Feasibility and results of a randomised pilot-study of pre-discharge occupational therapy home visits

BACKGROUND: Pre-discharge home visits aim to maximise independence in the community. These visits involve assessment of a person in their own home prior to discharge from hospital, typically by an occupational therapist. The therapist may provide equipment, adapt the home environment and/or provide education. The aims of this study were to investigate the feasibility of a randomised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation. METHODS: Ten patients participating in an inpatient rehabilitation program were randomly assigned to receive either a pre-discharge home visit (intervention), or standard practice in-hospital assessment and education (control), both conducted by an occupational therapist. The pre-discharge home visit involved assessment of the older person's function and environment, and education, and took an average of 1.5 hours. The hospital-based interview took an average of 40 minutes. Outcome data were collected by a blinded assessor at 0, 2, 4, 8 and 12 weeks. Outcomes included performance of activities of daily living, reintegration to community living, quality of life, readmission and fall rates. RESULTS: Recruitment of 10 participants was slow and took three months. Observed performance of functional abilities did not differ between groups due to the small sample size. Difference in activities of daily living participation, as recorded by the Nottingham Extended Activities of Daily Living scale, was statistically significant but wide confidence intervals and low statistical power limit interpretation of results. CONCLUSION: Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible, but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting

Examination of the change in Assessment of Motor and Process Skills performance in patients with acquired brain injury between the hospital and home environment

Aim: The Assessment of Motor and Process Skills (AMPS) is a standardised, valid, reliable, observational assessment that is sensitive to change over time. This research aimed to examine the change in AMPS performance in patients discharged from a neurosurgical rehabilitation ward to a home-based therapy programme over a four-week time frame. Methods: A total of 15 individuals with acquired brain injury who were participating in rehabilitation were recruited to the study. The AMPS was conducted with each individual during the participant's inpatient rehabilitation and again approximately four weeks later, while participating in home-based rehabilitation. Assessment results were collated using the AMPS computer programme and entered into a statistics package from which data were analysed. Results: As a group, no statistically significant change in function was identified between the home and hospital environments; however, individual results did indicate a change in occupational performance for many of the participants. Conclusions: The AMPS was shown to reflect a change in occupational performance for many of the research participants. This research supports previous studies which indicate that some individuals' motor and process skill abilities appear to be affected by the environment in which they perform. This suggests that occupational therapists wishing to know how an individual will perform activities of daily living should evaluate the individual's performance in the environment in which they will be functioning. © 2010 The Authors. Journal compilation © 2010 Australian Association of Occupational Therapists

Understanding the common inter-rater reliability measures

Health and rehabilitation professionals use a range of outcome instruments to evaluate the effectiveness of their interventions. In order to be evidenced-based practitioners, we need to understand the psychometric properties of these instruments and to be able to interpret the statistics used to test their psychometric properties. This paper focuses on inter-rater reliability. Different statistical methods for computing inter-rater reliability can be classified into one of three categories: consensus estimates, consistency estimates, and measurement estimates. The common statistical methods such as Kappa, intraclass correlation and Many-Facets Rasch Model are described along with the advantages and disadvantages of each approach. For each category of estimates, one paper has been chosen from the therapy and rehabilitation literature to illustrate the use of a number of commonly utilised inter-rater reliability measures. It is hoped that this overview will provide practitioners, students and/or new researchers with a ready reference of key measurements used for determining inter-rater reliability