how accurately are you measuring functional change with your … · 2012. 2. 29. · • ot takes...
TRANSCRIPT
How Accurately are you Measuring Functional Change
with Your Clients?
February 27th, 2012 Susan Pettit O.T. Reg. (Ont.)
Barb Ansley RN
Assessment of Motor and Process Skills (AMPS)
Objectives: • What is the AMPS evaluation?
• Conducting an AMPS Assessment • Evidence Based Projects at Hamilton Health
Sciences using the AMPS
Benefits of Using the AMPS:
• Direct inpatient care for best outcomes
• Predict Level of Assistance to live independently in the community
• Measure statistically significant functional change
• Support Program Evaluation
What is the AMPS
• Reflects the unique focus of OT by focusing on occupation
• Top-down approach
• Ages 3 and older
• Used with any diagnosis
• Tasks range from easy to hard
• Measures the quality of performance
Administering the AMPS
• Must do 2 familiar and life relevant standardized tasks
• Must be familiarized with environment
• Identify client priorities
• Establish `task contract`
• Observe the 2 tasks
• OT takes observational notes during task 5
Scoring the AMPS
OT rates the overall quality of the persons performance
35 skills items
Scale is Criterion-referenced NOT Norm-referenced
Scoring the AMPS
4 Point Scale: 4 = Competent 3 = Questionable 2 = Increased effort or inefficient 1 = Unacceptable amount of time, safety risk,
assistance needed
ADL MOTOR SKILLS
15 Observable goal directed actions
• Interacting with and moving task objects (grip, manipulates, flow, calibrates) • Moving ones self around the environment (walks, transports, stabilizes)
****ADL MOTOR SKILLS ARE NOT
PHYSICAL CAPACITIES!!
ADL PROCESS SKILLS
20 Observable, Goal Directed Actions
• Selecting, interacting with task tools and
materials (Chooses, Uses, Handles)
• Carrying out individual task actions and steps (Initiates, Sequences)
• Modifying task performance, anticipating problems ( Accommodates, Adjusts)
***ADL PROCESS SKILLS ARE NOT COGNITIVE CAPACITIES!!!
Scoring the AMPS
Computerized Scoring
• Program adjusts for task difficulty
• Adjusts for rater severity (calibration)
• Scores compared with what is normal for a
person that age
• Scores compared with cut-off for independent living in the community
AMPS Computer Generated Reports
Narrative Report
• Statement of Quality of the Task Performance
• ADL Motor and ADL Process Ability
• Prediction of Independent Living
• Statement by OT
Graphic Report and Progress Report • Report reflects the Quantitative aspect of the
AMPS • Progress Report shows the changes from one
assessment to another
AMPS Computer Generated Reports
Graphic Report
Benefits of Using the AMPS
• Determine where the task is breaking down and course of treatment
• Proof of level of assistance needed required to live independently in the community
• Determine if their stay resulted in a statistically significant functional change
• Use other research on AMPS - driving
Task B-1 : Toast and Instant Coffee
Essential Elements of Task • Prepare 2 slices of toast with one spread • Prepare a hot instant coffee • Serve toast and coffee in appropriate dishes
Task B-1 : Toast and Instant Coffee
Options • Type of bread • Type of toaster • Cutting toast • Type of spread (i.e. butter or jam) • Heating water in electric kettle, stove or
microwave • May add sweetener and/or milk or creamer
Task B-1 : Toast and Instant Coffee
Evidence Based Project 2009/10
Objective To determine if the AMPS is more sensitive than
the FIM™ at detecting functional change that occurred during usual care on the Complex Medical Rehabilitation Unit.
Evidence Based Project 2009/10
• Results demonstrated that our clients improved significantly in their functional performances on both the FIM and AMPS
• No Statistically significant difference between the AMPS ADL Motor Ability and the FIM Motor Scales
• The AMPS ADL Process Ability demonstrated a Large Positive Difference where the FIM Cognitive Scale was only a Moderate Positive Difference
Evidence Based Project 2009/10
Clinical Implications
Both the FIM™ and AMPS are able to detect patient change following in-patient rehabilitation. However, the AMPS process scale was found to be more sensitive than the FIM cognitive scale at detecting patient improvement. Therefore, using the AMPS as an outcome measure will allow practitioners to detect patient changes that otherwise may not be detected through the exclusive use of the FIM™.
Evidence Based Project 2010/11
Objective What factors affect statistically significant
functional change on the Complex Medical Rehabilitation Unit at the Juravinski Hospital?
Regression Models - AMPS
Regression Model
R2 P
Change in AMPS Motor
Two-Variable Model 1. AMPS Motor (Admit) 2. FIM™ Cognitive (Admit)
20% 12.4% 7.6%
<0.001
Change in AMPS Process
Two-Variable Model 1. AMPS Process (Admit) 2. Cognitive Performance
Test
26.5% 16.6% 9.9%
0.007
Regression Model -FIM
Regression Model
R2 P
Change in FIM™ Motor
Two-variable Model 1. Age (Lower) 2. SMMSE (Higher)
29.2% 29.2% 0.4%
0.04
Change in FIM™ Total
Two-variable Model 1. FIM Motor (Admit) 2. FIM Total (Admit)
50.0% 49.9% 0.1%
<0.001
Regression Model -FIM
• FIM Cognitive not significant in predicting success on Complex Medical Rehabilitation Unit
• Supports results of previous project suggesting that FIM Cognitive Scale is not as sensitive as the AMPS ADL Process Ability
Alison Douglas’ PhD Research
Objective To determine if the AMPS or Cognitive
Performance Test can predict incidents of harm post discharge from hospital.
Results Able to link incidents of harm with AMPS scores.
Results to be published.
Objective To determine the frequency of persons found to
have cognitive impairment not identified prior to admission in the geriatric population.
Use the AMPS to look at level and patterns of
scoring that have previously linked to persons with Alzheimer's Dementia
Evidence Based Project 2011/12
Take Home Message
AMPS data has allowed us to detect statistically functional change not being adequately
measured by the FIM™ alone
At HHS
• Rehabilitation/Seniors program has supported 15 staff to be trained in AMPS.
• 5 day workshop, registration fees,
calibration time. • All inpatient units now have trained
therapists.
At HHS
• Trained therapists meet quarterly with managers, Chief of professional practice and director to discuss implementation on each unit
• AMPS software has been located on a shared drive for all therapists use. Information about patients moving from 1 location to the next can be easily accessed.
• This will provide a larger data pool for research
RESEARCH
• Therapists, managers, Chief of Professional Practice will collaborate on research projects related to the AMPS tool.
• 1st goal is to replicate 2009/10 project
within expanded rehabilitation population.
Questions?
