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Tse T, Skorik S, Fraser R, Munro A, Darzins S. Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy. Aust Occup Ther J 2024; 71:226-239. [PMID: 38058208 DOI: 10.1111/1440-1630.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice. METHODS Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis. FINDINGS Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'. CONCLUSION Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.
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Affiliation(s)
- Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Occupational Therapy Department, St Vincent's Hospital, Melbourne, Australia
| | - Stefani Skorik
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Ruby Fraser
- School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Adrienne Munro
- Occupational Therapy Department, St Vincent's Hospital, Melbourne, Australia
| | - Susan Darzins
- School of Allied Health, Australian Catholic University, Melbourne, Australia
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2
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Stewart V, McMillan SS, Hu J, Collins JC, El-Den S, O’Reilly CL, Wheeler AJ. Are SMART goals fit-for-purpose? Goal planning with mental health service-users in Australian community pharmacies. Int J Qual Health Care 2024; 36:mzae009. [PMID: 38381655 PMCID: PMC10880889 DOI: 10.1093/intqhc/mzae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
Goal planning is an important element in brief health interventions provided in primary healthcare settings, with specific, measurable, achievable, realistic/relevant, and timed (SMART) goals recommended as best practice. This study examined the use of SMART goals by Australian community pharmacists providing a brief goal-oriented wellbeing intervention with service-users experiencing severe and persistent mental illnesses (SPMIs), in particular, which aspects of SMART goal planning were incorporated into the documented goals. Goal data from the PharMIbridge Randomized Controlled Trial (RCT) were used to investigate how community pharmacists operationalized SMART goals, goal quality, and which SMART goal planning format aspects were most utilized. Goals were evaluated using the SMART Goal Evaluation Method (SMART-GEM) tool to determine how closely each documented goal met the SMART criteria. Goals were also categorized into five domains describing their content or purpose. Descriptive analysis was used to describe the SMART-GEM evaluation results, and the Kruskal-Wallis H test was used to compare the evaluation results across the goal domains. All goals (n = 512) co-designed with service-users (n = 156) were classified as poor quality when assessed against the SMART guidelines for goal statements, although most goals contained information regarding a specific behaviour and/or action (71.3% and 86.3%, respectively). Less than 25% of goals identified how goal achievement would be measured, with those related to lifestyle and wellbeing behaviours most likely to include measurement information. Additionally, the majority (93.5%) of goals lacked details regarding monitoring goal progress. Study findings raise questions regarding the applicability of the SMART goal format in brief health interventions provided in primary healthcare settings, particularly for service-users experiencing SPMIs. Further research is recommended to identify which elements of SMART goals are most relevant for brief interventions. Additionally, further investigation is needed regarding the impact of SMART goal training or support tools on goal quality.
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Affiliation(s)
- Victoria Stewart
- Centre for Mental Health, Griffith University, Mt Gravatt, QLD 4122, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Sara S McMillan
- Centre for Mental Health, Griffith University, Mt Gravatt, QLD 4122, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jie Hu
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jack C Collins
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Claire L O’Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Amanda J Wheeler
- Centre for Mental Health, Griffith University, Mt Gravatt, QLD 4122, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Faculty of Health and Behavioural Sciences, University of Auckland, Auckland 1142, New Zealand
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Stewart V, McMillan SS, Hu J, Collins JC, El-Den S, O'Reilly C, Wheeler AJ. Refining a taxonomy of goals planned between mental health consumers and community pharmacists. Res Social Adm Pharm 2023; 19:1391-1397. [PMID: 37468372 DOI: 10.1016/j.sapharm.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND People living with severe and persistent mental illnesses are more likely to experience co-morbid health conditions. Health-related behavior change can be promoted by the use of goal planning within community pharmacy settings. OBJECTIVES To trial and refine a recently developed taxonomy to categorize goals co-designed between community pharmacists and people living with severe and persistent mental illnesses. This study also compared the data to the previously published taxonomy data to determine if the taxonomy could be applied across a range of mental health conditions. METHODS The published goal taxonomy was refined using data from a cluster randomized controlled trial (PharMIbridge). Community pharmacists provided an individualized support service using goal planning with people living with severe and persistent mental illnesses. Goals were categorized using the existing taxonomy and inconsistencies were used to modify and refine the taxonomy. Additionally, participant characteristics and categorization of goals were compared with results from the previous study. RESULTS 512 goals were reported by 158 consumer participants and categorized into five domains that included a diverse range of health behaviors (e.g., relationships, diet). Minor refinements to the taxonomy were made by replacing, adding or removing categories/descriptors. CONCLUSIONS Significant overlap between the goals of participants and the existing taxonomy was found, supporting the application of the taxonomy across different mental health conditions.
