Assessments used in occupational therapy practice: an exploratory study

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy

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.

Assessment of motor and process skills in Danish occupational therapy practice

BACKGROUND

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

AIMS

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS/SIGNIFICANCE

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

Feasibility of Increasing Occupation-Based Assessment Using the Knowledge to Action Framework

The Assessment of Motor and Process Skills (AMPS) is a standardized occupation-based measure; however, barriers often limit use in practice. The Knowledge to Action Framework (KTA) is one of the most widely used implementation approaches to induce practice change. The objective of the study is to examine the feasibility and acceptability of a KTA-informed intervention to increase the use of the AMPS. AMPS-trained occupational therapists were recruited through convenience sampling. Interventions included workshops, action planning, goal setting, peer support, and organizational resources. Recruitment and retention were tracked. Pre- and post-survey results of interventions' helpfulness, AMPS behaviors, and motivational changes informed acceptability. Participants (n = 5) rated 7/7 (100%) intervention strategies as helpful, reported decreased barriers and increased frequency of AMPS administration, increased resources for AMPS implementation, and improved compatibility with practice. Implementation of a KTA-informed intervention to increase AMPS practice was feasible and supported by environmental changes and peer support in a physical rehabilitation setting.

Exploring occupation-based practice among occupational therapists in hospitals and rehabilitation institutions

BACKGROUND

While occupational therapists value occupation-based practice, they appear to spend less time on this approach and more time on impairment-based practices. Several barriers are reported for the occupation-based approach.

AIM

To explore different aspects of occupation-based practice among occupational therapists working in hospitals and rehabilitation institutions, and to examine associations between sociodemographic factors, barriers, and occupation-based practice.

MATERIALS AND METHODS

A cross-sectional survey was conducted. Participants were occupational therapists working in hospitals and rehabilitation institutions in Norway. The data were analysed with descriptive statistics and logistic regression.

RESULTS

The therapists (n = 124) valued occupation-based practice and reported using it frequently and to a large extent. Relatively small proportions of their practice (26% assessments and 38% interventions) were classified as occupation-based. Lack of time, space and equipment were reported as large barriers. Lack of time and lack of equipment were associated with low self-reported level of occupation-based practice.

CONCLUSIONS

The participants valued occupation-based practice, while the reported assessment and intervention methods were mainly not occupation-based. Several barriers were reported, and some were associated with less use of occupation-based practice.

SIGNIFICANCE

The results can be used to raise awareness of occupational therapists' use of occupation-based practice and barriers to this approach.

Measurement of Self-regulation in Preschool and Elementary Children: A Scoping Review

AIMS

This scoping review sought to identify and characterize measurement of self-regulation in preschool and elementary aged children.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (ScR) guidelines were applied. Databases from the fields of allied health, education, medicine, and social sciences were searched including: CINAHL, Education Database (ProQuest), Education Research Complete, EMBASE, ERIC, iNFORMIT Combined, Medline, PsychINFO, Social Sciences (ProQuest), Teacher Reference Center, and Web of Science. Articles published between 2015 and 2020 were included. Dual review was utilized at all stages and a third reviewer resolved any conflicts.

RESULTS

Sixty-seven studies were included in this review. A range of observational, self-report, teacher report, caregiver report, and observational measures of self-regulation were identified. Included studies were primarily published in education and psychology disciplines, with no studies by occupational therapists identified.

CONCLUSIONS

Although a range of measures were identified in this scoping review, the results highlight the lack of consensus regarding self-regulation measurement that occupational therapists use to design and implement therapy programs to address child emotional and behavioral needs.

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

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

Development and Initial Testing of the Electronic Activity Card Sort (ACS3) Among Community-Dwelling Adults

IMPORTANCE

The Activity Card Sort is a valid, widely used measure of participation. There is a need for remotely delivered measures of participation to support the growing use of telehealth.

OBJECTIVE

To develop and test the concurrent validity and acceptability of the electronic Activity Card Sort (ACS3).

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

Community-dwelling adults.

OUTCOMES AND MEASURES

The Activity Card Sort (ACS) and the ACS3 were administered in randomized order. Relationships between performance on the overlapping items of the ACS and ACS3 were evaluated using Spearman's ρ correlations. Additionally, acceptability of the ACS3 was evaluated using a survey with a 5-point Likert scale.

RESULTS

High correlations were found between each of the four domains (rs ≥ .836) and total current activities score (rs = .863) between the ACS and ACS3. Ratings on the survey indicate high levels of acceptability and usability for the ACS3.

CONCLUSIONS AND RELEVANCE

Findings suggest that performance on the ACS3 is consistent with performance on the ACS. This finding coupled with a high level of acceptability indicates that the ACS3 may be a clinically useful tool for evaluating daily life participation. What This Article Adds: The ACS3 provides an electronic, paperless option for measuring multiple domains of participation in adults.

