Faculteit Geneeskunde en Gezondheidswetenschappen

MASTER IN DE ERGOTHERAPEUTISCHE WETENSCHAP
Interuniversitaire master in samenwerking met:
UGent, KU Leuven, UHasselt, UAntwerpen,
Vives, HoGent, Arteveldehogeschool, AP Hogeschool Antwerpen, HoWest,
Odisee, PXL, Thomas More
Faculteit Geneeskunde en Gezondheidswetenschappen
Conversion to the ICF and psychometric properties of the Housekeeping
Damage Scale (HODA- Scale)
Annelies VANOOTEGHEM
Masterproef ingediend tot
het verkrijgen van de graad van
Master of science in de ergotherapeutische wetenschap
Promotor: Dr. Dominique Van de Velde
Co- promotor: Lode Sabbe
Academiejaar 2015-2016
MASTER IN DE ERGOTHERAPEUTISCHE WETENSCHAP
Interuniversitaire master in samenwerking met:
UGent, KU Leuven, UHasselt, UAntwerpen,
Vives, HoGent, Arteveldehogeschool, AP Hogeschool Antwerpen, HoWest,
Odisee, PXL, Thomas More
Faculteit Geneeskunde en Gezondheidswetenschappen
Conversion to the ICF and psychometric properties of the Housekeeping
Damage Scale (HODA- Scale)
Annelies VANOOTEGHEM
Masterproef ingediend tot
het verkrijgen van de graad van
Master of science in de ergotherapeutische wetenschap
Promotor: Dr. Dominique Van de Velde
Co- promotor: Lode Sabbe
Academiejaar 2015-2016
Nederlandstalig abstract
Titel: Converteren naar de International Classification of Functioning, disability and
health en de psychometrische kenmerken van de Housekeeping Damage Scale (HODAschaal)
Achtergrond: Core sets zijn een set van categorieën gebaseerd op het ICF. Ze
representeren het minimum aantal nodige categorieën voor metingen, overdracht en
communicatie omtrent factoren voor een bepaalde doelgroep.
Doel: (1) het converteren van de HODA-schaal naar de ICF categorieën om de core set
voor personen met een traumatisch hersenletsel te coveren. (2) een evaluatie van de
psychometrische kenmerken van het meetinstrument.
Methode: Aan de hand van de linking rules en de expertise van een expertenpanel werden
de items van de HODA-schaal geconverteerd naar het ICF. Dataverzameling voor de
evaluatie van de psychometrische kenmerken vond plaats in het UZ Gent, bij 34 patiënten
met een NAH. De interne consistentie en de test-hertest betrouwbaarheid werd nagegaan.
Er werd gebruik gemaakt van twee meetinstrument, de ELIDA-schaal en de JAMAR.
Hiermee werd de construct- en discriminatieve validiteit te bepalen.
Resultaten: Drie items uit de HODA-schaal coveren de core set TBI. De interne
consistentie is zeer sterk blijkt uit de item- total correlatie van 0.592 tot 0.910. De testhertest betrouwbaarheid is zeer sterk op schaalniveau (ICC van 0.98) en matig op
itemniveau (Kappa van 0.56). de constructvaliditeit is sterk op schaalniveau (r=0.82), op
itemniveau varieert de correlatie tussen 0.15 en 0.83. De discriminatieve validiteit gaf een
correlatie van -0.558 met de JAMAR.
Conclusie: De HODA-schaal is een valide en betrouwbaar instrument en is succesvol
geconverteerd naar het ICF.
Trefwoorden: NAH, core set, ICF, psychometrische kenmerken, Housekeeping Damage
Scale.
Aantal woorden in deze masterproef: 8009
English abstract
Title: Conversion to the International Classification of Functioning, disability and
health and psychometric properties of the Housekeeping Damage Scale (HODA- Scale)
Background: Core sets are a set of categories based on the ICF. It represents the
minimum categories necessary for measurement, transmission and communication of
factors related to a patient population.
Aim: (1) convert the items of the HODA-scale to ICF-categories for covering the coreset of Traumatic Brain Injury (TBI). (2) evaluate the psychometric properties of the
HODA-scale.
Method: The linking rules and the expertise of an expert panel were used to convert the
items to the ICF. The data collection for the evaluation of the psychometric properties
was conducted at the University Hospital Ghent with 34 people with an Acquired Brain
Injury (ABI). The reliability and internal consistency were conducted. There were two
outcome scales used, ELIDA-scale and JAMAR to conduct the construct- and
discriminative validity.
Results: Three items of the HODA-scale covered the core set TBI. The internal
consistency was very strong appears out the item total correlation from 0.592 to 0.910.
The test-retest reliability is strong on scale level (ICC: 0.98) and moderate on itemlevel
(Kappa: 0.56). the construct validity is strong on scale level (r=0.82) and variates on itemlevel with a correlation between 0.15 and 0.83. The discriminative validity gave a
correlation of -0.558 with the JAMAR.
Conclusion: The HODA-scale is a valid and reliable instrument and is successfully
converted to the ICF.
Keywords: ABI, coreset, ICF, psychometric properties, Housekeeping Damage scale.
Amount of words in this master thesis: 8009
Inhoud
Woord vooraf.................................................................................................................... 1
Introduction ...................................................................................................................... 2
Qualitative part ................................................................................................................. 7
1.
Method ............................................................................................................... 7
Linking rules .............................................................................................................. 7
Expert panels.............................................................................................................. 8
Process of conversion ................................................................................................ 8
2.
Results ................................................................................................................ 9
Quantitative part ............................................................................................................. 12
1.
Sampling .......................................................................................................... 12
2.
Method ............................................................................................................. 12
2.1.
Assessment instruments ................................................................................... 12
2.2.
Protocol ............................................................................................................ 14
2.3.
Construct validity ............................................................................................. 15
2.4.
Discriminative validity .................................................................................... 17
2.5.
Factorial Validity ............................................................................................. 17
2.6.
Internal consistence .......................................................................................... 18
2.7.
Test- retest reliability ....................................................................................... 18
3.
Results .............................................................................................................. 19
3.1.
Study population .............................................................................................. 19
3.2.
Construct validity ............................................................................................. 19
3.3.
Discriminative validity .................................................................................... 21
3.4.
Factorial validity .............................................................................................. 22
3.5.
Internal consistence .......................................................................................... 24
3.6.
