Reliability and validity testing of the overt agitation severity scale
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Agitation, as conventionally conceptualized and utilized by health professionals, is a commonly occurring, highly-disabling set of emotions and behaviors. The immediacy, unpredictability, and intermittence of symptoms present safety and manageability issues for families and caregivers. A broad range of incidences may be accounted for by inconsistencies in the nosology, measurement, and biopsychosocial conceptualizations of agitation leading to the misinterpretation of data, and consequently, ineffective and variable treatment practices. Varying rating scales, which purport measuring agitation, blur its boundaries with psychiatric diagnoses such as anxiety, mood, and other disorders that may or may not be secondary to general medical conditions. The study proposed that agitation be conceptualized non-diagnostically by utilizing the observable behaviors outlined in the Overt Agitation Severity Scale (OASS), which, if present, would alert clinicians to search for the specific underlying disorder(s) that elicit the agitation. This study tested the reliability and validity of the Overt Agitation Severity Scale (OASS). Agitated and nonagitated subjects were examined and scored on the OASS. Internal consistency and equivalence reliability as well as content and construct validity were examined. The results established the reliability and validity of the OASS in measuring agitation severity in adults aged 19-85 years based on objectifiable vocalizations and motoric upper and lower body behaviors. The OASS demonstrated sensitivity to rate agitation intensity and severity. The OASS differs from other agitation scales in that it confines its rating exclusively to observable behavioral manifestations of agitation, as opposed to subjective inferences and a diffuse range of symptoms and problem behaviors. Having an instrument, which assists in the successful identification and measurement of agitation for clinicians, enhances the ability to quantify the evaluation of successful environmental modifications, interpersonal strategies, psychopharmacological interventions, as well as the use of physical or chemical restraints. The objective interpretation of agitation will lead to more appropriate interventions for the management of these types of highly problematic behaviors.