Development of Toileting Behaviour Evaluation for Older Adults Using Wheelchairs: A Validation Study

Abstract

Abstract Background Ageing limits the activities of daily living (ADLs). Among ADLs, a lack of toileting independence causes a decline in the quality of life, mental health, and social participation. Studies have also shown that toileting dependence results in economic, mental, and physical burdens for not only patients but also their families and society. Therefore, occupational therapists spend considerable time assessing toileting disability based on various assessment methods. However, these methods are limited to stroke patients and have few grading levels and activity components for toileting. Therefore, they fail to evaluate toileting behaviour accurately and sensitively. Hence, this study developed a Toileting Behaviour Evaluation (TBE) on a 6-point ordinal scale for patients using wheelchairs, with 22 activity components for various diseases. Methods This study examined the reliability and validity of the TBE in acute and subacute hospitals in Japan. To this end, two occupational therapists assessed 50 patients for inter-rater reliability at different times and one assessed them twice within 7–10 days for intra-rater reliability using the TBE. Furthermore, one occupational therapist assessed 100 patients for internal consistency using the TBE and for concurrent validity using the TBE and Functional Independence Measure (FIM). The patients had been diagnosed with a stroke, musculoskeletal disease, or disuse syndrome. Results The minimum weighted kappa coefficients for the inter-rater and intra-rater reliability for each item were .67 and .79, respectively. Cronbach’s alpha was .98 for the 22 items. The Spearman’s rank correlation coefficient between the mean scores on the TBE and FIM for toilet-related items was .74 (P < .01). Conclusions The TBE demonstrated good reliability and validity. This means that therapists can use it to identify impaired toileting behaviour. However, the relationship between impairments and each item of toileting behaviour should be explored in future studies. Additionally, studies should examine the creation of a specific index of functions of independence in each toileting behaviour.