uota assessment2018.pptx [read-only] · 2018-09-21 · safety hazards in the home • 12 simulated...
TRANSCRIPT
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The Why and How you should be using occupation‐based
assessments in your adult practice
Beth Cardell, PhD, OTR/L University of Utah
Department of Occupational & Recreational Therapies
Annie Wallace, MOT, OTR/L University of Utah
Sugar House Clinic
Introduce and educate OT practitioners to the value of occupation‐based assessment by demonstrating their ease of
administration and scoring.
Learning Objectives:
• 1. Participants will be familiar enough with several occupation‐based assessments, that they can identify those that would best fit their practice.
• 2. Participants will be able to express why occupation‐based assessments are important to OT practice and how they contribute to the profession.
• 3. Participants will have a general knowledge of how several occupation‐based assessments are administered.
Welcome to our Soap Box‐WHY
• To paraphrase GG
•OTs must return to their roots of using occupation as the focus of both treatments and assessments
• So that healthcare professionals, payers, and patients can easily identify the unique contributions of OT
A Fork In the Road: An Occupational Hazard?
Gillen, G. (2013). A fork in the road: An occupational Hazard? (Eleanor Clark Slagle Lecture). American Journal of Occupational Therapy, 67, 1‐12. doi: 10.5014/ajot.2013.676002
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Return to Occupation
• Too often in current practice
• Assessments used have been developed by another discipline
• They are used to evaluate performance skills and body function
• Then results are used to predict occupational performance
• The accuracy and usefulness of this practice is limited
• Undermines the value of our profession
Ecological Validity
• Ecological Validity‐ how well the results of a test/measure predict performance in real world settings.
• Practitioners need to reflect on why they use their current assessments, what value they have in contemporary OT practice, and what message they send our stakeholders.
He Said‐‐‐He Said
• Gillen, Glen and Hinojosa, Jim (2015) "He Said—He Said: A Scholarly Conversation about Assessment," The Open Journal of Occupational Therapy: Vol. 3: Iss. 3, Article 10.
• If we don’t use them we will lose our place at the reimbursement table
• Evaluation findings have to link explicitly to interventions
Recent Example
• Client: 39 y.o. sustained TBI June 26, 2018
•Discharged home from the hospital
•Outpatient clinic evaluation on July 30, 2018
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Why aren’t formal OT assessments being used?
• Why aren’t formal assessments used?
• No time
• Physicians are familiar with …………..
• Too costly
• Unfamiliar with administration/interpretation
Overcoming these barriers
• Why aren’t formal assessments used?
• No time We are already doing many of the activities, we just aren’t scoring or documenting them in a useful way
• Physicians are familiar with …. Educate them on something new and useful
• Too costly Many of the these are free or inexpensive
• Unfamiliar with administration/interpretation‐You can learn this with a little effort. That’s why you are here today
Clearing up some terms
• Performance based
• Self report
• Occupational based‐
• To engage a person in occupation and use that engagement as the foundation or method of evaluation and/or intervention—the person is engaged in the performance of a chosen daily life task that unfolds as it ordinarily does in the person’s life (Fisher, 2013; see also Pierce, 1998)
• Performance AND occupation based
The HOW
• Reliable and Valid occupation based assessments
• Designed for adult settings
• Assess motor and/or processing skills
• Different levels of difficulty
• Majority can be obtained for no cost• Some require purchase of materials
• Minimal training
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Toglia’sWeekly Calendar Planning Activity (WCPA)
• Developed by Joan Toglia, PhD, OTR/L, FAOTA
• Task: To schedule appointments on a weekly calendar while following rules, managing time, avoiding conflicts and ignoring distractions. Therapist does not intervene, and only observes.
• Scoring: Score is based on the amount of appointments entered, amount of correct appointments entered, rules followed, strategies used, planning time, total time, and efficiency (time/accuracy)
WCPA
PROS• So many versions, great for
retesting!