Reliability......................................................................................................... 24
Discussion....................................................................................................................... 25
Conclusion ...................................................................................................................... 27
References ...................................................................................................................... 28
Appendix ........................................................................................................................ 33
Appendix A: Occupational therapy in core set TBI .................................................... 33
Appendix B: HODA-scale .......................................................................................... 35
List of figures ................................................................................................................. 37
List of tables ................................................................................................................... 38
Woord vooraf
Deze masterproef is tot stand gekomen dankzij de hulp en steun van enkele personen.
Graag wil ik mijn promotor Dr. Dominique Van de Velde bedanken voor de nodige steun,
tips en advies dat hij mij gaf doorheen dit proces.
Daarnaast wil ik ook graag Lode Sabbe bedanken voor zijn tips en ondersteuning bij deze
masterproef.
Ook bedankt aan Sofie Slos. Zonder haar medewerking en hulp had het veldwerk dat
nodig was voor deze masterproef niet kunnen plaatsvinden.
Bedankt aan alle patiënten die bereidt waren deel te nemen aan de afnames van het
assessment, de ergotherapeuten van het CLNR die tijd voor mij vrij maakte en alle leden
van het expertenpanel dat nodig was voor de conversie van de HODA-schaal. Zonder de
medewerking van deze mensen was het niet mogelijk geweest om deze masterproef tot
stand te brengen.
Een speciale bedanking aan mijn mama die mij niet alleen de mogelijkheid geboden heeft
om deze opleiding te volgen maar mij ook altijd gesteund heeft en vertrouwen in mij had.
Tenslotte ook bedankt aan de rest van mijn familie en mijn vrienden die mij gesteund
hebben doorheen deze opleiding.
1
Introduction
An acquired brain injury or an ABI can be defined as an injury caused after birth and that
can’t be associated with a degenerative disease or a congenital disorder (Cochrane et al.
2000). It is used as an collective term and can be a result of a traumatic or non- traumatic
cause (O’Reilly & Pryor, 2002). A traumatic brain injury or TBI can be defined as a
change in the functioning of the brain or other proof of brain pathology such as seen on
visual, laboratory or neuroradiology validation of depravation of the brain, caused by an
external force (Menon, Schwab, Wright & Maas, 2010). A non- traumatic brain injury is
created by an internal event like an infection, stroke or hypoxia (O’Reilly & Pryor, 2002).
In Flanders there is a prevalence of 183/100000 people and an incidence of 28/100000
people for ABI. TBI has in Flanders an incidence of 11/100000 people with permanent
limitations. Brain injury of a non- traumatic cause more specifically people with stroke,
has an incidence of 35-57/100000 by people younger than 70 years (Lannoo et al., 2007).
A brain injury can have long term consequences on physical, social and health terms.
People indicate that one year after the injury they still need support for their cognitive and
physical ADL, that there is no social re-integration, that they experience problems in
fulfilling domestic roles and there is a sense of restrictions in productivity (Andelic et al.,
2010).
Assessment instruments can be used to make an evaluation and to get an idea of the
impact of the injury. (Goljar et al., 2010). As a caregiver it is important to measure
outcomes objectively in various areas and to ensure that those instruments show
significant and meaningful functional improvement (Watanabe, Miller, Jacinta &
McElligott, 2003). Outcome measures are necessary for supporting communication
between caregivers and for clinical learning and research (Turners- Stokes et al., 2012).
Using standardised assessment instruments for measuring the effectiveness of clinical
interventions is accepted as a central point in good clinical practice (Van der Putten,
Hobart, Freeman & Thompson, 1998). Yet there are still restrictions caregivers
experience. A big problem is the number of different available instruments for mapping
the performance and limitations by people with a brain injury (Bernabeu et al., 2009). A
major concern in using outcome measures is their psychometric properties. A good
2
instrument should be reliable and valid, reproducible and must have good scale properties,
preferable on interval level. In addition to these features a scale should also be clinical
sensitive and easy to apply in practice. It also should be interpretable, relevant and
responsive to chance that is clinical important (Turner- Stokes et al. 2012). Thereby an
ideal assessment instrument of human functioning or aspects of human functioning is
based on a universal and common shared classification. This can serve standards for
reporting aspects of functioning over a large amount of outcome measures and it can also
be used as a building block for the development of these instrument (Stucki, Kostanjsek,
Üstün & Cieza, 2008).
A general accepted framework is The International Classification of Functioning,
disability and health (ICF) developed by the World Health Organisation (WHO) in 2001.
The ICF gives a biopsychosocial approach to the different perspectives of health and
related aspects. It has the aim to help with understanding and studying health and related
states, determinants and outcomes related to health and this on a scientific basis. Thereby
it wants to improve communication between different persons by establishing a common
language, to give the opportunity to compare data across different care givers and services
and to classify health information in a systematic coding scheme (WHO, 2001).
The ICF can be divided in two main parts, ‘functioning and disability’ and ‘ contextual
factors’. These parts exist of two components, for ‘functioning and disability’ these are
‘body functions and structures’ and ‘activities’ and ‘participation’. For the ‘contextual
factors’ the components are ‘environmental factors’ and ‘personal factors’. The
components are indicated on a base of an alphanumeric system. ‘Body functions’ are
assigned to the letter ‘b’, ‘body structures’ to the letter ‘s’, ‘activity and participation’ is
assigned to the letter ‘d’ and ‘environmental factors’ are assigned to the letter ‘e’. The
‘personal factors’ do not have an assignment to a letter and is not further divided because
of the variation in the contextual factor which it’s based on (eg. sex and age). Because of
the hierarchical approach of the ICF each component is further divided in domains, these
domains are divided in categories and categories are divided in levels.
An example of the different levels:
b1: mental functions
b114 orientation functions
3
b1142 orientation to person
b11421 orientation to others (WHO,2001).
Figure 1: The ICF- framework (WHO, 2001)
When someone wants to use the codes one must take into account that the use of the codes
requires the use of one or more qualifiers. These are displayed in a code behind the point
(eg. xxx.0). If one does not place these qualifiers behind the codes, they lose their
meaning. There are seven possible qualifiers. The same generic scale is found in all the
components. Encountering a problem can refer to a limitation, impairment of restriction
(WHO, 2001).
Figure 2: ICF- qualifiers (WHO, 2001)
An issue in using the ICF in clinical practice is the size of this framework. Therefore a
practical tool is needed, like core sets (Stucki et al., 2008). Core sets are a set of categories
of the International Classification of Functioning, disability and health that represent the
4
minimum requirements for measurement, transmission and communication of factors
who are related to functioning and health of patients. Each core set should be goaloriented, compact and useful in daily clinical practice (Yen et al., 2012). These sets ensure
that professionals in clinical settings and researches can describe functioning of an
individual in a generally accepted universal language. In addition, it can also contribute
to the content validity of measurement scales and give professionals the possibility to
select the most appropriate scale for the specific needs of a given population patients
(Bernabeu et al. 2009).
