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Melville-Nelson Evaluation System

Melville-Nelson Evaluation System

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Purpose

The purpose of the SIGA/SCA is to collaborate with a client to identify goals, rate perceived competence, and evaluate performance of self-care activities.

Link to Instrument

Acronym SIGA/SCA

Area of Assessment

General Health
Life Participation
Patient Satisfaction
Quality of Life
Occupational Performance
Self-efficacy
Activities of Daily Living
Eating
Functional Mobility
Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • Section 1: Demographics/History (Hx)

    Questions include: diagnosis, past medical history, prior functioning, home situation, life work, interests, and customary routines.
  • Section 2: SIGA

    1) The therapist asks the patient about their goals.
    2) The client identifies 1-5 goals with guidance from family members if necessary. Some clients will be unable to identify goals because of cognitive impairments. If the goal does not come directly from the client, it is important to note that on the form.
    3) The client is shown the SIGA Visual Aid, which is a visual representation of the 0-10 scale (0 = unable to do at all and 10 = able to do at very best)
    4) Client rates how well they believe they can do all of the things they want to do on a scale from 0-10.
    5) Client rates how well they believe they can do each goal on a scale from 0-10.
    6) The therapist marks and notes the ratings on the form.
  • Section 3: SCA

    The therapist measures seven self-care occupations (bed mobility, transfers, dressing, eating, toileting, personal hygiene, and bathing). Each occupation has 3 to 9 sub-occupations, and each sub-occupation has 4 sub-categories.

    Self-performance scoring
    1) Mark a check for every sub-sub-occupation where the assessor provides support (0 = Independence and 1 = a checkmark)
    2) Total the check marks to obtain a self-performance score for each occupation.
    3) Total the self-performance scores for all occupations at the end of the form (ranges from 0-140).
    4) Cross out occupations or components that are not relevant to the client.

    Support scoring
    0 = No setup or physical help
    1 = Set up or standby assistance
    2 = One personal physical assist
    2a = Contact guard assist
    2b = One-person physical assist
    3 = Two or more persons physical assist

Number of Items

106

Equipment Required

  • Pen/Pencil
  • Evaluation form
  • SIGA visual aid
  • Items for self-care activities, e.g., clothes for dressing, food and utensils for eating

Time to Administer

60-90 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly

65 +

years

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Weronika Zuczek, Nancy Vong, and Keriakoula Andriopoulos

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Motor

Considerations

SIGA

  • If the client has trouble identifying goals, ask about their prior routine and what seems difficult to them now.

  • The ratings that correspond to each goal should be based on the client’s answers, not on the therapist’s perception of the client’s capabilities.

  • For every progress note and the discharge note, show the client a copy of the latest ratings and ask if they would like to add new goals or change goals.

  • Therapy progress can be reported in terms of increase in the total score of all goals or the scores of each individual goal.

  • There are only two validation studies available on the SIGA’s psychometric properties.

SCA

  • Certain sub-occupations may not apply to all clients depending on the client’s diagnosis.

  • There is only one validation study available on the SCA’s psychometric properties.

Non-Specific Patient Population

back to Populations

Interrater/Intrarater Reliability

SNF patients receiving subacute rehabilitation (varied diagnoses): (Nelson et al., 2002; n = 68; mean age = 76.5 (9.8) years).

  • Excellent interrater reliability for total self-performance (mean ICC = 0.94)

  • Excellent interrater reliability for all seven self-performance areas

    • Bed mobility mean (ICC = 0.96)

    • Transfers mean (ICC = 0.80)

    • Dressing mean (ICC = 0.93)

    • Eating mean (ICC = 0.98)

    • Toileting mean (ICC = 0.80)

    • Personal hygiene mean (ICC = 0.93)

    • Bathing mean (ICC = 0.77)

  • Excellent interrater reliability for two of the seven support areas

    • Bed mobility mean (ICC = 0.89)

    • Dressing mean (ICC = 0.87)

  • Adequate interrater reliability for five of the seven support areas

    • Transfers mean (ICC = 0.70)

    • Eating mean (ICC = 0.71)

    • Toileting mean (ICC = 0.74)

    • Personal hygiene mean (ICC = 0.60)

    • Bathing mean (ICC = 0.57)

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

SNF patients receiving subacute rehabilitation (varied diagnoses): (Nelson et al., 2002; n = 40; mean age = 75.1 (9.4) years).

