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RehabMeasures Instrument

Katz Index of Independence in Activities of Daily Living

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Purpose

To provide clinicians with a way “...to assess functional status as a measurement of the client’s ability to perform activities of daily living independently” in adults in diverse settings. (Wallace, M. & Mason, V., 2007).

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Instrument Details

Acronym Katz ADL/ Katz Index

Area of Assessment

Activities of Daily Living

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • This assessment is administered through observation of client performance.
  • Clients are classified as being “dependent,” requiring assistance, or “independent,” able to perform activity without assistance, in the performance of 6 ADLs
  • Clients score between 0 (dependent) and 6 (independent)
    A score of 6 indicates complete independence, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment

Number of Items

6

Equipment Required

  • May vary based on client’s needs and level of impairment

Time to Administer

5 or more minutes

Length of time is variable dependent upon client’s ability to perform the 6 tasks (White, 2011)

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initial review completed by Brianna Peterson and Jessica Donovan, December 2016. Reviewed and revised by Allison Peipert, 2017.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor

Considerations

This assessment can be used to define a client's level of function that can be easily understood across professionals and disciplines. This assessment only measures basic ADLs and does not provide any information regarding higher level ADLs and IADLs, this also causes a ceiling effect. There is also some debate over the hierarchy of ADLs proposed by Katz, as well as the inability of the scale to capture a client’s need for little assistance versus substantial assistance.

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Older Adults and Geriatric Care

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Cut-Off Scores

(Wallace, M & Shelky, M. 2008)

0-6 total points possible

  • 6 points= independent
  • 3-5 points= partially dependent
  • 2 or less points= dependent

Normative Data

Residents in Skilled Nursing facilities: (Gerrard, P. , 2013; n=13,507)

Hierarchy of difficulty of 6 items from least difficulty to greatest difficulty:

  1. Eating

  2. Maintaining continence

  3. Transferring

  4. Toileting

  5. Dressing

  6. Bathing

Test/Retest Reliability

Turkish Older Adults: (Arik et al., 2015; n=36 interviewed twice in one week)

  • Excellent Test-retest reliability (ICC = 1.000, 95% CI)

Interrater/Intrarater Reliability

Turkish Older Adults: (Arik et al., 2015)

  • Excellent Interrater reliability (ICC = 0.999, 95% CI)

Nursing Home Residents (Spector 1991) 

  • Excellent Interrater reliability (ICC = 0.95)

Internal Consistency

Turkish Older Adults: (Arik et al., 2015)

  • Excellent internal consistency (Cronbach's alpha =0.838)

    • Note: Internal consistency could be improved if feeding were excluded (Cronbach's alpha =0.845)

    • Note: Internal consistency could be improved if continence were excluded (Cronbach's alpha =0.884)

Nursing Home Residents: (Gerrard, P. 2013)

  • Adequate internal consistency (Cronbach's alpha = 0.792)

 (Spector 1991)

  • Excellent coefficient of reproducibility (0.95)

 

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Older Adults 2 years post hospitalization: (Katz, 1970)

  • Adequate predictive validity of Mobility (0.5033)

  • Adequate predictive validity of House-Confinement (0.3882)

 

Mixed Populations

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Test/Retest Reliability

Greek older adults with cancer: (Mystakidou et al., 2013; n=40)

  • Excellent test-retest reliability, 15 days apart (r = 0.944)

Internal Consistency

Greek older adults with cancer: (Mystakidou et al., 2013; n=90)

  • Excellent internal consistency (Cronbach's alpha = 0.88)

Construct Validity

Greek older adults with cancer: (Mystakidou et al., 2013; n=90)

  • Adequate to Excellent correlation between Katz ADL and the Instrumental Activities of Daily Living (IADL) scale (r = 0.756 for men, r = 0.572 for women)

Bibliography

Arik, G., Varan, H. D., Yavuz, B. B., Karabulut, E., Kara, O., Kilic, M. K., ... Cankurtaran, M. (2015). Validation of Katz index of independence in activities of daily living in Turkish older adults. Archives Of Gerontology And Geriatrics, 61(3), 344-350.

