This study investigated time use and the importance of instrumental activities of daily living (IADL) tasks to an older community‐dwelling population. In addition, the study compared occupational therapists’ and older people’s perception of importance of IADL tasks for maintaining community living. Thirty‐three subjects completed a time diary and an interview‐based questionnaire to ascertain their time use and the importance of IADL tasks. It was found that older people living in the community spent most of their time at home and alone, with nearly half the day being spent on IADL tasks. The subjects indicated that the three most important tasks were use of the telephone, use of transportation (including driving) and reading. Differences were found when the results from an earlier study of occupational therapists were compared with results from the present study of older people. The occupational therapists also considered use of the telephone as most important but then rated medication management and snack preparation as the most necessary activities for continued community living. These results emphasize the differences in the perception of ‘important’ between the two groups studied. The results from this research confirm the importance of IADL to both the occupational therapy profession and older people living at home in the community. Further, these results confirm the need for client‐centred practice and collaborative intervention planning for occupational therapy.

The Barthel Index (BI), the Modified Barthel Index ( M B I ) and the Functional Independence Measure (FIM) are all widely used by occupational therapists as assessment tools for clinical decision-making and outcome measurement. All of these tools have demonstrated validity and the BI and the FIM have demonstrated inter-rater reliability. The M B I has been modified to increase sensitivity; however, there have been no publications on the inter-rater reliability of this tool following the changes. The purpose of this research was to examine the inter-rater reliability of two versions of the Barthel Index, and draw some comparisons between this assessment tool and the FIM. Twenty-five patients with neurological and orthopaedic conditions were assessed by three occupational therapists using the three tools. The method of analysis selected was percentage agreement and intraclass correlation coefficient. The results indicated that both the original and modified versions of the Barthel Index possess good inter-rater reliability. As all three tools have demonstrated adequate reliability and validity, it is suggested that clinicians select the most sensitive tool that best meets their clinical needs, and use this assessment tool in its standardized format. K E Y W 0 R D S activities of daily living, functional assessment, Functional Independence Measure, modifiedBarthel Index, original Barthel Index.

A review of literature is undertaken to consider the issue of outcome measures and their current position in rehabilitation. The use of such indices in measuring and estimating the benefits of a rehabilitation programme is discussed in relation to outcome and funding issues. The selection and evaluation of suitable assessments is reviewed by considering their usefulness, construction, availability of manuals and training, reliability, validity and scoring. It is concluded that occupational therapists must introduce and use standardised assessments as part of their rehabilitation programme. By measuring change in status between admission and discharge and again at follow-up, it is possible to compare status at one date with another and so estimate and demonstrate the value of the treatment programme.