Cross-regional validity of the Assessment of Motor and Process Skills for use in Middle Europe

Changes in pain, daily occupations, lifestyle, and health following an occupational therapy lifestyle intervention: a secondary analysis from a feasibility study in patients with chronic high-impact pain

OBJECTIVES

This study explored changes in pain-related parameters, occupational function, occupational balance, lifestyle factors, and self-perceived health status in adults with chronic high-impact pain participating in an occupational therapy lifestyle intervention.

METHODS

This one-group longitudinal feasibility study was performed in three continuous feasibility rounds. The occupational therapists-led intervention targeted meaningful occupations, regular physical activity, and a healthy diet. The intervention contained individual and group sessions and was added to the standard multidisciplinary chronic pain treatment. Outpatients (n=40, 85 % females, 46.6 ± 10.9 years old) participated in the study between April 2019 and December 2021. The analysis includes data for 31 participants. Analysis of pre-post changes assessed after each feasibility round were performed for the outcomes: pain intensity, pain sensitivity and pain modulation (pressure pain threshold and tolerance, temporal summation of pain and conditioned pain modulation), pain self-efficacy, pain catastrophizing, motor and process skills, occupational balance, daily wake-time movement, daily walking steps, body mass index, waist circumference, blood pressure, and self-perceived health status.

RESULTS

Improvements in motor skills (assessment of motor and process skills score=0.20 (1.37; 1.57), 95 % CI 0.01; 0.38) and temporal summation of pain (-1.19 (2.86; -1.67), 95 % CI -2.16; -0.22), but a decrease in pain tolerance (-7.110 (54.42; 47.32), 95 % CI -13.99; -0.22) were observed. Correlation analysis suggested moderate-to-very strong statistically significant relationships in several outcomes related to pain, health, pain coping, occupational balance, occupational functioning, body anthropometrics, and pain sensitivity.

CONCLUSIONS

This study suggested that the lifestyle intervention would benefit motor skills while effects on other outcomes were unclear in adults with chronic pain. To confirm the findings, a randomized trial evaluating effectiveness is needed. Ethical committee number: SJ-307 Reg. Clinicaltrials.gov: NCT03903900.

Predicting length of stay with assessment of motor and process skills in subjects with acquired brain injury

BACKGROUND

The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM.

METHODS

A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM.

RESULTS

Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor.

CONCLUSIONS

The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS.

Construct Validity and Clinical Utility of World Health Organization Disability Assessment Schedule 2.0 in Older Patients Discharged From Emergency Departments

Introduction: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is designed to measure functioning and disability in six domains. It is included in the International Classification of Diseases 11th revision (ICD-11). The objective of the study was to examine the construct validity of WHODAS 2.0 and describe its clinical utility for the assessment of functioning and disability among older patients discharged from emergency departments (EDs). Material and Methods: This cross-sectional study is based on data from 129 older patients. Patients completed the 36-item version of WHODAS 2.0 together with the Barthel-20, the Assessment of Motor and Process Skills (AMPS), Timed Up and Go (TUG), and the 30-Second Chair Stand Test (30 s-CST). Construct validity was examined through hypothesis testing by correlating the WHODAS with the other instruments and specifically the mobility domain in WHODAS 2.0 with the TUG and 30 s-CST tests. The clinical utility of WHODAS 2.0 was explored through floor/ceiling effect and missing item responses. Results: WHODAS 2.0 correlated fair with Barthel-20 (r = -0.49), AMPS process skills (r = -0.26) and TUG (r=0.30) and correlated moderate with AMPS motor skills (r = -0.58) and 30s-CST (r = -0.52). The WHODAS 2.0 mobility domain correlated fair with TUG (r = 0.33) and moderate with 30s-CST (r = -0.60). Four domains demonstrated floor effect: D1 "Cognition," D3 "Self-care," D4 "Getting along," and D5 "Household." Ceiling effect was not identified. The highest proportion of missing item responses were present for Item 3.4 (Staying by yourself for a few days), Item 4.4 (Making new friends), and Item 4.5 (Sexual activities). Conclusion: WHODAS 2.0 had fair-to-moderate correlations with Barthel-20, AMPS, TUG, and 30s-CST and provides additional aspects of disability compared with commonly used instruments. However, the clinical utility of WHODAS 2.0 applied to older patients discharged from EDs poses some challenges due to floor effect and missing item responses. Accordingly, patient and health professional perspectives need further investigation.

