Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM)

INTRODUCTION

The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation.

METHODS

A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed.

RESULTS

A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury.

CONCLUSION

Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3 months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.

Measurement of Self-regulation in Preschool and Elementary Children: A Scoping Review

AIMS

This scoping review sought to identify and characterize measurement of self-regulation in preschool and elementary aged children.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (ScR) guidelines were applied. Databases from the fields of allied health, education, medicine, and social sciences were searched including: CINAHL, Education Database (ProQuest), Education Research Complete, EMBASE, ERIC, iNFORMIT Combined, Medline, PsychINFO, Social Sciences (ProQuest), Teacher Reference Center, and Web of Science. Articles published between 2015 and 2020 were included. Dual review was utilized at all stages and a third reviewer resolved any conflicts.

RESULTS

Sixty-seven studies were included in this review. A range of observational, self-report, teacher report, caregiver report, and observational measures of self-regulation were identified. Included studies were primarily published in education and psychology disciplines, with no studies by occupational therapists identified.

CONCLUSIONS

Although a range of measures were identified in this scoping review, the results highlight the lack of consensus regarding self-regulation measurement that occupational therapists use to design and implement therapy programs to address child emotional and behavioral needs.

Validity and reliability of the Occupational Experience Profile

BACKGROUND

This study was designed to evaluate the psychometric properties of a new tool, the Occupational Experience Profile (OEP). The OEP was designed to be used to evaluate people's levels of experiences of pleasure, productivity, restoration, and social connection during their occupational performances.

AIM

To evaluate aspects of validity and reliability of the OEP Pleasure, Productivity, Restoration and Social connection scales.

METHODS

Fifty-eight occupational therapy students each completed three OEPs. Many-faceted Rasch analyses were then used to examine rating scale structure, dimensionality, and reliability of each OEP scale. Pearson product moment correlations were used to evaluate the strength of the relationships among the four scales.

RESULTS

Each of the four OEP rating scales demonstrated effective rating scale functioning. The OEP items on each scale demonstrated acceptable levels of item goodness of fit and worked together to define a unidimensional scale of occupational experiences. The four scales appear to measure different but interrelated constructs.

CONCLUSION

The results provide preliminary evidence to support the validity and reliability of the OEP scales, but further research on larger and more diverse samples is recommended.

SIGNIFICANCE

The OEP has the potential to be used in occupational therapy practice and research to evaluate how people experience their occupational performances.

Concurrent validity and precision of the thumb disability examination (TDX) in first carpometacarpal osteoarthritis

STUDY DESIGN

A descriptive psychometric study of precision and concurrent validity of the Thumb Disability Examination (TDX).

INTRODUCTION

Thumb carpometacarpal osteoarthritis (CMC OA) is a painful joint condition impacting the functionality of the hand. Therapists use patient-reported outcome measures to evaluate change in disability and symptomology in response to interventions. The TDX is the only condition-specific outcome measure for persons with thumb CMC OA. Its responsiveness, test-retest reliability and concurrent validity with the DASH are published, yet it's precision and concurrent validity with a hand-region-specific tool has not yet been established.

PURPOSE OF THE STUDY

We aimed to determine the precision and concurrent validity of the TDX with a region-specific outcome measure in people with thumb CMC OA.

METHODS

Sixteen individuals with a medical diagnosis of CMC OA or a positive pressure-shear test completed the TDX across two visits and the Brief Michigan Hand Questionnaire (bMHQ) at the initial visit. The second visit was 7 to 21 days after the first. Self-administration of the TDX and bMHQ were observed by a licensed occupational therapist.

RESULTS

Across total and subscale scores of the TDX, standard error of measurement (SEM) values are used to indicate the precision of tool and demonstrate how confident a user can be that change in score exceeds the error inherent to the tool. Minimal detectable change percentage (MDC%) values for the TDX are acceptable (<30%). The TDX demonstrated high concurrent validity with the bMHQ (r_s = -0.733; P = .001).