Research by Ptyushki, Vidmar, Burger & Marincek (2012) confirmed the valuable
contribution of the ICF in traumatic brain injury rehabilitation. It states that the ICF can
help caregivers to take the different interactions and relationships between the
components of the framework into account. Semlyen, Summers & Barnes (1998)
investigated the multidisciplinary approach in rehabilitation. Such an approach seems to
be efficient in gaining functional improvement, reduce caregiver distress and to increase
the level of independence. An occupational therapist was part of such a multidisciplinary
team. An occupational therapist focuses in the rehabilitation process in patients with a
brain injury such as stroke, mainly on issues experienced by the patient in activities of
daily life, domestic tasks, leisure and cognition (De Wit et al., 2006).
A recently developed instrument that measures domestic tasks is the Housekeeping
Damage Scale or the HODA- Scale. The aim of the outcome measure is to indicate the
damage after injury in these tasks. The HODA-scale represents a total score of 100 which
shows the damage in terms of a percentage (Brusselmans, Thomas, Cook & Vermeulen,
2014).
Aim of the study:
This study consist of two main parts. First there is a qualitative part which involves the
conversion of the scale to the ICF. In this part the meaningful concepts of each item of
the HODA-scale was identified and linked to the most appropriate ICF-category. To link
the concepts the linking rules by Cieza et al. (2005) were implied and the input from a
number of experts all with years of clinical experience were used. The aim of the
5
conversion is to cover the ICF categories specifically for occupational therapists in the
core set for patients with TBI.
The second part is a quantitative part where the psychometric properties of the HODAscale are evaluated. Data was collected at the University Hospital Ghent by patients with
an acquired brain injury. The total sample consisted of 34 people. The overall aim of this
part is to examine the construct-, discriminative- and factorial validity, the internal
consistency and the test- retest reliability of the HODA- Scale by patients with ABI.
6
Qualitative part
This part of the study includes a conversion of the HODA-scale to the ICF categories.
The overall aim of the conversion is to identify the possibility of the outcome measure
to cover items in the core set for people with a traumatic brain injury.
1.
Method
Linking rules
To convert an assessment it is important to implement the Linking Rules of Cieza et al.
(2005). The aim of the linking rules are to provide guidelines to link systematic and
standardized measures to the ICF (Cieza et al. 2002). There are eight distinct linking rules
which has the intention to link technical and clinical measures, interventions and health
status measures to the ICF. When linking outcome measures to the ICF with these rules
it is important to take into account that all important meaningful concepts of the outcome
measure are linked to the ICF. When one is linking, it can be the case that an ICF category
may occur more than one time (Cieza et al. 2005). An overview of the linking rules is
listed in table 1.
Table 1: ICF linking rules (Cieza et al. 2005)
Linking rule
1.
Good knowledge of the taxonomical and conceptual fundaments of the ICF is necessary before starting to link meaningful
concepts to the ICF. Also knowledge of chapters, domains and categories of the ICF is important, as are knowledge of
the definitions.
2.
The meaningful concept must be linked to the most exact ICF category.
3.
The categories ‘other specified’ with code 8 may not be used. When the meaningful concept is not named in an ICF
category one has to state that the information is not explicit named in the ICF.
4.
The categories ‘unspecified’ with code nine may not be used. It has to be named with the lower level category
5.
Use ‘not definable’ when there can’t be a decision for the most appropriate ICF category. This rule includes special cases:
when meaningful concepts refer to health, mental of physical health they are assigned as “not definable general health,
not definable psychical health, not definable mental health”.
The same has to been done with concepts who refer to quality of life, they are assigned as “not definable quality of life”.
6.
When the ICF does not include the meaningful concept but it’s a personal factor like it is defined in the ICF, one has to
give the concept the assignment of personal factor
7.
When the concept is not include in the ICF and it is not a personal factor give it the assignment of not covered by the ICF
8.
When the concept is a diagnosis or a health state give the concept the assignment of health condition
7
Expert panels
In order to contain a reliable conversion an expert panel was assembled. This method was
also used in previous research concerning the conversion of outcome measures, eg. the
MMSE (De Vriendt, Gorus, Bautmans & Mets, 2012). The systematic review of Fayed,
Cieza & Bickenbach (2011) indicates that the persons who are involved in conversing
outcome measures have a lot of expertise in clinical practice, the ICF or have professional
or research experience. The experts that were involved in this research included three
occupational therapists, two psychologists, one physical therapist and a doctor in health
science. All of these people had clinical experience, expertise in the ICF or in
scientifically research. The experts were divided in two independent panels who
conversed the assessment separately.
Process of conversion
At first the items of the assessment were converted by myself and another student who
was involved in the research around the TBI-core set. In each item of the assessment the
meaningful concept was identified and we went true all the codes and selected the one we
thought was the most suitable. Later, when all concepts were linked to a category, we
invited the two independent expert panels. At the start of the meeting we explained the
goal of the research and elucidated the linking rules which were a major concern for the
reliability of the conversion. The independent expert panels converted the assessment to
the ICF, I was present the whole meeting but I had no input because of the interests of the
reliability of the conversion. The third step that was taken included a comparison of the
codes that were granted to the items. There is made a comparison between the codes the
other student and I gave to the items, the codes of the first expert panel and the codes of
the second expert panel. When there were three codes the same there was an overall
consensus, when two codes were the same the other one was excluded and when not one
code was the same there was asked for a second opinion of the expert panel. This was
done by an online survey, which was sent to all participants. When the conversion was
complete the categories assigned to the HODA-scale were compared with the core-set.
8
2.
Results
After the expert panel, 23 items were converted in consensus. Two items remained in
which no full consensus was reached. After sending the online survey to the experts one
expert did not complete the online survey. Beside the experts the other student and I also
answered on the survey. Because of the missing vote of one expert the total size for the
online survey was reduced from nine to eight. After the online survey there wasn’t a full
consensus over the two items. Therefore, it was decided to choose the items with the
largest number of votes. The results of the online survey can be seen in the figures 3 and
4.
Figure 3: item 1 online survey
Figure 4: item 2 online survey
9
After the survey each item of the HODA-scale was assigned to an ICF- category. An
overview of the conversion is shown in table 2.
Table 2 : conversion of the HODA- scale
Item HODA- Scale
1.
