Reliability and Validity of the Brazilian Version of the Late-Life Function and Disability Instrument

Maria Helena Morgani de Almeida; Rosé Colom Toldrá; Marina Picazzio Perez Batista; Ana Cristina Fagundes Souto

doi:10.5014/ajot.2016.017624

Abstract

OBJECTIVE. We evaluated the test–retest reliability, internal consistency, and construct validity of the Brazilian version of the Late-Life Function and Disability Instrument.

METHOD. A sample of 118 older adults provided data for testing construct validity and internal consistency, and 14 provided data for testing test–retest reliability. Factor analysis with varimax rotation was used to assess construct validity.

RESULTS. The Function component had excellent test–retest and total internal consistency reliability. Factor analysis revealed that the Upper Extremity Function and Advanced Lower Extremity Function domains were similar to the original analysis. The Disability component showed adequate to excellent test–retest reliability, except in the Management role; total internal consistency was excellent. Factor analysis revealed that its domains were similar to the original analysis, except for some items.

CONCLUSION. The Late-Life Function and Disability Instrument is recommended for assessment of Brazilian community-dwelling older adults who are functionally independent and who do not require mobility assistance.

The ability to maintain an independent lifestyle in old age is directly related to one’s health and the fit between the environment and one’s needs, abilities, age-related losses, and degree of maintenance of functional capacities (Crews & Zavotka, 2006). Functioning, understood to be the result of the dynamic relationship among states of health and personal and environmental factors (World Health Organization [WHO], 2001), contributes to autonomy and independence in older adults (WHO, 2002).

In Brazil, the number of older adults with disabilities is expected to reach 6.7 million in 2025 and 12.0 million in 2050 (Wong & Carvalho, 2006). Valid measures of functional patterns and status will be required to establish intervention plans for this population (Crews & Zavotka, 2006; Li, 2005). Such instruments are essential to allow early detection of and intervention in functional decline (Beauchamp, Schmidt, Pedersen, Bean, & Jette, 2014) and to avoid hospitalization or institutionalization (Quinn, McArthur, Ellis, & Stott, 2011).

Few instruments that address cultural context and lifestyle have been translated and validated for use by health care professionals in Brazil (Reichenheim & Moraes, 2007). Especially in occupational therapy, few valid tools are available to assess functioning and disability in performing activities of daily living (Chaves, Oliveira, Forlenza, & Nunes, 2010).

Development of the Late-Life Function and Disability Instrument (LLFDI; Jette, Haley, & Kooyoomjian, 2002) was guided by Nagi’s (1991) disablement framework and the International Classification of Functioning, Disability and Health (ICF;WHO, 2001). These comprehensive models recognize the impact of aging on both the performance of daily activities and on social roles and relationships. The LLFDI is a self-report assessment of functioning and disability for community-dwelling older adults with a wide range of health conditions (Gignac, Cao, McAlpine, & Badley, 2011).

The LLFDI has been translated into and validated for Hebrew (Melzer, Kurz, Sarid, & Jette, 2007), Swedish (Roaldsen, Halvarsson, Sarlija, Franzen, & Ståhle, 2014), and French Canadian (Sakakibara, Routhier, Lavoie, & Miller, 2013). Transcultural adaptation of the LLFDI to Brazilian Portuguese was carried out by Toldrá, Souto, Batista, and Almeida (2012) in accordance with guidelines proposed in the literature (Guillemin, Bombardier, & Beaton, 1993), resulting in the Brazilian version of the LLFDI (LLFDI–Br). This article describes evaluation of the test–retest reliability, internal consistency reliability, and construct validity of the LLFDI–Br.

Method

Design

This quantitative, nonexperimental study was conducted within a more comprehensive study called Maintaining Aging Functions: Older People in the Year 2020 and was approved by the committee on research ethics of the University Hospital of São Paulo University, Brazil. All participants were informed about the research and signed the informed consent statement.

Participants

A convenience sample of 118 older adults was selected. Participants age 60 yr or older who did not require mobility assistance (e.g., help of another person; use of a cane, wheelchair, other mobility aid) and resided in the community were recruited from social, health, and religious institutions located in São Paulo. People younger than age 60 yr or who had communication difficulties, were institutionalized, or did not consent to participate were excluded from the study. All participants were assessed for functional independence in performing activities of daily living using two instruments translated into Brazilian Portuguese: (1) the Barthel Index (Cincura et al., 2009; Mahoney & Barthel, 1965) and (2) the Lawton Instrumental Activities of Daily Living Scale (Lawton & Brody, 1969; Santos & Virtuoso Júnior, 2008).

Data Collection

The study was carried out between March and August 2012. Data were collected through interviews, each conducted in a private setting by a trained examiner who was an occupational therapy practitioner. As part of their training, examiners were instructed in the concepts underlying the instrument and its method of administration. They then conducted pilot interviews with older adults who were not included in the study to give examiners the opportunity to raise any doubts about administering the LLFDI–Br, which the researchers addressed. To evaluate construct validity and internal consistency reliability, the LLFDI–Br was administered to the entire sample. To assess test–retest reliability, the LLFDI–Br was readministered by the same examiner 21 days later to a subsample who agreed to participate.

Instrument

The LLFDI–Br consists of two components: Function and Disability. The Function component measures the ability to perform specific activities that require gross and fine motor skills. This component comprises 32 items that assess three domains: (1) Upper Extremity Function (activities that use the hands and arms; 7 items), (2) Basic Lower Extremity Function (activities that mainly involve standing, bending over, and walking; 14 items), and (3) Advanced Lower Extremity Function (activities with a high level of physical ability and resistance; 11 items; Haley et al., 2002).

