel Tool to Assess Basic Activities of Daily Living in Spanish Preschoolers

BACKGROUND

Basic activities of daily living (BADLs) are those related to self-care. Their performance depends on the development of sensorimotor and cognitive skills, as well as social and environmental aspects. A good performance in BADLs is required for independence and social participation, so they play an important role in early education and early care. We aim to create a tool for BADLs assessment for Spanish preschoolers.

METHODS

The tool was administered to 303 participants (48.5% boys and 51.5% girls) between three and six years of age. Analyses to find out the factorial structure and internal consistency was carried out.

RESULTS

The instrument was composed of 84 items in four scales (eating, personal hygiene, dressing, and daily functioning) with nine factors (oral sensitivity, good manners, manual dexterity, brushing teeth, toilet management, hygiene and grooming, dressing, higher-order and core executive function). Reliability values were from acceptable to preferred (0.74-0.94).

CONCLUSIONS

The instrument could be useful and shows preliminary good indicators in construct validity and reliability.

Activities of daily living and working memory in pediatric attention-deficit/hyperactivity disorder (ADHD)

Most children with ADHD have impaired working memory abilities. These working memory deficits predict impairments in activities of daily living (ADLs) for adults with ADHD. However, our understanding of the relation between pediatric ADHD and ADLs is limited. Thus, this study aimed to examine (1) the extent to which pediatric ADHD is associated with ADL difficulties; and if so (2) the extent to which these difficulties are related to their well-documented working memory difficulties and/or core ADHD inattentive and hyperactive/impulsive symptom domains. A well-characterized, clinically evaluated sample of 141 children ages 8-13 years (M = 10.36, SD = 1.46; 51 girls; 70% White/non-Hispanic) were administered a battery of well-validated working memory tests and assessed for ADHD symptoms (teacher-ratings) and ADL difficulties (parent-ratings); cross-informant reports were used to control for mono-informant bias. Children with ADHD exhibited medium magnitude difficulties with ADLs (d = 0.61, p < .005, 38% impaired). Results of the bias-corrected, bootstrapped conditional effects model indicated that lower working memory predicted reduced performance of age-expected ADLs (β =0.28) and greater ADHD inattentive (β = -0.40) and hyperactive/impulsive symptoms (β = -0.16). Greater inattentive, but not hyperactive/impulsive, symptoms predicted greater ADL difficulties (β = -0.36) even after controlling for working memory. Interestingly, working memory exerted a significant indirect effect on ADLs via inattentive (indirect effect: β = 0.15, effect ratio = .54) but not hyperactive/impulsive symptoms. These findings implicate ADHD inattentive symptoms as a potential mechanism underlying ADL difficulties for children with ADHD, both independently and via working memory's role in regulating attention.

Occupational Therapy-Related Assessments for Adults With Intellectual Disability: A Scoping Review

IMPORTANCE

Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time.

OBJECTIVE

To identify occupational therapy-related tools in the peer-reviewed literature for use in practice with adults with ID.

DATA SOURCES

Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy-related assessment with adults 18 yr or older who had primary or co-occurring ID.

FINDINGS

Fifty-eight articles identified 73 occupational therapy-related assessment tools.

CONCLUSIONS AND RELEVANCE

This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which may be unfamiliar to occupational therapy practitioners. What This Article Adds: This scoping review provides occupational therapy practitioners with a summary of occupational therapy-related assessment tools for adults with ID and an assessment reference guide.

Examining the Structure of a New Pediatric Measure of Functional Independence Using the interRAI Child and Youth Mental Health Assessment System

Activities of daily living (ADL) are key to daily living and adjustment. A number of ADL scales have been developed and validated to examine functional performance in the pediatric population; however, most of these scales are limited to specific groups. The purpose of this research was to test the plausibility of developing and validating a hierarchical versus additive ADL summary scale for children and youth using the interRAI Child Youth Mental Health (ChYMH) assessment system. Data from 8980 typically developing children (mean age 12.02 years) and 655 children with developmental disabilities (mean age 11.9 years) was used to develop ADL summary scales. Patterns among the data were analyzed and, unlike with adult populations, a hierarchical scale did not capture ADL performance and mastery. Two new ADL additive summary scales for children and youth were developed to measure ADL skills within this group.

