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Comparing assessments of physical functional independence in older adults with mobility limitations

Mortenson, W. Ben, PhD1,2,3; Demers, Louise, PhD4,5; Fuhrer, Marcus J., PhD6; Bilkey, Jessica, MSc1; Jutai, Jeffrey, PhD7,8; Alkadri, Jamal9; Aziz, Joseph9

American Journal of Physical Medicine & Rehabilitation: November 8, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001092
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Objectives 1) To assess the agreement and correlation between self-reported functional independence and observations of family caregivers in a heterogeneous population of community-dwelling older adults with disabilities. 2) To determine how self- and caregiver-reports correlate with evaluator rated functional independence over time.

Design Data were drawn from a larger, randomized controlled trial examining the effects of a caregiver-inclusive intervention on outcomes of care recipients and their family caregivers. Functional independence measures were obtained using a self-report version of the Functional Independence Measure (care recipient FIM-SR, caregiver FIM-SR) and the Functional Autonomy Measurement System (evaluator perspective). They were administered at baseline (pre-intervention), and following the intervention at 6-, 22-, and 58-weeks.

Results Bivariate correlation analyses of ninety dyads consisting of older care recipients and their family caregivers reported moderate to very strong correlations between the three functional independence measures across all time points (rS=0.45-0.91; P<0.01). Bland-Altman analyses revealed a small systematic bias between care recipient- and caregiver-assessments of functional independence, with participants reporting higher scores across all time points (mean difference=2.00-2.97).

Conclusion There is substantial consistency among the self-assessed, caregiver-assessed, and evaluator assessed functional independence of older adults. Caregivers may be used as proxies for community-dwelling older adults without severe cognitive impairments with functional limitations.

1 Department of Occupational Science and Occupational Therapy, University of British Columbia

2 GF Strong Rehabilitation Research Program

3 International Collaboration on Repair Discovery, Vancouver, BC

4 Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal

5 École de réadaptation, Université de Montréal, Montréal, PQ, Canada

6 Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

7 Interdisciplinary School of Health Sciences, University of Ottawa

8 Bruyère Research Institute, Ottawa, ON, Canada

9 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Funding: This project was funded by the Canadian Institutes of Health Research (CIHR) Open Operating Grant

Corresponding author: W. Ben Mortenson, University of British Columbia, The Department of Occupational Science and Occupational Therapy, T325-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. P: 604-822-7392. F: 604-822-7624. bmortens@interchange.ubc.ca

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