The inter-rater and test–retest reliability of the Self-care and Transfer scales,and intra-rater reliability of all scales of the Swedish Translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S)

Abstract

Objective: The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) are used internationally to measure the outcomes of occupational therapy services across diagnoses, ages, and health care settings. This study reports on the inter-rater and test–retest reliability of the Self-care and Transfer scales as well as the intra-rater reliability of all scales of the Swedish (AusTOMs-OT-S) translation. Methods: Fifteen occupational therapists rated 11 case study clients on two occasions, separated by two weeks. Test–retest reliability and inter-rater reliability were calculated for the Self-care scale and Transfer scales. Moreover, intra-rater reliability was calculated for each of the 15 therapists across all 12 scales. Results: The inter-rater reliability intraclass correlation coefficients (ICCs) were all found to be high to very high, ranging from ICC 0.762 to 0.904; the intra-rater reliability coefficients were also very good with 11 of the 15 therapists achieving ICCs of 0.745 or over, and finally the test–retest ICCs were also found to be high, ranging from 0.705 to 0.920. Conclusions: Although further research is required to confirm reliability, preliminary reliability of the AusTOMs-OT Swedish translation has been demonstrated and therapists can have confidence when using the scales.     

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.     

Reliability of the Perceive, Recall, Plan and Perform System of Task Analysis: A criterion-referenced assessment

Objective:  To conduct preliminary examination of the rater and test-reliability of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, an ecological measure designed to assess task-embedded information processing capacity during occupational therapy assessment of confused and agitated adults following traumatic brain injury.
Methods:  Occupational therapists observed and scored client performance using the PRPP System of Task Analysis. Correlational analysis and measures of agreement were performed to determine interrater and intrarater reliability. Test procedures were examined for reliability and internal consistency.
Results:  Interrater and test reliability considered three factors: therapists, clients and tasks. A moderate level of interrater reliability was achieved between trained therapists (intraclass correlation coefficient (ICC) = 0.60). Test procedures were highly reliable (ICC = 0.88). Across two measurement occasions, therapists showed a tendency towards harder rating on the second test occasion (      –4.5%; 95% confidence interval for     : –10.67%→ 3.17%).
Conclusion:  The findings of this study support the use of criterion-referenced tests in the area of occupational performance measurement. Occupational therapists achieved moderate interrater reliability when measuring the performance of adults with brain injury on various activities of daily living. Test procedures were found to be highly reliable in measuring the occupational performance of adults demonstrating confusion and agitation typical to the stage of post-traumatic amnesia following head injury.     

Therapy outcome measures for allied health practitioners in Australia: the AusTOMs.

OBJECTIVE: The aim of this study was to develop a valid and reliable measure of therapy outcome for three allied health professions in Australia: speech pathology, occupational therapy, and physiotherapy. The Australian Therapy Outcome Measures (AusTOMs) enable measurement of the differences in client profiles and patterns of services provision across health care settings. In this paper we describe phase 1 of the study: the development and preliminary validation of the AusTOMs. METHOD: The UK TOMs, developed by Enderby, were scrutinized by the research team. A pilot core scale was developed, based on the structure of the TOM. Focus groups of expert clinicians for each profession, across the state of Victoria in Australia, analysed and refined the scales further. A mail-out survey was then sent to therapists across Australia to assess both face and content validity of the AusTOMs. MAIN RESULTS: A new tool, the AusTOM, was developed and tailored to the needs of each profession, with input from specialist clinicians and allied health researchers. The face and content validity of the new scales were assessed, and good consensus was obtained for the wording and content validity of the scales. The discriminative validity, concurrent validity, and reliability of the tool are now being evaluated. CONCLUSION: We have produced an outcome measure in the Australian context for speech pathology, physiotherapy, and occupational therapy. There are six speech pathology scales, nine physiotherapy scales, and 11 occupational therapy scales in the AusTOMs. A clinician chooses the relevant scale(s) for the client (based on the goals of therapy) and makes a rating across all domains for each scale. Further papers will report on the reliability, validity, and clinical usefulness of the AusTOMs.     

Practitioner Training for Use of Evidence-Based Practice in Occupational Therapy

The purpose of this integrative review was to examine the evidence-based practice (EBP) training literature for occupational therapy practitioners in order to describe the relationships between EBP use in practice and practitioner training for EBP. A systematic search of literature related to EBP training in occupational therapy was followed by a research evaluation, review of case examples, and qualitative content analysis. Findings suggest that comprehensive, contextually-relevant, and collaborative training approaches are necessary for practitioners to address implementation of EBP. Research investigating the mechanisms of practitioner training and ways to measure the relationships between training, changes in how practitioners use evidence-based practices, and client outcomes and other quality indicators is recommended.     

