Use of the Perceive, Recall, Plan and Perform System of Task Analysis for persons with schizophrenia: A preliminary study

Background/aim:  Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for this clientele. The specific objectives were to describe information processing difficulties as measured by the PRPP and to examine preliminary evidence of construct validity and interrater reliability.
Methods:  In the first part of this study, 10 participants with schizophrenia living in the community were assessed using the PRPP during both a simple and a complex meal preparation task. Community functioning was measured using the Independent Living Skills Survey. In the second part, interrater reliability was appraised using three trained raters, who scored 15 participants preparing the complex meal preparation task.
Results:  Analysis of performance demonstrates that people with schizophrenia have difficulties especially in the Perceive and Plan quadrants of the PRPP and are more challenged in the complex task. The PRPP total score for the complex task is strongly related to the community functioning score. Results indicate good interrater reliability for the PRPP total score and moderate interrater reliability for the quadrant scores.
Conclusion:  Despite the small sample size, results from this preliminary study support the use of the PRPP System of Task Analysis to further explore the impact cognitive deficits have on daily task performance and thus on community functioning in people with schizophrenia.     

Using the Perceive, Recall, Plan and Perform System to assess cognitive deficits in adults with traumatic brain injury: A case study

One role of occupational therapy in the rehabilitation of people with traumatic brain injury is to determine the impact of cognitive and perceptual deficits on client performance of occupational tasks. Existing methods that can be used to assess cognitive deficits include standardised instruments and observations of everyday task performance. Few of these assessment methods are able to adequately link problems of cognition with problems with self-maintenance, productivity and leisure tasks relative to a client's expected occupational roles. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis enables observation of performance of any functional task and allows therapists to identify the cognitive basis of disordered performance. The results of this assessment are then used to establish and evaluate client-centred goals and guide subsequent intervention. This article describes the PRPP System of Task Analysis and outlines how it can be used by occupational therapists involved in the management of adults with traumatic brain injury. Specifically, an in-depth case study illustrates how this innovative model of assessment has effectively been used to promote client learning of self-maintenance skills.     

Reliability of the original and revised versions of the Assessment of Living Skills and Resources

Background/Aim:  The Assessment of Living Skills and Resources (ALSAR) measures instrumental activities of daily living in the older population and has some established reliability estimates. The study aimed to examine the interrater reliability of the original ALSAR in an Australian context and develop revised scoring criteria that were examined in a second interrater reliability study.
Method:  Seven occupational therapists rated a total of 20 clients over 65 years of age, with 10 clients in each study.
Results:  Using the original criteria, the ALSAR had relatively low interrater reliability across all scores (ICC range 0.253–0.756). The revised version yielded improved interrater reliability on all scores (ICC range 0.541–0.896).
Conclusion:  Detailed scoring criteria increased the interrater reliability of the ALSAR, enhancing its usefulness for clinical practice and research.     

Australian normative data for the Occupational Therapy Adult Perceptual Screening Test

Objectives:  The purpose of this study was to examine variables impacting on the performance of healthy adults on the Occupational Therapy Adult Perceptual Screening Test (OT-APST), and present the Australian normative data for this standardised assessment tool.
Method:  The OT-APST was administered to a sample of healthy adults aged 16–97 ( n  = 356).
Results:  Neither gender nor highest level of education significantly impacted on OT-APST performance in the healthy normative group. Increasing age significantly correlated with reduced performance on all OT-APST subscales except for body scheme. Australian normative data for the OT-APST are presented in two age intervals: 16–74 years ( n  = 232) and 75–97 years ( n  = 124).
Conclusion:  Presentation of a large, age-stratified Australian normative data set including cut-off scores for intact/impaired perceptual performance for each of the OT-APST subscales will enable occupational therapists to make a norm-referenced interpretation of scores for individual clients when using this screening tool.     

Reliability of the Australian Therapy Outcome Measures for Occupational Therapy Self-care scale

Background and Aims:  With the shift of health care towards evidence-based practice, demonstrating outcomes of intervention has become an important component of occupational therapy practice. Outcome measures and assessment procedures with sound psychometric properties are necessary to demonstrate such therapy outcomes. This study investigated the interrater and intrarater reliability of one of the 12 scales from a newly developed outcome measure, the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT).
Method and Results:  Seven occupational therapists rated 15 written case studies on two occasions on the four domains (impairment, activity limitation, participation restriction and distress/well-being) of the AusTOMs-OT self-care scale. The results showed that the AusTOMs-OT self-care scale had moderate to high interrater reliability with intraclass correlation coefficients (ICCs) of over 0.79 for the three domains: activity limitation, participation restriction and distress/well-being, and over 0.70 for impairment. Intrarater reliability was also reported to be moderate to high, with ICCs of 0.88 for activity limitation, 0.81 for participation restriction, 0.94 for distress/well-being, and 0.74 for impairment.
Conclusion:  The findings of this study support the reliability of the AusTOMs-OT self-care scale and suggest that it can be used to evaluate self-care intervention outcomes, thus contributing to the evidence-based practice of occupational therapy.     

