Implementing occupation-based assessment

Feasibility of Increasing Occupation-Based Assessment Using the Knowledge to Action Framework

The Assessment of Motor and Process Skills (AMPS) is a standardized occupation-based measure; however, barriers often limit use in practice. The Knowledge to Action Framework (KTA) is one of the most widely used implementation approaches to induce practice change. The objective of the study is to examine the feasibility and acceptability of a KTA-informed intervention to increase the use of the AMPS. AMPS-trained occupational therapists were recruited through convenience sampling. Interventions included workshops, action planning, goal setting, peer support, and organizational resources. Recruitment and retention were tracked. Pre- and post-survey results of interventions' helpfulness, AMPS behaviors, and motivational changes informed acceptability. Participants (n = 5) rated 7/7 (100%) intervention strategies as helpful, reported decreased barriers and increased frequency of AMPS administration, increased resources for AMPS implementation, and improved compatibility with practice. Implementation of a KTA-informed intervention to increase AMPS practice was feasible and supported by environmental changes and peer support in a physical rehabilitation setting.

No evidence of a minimal clinically important difference for the Beery-Buktenica Developmental Test of Visual-Motor Integration in children with autism spectrum disorder

The Beery Visual-Motor Integration (VMI) battery of tests are some of the most commonly used assessments in pediatric occupational therapy, often used to measure change over time. However, the minimal clinically important difference (MCID) has not been estimated for interpreting change scores. We estimated the MCID for the Beery VMI battery of tests in children with autism spectrum disorder (ASD). Four occupational therapists collected data in a public elementary school on 64 children with ASD. The Beery VMI battery was administered to children with ASD twice, approximately 11 months apart. To estimate MCID values, Beery VMI battery scores were anchored to 15-point Likert questions measuring occupational therapists’ ratings of functional change over three domains: fine motor skills, handwriting, and activities of daily living (ADLs). Using this anchor-based method, we were unable to estimate MCID values for the Beery VMI battery. Children’s Beery VMI battery scores did not change significantly over the course of the school year, and there was only one weak correlation between VMI battery change scores and therapists’ ratings of change. The inability to estimate Beery VMI battery MCID values for children with ASD adds further support for research cautioning the use of the Beery VMI as an outcome measure.

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective

BACKGROUND/AIM

Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective.

METHOD

This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes.

RESULTS

The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity.

CONCLUSION

Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.

Use of Standardised Tests in Paediatrics: The Practice of Private Occupational Therapists Working in the United Kingdom

This study is part of a larger research investigating the assessment methods used by occupational therapists working with children in independent practice in the United Kingdom. The focus of this paper is on the use of standardised tests. The research design was a cross-sectional descriptive survey, using a postal questionnaire as the data collection tool.

Out of 89 questionnaires sent, 66 (74%) were returned and 48 (54%) were deemed eligible. The findings demonstrated that 34 (71%) of the 48 respondents used standardised tests. The most common tests used regularly were the Movement Assessment Battery for Children (79%) and the Developmental Test of Visual-Motor Integration (74%). Standardised tests were used mainly to measure outcomes. The main reason that the participants did not use standardised tests or used them cautiously was the lack of suitable tests for the client.

Most of the study's findings were consistent with those of previous studies. The limited use of occupation-centred standardised tests and the necessity of critiquing standardised tests, especially when used as outcome measures, are discussed. It is suggested that further research on whether the standardised tests contribute to or do not contribute to an occupation-centred practice would be of great value.

The Importance of Maintaining a Focus on Performance Components in Occupational Therapy Practice

Some authors have promoted the need for occupational therapists to prioritise occupation over performance components in their clinical work (Fisher 1992, Mathiowetz 1993, Trombly 1995, Baum and Law 1997, Fortune 2000, Molineux 2004). Nevertheless, there is a strong case to be made for maintaining concurrently a focus on performance components. This case is based on a review of relevant literature, which yielded three ways in which performance component functioning could be used to enhance a person's experience of occupational therapy. It is concluded that there is a sound rationale for maintaining a dual focus on occupational performance and performance components in occupational therapy practice.

Epistemological Transformation in Occupational Therapy: Educational Implications and Challenges

An epistemological analysis of occupational therapy's history opens a novel perspective on the field's evolution and on important changes facing education and practice. Kegan's theory of epistemological transformation (e.g., how ways of knowing evolve) was used as an analytic tool to reexamine mostly secondary and some primary historical sources. Although the profession's history is often portrayed in terms of large and sweeping changes, this analysis suggests that little change occurred in occupational therapy's epistemology, making it difficult for the profession to become self-defined or easily adopt occupation, participation, and health as a focus for practice, education, and research. It is also suggested that recent developments in the field are at their core epistemological developments and serve as indicators that a new way of knowing has emerged in occupational therapy that is making new demands of practitioners and educators. Further, epistemological developments can help evaluate common educational assumptions and frame new educational approaches.

