Development and validation of the rural activities of daily living manual handling sort

Abstract

Occupational therapists in South Africa provide an essential service to claimants seeking compensation in the medico-legal and insurance industries. Performance in BasicActivities of Daily Living (bADLs) and Instrumental Activities of Daily Living (iADLs) is assessed, as independence in this regard is viewed as a prerequisite of work ability. The household amenities available in less-resourced rural communities differ significantly from those typically available in urban settings. Assessment of rural claimants can be problematic, as existing assessment instruments do not consider the unique manual handling demands of these settings. The aim of the study was to develop a contextual bADL and iADL assessment instrument to provide South African medico-legal occupational therapists with a means of justifying recommendations to compensation funds suited to the unique needs of rural dwellers. An instrument development design, combined with a descriptive, quantitative research methodology incorporating Rapid Rural Appraisal (RRA) methodologies, was selected to guide the study. The study was completed in two phases, with the first phase having three stages. Stage I consisted of an electronic survey of medico-legal occupational therapists to indicate their use of bADL and iADL assessment instruments. Data were collected through participatory mapping focus groups with Community Care Workers (CCWs) in Stage II. Data were analysed quantitatively using directed content analysis utilising the ICF and the OTPF III as frameworks for coding to identify domains, and an activity analysis exercise was completed. Stage III consisted of home visits with semi-structured interviews. The equipment used, weights lifted, carried and pushed, time taken and distances walked when performing bADLs and iADLs were measured. Photographic and video data were collected and data were analysed quantitatively Phase 1 results confirmed the absence of an instrument suitable for assessment of bADLs and iADLs for a rural context. Two Instrumental Activities of Daily Living (iADLs) not previously described in occupational therapy literature, namely water and fuelwood collection, were identified. The forms and manual handling demands of rural bADLs and iADLs were found to differ significantly from those carried out in typical urban Western contexts. The development of the assessment instrument and the content validity study took place in Phase 2. Data from Phase 1 were used for item identification and development of item descriptors. Content validity was established using inputs from Subject Matter Experts (SMEs). The newly-developed self-report instrument was named the Rural ADL Manual Handling Sort (RAMS) and had three subtests, which corresponded to the manual handling domains. The electronic format enabled generation of reports and results could be triangulated with other aspects of an FCE assessment battery. Further studies involving field-testing to investigate the remainder of the psychometric properties of the RAMS and its relevance in other fields of practice are anticipated. The study offered insights into the distinct challenges related to completing bADLs and iADLs in a rural, less-resourced context in South Africa. The RAMS includes unique bADL and iADL domains that do not appear in any existing bADL or iADL assessment instrument and will enable medico-legal occupational therapists to provide realistic evidence to compensation funds regarding the manual handling demands of a rural lifestyle