Test-Retest Reliability and Cross Validation of the Functioning Everyday With a Wheelchair Instrument

ArticleinAssistive technology: the official journal of RESNA 19(2):61-77 · June 2007with44 Reads
DOI: 10.1080/10400435.2007.10131866
The purpose of this study was to establish the test-retest reliability and content validity of an outcomes tool designed to measure the effectiveness of seating-mobility interventions on the functional performance of individuals who use wheelchairs or scooters as their primary seating-mobility device. The instrument, Functioning Everyday With a Wheelchair (FEW), is a questionnaire designed to measure perceived user function related to wheelchair/scooter use. Using consumer-generated items, FEW Beta Version 1.0 was developed and test-retest reliability was established. Cross-validation of FEW Beta Version 1.0 was then carried out with five samples of seating-mobility users to establish content validity. Based on the content validity study, FEW Version 2.0 was developed and administered to seating-mobility consumers to examine its test-retest reliability. FEW Beta Version 1.0 yielded an intraclass correlation coefficient (ICC) Model (3,k) of .92, p < .001, and the content validity results revealed that FEW Beta Version 1.0 captured 55% of seating-mobility goals reported by consumers across five samples. FEW Version 2.0 yielded ICC(3,k) = .86, p < .001, and captured 98.5% of consumers' seating-mobility goals. The cross-validation study identified new categories of seating-mobility goals for inclusion in FEW Version 2.0, and the content validity of FEW Version 2.0 was confirmed. FEW Beta Version 1.0 and FEW Version 2.0 were highly stable in their measurement of participants' seating-mobility goals over a 1-week interval.
  • [Show abstract] [Hide abstract] ABSTRACT: The Power-Mobility Community Driving Assessment (PCDA) is a performance-based measure designed to assess driving performance of individuals using power wheelchairs or scooters in community environments. This article reports the results of pilot testing and an evaluation of the assessment's reliability and validity. Pilot testing was conducted with a random selection of Canadian occupational therapists working in the area of mobility. Although the response rate was very low, feedback confirmed the utility of the measure and contributed to one substantive scoring revision. Reliability and validity testing was conducted with a sample of 34 drivers. Internal consistency results were positive. Interrater reliability was fair to high but limited by the lack of variability in the scores. Construct validity hypotheses were tested on the relationships between PCDA scores and vision, perception, cognition, and environmental accessibility. Results indicated no relationships between the PCDA and perceptual and cognitive function and only a weak trend for a relationship with environmental accessibility. Concurrent validity was established: PCDA scores were positively associated with the judgments of therapists familiar with the driving performance of participants. In summary, the PCDA has moderate to good reliability, and content and concurrent validity results were found. More research is needed, particularly on the underlying constructs of successful driving performance. At this point, rehabilitation professionals and their clients are urged to use this assessment to establish driving performance rather than relying on assessments of perception, cognition, or environmental accessibility to predetermine whether someone will receive power mobility. Clinicians may find this a useful tool to identify where clients are able to drive safely in community settings, to identify specific learning needs, and, through those, to promote independent living for drivers of power-mobility devices.
    Full-text · Article · Feb 2007
  • [Show abstract] [Hide abstract] ABSTRACT: The purpose of this paper is to explain the development, methodology, and implementation of an assistive technology (AT) service delivery protocol using a telerehabilitation consultation model for evaluation of remote wheelchair prescriptions. The provision of wheeled mobility and seating interventions can be complex when considering people with intricate seating and positioning needs, environmental factors, and wide array of product interventions. The availability of qualified practitioners with specialty expertise in this area is limited, especially outside of urban areas. Therefore, people are potentially isolated from rehabilitation services due to geography or physical limitations. A repeated measure study design is used to evaluate the service delivery protocol measured by the effectiveness of wheeled mobility and seating interventions provided in a remote location by a generalist occupational and/or physical therapy practitioner with consultation from an expert therapist via interactive teleconferencing. Effectiveness is measured by magnitude of change and scored by pre and post scores of the Functioning Everyday with a Wheelchair (FEW) outcome measure tool. Two model programs have been specified and are currently implementing the service delivery protocol. The live interaction has enabled remote therapists the ability to exchange personal and health information to experts in the field from an urban facility. The impact of this service delivery protocol will be augmented as it is to be launched and replicated in three additional sites. Telerehabilitation is a new field that can only be measured by its long-term impact; however, its success can be looked at by its development and implementation into everyday clinical service delivery.
    Article · Dec 2008
  • [Show abstract] [Hide abstract] ABSTRACT: The purpose of this project was to determine the effectiveness of a telerehabilitation (TR) consultation model to prescribe and procure an appropriate wheeled mobility and seating (WMS) device at a remotely located site. The availability of practitioners with specific expertise in this area was limited particularly in Westerns Pennsylvania. A telerehabilitation service delivery model was developed for a series of studies based on a current model implemented at the Center for Assistive Technology at the University of Pittsburgh Medical Center (CAT-UPMC). In a multi-center non-randomized clinical trial, 96 participants were evaluated: 50 In-Person (IP) at the CAT-UPMC and 46 TR participants at remote sites. The performance-based Functioning Everyday with a Wheelchair-Capacity (FEW-C) tool demonstrated excellent inter-rater reliability coefficients (ICC 2,k = 0.91) and good internal consistency measured by Cronbach's alphas with correlations ranging between 0.82 to 0.91 among the 46 TR participants. Results indicated that using a TR consultation model, a significant improvement in mean differences was observed for the each of the self-report Functioning Everyday with a Wheelchair (FEW) items and for the average FEW scores at the remotely sites. Effect size calculations indicated that nine of the ten items on the FEW as well as the total FEW had very large effect sizes using Cohen's d, indicating the effectiveness of not only the new WMS device but the TR assessment as well. A significant relationship was found between the self-report FEW and performance-based FEW-C tools at baseline measured by Spearman rho's correlations. A significant difference was found for participants previous WMS device evaluation and prescription process compared to their current TR WMS device evaluation and prescription scores as well as patient satisfaction regarding the impact of the technology. The findings based on confidence intervals of post FEW scores indicated that TR was non-inferior to the standard IP care at CAT-UPMC. Telerehabilitation services resulted in decreased travel for participants, improved access to specialized services, education benefits for generalist practitioners, and service stabilization at the remote sites. A TR consultation model offers new alternative and effective opportunities to provide rehabilitation services in clinical settings, especially in rural or underserved locations.
    Article · Jun 2009 · Telemedicine and e-Health
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