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Affiliation(s)
- Victoria Stewart
- Centre for Mental Health, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia.
| | - Sara S McMillan
- Centre for Mental Health, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia
| | - Jie Hu
- Centre for Mental Health, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia
| | - Jack C Collins
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia; Faculty of Health and Behavioural Sciences, University of Auckland, New Zealand
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Jung HT, Kim Y, Lee J, Lee SI, Choe EK. Envisioning the use of in-situ arm movement data in stroke rehabilitation: Stroke survivors' and occupational therapists' perspectives. PLoS One 2022; 17:e0274142. [PMID: 36264782 PMCID: PMC9584451 DOI: 10.1371/journal.pone.0274142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The key for successful stroke upper-limb rehabilitation includes the personalization of therapeutic interventions based on patients' functional ability and performance level. However, therapists often encounter challenges in supporting personalized rehabilitation due to the lack of information about how stroke survivors use their stroke-affected arm outside the clinic. Wearable technologies have been considered as an effective, objective solution to monitor patients' arm use patterns in their naturalistic environments. However, these technologies have remained a proof of concept and have not been adopted as mainstream therapeutic products, and we lack understanding of how key stakeholders perceive the use of wearable technologies in their practice. OBJECTIVE We aim to understand how stroke survivors and therapists perceive and envision the use of wearable sensors and arm activity data in practical settings and how we could design a wearable-based performance monitoring system to better support the needs of the stakeholders. METHODS We conducted semi-structured interviews with four stroke survivors and 15 occupational therapists (OTs) based on real-world arm use data that we collected for contextualization. To situate our participants, we leveraged a pair of finger-worn accelerometers to collect stroke survivors' arm use data in real-world settings, which we used to create study probes for stroke survivors and OTs, respectively. The interview data was analyzed using the thematic approach. RESULTS Our study unveiled a detailed account of (1) the receptiveness of stroke survivors and OTs for using wearable sensors in clinical practice, (2) OTs' envisioned strategies to utilize patient-generated sensor data in the light of providing patients with personalized therapy programs, and (3) practical challenges and design considerations to address for the accelerated integration of wearable systems into their practice. CONCLUSIONS These findings offer promising directions for the design of a wearable solution that supports OTs to develop individually-tailored therapy programs for stroke survivors to improve their affected arm use.
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Affiliation(s)
- Hee-Tae Jung
- Department of BioHealth Informatics, School of Informatics and Computing, Indiana University at IUPUI, Indianapolis, IN, United States of America
| | - Yoojung Kim
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, S. Korea
| | - Juhyeon Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America,* E-mail: (EKC); (SIL)
| | - Eun Kyoung Choe
- College of Information Studies, University of Maryland at College Park, College Park, MD, United States of America,* E-mail: (EKC); (SIL)
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Hand C, Donnelly C, Bobbette N, Borczyk M, Bauer M, O’Neill C. Examining utility and feasibility of implementing patient-reported outcome measures in occupational therapy primary care practice. Br J Occup Ther 2022. [DOI: 10.1177/03080226211042272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Occupational therapists are increasingly part of interprofessional primary care teams, helping to expand primary care to meet client needs. Effectiveness of occupational therapy services is difficult to determine with currently collected data, and little is known about the best tools to use or how to integrate tools into practice. We explored the utility and feasibility of implementing patient-reported outcome measures (PROMs) within occupational therapy primary care practice. Method We integrated pre-test/post-test and exploratory qualitative designs. Over 7 months, nine occupational therapists administered two PROMs to clients receiving falls prevention services, addressing falls efficacy and participation in daily occupations. Subsequent interviews with therapists explored the utility and feasibility of using the tools. We assessed pre-to-post change in PROM scores and thematically analyzed interview data. Results The occupational therapists valued measuring function and participation in daily occupations to inform practice, communicate with team members, and demonstrate effectiveness. The falls efficacy scale appeared to capture change over time and was feasible to implement at pre-test. Conclusion PROMs appear useful within occupational therapy primary care falls prevention services and can be feasible with attention to administration processes. Further development and testing of PROMs is needed to support occupational therapy primary care practice.