DISCUSSION

Precision of the TDX is acceptable and the concurrent validity of the TDX with a commonly used region-specific scale is high. The study was limited by a small, demographically homogeneous sample due to difficulty in recruitment.

CONCLUSIONS

The TDX is a precise and valid outcome measure for individuals having a clinical diagnosis or indications of having thumb CMC OA.

Impact of occupational therapy in an integrated adult social care service: Audit of Therapy Outcome Measure Findings

Purpose

Health and social care services should demonstrate the quality of their interventions for commissioners, patients and carers, plus it is a requirement for occupational therapists to measure and record outcomes. Use of the “Therapy Outcome Measure” (TOMs) standardised tool was implemented by an occupational therapy adult social care service to demonstrate outcomes from April 2020, following integration to a community NHS Trust.

Design/methodology/approach

The aim was to demonstrate occupational therapy outcomes in adult social care through a local audit of the TOMs. The objective was to determine if clients improved following occupational therapy intervention in the four domains of impairment, activity, participation and wellbeing/carer wellbeing. 70 cases were purposively sampled over a 2-month timeframe, extracting data from the local electronic recording system.

Findings

Occupational therapy in adult social care clearly makes an impact with their client group and carers. Evidence from the dataset demonstrates clinically significant change, as 93% of clients seen by adult social care occupational therapy staff showed an improvement in at least one TOMs domain during their whole episode of care. 79% of activity scores, 20% of participation scores and 50% of wellbeing scores improved following intervention. 79% of carer wellbeing scores improved following occupational therapy.

Research limitations/implications

The audit did not collect data on uptake from the separate teams (equipment, housing, STAR and adult social care work) in occupational therapy adult social care. Potential sampling bias occurred as cases with completed scores only were purposively sampled. Sampling was not random which prevented data gathering on uptake of TOMs across the separate teams. Additionally, the audit results can only be applied to the setting from which the data was collected, so has limited external validity.

Originality/value

These novel findings illustrate the valuable and unique impact of occupational therapy in this adult social care setting. The integration of adult social care into an NHS Community Trust has supported the service to measure outcomes, by utilising the same standardised tool in use by allied health professions across the Trust.

Decision-making aids for upper limb interventions in neurological rehabilitation: a scoping review

PURPOSE

To summarise the range and nature of decision-making aids that guide upper limb (UL) neurorehabilitation.

METHODS

Our scoping review followed Arksey and O'Malley's 6-step framework. Electronic databases were systematically searched; grey literature was hand-searched. Included papers were: (1) published in English; (2) related to UL rehabilitation for people with upper motor neuron conditions; and (3) provided a description of, or research on, a decision-making aid that guides therapists when choosing between two or more intervention approaches, techniques, or applications of a technique. Levels of evidence were rated. An expert panel of occupational therapists working in UL neurorehabilitation was consulted.

RESULTS

The 24 included articles described 15 decision-making aids with varying breadth and depth of the assessment process and suggested interventions. Six aids had published research, but lacked high quality evidence. The expert panel identified four key decision-making aids as being clinically useful. Preferred aids either included client-centred goal-setting within a holistic assessment or matched specific intervention options to distinct UL assessment results. Prompts to re-evaluate client performance are desirable.

CONCLUSION

Few decision-making aids guide therapists to holistically assess and make specific intervention decisions across all domains of UL neurorehabilitation. Their usefulness depends on the purpose, setting, and therapist experience.Implications for rehabilitationConsidering the complexity and heterogeneity of upper limb (UL) neurorehabilitation, a selection of evidence-based and purpose-designed decision-making aids may assist therapists across different experience levels and practice settings to choose individualised interventions.Decision-making aids for UL interventions in neurorehabilitation may be more clinically useful if they include a holistic and client-centred information gathering process that focuses on daily life goals.Decision-making aids should illustrate a clear clinical picture based on UL assessment results, with corresponding UL intervention recommendations provided.Inclusion of a cyclic process to re-evaluate client performance and function could also enhance the usefulness of a decision-making aid.

