ADL Profile

Evidence Reviewed as of before: 14-12-2012
Author(s): Valérie Poulin; Vanessa Barfod, BA
Editor(s): Annabel McDermott, OT.; Nicol Korner-Bitensky, PhD OT
Expert Reviewer: Carolina Bottari, erg. PhD

Purpose

The ADL Profile is a criterion-referenced measure of independence in everyday activities such as self-care, household management and community activities for individuals with a traumatic brain injury (TBI). The ADL Profile was created by Elisabeth Dutil, Carolina Bottari, Marie Vanier and Céline Gaudreault.

In-Depth Review

Purpose of the measure

The ADL Profile is a criterion-referenced measure of independence in everyday activities in consideration of the important contribution of executive functions for individuals with a traumatic brain injury (TBI) (Canadian Association of Occupational Therapists, 2012; C. Bottari, personal communication, November 6, 2012). The ADL Profile consists of both a performance-based assessment (evaluator’s direct observation of performance) and a questionnaire administered in the form of semi-structured interviews with the person and a significant other (perceptions of person and significant other of person’s functioning). The ADL Profile assesses an individual’s ability to formulate and plan goals for personal and instrumental activities of daily living (PADL and IADL) in interaction with the environment in which they live. Using a task-analysis framework, the individual’s independent performance of ADL tasks is quantitatively analyzed according to 4 executive function operations:

  1. Formulating a goal
  2. Planning
  3. Carrying out the task
  4. Verifying attainment of the initial goal (Bottari et al., 2010b).

The ADL Profile was originally developed for use with patients with traumatic brain injury as an assessment of independence in everyday activities within three environments:

  1. Personal (self-care dimension);
  2. Home (home dimension); and
  3. Community (community dimension).

An exhaustive list of variables was derived from existing ADL tools and were organized as activities, tasks or operations under the three dimensions of personal care, home and community environments, according to Crochart’s (1987) ergonomic model. An expert group of therapists and researchers were consulted to review the refined list of variables and to ensure that all domains related to the concept of ADLs were included in the instrument. A review of the literature on components of ADL assessments also provided support for the experts’ verdict (Dutil et al., 2005).

Available versions

There are no alternate versions of the ADL Profile.

The IADL Profile is a revised version of the ADL Profile (Bottari et al., 2010b) and as such is not included in this review.

Features of the measure

Items

The ADL Profile consists of 20 PADL and IADL tasks in two parts:

  1. A non-structured, performance-based assessment that comprises observation of 17 tasks; and
  2. A semi-structured interview administered to the patient and his/her significant other that documents 3 tasks (indicated below).

The 20 items relate to (a) personal care; (b) household management; and (c) community activities: Personal care items (6 tasks):

  1. Bathing/showering
  2. Grooming
  3. Toileting
  4. Putting on clothes and shoes
  5. Having a meal
  6. Following his or her diet/taking his or her medication*

Household management (5 tasks):

  1. Preparing a light meal
  2. Preparing a hot meal
  3. Doing daily housecleaning
  4. Doing weekly housecleaning
  5. Doing laundry

Community activities (9 tasks):

  1. Walking or moving outdoors
  2. Using public transportation
  3. Driving a car*
  4. Running errands
  5. Telephoning for information
  6. Paying bill
  7. Using an automatic banking machine
  8. Making a budget
  9. Keeping appointments*

* Three tasks are evaluated by semi-structured interview. Driving is not evaluated per se but certain information is gathered regarding this activity.

Description of tasks

The client is asked what he/she would normally do at that time of the day and is then given the opportunity to perform the ADL task without assistance from the clinician. The non-structured evaluation enables the clinician to observe deficits relating to executive processes. Accordingly, the clinician informs the client at the onset of the test that he/she will provide limited interactions with the client throughout the examination. This enables the clinician to observe the client’s ability to manage on his/her own. It is important that the clinician provides a minimum of structure and assistance during the test, even if the client makes an error, because observing their ability to monitor and correct errors without assistance is crucial to showing their independence in consideration of executive functions. The examiner may withhold cueing for up to 10 minutes, unless a situation is judged as dangerous. If the person is clearly unable to perform a component without help the examiner may provide graded assistance (Bottari et al, 2010b).

If the client chooses a task that is not part of the ADL Profile the clinician may ask the client to consider another goal.

What to consider before beginning

The ADL Profile is best administered in the client’s home and community environment (Bottari et al., 2010b).

Klein et al. (2008) reviewed standardized performance-based ADL measures developed for adult/geriatric populations using an action research study design with 10 occupational therapists working with adult/geriatric clients with physical dysfunction in a tertiary-care rehabilitation hospital, to identify which measures best matched principles of occupational therapy practice and intended outcomes. The ADL Profile achieved the highest rating for its ‘fit’ with the values, beliefs and principles that underpin occupational therapy practice when compared with 17 other ADL measures, including the Assessment of Motor and Process Skills, Rivermead ADL Assessment, the Functional Performance Measure, Nottingham ADL Scale, Barthel Index and Functional Independence Measure. The ADL Profile met four of five construct criteria:

  • Client-centred (score enables item relevancy for client);
  • Dynamic interaction (measure acknowledges dynamic interaction between the client, task and physical environment, but does not consider the financial or social environment);
  • Uniqueness of the individual (measure enables assessment of physical, affective and cognitive performance components); and
  • Uniqueness of performance (measure incorporates client determination of task process unless client safety is a factor).

