• Holding services to account

      Clegg, Jennifer (2008)
      Background: Recently, the frequency of audit inspections of health services for people with intellectual disability (ID) in the UK has increased, from occasional inquiries to a systematic audit of all services. From 2008, a process of continuous audit 'surveillance' of specialist health services is to be introduced. Similar regimes of inspection are in place for social care services. Aim: To explore the conceptual positions which inform audit, through detailed examination of the investigation into the learning disability service at Sutton and Merton. Findings: Audit is distinct from evaluation because it neither provides opportunities for service staff to give an account of their work nor represents a search for knowledge. Audit investigates adherence to government policy. In ID, audits measure aspirations derived from normalisation, despite research showing that some of these aspirations have not been achieved by any service. As audit consumes significant public resource, it is questionable whether the dominant finding of the Healthcare Commission's investigation into Sutton and Merton, that the ID service was chronically under-funded, represents value for money. Discussion and conclusions: While basic checks on minimum standards will always be necessary, service excellence requires not audit but research-driven evaluation. Audits inhibit rather than open-up debate about improving support to people with ID. They impose an ideology, squander resource, and demoralise carers and staff. Evaluations challenge the implicit management-versus-professional binary enacted by audit, and can inform new care systems which make effective use of all those engaged with people with ID. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • The reliability of balance, mobility and self-care measures in a population of adults with a learning disability known to a physiotherapy service

      Richardson, Patricia; McDonnell, Karen (2005)
      Objective: To estimate the reliability of three measures of balance, mobility and activity for use in clinical and research physiotherapy, with adults with a learning disability. Design: Prospective study to investigate test-retest and inter-rater reliability. Setting: Participants' homes and day centres. Measures: The Berg Balance Scale (BBS), the Rivermead Mobility Index (RMI) and the Barthel Activities of Daily Living Index (BI). Participants: Of the 181 adults known to the Nottingham Community Physiotherapy Service for Adults with Learning Disabilities, 64 with a known Rivermead Mobility score of less than three were excluded. Of 117 randomized, a further 21 were found to fail this criteria, 27 had acute medical, social or behavioural problems, 22 were unable to participate or refused: therefore 47 entered the study. Methods: Participants were visited in their own homes by two researchers on two occasions, one week apart and rated independently by each rater. Agreement was assessed with the kappa statistic (kappa) and percentage agreement for each item in each scale, and described using standard classification. Intraclass correlation coefficients for inter-rater and test-retest total scores and average differences of total scores, their standard deviations and limits of agreement, were calculated. Results: For inter-rater observations, the Barthel Index and the Rivermead Mobility Index had almost perfect agreement (kappa = 0.86-1.00 and 0.89-1.00 respectively), with the Berg Balance Scale having substantial to almost perfect agreement (kappa = 0.74-1.00). For test-retest comparisons, both the Barthel Index and the Rivermead Mobility Index demonstrated moderate to almost perfect agreement (kappa = 0.57-1.00 and 0.45-1.00 respectively). Kappa scores for the Berg Balance Scale varied from low to almost perfect agreement (kappa = 0.37-1.00). Conclusions: The Berg Balance Scale, Rivermead Mobility Index and Barthel Activities of Daily Living Index are all reliable clinical and research tools for physiotherapists working with adults with learning disabilities.