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

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.

Examining the Evidence Base for Occupational Therapy with Clients following Stroke

In order to conduct occupational therapy services that are evidence based, studies are urgently required which demonstrate the effectiveness of interventions offered. This paper presents the findings of a study undertaken to determine occupational therapy outcomes for clients with stroke during inpatient rehabilitation.

The participants were 43 clients with stroke and four occupational therapists. Therapy outcomes for personal activities of daily living were measured using the Functional Independence Measure (Adult FIMSM); instrumental activities of daily living were measured using the Assessment of Living Skills and Resources (ALSAR); and quality of life was measured using the Quality of Life Index (Q-L Index) and a semi-structured interview. The semi-structured interview was also used to understand clients' perceptions of the outcome of their participation in occupational therapy. The data were collected at client admission, discharge and 3 months' follow-up.

The results indicated that the clients believed that their ability to perform activities of daily living (Adult FIMSM t (38) = −7.80, p = 0.000, and ALSAR t (35) = 4.82, p = 0.000) and their quality of life (Q-L Index t (39) = −7.23, p = 0.000) improved over the course of their inpatient rehabilitation. The therapists also rated the clients as improving during their rehabilitation in relation to activities of daily living (Adult FIMSM t (42) = −9.71, p = 0.000, and ALSAR t (40) = 7.75, p = 0.000) and quality of life (Q-L Index t (39) = −11.20, p = 0.000). Many of the clients interviewed attributed these gains to participation in the occupational therapy programme.

In conclusion, this study demonstrated that a triangulated approach to data collection and analysis was useful in providing evidence that occupational therapy, as part of comprehensive rehabilitation, made a difference to the lives of many of the clients studied.

Organisational Change and Occupational Therapy

Major restructuring of health care services has meant changes in service delivery, organisational structures and work practices. There has been a significant impact on the roles and responsibilities required of health care professionals in the current health care environment. The literature reveals that this often brings about conflict between professional values and organisational values. Although many of the current changes in health care are compatible with the philosophy of occupational therapy, there are policy and organisational factors that have an impact on occupational therapy practice and service delivery.

In this article, the emerging characteristics of the contemporary health care environment are identified and the strengths and weaknesses of the profession in adapting to this environment are discussed. It is argued that the survival and growth of the profession are dependent on the extent to which it is able to capitalise on strengths, overcome weaknesses, articulate its overall purpose and function and redefine its role and scope of practice in order to meet changed societal and organisational demands.

Upper Limb Sensation in Children with Congenital Limb Deficiencies: Implications for Function and Prosthetic Use

Little is known about sensation in children with upper limb congenital deficiencies. Is sensation different in the deficient limb? If so, does sensation influence function and determine whether or not a prosthesis is used? This study was undertaken to measure sensation in children with transradial congenital limb deficiencies and to explore possible associations with function and prosthetic use.

Twenty-four children and adolescents were evaluated on touch pressure and kinaesthesia measurement tools. The participants' parents were required to rate their child's performance on everyday functional activities and, where appropriate, report on their child's patterns of prosthetic use. The results revealed that most participants had better touch pressure sensation at the stump circumference of the deficient limb, not only compared with the same level on the intact limb (p = 0.06) but also compared with the hand (p = 0.008). All the participants demonstrated perfect scores for kinaesthetic awareness for both limbs. No strong association was found between touch pressure and performing functional activities or prosthetic use patterns.

This study is an important contribution to understanding upper limb sensation in children with congenital limb deficiencies and the implications for function and prosthetic use. Further research involving multiple centres would provide an adequate sample size to explore more fully sensation in children with congenital upper limb deficiencies and its possible association with function and prosthetic use.

Challenges to Measuring Outcomes in Occupational Therapy: A Qualitative Focus Group Study

The aim of this study was to explore the process used by occupational therapists to measure the effect of their interventions. A second aim was to explore the challenges associated with this process. Stroke rehabilitation was chosen as the focus for the study.