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Affiliation(s)
- Carri Hand
- School of Occupational Therapy, University of Western Ontario, London, ON, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy and Director, Health Services and Policy Research Institute, Queen’s University, Kingston, ON, Canada
| | - Nicole Bobbette
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Maria Borczyk
- Matthews House Hospice, Alliston, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Martha Bauer
- McMaster Family Health Team, Hamilton, ON, Canada
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Wong SR, Ngooi BX, Kwa FY, Koh XT, Chua RJJ, Dancza KM. Exploring the meaning of value-based occupational therapy services from the perspectives of managers, therapists and clients. Br J Occup Ther 2021. [DOI: 10.1177/03080226211030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction There is a worldwide trend towards value-based health care, which strives to control healthcare costs while maximising value for clients. The main concept of value has been defined as health outcomes achieved per US dollar spent. This research explored how clients of occupational therapy services, managers and occupational therapists perceived value in occupational therapy services. Method A qualitative design was used to explore the perspectives of clients ( n = 11), occupational therapists ( n = 7) and occupational therapy managers ( n = 7). Appreciative inquiry guided the two phases of semi-structured interviews ( n = 5) and focus groups ( n = 6). Inductive and deductive coding were used to establish themes. Findings Three themes encompassed the participants’ perceived value of occupational therapy services: (1) outcomes which are meaningful to daily life, (2) a constructive client–therapist relationship and (3) affordable, coordinated and understandable therapy. Conclusion Participants attributed value to occupational therapy services when they encountered personalised goal setting, focused on meaningful outcomes, managed personal costs and experienced positive therapeutic relationships. Enhancing services could focus on (1) developing skills in collaborative goal setting, (2) determining suitable outcome measures which are meaningful at personal- and service-level reporting, (3) encouraging self-management strategies, and (4) emphasising therapeutic relationships and supporting therapeutic communication skill development.
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Affiliation(s)
- Su Ren Wong
- National University Hospital, Singapore
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | | | - Fang Yin Kwa
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Xiang Ting Koh
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Changi General Hospital, Singapore
| | - Rachel J J Chua
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Karina M Dancza
- Health and Social Sciences, Singapore Institute of Technology, Singapore
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7
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Sawers A, Kim J, Balkman G, Hafner BJ. Interrater and Test-Retest Reliability of Performance-Based Clinical Tests Administered to Established Users of Lower Limb Prostheses. Phys Ther 2020; 100:1206-1216. [PMID: 32280970 DOI: 10.1093/ptj/pzaa063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/02/2019] [Accepted: 02/03/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE A major barrier to reducing falls among users of lower limb prostheses (LLP) has been an absence of statistical indices required for clinicians to select and interpret scores from performance-based clinical tests. The study aimed to derive estimates of reliability, measurement error, and minimal detectable change values in performance-based clinical tests administered to unilateral LLP users. METHODS A total of 60 unilateral LLP users were administered the Narrowing Beam Walking Test, Timed ``Up and Go'' (TUG), Four Square Step Test (FSST), and 10-Meter Walk Test on 2 occasions, 3 to 9 days apart. Intraclass correlation coefficients (ICCs) were calculated to assess interrater and test-retest reliability, while standard error of measurement (SEM) and minimal detectable change (MDC90) were derived to establish estimates of measurement error in individual scores or changes in score for each test. RESULTS Interrater reliability ICCs (1,1) were high for all tests (ie, ≥0.98). Test-retest ICCs (2,1) varied by test, ranging from .88 for the TUG to .97 for the FSST. SEM and MDC90 varied between .39 and .96 and between .91 seconds and 2.2 seconds for the time-based tests (FSST, TUG, 10-Meter Walk Test). SEM and MDC90 for the Narrowing Beam Walking Test were .07 and .16, respectively. CONCLUSION With the exception of the TUG, studied tests had test-retest ICCs (2,1) that exceeded the minimum required threshold to be considered suitable for group- and individual-level applications (ie, ICC ≥ 0.70 and ≥ 0.90, respectively). Future research on individuals with dysvascular and transfemoral amputations or in specific age categories is required. IMPACT Along with published validity indices, these reliability, error, and change indices can help clinicians select balance tests suitable for LLP users. They can also help clinicians interpret test scores to make informed, evidence-based clinical decisions.
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Affiliation(s)
- Andrew Sawers
- Department of Kinesiology, University of Illinois at Chicago, 1919 W. Taylor Street, Chicago, IL 60612 (USA)
| | - Janis Kim
- Department of Kinesiology, University of Illinois at Chicago, 1919 W. Taylor Street, Chicago, IL 60612 (USA)
| | - Geoff Balkman
- Department of Kinesiology, University of Illinois at Chicago
| | - Brian J Hafner
- Department of Kinesiology, University of Illinois at Chicago
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Kristensen LQ, Muren MA, Petersen AK, van Tulder MW, Gregersen Oestergaard L. Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury: A systematic review. Scand J Occup Ther 2019; 27:168-183. [PMID: 31725339 DOI: 10.1080/11038128.2019.1689291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Performance-based measures that focus primarily on the ability to engage in ADL are routinely used by occupational therapists to assess a client's cognitive abilities.Objective: To perform a systematic review to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in individuals with traumatic brain injury.Material and methods: Pubmed, EMBASE, CINAHL, PsycINFO and OTseeker were searched. The Consensus-based Standards for the selection of health measurement instruments checklist was used to evaluate methodological quality of each included study. The quality criteria adapted by Terwee were applied to extract the results of each measurement property followed by a best evidence synthesis.Results: Twenty-eight articles, including 40 ratings of measurement properties, were included. The combination of the Functional Independence Measure and the Functional Assessment Measure showed moderate evidence of good internal consistency (Cronbach's alpha 0.99), but conflicting evidence of reliability (ICC 0.83) and poor evidence of construct validity. All other instruments showed limited or unknown evidence.Conclusions: This review provides an overview of measurement properties of performance-based instruments and contributes to such methodological considerations before choosing an instrument. Though, the results reveal a lack of high-quality evidence for any of the measurement properties, it is recommended to use tools with the highest possible evidence for positive ratings.Significance: This review contributes with psychometric evidence on instruments to use in occupational therapy practice and research.
