Reliability of the Australian Therapy Outcome Measures for Occupational Therapy Self-care scale

An Evaluation of the Overall Utility of Measures of Functioning Suitable for School-Aged Children on the Autism Spectrum: A Scoping Review

A diagnosis of an autism spectrum condition (autism) provides limited information regarding an individual's level of functioning, information key in determining support and funding needs. Using the framework introduced by Arksey and O'Malley, this scoping review aimed to identify measures of functioning suitable for school-aged children on the autism spectrum and evaluate their overall utility, including content validity against the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets for Autism. The overall utility of the 13 included tools was determined using the Outcome Measures Rating Form (OMRF), with the Adaptive Behavior Assessment System (ABAS-3) receiving the highest overall utility rating. Content validity of the tools in relation to the ICF and ICF Core Sets for Autism varied, with few assessment tools including any items linking to Environmental Factors of the ICF. The ABAS-3 had the greatest total number of codes linking to the Comprehensive ICF Core Set for Autism while the Vineland Adaptive Behavior Scales (Vineland-3) had the greatest number of unique codes linking to both the Comprehensive ICF Core Set for Autism and the Brief ICF Core Set for Autism (6-16 years). Measuring functioning of school-aged children on the spectrum can be challenging, however, it is important to accurately capture their abilities to ensure equitable and individualised access to funding and supports.

Use of the AusTOMs-OT to record outcomes in an occupational therapy homeless service

Introduction

Occupational therapists provide services to homeless people internationally, yet relatively little research evidence underpins this practice. This study aimed to describe the process of selecting an outcome measure for use in a homeless occupational therapy service and demonstrate the changes experienced in the occupational performance of individuals participating in this service.

Method

The Glasgow homeless occupational therapy service staff reviewed eight outcome measures against six pre-determined criteria. The selected tool was then used to collect data pre and post an occupational therapy intervention with 58 participants. Data were analysed using descriptive statistics and Wilcoxon Signed Ranks Test to determine statistically significant change from admission to discharge in the different domains of the selected outcome measure.

Results

The AusTOMs-OT was implemented in daily practice and 70% of participants were discharged following achievement of therapy goals. Clients made clinically and statistically significant improvements over their admission as measured on AusTOMs-OT in areas such as Transfers, Self-Care and Domestic Life-Home, across the health domains of activity, participation and wellbeing.

Conclusion

AusTOMs-OT was successfully implemented and demonstrated that participants improved over their time with the service. This evidence can be used to support the effectiveness of occupational therapy services with people experiencing homelessness.

Validity and reliability of the Australian Therapy Outcome Measures - Physiotherapy, for podiatry (AusTOMs-PT for use in podiatry)

Background

Valid and reliable outcome measure enable measurement of health care service impact. There are limited valid and reliable outcome measures for use in podiatry practice to measure the impact of treatment. This research aimed to test the face validity of the AusTOMs for Physiotherapy (AusTOMs-PT), it’s adaptability to podiatry clinical practice and the reliability of its use with podiatrists.

Methods

Stage 1 used a nominal group technique with podiatrists who worked in public and/or private settings. All podiatrists underwent self-directed training in the AusTOMs framework and measures prior to interviews or focus group discussion. Discussion was centred about transferability of the core scales of the AusTOMs-PT and an adjunct measure, AusTOMs for Occupational Therapy (AusTOMs-OT) to podiatry practice.

Stage 2 used 10 case studies representative of people who had foot or ankle concerns. Podiatrists were recruited and trained in the use of the relevant AusTOMs-PT scales. Podiatrists individually scored the cases at two timepoints (1 month apart) using the six scales from the AusTOMs-PT deemed by stage 1 as relevant to podiatry. Intra and inter-rater reliability of scales were determined using intraclass correlation coefficients (ICCs).

Results

Thirteen podiatrists participated in individual or focus group interviews in Stage 1. Consensus was gained on six of the nine core scales adopted from the AusTOMs-PT. These were 1. Balance and Postural Control, 3. Musculoskeletal Movement Related Functions, 4. Neurological Movement Related Functions, 5. Pain, 7. Sensory Functions, 8. Skin Functions. Each core scale rated the functional domains of Impairment, Activity Limitation, Participation Restriction and Wellbeing/Distress relating to that presentation of goals of the person in the case study.

