Validation of the Assessment of Motor and Process Skills for Use in Sweden

A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability

Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.

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.

The Use of Serious Gaming to Improve Sensorimotor Function and Motivation in People with Cerebral Palsy: A Systematic Review

The aim of this systematic review was to review the evidence for serious gaming interventions in improving sensorimotor function in children and adults with cerebral palsy (CP). Seven databases were searched with terms related to serious gaming and CP. Articles were evaluated according to the Downs and Black rating scale and important principles of serious gaming defined by Whyte et al. Extracted data included the population, intervention, serious gaming elements, outcomes, and authors' conclusions. Fifty-seven articles were identified for inclusion. Participants' ages ranged from 3 to 57 years. Interventions tested included commercial videogames as well as specially designed games. Most interventions had themed content, short-term goals, rewards, feedback, and multiple games. Outcome measures and study designs were inconsistent between studies. Sensorimotor function results of noncomparative studies were positive or neutral overall, but results of comparative studies were more mixed. We concluded that serious gaming interventions may be a useful adjunct to treatment as they are noninvasive, were not associated with deterioration in most cases, and may improve compliance. More comparative studies need to be completed to assess compliance and treatment outcomes. Future games should also aim to adhere more closely to the principles of serious gaming.

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.

Cross-Cultural Validation of the Assessment of Motor and Process Skills (AMPS)

The purpose of this study was to verify the assertion that underlying motor and process skill items and tasks defined in the Assessment of Motor and Process Skills (AMPS) are cross-culturally free from bias between North America, Scandinavia and the United Kingdom. Using many-faceted Rasch analysis, the hierarchical order of AMPS motor and process skill items and culture-general tasks were compared in order to test the assertion of bias-free assessment across regions. The unidimensionality of the AMPS motor and process skills and tasks through evaluation of their goodness-of-fit to the Rasch model was also investigated.

The results revealed that the hierarchical order of all the AMPS motor and process skill items and culture-general tasks remained stable among the three regions examined, verifying cross-cultural freedom from bias of the skill items and tasks between these regions. All items in North America met the criteria for goodness-of-fit on both the motor and the process scales of the AMPS, while only 4% of the items failed to meet these expectations in Scandinavia and the United Kingdom. It was concluded that the AMPS motor and process scales and tasks are unidimensional, demonstrating internal scale validity.

Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke

Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs).

Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later.

Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs.

Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.

Effects of physically active video gaming on cognition and activities of daily living in childhood brain tumor survivors: a randomized pilot study

Background

Physical activity can enhance cognitive functions in both animals and humans. We hypothesized that physically active video gaming could: i) improve cognitive functions and ii) improve the execution of activities of daily living among survivors of childhood brain tumors.

Methods

Children 7 to 17 years old who completed treatment, including radiotherapy, for a brain tumor 1 to 5 years earlier were randomized to either intervention or waiting list. After 10 to 12 weeks the groups crossed over. The intervention consisted of active video gaming, using a motion-controlled video console (Nintendo Wii), for a minimum of 30 minutes a day, 5 days a week and weekly Internet-based coaching sessions. Evaluations before and after each period included tests of the execution of activities of daily living, using the Assessment of Motor and Process Skills (AMPS) and cognitive tests. Test scores before and after the intervention were compared. A parallel group comparison was performed as a sensitivity analysis.

Results

All 13 children enrolled completed the program. Compared to baseline, the motor (P= .012) and process (P=.002) parts of AMPS improved significantly after active video gaming. In the parallel group analysis the improvement in the process part of AMPS remained statistically significant (P= .029), but not the change in AMPS motor score (P= .059). No significant change was found in cognitive tests although there were trends for improvement in sustained attention (P = .090) and selective attention (P = .078).

Conclusion

In this pilot study, active video gaming used as a home-based intervention for childhood brain tumor survivors improved motor and process skills in activities of daily living.

Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial

Objective: To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level.

Design: A randomized controlled study with blinded evaluations at discharge, three weeks, three months and one year after discharge.

Setting: Home of the patient or the ordinary day rehabilitation clinic at the university hospital.

Subjects: Fifty-eight patients (median age 53 years) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge.

Intervention: Rehabilitation was given for 9 hours/week over three weeks. The home group received individually tailored training, based on the patient's needs and desires, with a focus on activities in their natural context. Support and information were also given. The intervention in the day clinic group was aimed mainly at improved functions.

Main measures: The main outcome was activity, assessed with the Assessment of Motor and Process Skill (AMPS). The impairment level was also evaluated. Costs were estimated.

Result: There were no significant differences between the groups on any of the four assessments. However, there seemed to be an earlier improvement on some measures (including AMPS) for the home group. For both groups there was a greater improvement on the activity level than on the impairment level. The costs of the home group were less than half of the costs of the day clinic group.

Conclusion: With the present results, both rehabilitation programmes could be recommended, however, further studies are needed to define patients who may specifically benefit from the home rehabilitation programme. Costs should be taken into consideration.

Evaluation of Activities of Daily Living Ability and Awareness among Clients in a Forensic Psychiatry Evaluation Unit in Sweden

Introduction:

The aim of this exploratory study was to investigate activities of daily living (ADL) functioning for clients in a forensic psychiatry evaluation unit and also to investigate the relationship between ADL functioning and awareness of their ability to perform ADL.

Method:

The sample consisted of 35 participants at a forensic psychiatry evaluation unit in Sweden. ADL was investigated using the Assessment of Motor and Process Skills (AMPS) and awareness of ability was investigated using the Assessment of Awareness of Ability (A3).