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Affiliation(s)
- Lola Qvist Kristensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Neurorehabilitation Skive, Hammel Neurorehabilitation Centre and University Research Clinic, Skive, Denmark
| | - Marie Almkvist Muren
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maurits W van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Health Sciences and the EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Public Health, The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
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Sawers A, Hafner BJ. Using Clinical Balance Tests to Assess Fall Risk among Established Unilateral Lower Limb Prosthesis Users: Cutoff Scores and Associated Validity Indices. PM R 2019; 12:16-25. [PMID: 30900830 DOI: 10.1002/pmrj.12160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinicians are routinely required to make decisions about fall risk among lower limb prosthesis (LLP) users. These decisions can be guided by standardized clinical balance tests but require population- and test-specific cutoff scores and validity indices to categorize individuals as probable fallers or nonfallers on the basis of test performance. Despite the importance of cutoff scores and validity indices to clinical interpretation of clinical balance test scores, they are rarely reported for LLP users. In their absence, clinicians cannot use results from clinical balance tests to assess the likelihood of a fall by any one patient. OBJECTIVE Derive cutoff scores, and associated validity indices, for clinical balance tests administered to established unilateral LLP users. DESIGN Cross-sectional study. SETTING Outpatient clinic and research laboratory. PARTICIPANTS Established ambulatory unilateral transtibial and transfemoral prosthesis users (n = 40). INTERVENTION Not applicable. MAIN OUTCOME MEASURE(S) Optimal cutoff scores and related validity indices (ie, area under the curve, sensitivity, specificity, likelihood ratios) were computed for five balance tests, the activities-specific balance confidence scale (ABC), timed up and go (TUG), four square step test (FSST), Berg balance scale (BBS), and narrowing-beam walking test (NBWT). RESULTS Cutoff scores were identified for the NBWT (≤.43/1.0), TUG (≥8.17 seconds], FSST (≥8.49 seconds), BBS (≤50.5/56), and ABC (≤80.2/100). Validity indices (ie, area under the curve, sensitivity, specificity, and likelihood ratios) for the NBWT, TUG, and FSST had greater diagnostic accuracy and provided more information about the probability of a fall than those for the BBS or ABC. CONCLUSION Performance above or below identified cutoff scores for the NBWT, FSST, and TUG provides information about potentially important shifts in the probability of falling among established unilateral LLP users. These results can serve as initial benchmarks to reduce uncertainty surrounding fall risk assessment in established unilateral LLP users but require future prospective evaluation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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10
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Al Zoubi F, Mayo N, Rochette A, Thomas A. Applying modern measurement approaches to constructs relevant to evidence-based practice among Canadian physical and occupational therapists. Implement Sci 2018; 13:152. [PMID: 30563550 PMCID: PMC6299597 DOI: 10.1186/s13012-018-0844-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) is a complex process. To quantify it, one has to also consider individual and contextual factors using multiple measures. Modern measurement approaches are available to optimize the measurement of complex constructs. This study aimed to develop a robust measurement approach for constructs around EBP including practice, individual (e.g. knowledge, attitudes, confidence, behaviours), and contextual factors (e.g. resources). METHODS One hundred eighty-one items arising from 5 validated EBP measures were subjected to an item analysis. Nominal group technique was used to arrive at a consensus about the content relevance of each item. Baseline questionnaire responses from a longitudinal study of the evolution of EBP in 128 new graduates of Canadian physical and occupational therapy programmes were analysed. Principles of Rasch Measurement Theory were applied to identify challenges with threshold ordering, item and person fit to the Rasch model, unidimensionality, local independence, and differential item functioning (DIF). RESULTS The nominal group technique identified 70/181 items, and modified Delphi approach identified 68 items that fit a formative model (2 related EBP domains: self-use of EBP (9 items) and EBP activities (7 items)) or a reflective model (4 related EBP domains: attitudes towards EBP (17 items), self-efficacy (9 items), knowledge (11 items) and resources (15 items)). Rasch analysis provided a single score for reflective construct. Among attitudes items, 65% (11/17) fit the Rasch model, item difficulties ranged from - 7.51 to logits (least difficult) to + 5.04 logits (most difficult), and person separation index (PSI) = 0.63. Among self-efficacy items, 89% (8/9) fit the Rasch model, item difficulties ranged from - 3.70 to + 4.91, and PSI = 0.80. Among knowledge items, 82% (9/11) fit the Rasch model, item difficulties ranged from - 7.85 to 4.50, and PSI = 0.81. Among resources items, 87% (13/15) fit the Rasch model, item difficulties ranged from - 3.38 to 2.86, and PSI = 0.86. DIF occurred in 2 constructs: attitudes (1 by profession and 2 by language) and knowledge (1 by language and 2 by profession) arising from poor wording in the original version leading to poor translation. CONCLUSIONS Rasch Measurement Theory was applied to develop a valid and reliable measure of EBP. Further modifications to the items can be done for subsequent waves of the survey.
