Evidence-Based Occupational Therapy and Basic Elements for Conducting Assessments



Fig. 8.1
Different ways of collecting data using assessment instruments




Reporting Results of Assessments


Results of an assessment are determined in terms of the following:





  • Raw scores, which seldom give useful information for goal setting or evaluation. Normally, raw scores should at least be converted to percentage.


  • Response patterns or behavior outcome, which is used to compare and describe differences in function among people belonging to similar groups (e.g., clients with the same diagnoses, impairments, activity limitations, participation restrictions, or socioeconomic circumstances).


  • Derived scores (e.g., standard scores, measures of central tendency, standard deviations, or percentiles), which give OTs the opportunity to compare clients’ function over time and between groups; that is, evaluation of intervention effectiveness is possible.


  • Index, which is a ratio that compares two related measures. For example, the body mass index describes the relationship between a client’s height and weight.


  • The degree of difficulty in performing a task, which can be analyzed by using the Rasch method for analyzing data (Fisher 1993; Kirkley and Fisher 1999; Linacre and Wright 1991–1996). This statistical measure indicates the client’s estimated ability to perform tasks in relation to the degree of difficulty in performing the tasks. Thus, scoring occurs in two ways: (1) the difficulty level of the tasks, and (2) the way in which the results of a client are comparable to others having a similar disability. Use of the Rasch analysis method enables the OT to plan interventions. For example, the Evaluation of Daily Activity Questionnaire (EDAQ; Nordenskiöld et al. 1996) was used to describe how well women with rheumatoid arthritis (n = 47) could perform activities of daily living . Among 102 activities, the women indicated that grocery shopping was the hardest task to perform and walking indoors was the easiest task to perform. The Rasch analysis is used with the Assessment of Motor Process Skills (AMPS; Fisher 1993).


  • Method-time measurement (MTM) scores (Farrell 1993), which are criterion-referenced procedures that measure the time it takes for a client to complete a predetermined number of basic movements within a predetermined time standard (Jacobs 1991). These results are used in determining job readiness by comparing the worker’s performance to established job standards.


  • Modular Arrangement of Predetermined Time Standards (Farrell and Muik 1993), which is a version of MTM where the standard length of time is related to the area of work in which the specific movement is performed.



Outcome Assessments Aimed at Evaluating the Results of One Client’s Participation in an Intervention


Evaluation of one client’s participation in an OTI is not enough to determine evidence for the effectiveness of the intervention. However, evaluation of a client’s development during a series of occupational therapy sessions should be a natural part of OTIs, because it (1) gives the OT valuable information about the necessity of changes in the intervention, (2) might be a motivation factor for the client, and (3) could be a useful base for conducting studies that might contribute to a decision based on evidence effectiveness .

The clinical evaluation of the client’s progress is related to (1) the projected goals of the intervention, (2) the direction of the impairment or disability (improvement, maintenance, or deterioration; Söderback 1995), and (3) the focus of the evaluation (e.g., self-care, physical improvement).

Quantitative evaluations5 are most often based on assessment instruments of the client’s participation in an intervention. These evaluations are conducted as (1) a summative assessment including a testing before and after the intervention, or (2) a formative assessment or a series of assessments during the time an intervention is carried out. Pretesting identifies the client’s need for OTIs, while post-testing gives information about the client’s change(s).

The results of these summative or formative assessments are possible to determine by using the reliability change index (RCI; Guidetti and Söderback 2001; Ottenbacher et al. 1988).

Goal Attainment Scaling (GAS: Chang and Hasselkus 1998; Kiresuck et al. 1994) is a valuable method for determining a client’s change during participation in interventions . For example, in a vocational training program, the results showed that three out of four patients had attained their predetermined goals (T ≥ 50; Gruwsved et al. 1996). GAS has become an adequate and often used method for evaluating effectiveness of OTIs for the single client (a search in PubMed captured 13 scientific articles, years 2010–2013)

Finally, Single Case Research Experimental Design (Kazdin 1982; Stein and Cutler 2012) is a scientific alternative for OTs to receive information about the effectiveness of an intervention that is newly applied to or modified for a small group of clients. See, for example, Campbell et al.’s (2007) multiple-baseline study that investigated the effectiveness of errorless learning applied to a client with severe traumatic brain injury. The results showed significance (p  < 0.001) of memory lapses during a 3-month follow-up.