ICF code
Kitchen activities
1.
Kitchen activities
-
Heating a meal for example in the microwave
-
d6300 Preparing simple meals
-
Independent peeling and cutting potatoes
-
d6300 Preparing simple meals
-
Preparing a full meal, cooking process and
-
d6301 Preparing complex meals
timing preparation
-
d6401 Cleaning cooking area and utensils
setting and clearing of the table, inclusive hot
-
d6401 Cleaning cooking area and utensils
-
and fragile material
-
Cleaning the kitchen and the dining room,
washing the dishes
2.
3.
Cleaning
2.
-
dust off furniture
-
vacuum one or multiple rooms
-
mopping/wet
cleaning
Cleaning
-
(handle
cleaning
d6402 Cleaning living area
-
d6403 Using household appliances
-
d6402 Cleaning living area
convenience and bucket filled with water)
-
d6402 Cleaning living area
-
cleaning windows (maximum three steps high)
-
d6402 Cleaning living area
-
making the beds and change linens
clothing and maintenance of the house
3. clothing and maintenance of the house
-
perform hand wash (wash, rinse out, hang to
-
d6400 Washing and drying clothes and garments
dry)
-
d6403 Using household appliances
filling, emptying and operating washing
-
d6403 Using household appliances
machine and dryer
-
d6402 Cleaning living area
ironing and folds of several linen (inclusive
-
d6404 Storing daily necessities
-
opening and closing the ironing board)
-
cleaning the house (loose scattered clothing,
various objects, lecture, etc.)
-
storage in closets or racks and take out various
household products and food.
4.
jobs and managing household
4. jobs and managing household
-
performing repairs and replacements in the house
-
d6501 Maintaining dwelling and furnishings
(replacing lamps, replacing batteries, etc.)
-
d6405 Disposing of garbage
collect and sort garbage and placing it on the
-
d6200 Shopping
streetside.
-
d5700 Ensuring one's physical comfort
Management of the required reserves of household
-
d860 Basic economic transactions
-
equipment and making a shopping list
-
Keep supervision of the house and react appropriate
(heating, open and close doors and windows,
breakdowns, etc.)
-
Financial management housekeeping.
5.
transport and groceries
5. transport and groceries
10
-
shopping in a corner shop (butchery, bakery,
-
d6200 Shopping
newsagent)
-
d6200 Shopping
shopping in a supermarket (inclusive displacement,
-
d6200 Shopping
loading and unloading goods)
-
d3600 Using telecommunication devices
-
shopping in a shopping district or shopping centre
-
d4602 Moving around outside the home and other
-
shopping online
-
use and transfer to several services (post office,
-
buildings
bank, administrative services, etc.)
The HODA-scale covered d620 acquisition of goods and services, d640 doing housework
and d860 basic economic transactions in the TBI core set. An overview of the ICF
categories in the core set for TBI specifically for occupational therapy and which ones
are covered by the HODA-scale can be seen in appendix A.
11
Quantitative part
This part of the study includes an evaluation of the psychometric properties of the
HODA-scale in a ABI patient population.
1. Sampling
The collection of the data took place in the University Hospital Ghent, Centre of
Locomotor and Neurological Rehabilitation (CLNR). Inclusion criteria were people with
the different forms of an acquired brain injury. The exclusion criteria were people with
an aphasia and people who didn’t speak or understand the Dutch language.
2. Method
It is the goal of this part of the study to define the construct validity of the HODA.
Therefore, the ELIDA will be used. To determine the discriminative validity the Jamar
will be used. Factorial validity and internal consistency will be evaluated as is the testretest reliability.
2.1.
Assessment instruments
The Housekeeping Damage Scale
The Housekeeping Damage Scale or the HODA- scale is an assessment instrument
developed to indicate the damage after injury. Housekeeping damage is defined as the
damage of the energetic and functional potential of a victim with an economically
assessable impact on the ability of performing domestic chores. This manifests itself in a
partial or complete impossibility to perform this tasks or an increased effort. When
judging, one has to take the actual family situation and foreseeable evolution into account.
The HODA- scale has the aim to make a contribution to the determination of
housekeeping damage in accordance with the indicative table 2012. This table represents
a list of financial compensations after injury. The scale takes functional limitations when
performing household chores with the assignment of more effort and increased time of
performing. Domestic tasks can be defined as the activities with a general nature and
who are a part of the essence of the household. Damage can be displayed by comparing
the actual and potential functioning before and after the accident. For the development of
the HODA-scale the items of the assessment are based on chapter six of the ICF-
12
classification. Also the scoring system is based on the ICF criteria. The HODA-scale has
a five-point scale ranging from zero to four (Brusselmans et al., 2014).
Table 3: score system HODA-scale based on the ICF score criteria (Brusselmans et al.
2014)
Score
Definition
0
Normal or almost normal functioning
1
Mild obstruction of performance, the activity can be performed independent but requires a bit more effort and
increased time.
2
Moderate obstruction of performance, the activity can be performed independent but requires clearly more effort and
increased time.
3
Severe obstruction of performance, there is clearly increased effort and time needed, the activity can only be
performed with partial assistance from others.
4
Activity can’t be performed autonomic, full assistance of third is necessary
The HODA-scale consists of 25 items divided over five sections. Each item in the scale
can get a score between zero and four. The total score will variate between 0 and 100 and
gives a percentage of housekeeping damage. The assessor has to mention in each of the
five sections whether the patient uses tools and when this is the case, describe which tools.
The procedure for the completion of the assessment is questioning the patient, conducting
a case study and observation. (Brusselmans et al., 2014). A score sheet of the HODAscale can be seen in appendix B.
Estimate of Loss of Independence in Daily Activities Scale
The Estimate of Loss of Independence in Daily Activities or the ELIDA-scale is an
assessment scale designed to determine the need of assistance by patients with a work
related accident. It is independent of the nature of the injury and can as result be used by
various patients. It shows wider aspects of self-reliance such as instrumental activities of
daily life and social self- reliance. The instrument consists of 50 items that are located
into ten subscales. These subscale include: toilet, body hygiene, care: dress and undress,
food, food preparation, take care of clothes, daily domestic tasks, not- daily domestic
tasks, regulation of the environment and sleep, activities outside the house and
communication and basic skills. Within these subscale are five items that can be scored
with a positive (+) or a negative sign (-). A positive sign includes the ability to perform
the activities independent and a negative sign represents dependence. When the
assessment is completed the negative signs in each subscale are summed and multiplied
13
by two. As result one gets a score between 0-100. How lower the score on the scale how
more independent the functioning of the patient. The procedure for the completion of the
assessment is questioning the patient (Brusselmans, 1992).
