The Melville-Nelson Self-Care Assessment (SCA) is a standardized assessment developed in 2001 to objectively measure patients' abilities to complete self-care tasks in skilled nursing and rehabilitation facilities. The SCA assesses 7 activities of daily living through observation of subtasks and sub-subtasks. Research has found the SCA has excellent inter-rater reliability, is responsive to change, and can predict care needs post-discharge. However, the SCA lacks research on its development and organization of items. Occupational therapists are recommended to consider limitations when using the SCA in practice.
The Melville-Nelson Self-Care Assessment (SCA) is a standardized assessment developed in 2001 to objectively measure patients' abilities to complete self-care tasks in skilled nursing and rehabilitation facilities. The SCA assesses 7 activities of daily living through observation of subtasks and sub-subtasks. Research has found the SCA has excellent inter-rater reliability, is responsive to change, and can predict care needs post-discharge. However, the SCA lacks research on its development and organization of items. Occupational therapists are recommended to consider limitations when using the SCA in practice.
The Melville-Nelson Self-Care Assessment (SCA) is a standardized assessment developed in 2001 to objectively measure patients' abilities to complete self-care tasks in skilled nursing and rehabilitation facilities. The SCA assesses 7 activities of daily living through observation of subtasks and sub-subtasks. Research has found the SCA has excellent inter-rater reliability, is responsive to change, and can predict care needs post-discharge. However, the SCA lacks research on its development and organization of items. Occupational therapists are recommended to consider limitations when using the SCA in practice.
The Melville-Nelson Self-Care Assessment (SCA) is a standardized assessment developed in 2001 to objectively measure patients' abilities to complete self-care tasks in skilled nursing and rehabilitation facilities. The SCA assesses 7 activities of daily living through observation of subtasks and sub-subtasks. Research has found the SCA has excellent inter-rater reliability, is responsive to change, and can predict care needs post-discharge. However, the SCA lacks research on its development and organization of items. Occupational therapists are recommended to consider limitations when using the SCA in practice.
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MELVILLE-NELSON
SELF-CARE ASSESSMENT(SCA) N ATA L I E M . N O S S & J E S S I C A A . S C O T T
ASSESSMENT INFORMATION Publication Information Free download from University of Toledo Occupational Therapy Department website http://www.utoledo.edu/healthsciences/depts/rehab_sciences /ot/ melville.html
Assessment Type Standardized assessment Limitations
Criterion referenced Identifies the presence or absence of supports or assistance needed to perform an occupation of daily living (ODL)
MELVILLE-NELSON SELF-CARE ASSESSMENT (SCA) DETAILS Purpose To objectively measure and assess a patients abilities to complete self-care tasks while in a skilled nursing facility (SNF) or sub-acute rehabilitation facility (Nelson & Melville, 2001)
Development of the SCA
Developed in 2001 by David Nelson and Lisa Melville from the University of Toledo Minimum Data Set (MDS) federally mandated assessment in long-term care facilities OTs primarily use self-care section of MDS
Self-care section needed to be more in depth for OTs to
appropriately assess the needs of their patients (Nelson & Melville, 2002)
SCA CHARACTERISTICS ODLs
Bed Mobility Transfers Dressing Eating Toilet Use Personal Hygiene Bathing
O DL s Suboccupations Sub-suboccupations
(Melville & Nelson, 2001)
SCA CHARACTERISTICS ODL: Eating Sub-occupations
Sub-suboccupations
Finger food
Grasp
To mouth
Open mouth
In mouth
Utensil
Grasp
Scoop
To mouth
In mouth
Drink
Grasp
To mouth
Sip
Set down
(Melville & Nelson, 2001)
POPULATION Intended Patients within SNFs and sub-acute rehabilitation facilities who receive OT services
Alternative Populations Any individual who presents with limitations when completing any of the seven ODLs discussed within the SCA manual would be an appropriate patient to assess
Retrieved from http://www.tektone.com/skillednursing.php
USER QUALIFICATIONS Familiarity with Population & Setting Adult population and common diagnoses that are seen at SNFs and sub-acute rehabilitation facilities Therapeutic rapport is sufficient to elicit the appropriate responses from the patients Familiar with DME and AE Patient and caregiver goals and treatment plan
Specific Qualifications to Administer
Licensed occupational therapist working in sub-acute rehabilitation and SNFs Skilled in observation, activity analysis, and clinical reasoning
CLINICAL UTILITY Availability of Test & Ease of Use Free of charge Scoring examples Manageable length
Time Needed 30-26 minutes Dependent on competence of the OT The patient Experience with SCA
Learning the Test
Read through the manual a couple of times Practice trials Review and understand support score
CLINICAL UTILITY Format Observation based
Administration and Test Procedures
Observing the patient perform or attempt to form the listed ODLs
Response Format Observation and checklist scales
SCORING THE SCA
Self-performance Scores Measure what the patient actually did Independent-patient is able to complete all subtasks independently. Needs assistance-any verbal cueing, oversight, encouragement, or hands on physical assistance. Place a check mark under each subtask that any physical or verbal assistance was required Count the total number of check marks
*Cross out irrelevant items
(Melville & Nelson, 2001)
SCORING THE SCA
Support Scores The maximum amount of support provided to the patient by staff for each ODL category.