• Age related norms
• Scoring/observation worksheets helpful to guide therapist observations
• Reflection worksheets
• FUNCTIONAL
CONS
• Costs $100https://myaota.aota.org/shop_aota/prodview.aspx?TYPE=D&PID=271083346&SKU=900369
• Setup is particular
• Scoring can be tedious
Performance Assessment of Self‐Care Skills (PASS)
• Developed by Joan C. Rogers, PhD, OTR/L, FAOTA, Margo B. Holm, PhD, OTR/L, FAOTA and Denise Chisholm, PhD, OTR/L, FAOTA at University of Pittsburg
• Task: 26 core tasks split into four different categories;• Functional mobility (5)
• BADLs (3)
• IADLs with physical emphasis (4)
• IADLs with cognitive emphasis (14)
PASSPROS• 26 different tasks to choose from
• Great way to educate and show family/caregivers client’s challenges
• Complete survey and receive access to all documents required
https://www.shrs.pitt.edu/ot/about/performance‐assessment‐self‐care‐skills‐pass
• Both a clinic and a home version
• Separate scores for independence, safety and outcome
• Uses cueing hierarchy
• Good reliability and validity
• FUNCTIONAL
CONS• Gathering the items needed is up to you!
• Scoring takes a little practice
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PASS Items• Bed Mobility
• Stair Use
• Toilet Mobility and management
• Oral hygiene
• Bathtub and shower mobility
• Trimming toenails
• Dressing
• Shopping (money man.)
• Bill Paying by Check (money man.)
• Checkbook balancing (money man.)
• Mailing bills (money man.)
• Taking out garbage, key use (heavy house)
• Telephone use
• Medication management
• Changing bed linens (heavy house)
• Obtaining critical information from media (auditory)
• Obtaining critical information from media (visual)
• Flashlight repair (home maintenance)
• Sweeping (home maintenance)
• Indoor walking
• Home safety
• Playing bingo
• Oven use (meal prep)
• Stovetop use (meal prep)
• Use of sharp utensils (meal prep)
• Cleanup after meal prep (light housework)
FSTT Online Bill Pay
• Developed by Beth Cardell, PhD, OTR/L at U of U
• www.otiadl.net
• Task: Examine 4 bills. Identify if any actions need to take place to manage the 4 bills. Pay the bill ONLINE with credit cards and a working website
• Uses scoring from the PASS
FSTT Online Bill Pay
PRO• Free from the University of Utah Occupational
Therapy website
• Computer based bill pay task
• Uses cueing hierarchy
• Good inter‐rater reliability & construct validity
• FUNCTIONAL
CON• Need access to a computer and internet
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FSTT Online Shopping
• Developed by Beth Cardell, PhD, OTR/L
• www.otiadl.net
• Task: Purchase school uniform items for 8 yoniece
• Uses scoring from the PASS
FSTT Online Shopping
PRO• Free from the University of Utah Occupational
Therapy website
• Computer‐based assessment
• Different versions based on difficulty/complexity
• Uses cueing hierarchy
• Good inter‐rater reliability & construct validity
• FUNCTIONAL
CON• Need access to a computer and internet
Multiple Errands Test (MET)
• Originally examined by Shallice and Burgess (1991), but many versions have been developed since
• Task: To complete gathering information or completing errands (10 items in total)
• Scoring: Client’s ability and efficiency to complete tasks
MET
PROS
• Customizable to your setting
• Community, home, hospital, etc
• You do it in the setting the client is in
• No cost (only the amount of what you might have the client purchase)
• FUNCTIONAL
CONS
• You have to customize it for your setting
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Kettle Test
• Developed by Adina Hartman Maeir, PhD, OT, Nira Armon, MSc, OT, Noomi Katz, PhD, OTR
• Designed to assess older adults
• Task: Make 2 different hot beverages. The client chooses a beverage and the therapist choose a beverage that differs from the client in at least 2 ways
• Scoring: Therapist observes client and identifies if the 13 steps have been completed. Therapist only intervenes if safety is a concern, progression has stopped or if the client continues to repeat failure.
