Inter-Rater Agreement Using the Instrumental Activity Measure

Abstract

In the rehabilitation process it is vitally important to assess disability when following up clients with cerebral vascular diseases. It is not sufficient to just assess activities of daily living (ADL) according to personal care outside the clinical setting. Instrumental activities are tasks necessary for living in the community. The Instrumental Activity Measure (IAM) was developed as a supplement to the Functional Independence Measure (FIM). The aim of this study was to analyse the inter-rater agreement in assessing the dependency or need for assistance in clients after a stroke, using the eight items of the IAM in a seven-step scale. Two occupational therapists were present at all home visits, and did independent ratings during the interviews. Inter-rater agreement was analysed using percentage agreement (PA) and Cohen's unweighted kappa statistics. The results showed good inter-rater agreement, with kappa values exceeding 0.60. However, if the assessments are to be used to evaluate the treatment planning process it is essential to increase kappa values above 0.75 to identify individual deficits and assets as well as problem areas.