This qualitative study was conducted in Sydney, Australia. Ten occupational therapists from both hospital and community-based services participated in one of three focus groups. The data were analysed using constant comparison techniques.

The participants struggled when describing the process used to measure outcomes. They focused more on the challenges to measuring outcomes, which were described as focusing on occupation, deconstructing occupation and lacking knowledge, skills and assistance.

The participants in this study had difficulty in articulating and setting measurable goals linked to interventions. As a result, they could not easily select appropriate outcome measures. Education is needed to help such occupational therapists to develop the required skills and to begin to measure clinical outcomes. Further research should determine if similar experiences and challenges are faced in other areas of practice and by occupational therapists in other countries.

Measuring Outcomes using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT): Data Description and Tool Sensitivity

Although there is increasing demand for greater accountability from occupational therapists for the outcomes of their practice, there are few quick, simple and psychometrically sound tools available to measure these outcomes. This paper reports on the first data collection exercise using a new outcome measure, the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). The aims of this paper are to present the scales, describe the data set and examine whether the scales are sufficiently sensitive to detect change over time in client status.

Data were collected with 466 clients at 12 metropolitan and rural health care facilities using the 12 AusTOM-OT scales, which rate the client in relation to the four domains of Impairment, Activity limitation, Participation restriction and Distress/wellbeing. The findings indicated that the most frequently used scales were Self-care, Upper limb use, Transfers and Functional walking and mobility, and that all scales were successful in demonstrating statistically significant client change over time.

The AusTOMs-OT can be used to document client outcomes in relation to four important practice domains and thus be of value in research and quality assurance activities seeking to provide evidence that occupational therapy does make a difference to the lives of clients.

Functional Assessments Used by Occupational Therapists with Older Adults at Risk of Activity and Participation Limitations: A Systematic Review

Introduction

The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults.

Methods

A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria.

Results

Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population.

Conclusions

The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary.

The psychometric properties of the Arabic version of the Satisfaction with Daily Occupations

Introduction

There is a shortage of tools designed for use by occupational therapy practice in Arabic-speaking countries. The purpose of this study was to translate and cross-culturally adapt the original Satisfaction with Daily Occupations tool to Arabic and assess the psychometric properties of the adapted tool.

Method

A cross-cultural adaptation process was performed. Face, content, and criterion validity were examined, as well as internal consistency and test–retest reliability. The study included 147 healthy adults and 73 patients with cerebrovascular accident. They were purposefully selected from two countries (Kuwait and Jordan).

Results

The adapted tool comprised six domains and a total of 14 items. Face and content validity were established through prolonged content analysis. Criterion validity was indicated by significant differences between the healthy and the cerebrovascular accident group in all areas of the Satisfaction Daily Occupations scale ( p < 0.001). Satisfactory overall internal consistency (α = 0.77) and good test–retest reliability for the total satisfaction score for the healthy (inter-class correlation coefficient (ICC) = 0.984) and the cerebrovascular accident group (inter-class correlation coefficient (ICC) = 0.933) were found.

Conclusions

The Satisfaction with Daily Occupations-Arabic version is a valid and reliable tool for use with Arabic-speaking occupational therapy clients. This study has several implications for occupational therapy education, practice, and research in the Arab world.

Interrater Reliability and Clinical Utility of the Personal Care Participation Assessment and Resource Tool (PC–PART) in an Inpatient Rehabilitation Setting

OBJECTIVE. We examined the interrater reliability and clinical utility of the Personal Care Participation Assessment and Resource Tool (PC–PART) in a rehabilitation setting.

METHOD. Ninety-six patients were recruited from the caseload of four occupational therapists. Patients were assessed on admission. Clinical utility was based on time to complete assessments.

