CHAPTER 2: ACTIVITIES OF DAILY LIVING QUESTIONNAIRE (ADLQ)

Description

The Activities of Daily Living Questionnaire (ADLQ) is an informant-based assessment that measures an individual’s functional ability and is designed for those with probable neurocognitive disorders (NCD) of the Alzheimer’s and related types (Johnson, Barion, Rademaker, Rehkemper, & Weintraub, 2004). The ADLQ specifically measures occupational performance across 6 areas that can provide the clinician with a comprehensive profile of NCD-related deficits in everyday functioning, ranging from basic activities of daily living (ADLs) to more complex activities such as (1) the spectrum of self-care, (2) household maintenance, (3) employment and recreation, (4) shopping and money (5) travel, and lastly, (6) communication (Chu & Chung, 2008; Johnson et al., 2004). The ADLQ comprises 28 items and employs a unique scoring system where individual items are rated along a 4-point Likert scale from 0 (no problem) to 3 (no longer capable of carrying out the task) as well as the possibility of a score of 9 if the item is not applicable and is not factored into results (Chu & Chung, 2008). Scores are calculated according to a specific formula allowing for both total and subscale scores that can then be expressed as a percentage (0% to 100%) to indicate the level of functional impairment (Chu & Chung, 2008). The assessment can be completed in less than 10 minutes.

Psychometrics

Results derived from a longitudinal study (n = 140) of caregivers of person’s with probable NCD of the Alzheimer’s or related types showed that the total ADLQ score and each of its subscales were highly reproducible and excluding employment and recreation at 0.65, all subscales showed high test-retest reliability with coefficients greater than r = 0.86 (Johnson et al., 2004). The same study indicated the ADLQ to be both significantly and negatively correlated with the Mini-Mental State Examination (MMSE), considered the gold standard of cognitive assessment, at –0.38 and positively correlated with the Clinical Dementia Rating Scale at 0.55, where the closer the coefficients are to +1.0 and –1.0 the greater strength of the relationship is between the two assessments (Johnson et al., 2004). When administered to 63 caregivers of persons with NCD internal consistency of the Spanish version (SV-ADLQ) was determined to be high at α = 0.86. The same study found that the technology subscale of the T-ADLQ (which is a revised version of the ADLQ to include 5 technology-specific items relative to the use of a computer, cell phone, ATM, ability to access the internet, and e-mail use) was significantly correlated with SV-ADLQ total scores at r = 0.76; p < 0.001 (Munoz-Neira et al., 2012). Finally, using a cutoff point of 29.25 SV-ADLQ scores showed a sensitivity and specificity of 0.81 and 0.91, respectively (Munoz-Neira et al., 2012). Research by Chu and Chung (2008) found that factor analysis of the ADLQ-CV (Chinese version) yielded 6 factors that closely resembled the 6 subscales proposed in the original scale and along with the Spanish version suggests cross-cultural relevance of the measure. The ADLQ-CV Cronbach’s α coefficients of the subscales ranged from 0.92 to 0.98 and inter-rater reliability for the ADLQ-CV total score was shown to be 0.99. Intra-class correlation coefficients of the 6 subscales ranged from 0.98 to 0.99 (Chu & Chung., 2008).

Advantages

The ADLQ is a fast and relatively easy outcome measure to administer. No special training is required and its scoring grid is well thought out. The ADLQ is also free to use in clinical practice. Originally validated in an outpatient setting, it is considered to be applicable across various client populations where cognitive performance may be of concern. Its scores can also be used to generate a profile description of functional impairment, which can then be used to track the progression of functional decline over time (Munoz-Neira et al., 2012). The ADLQ has also been validated in both the Chinese and Spanish languages and a technology specific version also exists which is designed to gauge a person’s ability to use technology (Munoz-Neira et al., 2012).

Disadvantages

Although validity is established, its answers may rely on subjective observational information from the client or caregiver. Another potential limitation is the fact that the ADLQ was developed on the basis of clinical experience; as such, there was no caregiver involvement in the creation of the specific test items (Johnson et al., 2004). Finally, some test items may seem irrelevant or redundant to certain populations being studied such as driving, home maintenance, or home repairs questions that, when factored into scoring, may affect standardization and results.

Administration

The 28-item ADLQ is completed either through client interview or informant based in which answers are based on the person’s ability to engage in various ADLs and IADLs relative to the 6 domains discussed prior. The ADLQ employs a unique formula for scoring as follows:

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