Outcomes


Outcomes are efforts aimed at “assessing the quality and effectiveness of healthcare as measured by the attainment of a specified end result (goal) or outcome,” but the efficacy, safety, and practicability may also be investigated due to treatment evaluations (National Library of Medicine 2008b). Outcome is an important dimension of health attribute of interventions, including ability to function, health perceptions, and satisfaction with care (American Occupational Therapy Association 2002).


Reporting Outcome Evaluation of Interventions


The lack of changes or changes, i.e., stated outcomes that occur during and after a client has finished participation in OTIs is suggested to be evaluated using e.g., statements that concern the level of:



1.

Occupational performances ability

 

2.

Satisfaction with occupational performances

 

3.

Satisfaction with environmental and occupational adaptations

 

4.

Function, i.e., independence in personal and instrumental daily activities, plus cognitive, motor and emotional functions

 

5.

Quality of life

 

6.

Recovery

 

7.

Wellness—well-being

 

8.

Temporal balance

 

9.

Satisfaction with current (occupational/work) health status

 

10.

Adaptation to present impairment/disability

 

11.

Compliance with OTI’s

 

12.

Satisfaction with OTIs appropriateness, usefulness, and cost-effectiveness (Stein et al. 2006)

 

Such statements , used for evidence of the OTIs’ effectiveness, are of great importance for the credibility of outcome and for defining the profession. It might be suggested that the more the profession uses joint statements about outcome, the better respected the intervention will be. Of course, the opposite is also true: Disparate statements of outcome will cause less evidence for its effectiveness.

Therefore, the question is: What are the most appropriate statements to be used to determine OTIs? In other words, what outcome terms should be recommended for use? However, the answers to these questions are beyond the scope of this handbook.


Discussion

At present, in the literature of occupational therapy, a very wide range of outcome statements exists6. Some of them seem to have less connection to the core content of occupational therapy, e.g., survival time. Other outcome statements concern occupations, such as the number of occupational performances errors, extensive ability to perform activities of daily living , or ability to perform work tasks or sustaining work. Outcome statements were also originated from the International Classification of Functioning, Disability, and Health (ICF) terminology, for example, measures of impairments such as balance and anxiety.

The conclusion is: If outcome statements were used in professional compliance among OTs, the occupational therapy profession would be more respected.



Recommendations for the Future


I would recommend:





  • Further development and documentation of occupational therapy outcome statements, fixed by consensus among colleagues.


  • Teamwork for conducting more extensive RCT studies, which will result in greater numbers of clinical decisions being based on evidence.


  • Continuously assessed quality assurance as a natural part of clinical work.


  • Arrangement of consensus conferences aimed at discussing outcome statements that are congruent. Such statements would facilitate communication among OTs worldwide , as they are working to meet their clients’ occupational needs.



Appendix 1
















































A checklist of clinical decisions to make in choosing an assessment instrument

1

The assessment instrument entitled:
 
Version?

2

The source of the assessment instrument:
 
Author(s)?
 
Reference(s)?

3

References with:
 
(a) Clinical applications?
 
(b) Evidence of the psychometric functions of the assessment instrument?

4

Theory or model that constitutes the base of the assessment instrument?

5

Is a manual, a computer program, recording forms, and other equipment for administration of the assessment instrument available?

6

How is the assessment instrument administered? How are the data collected? How are results given to the client?

7

What is the focus of the assessment instrument? (global, diagnosis-specific, etc.)

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May 21, 2017 | Posted by in GENERAL | Comments Off on Evidence-Based Occupational Therapy and Basic Elements for Conducting Assessments
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