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 illusion of client-centred practice

Abstract

Aim: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession’s philosophical basis and espoused commitment to client-centred practice. Findings: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession’s espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine’s expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession’s core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. Conclusion: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.     

The Evolving Postbaccalaureate Entry: Analysis of Occupational Therapy Entry-Level Master's Degree in the United States

At the American Occupational Therapy Association's Annual Conference in 1999, the Representative Assembly passed Resolution J, which became Resolution 670–99 and mandated that entry to the professional level of practice in occupational therapy be at the post-baccalaureate degree level. The Accreditation Council for Occupational Therapy Education (ACOTE) set the effective date as 2007. As a result, more than 50 of the existing 157 occupational therapy educational programs faced the challenge of developing postbaccalaureate entry degree programs. These programs had previously offered only baccalaureate entry degrees. This article compiles the expectations that were articulated as outcomes of transitioning to postbaccalaureate entry, describes findings from an analysis of the current structure of the evolving master's entry level occupational therapy education and identifies concerns for consideration by educational programs and practitioners.     

A non-paternalistic value theory of occupational therapy: a comment to Dige

In an article by Morten Dige in the Scandinavian Journal of Occupational Therapy, a value theory for occupational therapy is developed where the goals of occupational therapy, i.e. activity and participation, are seen as valuable in themselves. Such a value theory opens up for a paternalistic approach towards the person in need of occupational therapy who risks being excluded from certain types of activities and the theory even risks excluding certain groups of persons. In this comment to Dige, it is argued that adopting a more subjective approach to value, in which activity and participation are instrumental to values such as subjective well-being or the fulfilment of desires, the risk of inherent paternalism and exclusion is minimized. Moreover, activity and participation can still maintain their central role as goals of occupational therapy.     

Evidence-based practice guidelines in OHS: are they agree-able?

The purpose of this study was to evaluate the acceptance, validity, reliability and feasibility of the AGREE (Appraisal of Guidelines and REsearch and Evaluation) instrument to assess the quality of evidence-based practice guidelines for occupational physicians. In total, 6 practice guidelines of the Netherlands Society of Occupational Medicine (NVAB) were appraised by 20 occupational health professionals and experts in guideline development or implementation. Although appraisers often disagreed on individual item scores, the internal consistency and interrater reliability for most domains was sufficient. The AGREE criteria were in general considered relevant and no major suggestions for additional items for use in the context of occupational health were brought up. The domain scores for the individual guidelines show a wide variety: 'applicability' had on average the lowest mean score (53%) while 'scope and purpose' had the highest one (87%). Low scores indicate where improvements are possible and necessary, e.g. by providing more information about the development. Key experts in occupational health report that AGREE is a relevant and easy to use instrument to evaluate quality aspects and the included criteria provide a good framework to develop or update evidence-based practice guidelines in the field of occupational health.     

Client-Chosen Goals in Occupational Therapy: Strategy and Instrument Pilot

ABSTRACT

Client-centered practice and outcomes research are missions of occupational therapy. Although strategies for client goal-setting have advanced the field, the process has limitations. This study tested a self-report strategy using brief, easy to score measures. The Goals for Occupational Therapy List was completed at mostly independent intake and paired with a follow-up measure of Goal Satisfaction Rating by 40 clients in an outpatient rehabilitation center. The strategy of pairing self-report measures of goal-setting and attainment was useful for clinicians and yielded important research findings. Application to occupational therapy and future research are suggested.     

Time use, tempo and temporality: Occupational therapy's core business or someone else's business

A primary assumption underlying occupational therapy intervention is that peoples' use of time, or their participation in activities, is related to their overall well-being and quality of life. However, the translation of this assumption into occupational therapy practice often is not only invisible, but it is becoming increasingly difficult to sustain in current health care practices. This paper outlines current research and literature related to relationships between peoples' time use, tempo and temporality, and their well-being, and will discuss implications for occupational therapy theory, practice and research.     

A non-paternalistic value theory of occupational therapy: a comment to Dige

Abstract

In an article by Morten Dige in the Scandinavian Journal of Occupational Therapy, a value theory for occupational therapy is developed where the goals of occupational therapy, i.e. activity and participation, are seen as valuable in themselves. Such a value theory opens up for a paternalistic approach towards the person in need of occupational therapy who risks being excluded from certain types of activities and the theory even risks excluding certain groups of persons. In this comment to Dige, it is argued that adopting a more subjective approach to value, in which activity and participation are instrumental to values such as subjective well-being or the fulfilment of desires, the risk of inherent paternalism and exclusion is minimized. Moreover, activity and participation can still maintain their central role as goals of occupational therapy.     

