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.

Comparing Component-Based and Occupation-Based Interventions of a Person with Visual Deficits' Performance

This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention (Vision Coach), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.

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.

Implementing the Assessment of Motor and Process Skills (AMPS) in the Workplace: A Comparison of the Experiences of Occupational Therapists and New Graduates

Learning to use new skills through continuing professional education courses is an important part of continuing professional development, contributing towards the evidence of competence to practise. Few studies have examined how such new learning is used in professional practice.

This study investigated the experiences of occupational therapists when learning to use the Assessment of Motor and Process Skills (AMPS) and whether years of experience or clinical area affected how the AMPS was used in practice. Twenty-three occupational therapists who undertook a 5-day AMPS course completed three questionnaires over a 10-month period. Thirteen were senior level occupational therapists and 10 were new graduates about to commence employment in their first post.

Significant differences between the two groups were found in three areas: the new graduates experienced more difficulties when starting to use the AMPS, completed fewer assessments and found workplace difficulties more time consuming. The two groups shared many difficulties when learning to use a new skill and implementing it within workplace teams, but the analysis of the ranking of these difficulties using the Mann-Whitney U test demonstrated no overall difference between the two groups. Successful implementation of the AMPS for all the participants depended on having sufficient time for new learning to take place and on support from managers so that they could change elements of practice to accommodate the use of new skills.

The Assessment of Motor and Process Skills: An Evaluation of the Impact of Training on Service Delivery

Thirty-six occupational therapists that completed a training course on the Assessment of Motor and Process Skills (AMPS), held in the West Midlands, took part in a follow-up evaluation. This examined the effectiveness of the AMPS training on the occupational therapy service delivery. Twenty-eight structured interviews were carried out with occupational therapists from the West Midlands region and eight postal questionnaires returned from occupational therapists outside the region.

The outcome indicated that observation skills had improved and that the AMPS was an appropriate tool to use for the purposes of assessment, guiding intervention and measuring outcomes of occupational therapy. There were variations in the ease with which the AMPS was administered with different client groups, but 89% of the occupational therapists were still using the AMPS at 9 months following training across a range of services. The main difficulties encountered were a lack of access to a computer and the additional support needed for the AMPS to be fully integrated into clinical practice.

The adaptability of the AMPS as a standardised assessment and outcome measure makes it a good choice of tool to use across an occupational therapy service. The effects of the AMPS training on such a service are discussed, with recommendations for managers planning the distribution of limited training budgets and the implications for service development needs.

Occupational Performance of People Diagnosed with Schizophrenia in Supported Housing and Outreach Programmes in Australia

This study compared the occupational performance in activities of daily living (ADL) of people diagnosed with schizophrenia in two settings: 25 people in residential rehabilitation facilities and 18 people receiving intensive outreach support in their homes in urban Australia. All participants were assessed with structured interviews, the Assessment of Motor and Process Skills (a performance-based measure of ADL ability) and the Life Skills Profile (an informant-report measure of disability).

Hypothesised differences in ADL performance between the two settings were not supported. Mean ADL process ability, based on the AMPS process skills subscale, indicated that the majority (58%) of the 43 participants needed some assistance in community living, irrespective of where they lived and the types of support received. Many participants (42%) performed ADL tasks with relative ease, efficiency, safety and independence as measured by AMPS, indicating that they could live in housing arrangements with outreach support. However, the ADL process ability measures for two-thirds of these participants indicated that they would struggle in community living in the absence of outreach support.

Given these findings, the eligibility criteria and screening for residential and outreach support services need re-examination and performance-based assessments of ADL ability could improve the identification of housing-related support needs. Occupational therapists have expertise in this area to develop individualised supports that enable a greater choice of living arrangements for people diagnosed with schizophrenia.

Differences in Activities of Daily Living Process Skills of Persons with and without Alzheimer's Disease

The purpose of this study was to determine if persons with dementia of the Alzheimer type (DAT) differed from nondisabled older controls in the actual, experienced difficulty of specific process skills that affect performance of activities of daily living (ADL). A two-group comparison was performed and all participants were evaluated in either clinical or home environments to which they had been familiarized. Participants (341 persons with DAT and 287 controls) were selected from the standardization sample of the Assessment of Motor and Process Skills (AMPS) computer-scoring software. The demographic characteristics of the two groups were comparable. The AMPS was used to evaluate the effort, efficiency, safety, and independence of 20 ADL process skills that are compiled to enact performance of familiar ADL tasks. The raw data for each sample was subjected to many-faceted Rasch analysis to determine item difficulty calibrations of the ADL process skill items for each group. Actual item difficulty calibrations of 19 ADL process skills differed meaningfully between the two groups. The results indicated that it is possible to identify specific ADL process skills that are actually easier or more difficult for each group. In addition, the results supported earlier research that has demonstrated that the underlying cognitive and physical impairments demonstrated by persons with DAT do manifest as ADL disability, negatively impacting their ability to perform ADL tasks.