JAMAR
The Jamar is an instrument that measures grip strength on the basis of a closed hydraulic
system. It represents the measured values in kilogram (kg) and is applicable in different
pathologic conditions such as stroke, neuromuscular diseases and rheumatoid arthritis
(Bellace, Healy, Besser, Byron & Hohman, 2000). Measuring the grip strength has to be
done bilateral (affected and non-affected hand) (Lafayette Instrument Company, 2004).
The reference values for males vary between 47,4 kg and 29,8 kg for the left hand and
53,3 kg and 28,0 kg on the right hand. For females the reference values for the left hand
range between 27,9 kg and 16,4 kg and for the right hand between 30,6kg and 18,0 kg.
These reference values are depending on the age of the patient (Boannon, Peolsson,
Massy- Westropp, Desrosiers & Bear- Lehman, 2006). The validity of the Jamar was
tested with the Dexter dynamometer and had an ICC of 0.99 at the dominant hand and an
ICC of 0.98 at the non-dominant hand (Bellace et al., 2000). The inter-instrument
reliability with the Rolyan Dynamometers gave as result an ICC that ranged from 0.90 to
0.97 (Mathiowetz, 2002).
2.2.
Protocol
Data was collected for the three different outcome measures, the HODA-scale, the
ELIDA-scale and the Jamar. Between the evaluation of the patients with these scale there
was a time interval of one week maximum, there is scientific proof that a test- retest
evaluation between two days and two weeks is adequate (Marx, Menezes, Horovitz, Jones
& Warren, 2003). In order to make the collection of data practically feasible and to limit
the change in functioning the same time interval was applied for the two other scales.
14
Figure 5: test protocol
2.3.
Construct validity
Construct validity can be defined as “the extent to which scores on a particular instrument
relate to other measures in a manner that is consistent with theoretically derived
hypotheses concerning the concepts that are being measured” (Terwee et al., 2007, p. 36).
To assess the construct validity predefined hypotheses should be tested. How more
specific the hypotheses the better for the results, otherwise there would be a higher risk
for biases. This because afterwards one can for the low correlation attempt to provide an
alternative explanation , instead of accepting that the instrument is not valid (Terwee et
al., 2007).
For the evaluation of the construct validity the HODA-scale is compared with the ELIDAscale.
The construct validity is calculated by a correlation on one hand between the total score
of the HODA- scale and the total score of the ELIDA- scale and on the other hand there
are correlations calculated between the different items (cfr. hypotheses.) .
Before processing the date a Shapiro- Wilk normality test is conducted to determinate the
distribution of the data. When this test is significant (p< .05), a non- parametric test will
be applied. When this test is not significant (p>.05) a parametric test will be applied.
15
Hypotheses
On scale level there is hypothesized that the total score of the HODA-scale would
correlate good with the total score of the ELIDA-scale because of the similarity in the
construct displayed by both scales.
On itemlevel there is hypothesized that (1) ‘Heating a meal for example in the
microwave’ would correlate with ‘can independently prepare a simple meal’, (2)
‘Independent peeling and cutting potatoes’ would correlate with ‘can independently
prepare a simple meal’, (3) ‘preparing a full meal, cooking process and timing
preparation’ would correlate with ‘Can safely and independently operate a stove and
monitor heating and cooking (taking a pot or pan on and off included)’, (4) ‘setting and
clearing of the table, inclusive hot and fragile material’ would correlate with ‘Can
independently set and clear the table (including hot and brittle materials)’, (5) ‘vacuum
one or multiple rooms’ would correlate with ‘Can independently sweep the floor/ handle
the vacuum cleaner’, (6) ‘mopping/wet cleaning (handle cleaning convenience and bucket
filled with water)’ would correlate with ‘Can independently scrub the floor’, (7) ‘cleaning
windows (maximum three steps high)’ would correlate with ‘Can independently wash the
windows’, (8) ‘making the beds and change linens’ would correlate with ‘Can
independently prepare and chance the bed’, (9) ‘perform hand wash (wash, rinse out, hang
to dry)’ would correlate with ‘Can make a small hand wash by himself’, (10) ‘filling,
emptying and operating washing machine and dryer’ would correlate with ‘Can control,
fill and empty a washing machine/dryer’, (11) ‘ironing and folds of several linen
(inclusive opening and closing the ironing board)’ would correlate with ‘Can safely use
an iron and folds clothes’, (12) ‘storage in closets or racks and take out various household
products and food’ would correlate with ‘Can take autonomous objects and store it
properly in closets and storage spaces (eg. Clothing, household equipment)’, (13)
‘performing repairs and replacements in the house (replacing lamps, replacing batteries,
etc.)’ would correlate with ‘can independently do minor repairs or replacements in the
house (eg. Replacement of a lamp)’, (14) ‘Keep supervision of the house and react
appropriate (heating, open and close doors and windows, breakdowns, etc.)’ would
correlate with ‘Independently have control over the state of the house and functioning of
devices (eg. Leaks, observing damage and respond appropriately)’, ‘Can independently
16
guarantee the necessary lighting, ventilation and shielding of the house (windows and
(role)shutters, switches)’ and ‘Can be independently responsible for opening and closing
the doors of the house’, (15) ‘shopping in a corner shop (butchery, bakery, newsagent)’
would correlate with ‘Can shop safely and completely independent in a known
environment (moving on varied terrain included)’, (16) ‘shopping in a supermarket
(inclusive displacement, loading and unloading goods)’ would correlate with ‘‘Can shop
safely and completely independent in a known environment (moving on varied terrain
included)’, (17) ‘Shopping in a shopping district or shopping centre’ would correlate with
‘Can move safely and independently in an unknown environment, for wheelchair use,
including riding on and off pavements and small obstacles (moving on varied terrain
included)’, (18) ‘use and transfer to several services (post office, bank, administrative
services, etc.)’ would correlate with ‘Can independently carry out activities in or not in a
wheelchair at an accessible public building (eg. Station, bank,…)’.
2.4.
Discriminative validity
Discriminative validity is an indication about the different results researches would
expect between two measures who assess different constructs (Portney & Watkins, 2014).
The discriminative validity is calculated by a correlation between the total score of the
HODA- scale and the mean score of the Jamar. Before processing the date a ShapiroWilk normality test is conducted to determinate the distribution of the data. When this
test is significant (p< .05), a non- parametric test will be applied. When this test is not
significant (p>.05) a parametric test will be applied.