Protecting the privacy of technology users who have cognitive disabilities: Identifying areas for improvement and targets for change

Introduction

Information Technologies (IT) may serve assistive roles that facilitate the interaction of people living with cognitive disabilities (CD) within their environments. However, there are some notable concerns related to privacy threats associated with the use of IT. The purpose of this study was to examine how assistive technology developers may best adapt over time to develop their IT to be resilient against threats to privacy. We therefore focused on the following areas: (1) developers' knowledge and practices related to privacy protection; (2) challenges when applying recommended practices, and; (3) preferred channels to acquire knowledge.

Method

We conducted semi-structured interviews with ten technology developers who are members of the AGE-WELL network undertaking research and development of assistive technologies to be used by people who have cognitive disabilities. We used an inductive-deductive method for the analysis of qualitative data to examine participant responses and generate themes related to the study goals.

Results

Principal themes that emerged from the data include practices specific to populations with CD, challenges to obtaining consent to use of information, and preferred channels to acquire knowledge.

Conclusion

We identify areas of focus for developing a knowledge mobilization strategy to improve relevant policies and practices.

Activities of daily living and transition to community living for adults with intellectual disabilities

BACKGROUND

As adults with intellectual disability (ID) in Ireland move to the community from residential settings, the changed environment is intended to increase opportunities for occupational engagement, autonomy and social relationships. It is important to consider how increased resources and opportunities available within the community can be optimized to promote engagement and quality of life.

AIMS

This paper investigates if and how ADL and IADL performance of people ageing with ID is related to place of residence.

METHODS

ADL and IADL performance of adults with ID in Ireland across different living situations was analyzed using descriptive and bivariate analysis of data collected from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS TILDA).

RESULTS

Greater ability to perform ADL and IADL was noted in those living in independent or community group home settings when compared to traditional residential settings. Place of residence was strongly related to ADL and IADL performance.

CONCLUSION AND SIGNIFICANCE

Given that people with ID will likely require physical and social supports to complete ADL and IADL when transitioning to community living from residential settings, an occupational justice perspective can inform occupational therapists working with people with ID, facilitating successful transitions to community living.

Factors associated with the amount of public home care received by elderly and intellectually disabled individuals in a large Norwegian municipality

This study reports an analysis of factors associated with home care use in a setting in which long-term care services are provided within a publicly financed welfare system. We considered two groups of home care recipients: elderly individuals and intellectually disabled individuals. Routinely collected data on users of public home care in the municipality of Trondheim in October 2012, including 2493 people aged 67 years or older and 270 intellectually disabled people, were used. Multivariate regression analysis was used to analyse the relationship between the time spent in direct contact with recipients by public healthcare personnel and perceived individual determinants of home care use (i.e. physical disability, cognitive impairment, diagnoses, age and gender, as well as socioeconomic characteristics). Physical disability and cognitive impairment are routinely registered for long-term care users through a standardised instrument that is used in all Norwegian municipalities. Factor analysis was used to aggregate the individual items into composite variables that were included as need variables. Both physical disability and cognitive impairment were strong predictors of the amount of received care for both elderly and intellectually disabled individuals. Furthermore, we found a negative interaction effect between physical disability and cognitive impairment for elderly home care users. For elderly individuals, we also found significant positive associations between weekly hours of home care and having comorbidity, living alone, living in a service flat and having a safety alarm. The reduction in the amount of care for elderly individuals living with a cohabitant was substantially greater for males than for females. For intellectually disabled individuals, receiving services involuntarily due to severe behavioural problems was a strong predictor of the amount of care received. Our analysis showed that routinely collected data capture important predictors of home care use and thus facilitate both short-term budgeting and long-term planning of home care services.

Comparison of motor and process skills among children with different developmental disabilities

[Purpose] The purpose of the present study was to compare the motor and process skills of children with different developmental disabilities. [Subjects] Thirty-nine children with developmental disabilities participated in this study which was conducted at N hospital in South Korea. [Methods] The motor and process skills of the participants were compared among three different disabilities: pervasive developmental disorder, cerebral palsy, and intellectual disorder. The data were analyzed using descriptive statistics and one-way ANOVA. [Results] Significant differences in motor skills were found among the diagnoses. The cerebral palsy group showed poorer motor skills than the pervasive developmental disability and intellectual disability groups. [Conclusion] The findings have clinical implications for strategies of rehabilitation for children with developmental disabilities.

