Cott CA, Teare G, McGilton KS, Lineker S. Reliability and construct
validity of the client-centred rehabilitation questionnaire. Disabil
Rehabil. 2006 Nov 30;28(22):1387-97. [Pub
Med ID 17071570]
Purpose
A key component in assessing the performance of rehabilitation services
is the client's perspective. The purpose of this paper is to report
on the development of a publicly available measure of client-centred
rehabilitation (CCRQ) that can be used for discriminative and evaluative
purposes.
[more…]
“Client-centredness” has emerged as an important underlying
principle for the delivery of health and rehabilitation services.
Client-centred rehabilitation considers clients’ experiences by
defining the dimensions of care that matter most to clients.
Several studies have shown that increased participation of clients
leads to more favourable clinical outcomes such as improvements in health
behaviours, functional outcomes and overall health status, as well as
greater client and provider satisfaction and better client-practitioner
communication. The two tools currently available for measuring client-centred
rehabilitation – Picker Institute Surveys and WASCANA Client-Centred
Care Questionnaire – are not available in the public domain.
Method
Mixed qualitative and quantitative methods were used. Phase 1: Identification
of seven domains of client-centred rehabilitation based on a literature
review, focus groups with clients, and review by content experts.
Phase 2: Item generation for the seven conceptually derived subscales
and cognitive interviews with inpatient rehabilitation patients. Phase 3:
Psychometric testing for internal reliability, test-retest reliability and
discriminative construct validity using data from a mailed, self-administered
survey to 1,568 patients discharged from two large inpatient rehabilitation
facilities.
[more…]
In Phase I, panel members were asked to review the seven domains of client-centred
rehabilitation and sample questions from the WASCANA that potentially
tapped into those domains. All panel members endorsed the seven
domains of client-centred rehabilitation. They generally supported the
WASCANA tool but felt that changes to the format and supplemental items
were needed. In Phase II, preliminary pilot testing was conducted for
clarity and relevance of the tool using cognitive interviews. Cognitive
interview methods are used to identify how and where a question fails
to meet its measurement purpose. For Phase III, the response rate was
64%, with 1,002 usable responses returned by the data accrual cut-off
date.
Results
The seven conceptually derived subscales all have strong internal (0.72
- 0.87) and test-retest reliability (0.74 - 0.85). Discriminative
construct validity is demonstrated by the ability of subscales
to identify significant differences between programs within two rehabilitation
facilities.
[more…]
From the focus group data, the following seven domains of client-centred
rehabilitation were identified that are important from the client’s
perspective: (i) participation in decision making and goal setting;
(ii) client-centred education; (iii) evaluation of outcomes
from the client’s perspective; (iv) family involvement; (v) emotional
support; (vi) coordination and continuity; (vii) physical comfort.
The conceptual definitions of these domains are presented in
Table 1 (see tables section). The seven subscales were moderately
to strongly intercorrelated. However, all but one of the individual items
is more strongly correlated with the score of the subscale into
which they are grouped than with the other subscales.
Conclusions
The results for the reliability and validity of this measure support its
value for use in clinical and quality improvement work as well as research.
[more…]
Overall CCRQ scores are not particularly helpful for quality improvement
purposes. Use of the subscales allows healthcare administrators
to focus improvement efforts on particular aspects of client-centred
practice and evaluate the impact of their effort by comparing results
at a unit or organizational level on the relevant subscales over time.
List of Tables and Figures (in the publication)
- Table 1. Client-centredness concepts and definitions.
- Table 2. Representativeness of returned CCRQs.
- Table 3. Reliability of the CCRQ and the conceptually derived subscales.
- Table 4. Correlation of CCRQ Conceptual Subscales.
- Table 5. ANCOVA results for CCRQ subscales by program controlling for age, sex and length of stay.
- No figures for this paper.
Selected Tables from the Publication (with interpretation)
Table 1 lists the seven domains of client-centred rehabilitation that were
identified as important from the client’s perspective in the qualitative
phase of this research project.
Table 3 shows the internal (Cronbach’s alpha) and test-retest (intraclass
correlation) reliability coefficients of the subscales based on
the remaining 30 items. The internal consistency reliability coefficients
ranged from 0.72 for the 3-item education subscale to 0.87 for
the six-item scale on client participation in decision-making.
The test-retest reliabilities ranged from 0.74 for the education
subscale to 0.85 for the continuity/coordination subscale. The test-retest
reliability of individual items was also acceptable, with intraclass correlation
coefficients ranging from 0.55 – 0.81 (mean 0.67) over all 30 retained
items.
Supplementary Tables (with interpretation)
No supplementary information is available for this paper.