The Disability component assesses major life activities. It comprises 16 items and assesses two dimensions: Frequency describes how regularly the respondent participates in each life task, and Limitation addresses the respondent’s ability to perform each life task. Frequency consists of two domains: Social Role (social and community tasks; 9 items) and Personal Role (personal tasks; 7 items). Limitation consists of two domains: Instrumental Role (activities at home and in the community; 12 items) and Management Role (organization or management of social tasks; 4 items).

The questionnaire items are administered through interview, and responses are selected from a 5-point Likert-type scale. In the Function component—for example, “How much difficulty do you have [doing a particular activity]?”—response options include none, a little, some, quite a lot, and cannot do. In the Disability component, response options for Frequency questions—for example, “How often do you do a particular task?”—include very often, often, once in a while, almost never, and never. Response options for Limitation questions—for example, “To what extent do you feel limited in [doing a particular task]?”—include not at all, a little, somewhat, a lot, and completely. Raw scores for all items are transformed to scaled scores from 0 to 100 (Jette, Haley, & Kooyoomjian, 2002, 2003).

Data Analysis

Using the scores for the total sample, descriptive statistical values for the domains of both components of the LLFDI–Br were calculated. Test–retest reliability was calculated using the intraclass correlation coefficient (ICC; Fleiss, 1986) with 95% confidence interval. ICCs ≥.75 indicate excellent, .40–.74 adequate, and <.40 poor reliability (Fleiss, 1986).

Cronbach’s α was calculated to analyze the internal consistency reliability of each domain of the LLFDI–Br. Values ≥.70 indicate excellent; .51–.69 adequate; and <.50 poor internal consistency (Fornell & Larcker, 1981).

To assess the construct validity of the LLFDI–Br, we used factor analysis, a mathematical technique that allows grouping of variables that are highly correlated into a common dimension, or factor (Johnson & Wichern, 2007). Varimax rotation was used to confirm the factors identified.

Results

Sample Characteristics

The study sample comprised 94 (79.7%) women and 24 (20.3%) men ages 60–90 yr (mean [M] age = 71.4 ± 6.9). Three (2.5%) had never attended school, 35 (29.7%) had 1–4 yr of study, 21 (17.8%) had 5–8 yr, 32 (27.1%) had 9–11 yr, and 27 (22.9%) had >12 yr of schooling. The mean Barthel Index score was 99.10 (±3.03), and the mean Lawton Instrumental Activities of Daily Living Scale score was 19.54 (±1.90). Table 1 shows the sample’s mean LLFDI–Br scores by domain.

Table 1.

Mean LLFDI–Br Scores by Domain

Component	Domain	M (SD)
Disability	Social Role	30.1 (6.5)
	Personal Role	30.7 (3.4)
	Instrumental Role	50.9 (7.4)
	Management Role	17.6 (2.5)
Function	Upper Extremity	31.9 (4.0)
	Basic Lower Extremity	63.4 (7.2)
	Advanced Lower Extremity	41.1 (9.0)

Note. LLFDI–Br = Brazilian version of the Late-Life Function and Disability Instrument; M = mean; SD = standard deviation.

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Table 1.

Mean LLFDI–Br Scores by Domain

Component	Domain	M (SD)
Disability	Social Role	30.1 (6.5)
	Personal Role	30.7 (3.4)
	Instrumental Role	50.9 (7.4)
	Management Role	17.6 (2.5)
Function	Upper Extremity	31.9 (4.0)
	Basic Lower Extremity	63.4 (7.2)
	Advanced Lower Extremity	41.1 (9.0)

Note. LLFDI–Br = Brazilian version of the Late-Life Function and Disability Instrument; M = mean; SD = standard deviation.

Test–Retest Reliability

Test–retest reliability was calculated using a subsample of 14 participants. Of this subsample, 12 (85.7%) were female and 2 (14.3%) were male, their age range was 60–90 (M = 68.5 ± 5.8), and 10 (71.4%) had 1–4 yr of schooling and 4 (28.6%) had 5–8 yr of study; the characteristics of the test–retest subsample thus were similar to those of the entire sample. Similar sample sizes were used in calculating the test–retest reliability of the two components of the original English instrument (Haley et al., 2002; Jette, Haley, Coster, et al., 2002).

Test–retest reliability was excellent for the three domains of the Function component of the LLFDI–Br, with ICCs of .95 for Upper Extremity Function, .93 for Basic Lower Extremity Function, and .78 for Advanced Lower Extremity Function. In the Disability component, test–retest reliability was excellent for Social Role (.81), adequate for Personal Role (.53) and Instrumental Role (.59), and poor for Management Role (.27).

Table 2 shows the test–retest reliabilities of the different versions of the LLFDI: the original English (Jette, Haley, & Kooyoomjian, 2002), Hebrew (Melzer et al., 2007), French Canadian (Sakakibara et al., 2013), and Swedish (Roaldsen et al., 2014). The LLFDI–Br showed moderate to excellent test–retest reliability in every domain except Management Role; poor reliability was also observed in the Management Role domain for the original English (Jette, Haley, & Kooyoomjian, 2002) and Hebrew (Melzer et al., 2007) versions.

Table 2.

