GERIATRIX - 75 - Februar 2011.pdf - Norsk Fysioterapeutforbund

has shown satisfactory reliability (Kukull et al.,1994). Information on validity and reliability is notbased on nursing home residents.MobilityWalking and wheelchair (WC) propulsion at selfselectedand maximum walking speed (m/s) or, fornon-walkers, self-selected and maximumwheelchair propulsion speed was tested indoors fora distance of 10m. There was no acceleration anddeceleration phase. The type of walking aids usedwas recorded. The walking test has been shown tohave a good intra- and inter-rater reliability(Connelly et al., 1996). Information on validity andreliability is not based on nursing home residents.Activities of Daily Living (ADL)Performance in Activities of Daily Living (ADL)was described according to the FunctionalIndependence Measure (FIM) (Buffali, 1994). Theinstrument consists of 18 items (13 itemsconcerning motor abilities and 5 items concerningcognition) rated on a seven-level ordinal scale thatdescribes levels of complete dependence (level 1) tocomplete independence (level 7) in the performanceof basic living activities. The maximum score is 91points on the motor scale (item a-m), called ‘FIMam’,and 35 points on the cognitive scale, called‘FIMn-r’, (item n-r). Both reliability and validityhave been found to be good (Cohen & Marino;2000, Finch et al., 2002). The ratings were done bya staff member who knew the participant well.Participants with results from less than 75% of theFIM items (> 3 items on ‘FIMa-m’ and >1 item on‘FIMn-r’) were excluded from all the calculations.If one, two or three items on ‘FIM a-m’ and oneitem on ‘FIMn-r’ were missing, the individualmedian score on that scale was used to replace themand the total sum was recalculated from that(Twisk& de Vente, 2002).Physiotherapy Clinical Outcome Variables (COVS)cover 13 different activities related to transfers.Each item is scored according to a scale rangingfrom 1 to 7, and with a sum score, called COVSsum,ranging from 13 to 91, where a high scoreindicates good functioning. The instrument hasbeen demonstrated to have a very good inter-raterand test–retest reliability (Seaby & Torrance, 1989),a good content (Seaby & Torrance, 1989) andconstruct validity (Hajek et al., 1997) and to besensitive to change (Przybylski et al., 1996).Physical activityExtent and frequency of mobility were assessedusing The Nursing Home Life Space Diameter(NHLSD) based on self-report/staff evaluation.“Life space” refers to the area throughout which anindividual moves during the previous two weeksand is estimated with the help of a six-grade scaleranging from 0 (never) to 5 (> 3times a day). Inaddition, a two-grade scale is used regardingdependence on human assistance for mobility(0=dependent, 1=independent). The scores can becomputed in two ways, either for only the area theperson moves around in, and the maximum score,NHLSD-area, is then 50 points, or in addition, thedependence on human assistance for mobility, andthen the maximum score, NHLSD- dependence, is100 points. Inter- and intra-rater reliability havebeen found to be high for nursing home residents,and the construct validity moderate (Tinetti &Ginter, 1990).ProcedureThe testing was performed by researchphysiotherapists or occupational therapists. Beforethe study was initiated, testers from the differentresearch sites took part in a training programme ontesting procedures in order to ensure high inter-ratertest reliability (see Frändin et al., 2009). Thetraining for the assessors achieved a predeterminedlevel of agreement and consensus of this level wasachieved for all instruments. The order of carringout the measurements is according to Table 1.Data AnalysisData were analysed using the SPSS statisticalpackage, version 17.0 (SPSS Inc., 2007). The levelof significance was set to p≤ 0.05. All thecontinuous variables were tested for normality byKolmogrorov-Smirnov statistic. The results of theKolmogrorov-Smirnov statistic showed that anormal distribution could not be assumed. In ourcase the p value was 0.000 for all the continuousvariables, thus suggesting violation of theassumption of normality (Pallant, 2007).Descriptive statistics were used to categorize thepopulation demographics. Spearman’s correlationcoefficient was used to explore correlation amongthe variables. T-tests are used to detect differencesbetween two groups (e.g. males and female)(Pallant, 2007). Mann Whitney U-tests are used forordinal data and non normally distributed variablesand chi-square for dichotomous values.Validity refers to the relationship between what atest is meant to measure and what it actually doesmeasure (Portney & Watkins, 2009) and isestimated by correlation analyses. The feasibility ofthe performance-based and self-reportedmeasurements was tested by examining ceiling andfloor effect of the subjects who had completed themeasurement, see Table 1. Floor and ceiling effectswere considered to be present if more than 15% ofthe respondents achieved the lowest or highestGeriatrix nr. 75, Februar 2011 - 7