Date Presented 04/06/19
To understand the limitation of clients who experienced neurological impairment, OTs should evaluate their functioning with behavioral observation assessments with cross-cultural adaptions. This study aims to perform a cross-cultural adaptation for the Korean population of the Activities of Daily Living (ADL)-focused Occupation-Based Neurobehavioral Evaluation (A-ONE) and examine its reliability and validity.
Primary Author and Speaker: Jaewon Kang
Contributing Authors: Hae-Yean Park, Jung-Ran Kim, Ji-Hyuk Park
PURPOSE: The individual’s contextual conditions, such as physical factors and environmental contexts, can influence his or her occupational performance. Evaluating performance in a natural context predicts the performance of clients as they return to their normal lives. However, limited ecological validity interferes with the interpretation of results. For this reason, cross-cultural adaptation should be carried out even if the tool is already standardized for use in other countries.This study aims to perform a cross-cultural adaptation for the Korean population of the Activities of Daily Living (ADL)-focused Occupation-Based Neurobehavioral Evaluation (A-ONE) and examine its reliability and validity.
PARTICIPANTS: Forty-two patients with stroke were recruited from rehabilitation hospitals and community welfare centers in Seoul and Wonju, Korea. Inclusion criteria include patients (ⅰ) at least 20 years of age, (ⅱ) who had been clinically diagnosed with stroke and had experienced stroke for > 3 months, (ⅲ) with a Mini Mental State Examination-Korean version (MMSE-K) score of at least 20, and (ⅳ) able to understand Korean.
METHOD: A multi-step process (Translation, Pilot testing of the pre-final version, Expert Committee, Final production, etc) was conducted to examine whether the Korean version of the A-ONE was linguistically and culturally equivalent to the original version of the A-ONE. For the validation, cross-cultural and concurrent validity were analyzed by using FIM and LOTCA. The internal consistency of all participants was measured using Cronbach’s α and the intraclass correlation coefficient (ICC) was used to estimate test-retest and inter-rater reliability.
RESULTS: The content validity index at the item level (I-CVI) for cross-cultural validity ranged between .92 and 1. The Pearson correlation between the Korean version of the A-ONE and FIM in feeding category was 0.77. For internal consistency of the FI and the NBSIS, Cronbach’s α had the values 0.58–0.93 and 0.42–0.93, respectively. For test-retest reliability, the intraclass correlation coefficient (ICC) was 0.79–1.00 for the FI and 0.74–1.00 for the NBSIS, while for inter-rater reliability the ICC was 0.75–1.00 for the FI and 0.72–1.00 for the NBSIS.
CONCLUSION: To understand the limitation of clients who experienced neurological impairment, occupational therapists should evaluate their functioning with behavioral observation assessments. The cross-cultural adaptions of observational assessments are very important because clients’ contextual conditions influence their occupational performance. Finding out an individual’s difficulties in real life based on his or her culture is helpful to occupational therapists in selecting intervention methods.
This study found that the Korean version of the A-ONE was relevant to Korean culture and demonstrated its validity and reliability. This study is vital because the Korean version of the A-ONE can be a useful instrument to test the ADL performance skills and overall neurobehavioral impairments of individuals with nervous system dysfunctions in a clinical setting and in research as an evidence-based approach for the Korean population. Moreover, this study provides a way to develop a new cross-cultural adaptation of other assessment tools in each country.
References
Árnadóttir, G. (2010). Measuring the impact of body functions on occupational performance: validation of the ADL-focused occupation-based neurobehavioral evaluation (A-ONE). Umeå University, Sweden.
Jacoby, R. J., Abramowitz, J. S., Reuman, L., & Blakey, S. M. (2016). Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty. Journal of Anxiety Disorders, 41, 43-49.