Test-Retest Reliability of the Assessment of Motor and Process Skills in Elderly Adults

We examined the test-retest reliability of the Assessment of Motor and Process Skills (AMPS) in a heterogeneous sample of 55 elderly adults. Subjects were reassessed within 1 to 10 days (M=4.0, SD=2.7 days). The subjects' Time 1 and Time 2 ability measures were highly correlated (Motor: r(55)=.88, P<.001; Process: r(55)=.86, P<.001). Measures were stable in 92% of the subjects. Significant variability occurred in only 8% (N=9) of the subjects' ability measures. Measurement error was a concern less than 2% of the time; 6% of the subjects' measures differed as a reflection of real changes in their task performances. Although some variability was attributed to fluctuations in subjects' medical conditions or motivation to adhere to the task requirements, not all of it could be attributed to a specific factor. These data provide support for the reliability of the AMPS, and serve as a reminder that not all test—retest differences represent measurement error.

Relationships between Cognitive Abilities and the Process Scale and Skills of the Assessment of Motor and Process Skills (AMPS) in Patients with Stroke

The purpose of this study was: 1) to determine the strength of the relationships between cognitive components at the body function/impairment level to the assessment of motor and process skills (AMPS) at the occupational performance/activities level in persons following stroke; and 2) to examine which cognitive components best explain the variance of the AMPS score. Stroke is a major cause of disability in older age that can result in motor and/or cognitive impairments leading to functional disability. The assessment of AMPS is an activity of daily living (ADL) and instrument activity of daily living (IADL) evaluation that measures two aspects enabling occupational performance and motor and process skills. Subjects included 30 hospitalized patients 4 to 5 weeks following stroke. Among them were 17 men and 13 women with a mean age of 71.33 (SD = 8.39) who had been independent in ADL prior to the event. Instruments included the AMPS IADL tasks, Thinking Operations from the LOTCA, Contextual Memory Test, Rey Complex Figure-copy, Star cancellation from the BIT, and COGNISTAT. The study supports the existence of moderate relationships between cognitive components and the AMPS' process scale and skills, and the results add information about relationships between cognitive impairments and occupational performance that can help in treatment planning.

Ecological assessment of cognitive functions in children with acquired brain injury: a systematic review

BACKGROUND

Childhood acquired brain injury (ABI) often leads to impairment in cognitive functioning, resulting in disabilities in both the home and school environment. Assessing the impact of these cognitive deficits in everyday life using traditional neuropsychological tests has been challenging. This study systematically reviewed ecological measures of cognitive abilities available for children with ABI.

METHOD

Eight databases were searched (until October 2011) for scales: (1) focused on ecological assessment of cognitive functioning; (2) with published data in an ABI population; (3) applicable to children up to 17;11 years of age; and (4) in English. The title and abstract of all papers were reviewed independently by two reviewers.

RESULTS

Database searches yielded a total of 12 504 references, of which 17 scales met the inclusion criteria for the review, focusing on executive functions (n = 9), memory (n = 3), general cognitive abilities (n = 2), visuo-spatial skills (n = 2) and attention (n = 1). Four tasks used observation of actual performance in a natural environment, five were proxy-reports and six were functional paper and pencil type tasks, performed in an office.

CONCLUSION

Overall, few measures were found; eight were still experimental tasks which did not provide norms. Executive functions were better represented in ecological assessment, with relatively more standardized scales available.

Analyse Critique D'instruments de Mesure Des AVQ en Pédiatrie: Déficits Exécutifs et Indépendance

Description. Bien que l'évaluation des activités de la vie quotidienne (AVQ) par analyse de tâches soit au cœur du rôle de l'ergothérapeute œuvrant auprès d'enfants ayant un traumatisme craniocérébral (TCC), aucune étude visant l'analyse des instruments utilisés à cet effet selon leur potentiel de mettre en évidence des déficits liés aux fonctions exécutives (ex: formuler un but, planifier) n'a été recensée.

But. Déterminer s'il existe des outils de mesure des AVQ qui considèrent les fonctions exécutives, validés auprès d'enfants de 10 à 15 ans ayant un TCC.

Méthodologie. Quatre outils, le «Assessment of Motor and Process Skills», le «Children's Kitchen Task Assessment», la «tâche du gâteau au chocolat» et le «Profil des AVQ» ont été analysés selon des critères tels que: 1) complexité des tâches, 2) approche d'évaluation non-structurée, et 3) qualités psychométriques adéquates pour la clientèle cible.

Résultats. Ces outils ne sont que partiellement conformes aux critères recherchés.

Conclusion. La poursuite des études sur ces outils serait primordiale pour mieux répondre aux besoins de cette clientèle.

