The ADL Profile was developed to provide a criterion-referenced measure of independence in everyday activities (PADL and IADL) for individuals with a traumatic brain injury (TBI). This clinical tool consists of two parts, a performance-based assessment and a questionnaire administered through semi-structured interviews to the patient and a significant other. It includes twenty-one tasks of which 17 are used for the performance-based observation. Each task is scored using a four-level ordinal scale that relates independence in task performance (task score) and the manner in which the task is performed (operation score). The task score reflects the lowest score on any of the four operations i.e. goal formulation, determination and organisation of steps and means of attaining the goal (planning), execution of the action plan and verification of its appropriateness in relation to the goal (quality control). Difficulty with any one of the operations therefore directly influences independence in the task as a whole. Scores are not added across tasks or across operations. The questionnaire measures the individual’s perception on variables such as life habits pre and post-injury and satisfaction with present level of functioning. Based on data obtained via all three approaches, the examiner determines whether there is presence of a handicap situation. Three conceptual / theoretical models underlie the ADL Profile: 1) the Model of Cerebral Functioning (Luria, 1973), 2) the Model of Human Occupation (Kielhofner, 1995) and 3) the conceptual model of the Disability Creation Process (Fouegeyrollas et al., 1998). Administration time varies with the patient’s ability but may take up to 7 hours. A five-day training session is recommended to ensure proper administration and analysis of the data.
Test-retest reliability coefficient for the global score indicates good stability upon repeated measurements 2 weeks apart (kappa coefficient for the global score ranging from 0.53 to 0.93) (Dutil et al., 1994). Rousseau et al (1994) calculated inter-rater reliability on task scores on a small sample (n=19) of patients with TBI with four occupational therapists with minimal training on the ADL Profile. Kappas ranged from 0.23 to 0.72. Kappa coefficients were below 0.4 for nine of the 21 tasks, which indicate, poor to fair agreement according to Landis and Koch (1977). Two revisions of the instrument have since been completed and therapists now receive a five-day training session. Internal homogeneity is good among tasks represented to select everyday activities (Cronbach’s alpha: 0.94 for the global score) and among the three subscales (Cronbach’s alpha: 0.93 personal care, 0.85 home management, and 0.82 community management). In an unpublished study of 92 severe TBI patients, Dutil et al (1994) identified, using a principal component analysis (varimax rotation), three factors that represent 69% of the variance of the 21 tasks. More automatic and routine activities, such as self-care, converge under one factor and seemingly more complex tasks are linked to two separate factors, one requiring higher-level physical skills and the other more complex cognitive skills. A separate analysis, using principal component analysis (varimax rotation), of operations’ scores indicated that most tasks loaded on a single factor for each operation.
The ADL Profile as one of the top measures most congruent with principles of occupational therapy practice (Klein, Barlow, & Hollis, 2008). Evaluating ADL measures from an occupational therapy perspective.
User's Guide Interviews 37 pages
Description of the Instrument 45 pages
User's Guide Performance-based Assessment 73 pages
Assessment form 36 pages
Élisabeth Dutil • Carolina Bottari • Marie Vanier
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