The traffic light system-BasicADL and person-centred care: a commentary on Asplin et al.

Abstract

I have read with great interest the study that was authored by Asplin and colleagues and published in the European Journal of Physiotherapy [1]. In this article, the authors investigated the concurrent validity of the traffic light system-BasicADL (TLS-BasicADL) on 50 patients with mixed medical diagnosis admitted to an oncologic/geriatric unit. In addition to that the authors evaluated the responsiveness of the TLS-BasicADL on 107 patients admitted to a geriatric/orthopaedic unit following hip fracture. The TLS-BasicADL is a scale to measure the level of functional independence to perform basic activities of daily living among the elderly population admitted to acute geriatric hospital settings [2]. The TLS-BasicADL is a scale that provides the multidisciplinary team with an understandable visual aid describing the independence of the geriatric population thus improving the communication of the multidisciplinary team [2]. The scale exhibited high inter-rater and fair intra-rater reliability among elderly individuals in a geriatric unit [2]. In their study, Asplin and colleagues [1] reported that the TLS-BasicADL displayed strong to excellent correlations for individual items with the modified Barthel index as well as the modified functional independence measure. The total score of the TLS-BasicADL was strongly correlated with the total score of the modified Barthel index as well as the total score of the modified functional independence measure. The authors of the study reported as well that most items were responsive to the changes in the function of the patients following the hip surgery. Communication is essential to the proper functioning of a hospital [3]. It is no surprise that physical therapists spend a considerable amount of time communicating with patients [4], this might be due to physical therapists being an integral part of the rehabilitation of patients to improve/regain their function. Thus, it is of paramount importance that researchers develop new methods that can improve the level of communication between therapists and other healthcare professionals. This is can be done largely due to the TLSBasicADL not just providing a simple system to describe a patient’s functioning but also can explain in detail without the need of much writing the extent that is needed by a patient to accomplish a specific task. Concerning geriatric patient satisfaction with physical therapy services, a recent cross-sectional analysis reported that more than half of elderly patients were dissatisfied with physical therapy [5]. The authors of the previously mentioned study recommended that physical therapists emphasise patient education [5]. Since the TLS-BasicADL is very understandable, physical therapists working in geriatric units and nursing homes can take advantage of the simplicity of the TLS-BasicADL to educate their patients about their level of functioning concerning their activities of daily living. The TLS-BasicADL can be used as well to help the patient set his/her own goals for physical therapy. By doing so, the elderly patient would be the centre of the therapeutic relationship and the care provided by the therapist would be patient-centred. From a physical therapist’s point of view, I believe that it is recommended that geriatric wards in hospitals and nursing homes begin integrating the use of the TLS-BasicADL. This is due to the excellent concurrent validity and the responsiveness of the scale [1] not to mention the high inter-rater reliability and fair intra-rater reliability of the scale [2] when applied among elderly individuals. Furthermore, the utilisation of the TLS-BasicADL can facilitate patient education and promote person-centred care in geriatric rehabilitation.