RESULTS. Interrater reliability for the total score was very high (intraclass correlation coefficient = .91). Limits of agreement for the program indicated aggregate data from individual scores were within 1.3 units (range = −1.3 to 0.5) but individual scores would be within 10 units (range = −9.3 to 0.2). The PC–PART took 27 min to complete.

CONCLUSION. The PC–PART may have sufficient interrater reliability and clinical utility to evaluate program outcomes. The limits of agreement for rating individuals were relatively large, suggesting that it may be difficult to use the PC–PART to make clinical inferences about an individual patient.

Outcome Measures for Wheelchair and Seating Provision: A Critical Appraisal

Introduction:

Every aspect of the wheelchair and seating provision process has an impact on overall outcomes for service users. This critical appraisal sought to identify outcome measures suitable for evaluation of wheelchair and seating provision, considering activity, participation, and impact of the service delivery on quality of life.

Method:

Outcome measures were identified using databases: Medline, CINHAL, PsychInfo, and Google Scholar. An evaluation was conducted to establish those that were particularly useful and a critical appraisal was completed.

Findings:

Five outcome measures identified as relevant for critical appraisal included: Wheelchair Outcome Measure; Functioning Every day in a Wheelchair; Goal Attainment Scale; Psychosocial Impact of Assistive Devices Scales; and the Quebec User Evaluation of Satisfaction with Assistive Technology. The strengths and limitations of each were identified.

Conclusion:

No single outcome measure captures all necessary information; trade-offs are inevitable. When choosing an outcome measure, the specific goals of the service evaluation and the resources available need to be considered within context. Critical appraisal of five outcome measures deemed appropriate for the evaluation highlighted some areas for consideration to inform decision making. A move towards sustainability indicators is suggested to monitor, measure, and respond to the provision processes and outcomes required to meet this primary need.

Can we associate the hours of clinical services at the rehabilitation outcomes? The case of the visual impairment rehabilitation program

The purpose of this study was to determine the effects on the elderly of clinical interventions by professionals from a visual impairment rehabilitation program, more specifically, the effects on their daily life and the extent to which such interventions encourage social participation. In accordance with the conceptual framework of the Disability Creation Process, the clinical results of a population study group of 100 persons with various types of visual impairment enrolled in a rehabilitation program were analyzed as per the intensity of the clinical interventions (eg, hours of clinical services provided and dispensed by professionals). The results of the study tend to show that the hours of services accorded to a patient positively contribute to the progression of his or her Functional Global Profile as per the rehabilitation outcomes progression measures. In contrast, age and the spreading of services negatively contribute. The contributions of the study are innovative for assessing clinical effectiveness. For instance, the understanding of the relationship between the measurement of a patient's clinical results and the services that he or she has received should help us improve the practices and methods used in visual impairment rehabilitation.

Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties

BACKGROUND

Older adults experience activity and participation limitations that are associated with ageing. Activity and participation limitations affect an older adult's ability to engage in meaningful daily activities and valued life roles. Occupational therapists provide interventions to reduce such limitations and monitor client change to ensure that interventions are effective. Client change should be measured through the use of valid and reliable assessments. Yet occupational therapists can favour the use of non-standardised assessments leading to inaccurate reflections of client change and difficulties in comparing the effectiveness of interventions. A number of reasons have been suggested as to why therapists may favour non-standardised assessments, including a lack of knowledge (of assessments and their properties) and lack of skill.

METHODS/DESIGN

This paper describes the systematic review protocol that will be used to identify functional assessments used in randomised trials of occupational therapy interventions for older adults (≥70 years of age). Interventions will focus on enhancing functional independence for either older adults transitioning from hospital to home, or community dwelling older adults. We will search Medline, EBSCO and OTseeker using a pre-determined search strategy to identify Functional assessments. These assessments will be recorded and, in phase two, their measurement properties analysed.

DISCUSSION

This protocol provides a comprehensive guideline for conducting the proposed systematic review. The results of this systematic review will provide a thorough and unbiased identification and evaluation of measurement properties of functional assessment tools used in randomised trials to evaluate occupational therapy intervention. This information can be used to determine which assessment has superior measurement properties and will inform occupational therapy practice.