Hypotheses
Because the HODA-scale and the Jamar measure two different constructs, there is
hypothesized that they will show a lower correlation than the correlation with the ELIDAscale.
2.5.
Factorial Validity
The factorial validity gives an indication about the factorial composition of a
measurement. It is based on the correlation between the identified factors that determine
the score on a test (Fawcett, 2009).
17
To conduct the factorial validity of the HODA-scale a confirmatory factor analyses was
conducted to the data. The goal was to confirm on an empirically way the factor structure
of the scale and identify possible additional underlying dimensions. There was a principal
component used as the extraction method and in function to maximize the factor
simplicity oblique rotation was used for the rotation method (Lorenzo- Seva, 1999). In
order to check whether the data was suitable for a confirmative factor analysis the KaiserMeyer-Olkin was applied. This had to have a value greater than 0.70 (Tabachnick, 2007).
Additionally a Bartlett’s test of sphericity was performed to check whether there were
correlations in the data set who were suitable for a factor analysis and was defined as
significant before processing the data (Tabachnick, 2007).
2.6.
Internal consistence
Internal consistency represents the extent to which items in an assessments scale are
correlated. It is important to examine in scales who have the intention to identify one
construct on basis of various items (Terwee et al., 2007). It is “the degree of
interrelatedness among the items” (Mokkink et al., p. 743, 2010).
The internal consistence of the HODA-scale was assessed using the Cronbach’s Alpha
coefficient. The internal consistence is considered to be good when the results of the
Cronbach’s Alpha range between 0.70 and 0.95 (Terwee et al., 2007).
2.7.
Test- retest reliability
Reliability can be defined as the coherence of scores when they are obtained by the same
person and are measured again on a different time or with different sets or similar sets of
items. When an assessment has a good test- retest reliability the test will give the same
results (Marx et al. 2003).
To examine the test- retest reliability of the HODA-scale the assessment instrument was
conducted twice with a time interval of up to one week. On scale level an Intraclass
Correlation Coefficient (ICC) was applied to the collected data with a confidence interval
(CI) of 95% (two way random model – absolute agreement) . On item level a weighted
kappa was applied. The reliability is rated as good if the ICC and the weighted kappa are
greater or equal to 0.70 (Terwee et al., 2007).
18
3. Results
3.1.
Study population
The total study sample included 34 people diagnosed with a form of acquired brain injury.
The response rate for testing construct validity was for the HODA- scale and the ELIDAscale 100% (n=34). All the patients who were assessed with the HODA- scale were also
assessed by the ELIDA-scale. For the discriminant validity with the Jamar the response
rate was lower, 47% (n= 16). For factorial validity and internal consistence the response
rate was also 100% (n= 34) for the HODA- scale. For the test- retest reliability there was
a response rate of 47% (n=16).
Table 4: Characteristics of the participants (n=34)
Age: mean (SD)
42,9 (11,7)
Gender: male/female
21/13
Diagnosis: n (%)
-
Non- traumatic: other than stroke
7 (20,6)
-
TBI
8 (23,5)
-
Stroke
19 (55,9)
Highest level of education: n (%)
-
General secondary education (12 to 18 years)
1 (2,9)
-
Technical and vocational secondary education (12 to 18 years)
14 (41,2)
-
Special secondary education (13 to 21 years)
1 (2,9)
-
Associate degree (18+)
2 (5,9)
-
University college (18+)
7 (20,6)
-
University (18+)
7 (20,6)
-
Unknown
2 (5,9)
Family situation: n (%)
3.2.
-
Married with children
16 (47,0)
-
Married
0
-
Couples living in a consensual union/registered partnership with children
2 (5,9)
-
Couples living in a consensual union /registered partnership
2 (5,9)
-
Single with children
4 (11,8)
-
Single
10 (29,4)
Construct validity
The Shapiro- Wilk normality test was significant (p<0.05), therefore a non-parametric
test was performed, the Spearman-rank correlation coefficient.
The Spearman correlation coefficient between the total score of the HODA-scale and the
total score of the ELIDA-scale was .819 (significant at the 0.01 level, 2-tailed).
19
Figure 6: scatterplot correlation total HODA-scale – total ELIDA-scale
An overview of the correlation between the congruent items of both assessment scales
can be seen in table 5.
Table 5: correlation HODA-scale items and ELIDA-scale items
Item HODA-scale
Item ELIDA-scale
Spearman
correlation
coefficient
(1)
Heating a meal for example in the microwave
Can independently prepare a simple meal
.154
(2)
Independent peeling and cutting potatoes
Can independently prepare a simple meal
.557**
(3)
Preparing a full meal, cooking process and timing
Can safely and independently operate a stove and
.634**
preparation
monitor heating and cooking (taking a pot or pan on
and off included)
(4)
Setting and clearing of the table, inclusive hot and
Can independently set and clear the table (including
fragile material
hot and brittle materials)
Cleaning the kitchen and the dining room, washing
Can independently wash and dry the dishes (including
the dishes
pots and pans)
(6)
Vacuum one or multiple rooms
Can independently sweep the floor/ handle the vacuum
(7)
Mopping/wet
(5)
.632**
.615**
.643**
cleaner
cleaning
(handle
cleaning
Can independently scrub the floor
.761**
convenience and bucket filled with water)
(8)
Cleaning windows (maximum three steps high)
Can independently wash the windows
.676**
(9)
Making the beds and change linens
Can independently prepare and chance the bed
.829**
Can make a small hand wash by himself
.315
(10) Perform hand wash (wash, rinse out, hang to dry)
20
(11) Filling, emptying and operating washing machine
Can control, fill and empty a washing machine/dryer
.431*
Can safely use an iron and folds clothes
.507**
Can take autonomous objects and store it properly in
.591**
and dryer
(12) Ironing and fold several linen (inclusive opening
and closing the ironing board)
(13) Storage in closets or racks and take out various
household products and food.
closets and storage spaces (eg. Clothing, household
equipment)
(14) Performing repairs and replacements in the house
(replacing lamps, replacing batteries, etc.)