Application of Rasch analysis to examine psychometric aspects of the activities-specific balance confidence scale when used in a new cultural context

Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context.

OBJECTIVE

To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context.

DESIGN

Cross-sectional, population-based, random selection from the Icelandic National Registry.

SETTING

Community-based.

PARTICIPANTS

Icelanders (N=183), 65 to 88 years old, and 48% women.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale.

RESULTS

Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested.

CONCLUSIONS

Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.

Group Constraint-Induced Movement Therapy: Motor and Functional Outcomes in Individuals with Stroke

Background

Strokes frequently cause limitations of the upper extremity and in performance of activities of daily living (ADL). Constraint-induced movement therapy (CIMT) is designed to enhance the use of the hemiplegic arm.

Purpose

To assess the effects of group CIMT on upper-extremity motor function and performance level of motor and process skills for instrumental activities in daily living (IADL) in community-dwelling individuals whose stroke occurred at least six months earlier.

Methods

Eight adults with stroke participated in this study. Group-based CIMT was administered for two weeks, five times per week, with two-hour intensive daily training.

Findings

The Fugl-Meyer Assessment (FMA) score and the Assessment of Motor and Process Skills (AMPS) scores improved after intervention.

Implications

The results of this study suggest that relatively brief group-based CIMT may be an effective intervention for improving motor function of the affected upper-limb and the level of IADL in individuals who have had stroke.

An Exploration of the Neural Control of Multitasking and the Implications for Practice

This paper aims to explore some of the published evidence concerning the skill of multitasking, including the neuroanatomy associated with this skill, and the assessments and interventions used within the rehabilitation setting. Multitasking is an essential skill for any person to be able to live independently. It involves a number of functions associated with the frontal lobe and is one of the components of dysexecutive syndrome. Although much has been written about other aspects of executive function, multitasking has only been researched in more detail over the last decade. It is an area of particular concern for occupational therapists aiming to rehabilitate people who have sustained a brain injury.

The Use of the Assessment of Motor and Process Skills (AMPS) in Predicting Need of Assistance for Adults with Mental Retardation

Because the ability to perform activities of daily living (ADL) is associated with global aspects of community functioning, it is critical to evaluate whether the information gained from specific ADL assessments contributes to a reliable prediction of the overall amount of assistance needed for a person to function in the community. The purpose of this study was to evaluate the predictive use of an ADL assessment, the Assessment of Motor and Process Skills (AMPS), to determine which people with mental retardation need support or assistance to function in the community. A sample of 380 data records from the AMPS international database of people with various levels of mental retardation was included in the study. Many-faceted Rasch analyses and logistic regression models were used for data analysis. The results indicated that only the AMPS ADL process ability measures contributed significantly and substantially to the prediction of the level of assistance required to function in the community for individuals with mild to moderate mental retardation when used in conjunction with age, gender, and level of mental retardation. The results have clinical implications for occupational therapists working with these people because ADL process ability can be improved by occupational therapy interventions.

Content comparison of occupation-based instruments in adult rheumatology and musculoskeletal rehabilitation based on the International Classification of Functioning, Disability and Health

OBJECTIVE

To compare the content of clinical, occupation-based instruments that are used in adult rheumatology and musculoskeletal rehabilitation in occupational therapy based on the International Classification of Functioning, Disability and Health (ICF).

METHODS

Clinical instruments of occupational performance and occupation in adult rehabilitation and rheumatology were identified in a literature search. All items of these instruments were linked to the ICF categories according to 10 linking rules. On the basis of the linking, the content of these instruments was compared and the relationship between the capacity and performance component explored.

RESULTS

The following 7 instruments were identified: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, the Sequential Occupational Dexterity Assessment, the Jebson Taylor Hand Function Test, the Moberg Picking Up Test, the Button Test, and the Functional Dexterity Test. The items of the 7 instruments were linked to 53 different ICF categories. Five items could not be linked to the ICF. The areas covered by the 7 occupation-based instruments differ importantly: The main focus of all 7 instruments is on the ICF component activities and participation. Body functions are covered by 2 instruments. Two instruments were linked to 1 single ICF category only.

CONCLUSION

Clinicians and researchers who need to select an occupation-based instrument must be aware of the areas that are covered by this instrument and the potential areas that are not covered at all.

Gender differences in the performance of activities of daily living11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVES

To verify that the activities of daily living (ADL) motor and process skill items and tasks in the Assessment of Motor and Process Skills (AMPS) are free from gender bias, and to compare mean differences in ADL motor and process ability between men and women.

DESIGN

Descriptive comparison; convenience sample.

SETTING

Existing data from the AMPS database.