Occupation-Based Practice and its Relationship to Social and Occupational Participation in Adults with Spinal Cord Injury

The objective of this study was to increase the evidence regarding the use of occupation-based practice and its effects on social and occupational participation in adults with spinal cord injury. Three individuals who had experienced a spinal cord injury 2 to 5 years previously, lived in the community, and received services from one of the two selected occupation-based occupational therapists participated in the study. Using a qualitative ethnographic design, they participated in one semi-structured, open-ended interview that contained questions designed to elicit experiences of life satisfaction, participation in meaningful occupations, social roles and responsibilities, and participation in occupational therapy. Data were analyzed using thematic analysis, narrative analysis, literature review, and narrative smoothing. Seven occupation-based approaches appeared to directly support the participants' current level of occupational and social participation. This study provides occupational therapists with a more practical understanding of how to apply these approaches in their own practices.

Living with Parkinson's and the Emerging Role of Occupational Therapy

Parkinson's disease is a chronic and increasingly complex condition, demanding multidisciplinary management. Over the last twenty years or so, alongside the growth of specialist services and healthcare teams specifically developed for people with Parkinson's, occupational therapy has grown in recognition as a treatment option, especially since evidence of its efficacy is now slowly emerging. The purpose of this work is to outline the role of occupational therapy clinical practice in the management of people living with Parkinson's disease and its emergent evidence base, combined with details of current occupational therapy philosophy and process, as applicable to occupational therapy practice for people with Parkinson's. The Canadian Practice Process Framework is used to structure this overview and was selected because it is a well-recognized, evidence-based tool used by occupational therapists and encompasses the core concepts of human occupation and person-centred practice. The framework employed allows the flexibility to reflect the pragmatic occupational therapy intervention process and so enables the illustration of the individually tailored approach required to accommodate to the complex pathology and personal, domestic, and social impacts, affecting the functioning of Parkinson's disease patients on a daily basis.

Role of sonographic imaging in occupational therapy practice

Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession's foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.

Construct validity of the functionally simulated technology task: an exploratory study

This study explored the construct validity of the Functional Simulated Technology Task (FSTT), online bill-pay version. The FSTT was administered to matched groups: persons with cognitive impairment and persons with no known cognitive impairment, established through the Montreal Cognitive Assessment (MoCA). Results indicated significance for construct validity by discriminating between the two groups. Results also indicated a good to excellent positive relationship between scores on the MoCA and the FSTT score areas of Outcome, Quality, Process, and Independence. The findings support the use of the FSTT to measure executive function using a simulated online bill-pay task.

Top-down and bottom-up approaches to motor skill assessment of children: are child-report and parent-report perceptions predictive of children's performance-based assessment results?

BACKGROUND/ AIM: Therapists use different types of tests, scales, and instruments to assess children's motor skills, including those classified as being top-down and bottom-up. The aim of the study was to investigate the ability of measures of children's motor skill performance from the perspectives of children and parents (a type of top-down assessment) to predict children's performance-based motor ability test results (a type of bottom-up assessment).

METHODS

A convenience sample of 38 children and parents was recruited from Victoria, Australia. Motor skill performance was evaluated from a top-down perspective using the Physical Self-Description Questionnaire (PSDQ) and the Movement Assessment Battery for Children--Second Edition (MABC-2) Checklist to measure children's and parents' perspectives respectively. Motor skill performance was also evaluated from a bottom-up approach using the Bruininks-Oseretsky Test of Motor Proficiency--Second Edition (BOT-2). Data were analyzed using multiple linear regression analysis to determine whether the PSDQ or MABC-2 Checklist was predictive of the children's BOT-2 performance results.

RESULTS

Two predictive relationships were identified based on parents' perspectives, where the total score of the MABC-2 Checklist was found to be a significant predictor of the BOT-2 Manual Coordination motor composite score, accounting for 8.35% of its variance, and the BOT-2 Strength and Agility motor composite score, accounting for 11.6% of its variance. No predictive relationships were identified between the children's self-report PSDQ perspectives and the BOT-2 performance scores.

CONCLUSIONS

Therapists are encouraged to utilize a combination of top-down and bottom-up approaches and purposefully to seek parents' and children's perspectives when evaluating children's motor skill performance.

Standardized tests of handwriting readiness: a systematic review of the literature

AIM

To establish if there are psychometrically sound standardized tests or test items to assess handwriting readiness in 5- and 6-year-old children on the levels of occupations activities/tasks and performance.

METHOD

Electronic databases were searched to identify measurement instruments. Tests were included in a systematic review if: (1) participants are 5 and 6 years old, (2) the focus was on handwriting readiness, and (3) the measurement was standardized. In the second step a further electronic search was undertaken for selected relevant measurement instruments to evaluate the content, psychometric properties, and feasibility of these instruments.

RESULTS

The search identified 1113 citations. In the final selection 39 articles with information about 12 tests were included. The content, feasibility, and psychometric properties of these 12 tests were evaluated and none of the instruments was satisfactory, according to the specific criteria.

