MELVILLE-NELSON

SELF-CARE ASSESSMENT(SCA)
N ATA L I E M . N O S S & J E S S I C A A . S C O T T

ASSESSMENT INFORMATION
Publication Information
Free download from University of Toledo Occupational
Therapy Department website
http://www.utoledo.edu/healthsciences/depts/rehab_sciences
/ot/
melville.html

Assessment Type
Standardized assessment
Limitations

Criterion referenced
Identifies the presence or absence of supports or assistance
needed to perform an occupation of daily living (ODL)

MELVILLE-NELSON SELF-CARE
ASSESSMENT (SCA) DETAILS
Purpose
To objectively measure and assess a patients abilities to
complete self-care tasks while in a skilled nursing facility
(SNF) or sub-acute rehabilitation facility
(Nelson & Melville, 2001)

Development of the SCA

Developed in 2001 by David Nelson and Lisa Melville from
the University of Toledo
Minimum Data Set (MDS) federally mandated assessment in
long-term care facilities
OTs primarily use self-care section of MDS

Self-care section needed to be more in depth for OTs to

appropriately assess the needs of their patients
(Nelson & Melville, 2002)

SCA CHARACTERISTICS
ODLs

Bed Mobility
Transfers
Dressing
Eating
Toilet Use
Personal Hygiene
Bathing

O
DL
s
Suboccupations
Sub-suboccupations

(Melville & Nelson, 2001)

SCA CHARACTERISTICS
ODL: Eating
Sub-occupations

Sub-suboccupations

Finger food

Grasp

To mouth

Open mouth

In mouth

Utensil

Grasp

Scoop

To mouth

In mouth

Drink

Grasp

To mouth

Sip

Set down

(Melville & Nelson, 2001)

POPULATION
Intended
Patients within SNFs and sub-acute rehabilitation facilities
who receive OT services

Alternative Populations
Any individual who presents with limitations when
completing any of the seven ODLs discussed within the
SCA manual would be an appropriate patient to assess

Retrieved from http://www.tektone.com/skillednursing.php

USER QUALIFICATIONS
Familiarity with Population & Setting
Adult population and common diagnoses that are seen at
SNFs and sub-acute rehabilitation facilities
Therapeutic rapport is sufficient to elicit the appropriate
responses from the patients
Familiar with DME and AE
Patient and caregiver goals and treatment plan

Specific Qualifications to Administer

Licensed occupational therapist working in sub-acute
rehabilitation and SNFs
Skilled in observation, activity analysis, and clinical
reasoning

CLINICAL UTILITY
Availability of Test
& Ease of Use
Free of charge
Scoring examples
Manageable length

Time Needed
30-26 minutes
Dependent on
competence of the
OT
The patient
Experience with
SCA

Learning the Test

Read through the manual a
couple of times
Practice trials
Review and understand
support score

CLINICAL UTILITY
Format
Observation based

Administration and Test Procedures

Observing the patient perform or attempt to form the listed
ODLs

Response Format
Observation and checklist scales

SCORING THE SCA

Self-performance Scores
Measure what the patient actually did
Independent-patient is able to complete all subtasks
independently.
Needs assistance-any verbal cueing, oversight,
encouragement, or hands on physical assistance.
Place a check mark under each subtask that any physical or verbal
assistance was required
Count the total number of check marks

*Cross out irrelevant items

(Melville & Nelson, 2001)

SCORING THE SCA

Support Scores
The maximum amount of support provided to the patient
by staff for each ODL category.

Support
Score

Description

No set up or physical help

Set up only

2a

Contact guard assist

2b

Active heavy lifting

Two + persons physical assist

Activity did not occur

(Melville & Nelson, 2001)

INTERPRETATION
Detailed scoring page
The higher the self- performance score the
greater the level of dysfunction

Retrieved from http://cdn2.hubspot.net/hub/149308/file27224979pg/images/navigator_final_rule_assistors.jpg?

t=1373997830000

SETTINGS, TOOLS, AND MATERIALS

Settings
Intended for use in SNFs
and sub-acute
rehabilitation facilities

Tools and Materials

Manual
Evaluation score sheet
The patient
Necessary supplies

DOCUMENTATION ON SCA
Description on Technical Manual
Overview page
Detailed descriptions of self-performance and support
scales
Score sheet
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DOCUMENTATION ON SCA
Published Critique
Constructs included holism, client-centered practice, dynamic
interaction, uniqueness of the individual, and uniqueness of
performance
SCA ranked 6th out of the 18 ADL measures rated by the researchers
Did not meet criteria for holism
Client-centered
Dynamic interaction
Uniqueness of the individual
Uniqueness of performance

(Klein et al., 2008)