Lee Fatigue And Energy Scales: exploring aspects of validity in a sample of women with HIV using an application of a Rasch model

This study examines the psychometric properties of the Lee Fatigue and Energy Scales (visual analog version) using a Rasch model application. The relationship between fatigue and energy is also described for a convenience sample of 102 women with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who completed the Lee Fatigue and Energy Scales in the morning and evening. Both scales were assessed for internal scale validity, unidimensionality, and uniform differential item functioning in relation to morning and evening ratings. Analyses confirmed that both the Fatigue and Energy Scales demonstrated evidence of internal scale validity and unidimensionality. Mean fatigue measures were also higher in the evening than in the morning and mean energy measures were higher in the morning than in the evening (both p<0.001), indicating that time of day is an important consideration. Fatigue and energy measures were moderately correlated with each other in the morning but not in the evening. The concepts of energy and fatigue were inversely related, but not polar opposites in this sample. Fatigue and energy may therefore be distinct constructs that should not be used interchangeably, either in measurement or when interpreting outcomes for research or clinical purposes.

A 7-item version of the fatigue severity scale has better psychometric properties among HIV-infected adults: an application of a Rasch model

PURPOSE

To examine the psychometric properties of the 9-item Fatigue Severity Scale (FSS) using a Rasch model application.

METHODS

A convenience sample of HIV-infected adults was recruited, and a subset of the sample was assessed at 6-month intervals for 2 years. Socio-demographic, clinical, and symptom data were collected by self-report questionnaires. CD4 T-cell count and viral load measures were obtained from medical records. The Rasch analysis included 316 participants with 698 valid questionnaires.

RESULTS

FSS item 2 did not advanced monotonically, and items 1 and 2 did not show acceptable goodness-of-fit to the Rasch model. A reduced FSS 7-item version demonstrated acceptable goodness-of-fit and explained 61.2% of the total variance in the scale. In the FSS-7 item version, no uniform Differential Item Functioning was found in relation to time of evaluation or to any of the socio-demographic or clinical variables.

CONCLUSION

This study demonstrated that the FSS-7 has better psychometric properties than the FSS-9 in this HIV sample and that responses to the different items are comparable over time and unrelated to socio-demographic and clinical variables.

Differences in Schoolwork Performance between Typically Developing Students and Students with Mild Disabilities

The purpose of this study was to examine whether students with mild disabilities differed from typically developing students in their ability to perform schoolwork tasks. The participants, selected from the School Assessment of Motor and Process Skills (School AMPS) database, comprised 175 students in each group. Their data were subjected to many-faceted Rasch analyses and then analyzed for statistically significant differences in mean school motor and school process abilities between groups. The relative and actual item difficulty calibration values were then compared to identify meaningful differences between groups. The results revealed a statistically significant mean difference in school motor and school process ability between groups (large effect sizes), essentially stable relative skill item hierarchies between groups, and actual hierarchies that differed such that some school motor and almost all school process skill items (occupational performance skills) were more difficult to perform for the mild disabilities group. The results of this study also provided evidence of validity for the use of the School AMPS measures to assist in identifying lower than expected schoolwork performance of students with mild disabilities.

The Use of the Assessment of Motor and Process Skills (AMPS) in Predicting Need of Assistance for Adults with Mental Retardation

Because the ability to perform activities of daily living (ADL) is associated with global aspects of community functioning, it is critical to evaluate whether the information gained from specific ADL assessments contributes to a reliable prediction of the overall amount of assistance needed for a person to function in the community. The purpose of this study was to evaluate the predictive use of an ADL assessment, the Assessment of Motor and Process Skills (AMPS), to determine which people with mental retardation need support or assistance to function in the community. A sample of 380 data records from the AMPS international database of people with various levels of mental retardation was included in the study. Many-faceted Rasch analyses and logistic regression models were used for data analysis. The results indicated that only the AMPS ADL process ability measures contributed significantly and substantially to the prediction of the level of assistance required to function in the community for individuals with mild to moderate mental retardation when used in conjunction with age, gender, and level of mental retardation. The results have clinical implications for occupational therapists working with these people because ADL process ability can be improved by occupational therapy interventions.