(15) Keep supervision of the house and react
Can independently do minor repairs or replacements in
.584**
the house (eg. Replacement of a lamp)
-
Independently have control over the state of the
.419*
appropriate (heating, open and close doors and
house and functioning of devices (eg. Leaks,
.429*
windows, breakdowns, etc.)
observing damage and respond appropriately)
.429*
-
Can independently guarantee the necessary
lighting, ventilation and shielding of the house
(windows and (role)shutters, switches)
-
Can be independently responsible for opening
and closing the doors of the house
(16) Shopping in a corner shop (butchery, bakery,
newsagent)
Can shop safely and completely independent in a
.679**
known environment (moving on varied terrain
included)
(17) Shopping
in
a
supermarket
(inclusive
displacement, loading and unloading goods)
Can shop safely and completely independent in a
.569**
known environment (moving on varied terrain
included)
(18) Shopping in a shopping district or shopping centre
Can move safely and independently in an unknown
.562**
environment, for wheelchair use, including riding on
and off pavements and small obstacles (moving on
varied terrain included)
(19) Use and transfer to several services (post office,
bank, administrative services, etc.)
Can independently carry out activities in or not in a
.528**
wheelchair at an accessible public building (eg.
Station, bank,…)
**: Significant at 0.01; 2 tailed
*: Signiant at 0.05; 2 tailed
3.3.
Discriminative validity
The Shapiro- Wilk normality test was not significant (p>0.05), therefore a parametric
test should be performed, the Pearson correlation coefficient.
De Pearson correlation coefficient between the total score of the HODA-scale and the
mean score of the JAMAR was -.558 (significant at the 0.05 level, 2 tailed).
21
Figure 7: scatterplot correlation HODA-scale- Jamar
3.4.
Factorial validity
The Kaiser-Meyer- Olkin measure had a result of .634, the Bartlett’s test of sphericity
was significant (X²= 1128.5, df=300, p<0.01). Communalities after extraction varied
between .760 and .935. Two factors were identified. Factor one accounted for 63,54% of
the total variance and factor two accounted 9,11% of the total variance.
Table 6: factorial validity HODA-scale
Item HODA-scale
Factor 1
Factor 2
Total variance
63,54%
1.
Heating a meal for example in the microwave
.682
2.
Independent peeling and cutting potatoes
.817
3.
Preparing a full meal, cooking process and timing preparation
.817
4.
setting and clearing of the table, inclusive hot and fragil material
.865
5.
Cleaning the kitchen and the dining room, washing the dishes
.865
6.
dust off furniture
.820
7.
vacuum one or multiple rooms
.894
8.
mopping/wet cleaning (handle cleaning convenience and bucket
.865
9,11%
filled with water)
9.
cleaning windows (maximum three steps high)
.850
22
10. making the beds and change linens
.929
11. perform hand wash (wash, rinse out, hang to dry)
.805
12. filling, emptying and operating washing machine and dryer
.835
13. ironing and fold several linen (inclusive opening and closing the
.909
ironing board)
14. cleaning the house (loose scattered clothing, various objects,
.833
lecture, etc.)
15. storage in closets or racks and take out various household
.819
products and food.
16. performing repairs and replacements in the house (replacing
.883
lamps, replacing batteries, etc.)
17. collect and sort garbage and placing it on the streetside.
.896
18. Management of the required reserves of household equipment
.692
and making a shopping list
19. Keep supervision of the house and react appropriate (heating,
.659
.406
20. Financial management household.
.605
.305
21. shopping in a corner shop (butchery, bakery, newsagent)
.657
.560
22. shopping in a supermarket (inclusive displacement, loading and
.603
.537
23. Shopping in a shopping district or shopping centre
.709
.453
24. shopping online
.766
.249
25. use and transfer to several services (post office, bank,
.709
.516
open and close doors and windows, breakdowns, etc.)
unloading goods)
administrative services, etc.)
23
3.5.
Internal consistence
The Cronbach’s Alfa for internal consistence is .975. The item- total correlation ranged
between .592 to .910. An overview can be seen in table 7.
Table 7: item- total correlation HODA-scale
Item HODA-scale
Item- total
correlation
1.
Heating a meal for example in the microwave
.661
2.
Independent peeling and cutting potatoes
.785
3.
Preparing a full meal, cooking process and timing preparation
.796
4.
setting and clearing of the table, inclusive hot and fragile material
.845
5.
Cleaning the kitchen and the dining room, washing the dishes
.843
6.
dust off furniture
.793
7.
vacuum one or multiple rooms
.877
8.
mopping/wet cleaning (handle cleaning convenience and bucket filled with water)
.838
9.
cleaning windows (maximum three steps high)
.821
10. making the beds and change linens
.910
11. perform hand wash (wash, rinse out, hang to dry)
.783
12. filling, emptying and operating washing machine and dryer
.812
13. ironing and fold several linen (inclusive opening and closing the ironing board)
.889
14. cleaning the house (loose scattered clothing, various objects, lecture, etc.)
.808
15. storage in closets or racks and take out various household products and food.
.789
16. performing repairs and replacements in the house (replacing lamps, replacing batteries, etc.)
.872
17. collect and sort garbage and placing it on the streetside.
.879
18. Management of the required reserves of household equipment and making a shopping list
.674
19. Keep supervision of the house and react appropriate (heating, open and close doors and windows,
.643
breakdowns, etc.)
20. Financial management household.
.592
21. shopping in a corner shop (butchery, bakery, newsagent)
.642
22. shopping in a supermarket (inclusive displacement, loading and unloading goods)
.596
23. Shopping in a shopping district or shopping centre
.701
24. shopping online
.756
25. use and transfer to several services (post office, bank, administrative services, etc.)
.705
3.6.
Reliability
The reliability statistics gave the result of a Cronbach’s alfa of .978. The ICC single
measures is .957 with a CI between .957 and .964. The kappa resulted in .560.
24
Discussion
Before discussing the results of this study a few limitations should be explained. First
completing the assessments was done only by questioning the patients. The manual of the
assessments states that the assessor has to question and observe the patients and should
consult the patient his file. In this study it was not possible to observe all the activities
which were represented by the HODA-scale. Therefore after questioning the patient, we
went through the assessment with the occupational therapist that worked with that specific
patient. Second, for the evaluation of the test-retest reliability the assessment was only
filled in based on the answers of the patient. It is import when using this approach to take
into account that a lot of patients with a brain injury haven an impaired self- awareness
what makes that the patient minimizes limitations and difficulties caused by the injury
(Caldwell et al., 2014). Therefore the psychometric properties should be evaluated in
other pathology groups to provide a complete and accurate picture of the psychometric
properties. Lastly, the overall sample size is small and for reliability and discriminative
validity they are even smaller which can have an influence on the results.