INTERPRETATION

None of the instruments include all necessary components to evaluate writing readiness. Therefore, the development of an all encompassing assessment is necessary to test handwriting readiness and to make tailored interventions possible.

Examining Content Validity and Reliability of the Assessment of Children’s Hand Skills (ACHS): A Preliminary Study

OBJECTIVE. We developed the Assessment of Children’s Hand Skills (ACHS) to evaluate hand skills using naturalistic observation and examined the assessment's interrater and test–retest reliability.

METHOD. We developed the hand skill framework, performed expert review, and pilot tested the ACHS. The ACHS's reliability was examined by recruiting 54 children (30 typically developing children and 24 children with disabilities).

RESULTS. The test–retest reliability for the ACHS was satisfactory at the individual item level (0.42 ≤ κ ≤ 0.79) and the total scale level (Spearman’s ρ = 0.78, p < .01). Moderate interrater agreement of the total scale scores was demonstrated (ρ = 0.63, p < .01), but individual items exhibited varied interrater agreement.

CONCLUSION. The ACHS demonstrated adequate content validity and preliminary reliability evidence and could be used to quantify children’s hand skill use. Construct validity should be established in a clinical setting.

Work-related hand injuries: Case analyses in a Brazilian rehabilitation service

PURPOSE

Professionals who work with rehabilitation of the hand usually assess performance components as their main outcome measures. Intervention is aimed at normalization of deficits of these components, with the expectation that the integrity of the structures and functions of the body will revert to improvements in the client's functional performance. The objectives of this study were to describe changes in patients who received rehabilitation in a Brazilian public hospital after having suffered hand injuries due to workplace accidents, and to examine the relations between performance components and levels of functioning.

METHODS

Observational cross-sectional study was used. A convenience sample was selected, including 42 patients assessed at service admission and at discharge. Assessed characteristics included grip strength, wrist and finger range of movement (ROM), sensitivity, and self-perceptions of functional performance (COPM). Statistical procedures included correlations between performance components and COPM scores and differences on selected variables at admission and discharge.

RESULTS

Significant improvements in all assessed functional components. COPM values increased more than 100% after intervention (effect size d = 1.996 for performance and d = 1.553 for satisfaction) demonstrating improvements in both domains. Low correlations between grip strength and COPM scores were found only at admission (r = 0.314; p = 0.045). When the relationship between gains in strength and COPM scores at discharge were examined, significant correlations were found with the performance (r = 0.324; p = 0.039) and satisfaction (r = 0.0326; p = 0.038) subscales.

CONCLUSIONS

Results of this study provide evidence for functional gains in clients treated in a rehabilitation service and supply information about the relation between specific components and functional performance.

Using Theory to Underpin an Integrated Occupational Therapy Service through the Canadian Model of Occupational Performance

The aim of this action research study was to embed the theoretical tenets of the Canadian Model of Occupational Performance and its structures in a way that was appropriate to, and would be used by, all staff within an integrated health and social care setting. The action research involved 10 phases of reflection and action, with data analysis occurring between the cycles.

The findings showed the importance of taking time to embed theory before implementing model structures in order to prevent those structures, and particularly the paperwork, becoming superficial. In addition, the importance of using theoretical structures (models) flexibly and adapting them to particular services was identified.

A more generally applicable finding was that occupational therapists can and should demonstrate their theory through their practice and that this can be done by using a model to illustrate their clinical and, more specifically, their conditional clinical reasoning (Mattingly and Fleming 1994). In addition, the demonstration of clinical reasoning proved vital in making the client-centred and occupational beliefs of the model overt.

It was concluded that implementing theory and using occupation-based literature (Williams and Bannigan 2008) in this way can take a long time but is worthwhile because it provides a sound and strong base for the profession's identity.

Development of a standardized occupational therapy screening tool for visual perception in adults

Occupational therapy assessment and treatment of visual perceptual impairments are integral to the rehabilitation of clients following stroke and other acquired brain injuries. Occupational therapists need to identify the nature of visual perceptual performance impairments in order to choose rehabilitation intervention strategies appropriate for remediation of specific problems or to compensate for limitations in daily function. This paper describes the variations in visual perception terminology and occupational therapy approaches to visual perceptual assessment. Limitations of existing assessment tools for visual perception are highlighted in terms of reliability, validity, normative information, length of time to administer, and comprehensiveness in screening for visual perceptual impairment. In response to these limitations, a battery of items, called the Occupational Therapy Adult Perceptual Screening Test (OT-APST) was selected to screen adults comprehensively for impairments of agnosia, visuospatial skills including body scheme and neglect, constructional skills, apraxia, and acalculia. It also includes a subtest to evaluate functional skills directly observed during screening. This new battery has established reliability, validity and age-stratified normative data for adults 16 to 97 years of age. The OT-APST is recommended for use in conjunction with observational assessment of activities of daily living for clients with stroke and acquired brain injury.