Support Score
Description
No set up or physical help
Set up only
2a
Contact guard assist
2b
Active heavy lifting
Two + persons physical assist
Activity did not occur
(Melville & Nelson, 2001)
INTERPRETATION Detailed scoring page The higher the self- performance score the greater the level of dysfunction
Retrieved from http://cdn2.hubspot.net/hub/149308/file27224979pg/images/navigator_final_rule_assistors.jpg?
t=1373997830000
SETTINGS, TOOLS, AND MATERIALS
Settings Intended for use in SNFs and sub-acute rehabilitation facilities
Tools and Materials
Manual Evaluation score sheet The patient Necessary supplies
DOCUMENTATION ON SCA Description on Technical Manual Overview page Detailed descriptions of self-performance and support scales Score sheet son l e N illev l e M SCA
DOCUMENTATION ON SCA Published Critique Constructs included holism, client-centered practice, dynamic interaction, uniqueness of the individual, and uniqueness of performance SCA ranked 6th out of the 18 ADL measures rated by the researchers Did not meet criteria for holism Client-centered Dynamic interaction Uniqueness of the individual Uniqueness of performance
(Klein et al., 2008)
DOCUMENTATION ON SCA Peer reviewed article Study conducted by Nelson et al. (2002) investigating the psychometric properties of the SCA. 68 participants were utilized based on their availability to be tested at both admission and discharge. The purpose was to explore the
Inter-rater reliability Responsiveness to change Concurrent validity with the FIM and the Klein-Bell ADL scale Predictive validity
Research teams consisted of OTs and OT graduate students
Limitations (Nelson et al., 2002)
PSYCHOMETRIC PROPERTIES Interrater Reliability Each team of raters (one OT and one OT graduate student) independently rated their group of participants on the SCA. Self-performance scores had excellent inter-rater reliability with a mean intraclass correlation coefficient (ICC) of .94 Bathing ODL as the highest ranked Inter-rater reliability for the 7 support scores ICCs to be in the almost perfect range
(Nelson et al., 2002, p. 55)
PSYCHOMETRIC PROPERTIES Concurrent Validity Self-performance scores Correlated the variables of the SCA to relevant items of the FIM and Klein-Bell scale The total performance score for the SCA was highly correlated with the relevant items of the Klein-Bell scale and the FIM The areas of bathing, personal hygiene, and eating were the lowest correlated items
Support Scores All areas were correlated between the SCA and Klein-Bell scale Areas of bathing and personal hygiene was the lowest correlated with the FIM areas at less than .50 Spearmans rank correlation coefficient (rho)
(Nelson et al., 2002)
PSYCHOMETRIC PROPERTIES Responsiveness to Change Highly responsive to change in scores from admission to discharge Changes were greatest in the areas of dressing, toileting, and transfers for both self-performance and support scores
Sensitivity Sensitivity is displayed because the scores identify if a patient is experiencing dysfunction in performing self-care tasks
Specificity Specificity is illustrated through identifying patients who do not need support in completing certain self-care tasks, based on their low self-performance scores and support scores
(Nelson et al., 2002)
PSYCHOMETRIC PROPERTIES Predictive Validity Correlations between The SCA total self-performance scores at discharge Mean duration of caregiving time the patients received daily The sum of all relevant FIM and Klein-Bell items and the total FIM and Klein-Bell scores
Results Results indicated that the SCA total self-performance scores at discharge were a significant predictor of the amount of time the patients required caregivers once home Results also indicated that the discharge SCA total self-performance scores were significant predictors of the patients levels of function at home as measured by KleinBell and FIM scales SCA self-performance and support scores for toilet use was the best predictor of caregiving time required post-discharge
(Nelson et al., 2002)
STUDENT CRITIQUE Strengths Organization of items Sub-occupations & subsuboccupations
Bed mobility ODL
Functional ambulation and transfers within the ODL
Limitations Lack of research Creation of assessment Many inferences Organization of items
RECOMMENDATIONS/CHANGES Revision With OT feedback
Detailed exceptions Standardized materials
User qualifications listed in manual
CONCLUSION Easily accessible User friendly The reviewers recommend the SCA as a useful ADL assessment, but caution OTs to consider the limitations prior to utilizing
QUESTIONS?
REFERENCES Klein, S., Barlow, I., & Hollis, V. (2008). Evaluating ADL measures from an occupational therapy perspective. Canadian Journal of Occupational Therapy, 75 (2), 69-81. doi: 10.1177/000841740807500203 Luebben, A. J., & Royeen, C. B. (2010). Nonstandardized testing. In J. Hinojosa, P. Kramer, & P. Crist (Eds.), Evaluation: Obtaining and interpreting data (3rd ed., pp.157-178). Bethesda, MD: AOTA Press. Nelson, D. L., & Glass, L. M. (1999). Occupational therapists involvement with the Minimum Data Set in skilled nursing and intermediate care facilities. American Journal of Occupational Therapy, 53, 348-352. doi:10.5014/ajot.53.4.348 Nelson, D., & Melville, L. (2001). Melville-Nelson Self-Care Assessment. Retrieved from http://www.utoledo.edu/healthsciences/depts/rehab_sciences/ot/pdfs/sca_overview.pdf Nelson, D. L., Melville, L. L., Wilkerson, J. D., Magness, R. A., Grech, J. L., & Rosenberg, J. A. (2002). Interrater reliability, concurrent validity, responsiveness, and predictive validity of the Melville-Nelson Self-Care Assessment. American Journal of Occupational Therapy, 56, 51-59. doi:10.5014/ajot.56.1.51 Pierce, S. L. (2008). Restoring mobility. In M. Radomski & C. Trombly-Latham (Eds.), Occupational therapy for physical dysfunction (6th ed., pp. 818-853). Philadelphia: Lippincott Williams and Wilkins. The University of Toledo. (2013). Melville Nelson Evaluation System. Retrieved from http://www.utoledo.edu/healthsciences/depts/rehab_sciences/ot/melville.html
