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  2. Kohlman Evaluation of Living Skills

Kohlman Evaluation of Living Skills

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Purpose

An observation and interview-based assessment to evaluate function in basic living skills by testing 17 skills in the 5 areas of self-care, safety and health, money management, community mobility and telephone, and employment and leisure participation. This is often used inpatient or outpatient for older adults.

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Instrument Details

Acronym KELS

Area of Assessment

Activities of Daily Living
Cognition
Communication
Life Participation
Occupational Performance

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$0.00

Cost Description

$99 (AOTA member) / $140 (non-member) includes materials

Diagnosis/Conditions

  • Brain Injury Recovery

Populations

Older Adults and Geriatric Care
Mental Health
Brain Injury

Key Descriptions

  • 17 items are scored through observation of performance or patient-reported interview questions
  • Each skill is rated “independent," “needs assistance," or “not applicable”
  • In the second edition of the KELS, a numerical score was calculated based on the following criteria:
    -Items are scored such that "independent" = 0 points and "needs assistance" = 1 point, resulting in a total score ranging from 0-17
    -Work and Leisure items receive ½ point for each “needs assistance”

    -A total score of 6 to 17 indicates need for assistance to live in community
    -A total score of 5.5 or less indicates a client is capable of living independently
  • Can be administered by any health professional

Number of Items

17

Equipment Required

  • Pencil
  • paper
  • KELS flash drive (banking, reading/writing, price tags, bank information card, sample of recorded message card, check form, money order form, utility bill, score form)
  • Reading and writing form
  • Household situation pictures
  • Telephone book
  • cell phone
  • Tablet/notebook/laptop
  • toothbrush
  • deck of cards
  • Utility bill with current due date
  • money
  • check form
  • envelope
  • landline telephone
  • KELS score form

Time to Administer

30-45 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Claire Mercer, OTS; Victoria Turnbull, OTS; Serena Saake, OTS -- University of Illinois - Chicago

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition

Considerations

  • Not appropriate for settings with long lengths of stay as person’s finances, transportation, work and leisure all change due to long stay
  • Items may not apply to people outside of US/Canada
  • When used in rural areas, many items may be scored as “Not Applicable”, limiting the ability to score the KELS
  • If a person has been hospitalized or institutionalized for more than 1 month, the KELS may not be useful due to changes in person’s living situation

Brain Injury

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Normative Data

Acquired Brain Injury: (Robnett et al., 2015; n = 31; age range = 18-64 years; TBI = 15, CVA=9, brain tumor = 2, anoxic brain injury = 2, concurrent TBI and SCI = 2, alcohol induced amnestic syndrome = 1; New England sample)

 mean score = 3.5

Criterion Validity (Predictive/Concurrent)

Concurrent validity

Acquired Brain Injury: (Robnett et al., 2015)

Adequate correlation with Safe at Home Screening (SAH) (r = -.53, p = .002)

Content Validity

“Content validity of the KELS was determined by a team of expert occupational therapists. The therapists rated the client’s needed level of assistance and home safety, which was then correlated with the KELS score. There was a moderate correlation for both level of assistance and home safety level.” (Robnett et al., 2015, pg. 22)

Older Adults and Geriatric Care

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Normative Data

Older Adults in the Community: (Zimnavoda, Weinblatt, & Katz, 2002; Community group: n = 34; mean age = 77.5 (6.9) years; Sheltered housing group: n = 44; mean age = 83.9 (5.7) years; Day care group: n = 14; mean age = 77 (10.5) years; Israeli sample; scores from Hebrew translation of KELS compared to Mini Mental State Examination (MMSE), Functional Independence Measure (FIM), and Routine Task Inventory (RTI) scores)

  • Community group mean KELS score: 1.87 (2.50)
  • Sheltered housing group mean KELS score: 4.37 (3.89)
  • Day care group mean KELS score: 10.28 (4.61)

 

Elderly Self-Neglectors: (Naik, Burnett, Pickens-Pace, & Dyer, 2008; Self-neglect referral group: n = 100; mean age = 76.5 (7.2) years; Community-living control group: n = 100; mean age = 76.1 (6.9); Texas sample).

