Article

Understanding whether there is an agreement between older persons who
provide information on their functional status and clinicians who assess their
function is an important step in the process of creating sound outcome
instruments. OBJECTIVES: To examine whether there is agreement between
self-reported and clinician assessment of similar performance items in older
adults. METHODS: Fifty independent older adults aged 70-91 years (mean age 80.3
+/- 5.2 years) who live in the community were examined separately and blindly in
two data collection sessions. Self-reported and observed lower and upper
extremity physical tasks were compared. Life Function and Disability Instrument
(LLFDI) was used in both sessions. We performed intra-class correlation
coefficients (ICC) as indices of agreement and "mountain plots" that were based
on a cumulative distribution curve. Associations between self-reported and
observed function with Fear of Fall Scale (FES) and Geriatric Depression Scale
(GDS) were also assessed. RESULTS: ICCs were high between self-reported lower
extremity function and observed lower extremity function (ICC = 0.83), and were
poorer for self-reported and observed upper extremity function (ICC = 0.31). In
both comparisons, mountain plots revealed a right shift that was larger for upper
than lower extremity functions, indicating systematic differences in
self-reported and observed assessments. Associations with FES and GDS were higher
for self-reported than observed function. CONCLUSION: There is a systematic bias
between self-reported and clinician observation. Professionals should be aware
that information provided by patients and observation of activity assessed by
clinicians could differ substantially, especially for upper extremity function.
Implications for Rehabilitation There is a systematic bias between self-reported
and clinician assessment of similar performance items in older adults. In
general, older adults overestimate their physical function or clinicians
underestimate older adults function. The bias between self-reported and clinician
assessment for upper extremity function is larger than that for lower extremity
function. The conclusions regarding agreement across upper extremity and lower
extremity function scores are not different when using mountain plots graphs
versus relying solely on the value of the ICCs. However, the graphs expand our
understanding of the direction and magnitude of score differences. Professionals
should be aware that information provided by patients and assessment by
clinicians could differ substantially, especially for upper extremity function.

Langue : ANGLAIS