Test–Retest and Internal Consistency Reliability of Versions of the LLFDI

Domain	Test–Retest, ICC [95% CI]					Internal Consistency, Cronbach’s α
Domain	Original	Hebrew	French Canadian	Swedish	Brazilian Portuguese	Original	Swedish	Brazilian Portuguese
Disability Component
Overall								.889
Frequency
Social Role	.753	.83 [.73, .90]	.87 [.77, .93]	.82	.81 [.52, .93]	.80	.90	.807
Personal Role	.633	.63 [.44, .77]	.76 [.59, 0.87]	.82	.53 [.00, .82]	.73	.90	.601
Limitation
Instrumental Role	.833	.72 [.57, .83]	.90 [.80, .95]	.91	.59 [.12, .85]	.92	.95	.856
Management Role	.435	.46 [.22, .64]	.68 [.48, .82]	.91	.27 [.00, .70]	.63	.95	.611
Function Component
Overall						.97	.96	.948
Upper Extremity	.912	.79 [.66, .87]	.97 [.95, .99]	.87	.95 [.86, .98]	.86	.94	.819
Basic Lower Extremity	.976	.77 [.64, .86]	.74 [.55, .85]	.89	.93 [.81, .98]	.96	.94	.889
Advanced Lower Extremity	.966	.86 [.77, .92]	.82 [.69, .90]	.91	.78 [.44, .93]	.96	.95	.914

Note. CI = confidence interval; ICC = intraclass correlation coefficient; LLFDI = Late-Life Function and Disability Instrument.

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Table 2.

Test–Retest and Internal Consistency Reliability of Versions of the LLFDI

Domain	Test–Retest, ICC [95% CI]					Internal Consistency, Cronbach’s α
Domain	Original	Hebrew	French Canadian	Swedish	Brazilian Portuguese	Original	Swedish	Brazilian Portuguese
Disability Component
Overall								.889
Frequency
Social Role	.753	.83 [.73, .90]	.87 [.77, .93]	.82	.81 [.52, .93]	.80	.90	.807
Personal Role	.633	.63 [.44, .77]	.76 [.59, 0.87]	.82	.53 [.00, .82]	.73	.90	.601
Limitation
Instrumental Role	.833	.72 [.57, .83]	.90 [.80, .95]	.91	.59 [.12, .85]	.92	.95	.856
Management Role	.435	.46 [.22, .64]	.68 [.48, .82]	.91	.27 [.00, .70]	.63	.95	.611
Function Component
Overall						.97	.96	.948
Upper Extremity	.912	.79 [.66, .87]	.97 [.95, .99]	.87	.95 [.86, .98]	.86	.94	.819
Basic Lower Extremity	.976	.77 [.64, .86]	.74 [.55, .85]	.89	.93 [.81, .98]	.96	.94	.889
Advanced Lower Extremity	.966	.86 [.77, .92]	.82 [.69, .90]	.91	.78 [.44, .93]	.96	.95	.914

Note. CI = confidence interval; ICC = intraclass correlation coefficient; LLFDI = Late-Life Function and Disability Instrument.

Internal Consistency Reliability

Internal consistency was excellent for the overall Function component (α = .948) and for its three domains: Upper Extremity Function (α = .819), Basic Lower Extremity Function (α = .889), and Advanced Lower Extremity Function (α = .914). For the Disability component overall, internal consistency was excellent (α = .889). Internal consistency of Social Role (α = .807) and Instrumental Role (α = .856) domains was excellent and of Personal Role (α = .601) and Management Role (α = .611) domains was adequate. As shown in Table 2, the α values for the LLFDI–Br were similar to those of the original English version (Jette, Haley, & Kooyoomjian, 2002), with the exception of Personal Role.

Construct Validity

For the Function component, the three domains were used in the factor analysis: Upper Extremity Function, Basic Lower Extremity Function, and Advanced Lower Extremity Function. These factors explain 53.5% of the total variability. Table 3 shows the factor loadings (with varimax rotation) for the Function component. Factor loadings for the Upper Extremity Function and Advanced Lower Extremity Function domains are similar to those obtained in the original analysis; however, the Basic Lower Extremity Function domain shows differences. Only Items F11 and F26 show high factor loadings in the original domain. Some items had high loadings in the original domain and in other domains (Items F15, F18, and F25 of Basic Lower Extremity Function; Item F3 of Upper Extremity Function; and Item F27 of Advanced Lower Extremity Function). Other items loaded significantly higher in other domains compared with the original domain (Items F2, F10, F12, F14, F21, F22, F23, F28, and F31 of Basic Lower Extremity Function and Item F13 of Upper Extremity Function).

Table 3.

LLFDI–Br Function Component Factor Analysis With Three Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Upper Extremity Function	Basic Lower Extremity Function	Advanced Lower Extremity Function
Upper Extremity Function	F1	Unscrew a lid	.508	.171	.120
	F3	Put on and take off pants	.452	.487	.368
	F5	Use common utensils	.775	.047	.233
	F6	Hold full glass of water in one hand	.550	−.090	.248
	F13	Reach behind back	.295	.794	.023
	F16	Remove wrapping with hands	.723	.077	.199
	F17	Pour from large pitcher	.843	.090	.248
Basic Lower Extremity Function	F2	One flight of stairs with handrail	.275	.151	.689
	F10	Reach overhead while standing	.651	.314	.186
	F11	Sit–stand from low soft couch	.069	.661	.294
	F12	Put on and take off coat	.580	.414	.004
	F14	Step up and down from curb	.471	.175	.428
	F15	Open a heavy outside door	.381	.317	.270
	F18	Get into and out of a car	.281	.482	.419
	F21	Lift kitchen chair	.450	.131	.525
	F22	Use stepstool	.215	.207	.629
	F23	Make a bed	.570	.396	.274
	F25	Bend over to pick up	−.150	.479	.574
	F26	Walk around one floor of home	.228	.521	.230
	F28	Wash dishes while standing	.653	.240	.041
	F31	Step on and off a bus	.240	.431	.611
Advanced Lower Extremity Function	F4	Run a half mile or more	.167	.145	.494
	F7	Walk a mile with rests	.336	−.030	.698
	F8	One flight of stairs without handrail	.234	−.037	.773
	F9	Run a short distance	.159	.206	.707
	F19	Hike a few miles	.201	.246	.647
	F20	Three flights of stairs with handrail	.128	.198	.708
	F24	Carry with both hands while climb stairs	.278	.056	.751
	F27	Get up from the floor	.171	.518	.610
	F29	Walk a few blocks	.223	.155	.707
	F30	Walk a brisk mile	−.060	.256	.709
	F32	Walk on a slippery surface	.220	.269	.579
% of variance explained			17.5	11.2	24.8