Injured workers' perspectives of their rehabilitation process under the New South Wales Workers Compensation System

Aim:  Occupational injury and the process of rehabilitation can impact significantly on an individual's life. Research on the perspectives of injured workers, and their perceptions of the occupational therapy role, is limited.
Method:  A qualitative, phenomenological study explored the experiences of six injured workers, from a large regional area health service, who had undergone occupational rehabilitation within the NSW Workers Compensation System. Data were collected through the use of in-depth, semistructured interviews and were analysed inductively.
Results:  Injured workers have a limited knowledge and understanding of the rehabilitation process, feel unsupported throughout the process, have unsatisfying return-to-work duties and often experience negative attitudes from key stakeholders.
Conclusion:  The results highlight the opportunity for occupational therapists to increase their role within occupational rehabilitation; however, they need to adopt a more holistic approach to their practice.     

Profile of paediatric occupational therapy practice in Australia

Background:  The purpose of the present study was to describe a profile of Australian paediatric occupational therapy practice in terms of theories, assessments and interventions used with the most frequently seen client groups.
Methods:  An ex post facto survey design was utilised. A purpose-designed survey was mailed to 600 occupational therapists identified by OT Australia as working in paediatrics.
Results:  The response rate was 55% ( n =  330). Respondents in the sample worked chiefly with children with developmental delays, learning disabilities, neurological impairments, and infants/toddlers. Theoretical models used by paediatric clinicians that were common to the most frequently seen client groups focused on sensory integration/multisensory approaches, occupational performance, and client-centred practice. Assessment tools most frequently used were the Test of Visual Motor Integration, Sensory Profile, Bruininks-Oseretsky Test of Motor Proficiency, Handwriting Speed Test, and Motor-Free Visual Perception Test. The most often used treatment methods across the four most frequently seen client groups were parent/caregiver education, sensory integration/stimulation techniques, and managing activities of daily living.
Conclusions:  Paediatric occupational therapists appeared to draw on a range of theoretical models. With the exception of the Sensory Profile, the assessment and treatment methods most frequently used are not congruent with the most commonly used theoretical models. It is critical that the assessment and treatment methods used are conceptually consistent with the theoretical models that guide practice. Occupational therapists need to examine the evidence and determine whether their clinical practice is grounded in the best contemporary theoretical models, assessments and interventions.     

The Occupational Performance History Interview in community mental health case management: Consumer and occupational therapist perspectives

Background/aim:  This study aimed to explore the use of the Occupational Performance History Interview from the perspectives of mental health consumers and occupational therapist case managers in community mental health settings.
Methods:  This qualitative study, based on naturalistic inquiry, involved 10 participants: four occupational therapists who interviewed six mental health consumers, using the Occupational Performance History Interview. All participants participated in follow-up interviews or in focus groups to gain an understanding of their perspectives of this experience. Transcribed data were analysed using the constant comparative method.
Results:  Consumer participants valued telling their occupational stories. Occupational therapist participants described the interview as supporting them to be more occupationally focused within their case management roles.
Conclusion:  The findings suggest that the Occupational Performance History Interview can potentially enhance client-centred and occupationally focused practice in community mental health case management.     

Discharge decision-making with older people: The influence of the institutional environment

Background/Aim:  Occupational therapists often participate in decision-making about postdischarge accommodations. This paper presents the findings of a study that identified and explored institutional factors influencing discharge accommodation decision-making with older people, from the perspective of occupational therapists.
Methods:  Qualitative, semistructured, face-to-face interviews were conducted with 10 occupational therapists. Interviews were recorded, transcribed, coded and analysed for the presence and emergence of themes.
Results:  Decision-making processes were influenced by the institutional environment. The medical model and pressure for fast decisions seemed to impede client-centred processes in acute settings.
Conclusions:  When possible, decision-making about long-term care needs to occur in community or longer-stay rehabilitation settings that allow time for negotiated client-centred processes.     