Resumption of valued activities in the first year post liver transplant

ABSTRACT Current practice in education of transplant recipients includes general guidelines about return to involvement in life activities emphasizing medical precautions during wound healing and avoidance of activities that present risk of infection or rejection. This approach assumes patients gradually resume pre-transplant involvement in life activities: an assumption that has not been tested. Using the Canadian Occupational Performance Measure, this cross-sectional descriptive pilot study (n = 20) explored differences in the performance of activities of daily living, instrumental activities of daily living, leisure, and productivity at three time periods within the first year. Results showed basic daily tasks are stable by the third month but some instrumental tasks declined by the end of the first year post transplant. Results indicated that there were significant differences in the Short Form-36 mental component score of the group performing "worse than expected" suggesting that preparation of recipients is needed to enable them to set realistic expectations. Results indicate the need for a longitudinal study of the resumption patterns of life activities for realistic expectations of recovery and guidelines for the treatment team.

Routine administration of the Canadian Occupational Performance Measure: effect on functional outcome

BACKGROUND/AIM

Routinely using outcome measures as an integral component of practice has been encouraged for decades yet has not been widely adopted. There are many reasons to measure outcomes yet any positive effect of measurement on our programs or clients has not been substantiated. If the time-consuming nature of outcome measurement is to be encouraged, we need to begin addressing larger questions of the value of outcome measurement on care and outcomes. This cohort study evaluated the impact of routinely administering the Canadian Occupational Performance Measure on client outcomes on a geriatric rehabilitation unit.

METHODS

Changes in Functional Independence Measure™ scores between an experimental group (n = 45) that received the routine use of the Canadian Occupational Performance Measure for evaluation/planning versus a historical comparison group (n = 58) that received 'usual' care were analysed using generalised linear modeling.

RESULTS

Both groups had significant changes in Functional Independence Measure™ scores over time. Results for differences between groups were inconclusive with a significantly underpowered analysis; however, results suggest that a medium to large effect of this intervention cannot be expected.

CONCLUSIONS

Results are significant for the field of routine outcome measurement, suggesting that when adding the Canadian Occupational Performance Measure to routine assessment within an inpatient rehabilitation setting, substantially improved Functional Independence Measure™ score outcomes should not be expected. The value of routine outcome measurement on client outcomes remains largely unexplored. Routinely, using outcome measures requires additional research to determine the specific benefits to our programs and client outcomes.

An interactive education session and follow-up support as a strategy to improve clinicians' goal-writing skills: a randomized controlled trial

BACKGROUND

Recent research indicates that allied health clinicians have difficulty articulating client needs and priorities into specific and measurable goals. As a result, a number of strategies to facilitate improvement in allied health clinicians' goal-setting skills have been recommended in the literature. In order to assist clinicians develop the skills required to set SMART goals, it is necessary that the strategies are rigorously tested.

AIM

To determine if a 50-minute education session and 3-month email and telephone support programme improves clinicians' SMART goal-writing skill and accurately predicts improved goal-writing behaviour.

METHODS

Concealed random allocation of participants (n = 120) into two parallel groups: (1) intervention group received education on writing goals using the SMART Goal Evaluation Method as part of a workshop on outcome measurement and received 3 months of follow-up support (n = 60); and (2) control group attended a workshop on evidence-based practice (n = 60).

RESULTS

Education and follow-up support improved clinicians' SMART goal-writing skills at both the 3- and 6-month review (Yates chi(2) = 4.324, d.f. = 1, P = 0.0375). Structural equation modelling revealed education and follow-up support is an accurate predictor of SMART goal-setting behaviour change at both 3 months (standardized regression weights = 0.21; P = 0.014) and 6 months (standardized regression weights = 0.19; P = 0.02) post intervention. Changes were modest and developed over a 6-month period.

