Development and Psychometric Properties of the Home Programme Quality Evaluation Tool for Therapists, Clients and Caregivers: A Validity and Reliability Study

Abstract

Background/Aims Home programmes - where rehabilitation activities are carried out in the client's home - are frequently used in the rehabilitation process but there are no standardised measurements to assess preparation, delivery and quality. The aim of this study was to determine the validity and reliability of two different forms - one for therapists and one for client and caregivers - that were developed as part of the Home Programme Quality Evaluation tool. Methods Initially, two 38-item forms were created based on a comprehensive literature review and expert panel evaluation. These forms were piloted with 30 participants from each target group to assess grammatical clarity, comprehensibility and cultural appropriateness. Based on the pilot feedback, minor linguistic adjustments were made, and the refined 38-item forms were then administered to 179 physiotherapists, occupational therapists and speech and language therapists, and 185 clients/caregivers (100 clients, 85 caregivers) for psychometric analyses. Psychometric analyses were conducted to evaluate validity and reliability, including exploratory and confirmatory factor analyses (chi-square/degree of freedom ratio, Goodness-of-Fit Index, Tucker-Lewis Index, Comparative Fit Index, Incremental Fit Index, root mean square error of approximation, standardised root mean square residual and internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient and Pearson correlation). Results Exploratory and confirmatory factor analyses supported a one-factor structure for both forms, resulting in the final 11-item therapist form and 8-item client/caregiver form. The Home Programme Quality Evaluation tool demonstrated a good model fit for both forms (therapist form: chi(2)/df=2.66, goodness-of-fit index=0.909, Tucker-Lewis Index=0.886, standardised root mean square residual=0.060; client/caregiver form: chi(2)/df=3.37, goodness-of-fit index=0.929, Tucker-Lewis Index=0.950, standardised root mean square residual=0.027). Cronbach's alpha was 0.868 for the therapist form and 0.932 for the client/caregiver form. Test-retest reliability revealed strong positive correlations (r=0.994, P<0.001; r=0.998, P<0.001) and excellent stability over time (intraclass correlation coefficient=0.998 and 0.990, respectively). Conclusions The Home Programme Quality Evaluation's therapist and client/caregiver forms were found to have strong validity and reliability. The therapist form can enable therapists to monitor themselves, while the client and caregiver form can help clients or caregivers provide feedback on the home programme. Future studies can explore its application across different clinical populations and rehabilitation settings to further refine and optimise home-based interventions. Implications for practice For allied health professionals, the Home Programme Quality Evaluation tool serves as a practical tool for improving home programme design and implementation. By systematically assessing home programme quality, therapists can identify areas for improvement, ensuring that programmes are clear, feasible and well-integrated into the daily life of clients and their caregivers. Integrating the Home Programme Quality Evaluation tool into routine clinical practice can contribute to more effective rehabilitation outcomes, promoting structured, high-quality home programmes that align with the needs and capabilities of both clients and caregivers.