Integrating Occupational Therapy Specific Assessments in Practice: Exploring Practitioner Experiences

Assessment of motor and process skills in Danish occupational therapy practice

BACKGROUND

The demand for employment of standardized evaluations is increasing. In Denmark, approximately 25% of all occupational therapists (OTs) are trained to use the standardized occupational therapy instrument Assessment of Motor and Process Skills (AMPS).

AIMS

To investigate the use of AMPS within Danish occupational therapy practice and determine factors supporting or hindering the use.

MATERIAL AND METHODS

An online cross-sectional survey was conducted among OTs from various settings.

RESULTS

Overall, 844 calibrated OTs participated in the survey. Of these, 540 (64%) met the inclusion criteria and 486 (90%) completed the questionnaire. Forty percent of the participants used the AMPS in a standardized way during a one-month period and 56% reported being dissatisfied with the low number of AMPS evaluations completed. Five supporting and nine hindering factors were found to significantly influence the use of standardized AMPS evaluations.

CONCLUSIONS/SIGNIFICANCE

Despite demands for standardized evaluations, the AMPS is not regularly used in a standardized way within Danish occupational therapy practice. Use of AMPS in clinical practice seems to be facilitated by an acknowledgement from the management and the OT's ability to develop habits and routines. Time restraints were reported, however, time to conduct evaluations was not a statistically significant influencing factor.

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.

Understanding the Barriers of Implementing a Self-Awareness Assessment in Occupational Therapy Practice within a Brain Injury Population: An Exploratory Study

Background

Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings.

Aims

(1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice.

Materials and Methods

A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment.

Results

14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up.

Conclusion

Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts.

Uncovering the experiences of engaging in an inpatient occupation-based group program: The LifeSkills group

BACKGROUND

Consumer engagement is an important element for developing and maintaining value-based healthcare standards. Occupation-based practice in the context of a group has been adopted by inpatient rehabilitation clinicians, but little research has explored if these groups are valuable and useful to patients.

AIMS/OBJECTIVES

To explore the experiences of patients participating in an occupation-based group intervention for instrumental activities of daily living to understand its value and usefulness in an inpatient rehabilitation setting.

MATERIAL AND METHODS

Interpretive description guided the development of the study. Semi-structured interviews were completed with 15 participants of an occupation-based group, the LifeSkills group. Comparative analysis was used to analyse the data and develop themes.

RESULTS

Five themes were reported by participants: choice and control, confidence through doing, a real-world connection, the power of the therapeutic relationship and the impact of the shared experience.

CONCLUSIONS AND SIGNIFICANCE

In line with current rehabilitation literature, patient experiences around client-centredness, occupational engagement in a 'real-world' environment, and valued relationships can be facilitated through an occupation-based group. This study supports the implementation of valued-based healthcare in understanding patient perceptions of occupation-based interventions into rehabilitation; ensuring that the right intervention is being used at the right time for the right patient.

Assessments of Functional Cognition Used with Patients following Traumatic Brain Injury in Acute Care: A Survey of Australian Occupational Therapists

This study aimed to describe how occupational therapists working in acute care settings in Australia assess cognitive function in patients with TBI, the influences on assessment choice, and clinician perceptions of performance-based assessment. An online survey was completed by 81 occupational therapists. The most common method of cognitive assessment was reported as non-standardized observation of functional tasks (94.7%), followed by carer-report / self-report (93%). Despite their being positive perceptions of performance-based assessment there was limited use in practice. Assessment use was impacted by practical and organizational constraints including access to assessment resources, time and the built environment in acute care.

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.

Learning, translating, and applying the perceive, recall, plan, perform system of task analysis assessment to practice: Occupational therapists’ experiences

Introduction

This study explored occupational therapists’ experiences of embedding the Perceive, Recall, Plan, Perform System of Task Analysis (PRPP) assessment in practice and gained understandings of the clinical utility.

Methods

Qualitative interpretive description research using data from semi-structured interviews with 11 New Zealand registered occupational therapists and a focus group with two Māori occupational therapists. Thematic data analysis was used to develop themes.

Results

Five themes emerged: Resonating with practice as it should be, Translating to practice, Communicating assessment findings using an occupational performance focus on cognition, Validating the practice fit and Cultural application. Participants described the PRPP assessment as a flexible tool, which was applied in different ways in varied practice settings, with clients performing a range of culturally specific occupations. Embedding the assessment in practice was an involved process that challenged many participants’ existing assessment procedures and included managing team expectations to perform cognitive-based assessments.

Conclusions

The PRPP assessment added value to occupational therapists’ practice. Effective implementation of the assessment required a secure occupation-focused perspective and client-centred culturally responsive communication skills. Commitment was needed to both adopt a new assessment process and to communicate occupation-based assessment results. Participants connected as social learners to address practice challenges post-training.

Occupation-based group programs in the inpatient hospital rehabilitation setting: a scoping review

PURPOSE

Occupation-based practice involves the inclusion of meaningful occupations in the therapeutic process and is promoted within hospital-based general rehabilitation contexts for individual clients or within a group setting. The purpose of this paper is to summarise the current literature regarding the types of occupation-based group programs used within general inpatient rehabilitation and the reported outcomes.

METHODS

A scoping review was conducted and included papers if they described an occupation-based intervention, delivered in a group setting, conducted in an inpatient rehabilitation hospital context, with an adult population. Studies were collated, summarized and key findings are presented.

RESULTS

Ten articles met inclusion criteria. The results indicate that occupation-based groups are used in inpatient rehabilitation across a variety of settings, the approach is valued by the occupational therapy profession and it appears to have an influence on patient satisfaction and experience. However, the impact on a patient's confidence and occupational performance outcomes post-inpatient rehabilitation remains unclear.

CONCLUSIONS

There is a dearth of evidence on the impact of occupation-based group service focus in the inpatient rehabilitation setting. Considering the importance of occupation to the profession, further investigation into the use of this approach in a group setting is required.Implications for rehabilitationOccupation-based groups are used in inpatient rehabilitation to achieve more therapy time but there is variability in group processes and outcomes measured.Patient centred occupation-based groups appear to have an influence on patient satisfaction and experience.For the occupation-based groups reviewed, providing explicit links between patient goals, therapeutic activity and real life was important for improving outcomes.There is a growing focus for the use of occupation-based groups in occupational therapy and more research is needed to establish effectiveness.

Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective

This exploratory study was aimed at evaluating the current status of global occupational therapy practice on the use of assessments for clients with cognitive impairments and providing recommendations for ongoing evidence. We targeted international occupational therapy clinicians working with clients experiencing neurocognitive impairments. 323 occupational therapists from a wide range of clinical practice areas participated in the study. A large number of therapists used noncognitive specific assessments with a focus on functional approaches. The most commonly used standardized assessments were the COPM (56.7%), followed by MMSE (54.2%) and MoCA (45.5%), while the nonstandardized assessments were clinical observation (38.4%) and generic ADL assessment (34.1%). The use of main assessments was significantly different across world regions (p < 0.05), as were the reasons for choosing them (p < 0.05). The occupational therapists' use of assessment tools with clients suffering from neurocognitive impairments is inconsistent across the globe. The identification of international best practices for selecting and implementing proper outcome measures is warranted. It is essential to promote the development of an occupational therapy initiative to support the use of appropriate assessments at the international levels to facilitate consistent best practice.