The overall aim of this master thesis was to conduct the possibility of the HODA-scale to
be converted to ICF categories and to contribute in this way to the covering of the TBI
core set. In addition to this an evaluation of the psychometric properties of the scale was
conducted. The conversion included two expert panels who came together once. Previous
investigation showed that it is the intention to keep the discussion about the most
appropriate category of the ICF until consensus is reached (De Vriendt et al. 2012). This
was not done in this study, instead an online survey was send to the different experts. A
negative aspect of this approach was that one expert did not answered the online survey
and therefore the HODA-scale was converted with a reduced number of experts for these
two items. The converted HODA-scale covered only a few items from the core set.
Besides the conversion, five psychometric properties of the HODA-scale were examined.
The construct validity with the ELIDA scale on scale level indicated a good significant
result of .819 which was above the limit of .70 as given by Terwee et al. (2007). However
on item-level the correlations were lower than was hypothesised for most of the items.
Only for hypothesis six ‘mopping/wet cleaning (handle cleaning convenience and bucket
25
filled with water)’ which was assumed to correlate with ‘Can independently scrub the
floor’ and hypothesis eight ‘making the beds and change linens’ which was assumed to
correlate with ‘Can independently prepare and chance the bed’ the limit of .70 was
reached with .761 for hypothesis six and .829 for hypothesis eight, both significant. The
lower correlations are remarkable because at first side there is an agreement between the
items, they handle about the same concept.
The discriminative validity was obtained by a correlation with the Jamar. As hypothesized
this correlation would be lower because of the different constructs. The result was a
negative and a moderate correlation. The negative sign of the correlation can indicate that
it is possible to have a good score on the Jamar but a low score on the HODA-scale or
when one has a high score on the HODA-scale one will have a low score on the Jamar.
In other words a patient with a high score on the HODA-scale will have a lower grip
strength and one with a good grip strength will have a lower HODA-scale score and less
problems with fulfilling domestic tasks.
The factorial validity of the HODA-scale was performed by a confirmatatory factor
analysis. The Kaiser-Meyer-Olkin was .634 which is lower than .70. This can be
explained by the small sample size. But because the Bartlett’s test of sphericity was
significant and the score of the Kaiser-Meyer-Olkin was moderate a factor analyse could
be performed. All items of the assessment were mostly loaded on the first factor. A small
part of them were loaded on the second one. The HODA-scale originally consists of five
components and 25 items. The result of this factor analysis does not confirm these five
factors, but shows only two. This result offers opportunities to reduce the number of items
in two subscales to obtain the same results. However, when all items are relevant to obtain
a detailed view of the patients’ functioning, one can decide to keep the items instead of
removing them from the scale.
The internal consistency of the HODA-scale gave an Cronbach’s Alfa of .975, which
falls outside the limits of .70 and .90 reported by Terwee et al. (2007). A high Cronbach’s
Alfa could point to an excess of items in the scale (Terwee et al. 2007). It may refer to an
unnecessary duplication of items and to redundancy of items instead of homogeneity
(Streiner, 2003). The item-total correlation varied .592 to .910. The literature states that
26
a strong internal consistency includes a moderate correlation between the items that vary
between .70 and .90. Some items of the HODA-scale are under or above this limit which
can indicate that when they are too low they measure possibly different characteristics
and when it is too high the items can be redundant which may have an influence on the
content validity (Portney & Watkins, 2014).
The test-retest reliability gave an ICC of .957 and a weighted kappa of .560. The ICC
gives an idea about the reliability on scale level and is indicated as good (above .70). The
weighted kappa was too low and indicates there is only for 56% an agreement on the
different items for the test and the retest. An explanation for this can be due to the three
different scores one gets on the HODA-scale. All items who get a score from zero to two
are separately added from the items with the scores from three to four. These are named
as more effort and time to perform (score zero to two) and help from others (score three
to four). When these two scores are counted together a patient can have the same total
score but these both can vary.
Conclusion
The HODA-scale is an assessment instrument to indicate the total damage in domestic
tasks after injury. It is based on the scoring-system of the ICF and also the items are based
on chapter six of the ICF. It is successfully converted to ICF categories and it covers some
items in the core set for TBI. The psychometric properties of the HODA-scale evaluated
with people with an ABI are moderate (take the small sample size into account), but there
is more research needed to conduct these properties in other patient populations.
27
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32
Appendix
Appendix A: Occupational therapy in core set TBI
ICF-categories core set TBI for occupational therapy
ICF- categories core set
TBI covered by HODAscale
d155 Ontwikkelen van vaardigheden
d175 Oplossen van problemen
d177 Besluiten nemen
d210 Ondernemen van enkelvoudige taak
d220 Ondernemen van meervoudige taken
d230 Uitvoeren van dagelijkse routinehandelingen
d430 Optillen en meenemen
d440 Nauwkeurig gebruiken van hand
d445 Gebruiken van hand en arm
d470 Gebruiken van vervoermiddel
d510 Zich wassen
d620 Verwerven van goederen en diensten
x
d640 Huishouden doen
x
d825 Beroepsopleiding
d840 Werkend leren
d850 Betaald werk
33
d860 Basale financiële transacties
x
d865 Complexe financiële transacties
d870 Economische zelfstandigheid
e115 Producten en technologie voor persoonlijk gebruik in het
dagelijks leven
e135 Producten en technologie voor werkdoeleinden
e165 Activa
e590 Voorzieningen, systemen en beleid met betrekking tot
werkgelegenheid
34
Appendix B: HODA-scale
35
Appendix C
“De auteur en de promotor geven de toelating deze masterproef voor consultatie
beschikbaar te stellen en delen ervan te kopiëren voor persoonlijk gebruik. Elk
ander gebruik valt onder de beperkingen van het auteursrecht, in het bijzonder
met betrekking tot de verplichting uitdrukkelijk de bron te vermelden bij het
aanhalen van resultaten uit deze masterproef.”
Datum:
(handtekening student)
(handtekening promotor)
(Naam student)
(Naam promotor)
36
List of figures
-
Figure 1: The ICF-framework
-
Figure 2: ICF- qualifiers
-
Figure 3: item 1 online survey
-
Figure 4: item 2 online survey
-
Figure 5: test protocol
-
Figure 6: scatterplot correlation total HODA-scale and total ELIDA-scale
-
Figure 7: scatterplot correlation total HODA-scale and mean Jamar
37
List of tables
-
Table 1: ICF-linking rules
-
Table 2: Conversion of the HODA-scale
-
Table 3: Scoresystem HODA-scale based on the ICF score criteria
-
Table 4: characteristics of the participants
-
Table 5: correlation HODA-scale items and ELIDA-scale items
-
Table 6: factorial validity of the HODA-scale
-
Table 7: item-total correlation HODA-scale
38

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