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

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Table 3.

LLFDI–Br Function Component Factor Analysis With Three Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Upper Extremity Function	Basic Lower Extremity Function	Advanced Lower Extremity Function
Upper Extremity Function	F1	Unscrew a lid	.508	.171	.120
	F3	Put on and take off pants	.452	.487	.368
	F5	Use common utensils	.775	.047	.233
	F6	Hold full glass of water in one hand	.550	−.090	.248
	F13	Reach behind back	.295	.794	.023
	F16	Remove wrapping with hands	.723	.077	.199
	F17	Pour from large pitcher	.843	.090	.248
Basic Lower Extremity Function	F2	One flight of stairs with handrail	.275	.151	.689
	F10	Reach overhead while standing	.651	.314	.186
	F11	Sit–stand from low soft couch	.069	.661	.294
	F12	Put on and take off coat	.580	.414	.004
	F14	Step up and down from curb	.471	.175	.428
	F15	Open a heavy outside door	.381	.317	.270
	F18	Get into and out of a car	.281	.482	.419
	F21	Lift kitchen chair	.450	.131	.525
	F22	Use stepstool	.215	.207	.629
	F23	Make a bed	.570	.396	.274
	F25	Bend over to pick up	−.150	.479	.574
	F26	Walk around one floor of home	.228	.521	.230
	F28	Wash dishes while standing	.653	.240	.041
	F31	Step on and off a bus	.240	.431	.611
Advanced Lower Extremity Function	F4	Run a half mile or more	.167	.145	.494
	F7	Walk a mile with rests	.336	−.030	.698
	F8	One flight of stairs without handrail	.234	−.037	.773
	F9	Run a short distance	.159	.206	.707
	F19	Hike a few miles	.201	.246	.647
	F20	Three flights of stairs with handrail	.128	.198	.708
	F24	Carry with both hands while climb stairs	.278	.056	.751
	F27	Get up from the floor	.171	.518	.610
	F29	Walk a few blocks	.223	.155	.707
	F30	Walk a brisk mile	−.060	.256	.709
	F32	Walk on a slippery surface	.220	.269	.579
% of variance explained			17.5	11.2	24.8

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

For the Disability component, the four domains were used in the factor analysis: Social Role and Personal Role in the Frequency dimension and Instrumental Role and Management Role in the Limitation dimension. These factors explain 46.6% of the total variance. Table 4 shows the factor loadings for the Disability component. The factor loadings were similar to those obtained in the original analysis, with some exceptions. Some items had high loadings in the original domain and in other domains (Items D1F, D3F, D6F, and D11F of Social Role and Item D15L of Instrumental Role), whereas other items loaded significantly higher in other domains compared with the original domain (Item D10F of Personal Role, Items D13L and D16L of Instrumental Role, and Item D7L of Management Role).

Table 4.

LLFDI–Br Disability Component Factor Analysis With Four Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Social Role	Personal Role	Instrumental Role	Management Role
Social Role	D1F	Keep in touch with others	.481	.230	−.014	.462
	D2F	Visit friends and family	.708	.009	.060	.229
	D3F	Assist others	.541	.428	−.055	.218
	D5F	Work at volunteer job	.452	.077	−.034	−.038
	D6F	Take part in active recreation	.448	.239	.537	−.181
	D9F	Travel out of town for overnight stay	.725	−.007	.169	.001
	D11F	Invite people for meal or entertainment	.425	.079	−.198	.580
	D12F	Go out to public places	.734	.082	.284	.051
	D14F	Take part in social activities	.615	.078	.296	.030
Personal Role	D4F	Take care of inside of home	.146	.668	−.027	.156
	D7F	Take care of household finances	.093	.572	.240	−.035
	D8F	Take care of own health	.089	.567	−.001	−.154
	D10F	Take part in exercise program	.480	.130	.530	−.199
	D13F	Take care of personal care	−.158	.354	.064	.220
	D15F	Take care of local errands	.147	.438	.315	−.032
	D16F	Provide meals	.168	.636	−.215	.264
Instrumental Role	D2L	Visit friends and family	.012	−.186	.562	.376
	D3L	Assist others	−.011	.111	.489	.318
	D4L	Take care of inside of home	.072	.132	.502	.310
	D5L	Work at volunteer job	.000	−.052	.564	.013
	D6L	Take part in active recreation	.074	.169	.774	.143
	D9L	Travel out of town for overnight stay	.327	−.115	.462	.075
	D10L	Take part in exercise program	.204	.073	.710	.123
	D12L	Go out to public places	.192	−.023	.522	.207
	D13L	Take care of personal care	−.126	.120	.283	.597
	D14L	Take part in social activities	.117	.022	.709	.282
	D15L	Take care of local errands	.036	.200	.464	.445
	D16L	Provide meals	.011	.482	.327	.441
Management Role	D1L	Keep in touch with others	.070	.011	.270	.647
	D7L	Take care of household finances	.002	.372	.656	.062
	D8L	Take care of own health	−.119	.342	.378	.449
	D11L	Invite people for meal or entertainment	.184	−.059	.223	.554
% of variance explained			11.5	8.8	16.7	9.6

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

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Table 4.

