Synonyms

ADLQ

Description

The activities of daily living questionnaire (ADLQ) was developed to measure the functional abilities of people with dementia. It is an informant-rated questionnaire and should be completed by the patient’s primary caregiver. It consists of 28 items covering both basic and instrumental activities of daily living, organized into six subscales: self-care activities, household care, employment and recreation, shopping and money, travel, and communication. The informant rates the subject’s competence in each area according to a set of four descriptions of different competence levels; scores range from 0 to 3 where higher scores indicate greater impairment. A fifth response option, “don’t know/has never done” is also available, and if this option is selected, the item is excluded from scoring. Scores from individual items are summed (with adjustment for any items marked “don’t know/has never done”) to form subscale scores and then transformed to a percentage impairment total score. Scores of 0–33% are classified as no/mild impairment, those of 34–66% as moderate impairment, and those of 67–100% as severe impairment.

Historical Background

The first reported use of the ADLQ was in a longitudinal study looking at cognitive test performance and daily functioning in patients with Alzheimer’s disease (Locascio et al. 1995). However, the development and psychometric properties of the measure were first reported in Johnson et al. (2004). Since then, a Chinese version has been developed and evaluated (ADLQ-CV; Chu and Chung 2008), and it has been used in several studies involving people with non-Alzheimer’s dementia.

Psychometric Data

Johnson et al. (2004) collected ADLQ data from the primary caregivers of 140 people with dementia of various types (Alzheimer’s disease, vascular/mixed, and frontotemporal/primary progressive aphasia). The scale was completed twice, with a 1 year interval between completions. Evidence of convergent validity was in the form of correlations with global severity ratings (clinical dementia rating r = 0.5 and 0.55 for first/second ratings, respectively; MMSE r = −0.42 and −0.38 for first and second ratings, respectively). Further evidence of its validity came from the finding that scores declined significantly over the year-long interval between testings, as would be expected in people with degenerative conditions. A subgroup of 28 participants took part in a test-retest reliability study, with a 2–8 week interval between testings (mean 25.6 days, SD 12.2). Correlations between first and second ratings for the six subscales were high, between 0.86 and 0.92, with the exception of the employment subscale, which correlated at 0.65. Kappa scores for 25% of scale items were 0.42–0.60 (classified as “moderate”), for 54% of scale items were 0.61–0.80 (classified as “good”), and for 21% of scale items 0.81–1.0 (classified as “very good”). The validity of the ADLQ was investigated via correlations between 29 participants’ scores on the ADLQ and the record of independent living (RIL), another ADL measure. In line with Johnson et al.’s predictions, there were significant correlations between the ADLQ and the “activities” and “communication” subscales of the RIL but not the “behavior” subscale of the RIL.

Chu and Chung (2008) conducted a study examining the psychometric properties of a Chinese translation of the ADLQ (ADLQ-CV), with 125 caregivers of people with moderate Alzheimer’s disease. The ADLQ-CV was shown to have good internal consistency (α = 0.81), test-retest reliability at a 2-week interval (intra-class correlation (ICC) = 0.998), and inter-rater reliability (ICC = 0.997, for primary and secondary caregiver ratings). Correlations with the disability assessment for dementia were strong (r = 0.92), suggesting that it is a valid measure. A factor analysis also confirmed that the ADLQ-CV has a six-factor structure, following the six proposed subscales.

Clinical Uses

The ADLQ may be used to assist in the diagnosis of dementia, in decision-making regarding necessary intervention and/or assistance, and in monitoring change over time or in response to treatment.

Cross-References