Comparison of Complex versus Simple Activity of Daily Living Staging: Validation of Simple Stages

Available online 9 January 2013
Publication year: 2013
Source:Archives of Physical Medicine and Rehabilitation



Objective To compare simple activities of daily living (ADL) staging with complex ADL staging and to assess the face, construct and predictive validity of simple ADL stages. Activities of Daily Living (ADL) staging is an innovative, partially hierarchical approach to ADL difficulty measurement. Initial staging validation studies used four-level responses to ADL difficulty questions to derive stages (complex ADL staging). Simple ADL stages are based on two-level responses to ADL difficulty questions. Design Analysis of the second Longitudinal Study of Aging, a prospective cohort study, using descriptive statistics and logistic regression. Setting United States Participants 9,447 community dwelling persons ≥ age 70 years in 1994. Interventions Not applicable Main Outcome Measures Agreement & Face Validity: Baseline simple ADL stage Construct Validity: Baseline health, difficulty and need characteristics Prognostic Comparison (determined at the Wave 2 interview): Primary: nursing home use and/or death; Secondary: death Results The systems showed good agreement (kappa = 0.75). The simple ADL stages stratified people into distinct groups and reflected the expected step-wise increases from Stage 0 to Stage IV in health and need characteristics, such as the prevalence of home-related challenges (2.9% to 84.5%) and perceived need for home modifications (2.1% to 33.6%). In comparing the prognostic ability using the primary outcome, the complex system model demonstrated slightly increased discrimination between milder stages and a slightly higher C-statistic (0.666 vs. 0.664) Conclusion Although complex staging appears slightly better at classifying people into distinct prognostic strata with respect to nursing home use and/or death at Wave 2, simple ADL stages demonstrate strong, clinically relevant associations with health and need characteristics.

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