LLFDI–Br Disability Component Factor Analysis With Four Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Social Role	Personal Role	Instrumental Role	Management Role
Social Role	D1F	Keep in touch with others	.481	.230	−.014	.462
	D2F	Visit friends and family	.708	.009	.060	.229
	D3F	Assist others	.541	.428	−.055	.218
	D5F	Work at volunteer job	.452	.077	−.034	−.038
	D6F	Take part in active recreation	.448	.239	.537	−.181
	D9F	Travel out of town for overnight stay	.725	−.007	.169	.001
	D11F	Invite people for meal or entertainment	.425	.079	−.198	.580
	D12F	Go out to public places	.734	.082	.284	.051
	D14F	Take part in social activities	.615	.078	.296	.030
Personal Role	D4F	Take care of inside of home	.146	.668	−.027	.156
	D7F	Take care of household finances	.093	.572	.240	−.035
	D8F	Take care of own health	.089	.567	−.001	−.154
	D10F	Take part in exercise program	.480	.130	.530	−.199
	D13F	Take care of personal care	−.158	.354	.064	.220
	D15F	Take care of local errands	.147	.438	.315	−.032
	D16F	Provide meals	.168	.636	−.215	.264
Instrumental Role	D2L	Visit friends and family	.012	−.186	.562	.376
	D3L	Assist others	−.011	.111	.489	.318
	D4L	Take care of inside of home	.072	.132	.502	.310
	D5L	Work at volunteer job	.000	−.052	.564	.013
	D6L	Take part in active recreation	.074	.169	.774	.143
	D9L	Travel out of town for overnight stay	.327	−.115	.462	.075
	D10L	Take part in exercise program	.204	.073	.710	.123
	D12L	Go out to public places	.192	−.023	.522	.207
	D13L	Take care of personal care	−.126	.120	.283	.597
	D14L	Take part in social activities	.117	.022	.709	.282
	D15L	Take care of local errands	.036	.200	.464	.445
	D16L	Provide meals	.011	.482	.327	.441
Management Role	D1L	Keep in touch with others	.070	.011	.270	.647
	D7L	Take care of household finances	.002	.372	.656	.062
	D8L	Take care of own health	−.119	.342	.378	.449
	D11L	Invite people for meal or entertainment	.184	−.059	.223	.554
% of variance explained			11.5	8.8	16.7	9.6

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

Discussion

This is the first validation study of the LLFDI in Brazilian Portuguese. It addresses the two components of the instrument, Disability and Function, and indicates that the instrument has sufficient reliability and validity to be used with Brazilian community-dwelling older adults who do not require mobility assistance (e.g., help of another person, use of a cane, wheelchair, or other device).

The LLFDI–Br Function component showed excellent test–retest reliability consistent with other versions of the instrument (Melzer et al., 2007; Sakakibara et al., 2013; Roaldsen et al., 2014), including the original English version (Jette, Haley, & Kooyoomjian, 2002). Internal consistency of this component and its domains was excellent and was similar to that of the original English (Jette, Haley, & Kooyoomjian, 2002) and Swedish (Roaldsen et al., 2014) versions.

Factor analysis of the LLFDI–Br Function component showed that many items in the Upper Extremity Function and Advanced Lower Extremity Function domains had higher loadings in their own domains, unlike the Basic Lower Extremity Function, in which the majority of the items (11) did not have a higher factor loading in their own domain. These items may not require high enough physical demands of the lower limbs to capture difficulties in the participants in this study, who did not require mobility assistance and were evaluated as functionally independent as conditions of inclusion in the study.

That few items had factor loadings in the Basic Lower Extremity Function domain may reflect the more intense interaction between the physical abilities of the lower limbs and the demands of the environment (Sayers et al., 2004). These items may be more sensitive in capturing accessibility difficulties, including those in the household, which are often experienced by Brazilian older adults. To assess basic lower extremity function in functionally independent people who do not require mobility assistance, we suggest using the LLFDI–Br Function component in combination with a lower limb performance instrument. Coster (2008) suggested using multiple instruments to describe functioning in all its comprehensiveness and complexity.

The LLFDI–Br Disability component showed adequate to excellent test–retest reliability in almost every domain except Management Role, likely because of the low number of items in this domain (Beauchamp et al., 2014; Gignac et al., 2011). Poor test–retest reliability was also observed in Management Role in the original English (Jette, Haley, & Kooyoomjian, 2002) and Hebrew (Melzer et al., 2007) versions.

Overall, internal consistency of the LLFDI–Br Disability component was excellent. The α values for Social Role and Instrumental Role were excellent, and those for Personal Role and Management Role were acceptable. Internal consistency of the Disability component was similar to that of the original version (Jette, Haley, & Kooyoomjian, 2002) with the exception of Personal Role.