Relationship between the perceived burden of suffering and the observed quality of ADL task performance before and after a 12-week pain management programme

BACKGROUND/OBJECTIVE

Constant pain causes suffering and affects performance of activities of daily living (ADL). In clients with chronic musculoskeletal pain, we wanted to determine (i) the relationship between the perceived burden of suffering (measured with the Pictorial Representation of Illness and Self Measure (PRISM)) and the observed quality of ADL task performance (measured with the Assessment of Motor and Process Skills (AMPS)); and (ii) the change in these assessments before and after a 12-week pain programme.

METHODS

In this cross-sectional cohort study, we retrospectively collected data from participants in a Swiss pain management programme. We calculated the relationship, correlations and effect sizes for the PRISM and AMPS using non-parametric tests. We set the level of significance at α = 0.05.

RESULTS

Out of 138 clients, 74 participated. We found no significant correlations between the PRISM and AMPS (p = 0.55-0.36), except for the PRISM and AMPS process ability measure after the pain management programme (p = 0.023). Pre-post-correlations of the AMPS and PRISM were significant, with medium to strong effect sizes (-0.48-0.66).

CONCLUSION

Participation in this pain programme improved both, the PRISM and AMPS scores. The lack of correlation between these assessments in clients with chronic musculoskeletal pain, however, strongly argues for a thorough clinical assessment.

Motor and process skills in activities of daily living in survivors of out-of-hospital cardiac arrest: a cross-sectional study at hospital discharge

AIMS

An individuals' ability to perform basic activities of daily living (ADL) is said to be one of the strongest predictors of performance ability and independent living within the community. The Assessment of Motor and Process Skills (AMPS) tool was designed to assess global functional level during ADL by investigating motor and process skills. The purpose of this study was to assess ADL performance ability by investigating motor and process skills in a consecutive cohort of adult survivors of out-of-hospital cardiac arrest at the time of discharge from hospital.

METHODS AND RESULTS 

This cross-sectional study uses data from a prospective cohort of cardiac arrest survivors admitted to the Copenhagen University Hospital, Rigshospitalet. The specific data used in this study were obtained at the time of the days or the day before hospital discharge. Adult survivors of out-of-hospital cardiac arrest due to cardiac causes were eligible for inclusion. Assessment of Motor and Process Skills was used to assess ADL performance ability by investigating motor and process skills. The ADL ability of 61 individuals was assessed. The mean ADL ability measures recorded were AMPS process 1.40 logits (0.48) and AMPS motor 1.82 logits (0.40). Based on the dichotomized AMPS results, 23% were most likely to need assistance to live independently in the community.

CONCLUSION 

Performance ability during ADL revealed difficulty in the performance of process skill and an increased need for rehabilitation among survivors of out-of-hospital cardiac arrest at the time of hospital discharge.

Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study

Background: Functional surgery is an effective approach in the treatment of the rigid equinovarus foot deformity (EVFD). This must be associated with early rehabilitation treatments (ERTs) to prevent muscle rearrangements due to immobilization. Objectives: To assess the effects of EVFD surgical correction in adult stroke patients, when assessed according to the ICF domains. Methods: Variables from 24 adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55 ± 13 years, affected side 12L/12R, time from lesion 5 ± 4 years were analyzed. Body function domain: pain (NPRS), walking speed, clinical global impression of change (cGIC). Activity domain: Rivermead Mobility Index (RMI), FAC, and 6 min walking test (6MWT). Participation domain: Walking Handicap Scale (WHS). Patients were assessed before (T0), one (T1), three (T2) and twelve (T3) months after surgery by a single assessor. Results: All variables but the 6MWT significantly improved (Wilcoxon test, p < .05) at T1 or T2 and this remained until the 12-months mark. Since T1, all patients reached and maintained a supervised independent walking (FAC≥3) and all those wearing an AFO stopped using it. The median cGCI was "much improved" at T1, with a "further minimal improvement" at T3. This was not associated with the improvement measured by both FAC, and WHS (Chi-square test, p = .20 and p = .36, respectively). Conclusions: Functional surgery combined with ERT is effective in improving the patients' condition according to all ICF domains. Both subjective and objective assessments have to be used when assessing these patients.