  • Adequate predictive validity of the SCA total self-performance at discharge at predicting caregiving time in home (min/day) (rho = 0.44; p = 0.003)

  • Adequate predictive validity of the SCA total self-performance at discharge at predicting FIM self-care and transfers in home (rho = -0.51; p = < 0.001)

  • Adequate predictive validity of the SCA total self-performance at discharge at predicting FIM total score in home (rho = -0.55; p = < 0.001)

  • Adequate predictive validity of the SCA total self-performance at discharge at predicting Klein-Bell self-care in home (rho = -0.51; p = < 0.001)

  • Adequate predictive validity of the SCA total self-performance at discharge at predicting Klein-Bell total score in home (rho = -0.54; p = < 0.001)

Concurrent Validity:

  • SNF patients receiving subacute rehabilitation (varied diagnoses): (Nelson et al., 2002; n = 68; mean age = 76.5 (9.8) years).

  • Excellent correlation with relevant areas of the Functional Independence Measure (FIM) (r = -0.86; p < 0.001)

  • Excellent correlation with relevant areas of the Klein-Bell Activities of Daily Living Scale (r = -0.85, p < 0.001)

Construct Validity

Convergent Validity:

Transitional care center patients receiving subacute rehabilitation (varied diagnoses): (Stuber & Nelson, 2010; n = 30; mean age = 74 (9.9) years).

  • Adequate correlation between the SIGA (overall) and COPM (Canadian Occupational Performance Measure: performance scores) (r = 0.58)

  • Adequate correlation between the SIGA (overall) and OSA (Occupational Self-Assessment) (r = 0.41)

  • Excellent correlation between the mean of SIGA self-identified goals and COPM performance scores (r = 0.76)

  • Excellent correlation between the mean of SIGA self-identified goals and COPM performance scores (r = 0.76)

  • Excellent correlation between the mean of SIGA self-identified goals and COPM satisfaction scores (r = 0.81)

  • Excellent correlation between the SIGA (overall) and COPM satisfaction scores (r = 0.81)

Content Validity

Hospital-based transitional care center patients receiving subacute rehabilitation (varied diagnoses): (Melville, Baltic, Bettcher, & Nelson, 2002; n = 30; mean age = 73.4 (12.2) years).

  • 30 participants were administered the SIGA after admission into a subacute facility and prior to discharge. They were asked fixed-alternative questions, as well as open-ended questions, about the effectiveness of the SIGA after both administrations.

  • 29 of the participants verified that the goals they identified using the SIGA during admission were meaningful to them.

  • The results showed that 28 of the participants felt the SIGA was a useful tool for guiding the therapist to understanding what matters to them.

  • Nine participants reported they found it challenging to decide what score to give their performance of each goal on the 0-10 scale during admission.

  • 27 participants reported their ratings were correct representations of their perceived abilities.

  • The SIGA received mostly positive responses to the questions posed about the assessment around discharge.

  • The researchers recommend using the SIGA in subacute rehabilitation and skilled nursing facilities but indicate that further research is necessary.

Responsiveness

SNF patients receiving subacute rehabilitation (varied diagnoses): (Nelson et al., 2002; n = 68; mean age = 76.5 (9.8) years; assessed at change from admission to discharge).

  • Highly sensitive responsiveness (Cohen Effect Size (CES) = 1.10) for total self-performance

  • Highly sensitive responsiveness to change in areas of transfers self-performance (CES = 1.17), dressing self-performance (CES = 1.19), toileting self-performance (ES = 0.97), transfers support (CES = 1.63), dressing support (CES = 1.10), toileting support (CES = 1.36), and personal hygiene support (CES = 1.07)

  • Moderate responsiveness to change in bed mobility support (CES = 0.68), bathing support (CES = 0.61), and bed mobility self-performance (Stratford, Binkley, and Riddle Effect Size (SBR ES) = 0.51)

  • Small responsiveness (ES = 0.25) to change in eating self-performance (SBR ES = 0.06), personal hygiene self-performance (CES = -0.11), bathing self-performance (CES = -0.02), and eating support (CES = 0.30)

Bibliography

Melville, L. L., Baltic, T. A., Bettcher, T. W., & Nelson, D. L. (2002). Patients’ perspectives on the self-identified goals assessment. The American Journal of Occupational Therapy, 56(6), 650–659.

Nelson, D. L. & Melville, L. L. (2017). Overview of the Melville-Nelson SCA. Retrieved from

Nelson, D. L. & Melville, L. L. (2017). Second alternative for recording. Retrieved from

Nelson, D. L. & Melville, L. L. (2017). SIGA protocol. Retrieved from

Nelson, D. L. & Melville, L. L. (2017). SIGA visual aid. Retrieved from

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(1), 51-59.

Stuber, C. J., & Nelson, D. L. (2010). Convergent validity of three occupational self-assessments. Physical and Occupational Therapy in Geriatrics, 28(1), 13–21.