Evaluating the validity, reliability and acceptability of a seated postural assessment tool for older people with restricted mobility in care homes (The HARP Study)


Care home residents are frail, with co-morbidities that result in a range of symptoms including increased disability and pain. Care home staff are often unaware of the importance of good posture and seating (e.g. the importance of trunk alignment and chair dimensions) in all aspects of care (e.g. influence on eating, respiration, pain and pressure areas). We developed a posture and mobility training package for staff, the feasibility of which was evaluated in the PATCH trial (<<insert link to PATCH trial profile>>). Before commencing the PATCH trial a comprehensive search of the literature was undertaken to identify a method of assessing residents’ posture and seating, but no appropriate tools could be found.

Through detailed iterative work, the PATCH research team (including physiotherapists, researchers and care staff), developed a 9-item Postural Assessment Tool (PAT), which is completed by observation.  The PAT was administered by researchers with over 100 residents who participated in the PATCH trial. Informal feedback from researchers and residents indicated acceptability. This study directly builds on the initial development of the tool, involving a formal evaluation of validity, reliability and wider acceptability of the PAT. 

The aim of this project is to evaluate the validity, reliability and acceptability of the Postural Assessment Tool (PAT), initially developed for use in the PATCH trial to facilitate assessment of seated posture in care home residents with restricted mobility. 


  1. Refine the PAT (content and clarity) following scrutiny of data from the existing PAT dataset collected during the PATCH trial. 

  1. Review the content and face validity of the provisionally developed PAT via independent expert physiotherapists review, and refine further as required. 

  1. Explore ease of use and acceptability of the refined PAT with care home staff members of the lay group prior to finalising the tool for validity and reliability testing. 

  1. Develop a short training package for non-experts (e.g. care staff) to include awareness of posture and how to use the PAT. 

  1. Assess concurrent validity of the PAT: by expert clinical assessment of posture using a body chart assessment against non-expert rating of posture using the PAT. 

  1. Assess inter-rater reliability of the PAT i.e. agreement on scores between dyads of trained non-experts. 

  1. Evaluate acceptability to non-expert users and residents, and the potential for integration of the PAT into everyday care practice in care homes. 


Data from the existing PAT dataset collected as part of the PATCH trial will be scrutinised (e.g. to identify items with high levels of missing data) to improve content and clarity. The content and face validity of the provisionally developed tool will be reviewed via independent expert physiotherapists’ review. The opinions of stakeholders e.g. carers and care home managers will be sought during this process to ensure acceptability of the tool for potential users and the tool will be iteratively refined for content and clarity. 

A short training package for non-experts (e.g. care staff) to include awareness of posture and how to use the tool will be developed. 

To assess concurrent validity, experts (physiotherapists) will undertake clinical assessment of residents’ seated posture using a body chart assessment which will be compared to the PATs completed simultaneously by trained non-experts. 

Inter-rater reliability will be assessed by completion of the PAT by dyads of non-experts, and agreement between scores analysed. 

An evaluation through qualitative and ethnographic methods (observations, interviews and informal conversations) will be undertaken with non-expert users (care staff) and residents to gain insight into the acceptability of the refined tool, as well as its potential for use in every day practice in care homes. 

For further information contact Professor Anne Forster (a.forster@leeds.ac.uk) or Liz Graham (liz.graham@bthft.nhs.uk) Telephone: 01274 383443