  • Self-neglect group mean KELS score: 5.9 (2.7)

Community-living control group mean KELS score: 4.3 (2.2)

Test/Retest Reliability

Older Adults in the Community: (Zimnavoda et al., 2002)

Recommended that test-retest reliability undergo further evaluation

Interrater/Intrarater Reliability

Interrater reliability

Older Adults in the Community:

  • 100% agreement between two occupational therapists rating 10 subjects (Zimnavoda et al., 2002)

Adequate to excellent interrater reliability (ICC = .74-.98) (Kohlman & McGourty, 1978; unpublished manuscript without details on population)

Criterion Validity (Predictive/Concurrent)

Concurrent validity

Older Adults in Assisted Living: (Cinquemano, Gaijjar, & Martin, 2009): unpublished master’s thesis without details  on population

  • Adequate concurrent validity: Scores on MMSE correlated with scores on the second and third version of KELS (no ICC given)

 

Older Adults in the Community: (Zimnavoda et al., 2002)

  • Excellent Spearman correlations in all participants (p = 0.000)
  • Excellent concurrent validity for all measures:
    • KELS and MMSE: r = -0.757
    • KELS and FIM: r = -0.707
    • KELS and RTI: r = -0.895

 

Predictive validity

Inpatients on Geriatric Unit: (Morrow, 1985; n = 20): unpublished master’s thesis without details on population

  • Excellent predictive validity; pre-discharge KELS scores were 100% accurate in predicting which geriatric patients would be successful in community-living placements 40 days after discharge (r = 1.00)

 

Elderly Self-Neglectors: (Pickens et al., 2006; self-neglect group: n = 50; mean age = 76.3 y; community control group: n = 50; mean age = 76.5 y)

Self-neglectors were significantly more likely to fail the KELS than community matched controls (50% vs 30%, chi squared = 5.0, p = .025).

Construct Validity

Convergent Validity:

Older Adults in the Community: (Burnett, Dyer, & Naik, 2009; adult protective services referral group: n = 100, mean age = 76.5 (7.2); community comparison group: n=100, mean age = 76.1 (6.9); Texas sample)

Correlation coefficients of KELS scores with various functional, cognitive, affective, and Executive function measures amont a sample of community-living older adults
Assessment measures All Participants r* (p-value) Community Comparison Group r* (p-value) Adult Protective Services Referral r* (p-value)
Modified Physical Performance Test .472 (<.001) -.506 (<.001) -.419 (<.001)
8 Foot Walk .264 (.001) .346 (.002) .175 (.153)
Knee Extension Break Test -.068 (456) .132 (.296) -.320 (.013)
Geritric Depression Scale .318 (<.001) .459 (<.001) .080 (.450)
Mini-Mental State Examination -.508 (<.001) -.470 (<.001) -.506 (<.001)
ƗExecutive Interview (EXIT) .705 (<.001) .668 (<.001) .773 (<.001)
ƗCLOX 1 -.629 (<.001) -.424 (.020) -.661 (.002)
ƗCLOX 2 -.421 (<.001) -.171 (.356) -.577 (.010)
All Participants N=192 Community Comparison N=100 r* = Pearson product moment correlation coefficients; all p-values are 2-tailed
 indicates N=50 Adult Protective Services Referrals N=92

 

  • Authors report that convergent validity of the KELS ranges from poor to excellent depending on the assessment measure and group being assessed
  • KELS showed poor convergent validity with the Knee Extensor Break Test with all participants and in the 8 Foot Walk Test with the Adult Protective Services Group

 

Discriminant Validity

Older Adults in the Community: (Zimnavoda et al., 2002)

  • KELS shows significant discrimination between groups living in the community, in sheltered housing, and in day care (Post-hoc Scheffe range: p = 0.01 to 0.000).

 

Geriatric Self-Neglectors: (Naik et al., 2008)

Comparison between modified Physical Performance Test (mPPT) and KELS across four models (Socio-demographics, Social Support, Health Status, and Composite) showed significant impairment in ADLs as reflected by KELS scores, but no significant impairment in mPPT scores.

Mental Health

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Standard Error of Measurement (SEM)

Inpatient schizophrenic: (calculated from Kazazi, Karbalaei-Noori, & Karimlou, 2011;  n = 35; mean age = 33.20 (8.92) ; mean KELS score = 6.271)

  • SEM for entire group: 0.511

 

Outpatient schizophrenic: (calculated from Kazazi et al., 2011; n = 51; mean age = 35.80 (9.58); mean KELS score = 6.931)

  • SEM for entire group: 0.427

 

*note: Kazazi et al., 2011 uses a version of the KELS translated to Farsi

Minimal Detectable Change (MDC)

Inpatient schizophrenic: (calculated from Kazazi et al., 2011; n = 35; mean age = 33.20; mean KELS score = 6.271)

  • MDC: 1.416

Outpatient schizophrenic: (calculated from Kazazi et al., 2010; n = 51; mean age = 35.80; mean KELS score = 6.931)