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Affiliation(s)
- Fadi Al Zoubi
- McGill University, Montreal, QC, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.
| | - Nancy Mayo
- McGill University, Montreal, QC, Canada
- Center for Outcomes Research and Evaluation (CORE), Research Institute of McGill University Health Center, Montreal, QC, Canada
| | - Annie Rochette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Aliki Thomas
- McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Centre for Medical Education, Montreal, Canada
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Lam Wai Shun P, Bottari C. Development and Pilot Testing of a Measure of Potential Barriers and Facilitators to the Use of a Standardized Assessment Tool. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:94-101. [PMID: 29624521 DOI: 10.1097/ceh.0000000000000194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Standardized assessment tools (SATs) are essential to evidence-based assessment practices. Identifying what impedes clinicians' use of a SAT can help tailor strategies promoting its use in clinical practice. This article presents the development of the "Measure of potential barriers and facilitators to the Use of a Standardized assessment Tool (MUST)" questionnaire. Preliminary findings are also reported from pilot testing in which the MUST was used to investigate occupational therapists' (OTs) perceptions of potential barriers and facilitators to the use of the Activities of Daily Living Profile (ADL Profile), a SAT evaluating independence in everyday activities of cognitively impaired adults. METHODS The MUST was administered to 41 OTs attending continuing education workshops on the ADL Profile. Internal consistency was explored using Chronbach alpha. Descriptive statistics were used to analyze scores for each statement. RESULTS Internal consistency for subscales related to clinicians' characteristics (α = 0.7) and to the SAT's characteristics (α = 0.8) were adequate but lower for the subscale related to the clinical setting (α = 0.6). OTs' perceptions of potential barriers were associated with: OTs' perceived self-efficacy; ADL Profile's applicability to OTs' clienteles; ADL Profile's compatibility with values promoted in the work setting and with clients' preferences; limited peer support; time to implement the ADL Profile. DISCUSSION The MUST, a theory-informed questionnaire, may prove useful in identifying potential barriers needing to be addressed in continuing education training promoting the use of SATs by clinicians. The MUST is quick to administer and initial testing provides support for its internal consistency.
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Affiliation(s)
- Priscilla Lam Wai Shun
- Ms. Lam Wai Shun: Doctoral Candidate, Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada. Dr. Bottari: Associate Professor, Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada, and Researcher, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
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Kuk NO, Bours GJ, Hamers JP, Kempen GI, Zijlstra GR. Feasibility of the Translating Innovations into Practice-toolbox (TIP-toolbox): A mixed-methods study for implementing activity innovations in nursing homes. Geriatr Nurs 2017; 38:498-504. [DOI: 10.1016/j.gerinurse.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
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Sawers A, Hafner BJ. A study to assess whether fixed-width beam walking provides sufficient challenge to assess balance ability across lower limb prosthesis users. Clin Rehabil 2017; 32:483-492. [PMID: 28948848 DOI: 10.1177/0269215517732375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility of fixed-width beam walking for assessing balance in lower limb prosthesis users. DESIGN Cross-sectional. SETTING Laboratory. SUBJECTS Lower limb prosthesis users. METHODS Participants attempted 10 walking trials on three fixed-width beams (18.6, 8.60, and 4.01 wide; 5.5 m long; 3.8 cm high). MAIN MEASURES Beam-walking performance was quantified using the distance walked to balance failure. Heuristic rules applied to each participant's beam-walking distance to classify each beam as "too easy," "too hard," or "appropriately challenging" and determine whether any single beam provided an appropriate challenge to all participants. The number of trials needed to achieve stable beam-walking performance was quantified for appropriately challenging beams by identifying the last inflection point in the slope of each participant's trial-by-trial cumulative performance record. RESULTS In all, 30 unilateral lower limb prosthesis users participated in the study. Each of the fixed-width beams was either too easy or too hard for at least 33% of the sample. Thus, no single beam was appropriately challenging for all participants. Beam-walking performance was stable by trial 8 for all participants and by trial 6 for 90% of participants. There was no significant difference in the number of trials needed to achieve stable performance among beams ( P = 0.74). CONCLUSION Results suggest that a clinical beam-walking test would require multiple beams to evaluate balance across a range of lower limb prosthesis users, emphasizing the need for adaptive or progressively challenging balance tests. While the administrative burden of a multiple-beam balance test may limit clinical feasibility, alternatives to ease this administrative burden are proposed.