Kettle Test
PRO• Simple and quick to administer (10‐30 mins)
• Free access with contacting authors
Dr. Adina Hartman Maeir at [email protected] or Prof. Noomi Katz at [email protected]
• Clinic or home environment
• Scoring is simple
• FUNCTIONAL
CON• Difficult to find the right kettle
• Keeping food items restocked and fresh
I‐HOPE
• Developed at Washington University• https://starklab.wustl.edu/i‐hope‐kit/
• In‐Home Occupational Performance Evaluation• Meant to assess performance of older adults in their home and identify
components of environment that impact participation• One component has client sort cards of everyday tasks according to participation
and satisfaction‐ similar to Activity Card Sort• Second component is performance based, in client’s home
I‐HOPE
PROS
• Easy to administer
• Considers clients satisfaction with task performance
• Performed in client’s home
• No special equipment needed
CONS
• Costs $75
• Performed in client’s home
• Administration can take up to 1 hour
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Safe at Home Screening
• Developed by Regi Robnett, PhD, OTR
• Assesses client’s ability to identify and fix safety hazards in the home
• 12 simulated hazards
Safe at Home
PROS• You are probably already doing this activity
• Can set up hazards in any kitchen area
• Kit provides some of the harder to find items
• Fake broken glass, fake knife
• Standardized in community dwelling adults
• Easy to administer and score
CONS• Cost is about $35
• www.neattests.com
ManageMed
• Developed by Regi Robnett, PhD, OTR
• Assessment of medication management
• Reading labels, handouts, managing pills, problem solving
ManageMed
PRO• Everything you need comes in kit
• Realistic looking prescriptions
• Includes questions using pharmacy handouts
• 15‐20 minutes to administer
• FUNCTIONAL
CON• Had to buy a new box for it, one it came in
broke within a few uses
• Costs about $50
• www.neattests.com
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Pillbox Test
• Developed by Zartman, et al. (2013)
• Task‐medical management: fill pillbox according to prescriptions on five pill bottles with commonly prescribed “medications”
• Instructions and materials listed in manuscript
• Zartman, A. L., Hilsabeck, R. C., Guarnaccia, C. A., Houtz, A. (2013). The Pillbox Test: An ecological measure of executive functioning and estimate of medication management abilities. Archives of Clinical Neuropsychology, 28(4). doi:10.1093/arclin/act014
Pillbox Test
PRO• Good convergent validity, control group
performed better
• Quick to administer
• Free, instructions available in manuscript
• FUNCTIONAL
CON• Gather items to fabricate the test
Stroke Upper Limb Capacity Scale (SULCS)
• Developed by Roorda, et al. (2011)
• Assessment of UE motor performance after stroke
• 10 Tasks include: reaching/moving items, open screw‐top lid, drink from glass, comb hair, button shirt, writing, manipulate coins
• Scoring: Identify if the client can complete in a reasonably easy manner‐yes/no
SULCS
PRO• Easy and quick to assemble and administer
• Easy scoring‐ dichotomus
• Tasks are done in order of complexity
• Good psychometrics
• FUNCTIONAL
CON• Gather and assemble yourself
• Tasks are limited
• Scoring might not show progress easily
• Developed in Netherlands so can be difficult to get information from author
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Wheelchair Collision
• Developed by Qiang, Sonoda, Suzuki, Okamoto & Saiton (2005)
• Tests for visual spatial neglect
• Extrapersonal
• Task‐ requires client to navigate wheelchair through obstacle course
• Score number of collisions
• Moderate reliability and validity, negative correlation with FIM
Wheelchair Collision
PRO• Instructions for set up and scoring available in
manuscript
• Easy to set up with available equipment
• Quick to administer
• FUNCTIONAL
CON• Space to set up obstacle course
• Only useful for those who use a wheelchair for mobility
Catherine Bergego Scale (CBS)
• Developed by: Azouvi, et al. (1996)
• Details found in article: Azouvi, P., Olivier, S., de Montety, G., Samuel, C., Louis‐Dreyfus, A., Tesio, L. (2003) Behavioral assessment of unilateral neglect: study of the psychometric properties of the Catherine BergegoScale. Archives of Physical Medicine & Rehabilitation, 84:51‐7.