Of the 18 tools analysed, none achieved a score for the fifth dimension, a holistic perspective (i.e. integration of the client’s roles, culture, resources, spiritual beliefs and values). While it was reported that the ADL Profile did not consider the social environment, it is important to note that the questionnaire is administered to the patient’s significant other.

Scoring and Score Interpretation

Each task is scored according to independence in task performance (task score) and the manner in which the task is performed (operation score) with regards to the following four operations:

(i)formulate a goal
(ii)plan
(iii)carry out the task
(iv)verify attainment of the initial goal (Bottari et al., 2010b).

Tasks are scored using a four-level ordinal scale:

0 dependent
1 requires verbal assistance (1v) or physical assistance (1p) or verbal and physical assistance (1vp)
2 independent with difficulty
3 independent

Scores are not added across tasks or operations. The task score is determined by the lowest score on any of the four operations observed during performance of the task. Therefore, difficulty in any operation directly influences independence and task performance.

Time

Time to administer the ADL Profile will depend on the client’s stage of recovery and the number of tasks the clinician needs to administer. In acute care, it may take between 30 and 60 minutes as the clinician may decide to only administer self care tasks and one or two tasks from the community or home domains. When administered in preparation for discharge from a rehabilitation hospital or to community based participants to whom all tasks may be pertinent to administer, up to 7 hours may be required.

The administration time is acceptable when only components of the tool are administered to the subjects, but the assessment is length if administered in full. However, the authors note that the wealth of information obtained from observing the person complete various activities in her home and community environment cannot be underestimated in terms of its contribution to treatment planning.

Training requirements

The ADL Profile is intended for use by occupational therapists. It is recommended that clinicians complete a three-day training course to ensure correct administration and interpretation. The course provides information regarding the measure (objectives, conceptual frameworks, variables, administration procedure, scoring and interpretation), uses video to provide instruction regarding administration, and provides opportunities to practice task analysis and scoring (Bottari et al., 2010a).

Subscales

N/A

Equipment

The ADL Profile does not necessitate specialized equipment but requires any objects the client typically uses in his/her daily living.

Alternative forms of the ADL

There are no other forms of the ADL Profile.

Client suitability

Can be used with

  • Patients with stroke.
  • Patients with TBI throughout the continuum of care: – to assist in discharge planning from an acute care hospital, in rehabilitation and for community reintegration (Bottari et al., 2006; C. Bottari personal communication, November 6, 2012).
  • Patients with schizophrenia (Semkovska et al., 2004).

Should not be used with

  • None reported

In what languages is the measure available?

French and English.

Summary

What does the tool measure? The ADL Profile measures independence in everyday activities in consideration of executive function deficits related to goal setting, planning and execution.
What types of clients can the tool be used for? Clients with traumatic brain injury and stroke.
Is this a screening or assessment tool? Assessment tool
Time to administer Time to administer the ADL Profile will depend on the client’s stage of recovery and the number of tasks the clinician needs to administer. In acute care, it may take between 30 and 60 minutes as the clinician may decide to only administer self care tasks and one or two tasks from the community or home domains. When administered in preparation for discharge from a rehabilitation hospital or to community based participants to whom all tasks may be pertinent to administer, up to 7 hours may be required.
Versions ADL Profile
Other Languages French
Measurement Properties
Reliability

Internal consistency:

No studies have examined the internal consistency of the ADL Profile when used with an adult stroke population.

Inter-rater:

One study reported adequate inter-rater reliability for 3 tasks: preparing a hot meal; eating; obtaining information.

Intra-rater reliability:

No studies have examined the intra-rater reliability of the ADL Profile when used with an adult stroke population.

Test-retest:

No studies have examined the test-retest reliability of the ADL Profile when used with an adult stroke population.

Validity

Content

The ADL Profile was established through literature reviews & consultation with expert researchers and clinicians.

Construct
Convergent Validity:

One study reported significant correlations between 5 ADL Profile tasks related to personal care and corresponding tasks of the FIM [Standing up, Toilet, Bathtub, Walking, Stair climbing].

Criterion

No studies have reported on the criterion validity of the ADL Profile when used with an adult stroke population.

Floor/Ceiling Effects No studies have examined ceiling effects of the ADL Profile when used with an adult stroke population.
Sensitivity / Specificity No studies have examined the sensitivity/specificity of the ADL Profile when used with an adult stroke population.
Does the tool detect change in patients? No studies have reported on responsiveness of the ADL Profile when used with an adult stroke population.
Acceptability The administration time is acceptable when only components of the tool are administered, but administration in full may take up to seven hours over several sessions. However, the wealth of information obtained from observing the person complete various activities in her home and community environment cannot be underestimated in terms of its contribution to treatment planning.
Feasibility The ADL Profile can be administered by an occupational therapist. It requires completion of a three-day training course.
How to obtain the tool? Available at the Canadian Association of Occupational Therapists: www.caot.ca or Les Éditions Émersion http://www.leseditionsemersion.com/articles.php?lng=fr&pg=6.

