Development and Preliminary Validation of the Toileting Questionnaire

BACKGROUND: Toileting is a basic component of daily living activities. For elderly adults, toileting independence has been linked to health and quality of life (Burton, Reed, & Chamberlain, 2010). The Occupational Therapy Practice Framework definition of toileting (American Occupational Therapy Association, 2014) suggests that it is multifactorial. Although there are assessment tools that measure some of elements of toileting independence, they are not comprehensive and do not take into consideration the client’s disability/ability experience. In this study, a research version of the Toileting Questionnaire, initially developed to measure outcomes of short-term rehabilitation, was assessed for internal consistency and predictive and criterion validity.

METHOD: Participants from four skilled nursing facilities, ages 65 yr and older, with short-term rehab needs and able and willing to give consent were recruited for the study. Within 72 hr of admission, participants were administered the Toileting Questionnaire (TQ), Timed Get Up and Go (TUG), the Trunk Control Test, Trunk Impairment Scale (TIS), Barthel Index (BI), and the Geriatric Depression Scale. The BI and TQ were also administered within 72 hr of discharge. At 1-mo follow-up, the TQ, Lawton Instrumental Activities of Daily Living Scale (Lawton), and the Modified Reintegration to Normal Living Index were administered. Age, admitting diagnoses, comorbidities, prior level of functioning, discharge status, and discharge location were collected.

All data were entered into a Microsoft Excel and SPSS for descriptive and correlational analyses. A total of 47 participants were included in the data analysis.

RESULTS AND DISCUSSION: Each question of the TQ had moderate to strong correlations with each other (p = .001 or p = .000). A moderate correlation existed between the TQ and BI total admission score (p = .001). There was a strong negative correlation with the TUG (p = .000). The TQ total moderately correlated with assessments of trunk control, the TIS total, and TCT (both ps = .007). A moderate correlation existed between the TQ and BI at discharge (p = .016).

Correlations among TQ items reveal the assessment has internal consistency and measures multiple aspects of toileting. Correlations with the TUG, TCT, and TIS indicate that functional mobility and trunk control–mobility affect successful toileting. Because the BI is a gold standard of measurement for ADL function, correlations between the TQ and the BI reinforce that independence in toileting function is related to ADLs, demonstrate that the TQ is able to detect change in functional status during the span of therapy, and reveal that the TQ is moving toward criterion validity. Unlike the BI, the TQ did not significantly correlate with discharge destination or status, indicating that the TQ may be a complementary measure that may guide discharge planning decisions.

IMPACT STATEMENT: This study contributes to OT practice particularly in determining OT outcomes and assisting with the discharge planning process for older adults undergoing short-term rehabilitation. With the link between toilet and specific performance skills (trunk control and functional mobility) established, occupational therapy practitioners and researchers may capitalize on developing focused interventions to improve toileting independence that will contribute on the older adult’s overall health and quality of life (Sims, Browning, Lundgren-Lindquist, & Kendig, 2011).

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Burton, M., Reed, H., & Chamberlain, P. (2010). Age related disability and bathroom use. Journal of Integrated Care, 19, 37–43. http://dx.doi.org/10.5042/jic.2011.0034

Sims, J., Browning, C., Lundgren-Lindquist, B., & Kendig, H. (2011). Urinary incontinence in a community sample of older adults: Prevalence and impact on quality of life. Disability and Rehabilitation, 33, 1389–1398. http://dx.doi.org/10.3109/09638288.2010.532284