PARTICIPANTS

Potential participants included nonwell persons (age range, 18-99y) matched within 3 age groups, first by functional level and then by diagnostic category. The resulting sample included 9250 men and 9250 women.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The AMPS, a standardized observational assessment of the quality of ADL task performance.

RESULTS

None of the AMPS task calibrations and 1 motor skill item calibration (Lifts) demonstrated an observable difference between men and women. Men had higher ADL motor ability (F(1,18494)=11.58, P<.01) and women had higher ADL process ability (F(1,18494)=76.18, P<.01).

CONCLUSION

The results suggest that the AMPS is free of gender bias. Although differences were found between men and women in mean ADL motor and process ability, they were not considered clinically detectable differences.

Validity of a performance assessment of activities of daily living for people with developmental disabilities

BACKGROUND

Since clients with different types of developmental disabilities often experience difficulties in activities of daily living (ADL), it is critical that assessments of ADL are evaluated in order to ensure that one can make valid judgements based on the results of the appraisal. The purpose of the present study was to evaluate the validity of a specific performance assessment instrument, the Assessment of Motor and Process Skills (AMPS), when used by occupational therapists with clients with developmental disabilities. Unlike global ADL assessments, the AMPS is used not only to evaluate the level of ADL dependence, but also to estimate the quality of each specific action performed when a person is performing ADL tasks.

METHODS

Data were gathered from 1724 participants with different developmental disabilities, including intellectual disability (ID), cerebral palsy and spina bifida. Many-Facet Rasch (MFR) analysis was used to examine person-response validity, and task and item scale validity.

RESULTS

Goodness-of-fit statistics showed that the tasks and items had acceptable scale validity. The participants had acceptable person-response validity on the ADL motor scale, but had slightly lower than expected levels of person-response validity on the ADL process scale. The results indicate that clients with more severe forms of ID may have a higher proportion of different performance profiles in ADL than is expected by the MFR model of the AMPS. Since the proportion of participants who did not meet the criteria was only 3% lower than expected and in accordance with other studies, the difference may not be clinically meaningful. Otherwise, the results indicated that the AMPS is a valid tool when used with clients with developmental disabilities.

CONCLUSIONS

Further research is needed to evaluate the use of the AMPS in clinical assessment and intervention planning for this group of clients.

A conceptual review of functioning: implications for the development of consumer outcome measures

OBJECTIVE

Australia's National Mental Health Strategy aims to achieve improved consumer outcomes. The development and refinement of consumer outcome measures is targeted within the Second National Mental Health Plan. The National Standards for Mental Health Services identify measures of functioning, quality of life and satisfaction with services as relevant to assessing and monitoring consumer outcome. Consumers have described gauging their own recovery through the achievement of functional goals in everyday life. This paper reviews how functioning is viewed within the mental health field, and implications for developing better functional outcome measures.

METHOD

Literature describing the development of measures of functioning, principles of outcome measurement, and functional outcomes for people with severe mental illness was identified, using PsycLIT. A review yielded themes reflecting a number of assumptions about the concept of functioning.

RESULTS

Functioning is inadequately defined, raising issues about what is focused on, and from whose viewpoint, each of which has implications for using measures of functioning to monitor consumer outcome. Conflation of dissimilar functional domains, and flawed assumptions about the importance of symptomatology in influencing functional outcome limit the sensitivity to meaningful change of functional measures. Consumer perspectives are relatively neglected in functional tool development.

CONCLUSIONS

A conceptual framework that recognizes lived experience and the interaction between persons and their environment is much needed to guide the development of functional outcome measures. Qualitative and quantitative research methodologies should be used to advance understanding of functioning and to address limitations of current approaches to functional outcome measurement.

Environment effect of functional task performance in adults with acquired brain injuries: use of the assessment of motor and process skills

OBJECTIVE

To examine household task performance in both familiar (home) and unfamiliar (clinic) environments in adults with acquired brain injuries.

DESIGN

The research performed was a comparison study examining the effect of the environment on functional task performance. Individuals were evaluated using the Assessment of Motor and Process Skills both in their homes and in an unfamiliar clinic setting.

PARTICIPANTS

Twenty individuals with acquired brain injuries living in the community.

MAIN OUTCOME MEASURES

The Assessment of Motor and Process Skills, an observational, standardized, occupational therapy assessment tool, was used to evaluate household task performance.

RESULTS

Paired one-tailed t tests indicated a significant difference between home and clinic performance measures in process ability (t=-4.28, p=.00), but no significant difference in motor ability performance measures (t=-1.84, p=.410). Scatter plot analyses showed that performance scores of 6 of the 20 subjects differed in a clinically meaningful way, and that instrumental activities of daily living motor performance scores for 3 of the 20 differed in a clinically meaningful way.

CONCLUSIONS

Individuals with acquired brain injuries may be influenced by their environment when performing household tasks, although further study is necessary to determine the extent of the environmental effect.