Reliability and validity of the self-reported Activities of Daily Living Scale for people with mental illness

Background/objectives

Patient-reported outcome measures have been found to be an effective method of reflecting client perspectives on their personal health condition. The primary aim of this study was to determine the reliability and validity of the self-reported Activities of Daily Living Scale (sf-ADLS) using Rasch analysis in Taiwan.

Methods

A total of 455 people were included in this study; 224 were persons with mental illness and 231 were healthy adults. We applied Rasch analysis as the means of testing the psychometrics of the scale.

Results

The final version of the sf-ADLS used in this study included 14 items, with no differential item functioning being discernible on the gender variable. The scale was found to be of use in classifying the subjects into four levels of independence.

Conclusions

The revised sf-ADLS conforms to the Rasch measurement model in the formulation of a unidimensional scale. The scale can be used to measure the level of independence with acceptable reliability (internal consistency as 0.9) and validity.

Are the school version of the assessment of motor and process skills measures valid for German-speaking children?

BACKGROUND

There are no validated assessment tools for evaluating quality of schoolwork task performance of children living in German-speaking Europe (GSE).

OBJECTIVE

To determine whether the international age-normative means of the School Version of the Assessment of Motor and Process Skills (School AMPS) are valid for use in GSE.

METHODS

The participants were 159 typically-developing children, 3-12 years, from GSE. We examined the proportions of School AMPS measures falling within ±2 standard deviation (SD) of the international age-normative means, and evaluated for significant group differences (p < 0.05) in mean School AMPS measures between the GSE sample and the international age-normative sample using one-sample Z tests. When significant mean differences were found, we evaluated if the differences were clinically meaningful.

RESULTS

At least 95% of the GSE School AMPS measures fell within ±2 SD of the international age-normative means for the School AMPS. The only significant mean differences were for 6- (p < 0.01) and 8-year-olds (p = 0.02), and only the 6-year-old school process mean difference was clinically meaningful.

CONCLUSIONS

Because the only identified clinically meaningful difference was associated with likely scoring error of one rater, the international age-normative means of the School AMPS appear to be valid for use with children in GSE.

A qualitative study of cognitive behavioural therapy in multiple sclerosis: experiences of psychotherapists

Purpose: To investigate how psychotherapists experience using individual, face-to-face cognitive behavioural therapy (CBT) aimed at alleviating depressive symptoms in persons with multiple sclerosis (MS).

Method: Semi-structured interviews with three psychotherapists were conducted after CBT with 12 participants with MS, and analysed using qualitative content analysis.

Results: Two main themes emerged: Trusting their expertise as psychotherapists whilst lacking MS-specific knowledge, and The process of exploring the participants’ readiness for CBT with modifications of content and delivery. The psychotherapists perceived it difficult to know whether a symptom was attributable to depression or to MS, and for some participants the CBT needed to be adapted to a more concrete content.

Conclusions: Psychotherapists may need more MS-specific knowledge and an insight into the individual’s functioning. The content of CBT in terms of concrete home assignments and behavioural activation needs to be individualised.

Cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G)-a Rasch model application

AIM

The aim of this study was to evaluate the cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G) when used in Austria, Germany and Switzerland.

METHOD

A total of 118 girls and 144 boys participated in this study; 198 of the children (75.6%) had a developmental disability and 64 (24.4%) were without a known disability. The mean age was four years (range 11 months to 10 years and six months, SD 1.91). Item goodness of fit, differential item functioning (DIF) and differential test functioning (DTF) were evaluated by use of a Rasch model.