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Affiliation(s)
- Andrew Sawers
- 1 Department of Kinesiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian J Hafner
- 2 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Hafner BJ, Spaulding SE, Salem R, Morgan SJ, Gaunaurd IA, Gailey RS. Prosthetists' perceptions and use of outcome measures in clinical practice: Long-term effects of focused continuing education. Prosthet Orthot Int 2017; 41:266-273. [PMID: 27638012 PMCID: PMC5354985 DOI: 10.1177/0309364616664152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Continuing education is intended to facilitate clinicians' skills and knowledge in areas of practice, such as administration and interpretation of outcome measures. OBJECTIVE To evaluate the long-term effect of continuing education on prosthetists' confidence in administering outcome measures and their perceptions of outcomes measurement in clinical practice. DESIGN Pretest-posttest survey methods. METHODS A total of 66 prosthetists were surveyed before, immediately after, and 2 years after outcomes measurement education and training. Prosthetists were grouped as routine or non-routine outcome measures users, based on experience reported prior to training. RESULTS On average, prosthetists were just as confident administering measures 1-2 years after continuing education as they were immediately after continuing education. In all, 20% of prosthetists, initially classified as non-routine users, were subsequently classified as routine users at follow-up. Routine and non-routine users' opinions differed on whether outcome measures contributed to efficient patient evaluations (79.3% and 32.4%, respectively). Both routine and non-routine users reported challenges integrating outcome measures into normal clinical routines (20.7% and 45.9%, respectively). CONCLUSION Continuing education had a long-term impact on prosthetists' confidence in administering outcome measures and may influence their clinical practices. However, remaining barriers to using standardized measures need to be addressed to keep practitioners current with evolving practice expectations. Clinical relevance Continuing education (CE) had a significant long-term impact on prosthetists' confidence in administering outcome measures and influenced their clinical practices. In all, approximately 20% of prosthetists, who previously were non-routine outcome measure users, became routine users after CE. There remains a need to develop strategies to integrate outcome measurement into routine clinical practice.
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Affiliation(s)
- Brian J. Hafner
- Department of Rehabilitation Medicine, University of
Washington School of Medicine, Seattle, WA 98195
| | - Susan E. Spaulding
- Department of Rehabilitation Medicine, University of
Washington School of Medicine, Seattle, WA 98195
| | - Rana Salem
- Department of Rehabilitation Medicine, University of
Washington School of Medicine, Seattle, WA 98195
| | - Sara J. Morgan
- Department of Rehabilitation Medicine, University of
Washington School of Medicine, Seattle, WA 98195
| | - Ignacio A. Gaunaurd
- Research, Miami Veterans Affairs Healthcare System, Miami,
FL 33125,Department of Physical Therapy, University of Miami Miller
School of Medicine, Coral Gables FL 33146
| | - Robert S. Gailey
- Research, Miami Veterans Affairs Healthcare System, Miami,
FL 33125,Department of Physical Therapy, University of Miami Miller
School of Medicine, Coral Gables FL 33146
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Cook C, McCluskey A, Bowman J. Occupational Therapists Report Increased Use of Outcome Measures after Participation in an Education Programme. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Darzins SW, Imms C, Stefano MD, Radia-George CA. Personal Care Participation Assessment and Resource Tool: Clinical utility for inpatient rehabilitation. The Canadian Journal of Occupational Therapy 2016; 83:237-248. [DOI: 10.1177/0008417416648446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Evidence supports validity of the Personal Care Participation Assessment and Resource Tool (PC-PART), but clinical utility remains unverified. Purpose. This study aimed to investigate occupational therapists’ perceptions about the PC-PART’s clinical utility for inpatient rehabilitation. Method. Using mixed methods, occupational therapists who had used the PC-PART as part of a research study in an inpatient rehabilitation setting completed a questionnaire ( n = 9) and participated in a focus group ( n = 6) to explore their perspectives about its clinical utility. Quantitative data were summarized and qualitative data analyzed using inductive thematic analysis. Findings. Quantitative data highlighted both positive and negative aspects of the PC-PART’s clinical utility. Five themes emerged from the qualitative data: nature of information gathered; familiarity with the instrument; perceived time and effort; item phrasing, interpretation, and presentation; and external influences on clinical use. Implications. The PC-PART was perceived to support gathering of clinically useful information, helpful to intervention and discharge planning. Recommendations for improving some item phrasing, operational definitions, and instructions were identified. Although standardized assessments were valued, use in routine practice was challenging, requiring a knowledge translation strategy.