Factor analysis of the Disability component indicated that the domains are similar to those obtained in the original analysis (Jette, Haley, & Kooyoomjian, 2002), except for some items that loaded significantly higher in other domains For example, Item D10 of Personal Role had a low factor loading in the original English version; the authors attributed this low loading to the item’s importance in understanding the general concept of disability. The activities in the item point to tasks that imply more individual inclusion in social and collective roles than the other roles in the instrument do.

The low factor loading of Item D13L in its own domain could be explained by the fact that D13L is the only item that relates to self-care in this domain. The other items of the domain refer to instrumental and advanced activities of daily living. Item D7L originally belonged to Management Role and showed a higher factorial load in Instrumental Role. Management Role was less able to capture the frequency and perceived limitations for complex tasks that require more sophisticated cognitive skills because of the small number of items. The item’s difficulty in capturing what is proposed was indicated in the original English (Jette, Haley, & Kooyoomjian, 2002) and Hebrew (Melzer et al., 2007) versions.

In general, considering the diversity of activities involved in the LLFDI and the multiplicity of skills needed for the different tasks, it is understandable that some items loaded relatively high in more than one role. This pattern was also found in a longitudinal study reevaluating the psychometric properties of the original instrument at three time points (Hsu et al., 2010).

Limitations and Future Research

This study was conducted with older adults who did not require mobility assistance, which can be considered a study limitation. A second limitation is the small sample for the test–retest reliability study, although its size was similar to that of such samples in other studies. Further research is needed to assess the sensitivity of the LLFDI–Br in capturing changes attributable to interventions and in monitoring functioning in older adults.

Implications for Occupational Therapy Practice

The results of this study have the following implications for occupational therapy practice:

The LLFDI is based on the ICF, a relevant and holistic model used by rehabilitation professionals in clinical practice and research (Pettersson, Pettersson, & Frisk, 2012). The ICF’s influence on the development of the LLFDI confers multidisciplinary relevance, fostering communication among health care professionals.
The LLFDI can be broadly applied in clinical occupational therapy practice to evaluate a broad range of daily activities.
The Function component assesses functioning across a wide variety of daily activities involving both the upper and lower limbs. Functional evaluation, one of the pillars of occupational therapy (Doucet & Gutman, 2013), is especially relevant for older adult clients because aging affects functioning, autonomy, and independence (WHO, 2002).
The Disability component of the LLFDI includes a wide variety of roles and addresses both frequency and perceived limitations in performing life tasks. The LLFDI can be used to identify changes in disability (Jette, Haley, & Kooyoomjian, 2002).
The findings of this study regarding the reliability and construct validity of the LLFDI–Br confirm its appropriateness for use with older adults, making it a valuable addition to validated instruments available in Brazilian Portuguese for use by occupational therapy practitioners (Chaves et al., 2010).

Conclusion

The psychometric evaluation presented in this study provides evidence of the test–retest and internal consistency reliability and construct validity of the LLFDI–Br. The results of this study indicate the potential use of the instrument for practitioners working with community-dwelling older adults who are functionally independent and who do not require mobility assistance to assess functioning and disability in performing activities of daily living. Further work should be conducted aiming to increase the evidence of the instrument validity.

Acknowledgments

This study was funded by MCT/CNPq/Saúde (Conselho Nacional de Desenvolvimento Científico e Tecnológico, No. 1005/10).

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Table 1.

Mean LLFDI–Br Scores by Domain

Component	Domain	M (SD)
Disability	Social Role	30.1 (6.5)
	Personal Role	30.7 (3.4)
	Instrumental Role	50.9 (7.4)
	Management Role	17.6 (2.5)
Function	Upper Extremity	31.9 (4.0)
	Basic Lower Extremity	63.4 (7.2)
	Advanced Lower Extremity	41.1 (9.0)

Note. LLFDI–Br = Brazilian version of the Late-Life Function and Disability Instrument; M = mean; SD = standard deviation.

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Table 1.

Mean LLFDI–Br Scores by Domain

Component	Domain	M (SD)
Disability	Social Role	30.1 (6.5)
	Personal Role	30.7 (3.4)
	Instrumental Role	50.9 (7.4)
	Management Role	17.6 (2.5)
Function	Upper Extremity	31.9 (4.0)
	Basic Lower Extremity	63.4 (7.2)
	Advanced Lower Extremity	41.1 (9.0)

Note. LLFDI–Br = Brazilian version of the Late-Life Function and Disability Instrument; M = mean; SD = standard deviation.

Table 2.

Test–Retest and Internal Consistency Reliability of Versions of the LLFDI

Domain	Test–Retest, ICC [95% CI]					Internal Consistency, Cronbach’s α
Domain	Original	Hebrew	French Canadian	Swedish	Brazilian Portuguese	Original	Swedish	Brazilian Portuguese
Disability Component
Overall								.889
Frequency
Social Role	.753	.83 [.73, .90]	.87 [.77, .93]	.82	.81 [.52, .93]	.80	.90	.807
Personal Role	.633	.63 [.44, .77]	.76 [.59, 0.87]	.82	.53 [.00, .82]	.73	.90	.601
Limitation
Instrumental Role	.833	.72 [.57, .83]	.90 [.80, .95]	.91	.59 [.12, .85]	.92	.95	.856
Management Role	.435	.46 [.22, .64]	.68 [.48, .82]	.91	.27 [.00, .70]	.63	.95	.611
Function Component
Overall						.97	.96	.948
Upper Extremity	.912	.79 [.66, .87]	.97 [.95, .99]	.87	.95 [.86, .98]	.86	.94	.819
Basic Lower Extremity	.976	.77 [.64, .86]	.74 [.55, .85]	.89	.93 [.81, .98]	.96	.94	.889
Advanced Lower Extremity	.966	.86 [.77, .92]	.82 [.69, .90]	.91	.78 [.44, .93]	.96	.95	.914

Note. CI = confidence interval; ICC = intraclass correlation coefficient; LLFDI = Late-Life Function and Disability Instrument.