RESULTS

Twenty-four (11.6%) out of 206 items of the Functional Skills Scale and one (5%) out of 20 items of the Caregiver Assistance Scale demonstrated misfit according to the Rasch model. Thirty-four (16.5%) out of 206 items of the Functional Skills Scale and no item from the Caregiver Assistance Scale demonstrated DIF. Almost half (46%) of the items demonstrating misfit also demonstrated DIF, indicating an association between them. The DIF by country only demonstrated a minimal impact on the person measures of the PEDI-G.

INTERPRETATION

Even though some items did not meet the statistical and clinical criteria set, the PEDI-G can be used, on a preliminary basis as a valid tool to measure activities of daily living of children with and without a disability in these countries. Further larger studies are needed to evaluate more psychometric item properties of the PEDI-G in relation to context.

Rasch Analysis and Differential Item Functioning of a Social Support Measure in Jail Inmates With HIV Infection

The protective effects of social support on health have been documented in a variety of groups. For HIV-infected persons released from correctional settings, strong social support may be particularly important for obtaining effective postrelease medical treatment and supportive services. Researchers and program evaluators seeking to improve access and adherence to postrelease HIV medical care in this population need accurate measures for the level and type of social support, but current measures have not been fully validated for incarcerated individuals with HIV infection. We used the Rasch model to test the Medical Outcomes Study (MOS) social support survey. Data for the analysis were collected as part of the EnhanceLink project in the five urban jails where the MOS was administered. Findings indicate that the MOS survey items may not capture the entire variability of person abilities. Respondents showed problems in discriminating among response options, indicating potential systematic bias. In addition, while there was no significant gender difference, overall levels of social support differed by gender. Further research is warranted to develop more effective social support measurement tools that can better guide interventions for persons transitioning from jail and prison to the community.

Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention

BACKGROUND

Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials.

AIM

To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT.

MATERIAL AND METHODS

A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories.

RESULTS

Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design.

CONCLUSION

The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.

Differences in activities of daily living (ADL) abilities of children across world regions: a validity study of the assessment of motor and process skills

BACKGROUND

One important goal of paediatric occupational therapy services is to improve activities of daily living (ADL) abilities of children. In order to plan and evaluate the effectiveness of targeted interventions, valid assessments are critically needed. The Assessment of Motor and Process Skills (AMPS) is an internationally standardized assessment of ADL performance that has not been validated for use with children in Middle Europe.

AIM

To evaluate for (i) significant differences in mean ADL motor and mean ADL process ability measures among children from Middle Europe compared with children from North America, UK/Republic of Ireland, Nordic countries, Western Europe, Australia/New Zealand and Asia; and (ii) meaningful differences between the international age-normative means of the AMPS and those for children from Middle Europe.

METHOD

We analysed data of children across world regions extracted from the international AMPS database using many-facet Rasch and two-way anova analyses and by estimating contrasts to evaluate for significant group differences.

RESULTS

anova analyses of data for 11 189 children ages 2-15 revealed significant effects for mean ADL motor and ADL process ability by region [F ≥ 15.32, d.f. = (6, 11 091), MSE ≥ 0.20, P < 0.001, ή(2) ≥ 0.008], and age [F ≥ 253.47, d.f. = (13, 11 091), MSE ≥ 0.20, P < 0.001, ή(2) ≥ 0.229], and a significant interaction effect for mean ADL process ability [F = 1.48, d.f. = (78, 11 091), P = 0.004, ή(2) = 0.010]. Out of 168 estimated contrasts between Middle Europe and the other world regions for mean ADL motor and ADL process ability, seven were statistically significant (4.17%), but none exceeded ±1SE from the international means.

CONCLUSION

The AMPS remains free of relevant differences in mean ADL ability measures between Middle Europe and other world regions, indicating that the international age-normative mean values are likely to be applicable to children from Middle Europe. The AMPS can be used internationally to evaluate ADL performance in children and to determine if the child is eligible for occupational therapy services.