Asberg KH, Sonn U. (1989) The cumulative structure of personal and instrumental ADL: a study of elderly people in a health service district. Scandinavian journal of rehabilitation medicine  21, 171–177.

Asberg, K. H., & Nydevik, I. (1990). Early prognosis of stroke outcome by means of Katz Index of activities of daily living. Scandinavian journal of rehabilitation medicine, 23(4), 187-191.

Beloosesky, Y., Grinblat, J., Epelboym, B., Weiss, A., Grosman, B., & Hendel, D. (2002). Functional gain of hip fracture patients in different cognitive and functional groups. Clinical rehabilitation, 16(3), 321-328.

Brorsson, B.,  Asberg, K. H. (1983). Katz index of independence in ADL. Reliability and validity in short-term care. Scandinavian journal of rehabilitation medicine, 16(3), 125-132.

Cabañero-Martínez, M. J., Cabrero-García, J., Richart-Martínez, M., & Muñoz-Mendoza, C. L. (2009)., 49(1), e77-e84.

de Rekeneire, N., & Volpato, S. (2015). Physical function and disability in older adults with diabetes. Clinics in geriatric medicine, 31(1), 51-65.

Ferretti-Rebustini, Renata Eloah de Lucena, Balbinotti, Marcos Alencar Abaide, Jacob-Filho, Wilson, Rebustini, Flávio, Suemoto, Claudia Kimie, Pasqualucci, Carlos Augusto Gonçalves, Farfel, José Marcelo, Leite, Renata Elaine Paraizo, Grinberg, Lea Tenenholz, & Nitrini, Ricardo. (2015). Validity of the Katz Index to assess activities of daily living by informants in neuropathological studies. Revista da Escola de Enfermagem da USP, 49(6), 944-950.

Gerrard, P. (2013). The Hierarchy of the Activities of Daily Living in the Katz Index in Residents of Skilled Nursing Facilities. Journal Of Geriatric Physical Therapy, 36(2), 87-91.

Gresham, G., Phillips, T., Labi, M. (1980) ADL status in stroke: relative merits of three standard indexes. Archive Physiological Medical Rehabilitation, 61 (8)355.

Katz, S., Downs, TD., Cash, HR., Grotz, RC.(1970). Progress in development of the index of ADL. Gerontologist, (10) 20–30.

Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. Jama, 185(12), 914-919.

Shelkey, M. & Wallace, M. (2012) Katz index of independence in activities of daily living (ADL). The Hartford Institute of Geriatric Nursing 2, 1-2.

Mystakidou, K., Tsilika, E., Parpa, E., Mitropoulou, E., Panagiotou, I., Galanos, A., & Gouliamos, A. (2013). Activities of daily living in Greek cancer patients treated in a palliative care unit. Supportive Care in Cancer, 21(1), 97-105.

Rockwood, K., Stolee, P., Fox, R. (1993) Use of goal attainment scaling in measuring clinically important change in the frail elderly. Journal of Clinical Epidemiology , 46 (8) 1113.

Spector, W., Takada, H.,(1991) Characteristics of nursing homes that affect resident outcomes. Journal of Aging Health (3) 427–54.

Thomas, V. S., Rockwood, K., & McDowell, I. (1998). Multidimensionality in instrumental and basic activities of daily living. Journal of clinical epidemiology, 51(4), 315-321.

White, D. K., Wilson, J. C., & Keysor, J. J. (2011). Measures of adult general functional status: SF‐36 Physical Functioning Subscale (PF‐10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in Activities of Daily Living, Functional Independence Measure (FIM), and Osteoarthritis‐Function‐Computer Adaptive Test (OA‐Function‐CAT). Arthritis care & research, 63(S11), S297-S307.

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