ADL Profile

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.