Declines in mobility and changes in performance in the instrumental activities of daily living among mildly disabled community-dwelling older adults

BACKGROUND

Gait speed is as an important predictor of mortality, volume of medical care, hospitalization, onset of activities of daily living (ADL) disability, and nursing home placement. We examined associations between change in gait speed and change in observed performance in the instrumental ADL (IADL) in a sample of mild-to-moderately disabled older adults.

METHODS

Participants in the Sources of Independence in the Elderly project (n = 375) were approached to complete a 4-m gait assessment and a performance test of IADL competency at three points over 2 years. IADL competency was assessed by occupational therapists, who rated participants using the Assessment of Motor and Process Skills (AMPS) and who also made a global rating of need for help or supervision. Linear mixed models were developed to assess change in motor AMPS score relative to baseline status and change in gait speed and AMPS process scores.

RESULTS

Baseline gait and change in gait were significant correlates of change in the AMPS motor ability measures in models that adjusted for cognitive status and AMPS process ability. Even respondents with gait speeds of 1 m/s at baseline were at risk of declining AMPS motor ability and an occupational therapist rating of IADL disability if gait speed declined.

CONCLUSIONS

Slowing in gait speed is an important risk factor for IADL disability in mild to moderately disabled older adults.

Detecting differences in activities of daily living between children with and without mild disabilities

OBJECTIVE

We evaluated whether the Assessment of Motor and Process Skills (AMPS) measures are valid for detecting differences in activities of daily living (ADL) ability among children with and without mild disabilities.

METHOD

Retrospective data from the AMPS database were analyzed using many-facet Rasch analyses and forced regression analyses to evaluate for significant group differences.

RESULTS

Regression analyses of data for 10,998 children ages 4-15 who met the inclusion criteria revealed significant Age × Group interaction effects (B ≥ 0.23, T ≥ 6.20, p ≤ .001). Post hoc t tests revealed significant group differences in ADL ability at all ages beyond age 4. ADL process ability effect sizes were moderate to large at all ages, and ADL motor ability was mostly moderate to large at ages 6 or older.

CONCLUSION

These findings support the validity of the AMPS measures when used to identify ADL problems among children with mild disabilities.

Effects and feasibility of an Integrative Medicine program for geriatric patients-a cluster-randomized pilot study

Background

Older adults often use complementary medicine; however, very few interventional studies have focused on them. The aim of this study was to evaluate the feasibility and to obtain preliminary data on effectiveness of an Integrative Medicine (IM) program compared to usual medical care.

Methods

The study consisted of older adults living in shared apartment communities including caregiving. The shared apartments were cluster-randomized to the IM program or Usual Care (UC). IM consisted of additional lifestyle modification (exercise and diet), external naturopathic applications, homeopathic treatment, and modification of conventional drug therapy for 12 months. The UC group received conventional care alone. The following outcomes were used: Nurses Observation Scale for Geriatric Patients (NOSGER); Assessment of Motor and Process Skills; Barthel Index; Qualidem; Profile of Wellbeing; and Mini-mental State Examination. Exploratory effect sizes (Cohen’s d, means adjusted for differences of baseline values) were calculated to analyze group differences.

Results

A total of eight shared apartment communities were included; four were allocated to IM (29 patients, median seven patients; [mean ± standard deviation] 82.7 ± 8.6 years) and four to UC (29 patients, median eight patients; 76.0 ± 12.8 years of age). After 12 months, effect sizes ≥0.3 were observed for activities of daily living on the NOSGER-Activities of Daily Living subscale (0.53), Barthel Index (0.30), Qualidem total sum score (0.39), Profile of Wellbeing (0.36), NOSGER-Impaired Social Behavior (0.47), and NOSGER-Depressed Mood subscales (0.40). Smaller or no effects were observed for all other outcomes. The intervention itself was found to be feasible, but elaborate and time consuming.

Discussion

This exploratory pilot study showed that for a full-scale trial, the outcomes of Activities of Daily Living and Quality of Life seem to be the most promising. The results have to be interpreted with care; larger confirmatory trials are necessary to validate the effects.