MDC: 1.185

Test/Retest Reliability

Outpatient schizophrenic: (Kazazi et al., 2011)

Excellent test-retest reliability: (ICC = 0.997, p < 0.001)

Interrater/Intrarater Reliability

Outpatient schizophrenic: (Kazazi et al., 2011)

  • Excellent test-retest reliability: (ICC = 0.966)

Psychiatric patients: (Ilika & Hoffman, 1981) unpublished study with unknown research design

Adequate to Excellent Interrater correlations significant at p < .001 (ICC = 0.74-0.94)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Inpatient Schizophrenic: (Kazazi et al., 2011)

  • Excellent concurrent validity between KELS and global assessment scale in 35 patients: (r = 0.688; p < 0.001)

Inpatient Psychiatric (general):

  • Excellent concurrent validity between KELS and global assessment scale: (r = 0.78 to 0.89; p<0.001) (Zimnavoda et al., 2002)
  • Excellent concurrent validity between KELS and BaFPE: (r = -0.84; p<0.0001) (Zimnavoda et al., 2002)
  • Adequate concurrent validity between KELS and Bay Area Functional Performance Evaluation (BaFPE) (r= -.84) (Kauffman, 1982; unpublished master’s thesis without details on population)

Predictive validity

Inpatient Psychiatric (general): (Kohlman & McGourty, 1978)

Poor predictive validity for predicting independent living after discharge from hospital (r = .04)

Construct Validity

Construct validity

Psychiatric inpatient, outpatient, and healthy individuals: (Kazazi et al., 2011)

  • Living skills in the three groups (Chi-squared = 69.714, p = 0.020)
  • Mean scores in healthy individuals showed significant differences within patients and outpatients (p = 0.001)

No difference between scores of outpatients and inpatients (p = 0.693)

Face Validity

Psychiatric inpatient, outpatient, and healthy individuals: (Kazazi et al., 2011)

Face validity was determined by two experts who reviewed and approved the translated version of the KELS.

Bibliography

Burnett, J., Dyer, C., & Naik, A. (2009). Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults’ capacity to live safely and independently in the community. Archives of Physical Medicine and Rehabilitation, 90(11), 1948-1952. doi: 10.1016/j.apmr.2009.05.021

 

Cinquemano, K., Gaijjar, A., & Martin, J. (2009). Concurrent and predictive validity of the revised Kohlman Evaluation of Living Skills. Unpublished master’s thesis. Brenau University, Gainesville, Florida.

 

Ilika, J., & Hoffman, N. (1981). Concurrent validity study on Kohlman Evaluation of Living Skills and the Global Assessment Scale. Unpublished manuscript.

 

Kauffman, L. (1982). Concurrent validity study on the Kohlman Evaluation of Living Skills and the Bay Area Functional Performance Evaluation. Unpublished master’s thesis, University of Florida, Gainesville.

 

Kazazi, L., Karbalaei-Noori, A., & Karimlou, M. (2012). Assessment of living skills in schizophrenic patients by Kohlman Evaluation. Zahedan Journal of Research in Medical Sciences, 14(9), 14-18.

 

Kohlman & McGourty, L. (1978). Kohlman Evaluation of Living Skills. Seattle, WA: KELS Research.

 

Morrow, M. (1985). A predictive validity study of the Kohlman Evaluation of Living Skills. Unpublished master’s thesis, University of Washington, Seattle.

 

Naik, A., Burnett, J., Pickens-Pace, S., & Dyer, C. B. (2008). Impairment in instrumental activities of daily living and the geriatric syndrome of self-neglect. Gerontologist, 48(3), 388-393.

 

Pickens, S., Naik, A., Burnett, J., Kelly, P.A., Gleason, M., & Dyer, C.B. (2006). The utility of the Kohlman Evaluation of Living Skills test is associated with substantiated cases of elder self-neglect. American Academy of Nurse Practitioners, doi: 10.1111/j/1745-7599.2007.00205.x

 

Robnett, R., Bliss, S., Buck, K., Dempsey, J., Gipatric, H., & Michaud, K. (2015). Validation of the safe at home screening with adults who have acquired brain injury. Occupational Therapy in Health Care. doi: 10.3109/07380577.2015.1044691

 

Zimnavoda, T., Weinblatt, N., & Katz, N. (2002). Validity of the Kohlman Evaluation of Living Skills (KELS) with Israeli elderly individuals living in the community. Occupational Therapy International, 9(4), 312-325. 

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