CONCLUSION

This study provides empirical evidence that a programme of educating clinicians in a standardized method of goal setting and providing follow-up support improves allied health clinicians' SMART goal-writing skills.

Assessments used in occupational therapy practice: an exploratory study

ABSTRACT The purpose of this study was to explore the assessments used in occupational therapy practice through identifying most commonly used assessments and the rationale for their use in different occupational therapy practice areas. The study utilized a nonprobability convenience sample of 260 occupational therapy practitioners attending the American Occupational Therapy Association's annual conference. A descriptive survey research design was used for conducting this study. The survey instrument addressed three major questions related to (a) the area of practice, (b) the specific assessments used, and (c) reasons for using the specific assessments. Descriptive statistics were utilized to analyze the results. Results indicated most of the assessments used in occupational therapy clinics target body structure and function. Assessments were used due to their convenient availability in clinics, clinical utility and standardization, client-centeredness, development by occupational therapists, being taught in school/fieldwork, and being satisfying to insurance companies. Implications for occupational therapy education, practice, and research are presented.

Development and psychometric testing of the Clinician Readiness for Measuring Outcomes Scale

BACKGROUND

If allied health professionals are to begin measuring outcomes routinely, a change in attitudes and behaviour is necessary. However, individuals need to be ready to change and often move through several stages before practice change is observed.

AIM

To develop and test the psychometric properties of a questionnaire that determines clinicians' readiness to measure outcomes.

METHODS

A study of instrument development, validation and reliability. Ten expert allied health professionals were involved in content validity testing. A further 396 allied health professionals completed the questionnaire to establish content and construct validity, internal consistency and temporal reliability (or stability). Of these 396 allied health professionals, 70 participated in the temporal reliability assessment. Content validity was established using the Content Validity Index (CVI). Construct validity was determined using confirmatory factor analysis (CFA) and internal consistency was ascertained using Cronbach's alpha. Temporal reliability was confirmed using intraclass correlation coefficients (ICC 3,1).

RESULTS

A 30-item questionnaire was developed, reflecting the five stages of change from the Transtheoretical Model of Change, and commonly cited barriers to outcome measurement. Content validity was excellent (CVI = 0.96). Using CFA, a two-factor model provided best fit. Based on CFA results, four items were dropped resulting in a 26-item questionnaire (range 26-156). Internal consistency reliability was excellent (alpha = 0.94). Temporal (stability) reliability ICC (3,1) was very good (r = 0.86, P = 0.0001).

CONCLUSIONS

The final 26-item questionnaire takes 10 minutes to complete and 5 minutes to score. The Clinician Readiness for Measuring Outcomes Scale provides educators with useful information about clinician readiness and helps identify strategies for affecting behaviour change.

Clinical heterogeneity was a common problem in Cochrane reviews of physiotherapy and occupational therapy

BACKGROUND AND OBJECTIVE

To identify the strategies used to deal with the clinical heterogeneity of interventions and multiple outcome measures used in Cochrane reviews on physiotherapy and occupational therapy.

METHODS

A search for systematic reviews on physiotherapy and occupational therapy in the Cochrane Library was performed. Data on the method of categorization of interventions, on measures, and on the method of data synthesis were systematically extracted.

RESULTS

52 reviews were identified. In 22 (42%) reviews only one index intervention was evaluated, in the other 30 reviews index interventions were categorized. A large diversity in the number and type of outcome measures was found (median 6.5, range 1-23). In 48% of the reviews one or more primary outcome measures were defined. In 52% of the reviews no quantitative data synthesis was performed, whereas five different methods for qualitative data synthesis were applied in 11 reviews.

CONCLUSIONS

Limitation to a few outcome measures and explicit procedures for the categorization of interventions might increase the transparency and reproducibility of systematic reviews on physiotherapy and occupational therapy. Qualitative data synthesis is not often applied, although it is a useful tool to summarize results if a quantitative synthesis is not appropriate. International consensus on a method for qualitative synthesis is clearly needed.