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Table 2.

Test–Retest and Internal Consistency Reliability of Versions of the LLFDI

Domain	Test–Retest, ICC [95% CI]					Internal Consistency, Cronbach’s α
Domain	Original	Hebrew	French Canadian	Swedish	Brazilian Portuguese	Original	Swedish	Brazilian Portuguese
Disability Component
Overall								.889
Frequency
Social Role	.753	.83 [.73, .90]	.87 [.77, .93]	.82	.81 [.52, .93]	.80	.90	.807
Personal Role	.633	.63 [.44, .77]	.76 [.59, 0.87]	.82	.53 [.00, .82]	.73	.90	.601
Limitation
Instrumental Role	.833	.72 [.57, .83]	.90 [.80, .95]	.91	.59 [.12, .85]	.92	.95	.856
Management Role	.435	.46 [.22, .64]	.68 [.48, .82]	.91	.27 [.00, .70]	.63	.95	.611
Function Component
Overall						.97	.96	.948
Upper Extremity	.912	.79 [.66, .87]	.97 [.95, .99]	.87	.95 [.86, .98]	.86	.94	.819
Basic Lower Extremity	.976	.77 [.64, .86]	.74 [.55, .85]	.89	.93 [.81, .98]	.96	.94	.889
Advanced Lower Extremity	.966	.86 [.77, .92]	.82 [.69, .90]	.91	.78 [.44, .93]	.96	.95	.914

Note. CI = confidence interval; ICC = intraclass correlation coefficient; LLFDI = Late-Life Function and Disability Instrument.

Table 3.

LLFDI–Br Function Component Factor Analysis With Three Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Upper Extremity Function	Basic Lower Extremity Function	Advanced Lower Extremity Function
Upper Extremity Function	F1	Unscrew a lid	.508	.171	.120
	F3	Put on and take off pants	.452	.487	.368
	F5	Use common utensils	.775	.047	.233
	F6	Hold full glass of water in one hand	.550	−.090	.248
	F13	Reach behind back	.295	.794	.023
	F16	Remove wrapping with hands	.723	.077	.199
	F17	Pour from large pitcher	.843	.090	.248
Basic Lower Extremity Function	F2	One flight of stairs with handrail	.275	.151	.689
	F10	Reach overhead while standing	.651	.314	.186
	F11	Sit–stand from low soft couch	.069	.661	.294
	F12	Put on and take off coat	.580	.414	.004
	F14	Step up and down from curb	.471	.175	.428
	F15	Open a heavy outside door	.381	.317	.270
	F18	Get into and out of a car	.281	.482	.419
	F21	Lift kitchen chair	.450	.131	.525
	F22	Use stepstool	.215	.207	.629
	F23	Make a bed	.570	.396	.274
	F25	Bend over to pick up	−.150	.479	.574
	F26	Walk around one floor of home	.228	.521	.230
	F28	Wash dishes while standing	.653	.240	.041
	F31	Step on and off a bus	.240	.431	.611
Advanced Lower Extremity Function	F4	Run a half mile or more	.167	.145	.494
	F7	Walk a mile with rests	.336	−.030	.698
	F8	One flight of stairs without handrail	.234	−.037	.773
	F9	Run a short distance	.159	.206	.707
	F19	Hike a few miles	.201	.246	.647
	F20	Three flights of stairs with handrail	.128	.198	.708
	F24	Carry with both hands while climb stairs	.278	.056	.751
	F27	Get up from the floor	.171	.518	.610
	F29	Walk a few blocks	.223	.155	.707
	F30	Walk a brisk mile	−.060	.256	.709
	F32	Walk on a slippery surface	.220	.269	.579
% of variance explained			17.5	11.2	24.8

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

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Table 3.

LLFDI–Br Function Component Factor Analysis With Three Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Upper Extremity Function	Basic Lower Extremity Function	Advanced Lower Extremity Function
Upper Extremity Function	F1	Unscrew a lid	.508	.171	.120
	F3	Put on and take off pants	.452	.487	.368
	F5	Use common utensils	.775	.047	.233
	F6	Hold full glass of water in one hand	.550	−.090	.248
	F13	Reach behind back	.295	.794	.023
	F16	Remove wrapping with hands	.723	.077	.199
	F17	Pour from large pitcher	.843	.090	.248
Basic Lower Extremity Function	F2	One flight of stairs with handrail	.275	.151	.689
	F10	Reach overhead while standing	.651	.314	.186
	F11	Sit–stand from low soft couch	.069	.661	.294
	F12	Put on and take off coat	.580	.414	.004
	F14	Step up and down from curb	.471	.175	.428
	F15	Open a heavy outside door	.381	.317	.270
	F18	Get into and out of a car	.281	.482	.419
	F21	Lift kitchen chair	.450	.131	.525
	F22	Use stepstool	.215	.207	.629
	F23	Make a bed	.570	.396	.274
	F25	Bend over to pick up	−.150	.479	.574
	F26	Walk around one floor of home	.228	.521	.230
	F28	Wash dishes while standing	.653	.240	.041
	F31	Step on and off a bus	.240	.431	.611
Advanced Lower Extremity Function	F4	Run a half mile or more	.167	.145	.494
	F7	Walk a mile with rests	.336	−.030	.698
	F8	One flight of stairs without handrail	.234	−.037	.773
	F9	Run a short distance	.159	.206	.707
	F19	Hike a few miles	.201	.246	.647
	F20	Three flights of stairs with handrail	.128	.198	.708
	F24	Carry with both hands while climb stairs	.278	.056	.751
	F27	Get up from the floor	.171	.518	.610
	F29	Walk a few blocks	.223	.155	.707
	F30	Walk a brisk mile	−.060	.256	.709
	F32	Walk on a slippery surface	.220	.269	.579
% of variance explained			17.5	11.2	24.8

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

Table 4.

