Assessment of Disabilities in Stroke Patients with Apraxia: Internal Consistency and Inter-Observer Reliability

In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in general hospitals, rehabilitation centers and nursing homes in the Netherlands. Patients (n=42) diagnosed to have had a stroke in the left hemisphere and to have apraxia as well, participated in the study (48% male, aged 39–91). Guidelines were offered for the ADL-observation and the assessment of disabilities in these activities. The internal consistency of the scales is expressed by means of Cronbach's alpha and Mokken-scale analysis. The inter-observer reliability is expressed by means of percentage of agreement between two observers, Cohen's kappa and the intra-class correlation coefficient (ICC). The internal consistency of the observations is good: alpha is high (0.94). The Mokken-analysis confirms this finding: an H-coefficient of 0.58 and corresponding rho of 0.94 indicate a strong and reliable scale composed of the set of all ADL-observations. Results indicate that the inter-observer reliability can be considered fair to good: all kappa values were higher than 0.44; the maximum kappa was 0.95. Percentages of agreement vary between 60% and 96%. The ICC range from 0.62 to 0.98. The results of this study imply that the ADL-observations can be considered an internally consistent and reliable instrument for the assessment of disabilities in stroke patients with apraxia.

Clients using community occupational therapy services: sociodemographic factors and the occurrence of diseases and disabilities

PURPOSE

The aim of this study was to describe sociodemographic factors and the occurrence of diseases and disabilities among a representative sample of clients who were using community occupational therapy services in Norway.

METHOD

A postal survey of occupational therapists about their last clients (n=168) was carried out in 2001. A survey questionnaire based on the International Classification of Functioning, Disability, and Health (ICF) was developed. Diagnoses were coded according to the International Classification of Primary Care (ICPC-2).

RESULTS

This study showed that more than half of the clients were adults, youths, or children. Only 17% of adults participated in "ordinary working life", and of those approximately 10% were on sick leave and 62% were on disablement pension. A predominance of neurological diseases such as multiple sclerosis and Parkinson's disease was found (24%). Stroke was the most common principal diagnosis (19%). Musculoskeletal (16%) and mental diseases (13%) were also frequently reported. "Movement impairments" (96%) were most common in the body function component. Frequent problems in several domains of the activity and participation components were reported, in particular in "education, work and employment" (93-94%) and "recreation and leisure" (94%).

CONCLUSION

Clients using community occupational therapy in Norway had numerous types of chronic and severe diseases, and a high occurrence of musculoskeletal impairment, activity limitations, and participation restrictions.

Development of a uniform record for patients with burns of the hand

This study reports the development of a uniform record for patients with burns of the hands. The steps in the development of the record are outlined and discussed. The use of a uniform standardized record is intended to improve communication within a network of three burn centers and to facilitate joint research projects. A data entry method to facilitate pooling and subsequent data analysis is also described.

Occupational therapy for patients with chronic diseases: CVA, rheumatoid arthritis and progressive diseases of the central nervous system

A substantial proportion of the patients treated by occupational therapists have a chronic disease. The aim of this study was to describe the outlines of occupational therapy treatment for three specific groups of chronic diseases: progressive neurological diseases, cerebrovascular accident and rheumatoid arthritis. A total of 143 therapists, working in 49 occupational therapy departments in The Netherlands, were asked to complete a standard registration from based on the ICIDH. This form consisted of three sections: (a) patient characteristics, (b) occupational therapy diagnosis and treatment goals in terms of ICIDH and (c) treatment characteristics. The present study concerns 507 patients: 102 had progressive neurological diseases (PND), 338 had a CVA and 67 had rheumatoid arthritis (RA). Our results showed that each patient group was characterized by a specific treatment approach. Especially at the level of treatment programmes substantial differences between groups were observed. Besides the clear differences, similarities in approaches were found between the PND and RA group, e.g. total time spent on therapy differed largely between the PND and RA patients (both averages 6 h) and the CVA patients (average 14 h).