Reliability and Validity of a New Toileting Assessment Form for Patients with Hemiparetic Stroke.
Shin Kitamura, Yohei Otaka, Yudai Murayama and 5 others
PMID 32418365WHAT IT FOUND
A new 24-item toileting form for stroke patients was scored consistently by therapists and matched existing FIM toileting ratings, but it was tested only on 30 simulated videos in one hospital.
Key findings
01All TTAF items met the 80% consensus rule in both therapist surveys.
02The four raters' agreement was at least 0.61 for every item and 0.97 for the mean score; after 2 weeks, two raters' mean scores had 0.99 agreement, and a change of 0.29 point was considered true.
03The form's mean scores were related to FIM toileting and toilet-transfer ratings, and patients with the same FIM ratings received different TTAF item scores.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was done in one subacute rehabilitation hospital in Japan, so results may not apply to other settings. Only 30 patients were tested, and they were recruited by convenience sampling, so the sample may not represent all wheelchair-using stroke patients. Participants were limited to hemiparetic stroke patients who usually used a wheelchair, so it does not address patients who walk. Toileting was simulated and did not include actual urination or defecation, and performance was scored from video, not in the bathroom. Some tasks were hard to judge from a single video, especially standing tasks, and nurse call button items were sometimes marked not applicable. Most participants were men (male, 80%), so findings may not apply equally to women. The assessors worked at the same hospital where the form was developed, and the FIM used was not the latest version. There was no gold-standard subtask assessment to compare against, so criterion validity was not tested. Content validity was judged by therapists from the same hospital, and only occupational therapists had prior experience with the form.
The easy way to misread this
Do not conclude that the TTAF improves stroke patients' toileting independence or works in real bathrooms. The study tested 30 simulated video performances in one hospital and did not assess urination or defecation or patient outcomes.