The use of occupation-based interventions and assessments in hand therapy: A cross-sectional survey

INTRODUCTION

The purpose of this study was to gather information on how hand therapists incorporate occupation-based interventions in their clinical practice and what outcome measures hand therapists use to measure the occupational performance of their clients STUDY DESIGN: Cross-Sectional Survey Design.

METHODS

The 16-item Survey was distributed to members of the American Society of Hand Therapists on two occasions.

RESULTS

Three hundred eleven hand therapists responded to the survey. Hand therapists use a variety of occupation-based interventions (OBI) in clinical practice and most believe they are important. Findings from this study reveal that incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely. One hundred twenty-six (41%) respondents indicated that they use occupation-based activities 26-50% of the time with their clients.

DISCUSSION

The top three OBI interventions used by hand therapists included dressing tasks, cooking and meal preparation, and in hand manipulation of coins and medication. The lack of understanding of the theoretical models regarding occupation-based interventions may be a barrier toward implementation of occupation-based interventions and assessments as many hand therapists may have trained under a medical model.

CONCLUSION

Most respondents to this survey indicated that they believe OBI should be performed by hand therapists and use them routinely in practice. The most frequently used type of assessment was the DASH (Disabilities of the Shoulder Arm & Hand). The least frequently used assessment was the Short Form 36 and patient specific occupation-based assessment.

Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective

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

Measurement properties of instruments to assess mental function during activity and participation in individuals surviving traumatic brain injury: A systematic review protocol

Background: Most studies assessing mental function in individuals with traumatic brain injury (TBI) assess the impairments through pen and paper tests. However, weak correlation has been found between the results from pen and paper tests and the results from performance-based tests during activity and participation. Objective: To investigate measurement properties of performance-based instruments that are used to assess mental function during activity and participation in individuals with a TBI. Material and methods: PubMed, EMBASE, CINAHL, PsycINFO, and OTseeker will be searched for relevant studies reporting on measurement properties of performance-based instruments to assess mental function in individuals with a TBI. The COnsensus-based Standards for selection of Health Measurement Instruments (COSMIN) checklist will be used to evaluate the methodological quality of the included studies. The Terwee quality criteria will be applied to evaluate the study findings for each measurement property. To summarize all the evidence, a best evidence synthesis will be performed. Results: Results will be presented in text and tables. Conclusions: Conclusion will be drawn up-on the overall evidence Significance: It is expected that the findings of the review will provide evidence to guide clinicians in the selection of instruments to use in occupational therapy practice and research.

Performance of the Arabic Population on the Adolescent-Adult Sensory Profile: An Observational Study

BACKGROUND

The Adult-Adolescent Sensory Profile (AASP) is a questionnaire developed to measure the way in which people in different age groups respond to different sensory stimuli. These sensory stimuli may uncover different behavioral problems that may affect activities of daily living. This observational study aimed to validate the Arabic version of the AASP used to assess the sensory processing abilities of healthy individuals.

METHODS

Participants comprised 560 Jordanians aged 11 years and older. Participants were recruited from different community centers in Amman, Jordan during 10th March 2017 to 10th September 2017. The English version of the AASP was translated into Arabic and all participants were instructed to complete this version of the scale.

RESULTS

Internal consistency was 0.78 and 0.79 for the Arabic and the English version, respectively. The ranges of cut-off scores in the Arabic version were higher than the English version for all the quadrants of the scale. The biggest differences were found in the sensation seeking and sensory sensitivity quadrants. In certain age groups (11-17 and 18-64 years), women were more sensitive compared with men.

CONCLUSION

The Arabic version of the AASP showed good internal consistency and can be used to assess the sensory processing abilities of healthy individuals.

Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury: A systematic review

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.

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

Integrating Occupational Therapy Specific Assessments in Practice: Exploring Practitioner Experiences

BACKGROUND

Occupational therapists sometimes find it challenging to integrate client-centered and occupational therapy specific assessments in practice. The aim of this study was to explore the use of occupational therapy specific assessments such as the Assessment of Motor and Process Skills (AMPS) among occupational therapists in Sweden and Japan.

METHODS

Interviews and qualitative thematic analyses were utilized.

FINDINGS

Four themes are reported: (1) use it or lose it, (2) simply no space until after hours, (3) biggest barriers can be colleagues, and (4) being more specific: communication.

CONCLUSION

In keeping with previous studies, occupational therapists often find it challenging to implement client-centered and occupation-based assessment tools into practice. However, more work is needed to understand how best practices can be incorporated into a changing occupational therapy daily practice.

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

BACKGROUND

With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments.

METHOD

An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR = 36%) Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%).

CONCLUSION

The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.

The use of occupation-based assessments and intervention in the hand therapy setting - A survey

STUDY DESIGN

Descriptive survey.

INTRODUCTION

This study specifically explored the use of occupation-based assessments and intervention in the hand therapy setting, but also more generally, current practice trends about all assessments being utilized in this setting, frequency of their use, and therapists' perceptions about them.

METHODS

An online survey was distributed via email to members of the American Society of Hand Therapists (ASHT). The survey consisted of ten questions and was administered via Survey Monkey.