DOCUMENTATION ON SCA
Peer reviewed article
Study conducted by Nelson et al. (2002) investigating the
psychometric properties of the SCA.
68 participants were utilized based on their availability to be
tested at both admission and discharge.
The purpose was to explore the

Inter-rater reliability
Responsiveness to change
Concurrent validity with the FIM and the Klein-Bell ADL scale
Predictive validity

Research teams consisted of OTs and OT graduate students

Limitations
(Nelson et al., 2002)

PSYCHOMETRIC PROPERTIES
Interrater Reliability
Each team of raters (one OT and one OT graduate student)
independently rated their group of participants on the SCA.
Self-performance scores had excellent inter-rater reliability
with a mean intraclass correlation coefficient (ICC) of .94
Bathing ODL as the highest ranked
Inter-rater reliability for the 7 support scores ICCs to be in the
almost perfect range

(Nelson et al., 2002, p. 55)

PSYCHOMETRIC PROPERTIES
Concurrent Validity
Self-performance scores
Correlated the variables of the SCA to relevant items of the FIM and
Klein-Bell scale
The total performance score for the SCA was highly correlated with the
relevant items of the Klein-Bell scale and the FIM
The areas of bathing, personal hygiene, and eating were the lowest
correlated items

Support Scores
All areas were correlated between the SCA and Klein-Bell scale
Areas of bathing and personal hygiene was the lowest correlated with
the FIM areas at less than .50 Spearmans rank correlation coefficient
(rho)

(Nelson et al., 2002)

PSYCHOMETRIC PROPERTIES
Responsiveness to Change
Highly responsive to change in scores from admission to discharge
Changes were greatest in the areas of dressing, toileting, and
transfers for both self-performance and support scores

Sensitivity
Sensitivity is displayed because the scores identify if a patient is
experiencing dysfunction in performing self-care tasks

Specificity
Specificity is illustrated through identifying patients who do not
need support in completing certain self-care tasks, based on their
low self-performance scores and support scores

(Nelson et al., 2002)

PSYCHOMETRIC PROPERTIES
Predictive Validity
Correlations between
The SCA total self-performance scores at discharge
Mean duration of caregiving time the patients received daily
The sum of all relevant FIM and Klein-Bell items and the total FIM and Klein-Bell scores

Results
Results indicated that the SCA total self-performance scores at discharge were a
significant predictor of the amount of time the patients required caregivers once home
Results also indicated that the discharge SCA total self-performance scores were
significant predictors of the patients levels of function at home as measured by KleinBell and FIM scales
SCA self-performance and support scores for toilet use was the best predictor of
caregiving time required post-discharge

(Nelson et al., 2002)

STUDENT CRITIQUE
Strengths
Organization of items
Sub-occupations & subsuboccupations

Bed mobility ODL

Functional ambulation and
transfers within the ODL

Limitations
Lack of research
Creation of assessment
Many inferences
Organization of items

RECOMMENDATIONS/CHANGES
Revision
With OT feedback

Detailed exceptions
Standardized materials

User qualifications listed in manual

CONCLUSION
Easily accessible
User friendly
The reviewers recommend the SCA as a useful
ADL assessment, but caution OTs to consider the
limitations prior to utilizing

QUESTIONS?

REFERENCES
Klein, S., Barlow, I., & Hollis, V. (2008). Evaluating ADL measures from an occupational therapy
perspective. Canadian Journal of Occupational Therapy, 75 (2), 69-81. doi:
10.1177/000841740807500203
Luebben, A. J., & Royeen, C. B. (2010). Nonstandardized testing. In J. Hinojosa, P. Kramer, &
P. Crist (Eds.), Evaluation: Obtaining and interpreting data (3rd ed., pp.157-178).
Bethesda, MD: AOTA Press.
Nelson, D. L., & Glass, L. M. (1999). Occupational therapists involvement with the Minimum
Data Set in skilled nursing and intermediate care facilities. American Journal of
Occupational Therapy, 53, 348-352. doi:10.5014/ajot.53.4.348
Nelson, D., & Melville, L. (2001). Melville-Nelson Self-Care Assessment. Retrieved from
http://www.utoledo.edu/healthsciences/depts/rehab_sciences/ot/pdfs/sca_overview.pdf
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, 51-59. doi:10.5014/ajot.56.1.51
Pierce, S. L. (2008). Restoring mobility. In M. Radomski & C. Trombly-Latham (Eds.),
Occupational therapy for physical dysfunction (6th ed., pp. 818-853). Philadelphia:
Lippincott Williams and Wilkins.
The University of Toledo. (2013). Melville Nelson Evaluation System. Retrieved from
http://www.utoledo.edu/healthsciences/depts/rehab_sciences/ot/melville.html

DEMONSTRATION