[homeles_ot-l] ODSP

[Reuel S. Amdur]

41, chemin Lavoie

Val-des-Monts, QC J8N 7N2

819-671-5526

amdurre2 at sympatico.ca

                        What's Wrong with the Activities of Daily Living Index

                                                            By

                                    Reuel Amdur, M.S.W., R.S.W., A.C.S.W.

                        

The problems with the Index begin at the top: the title itself.  The meaning of ADL in the health field is far more circumscribed than the definition that is used on the form.  In the health field it refers simply to self-care.  It is a commonplace in the field of opinion research that answers to a question will be dependent on the context in which it is asked, and for that reason a health care professional completing the form will have a tendency to understate severity.  One physician to whom I explained the definitional factor replied, in total disbelief, "Why would they do that?"

 

The next problem relates to the weighting of the responses.  Typically, the Adjudicator will count the number of 3's and 4's.  Often these tallies are specifically noted in the adjudication.  However, the importance of the items varies widely.  For example, a class 4 response on orientation to time, person, and place is certainly far more noteworthy than a class 4 response on "Walks three blocks or more on level ground without need to rest."  The former might in itself qualify as disabling, without regard to the rest of the questionnaire.  The questions on the form are a mixture of self-care items and other items.

 

The Adjudicator often places more weight on the scaling of the Index than on the Health Status Report and on the other written comments on the Index.  

 

To take an example: In one case where the Adjudicator found that there was no substantial restriction, on the Index the doctor marked item 6, "Exhibits normal limits of functioning with respect to impulse control and behaviour," as class 1.  However, on the Health Status Report the doctor listed under conditions: mood disorder, depression with anxiety and panic attacks, with an additional restriction on concentration.  Clearly it would be irresponsible to give greater weight to the Index check mark response than to the written response of the doctor.

 

Quite some time ago, I wrote asking the DAU if the Index had been tested for validity and reliability.  I never received an answer, so I must assume that the answer is no.  My example above on the difference between the HSR response and the Index response speaks to validity.  Because of the aura phenomenon to be experienced with the ADL title on the Index, one would expect varied responses from similarly placed respondents given the same subject who exhibits the same conditions.  Hence, there is serious question both as to validity and reliability.

 

 For these reasons, the Index is in need of serious revision.  In addition, while it is still in use it behoves the Adjudicator to treat the Index with great caution.      
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://list.web.net/lists/private/homeles_ot-l/attachments/20080415/33314985/attachment-0001.htm 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: ADL Index.doc
Type: application/msword
Size: 26624 bytes
Desc: not available
Url : http://list.web.net/lists/private/homeles_ot-l/attachments/20080415/33314985/attachment-0001.doc