RESULTS

Responses were received from 22% of those surveyed. A descriptive analysis was completed of the results and indicated that over half use occupation-based assessments on a daily basis; most are related to ADL function and used for the development of goals. The primary reason for not utilizing occupation-based assessments is time limitation. Seventy-nine percent believe these measures are important for the services provided in the hand therapy setting.

CONCLUSION

Occupation-based assessments and intervention are not utilized as much as therapists would like in the hand therapy setting, primarily due to time constraints. While not formally assessed, the majority of those who responded indicated that they do address occupation in their assessments and interventions.

LEVEL OF EVIDENCE

Not applicable.

The psychometric properties of the Arabic version of the Satisfaction with Daily Occupations

Introduction

There is a shortage of tools designed for use by occupational therapy practice in Arabic-speaking countries. The purpose of this study was to translate and cross-culturally adapt the original Satisfaction with Daily Occupations tool to Arabic and assess the psychometric properties of the adapted tool.

Method

A cross-cultural adaptation process was performed. Face, content, and criterion validity were examined, as well as internal consistency and test–retest reliability. The study included 147 healthy adults and 73 patients with cerebrovascular accident. They were purposefully selected from two countries (Kuwait and Jordan).

Results

The adapted tool comprised six domains and a total of 14 items. Face and content validity were established through prolonged content analysis. Criterion validity was indicated by significant differences between the healthy and the cerebrovascular accident group in all areas of the Satisfaction Daily Occupations scale ( p < 0.001). Satisfactory overall internal consistency (α = 0.77) and good test–retest reliability for the total satisfaction score for the healthy (inter-class correlation coefficient (ICC) = 0.984) and the cerebrovascular accident group (inter-class correlation coefficient (ICC) = 0.933) were found.

Conclusions

The Satisfaction with Daily Occupations-Arabic version is a valid and reliable tool for use with Arabic-speaking occupational therapy clients. This study has several implications for occupational therapy education, practice, and research in the Arab world.

Cognitive assessment across the continuum of care: the importance of occupational performance-based assessment for individuals post-stroke and traumatic brain injury

BACKGROUND/AIM

When working with individuals following stroke or traumatic brain injury, an important role of the occupational therapist is to assess the impact of cognitive impairment on their ability to engage in occupations and resume important life roles. The aim of this study was to survey therapists' reasons for selection of and challenges with using various cognitive assessment approaches, across the continuum of care, when working with individuals following stroke and traumatic brain injury.

METHODS

A cross-sectional survey, completed via post or online, with responses from 209 Australian occupational therapists was conducted. Participants included clinicians working in acute, inpatient rehabilitation and community settings.

RESULTS

Occupational performance-based assessments were ranked as the most important assessment method, with 69% of participants reporting using these assessments for more than 75% of their clients with cognitive impairment. Participants identified the lack of quantitative data provided by these assessments as a frequent challenge. The identification of cognitive deficits was the highest ranked reason for using cognitive screens and batteries. Challenges identified with using cognitive screens and batteries included difficulty linking assessment results to occupational performance, and difficulty using results to generate intervention strategies. The majority of participants reported using a combined approach to assessment, and used screens and batteries to support findings of occupational performance-based assessments.

CONCLUSIONS

Targeted efforts to further incorporate standardised occupational performance-based methods into clinical practice, research, and ongoing professional development is required to enhance occupational therapy services when working with individuals with cognitive impairment.

Development of the Activity Card Sort—United Kingdom Version (ACS-UK)

The Activity Card Sort (ACS) is a valid and reliable measure of older adults' participation; however, cultural sensitivity issues are a limitation to its application in the United Kingdom. A content validity study was undertaken to identify culturally relevant activity items to be included in a United Kingdom version of the ACS (ACS-UK). For item generation, United Kingdom time-use studies, research related to other ACS versions, and expert opinions were used. A two-round survey of community-living United Kingdom older adults (aged 65 years and older; round 1, n = 177; round 2, n = 21) was used for item selection, clarifying the wording of activity labels, and agreeing activity domain classification. Ninety-one activities were identified for the ACS-UK and these were compared with items from other ACS versions. The ACS-UK is a culturally relevant measure that can provide useful insight into the participation of older adults for clinical practice and research.

The use of standardized assessments in occupational therapy in the United States

ABSTRACT The purpose of this study was to investigate the use of standardized assessments in occupational therapy practice. Five-thousand surveys were mailed to recipients of ADVANCE for OT who indicated their primary role to be a "clinician." With a response rate of 16%, 794 responses were analyzed. Results include occupational therapists in a pediatric practice setting reporting using standardized assessments more frequently to determine eligibility of services than do adult setting practitioners. Respondents also perceived they have the highest knowledge or skill level in their ability to communicate the results of standardized assessments to their clients and other health professionals, but lacked knowledge or skill level in knowing the difference between criterion and norm-referenced measures. Implications for practice, research, as well as academic and continuing professional education are discussed.