LLFDI–Br Disability Component Factor Analysis With Four Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Social Role	Personal Role	Instrumental Role	Management Role
Social Role	D1F	Keep in touch with others	.481	.230	−.014	.462
	D2F	Visit friends and family	.708	.009	.060	.229
	D3F	Assist others	.541	.428	−.055	.218
	D5F	Work at volunteer job	.452	.077	−.034	−.038
	D6F	Take part in active recreation	.448	.239	.537	−.181
	D9F	Travel out of town for overnight stay	.725	−.007	.169	.001
	D11F	Invite people for meal or entertainment	.425	.079	−.198	.580
	D12F	Go out to public places	.734	.082	.284	.051
	D14F	Take part in social activities	.615	.078	.296	.030
Personal Role	D4F	Take care of inside of home	.146	.668	−.027	.156
	D7F	Take care of household finances	.093	.572	.240	−.035
	D8F	Take care of own health	.089	.567	−.001	−.154
	D10F	Take part in exercise program	.480	.130	.530	−.199
	D13F	Take care of personal care	−.158	.354	.064	.220
	D15F	Take care of local errands	.147	.438	.315	−.032
	D16F	Provide meals	.168	.636	−.215	.264
Instrumental Role	D2L	Visit friends and family	.012	−.186	.562	.376
	D3L	Assist others	−.011	.111	.489	.318
	D4L	Take care of inside of home	.072	.132	.502	.310
	D5L	Work at volunteer job	.000	−.052	.564	.013
	D6L	Take part in active recreation	.074	.169	.774	.143
	D9L	Travel out of town for overnight stay	.327	−.115	.462	.075
	D10L	Take part in exercise program	.204	.073	.710	.123
	D12L	Go out to public places	.192	−.023	.522	.207
	D13L	Take care of personal care	−.126	.120	.283	.597
	D14L	Take part in social activities	.117	.022	.709	.282
	D15L	Take care of local errands	.036	.200	.464	.445
	D16L	Provide meals	.011	.482	.327	.441
Management Role	D1L	Keep in touch with others	.070	.011	.270	.647
	D7L	Take care of household finances	.002	.372	.656	.062
	D8L	Take care of own health	−.119	.342	.378	.449
	D11L	Invite people for meal or entertainment	.184	−.059	.223	.554
% of variance explained			11.5	8.8	16.7	9.6

Note. Values ≥.400 indicate that the item has adequate loading on the factor.

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Table 4.

LLFDI–Br Disability Component Factor Analysis With Four Domains and Varimax Rotation

Domain	Item No.	Item Content	Factor Loading
Domain	Item No.	Item Content	Social Role	Personal Role	Instrumental Role	Management Role
Social Role	D1F	Keep in touch with others	.481	.230	−.014	.462
	D2F	Visit friends and family	.708	.009	.060	.229
	D3F	Assist others	.541	.428	−.055	.218
	D5F	Work at volunteer job	.452	.077	−.034	−.038
	D6F	Take part in active recreation	.448	.239	.537	−.181
	D9F	Travel out of town for overnight stay	.725	−.007	.169	.001
	D11F	Invite people for meal or entertainment	.425	.079	−.198	.580
	D12F	Go out to public places	.734	.082	.284	.051
	D14F	Take part in social activities	.615	.078	.296	.030
Personal Role	D4F	Take care of inside of home	.146	.668	−.027	.156
	D7F	Take care of household finances	.093	.572	.240	−.035
	D8F	Take care of own health	.089	.567	−.001	−.154
	D10F	Take part in exercise program	.480	.130	.530	−.199
	D13F	Take care of personal care	−.158	.354	.064	.220
	D15F	Take care of local errands	.147	.438	.315	−.032
	D16F	Provide meals	.168	.636	−.215	.264
Instrumental Role	D2L	Visit friends and family	.012	−.186	.562	.376
	D3L	Assist others	−.011	.111	.489	.318
	D4L	Take care of inside of home	.072	.132	.502	.310
	D5L	Work at volunteer job	.000	−.052	.564	.013
	D6L	Take part in active recreation	.074	.169	.774	.143
	D9L	Travel out of town for overnight stay	.327	−.115	.462	.075
	D10L	Take part in exercise program	.204	.073	.710	.123
	D12L	Go out to public places	.192	−.023	.522	.207
	D13L	Take care of personal care	−.126	.120	.283	.597
	D14L	Take part in social activities	.117	.022	.709	.282
	D15L	Take care of local errands	.036	.200	.464	.445
	D16L	Provide meals	.011	.482	.327	.441
Management Role	D1L	Keep in touch with others	.070	.011	.270	.647
	D7L	Take care of household finances	.002	.372	.656	.062
	D8L	Take care of own health	−.119	.342	.378	.449
	D11L	Invite people for meal or entertainment	.184	−.059	.223	.554
% of variance explained			11.5	8.8	16.7	9.6

Note. Values ≥.400 indicate that the item has adequate loading on the factor.