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Bowman J, Mogensen L, Marsland E, Lannin N. The development, content validity and inter-rater reliability of the SMART-Goal Evaluation Method: A standardised method for evaluating clinical goals. Aust Occup Ther J 2015; 62:420-7. [PMID: 26286379 DOI: 10.1111/1440-1630.12218] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Goal setting is a complex skill. The use of formal goal writing procedures (including the use of the SMART goal model) has been advocated. However, a standardised method of writing and evaluating SMART goals is currently lacking. This study comprised of two phases. The aims of phase one was to (i) develop the SMART Goal Evaluation Method (SMART-GEM) based on a SMART goal model; and (ii) investigate the content validity of the SMART-GEM. The aim of phase two of the study was to test the inter-rater reliability of the SMART-GEM. METHODS Development of the SMART- GEM involved defining and constructing evaluation criteria suitable for auditing goal statements. A content validity assessment was conducted using an expert panel of Occupational Therapists (n = 10). Inter-rater reliability of the SMART-GEM was examined using a purposive sample of multiple raters (n = 24). RESULTS The SMART- GEM was rated as having good content validity (individual items CVI ranged from 0.90 to 1.00; total SMART- GEM CVI = 0.99, ρ = 0.05). Agreement between raters on individual items ranged from poor (κ = 0.254) to excellent (κ = 0.965) and agreement of overall grades was fair to good (κ = 0.582). Inter-rater agreement on total scores was found to be very good (ICC = 0.895, 95% CI = 0.743 to 0.986, ρ = 0.001) with excellent internal consistency (α = 0.995). CONCLUSION The SMART-GEM demonstrated good construct validity and very good inter-rater reliability on total score and shows promise as a standardised method to writing and evaluating clinical goals.
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Affiliation(s)
- Julia Bowman
- Research and Evaluation Service, Justice Health and Forensic Mental Health Network, Malabar, New South Wales, Australia.,Occupational Therapy Department, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Lise Mogensen
- School of Medicine, University of Western Sydney, Campbelltown, New South Wales, Australia
| | - Elisabeth Marsland
- School of Science and Health, University of Western Sydney, Penrith South, New South Wales, Australia
| | - Natasha Lannin
- Occupational Therapy Department, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia.,John Walsh Centre of Rehabilitation Research, Northern Clinical School, Sydney Medical School, University of Sydney, St Leonards, New South Wales, Australia
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Valdes K, MacDermid J, Algar L, Connors B, Cyr LM, Dickmann S, Lucado AM, Naughton N. Hand therapist use of patient report outcome (PRO) in practice: a survey study. J Hand Ther 2015; 27:299-307; quiz 308. [PMID: 25150584 DOI: 10.1016/j.jht.2014.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/08/2014] [Accepted: 07/08/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this survey was to gain greater insight into hand therapists' use of Patient Report Outcome (PRO) measures. METHODS An 11-question survey that evaluated therapists' perceptions, preferences, and patterns of use of patient report outcome measures was sent to members of ASHT. RESULTS A total of 633 ASHT members participated in the survey study. A large majority of participants (92%) responded affirmatively to using a PRO measure in practice. The DASH was reported as the most frequently used measure (90%). The majority of therapists (84%) discuss the results of the outcome measurement score with their patients. Of the participants who use more than one outcome measure, 44% report that this allows them to better establish their patient's functional and physical limitations. CONCLUSION The findings in this study suggest that a large percentage of hand therapists are currently including a PRO measure in their hand therapy practice.
