Competence and performance in activities of daily living of patients following rehabilitation from stroke.

Abstract

Indices of activities of daily living (ADL) are commonly criticized for failing to yield other than functional information. We suggest an alternative approach in which tested functional ability (ADL competence) is distinguished from actual behaviour (ADL performance). A method of making these assessments, based on the Australian ADL Index, was trialled in a longitudinal study involving 130 patients admitted for rehabilitation following stroke. Twelve months after discharge from rehabilitation the total ADL performance score was higher, that is to say worse, than the total ADL competence score; further, there was no significant agreement between the competence and performance ratings for nine of the 17 activities. It appears that ADL competence and ADL performance can be distinguished both theoretically and empirically. Two case studies illustrate the usefulness of the performance assessment. We recommend the ADL performance assessment as an outcome measure in rehabilitation.