Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties

The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers’ expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults’ caregivers

Examining the benefit of occupational therapy with older adults: Measuring functional ability and costs of practice

Introduction: Measurement is a key aspect of healthcare, it allows the assessment of patients, monitoring of effectiveness, and the calculation of expenditure. Inconsistencies in measurement practice has led to difficulties in bench marking and promoting the value of occupational therapy. Objective: Recommendations regarding the measurement of older adults’ functional ability from an occupational therapy perspective will be provided, and the cost of an occupational therapy led health intervention for older adults explored. Methods: Study one is a systematic review of the quality of measurement properties of functional assessments used with older adults, study two provides validation of assessments used in the transition from hospital to home, and study three analyses the cost of two occupational therapy led discharge planning interventions. Results: Study one identified 28 assessments have been used in older adult populations in randomised controlled trials to measure function. A number had been modified over time (e.g. Barthel Index) and others not been evaluated for measurement quality in this population. The functional autonomy measurement system (SMAF) was identified as being a promising assessment for use with older adults. Study two provided further validation of assessments. The Groningen activity restriction scale (GARS) and modified reintegration to normal living index (mRNLI) were valid and sensitive to change in this population. Study three confirmed the value of cost analysis in randomised controlled trials identifying that with two discharge planning interventions that had similar effectiveness an enhanced program was not recommended for routine care for medical/acute patients. Conclusion: Measurement is complicated by a mix of assessments that vary in purpose and quality. Strategic and planned selection of assessments is required so informed decisions of use are made that benefit practice and allow for the monitoring of cost and benefits

The measurement properties of the original Barthel Index : A systematic review

Background: Worldwide many countries are experiencing ageing populations. Ageing can result in older adults experiencing compromised health and increased hospitalisations making older adults recurrent users of health care services. The process of ageing can reduce an older adult’s ability to perform everyday tasks and participate in the activities required for daily life. As a result, older adults are often referred to occupational therapists to improve functional capacity and support engagement in activities and occupations. One role occupational therapists perform when working with older adults in a hospital or rehabilitation setting is to enhance function in self-care tasks and plan for discharge. Occupational therapists use functional assessments to determine an older adult’s ability to carry out everyday tasks. Some occupational therapists use standardised assessments whereas others prefer to use non-standardised assessments. The major barriers to occupational therapists using non-standardised assessments are a lack of knowledge and skill. Standardised assessments are used to measure function, monitor change and determine the effectiveness of therapy. The quality of these measurements relies on the validity and reliability of standardised assessments when used with specific patient groups and clinical settings they were designed for. The original Barthel Index (BI) developed by Mahoney and Barthel (1965) is a standardised functional assessment widely used within rehabilitation, hospital and community settings with various patient groups. To date, the validity and reliability of the original BI has not been established with older adults. Aim: The aim of this research is to investigate the measurement properties of the original BI and to determine its suitability as a standardised assessment to measure function with older adults. Method: A comprehensive systematic review of the literature was undertaken and the following databases were searched; Cumulative Index of Nursing and Allied Health (CINAHL), Embase and Medline. Methodological quality of the included studies was assessed using the COnsensus-based Standard for the selection of health Measurement INstruments (COSMIN) checklist. Results: 3273 abstracts were screened and 5 articles included. COSMIN rated structural validity (good), cross-cultural validity (poor), hypothesis testing (fair to poor), internal consistency (poor) and responsiveness (fair). No studies investigated reliability, measurement error, criterion or content validity. Discussion: Limited research has been undertaken on the measurement properties of the original BI, highlighting the need for further robust research to be undertaken on the measurement properties of the original BI, so that the reliability, validity and limitations of the original BI to be established with older adults. Multiple versions of the BI were identified making interpretation of results problematic. This review recommends re-naming these versions to ensure transparency and straightforward interpretation of results. Implications: This and further research will continue to bridge knowledge gaps within the occupational therapy profession and enable occupational therapists to make informed decision when selecting the most appropriate standardised assessment to measure function with older adults. Breaking down the barriers to measuring outcomes through increased knowledge and use of standardised assessments will increase occupational therapists adherence to evidence base practice and professional accountability to the occupational therapy profession. This in turn will provide older adults with accurate measurements of their functional capacity which will ultimately impact on patient recovery, quality of care and earlier discharge

