CHAPTER 5: INSTRUMENTAL ACTIVITIES OF DAILY LIVING (IADL) PROFILE

Description

The Instrumental Activities of Daily Living (IADL) Profile is a performance-based measure designed for those with traumatic brain injury (TBI) that is typically administered in the subject’s home and/or community. The assessment quantifies a person’s ability to engage in IADLs as well as their level of independence in those IADLS (Bottari, Dassa, Rainville, & Dutil, 2009a). The test is composed of 29 items revolving around 8 tasks of which 6 are designed to accomplish the goal of the client being able to receive guests for a meal and include such things as putting on outdoor clothing, going to the grocery store, shopping for groceries, preparing a hot meal for guests, having a meal with guests, and cleaning up after the meal (Bottari et al., 2009a). The two remaining tasks are single complex IADLs considered necessary for continued independence: obtaining information and making a budget (Bottari et al., 2009a). During the assessment subjects receive minimal instructions and are left to formulate goals in order to plan, engage, and carry out the meal preparation and independence tasks (Bottari et al., 2009a). Each operation is scored using a 5-level ordinal scale relative to performance (dependence, verbal and physical assistance, verbal or physical assistance, independence with difficulty, and independence) that specifically address whether the subject’s main difficulties pertain to goal formulation, planning, carrying out the task, and/or attaining the initial task goal, all important components of executive function (Bottari, Dassa, Rainville, & Dutil, et al., 2009b). The IADL Profile is unique in that it attempts to assess the real world functional performance of individuals; thus some components can take a considerable amount of time and energy such as grocery shopping, preparing a hot meal, or having a meal with guests.

Psychometrics

A study of 30 subjects with severe TBI found excellent intra-rater agreement 4 four raters at 0.94 (Bottari, Dassa, Rainville, & Dutil, 2010). Its creators have also noted a good level of inter-rater agreement (r = 0.80) as well as excellent internal consistency for all scales (α = 0.95) with a range of 0.81 to 0.98 (Bottari et al., 2009b). A factor analysis of the assessment supported the following six correlated factors that explained 74% of the variance which suggests good uni-dimensionality of the assessment: (1) going to grocery store/shopping for groceries, (2) having a meal with guests/cleaning up, (3) putting on outdoor clothing, (4) obtaining information, (5) making a budget, and (6) preparing a hot meal for guests (Bottari et al., 2009a). Further research suggested that the indices of injury severity, measures of executive function, education, age, and environmental factors may account for up to 12% to 28% of the variance in IADL Profile scores (Bottari et al., 2009a). Two outcome measures have shown to be modestly correlated with the IADL Profile, the Tower of London test (r = 0.37) and the Working Memory Index of the Wechsler Memory Scale–III (r = 0.38) (Bottari et al., 2009a). Alas, where a score of 4 equates independence and a score of 0 dependence, Bottari et al. (2010) found that mean scores on the IADL Profile of 30 subjects with TBI were 2.94 going to grocery store/shopping for groceries; 3.57 having a meal with guests/cleaning; 3.61 putting on outdoor clothing; 2.22 obtaining information; 1.30 making a budget; and 3.23 preparing a hot meal for guests.

Advantages

There is a fair amount of research in support of the assessment for use in clinical practice for the TBI population. The IADL Profile also has the ability to document the effects of executive function on IADL engagement and expands on the previous work of the ADL Profile also included in this manual. The assessment also may contribute to a better understanding of executive function deficits through its analysis of everyday IADLs. Due to incomplete literature relative to diverse patient populations there is an opportunity for research oriented individuals to expand the knowledge base of the assessment.

Disadvantages

There is a limited amount of a research outside of what has been established by its creators and most is confined to the TBI population. The assessment requires administration in the home and community environment which may impede testability for many clients. The IADL Profile also requires a significant amount of set up and time to administer and can be fatiguing for some populations (Bottari et al., 2010).

Administration

The authors stress that it is important to be forthcoming during initial discussions with the client in order to develop an understanding that the IADL Profile is a real world-type of assessment with the ultimate goal of evaluating a person’s ability to function alone in the community environment following his or her injury, as most occupational therapy assessments do not necessarily ask clients to perform real world activities such as grocery shopping. Once testing begins the clinician uses a non-structured approach and employs naturalistic observations and a minimal amount of cueing, if possible, as the subject plans, formulates, initiates, and engages in tasks. Occupational performance is then rated relative to the amount and type of assistance needed such as: requiring only verbal or physical assistance or whether the subject was independent with difficulties.

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