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Affiliation(s)
- Kristin Valdes
- Rocky Mountain University, UT, USA; Drexel University, PA, USA.
| | | | - Lori Algar
- Northeast Orthopaedic and Hand Surgery, CT, USA
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Gaunaurd I, Spaulding S, Amtmann D, Salem R, Gailey R, Morgan S, Hafner B. Use of and confidence in administering outcome measures among clinical prosthetists: Results from a national survey and mixed-methods training program. Prosthet Orthot Int 2015; 39:314-21. [PMID: 24827935 PMCID: PMC4232484 DOI: 10.1177/0309364614532865] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/20/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Outcome measures can be used in prosthetic practices to evaluate interventions, inform decision making, monitor progress, document outcomes, and justify services. Strategies to enhance prosthetists' ability to use outcome measures are needed to facilitate their adoption in routine practice. OBJECTIVE To assess prosthetists' use of outcome measures and evaluate the effects of training on their confidence in administering performance-based measures. STUDY DESIGN Cross-sectional and single-group pretest-posttest survey. METHODS Seventy-nine certified prosthetists (mean of 16.0 years of clinical experience) were surveyed about their experiences with 20 standardized outcome measures. Prosthetists were formally trained by the investigators to administer the Timed Up and Go and Amputee Mobility Predictor. Prosthetists' confidence in administering the Timed Up and Go and Amputee Mobility Predictor was measured before and after training. RESULTS The majority of prosthetists (62%) were classified as non-routine outcome measure users. Confidence administering the Timed Up and Go and Amputee Mobility Predictor prior to training was low-to-moderate across the study sample. Training significantly (p < 0.0001) improved prosthetists' confidence in administering both instruments. CONCLUSION Prosthetists in this study reported limited use of and confidence with standardized outcome measures. Interactive training resulted in a statistically significant increase of prosthetists' confidence in administering the Timed Up and Go and Amputee Mobility Predictor and may facilitate use of outcome measures in clinical practice. CLINICAL RELEVANCE Frequency of outcome measure use in the care of persons with limb loss has not been studied. Study results suggest that prosthetists may not regularly use standardized outcome measures and report limited confidence in administering them. Training enhances confidence and may encourage use of outcome measures in clinical practice.
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Affiliation(s)
- Ignacio Gaunaurd
- Research Department, Miami Veterans Affairs Healthcare System, Miami, FL 33125,Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables FL 33146
| | - Susan Spaulding
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105
| | - Robert Gailey
- Research Department, Miami Veterans Affairs Healthcare System, Miami, FL 33125,Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables FL 33146
| | - Sara Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105
| | - Brian Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105
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Wales K, Clemson L, Lannin NA, Cameron ID. Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review and evaluation of measurement properties. Syst Rev 2012; 1:45. [PMID: 23067564 PMCID: PMC3582570 DOI: 10.1186/2046-4053-1-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 09/24/2012] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Kylie Wales
- Ageing Work and Health Research Unit and The Centre for Excellence in Population Ageing Research, Faculty of Health Sciences, The University of Sydney, PO BOX 170, Lidcombe, NSW, 2141, Australia
| | - Lindy Clemson
- Ageing Work and Health Research Unit and The Centre for Excellence in Population Ageing Research, Faculty of Health Sciences, The University of Sydney, PO BOX 170, Lidcombe, NSW, 2141, Australia
| | - Natasha A Lannin
- Occupational Therapy Department, Alfred Health, and Faculty of Health Sciences, Alfred Clinical School, La Trobe University, The Alfred, 55 Commercial Road, Prahran, VIC, 3181, Australia
| | - Ian D Cameron
- Rehabilitation Studies Unit, Sydney Medical School, The University of Sydney, PO BOX 6, Sydney, NSW, 2112, Australia
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Abstracts. Br J Occup Ther 2012. [DOI: 10.1177/03080226120758s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Samsonraj RS, Loughran MF, Secker J. Evaluating outcomes of therapies offered by occupational therapists in adult mental health. J Ment Health 2012; 21:531-8. [DOI: 10.3109/09638237.2011.638000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Carolyn A Unsworth
- Associate Professor, Department of Occupational Therapy, La Trobe University, Australia
- Adjunct Professor, School of Health Sciences, Jönköping University, Jönköping, Sweden
- Visiting Professor, Faculty of Health and Social Care, London South Bank University, London
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Marsland E, Bowman J. An interactive education session and follow-up support as a strategy to improve clinicians' goal-writing skills: a randomized controlled trial. J Eval Clin Pract 2010; 16:3-13. [PMID: 20367810 DOI: 10.1111/j.1365-2753.2008.01104.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Elisabeth Marsland
- Occupational Therapist, Department of Housing, Sydney, NSW, Australia and Macarthur Home Modifications and Maintenance Service, Sydney, NSW, Australia.
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Fänge A, Ivanoff SD. Integrating research into practice: A challenge for local authority occupational therapy. Scand J Occup Ther 2009; 16:40-8. [DOI: 10.1080/11038120802419357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bowman J, Lannin N, Cook C, McCluskey A. Development and psychometric testing of the Clinician Readiness for Measuring Outcomes Scale. J Eval Clin Pract 2009; 15:76-84. [PMID: 19239585 DOI: 10.1111/j.1365-2753.2008.00957.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Julia Bowman
- School of Biomedical and Health Sciences, College of Health and Science, University of Western Sydney, Australia.
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