Exploration of the link between conceptual occupational therapy models and the International Classification of Functioning, Disability and Health

Background and Aim:  Because occupational therapy focuses on occupations and activities of daily living in the context of the environment, conceptual occupational therapy models might be closely related to the International Classification of Functioning, Disability and Health (ICF). The purpose of this paper is to explore the link of conceptual occupational therapy models to the ICF.
Methods and Results:  A structured literature search was performed. The concepts on which the models are built were linked to the ICF categories and components according to 10 established linking rules. Three conceptual occupational therapy models were identified in the literature: the Model of Human Occupation, the Canadian Model of Occupational Performance and the Occupational Performance Model (Australia). The majority of the concepts from the three models could be linked to the ICF.
Conclusion:  By applying the conceptual models, occupational therapists might add an additional perspective to multidisciplinary teams that use the ICF.     

Interrater reliability of the Social Profile: Assessment of community and psychiatric group participation

Background/Aim:  The Social Profile was developed based on the theoretical concepts of activity group participation skills: Parallel, Associative, Basic and Supportive Cooperative and Mature activity levels. The aim of this study is to assess the interrater reliability of observations in groups of children and adults using the Social Profile.
Methods:  Two community and two hospital populations were used to determine the interrater reliability of the Social Profile as observed by clinicians and graduate students. These groups included preschool children, older adults, general, geriatric and substance abuse psychiatric patients. Observers consisted of clinicians and graduate student pairs.
Results:  Moderately high intraclass correlation coefficient (ICC) scores of interrater reliability were found in separate and combined scores from the Social Profile measurements.
Conclusion:  These ICC reliability rates indicate that the Social Profile interrater scores are adequately high for acceptable measurement of social and activity participation levels in clinical, community and school groups.     

The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes

Background/aim:  The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention.
Methods:  Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention.
Results:  A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction.
Conclusions:  The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance.     

Fine motor difficulties: The need for advocating for the role of occupational therapy in schools

Background:  Fine motor difficulties can impact on the academic, social and emotional development of a student.
Aim:  The aims of this paper are to: (i) investigate the need for support to students experiencing fine motor difficulties from the perspective of their classroom teachers, and (ii) report on the level of knowledge teachers have in regard to the role of occupational therapists in supporting students with fine motor difficulties.
Methods:  Fifteen teachers from a stratified random sample of public schools within two regions of Victoria, Australia, were interviewed in this qualitative, grounded theory investigation.
Results:  Results showed that the current level of support for students with fine motor difficulties is inadequate.
Conclusion:  Occupational therapists in Victoria need to advocate their role in developing the fine motor skills of students at both an organisational and an individual level in order to increase the access of students with fine motor difficulties to occupational therapy services.     

The concurrent validity of the 3-day Physical Activity Recall questionnaire administered to female adolescents aged 12–14 years

Aim:  This pilot study was conducted as part of an honours project and aimed to provide evidence of validity for the 3-day Physical Activity Recall (3dPAR) questionnaire in a sample of female adolescents aged 12–14 years ( N  = 20) for use by occupational therapists to assess adolescents' physical activity.
Methods:  Participants wore a Computer Science and Applications 7164 accelerometer for seven consecutive days and completed the 3dPAR questionnaire after the recording period.
Results:  A significant correlation was found between self-reported total metabolic equivalents and accelerometer total counts for 3 days ( r =  0.630, P  < 0.01) and self-reported vigorous physical activity and accelerometer minutes of vigorous physical activity for the 7 days ( r =  0.568, P  < 0.01) and corresponding 3 days ( r =  0.493, P  < 0.05) of monitoring.
Conclusions:  A validity coefficient has been established for the 3dPAR questionnaire when measuring total and vigorous physical activity in females aged 12–14 years over a 3-day period. It is anticipated that this study will assist in familiarising the occupational therapy field with the 3dPAR questionnaire as a potential self-report tool to assess and explore the complexity of adolescents' physical activity.     

The structure of novice and expert occupational therapists' clinical reasoning before and after exposure to a domain-specific protocol

Background/aim:  The research aimed to determine the influence of a protocol designed for use in the domain of upper limb hypertonia due to brain injury on novice and expert occupational therapy clinical reasoning.
Method:  Individual, structured repertory grid interviews were completed with 13 novice and eight expert occupational therapists prior to, and following, exposure to a domain-specific clinical reasoning protocol. Data were subjected to quantitative analyses (Principal Components Analysis, Generalised Procrustes Analysis).
Results:  Novice participants demonstrated statistically significant change in the structure of their clinical reasoning following exposure to the protocol ( P  < 0.004). Prior to exposure, novices relied on therapy tasks, the problem-solving process, environmental factors and standard practice to structure their reasoning. Following exposure, novices' clinical reasoning changed to more closely reflect experts' reasoning. Thus, a 'structured approach' and (theoretical) practice perspectives became evident. Prior to exposure to the protocol, experts structured reasoning in terms of (personal and theoretical) practice perspectives, therapy tasks and the scope of such tasks (either 'general' or 'specific'). Following exposure, therapist/client collaboration and upper-limb-related constructs emerged as being used to structure experts' reasoning, although these changes were not statistically significant.
Conclusion:  A protocol designed for guiding clinical reasoning in the context of upper limb hypertonia was perceived to be conceptually useful by novice and expert occupational therapists.     

