Department of Psychology, University of Edinburgh, Geriatric Medicine Unit, Royal Victoria Hospital, Edinburgh, UK.
Gerontology. 2010;56(5):483-90. doi: 10.1159/000271603. Epub 2009 Dec 23.
As the number of adults in older age groups expands, difficulty performing usual activities of daily life is a rising health concern. A common exercise regimen employed to attenuate functional decline and disability has been resistance strength training. However, recent evidence suggests that functional tasks exercise may be more effective in preventing disability.
Activities of Daily Living (ADL) measures are one of the most widely used tools in gerontology, and yet the full sensitivity of these instruments is often not realized. The purpose of this study is to enhance the interpretive power of ADL by formally confirming a hierarchy of decline, assessing discriminatory power, and examining option characteristic curves. Theoretically, a revised ADL instrument can improve the efficacy of functional tasks training programs.
This was a cross-sectional study that employed Item Response Theory (IRT) to interpret ADL outcomes. Participants consisted of community-dwelling older adults (n=548, aged 79) living in Scotland.
A Mokken scale with rho=0.77 was obtained, indicating good reliability, and satisfying the IRT assumption that a single unidimensional scale is present. The set H coefficient of 0.48 indicated that the scale may be ordered by decreasing difficulty, with the 'Cut your own toe-nails?' item being the most difficult and 'Tie a good knot in a piece of string?' being the least difficult. Discriminatory and option characteristic parameters revealed 'Get on a bus?' to be the task most closely related to the latent construct and that item options can be used to ascertain critical thresholds for prevention type strategies.
Examining parameters relating to difficulty, discriminatory power, and option characteristics facilitated the identification of ADL/Instrumental ADL items that may serve to enhance functional task training in community-dwelling older adults. These analyses demonstrated that functional tasks have differing levels of discriminatory power, and that a task's discriminatory power is likely to change with varying levels of disability. This observation reinforces the notion that exercises based on functional tasks may differ significantly in their therapeutic effect. Lastly, this study was able to highlight statistically meaningful cut-points relating to when older adults should begin 'prehabilitation' interventions.
随着年龄较大群体中的成年人数量增加，日常生活活动的困难成为一个日益严重的健康问题。一种常见的用于减轻功能下降和残疾的锻炼方案是抗阻力量训练。然而，最近的证据表明，功能任务锻炼可能更有效地预防残疾。
日常生活活动（ADL）测量是老年学中最广泛使用的工具之一，但这些工具的全部敏感性通常并未得到体现。本研究的目的是通过正式确认下降层次、评估判别能力和检查选项特征曲线来增强 ADL 的解释能力。从理论上讲，修订后的 ADL 工具可以提高功能任务训练计划的功效。
这是一项横断面研究，采用项目反应理论（IRT）来解释 ADL 结果。参与者由居住在苏格兰的 548 名社区居住的老年人（年龄 79 岁）组成。
获得了莫肯量表，rho=0.77，表明可靠性良好，并满足 IRT 假设，即存在单一的单维量表。设置 H 系数为 0.48 表明，该量表可能按照难度递减排序，“自己剪脚趾甲？”项目最难，“在一根绳子上系一个好结？”项目最简单。判别和选项特征参数表明，“上公共汽车？”是与潜在结构最相关的任务，并且可以使用项目选项来确定预防类型策略的关键阈值。
检查与难度、判别能力和选项特征相关的参数有助于确定 ADL/工具性 ADL 项目，这些项目可能有助于增强社区居住的老年人的功能任务训练。这些分析表明，功能任务具有不同的判别能力水平，并且任务的判别能力可能随着残疾程度的不同而变化。这一观察结果强化了基于功能任务的锻炼可能在治疗效果上存在显著差异的观点。最后，本研究能够突出与老年人开始“预康复”干预相关的具有统计学意义的临界点。
