A randomized clinical trial using an educational intervention demonstrated no effect on interobserver agreement on assessments of functional status

AIM: To evaluate the effect of an educational intervention on interobserver agreement of assess-ments of functional status performed by registered nurses and care assistants in a nursing home and to compare interobserver agreement in persons with and without cognitive impairment. BACKGROUND: High accuracy of assessments of functional status in care settings for older persons is needed for the efficacy of the planning and the evaluation of the nursing care. METHOD: Randomized clinical trial. Six registered nurses and six care assistants were randomized to participate in an educational session about assessment instruments for functional status (intervention) or in a session about falls in the elderly (control). Each of the registered nurses and care assistants performed assessments on the same thirty-four residents using the Belgian Evaluation Scale (BES) and the AGGIR instrument. The kappa statistic (κ) for multiple observers (and its 95% confidence interval) was the main outcome measure. FINDINGS: At baseline, interobserver agreement for BES total score was: κ = 0.43 (0.35-0.51) in the intervention group and κ = 0.48 (0.39-0.57) in the control group. At the second assessment, agreement measures were: κ = 0.48 (0.41-0.57) in the intervention group and κ = 0.58 (0.50-0.66) in the control group. Results for AGGIR total scores were similar. CONCLUSION: Interobserver agreement of assessments on nursing home residents was moderate and did not improve significantly after an educational session.