There were 22 podiatrists complete training and scored two rounds of case studies using the six scales in Stage 2. There were 91%(n = 20) participants with an intra-rater ICC > 0.5 (moderate or greater). Each domain had an inter-rater reliability of > 0.9 (excellent) during the first round.

Conclusions

The AusTOMs-PT for use in podiatry may be implemented to record change in impairment, function, participation and wellbeing of people receiving podiatry treatment. Podiatry specific training and mentoring, together with repeated use could be expected to improve intra-reliability.

A randomized controlled trial protocol investigating effectiveness of an activity-pacing program for deconditioned older adults

Background.

Acute hospitalization of older adults can lead to deconditioning and the need for rehabilitation to facilitate a return to home and previous lifestyle. An occupational therapy intervention to combat deconditioning is activity pacing, an active self-management strategy where individuals learn to modify how and when activities are completed with the aim of improving participation in occupation.

Purpose.

This study will examine the effectiveness of occupational therapy with activity pacing during rehabilitation for deconditioned older adults.

Method.

A randomized controlled trial is proposed with inclusion criteria of older adults, 65+ years old, living independently in the community prior to admission, with adequate cognition and language to participate in the intervention. Participation, health status, self-efficacy in daily activities, self-efficacy in activity pacing techniques, and symptom management (pain and fatigue) will be measured at admission, discharge, and 3 months postdischarge.

Implications.

Determining if an activity-pacing program is effective will provide occupational therapists with evidence to support service delivery.

Occupational therapy and activity pacing with hospital-associated deconditioned older adults: a randomised controlled trial

Purpose: To examine the efficacy of an occupational therapy activity pacing intervention with deconditioned older adults in rehabilitation.Method: Randomised, single-blind controlled trial of deconditioned older adults admitted for rehabilitation following treatment of an acute medical condition, allocated to intervention [n = 51, males = 14, mean age = 80(8)] or control [n = 49, males = 12, mean age = 81(7)] group. The intervention group received individual and group activity pacing education with practice and application of techniques to daily activities and the home environment, while the control group received a typical occupational therapy program, which included brief activity pacing education. Outcomes included participation in daily living skills, health status (including pain and fatigue symptoms), self-efficacy in daily activities and activity pacing techniques using the Australian Therapy Outcome Measures-Occupational Therapy (AusTOMs-OT), Short Form-36 Health Survey (SF-36), Self-Efficacy Gauge and Activity Pacing Assessment.Results: No differences in groups at admission. Comparison at discharge and three months post discharge using 2 × 2 mixed ANOVA demonstrated small differences in only one scale of the activity limitation domain of the AusTOMs-OT. No significant differences were found in other scales or domains of the AusTOMs-OT, nor secondary outcome measures.Conclusion: Activity pacing in addition to typical occupational therapy during inpatient rehabilitation did not demonstrate benefits to participants in the management of their daily activities on returning home post hospitalisation.Implications for rehabilitationActivity pacing has been identified as one of the commonly used occupational therapy interventions utilised with deconditioned older adults in rehabilitation.An activity pacing intervention in conjunction with typical occupational therapy demonstrated no benefits for deconditioned older adults over typical occupational therapy which included basic education on this topic.Continuation of the activity pacing intervention into the outpatient setting may be of benefit to older adults and requires further investigation.

Analysing and interpreting outcomes data to support evidence-based practice using the example of AusTOMs-OT

Statement of context

Occupational therapists working with clients who have neurological impairments routinely collect outcomes data. However, data cannot inform practice unless it is routinely reviewed. The aim of this paper was to show how outcomes data collected on the Australian Therapy Outcome Measures – Occupational Therapy scale were analysed and interpreted. Although the example pertains to clients with neurological problems, the approach can be applied to all areas of practice.

Critical reflection on practice

When outcomes data are routinely analysed and findings reviewed, occupational therapists have an increased understanding of practice strengths and limitations.

Implications for practice

Incorporating analysis and interpretation of outcomes data for clients with neurological problems into practice contributes evidence to support therapy and ensures clinicians retain control of their data.

