Reliability and Validity of a New Toileting Assessment Form for Patients with Hemiparetic Stroke

Abstract

Background Acquiring toileting independence is an important target of stroke rehabilitation. In planning an intervention for acquiring toileting independence, developing an assessment for individual subtasks that comprise toileting would assist in identifying specific tasks that prevent independence in patients and would facilitate interventions to improve toileting independence. Objective To examine the reliability and validity of a newly developed toileting assessment form, the Toileting Tasks Assessment Form (TTAF), for assessing toileting subtasks in hemiparetic stroke. Design Validation and test‐retest study. Setting Subacute rehabilitation wards in Japan. Participants Eighty‐two therapists verified the form's content validity; 30 stroke patients who were using a wheelchair participated in the validation and test‐retest study. Interventions Not applicable. Main Outcome Measures The content validity of the assessment form was initially assessed based on a questionnaire. Subsequently, four occupational therapists used the form to evaluate video‐recorded toileting performances simulated by participants with hemiparetic stroke. Two assessors evaluated each video‐recorded performance once and repeated the evaluation of the same performance at 2 weeks later. The interrater reliability, intrarater reliability, internal consistency, and concurrent validity of the form were examined. Results Fleiss’ κ coefficient for interrater reliability for each form item was 0.61 or more. Cohen's κ coefficient for intrarater reliability for each item was 0.60 or more. Cronbach's coefficient alpha ranged from 0.94 to 0.95. Spearman's rank correlation coefficients for the mean score on the form and the Functional Independence Measure (FIM) score for “toileting” ranged from 0.88 to 0.93 (P < .001). Spearman's rank correlation coefficients for the mean score on the form and the FIM score for “toilet transfer” ranged from 0.91 to 0.93 (P < .001). Conclusions The TTAF demonstrated good reliability and validity. Further multicenter studies involving patients at different stroke phases are required to verify the reliability and validity of TTAF and confirm the generalizability of these findings.

Development of Toileting Behaviour Evaluation for Older Adults Using Wheelchairs: A Validation Study

“…Previous studies reported the minimum weighted kappa coe cient value for inter-rater reliability of the TPAT to be the same as that of the TTAF (.61) [18,19]. For intra-rater reliability, minimum weighted kappa coe cient values were reported at .83 [18] and .60 [19] for the TPAT and the TTAF, respectively, similar to those in this study. They also reported Cronbach's alpha values of .97 for the TPAT [18] and .95 or .94 for the TTAF [19], which are also similar to the current results.…”

“…However, these instruments do not provide a breakdown of the individual component activities comprising toileting behaviour and indicating poor responsiveness [18]. These component activities include putting on and taking off pants, wiping the buttocks, and tearing off toilet paper [19,20]. An assessment of the individual components of each daily activity has been shown to be effective for determining rehabilitation goals and treatment planning [19].…”

“…These component activities include putting on and taking off pants, wiping the buttocks, and tearing off toilet paper [19,20]. An assessment of the individual components of each daily activity has been shown to be effective for determining rehabilitation goals and treatment planning [19].…”

“…In this study, we searched for methods to evaluate these component activities, which identi ed the Toileting Performance Assessment Test (TPAT) [18], Toileting Tasks Assessment Form (TTAF) [19], and Toileting Assessment Test (TAT) [20]. The TPAT classi es the toileting activities of patients using wheelchairs into 10 component activities, such as transferring from bed to wheelchair, standing up, and shifting weight to one side while maintaining a standing position.…”

“…The TTAF classi es the toileting behaviour of patients using wheelchairs into 24 component activities, including opening and closing the toilet door, standing up from the wheelchair, and pulling the lower garments down. It has three grading levels-(A) independent, (B) requires supervision or verbal assistance, and (C) requires assistance, and research has veri ed its reliability and validity [19]. The TAT classi es the toileting behaviour of patients using wheelchairs into 10 component activities, such as standing up from the toilet, taking off pants, and wiping the buttocks.…”