Assessment of functional status and rehabilitative strategies in occupational therapy: role of the Groningen Activity Restriction Questionnaire

Background and Purpose. The Groningen Activity Restriction Scale (GARS) is a self-reported non-diseasespecific instrument for measuring patients' disability in Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL). In literature, several studies have demonstrated high psychometric properties of GARS for disability assessment.
The aim of this study was to evaluate the use of GARS administered and scored by the occupational therapists, rather than self-reported by the patient, as a tool for measuring disability in adult patients treated with occupational therapy. Methods. A inter-operator reliability and correlation study was conducted among 31 people (mean age 70.6+13.1 years), admitted to inpatient Occupational Therapy rehabilitation service of ICS Maugeri, Pavia, from May through September 2018. ADL and IADL dependency indices were measured with GARS, which was assessed by three independent occupational therapists during admission of patients to occupational therapy rehabilitation service. Other measures included demographic characteristics and healthcare resource utilization.
Therefore, a single occupational therapist performed a second evaluation of patient's performance using GARS at the discharge from treatment, in order to identify any changes in patient's functional abilities after rehabilitation treatment; the results obtained were compared with those detected by the functional independence measures (FIM). Statistical analysis was conducted by Cohen's k coefficient and Pearson's p correlation coefficient. Results. The statistical analysis showed a discrete reliability and responsiveness of GARS (Coen's k = 0.531), due to a moderate correlation between GARS and FIM instruments (Pearson's p = 0.359) for evaluating the effectiveness of occupational therapy interventions.
Conclusions. Even if conducted by occupational therapists, GARS is a useful tool for measuring disability in ADL and IADL, which can help clinicians to develop a customized plan of care in occupational therapy, improving patient's management and clinical outcome.