Results:

The ADL mean motor ability for the participants was 1.68 logits and the process ability showed an ADL mean value of 0.83 logit. The mean value of awareness was 0.60 logit. A majority of the participants demonstrated ability measures below the cut-off criteria in the AMPS, which indicates that they might need support to function in the community. There was also a significant relationship between awareness of ability and ADL motor ability (rho = 0.49, p<0.01) and ADL process ability (rho = 0.77, p<0.01).

Conclusion:

Clients in forensic psychiatry demonstrate limited ability in ADL, associated with a limited awareness. Clients in forensic psychiatry may also need assistance to live in the community, which suggests that occupational therapy may be offered to these clients in order to prepare them to manage in the community.

Dealing with Real-Life Challenges: Outcome of a Home-Based Occupational Therapy Intervention for People with Severe Psychiatric Disability

The authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful daily occupations. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 and 66 years participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a 6-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made. These findings support the use of the ELR intervention and suggest that larger randomized clinical trials are needed.

The return to work after a neuropsychological programme and prognostic factors for success

INTRODUCTION

Several factors influence the return to work (RTW) after brain injury (BI). The aims of the study were to follow-up the RTW after a vocational neuropsychological programme for individuals with a brain injury and to explore factors predicting RTW. The hypothesis was that as self-awareness was already addressed in the programme, severity of injury would have a greater impact on RTW.

METHOD

Sixty-five of 72 persons (median age 27) who had attended the programme 1998-2003 were interviewed about their occupation at 1, 2, 3 and 5 years after the programme. A logistic regression was made with the variables concerning process skill, somatic problems and irritability, the digit symbol coding and pre-morbid occupation to explore predictors of RTW.

RESULTS

The main cause was TBI (44.6%). Before injury 77% were employed or studied and after the injury 80% did not have any occupation. After 5 years 40% had returned to work. The only significant variable in the regression was the pre-morbid occupation.

DISCUSSION

The study stresses the difficulty to know the key elements involved in RTW which confirms the need for rehabilitation to focus on several factors in different contexts in order to affect the outcome.

Considerations in evaluating new treatment alternatives following peripheral nerve injuries: A prospective clinical study of methods used to investigate sensory, motor and functional recovery

The current problem finding reliable and objective methods for evaluating results after peripheral nerve repair is a challenge when introducing new clinical techniques. The aim of this study was to obtain reference material and to evaluate the applicability of different tests used for clinical assessment after peripheral nerve injuries. Fifteen patients with a history of complete median nerve transsection and repair, and 15 healthy volunteers were included. Each subject was investigated using a battery of conventional and new tests for functional, sensory and motor recovery including questionnaires, clinical evaluations, neurophysiological and physiological findings. The results were statistically analysed and comparisons were made within the patient group and between patients and healthy volunteers using a 'per protocol' and an 'intention to treat' approach. Criteria for success were stipulated in order to be able to judge the usefulness of each method. The results showed that 19 of 34 variables, representing six of 16 methods, were not able to fulfil the criteria and were thus questionable for the evaluations of nerve repair in a clinical trial setting. However, 2pd, sensory recovery according to the non-modified British Medical Research Council, sensory neurography, manual muscle test, electromyography, questionnaires (i.e. DASH and the 4 question form) and performance tests (i.e. AMPS and Sollerman's subtests 4 and 8) did fulfil the criteria defined for being useful.

Cognitive training in home environment

PRIMARY OBJECTIVE

To examine the efficacy of cognitive rehabilitation in the patient's home or vocational environment.

RESEARCH DESIGN

Pre-post-follow-up design.

METHODS AND PROCEDURES

Ten outpatients with acquired attention and memory problems received cognitive training three times weekly, for 3 weeks. They received individual attention training with Attention Process Training, training for generalization for everyday activities and education in compensatory strategies for self-selected cognitive problems. Treatment effects were evaluated with neuropsychological and occupational therapy instruments before and after the training and after 3 months on impairment, activity and participation levels.

MAIN OUTCOMES AND RESULTS

The results indicated a positive effect on some measures on impairment level, but no differences on activity or participation levels at follow-up.

CONCLUSIONS

The study indicates that home-based cognitive training improves some attentional and memory functions and facilitates learning of strategies. Future controlled studies are needed to confirm the results and analyse the efficacy of different aspects of home-based training.

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.

Male and female performance on the assessment of motor and process skills

OBJECTIVE

To examine the validity of the assertion that men and women do not differ significantly on the Assessment of Motor and Process Skills (AMPS), a functional assessment tool used to evaluate the interaction between component motor and process skills and IADL (instrumental or domestic activities of daily living) performance capacity.

DESIGN

Descriptive comparison. Using many-faceted Rasch analysis, the AMPS motor and process scales were examined for differential item response between gender subgroups. Mean motor and process ability measures of age-matched groups of male and female subjects were also compared.

PARTICIPANTS

A convenience sample of more than 3,500 men and women from the standardization sample for the pilot version of the AMPS computer-scoring software. The subjects had a variety of physical disabilities or psychiatric diagnoses.

MAIN OUTCOME MEASURES

Hypotheses were as follows: (1) no differential item response would be found on the motor or process scales; (2) if differential item response was found, it would not have an impact on the final estimation of client ability; (3) men and women would not differ in mean AMPS motor or process ability.

RESULTS

Of the 36 AMPS items, only one (Lifts) differed between men and women. This differential item response did not disrupt the final estimation of client ability. Men and women did not differ in mean motor ability. Women on the whole were more able than men in mean process ability.

CONCLUSIONS

The AMPS is valid for use across gender subgroups. Men and women do not differ in AMPS motor ability, but overall, women are slightly more able than men in AMPS process ability.