Preliminary investigation of the reliability and validity of the BIRT Independent Living Scale

Abstract

Purpose: Neurorehabilitation aims to increase independence and participation in ordinary life. It is argued that the fundamental indices of this are independent living and engagement in occupational or productive activity. The Brain Injury Rehabilitation Trust Independent Living Scale was designed to capture change in levels of participation and independence following neurorehabilitation. With greater use of outcome measures in health care, it becomes necessary to develop tools which are simple to use and that capture the holistic impact of rehabilitation. This study examines the inter-rater reliability and validity of the Brain Injury Rehabilitation Trust Independent Living Scale, which comprises two single item, multiple-choice sub-scales.

Method: Inter-rater reliability was assessed by comparing the ratings on the Brain Injury Rehabilitation Trust Independent Living Scale, by five pairs of graduate psychologists, of 37 individuals who had undergone neurorehabilitation. Retrospective data collected by other members of the clinical team for the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and Care And Needs Scale were correlated with the Brain Injury Rehabilitation Trust Independent Living Scale to establish concurrent validity.

Results: Weighted kappa coefficients revealed moderate (occupation) to strong (accommodation) inter-rater reliability for the two sub-scales. All correlations between the Brain Injury Rehabilitation Trust Independent Living Scale and the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and the Care And Needs Scale were high, demonstrating good concurrent validity.

Conclusions: This study highlights some of the psychometric properties of the Brain Injury Rehabilitation Trust Independent Living Scale and demonstrates its utility in assessing independent living ability and level of social participation after neurorehabilitation.

Implications for rehabilitation

• The BIRT Independent Living Scale is a validated method for ranking accommodation and occupation status as an indicator of independent living ability and occupational activity.

• The two freely available single-item scales emerging from this study provide a brief method for measuring independent living ability and participation following rehabilitation in research and clinical practice.

• The BIRT Independent Living Scale’s simplicity means it does not require specific training to administer, facilitating its use by a wide range of multidisciplinary staff members and researchers.

Keywords:

• Outcome measures
• neurorehabilitation
• community integration
• participation
• brain injury
• BILS

Acknowledgements

We would like to thank all those who helped in collecting the data for this study, and Ms. Ashleigh Madigan for her assistance with the revision of the manuscript.

Disclosure statement

At the time of preparation of this manuscript, all four authors worked for the Brain Injury Rehabilitation Trust, a not-for-profit organization that offers post-acute neurorehabilitation. The authors did not receive direct funding from external sources to conduct this study and they alone are responsible for the content and writing of the paper.