Outcome measurement in dysphagia: not so hard to swallow

This article reports on the use of a new tool from the Australian Therapy Outcome Measures (AusTOMs) set-the Swallowing scale. The scale is one of six, designed to measure outcomes of clients attending speech pathology practices in Australia. The tool was used for six months in clinical practices across 14 healthcare sites in Victoria, Australia (including six acute hospitals, six rehabilitation services, one specialist pediatric hospital, and one specialist cancer institute). This article provides preliminary descriptive data and analyses of outcomes from swallowing therapy, along with discussion of the strengths and weaknesses of this tool. Potential clinical applications are suggested.

Evidence-based practice and rehabilitation: occupational therapy in Australia and New Zealand experiences

Evidence-based practice has become the dominant paradigm in the delivery of rehabilitation programme. However, occupational therapists in Australia and New Zealand have been slow in making the transition to become evidence-based practitioners. Collaboration between the university/tertiary institute and clinical setting is one way that clinicians can be assisted with incorporating research into their practice. Two case examples are presented outlining how collaborative practice can result in improved outcomes for all concerned.

Is there evidence of the International Classification of Functioning, Disability and Health in undergraduate nursing students' patient assessments?

This paper reports on a secondary analysis of undergraduate nursing students' patient assessments while on clinical placement in a rehabilitation setting in search of evidence of the International Classification of Functioning, Disability and Health (ICF). It describes the evolution of the original World Health Organization's International Classification of Impairment, Disability and Handicap into the ICF. Data was analysed using the ICF categories of function, activity, participation, environmental factors and personal factors. Some evidence of ICF was revealed. Nurses are encouraged to further explore the relevance of ICF for nursing.

Content validity and clinical applicability of the Irena Daily Activity assessment measuring occupational performance in adults with developmental disability

The purpose of this study was to investigate the validity of the Irena Daily Activity (IDA) assessment which measures occupational performance in adults with developmental disabilities. The instrument's content validity was investigated by elucidating its general appropriateness, its clinical applicability and the feasibility of the measurement procedure. Data were collected from a multidisciplinary panel of clinical experts working in day activity centres. Each expert independently judged and reviewed the IDA instrument's content validity. The results show that the content validity index (CVI) values ranged from 0.8 to 1.0 for the instrument's general appropriateness and clinical applicability, and from 0.7 to 1.0 with respect to the significance of the IDA domains' clinical applicability. The applicability of the IDA items were judged as satisfactory (CVI > 80) with respect to their importance for planning treatment and intervention. The feasibility of the measurement procedure was estimated as satisfactory in relation to the items (CVI > 0.70) and satisfactory with respect to the time needed and material used, with CVI values ranging from 0.8 to 1.0. The results of this study support the use of the IDA as a feasible and time-efficient assessment that provides insights regarding the occupational performance of adults with developmental disabilities. A limitation of this study was that it could not illuminate all-important aspects of validity. In conclusion, the IDA has the potential to become a reliable and valid clinical assessment, but additional research on psychometric properties is still needed.

Clinical outcomes research from the occupational therapist's perspective

With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical outcomes research a qualitative study was undertaken involving three in-depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception: (a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented.

Validity of the patient-focused wrist outcome instrument: do impairments represent functional ability?

The development of outcome instruments has been reported to be a long process, often taking years to complete. In a previous article, we reported on the rationale behind the construction of a new wrist outcome instrument that assesses, from the wrist-injured individual's perspective, their ability to perform activities of daily living following a wrist disorder. Content validity and test-retest reliability of the wrist outcome instrument also was demonstrated. Here we report on the results of the assessment of other aspects of validity, specifically construct validity of the wrist outcome instrument and the ability of the instrument to detect change over time. We evaluated these psychometric properties against frequently used clinical tests that assess impairments and thus report on the relationship between the ability to perform activities of daily living and impairment measures.