A national evaluation of the Australian Occupational Therapy Competency Standards (1994): A multistakeholder perspective

This paper summarises results from an evaluation of the adequacy and utility of the Australian Competency Standards for Entry-Level Occupational Therapists © (OT AUSTRALIA, 1994a). It comprised a two-part study, incorporating an online survey of key national stakeholders ( n  = 26), and 13 focus groups ( n  = 152) conducted throughout Australia with occupational therapy clinicians, academics, OT AUSTRALIA association and Occupational Therapy Registration Board representatives, as well as university program accreditors. The key recommendations were that: (i) urgent revision to reflect contemporary practice, paradigms, approaches and frameworks is required; (ii) the standards should exemplify basic competence at graduation (not within two years following); (iii) a revision cycle of five years is required; (iv) the Australian Qualifications Framework should be retained, preceded by an introduction describing the scope and nature of occupational therapy practice in the national context; (v) access to the standards should be free and unrestricted to occupational therapists, students and the public via the OT AUSTRALIA (national) website; (vi) the standards should incorporate a succinct executive summary and additional tools or templates formatted to enable occupational therapists to develop professional portfolios and create working documents specific to their workplace; and (vii) language must accommodate contextual variation while striking an appropriate balance between providing instruction and encouraging innovation in practice.     

Teaching Evidence-Based Practice in a Distance Education Occupational Therapy Doctoral Program: Strategies for Professional Growth and Advancing the Profession

ABSTRACT

The Centennial Vision of the American Occupational Therapy Association (AOTA) projects that by 2017 all occupational therapy (OT) practice areas will be supported by evidence. Achieving this goal requires preparing clinicians with the skills to assimilate, analyze, and apply research to their areas of practice and communicate the value of OT services to consumers and payers. These skills are at the heart of evidence-based practice (EBP). Educators must be prepared to teach EBP skills in both entry-level and postprofessional programs. This article outlines how EBP can be taught to postprofessional occupational therapy clinical doctoral students using a distance education format. Key features of a successful EBP course include having access to full-text electronic articles, opportunities for students to explore the literature in their own areas of interest, consistent and timely feedback on written work and discussion topics, and opportunities to collaborate with peers.     

How and why do occupational therapists use the OTseeker evidence database?

Background:  OTseeker is a free online bibliographic database containing systematic reviews and methodological ratings of randomised controlled trials relevant to occupational therapy. The database aims to help therapists efficiently identify high quality pre-appraised research.
Aim:  This study explored the search practices of therapists who regularly used OTseeker, what they did with the information retrieved and their perceptions of the database.
Sample:  A purposive sample of 11 occupational therapists was recruited in 2004. All had visited OTseeker at least five times in the previous 12 months.
Study design:  Qualitative.
Methods:  A semistructured interview was conducted with each participant. Grounded theory methods were used for analysis.
Findings:  Five distinct categories were identified: reasons for visiting OTseeker, learning about OTseeker, search times and locations, using information from OTseeker, and improving OTseeker. Therapists used the database to teach or model evidence-based practice, answer clinical questions and keep up-to-date. Suggestions for improvement focussed on search functionality, access to abstracts and the location of the PEDro rating scale. Only two participants synthesised information from OTseeker into a summary, and/or used it to inform client reports.
Conclusion:  This study suggests that OTseeker is helping to increase research utilisation by occupational therapists. Further research is needed to help therapists apply research evidence to change practice and policy.     

Well-being and occupational rights: An imperative for critical occupational therapy

Abstract

Background: One of occupational therapy's core assumptions is that engagement in occupations influences well-being. Because occupational engagement is integral to human well-being, and because well-being is integral to human rights, this paper contends that the ability and opportunity to engage in occupations is an issue that concerns rights. Aims: To outline well-being and its centrality to human rights; to explore the relationships between well-being and occupation and between well-being and occupational rights; and to highlight the consequent imperative to engage in critical occupational therapy. Key issues: The World Federation of Occupational Therapists asserts that all people have the right to participate in a range of occupations that enable them to flourish, fulfil their potential, and experience satisfaction congruent with their culture and beliefs; and further asserts the human right to equitable access to participation in occupation. Conclusions: If occupational therapists are to take seriously their espoused commitment to enabling equitable access to participation in occupation, the inequitable conditions of people's lives will need to be addressed. Critical occupational therapy is a committed form of practice which acknowledges that well-being cannot be achieved solely by enhancing individuals' abilities, and that consequently endeavours also to address the conditions of people's lives.