The measurement properties of the original Barthel Index : A systematic review

Background: Worldwide many countries are experiencing ageing populations. Ageing can result in older adults experiencing compromised health and increased hospitalisations making older adults recurrent users of health care services. The process of ageing can reduce an older adult’s ability to perform everyday tasks and participate in the activities required for daily life. As a result, older adults are often referred to occupational therapists to improve functional capacity and support engagement in activities and occupations. One role occupational therapists perform when working with older adults in a hospital or rehabilitation setting is to enhance function in self-care tasks and plan for discharge. Occupational therapists use functional assessments to determine an older adult’s ability to carry out everyday tasks. Some occupational therapists use standardised assessments whereas others prefer to use non-standardised assessments. The major barriers to occupational therapists using non-standardised assessments are a lack of knowledge and skill. Standardised assessments are used to measure function, monitor change and determine the effectiveness of therapy. The quality of these measurements relies on the validity and reliability of standardised assessments when used with specific patient groups and clinical settings they were designed for. The original Barthel Index (BI) developed by Mahoney and Barthel (1965) is a standardised functional assessment widely used within rehabilitation, hospital and community settings with various patient groups. To date, the validity and reliability of the original BI has not been established with older adults. Aim: The aim of this research is to investigate the measurement properties of the original BI and to determine its suitability as a standardised assessment to measure function with older adults. Method: A comprehensive systematic review of the literature was undertaken and the following databases were searched; Cumulative Index of Nursing and Allied Health (CINAHL), Embase and Medline. Methodological quality of the included studies was assessed using the COnsensus-based Standard for the selection of health Measurement INstruments (COSMIN) checklist. Results: 3273 abstracts were screened and 5 articles included. COSMIN rated structural validity (good), cross-cultural validity (poor), hypothesis testing (fair to poor), internal consistency (poor) and responsiveness (fair). No studies investigated reliability, measurement error, criterion or content validity. Discussion: Limited research has been undertaken on the measurement properties of the original BI, highlighting the need for further robust research to be undertaken on the measurement properties of the original BI, so that the reliability, validity and limitations of the original BI to be established with older adults. Multiple versions of the BI were identified making interpretation of results problematic. This review recommends re-naming these versions to ensure transparency and straightforward interpretation of results. Implications: This and further research will continue to bridge knowledge gaps within the occupational therapy profession and enable occupational therapists to make informed decision when selecting the most appropriate standardised assessment to measure function with older adults. Breaking down the barriers to measuring outcomes through increased knowledge and use of standardised assessments will increase occupational therapists adherence to evidence base practice and professional accountability to the occupational therapy profession. This in turn will provide older adults with accurate measurements of their functional capacity which will ultimately impact on patient recovery, quality of care and earlier discharge

Functional Assessments Used by Occupational Therapists with Older Adults at Risk of Activity and Participation Limitations: A Systematic Review.

INTRODUCTION:The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. OBJECTIVE:To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. METHODS:A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. RESULTS:Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. CONCLUSIONS:The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary

A systematic review of the psychometric properties of the Action Research Arm Test in neurorehabilitation

Background/aim: The Action Research Arm Test (ARAT) measures upper limb activity limitations in people with acquired brain injuries. Evidence relating to the use of this test in neurorehabilitation is scattered. This review identifies, rates and synthesises evidence on the original 1981 ARAT use within neurorehabilitation. Psychometric properties are reviewed, including specific examination of participants with upper limb spasticity. Methods: Systematic review of published articles describing psychometric properties and/or use of the original version of the ARAT in neurorehabilitation. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy, reporting and methodological checklist with criterion-based appraisal of quality criteria for good measurement properties were applied. A best evidence synthesis for each psychometric property was completed. Results: In 28 included studies, participants had suffered a stroke or traumatic brain injury, with 46% >6 months post-injury. Six studies identified participants with upper limb spasticity. Methodological quality of psychometric properties ranged from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra-rater reliability (ICC 0.71 (95% CI 0.53–0.89) to 0.99 (95% CI 0.98, 0.99)); responsiveness (ROC curve 0.72–0.88, SRM 0.89); and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55–0.78). Gaps in evidence were found for inter and test–retest reliability, measurement error, content validity, structural validity, floor and ceiling effects. Conclusions: The ARAT is an appropriate measure of activity limitation post-stroke and should be considered for use with people with TBI; evidence for people with upper limb spasticity is limited. Gaps and mixed limited to moderate evidence for psychometric properties in neurorehabilitation mean further research is required. © 2018 Occupational Therapy Australi