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.

Adopting the Assessment of Motor and Process Skills into Practice: Therapists' Voices

A qualitative study was undertaken to explore occupational therapists' experiences following a continuing professional education course to learn how to use the Assessment of Motor and Process Skills (AMPS). This paper describes the challenges and barriers they faced when adopting it within existing professional practice. Twenty-two occupational therapists from 16 National Health Service trusts across the United Kingdom who had attended an AMPS course took part in a series of three semi-structured interviews over a 9-month period. The data were analysed inductively; six themes and a number of subthemes emerged.

Three themes are explored in this paper: adopting the AMPS into professional practice, the diffusion of innovation and the embedding of new skills in clinical teams. Using the voices of the participants in the study, the findings explore some of the barriers to learning new skills and to utilising them within workplace teams. Overall, the therapists were able to overcome these barriers if they had sufficient personal motivation and workplace support from either their manager or the clinical team.

The spread of a new idea and its adoption into current practice are complex and affected by many factors. Research evidence alone may not be enough to persuade individuals and teams to change: additional resources of leadership, skills and time also appear essential to success.

Talk the talk and walk the walk. Evaluation of autonomy in aging and Alzheimer disease by simulating instrumental activities of daily living: the S-IADL

Objective

The autonomy of individuals is linked to the achievement of instrumental activities of daily living that require complex behavior. In the elderly, the assessment of autonomy is usually based on questionnaires that have strong subjective constraints. Considering this fact, we tested elderly healthy adults and Alzheimer disease patients using a new measure, the S-IADL (Simulation of Instrumental Activities for Daily Living), to assess the ability to perform effectively activities of daily living.

Method

The S-IADL shares many items with the well-known IADL questionnaire proposed by Lawton & Brody (1969). However, as opposed to the IADL, the assessment of autonomy is not based on the completion of a questionnaire but requires the realization or simulation of various activities of daily living. Eighty-three participants (69 healthy elderly, and 14 Alzheimer Disease patients) completed the IADL and performed the S-IADL assessment.

Results

Results revealed that, like the IADL, the S-IADL is able to identify AD patients who are likely to encounter difficulties in performing everyday activities, and no major differences were found between the IADL and the S-IADL.

Conclusions

We outlined some advantages for prefering, in certain situation, this new tool based on simulation of activities in functional evaluation. Finally, we discuss the main limits of the S-IADL that should be investigated prior to its utilization by clinicians.

Implementing the Model of Human Occupation across a Mental Health Occupational Therapy Service: Communities of Practice and a Participatory Change Process

The implementation of evidence-based change in practice settings is complex and far reaching, but only limited research has been undertaken in this area. This participatory action research study investigated the implementation of the Model of Human Occupation (MOHO) across a mental health occupational therapy service.

Method:

The study involved preparatory workshops and 12 months of team-based, monthly group reflective supervision sessions, facilitated by a colleague from academia, with follow-up contact for a further 12 months.

Findings:

The main findings emphasise the importance of developing a critical learning space, or ‘community of practice’, and identify that barriers to theory implementation can be overcome by collective effort with a shared dialectic. The successful development of a community of practice required the careful consideration of a number of interconnected influences, including those of self, peer and facilitator, and contextual and theoretical relationships.

Conclusion:

The study concluded that the community of practice was central in supporting the effective implementation of MOHO and its associated assessment tools. A key output of the study is a Participatory Change Process, which illustrates the key steps undertaken and interrelated factors affecting theory uptake. The process requires further testing, but has potential to guide theory implementation in other settings.