Occupational therapists can play a vital role in enabling clients to compose or re-orchestrate their occupational lives so they are able to meet their occupational needs more consistently. This role may be fulfilled by intervening directly with clients or by indirectly influencing clients' occupational lives or society at large to effect changes at an environmental or organizational level.
The activities of daily living (ADL) functioning of 26 subjects with Alzheimer's disease was measured using the Assessment of Motor and Process Skills (AMPS) and family informants' Older Americans Resources and Services (OARS) Activities of Daily Living (ADL) reports. Concordance with a clinician's ratings of subjects' level of ADL functioning was achieved for 77% of the subjects based on their AMPS ADL process ability measures and for 54% for the subjects based on their family informants' OARS ADL ratings. In cases of discordance, subjects' AMPS ADL process ability measures were just as likely to overestimate (11.5%) as to underestimate (11.5%) subjects' ADL functioning. In contrast, 46% of the informants overestimated their family members' ADL functioning, and this was more likely to occur when subjects' cognitive impairment was mild.
In response to the inadequacy of models grounded in risk avoidance or autonomy promotion, occupational therapists are challenged to move toward a balanced approach to decision making with older people, grounded in partnership, shared power, and negotiation.
The fatigue impact scale (FIS) was developed previously as a symptom-specific profile measure of health-related quality of life (HRQoL) for use in medical conditions in which fatigue is a prominent chronic symptom. Thus, it was not developed to be a responsive measure of daily changes in fatigue. This study describes the development and initial validation of an adaptation of the FIS for daily use. Items for the daily fatigue impact scale (D-FIS) were selected from the pool of original FIS items through Rasch analyses of existing data. The reduced-item FIS was administered to a sample of 93 subjects with flu-like illness, 25 of whom were followed for a 21-day period. Rasch analyses were used to further reduce the scale to a minimum number of items that represented a unidimensional measure of self-reported fatigue impact. This 8-item D-FIS demonstrated good relations to flu symptom ratings and to other general health ratings. It also proved to be a responsive measure of change in reported fatigue impact for subjects who were followed longitudinally. This initial validation study indicates that the D-FIS has considerable promise as a valid measure of the subjective daily experience of fatigue.
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