• Measures amount of inter and extrapersonal neglect during ADL performance
CBS
PROS• Easy to administer/score
• Can be administered in conjunction with ADL
• Does not require any equipment beyond ADL
• Fits multiple settings
• Good psychometrics
CONS
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Rabideau Kitchen Evaluation (RKE‐R)
• Developed by Maureen E. Neistadt (1992)
• Tasks‐ preparing a hot beverage and cold sandwich
• Originally designed for adult clients with TBI
• Scoring: Evaluate how much assist the client needs to complete each step of the task
RKE‐R
PRO• Quick to administer 10‐15 min.
• Moderate‐ good psychometrics
• Breaks tasks down into components so you can see where problems are
• FUNCTIONAL
CON• Can be difficult to locate score sheet
• Requires a way to heat water
Executive Route Finding Task (EFRT)
• Developed by T.M. Boyd & S. W. Sautter (1985)
• Originally designed to assess executive function in clients with BI
• Intended to be administered at an inpatient facility
EFRT
PRO• Easy to administer
• Flexible location
• Instructions available in manuscript• Boyd, T. M. & Sautter, S. W. (1993). Route‐finding:
A measure of everyday executive functioning in the head‐injured adult. Applied Pscyology, (7).
• Fair psychometrics
• FUNCTIONAL
CON• Not developed by an OT
• Must develop your own version specific to setting
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Executive Functional Performance Test (EFPT)‐
• Developed at Washington University• Baum CM, Connor LT, Morrison T, Hahn M, DromerickAW, Edwards DF: Reliability,
validity, and clinical utility of the Executive Function Performance Test: a measure of executive function in a sample of people with stroke. Am J OccupTher; 2008 Jul‐Aug;62(4):446‐55.
• Assessment of functional cognition
• Tasks‐wash hands, make oatmeal, pay bills, use phone, medication
• Uses a hierarchy of cueing in administration and cueing
EFPT
PRO• Free just contact author and download files
https://www.ot.wustl.edu/about/resources/executive‐function‐performance‐test‐efpt‐308
• Easy to assemble
• More updated version in development
• FUNCTIONAL
CON• At this time it requires a stove top
• Pan can be hard to find
• Pill labels have to be printed for each client
• Some tasks might be considered outdated
Structured Observation Test of Function (SOTOF)
• Developed by Alison Laver‐Fawcett & E. Marrison (2016)
• Assessment of self‐care and neuropsychological function in older people, for use in the client's home and in clinical settings
• Tasks‐ eating, washing hands, pouring/drinking, dressing
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SOTFOPROS
• Contact Author for information
• Good preliminary psychometrics
• Dynamic assessment/hierarchy of cues
• Developed to be portable
• Easy to assemble
CONS• Still in development stages
• Gather and assemble items for test
Mortera Cognitive Screening Measure(M‐CSM) & Cognitive Screen for Grooming
• Developed by Marianne H. Mortera (2004)
• Assessments of functional cognition in clients with BI
• Two different assessments for same purpose
• Tasks‐meal prep or grooming
• Heat a bowl of soup and make a tuna sandwich
• Oral care
Mortera
PRO• Contact author for information
• Breaks tasks down step by step
• Defines/identifies neurobehavioral deficits
• FUNCTIONAL
CON• Detail of the scoring sheet can be difficult to
manage until you are used to it
• Access to kitchen/bathroom
Screening for Safe Self‐medication post‐Stroke Scale (S5)
• Developed by N. Korner‐bitensky (2010)
• Quick assessment of medication management
• Designed for patients post stroke
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S5
PRO• Specific to stroke
• Assesses common performance deficits
• Quick to administer
• Good preliminary psychometrics
• FUNCTIONAL
CON• Gather and assemble yourself
• “pills” are specific shape and color‐may be difficult to purchase
Naturalistic Action Test (NAT)
• Developed by Schwarts, Buxbaum, Veramonti, Ferraro, & Segal (2002)
• Originally developed for neuro‐rehab clients
• 3 Tasks‐make toast and coffee, wrap a present, pack a backpack
NATPRO
• Free information to set up test
• Authors state it can be used with clients who have aphasia
• Can detect inattention
• FUNCTIONAL
CON• Not developed by an OT
• Set up of tasks can be awkward
• Up to 45 minutes to administer
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Overserved Tasks of Daily Living (OTDL)
• Developed by Marsiske, et al. (2004)
• Assessment of functional cognition in older adults
• Tasks‐medication, telephone, finances
OTDLPRO
• Information/files obtained through author
• FUNCTIONAL
CON• Some tasks could be considered outdated
• Documents describe a certification process but it appears to be free to do
• Last communication this was still in development stages, no new info found
Functional Cognition Assessment Scale (FUCAS)
• Developed by Fotini Kounti , Magda Tsolaki, and Grigoris Kiosseoglou
• Assessment of functional performance & cognition in older adults with dementia
• Tasks‐medication, money/shopping, dressing, wash hands, orientation, communication
FUCAS
PROS• 20 minute administration
• Free by contacting authors
• Made from easy to find items
• Good psychometrics
CONS• Gather and assemble yourself
• Developed in Greece, need to convert some info (measurements).
