Assessment And Clinimetrics_ Topic 1-15 (1).pdf

TOPIC 10: ACTIVITIES OF DAILY LIVING Dependency assessment Multidisciplinary Personal life Family Social Health Economic Care Physiotherapy: Motor-functional aspects —> MSK problems Geriatry: Cognitive-physiological aspects —> Senescense, dementia. Family medicine and palli...

TOPIC 10: ACTIVITIES OF DAILY LIVING Dependency assessment Multidisciplinary Personal life Family Social Health Economic Care Physiotherapy: Motor-functional aspects —> MSK problems Geriatry: Cognitive-physiological aspects —> Senescense, dementia. Family medicine and palliative care: Symptom control and quality of life Evaluating medicine: Graduation for obtaining compensation and access to services. Social work: Domestic aspects, the environment and support for caregivers. Why assess dependency? A system for a variety of services and programs related to caring for the elderly and those with disabilities. Determine type of assistance Set goals of treatment Determine patient health status Dependency grades Grade I: Moderate dependency Help to perform ADLs at least once a day, or intermittent or limited support needs for personal autonomy. Grade II: Service dependency Help to perform various ADLs twice or three times a day, but does not want permanent support from a caregiver or has significant support needs for personal autonomy. Measures of function: Generic VS Specific tools General health status questionnaires Not specific to any pathology or diagnosis Overall aspects of functional capacities Could evaluate physical function alone (+) Goof measurement properties (-) Miss out specific problems of each pathology. Not sensitive with functional changes Specific: Health-related quality of life for a specific pathology Generic: Not related to any type of disease. Applicable to the gernal population and to group of patients. 3 subgroups: single item measures, health profiles and utility measures. ICF Barthel index EUROQo-5D SF-36 Barthel index functional assessment Mainly used in rehabilitation, geriatrics and residential admissions. Is to establish degree of independence from any help, however minor and for whatever reason. A patient’s performance should be established using the best available evidence. Ask patient and their friends/ relatives for usual source. 10 sections: 8 sections (11 activities): -7 self care: Feeding, washing the whole body, dressing, personal hygiene, toilet use. -4 mobility: Body transfers, mobility in a wheelchair, going up and down stairs. 2 sections: -Stooling and urination Objectives Functional capacity assessment Detect the degreee of deterioration Objectively control the clinical evolution Design care and rehabilitation plans in an interdisciplinary way Severity levels 1. Independent, but requires technical aids, prostheses or orthoses. 2. Help is required, but patient performs at least 50% of the activity. 3. Patient requires a lot of help. 4. Total incapacity or major help to perform the activity. Barthel index interpretation Multiply each item score x10 -80-100 => Able to live independently -60-79 => Minimally dependent -40-59 => Partially dependent -20-39 => Very dependent - Total dependence EUROXoL-5D Quality of life health related measurement tool European consensus Two parts: 1. Descriptive System: Mobility, Personal care, Daily activities, Pain/discomfort, anxiety/depression -1) = No problem -2)= Some problems/ moderate problems -3) = Many problems/ unable 2. Vertical VAS (20 cm) “Worst health you can imagine” “Best health you can imagine” SF- 36 Health Survey Developed from the medical outcomes study questionnaire battery. SF-20 and SF-12 versions. 8 health concepts Physical function Physical role Body pain General health Standard version: 4 weeks Vitality Acute version: 1 week Social function Emotional role Mental health 1 Transition item: Change in health status from previous year. Not use in scoring Measures of function Specific tools Pathology-specific” Items generated specifically with a given pathology Body part specific: Region specific; items about tasks using the involved body part. Patient-specific: Each patient identifies his or her own set of disabilities. Measures of function. Generic vs specific Specific tools Positive (+): Able to detect specific limitations associated to certain pathologies. Positive (+): Sensitive to detect functional changes in response to treatment. Negative (-): not able to detect general psychosocial or health related quality of life status. Grade III: High dependency Help to perform several ADLs several times a day, because of total loss of physical, mental, intellectual or sensory autonomy, needs the indispensable and continuous support of another person. Disabilities components assessed with dependency scales Activities of daily living (ADLs) Set of behaviors that a person performs every day or almost every day in order to live autonomously and integrated in his environment and to fulfill his social role.