ProQuest Document View - Developpement d'un outil d'evaluation du statut fonctionnel pour les personnes agees en visite a l'urgence

Developpement d'un outil d'evaluation du statut fonctionnel pour les personnes agees en visite a l'urgence

by Veillette, Nathalie, Ph.D., UNIVERSITE DE MONTREAL , 2008, 221 pages; NR53554

Abstract: There are few tools designed to help emergency department (ED) staff to make clinical decisions regarding patient disposition following an ED visit. In response to this shortcoming, the present doctoral thesis aims to develop and validate an assessment tool of the functional status for older adults visiting ED. Specific objectives will be to document assessment practices in ED, to detail the development steps of the tool and to evaluate some of its Psychometric properties. At the very beginning of this study, information was scarce about assessment of functional status in ED. Therefore, as a preliminary step an inventory was made and content of collected tools was analysed. Results showed a huge diversity in domain coverage between tools. None of the tools covered all relevant domains and the applicability of some tools didn't meet ED requirements. Occupational therapist's (OTs) professional practice in ED was also explored with a survey conducted among OTs in the province of Qu?bec. Results confirmed that OTs work mostly with older adults in ED; they assess diverse areas of functioning, 75% of them using in-house assessment tools. Respondents stressed the need to develop a better tool for ED practice. The development methodology was based on stages described by Benson and Clark (1982), combined with steps suggested by Kielhofner (2006). The planning stage included identification of need, objectives, targeted population and domains, as well as the construction of a specification table. Construction stage was comprised of developing an initial pool of items and reviewing them with a group of experts. In the evaluation stage, the prototype was piloted with 23 subjects and rating scales were subsequently revised. Finally, a validation stage was conducted with an item analysis. Item analysis was conducted with a sample of 150 subjects. Three measurement properties were considered relevant: applicability, interrater reliability and responsiveness. Criteria related to these properties were established to classify items as being excellent, acceptable or weak. Applicability--described in terms of the response distributions--was excellent or acceptable for 36 items out of 40. Results pertaining to interrater reliability showed 39 excellent or acceptable items. Responsiveness, as indicated by the comparison of the responses before and following the ED consultation, showed 24 excellent or acceptable items and 16 weak items; the latter were related to communication and cognitive skills. In conclusion, at the item level the tool provides reliable and clinically relevant information about the functional status of older adults consulting ED. Keywords : functional status, emergency department, older adults, assessment, occupational therapy, tool development.		Advisor: School: UNIVERSITE DE MONTREAL Source: DAI-B 70/12, p. , Jun 2010 Source Type: Ph.D. Subjects: Health care management Publication Number: NR53554

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