'Why yet another functional assessment' uk edaq dr alison hammond and rachel gill

11/18/2010 © A Hammond 2010A Hammond 2010 1
Why yet another functional
assessment?
Developing the UK- Evaluation of
Daily Activity Questionnaire (EDAQ).
Alison Hammond PhD, FCOT,
Rachel Gill BSc(Hons)
Centre for Health, Sport & Rehabilitation Research
University of Salford
a.hammond@salford.ac.uk; r.e.gill@salford.ac.uk

Overview
Background: why are we doing this study?
What is the EDAQ?
Method & Results:
1. Linguistic validation
2. Cross-cultural validation for UK: item
generation
3. Psychometric testing (in progress):
What next?
.

Assessment types:
1. Patient Reported Outcome Measures (PROMs)
 Reliable, valid self-report measures
Good for research,
limited coverage of activities?
Eg HAQ (24 activities); AIMS2 (28 activities)
2. Reliable, valid observational measures
Good for research
time consuming in clinical practice?
some irrelevant content for Rheumatology?
Eg Functional Independence Measure (FIM)

11/18/2010 © A Hammond 2010A Hammond 2010
Assessment types
3. Structured, validated interviews:
Eg Canadian Occupational Performance
Measure (COPM)
approx. 45 minute+ interview
4. Non-validated checklists:
 commonest approach used in
Rheumatology OT

Survey: Use of functional assessments by
North-West Rheumatology OTs (2009)
18 respondents:
10 = department checklists exclusively
8 = department checklists + standardised
assessment/s for some patients
DASH = 4 (upper limb function only)
HAQ = 2
AIMS2 = 2
ClinHAQ = 1
COPM = 1

11/18/2010 © A Hammond 2010A Hammond 2010A Hammond 2010 6
Checklists: problems?
1. Checklists vary++ across the region/
country
simple (eg 6-10 key headings) to detailed
(eg 30-40+ specific activities)
varied measurement scales (comments to
5 point scales)
no reliability and validity.
2. Interviews can be time consuming?

The S-EDAQ: three parts
(Nordenskiold et al 1996)
1. How does RA affect you?
10cm VAS for pain, fatigue, movement, sleep, stiffness, mood.
Satisfaction with life… and most important activity
2. How do you manage doing everyday activities?
(11 activity sub-scales; 102 activities)
without gadgets or alternate methods?
With gadgets or alternate methods?
And what solutions have you found already?
4 point scale (same as HAQ)
3. Which assistive devices/gadgets do you have?
How often do you use them?

Part 2: 11 Sub-scales:
1. Eating & drinking (12 activities)
2. Going to the bathroom/personal care (13 activities)
3. Getting dressed/undressed (11)
4. Bathing/showering (12)
5. Cooking (12)
6. Moving around Indoors (7)
7. Cleaning the house (7)
8. Laundry/clothes care (9)
9. Moving and transfers (4)
10. Communication (4)
11. Moving around outdoors/ shopping (11)

EATING /
DRINKING
How do you do
the activity?
A. How do you normally do it
without aids or alternate
methods?
B. How else would you do it with an aid or
alternate method?
Without
difficulty
Some
difficulty
Much
difficulty
Impossible Please describe
which aids or
other
methods you
use
Without
difficulty
Some
difficulty
Much
difficulty
Impossible
1. Lift a glass
 ___
2. Lift a cup/mug
 ___
3. Use a knife and
fork (e.g.
cutting up
food)
 ___
4. Slice bread
 Angled knife

5. Slice cheese
 Cheese slicer

Part 2: S-EDAQ example page:
Eating/Drinking (12 items)
---- Line indicates does not use any alternate method/aid

Potential benefits of EDAQ?
Clinical:
Could help standardise:
Identifying problems (in detail)?
Support OTs offer?
Research:
Provide detailed OT assessment
eg Nordenskiold et al 1996, 1998; Thyberg et al 2004,
2005; Sandqvist et al 2004; Cederlund et al 2001, 2007)
Useful for practice, audit and research?

Potential benefits of EDAQ
Self-report measure:
completed at home: time to reflect
increases client’s responsibility in process
Includes identifying own current solutions
Reduces therapist interview time
Increases therapist time to focus on client’s
identified priority needs
Can be scored

Limitations to EDAQ
Not professionally translated, eg
“managing potato water”.
Needs culturally appropriate wording
Gender bias
Needs updating:
Some items now rarely performed
Some common activities not included

Limitations: cultural relevance
Some activities less relevant to UK
population (infrequent problems)
For example, go out on a balcony

Limitations: cultural relevance
Does not include:
Some common activities people with RA
find a problem in UK
For example, “turn taps” or “lift a kettle.”
Content needs revision.

Limitations: range of content
1. No activities related to:
gardening/household maintenance;
caring;
or leisure/social activities.
Should it?
Patient research partner emphasised: yes.

Limitations:
Scoring and Psychometrics
Several scoring methods used in published
research
Limited validity testing
Developed in RA, but used also for OA,
scleroderma etc – validity?
No test-retest reliability testing

Study aims
1. To linguistically validate the EDAQ
2. To establish cultural relevance of items,
generate additional activities appropriate for
people with RA in the UK
3. To revise content, structure/ layout and
scoring as necessary
4. To test the UK-EDAQ in RA: reliability and
validity

Aim 1:Linguistic validation
(Acquadro et al 2004)
Conceptual definition meeting: 2 days
(Gothenburg)
Instructions, scales, scoring, activities –
discussed to identify meaning and
methods.

Aim 1: Translating the EDAQ
Forward translated Swedish to English –
two independent Swedish professional
translators
Wording reviewed by UK panel (OT, PT,
research partner with RA) – choose best
options, alter if need be.

Swedish EDAQ:
translated patient introduction
”To you who are just now, in peace and quiet, about to fill the EDAQ
questionnaire. The EDAQ questionnaire (Evaluation of Daily
Activities) is designed to gain knowledge about your ability,
problems and possibilities in daily tasks.
You might have noticed that your difficulties have decreased when you
use helping devices/everyday tools or other work methods. Sharing
your own ideas and solutions to problems occurring in daily tasks is
very valuable to us.
Another purpose of the questionnaire is to find the daily activities that
are devoid of facilitating tools and which we need to influence in our
industry. If designers can develop better and more appealing
everyday tools, e.g. for people with weakened hand function, these
tools can most times be used by everybody.”

Aim 1. Translating the EDAQ
Backward translated English to Swedish – two
independent English professional translators.
Reviewed by 2 Swedish OTs (Ulla and Ingrid):
check still retain meaning
Harmonisation:
Further discussion in teleconference/s & e-mails
to resolve issues… gain agreement

Aim 1: Results
Developed prototype UK-EDAQ:
11 sub-scales; 102 items
Revised introduction

Aim 1: Discussion
Clarified further issues to address:
Changes to layout
Develop completion instructions (wording;
worked example)
Common UK problem activities not
included – initial list

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