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.
106
60-90 minutes
Adult
18 - 64
yearsElderly
65 +
yearsInitially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Weronika Zuczek, Nancy Vong, and Keriakoula Andriopoulos
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.
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)
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)
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)
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.
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)
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.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.