APH 2009, 67, 128-141:

A randomized clinical trial using an educational inter-vention demonstrated no effect on interobserver agreement on assessments of functional status

L. Paquay, J. De Lepeleire, K. Milisen, M. Ylieff, F. Buntinx

Keywords: assessment, nursing, nursing home, reliability, randomized clinical trial, Belgian Evaluation Scale, Autonomie Gérontologie Groupe Iso-Ressources (AGGIR)

Aim
To evaluate the effect of an educational intervention on interobserver agreement of assessments of functional status performed by registered nurses and care assistants in a nursing home and to compare interobserver agreement in persons with and without cognitive impairment.

Background
High accuracy of assessments of functional status in care settings for older persons is needed for the efficacy of the planning and the evaluation of the nursing care.

Method
Randomized clinical trial. Six registered nurses and six care assistants were randomized to participate in an educational session about assessment instruments for functional status (intervention) or in a session about falls in the elderly (control). Each of the registered nurses and care assistants performed assessments on the same thirty-four residents using the Belgian Evaluation Scale (BES) and the AGGIR instrument. The kappa statistic (κ) for multiple observers (and its 95% confidence interval) was the main outcome measure.

Findings
At baseline, interobserver agreement for BES total score was: κ=0.43 (0.35-0.51) in the intervention group and κ=0.48 (0.39-0.57) in the control group. At the second assessment, agreement measures were: κ=0.48 (0.41-0.57) in the intervention group and κ=0.58 (0.50-0.66) in the control group. Results for AGGIR total scores were similar.

Conclusion
Interobserver agreement of assessments on nursing home residents was moderate and did not improve significantly after an educational session.