* Initially developed for a traumatic-brain injured population, the psychometric properties of the tool with this population are described in the administration guide of the too

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the ADL Profile relevant to individuals with stroke. Two studies were found.

Floor/Ceiling Effects

No studies have reported ceiling effects of the ADL Profile in clients with stroke.

Reliability

Internal Consistency:

No studies have reported on the internal consistency of the ADL Profile in clients with stroke.

Inter-rater reliability:

Dell’Aniello-Gauthier (1994) reported that the ADL Profile demonstrates adequate inter-rater reliability (mean kappa = 0.58-0.68) for 3 ADL tasks: preparing a hot meal, eating and obtaining information.

Intra-rater reliability:

No studies have reported on the intra-rater reliability of the ADL Profile in patients with stroke.

Test-retest reliability:

No studies have reported on the test-retest reliability of the ADL Profile in patients with stroke.

Validity

Content

The ADL Profile was established through literature reviews & consultation with expert researchers and clinicians (Dutil et al., 2005).

Construct

Convergent Validity:
Gervais (1995) found significant correlations between 5 tasks of the ADL Profile related to personal care and corresponding tasks of the Functional Independence Measure (Kendall’s tau c = 0.40-0.73; p<.001).

Criterion

No studies have reported on the criterion validity of the ADL Profile.

Responsiveness

No studies have examined the responsiveness of the ADL Profile.

References

  • Azegami M., Ohira M., Miyoshi K., Kobayashi C., Hongo M., Yanagihashi R., & Sadoyama T. (2007) Effect of single and multi-joint lower extremity muscle strength on the functional capacity and ADL/IADL status in Japanese community-dwelling older adults. Nursing & Health Sciences, 9(3), 168-176.
  • Bottari, C., Dutil, C., Dassa, C., & Rainville, C. (2006) Choosing the most appropriate environment to evaluate independence in everyday activities: Home or clinic? Australian Occupational Therapy Journal, 53, 98-106.
  • Bottari, C., Dassa, C., Rainville, C., & Dutil, C. (2010a). A Generalizability Study of the Instrumental Activities of Daily Living Profile. Archives of Physical Medicine and Rehabilitation, 91, 734-42
  • Bottari, C., Dassa, C., Rainville, C., & Dutil, C. (2010b). The IADL Profile: Development, content validity, intra- and interrater agreement. The Canadian Journal of Occupational Therapy, 77 (2), 90-101.
  • Canadian Association of Occupational Therapists. (2012). ADL Profile. Retrieved from: http://www.caot.ca/default.asp?pageid=1438
  • Crochard, K. (1987). Les activités du GESCOM en 1986. Paris: Centre national d’études des telecommunications.
  • Dell’Anniello-Gauthier, M. (1994). Étude métrologique du mini-profil, instrument de mesure du statut fonctionnel des personnes âgées victimes d’un accident vasculaire cérébral. Sherbrooke, Québec : Université de Sherbrooke.
  • Dutil, E., Bottari, C., Vanier, M., & Gaudreault, C. (2005). ADL Profile: description of the instrument. 4th ed. Montréal: Les Éditions Émersion.
  • Dutil, E., Bottari, C., Vanier, M. & Gaudreault, C. (2005). Profil des AVQ: Description de l’outil, 4th ed. Montréal: Les Éditions Émersion.
  • Fougeyrollas, P. Saint-Michel, G. & Blouin, M. (1989). Propostition d’une révision du 3e niveau de la CIDIH: le handicap. [Proposition for a revision of the 3rd level of the International Classification of Handicaps: the handicap]. Réseau International CIDIH, 2 (1), 9-32.
  • Gervais N. (1995). Comparaison du profil des AVQ et de la mesure d’indépendance fonctionnelle: validité de trait. Montréal: Université de Montréal.
  • Kielhofner, G. (1995). A Model of Human Occupation: Theory and Application. USA: Lippincott Williams & Wilkins.
  • Klein, S., Barlow, I. & Hollis, V. (2008). Evaluating ADL measures from an occupational therapy perspective. Canadian Journal of Occupational Therapy 75,: 69-81.
  • Lawton, P. (1983). Environment and other determinants of well-being in older people. The Gerontologist 23, 349-357.
  • Luria, A.R. (1973). The Working Brain – An Introduction to Neuropsychology. New York: Basic Books.
  • Semkovska, M., Bedard, M.A., Godbout, L., Limoge, F., & Stip, E. (2004) Assessment of executive dysfunction during activities of daily living in schizophrenia. Schizophrenia Research, 69: 289-300

See The Measure

How to obtain the ADL Profile:

The ADL Profile can be purchased online at the Canadian Association of Occupational Therapists online store (www.caot.ca) or at Les Éditions Émersion (http://www.leseditionsemersion.com).

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