Using the Assessment of Motor and Process Skills to measure functional change in adults with severe traumatic brain injury: A pilot study

Aim:  To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS).
Methods:  This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation.
Results:  Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation ( z = – 2.70 , p  =  0.01 ; z = – 2.81 , P =  0.01 , respectively).
Conclusions:  The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.     

Are we applying interventions with research evidence when targeting secondary complications of the stroke-affected upper limb

Background/aim:  This study aimed to survey occupational therapy practice with reference to the current evidence for management of secondary complications of the stroke-affected upper limb.
Methods:  A questionnaire was developed to identify the clinical practice of occupational therapists in managing the client's stroke-affected upper limb. Participants were recruited via an email to the national occupational therapy neurology listserve. Occupational therapists working in stroke rehabilitation were invited to complete the questionnaire online or to print off and return.
Results:  Fifty-five occupational therapists completed the questionnaire. Results revealed that treatment techniques with little to no evidence were used frequently, including pillow cushion supports (98%), positional stretch (94%) and slings (61%). Alternatively, treatment techniques with significant supporting evidence were used at a lower frequency, such as electrical stimulation (39%).
Conclusions:  The results of the questionnaire highlight an inconsistent application of evidence within clinical practice and the consistent application of treatment techniques with poor supporting evidence. This result does not represent poor clinical practice. Rather, it highlights the need for the research literature to articulate the clinical reasoning underpinning clinicians' selection of treatment techniques and to determine the effectiveness of frequently used, but poorly supported treatment techniques.     

Workers' compensation insurance agents' satisfaction with occupational therapy activities of daily living assessments

Background and Aim:  Little is known about insurance agents' (insurers) satisfaction with the services provided by occupational therapists when they assess injured workers' activities of daily living (ADL). Demonstration of accountability and provision of high-quality services are important to the occupational therapy profession. The aim of this study was to evaluate insurers' overall satisfaction with occupational therapy ADL assessments for injured workers, including communication, timeliness of reports, equipment provision, knowledge of insurers' requirements and the workers' compensation process, and provision of a professional opinion. Relationships between insurers' overall satisfaction with ADL assessments, degree of experience in their job, formal qualifications and roles within their organisation were also investigated.
Method:  A telephone survey was developed and administered to a sample of 40 claims officers and injury management advisors from 10 Victorian Work Cover Authority authorised agents.
Results:  Insurers were generally satisfied with occupational therapy ADL assessments. They were less satisfied with occupational therapists' knowledge of workers' compensation system requirements and how occupational therapists made decisions when recommending household services.
Conclusion:  To improve services to the insurance industry, occupational therapists need to better understand relevant legislative frameworks.     

Cognitive strategy use by children with Asperger's syndrome during intervention for motor-based goals

Background:  Cognitive Orientation for (daily) Occupational Performance (CO-OP) is a cognitive approach utilised by occupational therapists to help guide children in the discovery of appropriate strategies for effective task performance through a structured problem-solving process. There has been limited research into its utility for children with Asperger's syndrome (AS). These children often present with motor difficulties, although these are not required for diagnosis of the syndrome. A recent study found that children with AS were able to use the CO-OP framework to enhance their performance of motor-based goals.
Methods:  This paper presents two case studies demonstrating the use of CO-OP with children with AS, and explores the global and domain-specific strategies and types of guidance utilised to improve their task performance. Two children with AS, aged 9 and 11, with above average intellectual ability, engaged in 10 sessions of CO-OP. All sessions were videotaped. One hundred minutes of randomly selected footage were coded per child using the Observer Software Package version 5.0.
Results:  The mean interrater agreement for the two children was 94.06% and 89.30%. Both children (i) utilised the global strategies 'do', followed by 'plan' and 'check', (ii) used at least three domain-specific strategies in each session with 'task specification/modification' and 'body position' utilised most, and (iii) used limited verbal self-guidance.
Conclusion:  These two children with AS were able to utilise cognitive strategies to effectively solve their motor performance problems. Children with AS and those with DCD used similar strategies to achieve motor goals. CO-OP appears to have potential as an effective intervention for children with AS. Study limitations, clinical implications and directions for future research are discussed.