Complicated daily tasks of Chinese elderly with stroke

Abstract

The term Complicated Daily Task (CDT) is used to describe community-living tasks. These, when performed by people, are meant to be more demanding when compared with other tasks, such as self-care. CDTs are more complicated, demanding higher cognitive and motor abilities, and more interactions with the environment. Despite the fact that CDTs are commonly used for the training and assessment of people with disabilities, there has been insufficient evidence on their construct and measurement characteristics. This study was designed to identify a core list of CDTs relevant to Chinese older people. The latent construct and measurement characteristics of these tasks with reference to the motor, cognitive, and emotional-coping abilities of patients with stroke were further investigated. The study was divided into two stages: 1) the survey on the core CDTs and 2) the testing of CDT task performance and abilities of a group of patients with stroke. Stage 1. Forty-six females of mean age 67.6 (SD=9.2) were recruited to participate in a face-to-face interview. None had had any major medical events and lived independently in the community at the time they were interviewed. A questionnaire was used to guide the interview, which contained 21 CDT items such as hanging laundry, shopping and budgeting. The participants were asked to assign perceived complexity and importance ratings to each task item using two separate five-point Likert scales. Based on the participants' perceived complexity ratings, the 21 items were factor-analyzed into the "home maintenance", "outdoor" and "technological" categories, which accounted for 48.2% of the total variance. The tasks, which had higher importance scores, were selected pro-rata from each of the categories to form the core CDTs. A total of 12 tasks were identified: hanging laundry, preparing vegetables, taking medication, changing the bed, sweeping the floor, cleaning the bathroom, cooking rice with steamed fish, shopping, using public transportation, using the telephone, using the Octopus travel ticket, and budgeting. Stage 2. Fifty-two post-stroke patients of mean age 76.0 (SD=6.7) were recruited from two rehabilitation hospitals and a geriatric day hospital to participate in the performance testing and assessment. Each patient was tested on the 12 core CDTs (using a seven-point Likert scale). After testing, three clinical instruments were administered to test the motor, cognitive and emotional-coping abilities of the patients. They were the McCarron Assessment of Neuromuscular Development (MAND), Neurobehavioral Cognitive Screening Examination (Cognistat), and Observational Emotional Inventory (OEI). The sequence of assessments was randomized for each of the patients. Factor analysis on the patients' CDT performance scores revealed a two-factor solution explaining 73% of the total variance. Factor 1 appeared to consist of eight "home maintenance" tasks whilst factor 2 was the four "administrative" tasks. The motor (p<0.001) and emotional-coping abilities (p=0.002) were significant variables predicting the performance of the home maintenance tasks, whereas cognitive (p<0.001) and emotional-coping skills (p=0.009) were significant predictors for the administrative tasks. The unidimensionality within each of the CDT factors was further tested with Rasch analysis. The Rasch results suggested a model fit within each factor (Factor 1: Chi-Sq. probability: 0.99; Factor 2: Chi-Sq. probability: 0.85). However, "preparing vegetables" in the home maintenance tasks was found to be a misfit and was removed from the final task list. The item calibration suggested a considerable variation of difficulty level of the tasks: -2.4 to 1.5 logits for the home maintenance tasks and -0.9 to 1.0 for the administration tasks. The task demand profile of most of the home maintenance tasks belonged to "high" motor and "low" cognitive categories. In contrast, those of administrative tasks were "high" cognitive and "low" motor ones. The emotional-coping profile was found to be "high" for all tasks. Conclusion. The results of this study suggest that CDTs tasks are multi-dimensional in nature, which can be accounted for by at least the "home maintenance" and "administration" factors. The perception score-based three-factor structure and the performance score-based two-factor structure revealed different emphases which are important for identification of core task domain and task demands respectively. Within a single factor of the Rasch scale, the measurement characteristics of the tasks are regarded as satisfactory. The different profiles reflected from the "task demands" of motor, cognitive and emotional-coping capabilities, further demonstrate the uniqueness of each CDT on the abilities of the post-stroke patients. The Rasch-based difficulty level calibrated for each task such as hanging laundry (easiest) and cleaning the bathroom (most difficult) illustrated the unidimensional, hierarchical and additive properties within each factor. Moreover, it showed the unique ability demands of performing CDTs by patients with strokes. These characteristics are useful for the development of a theory-based clinical measure of complicated tasks. The task hierarchies obtained in this study form the basis for designing upgrade strategies for rehabilitation programs and placement criteria for post-stroke patients.