Use of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) in an early supported discharge programme for stroke patients in Singapore

Introduction

This short report describes the use of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) in an early supported discharge programme for stroke patients in Singapore.

Method

The Australian Therapy Outcome Measures for Occupational Therapy was assessed at the start and end of the early supported discharge programme and differences were statistically analysed.

Findings

All Australian Therapy Outcome Measures for Occupational Therapy scales demonstrated statistically significant change over time. The most commonly used scales were ‘Upper limb use’, ‘Functional walking and mobility’ and ‘Community life, recreation, leisure and play’, reflecting the pertinent types of occupational therapy intervention used in stroke rehabilitation in the home setting.

Conclusion

This study shows that the Australian Therapy Outcome Measures for Occupational Therapy is a useful outcome measure that can be used to articulate the administered occupational therapy interventions to members of the multi-disciplinary team and support the effectiveness of occupational therapy in stroke rehabilitation.

Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to Measure Client Participation Outcomes

Introduction:

Measuring change in clients' ‘participation’, and being able to attribute this change to occupational therapy intervention, is important in the quest to provide evidence to support practice. The Australian Therapy Outcome Measures for Occupational Therapy is an outcome measure that has four domains, one of which is concerned with measuring client participation. An occupational therapy service wanted to determine if client level of participation was improving, as measured by the Australian Therapy Outcome Measures for Occupational Therapy.

Method:

Data were collected between 2009 and 2012 from three home-based therapy services, using the Australian Therapy Outcome Measures for Occupational Therapy. Data were divided into diagnostic cohorts, and then exploratory data analysis techniques and paired t-tests were performed.

Findings:

Data from 506 participants were analysed and clients in all diagnostic groups made statistically (p < .05) significant improvements over time in relation to their participation.

Conclusion:

Most clients in this study improved or maintained their level of participation between admission and discharge, with few clients deteriorating, when measured on the Australian Therapy Outcome Measures for Occupational Therapy scales. These results suggest the home-based therapy service was meeting its goal, and further supports the responsiveness of the Australian Therapy Outcome Measures for Occupational Therapy to detect change in clients' participation status over time. Randomized control trials are needed to determine whether improvements in participation are due to engaging in the occupational therapy program.

Introducing the therapy outcome measure for AAC services in the context of a review of other measures

PURPOSE

This article discusses the importance of outcome measures in improving Augmentative and Alternative Communication (AAC) services, reviews existing methods and introduces a new approach.

METHOD

Three methods were used in this study. 1. A literature review identifying outcome measures used in AAC research. 2. A questionnaire to AAC services in the UK which aimed to identify the objectives of their services and the outcome measures commonly used. 3. A working group of AAC experts provided additional information and interpretation. Central properties and conceptual framework were considered.

RESULTS

The literature review and questionnaire identified 23 outcome measures none of which cover the conceptual frameworks associated with all of the overall objectives of AAC provision. The review has informed the further development of a particular outcome measure the AAC Therapy Outcome Measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning (ICF-WHO) are retained and the measure can be used in benchmarking.

CONCLUSION

An outcome measure needs to reflect change associated with service delivery. AAC services endeavour to impact on all of the domains of the ICF. A new measure is required in order to reflect the nature of these services. This article introduces an outcome measure which is in the process of being trialled by some services in the UK.

Interrater Reliability of the Road Law and Road Craft Test as Part of the OT-DORA Battery for Off-Road Driver Assessment

Background:

The Occupational Therapy Driver Off Road Assessment (OT-DORA) Battery is in development as a comprehensive off-road evaluation of fitness to drive. Although several psychometric properties of the Road Law and Road Craft Test (RLRCT) have been previously studied, interrater reliability must also be established to include this test in the battery.

Aim:

The aim of the study was to determine the interrater reliability of the RLRCT.

Method:

Three occupational therapy driver assessors independently scored 20 client responses on the 14-item RLRCT.

Results:

The interrater reliability for all items, except item 6, was found to be between 0.57 and 1.00. The scoring instructions for item 6 were revised and the interrater reliability rose from 0.42 to 0.77.

Conclusion:

The RLRCT has been found to be reliable when administered by different raters and is thus suitable for inclusion in the OT-DORA Battery. Ongoing research to confirm the psychometric properties of the RLRCT is required.

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.