Reliability and Validity of a New Toileting Assessment Form for Patients with Hemiparetic Stroke

Background: Acquiring toileting independence is an important target of stroke rehabilitation. In planning an intervention for acquiring toileting independence, developing an assessment for individual subtasks that comprise toileting would assist in identifying specific tasks that prevent independence in patients and would facilitate interventions to improve toileting independence. Objective: To examine the reliability and validity of a newly developed toileting assessment form, the Toileting Tasks Assessment Form (TTAF), for assessing toileting subtasks in hemiparetic stroke. Design: Validation and test-retest study. Setting: Subacute rehabilitation wards in Japan. Participants: Eighty-two therapists verified the form's content validity; 30 stroke patients who were using a wheelchair participated in the validation and test-retest study. Interventions: Not applicable. Main Outcome Measures: The content validity of the assessment form was initially assessed based on a questionnaire. Subsequently, four occupational therapists used the form to evaluate video-recorded toileting performances simulated by participants with hemiparetic stroke. Two assessors evaluated each video-recorded performance once and repeated the evaluation of the same performance at 2 weeks later. The interrater reliability, intrarater reliability, internal consistency, and concurrent validity of the form were examined. Results: Fleiss’ κ coefficient for interrater reliability for each form item was 0.61 or more. Cohen's κ coefficient for intrarater reliability for each item was 0.60 or more. Cronbach's coefficient alpha ranged from 0.94 to 0.95. Spearman's rank correlation coefficients for the mean score on the form and the Functional Independence Measure (FIM) score for “toileting” ranged from 0.88 to 0.93 (P <.001). Spearman's rank correlation coefficients for the mean score on the form and the FIM score for “toilet transfer” ranged from 0.91 to 0.93 (P <.001). Conclusions: The TTAF demonstrated good reliability and validity. Further multicenter studies involving patients at different stroke phases are required to verify the reliability and validity of TTAF and confirm the generalizability of these findings.