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Everyday Problems Test
• Developed by S.L. Willis, Penn State University (1993)
• Originally developed for older adults
• Tasks‐gathering information and solving problems
• reading food labels, medication labels, applications, instructions, food prep
• Free to access
Everyday Problems Test
PRO• 2 versions
• Open ended questions
• Simplified version can be answered through multiple choice
• Good psychometrics
• All needed materials included
• FUNCTIONAL
CON• Not developed by an OT
• Older test, activities might not be current and relevant to clients
• Heavy reading component
Cognitive Performance Test (CPT)
• Developed by Claudia Allen
• Cognitive Disabilities Model
• Older adults & dementia settings
• 7 tasks‐ Fill med box, shop for a belt, wash hands, make toast, buy paint over phone, select outerwear, use a map
CPT
PRO• Good theoretical basis
• Less than 30 minutes to administer
• Good psychometrics for reliability and validity
• Scores link to intervention based on CDM
• FUNCTIONAL
CON• Cost is $500
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Routine Task Inventory (RTI)
• Noomi Katz, PhD, OTR (2006)
• Free pdf at www.allen‐cognitive‐network.org
• Expanded and updated version of Claudia Allen’s RTI (1989)
• Cognitive Disability Model
• Cognitive Skills‐ typically used in Mental Health/dementia settings
• 4 Scales‐ Physical, communication, community, work readiness
RTI‐E
PRO• High inter‐rater, test retest reliability, Good
content and construct validity
• Easy instructions and scoring
• Good theoretical basis
• Scores link to intervention based on CDM
• FUNCTIONAL
CON• Some of the tasks might be hard to set up in all
settings
• Work readiness‐ interaction with coworkers
• Observation done over several sessions
Assessment of Motor & Process Skills(AMPS)
• Developed by A. G. Fisher (1993)
• Assesses both motor and process skills during occupations
• ADL & IADL
• Interview client and pick 2 tasks based on this
AMPS
PRO• 140 activities to choose from
• Client centered
• Excellent psychometrics
• Uses OTPF terminology
• http://www.ampsintl.com/AMPS/resources/tasks.php
• Software assists with scoring and documentation
• FUNCTIONAL
CON• Expensive, time consuming training
• Administration requires calibration
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A‐ONE
• Developed by G. Arnadottir (1990)
• Assessment completed during ADL routine
• Designed to identify neurobehavioral deficits after Stroke/BI
• Intended to administer in acute care and/or inpatient rehab
A‐ONE
PRO• Assists in the recognition of neurobehavioral
deficits
• Easy to score and interpret
• Can be done during routine ADL• Dressing, grooming, transfers, self‐feeding,
communication
• Excellent psychometrics
• FUNCTIONAL
CON• Training at a 2 day course
• Only offered 1/year in NYC
• Cost‐ reasonable
Complex Performance Task Assessment
• Developed at Washington University
• https://www.ot.wustl.edu/about/resources/assessments‐388
• Assessment of high level cognitive skills
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CTPA
PRO• Free download of all files
• FUNCTIONAL
CON• Only useful with very high level clients
• Administration time is long
• Some of the set up can be cumbersome
Assessment Resource
• https://health.utah.edu/occupational‐recreational‐therapies/colleagues‐clinicians/evaluation‐assessment.php
• U of U Department page
• Student reviews of available assessments
DISCUSSION
QUESTIONS?