OT Assessments Exam 1 Flashcards
1
Q
Everything people do to occupy themselves
Groups of activities and tasks of everyday life that are organized, have value and are meaningful to the individual
A
Occupations
2
Q
Self- care: getting ready for the day (dressing, showering, eating)
Productivity: Contributing to the environment (working or volunteering)
Leisure: How a person relaxes ( socializing, reading, sports, watching TV)
A
Types of occupations
3
Q
The ability to choose, organize and satisfactorily perform meaningful occupations
Ex: dressing oneself
A
Occupational performance
4
Q
Any problem or issue related to meaningful and purposeful doing
A
Occupational Performance Issues (OPI)
5
Q
The satisfactory experience of a person participating in everyday occupations
Comes from a person values, roles and interests
A
Optimal Occupational performance
6
Q
The art and science of enabling engagement in everyday living though. occupation
Enabling people to perform the occupations that Forster health and well-being
Enabling just and inclusive society so that all people may participate to their potential in the family occupations of life
A
Occupational therapy
7
Q
level of satisfaction brought to an individual when performing an occupation
A
Occupational Therapy goals
8
Q
OT’s increase the potential for occupation by using these factors
Personal factors
Environmental factors
Occupational factors
A
Person Occupation-Environment Interaction
9
Q
The set of tasks involved in finding out about a client and their occupational performance. Helps us determine OPI’s
A
Assessments
10
Q
- What people need to do
- What people want to do
- What people are required to in every day life
A
What do OT’s assess
11
Q
-To describe a clients status at a point in time
- To predict a clients future performance/status
- To evaluate a change in status over tome
A
Why do OT’s assess
12
Q
- Organizing frameworks (CPPF)
- Theoretical Considerations
- Guiding principles
A
How do OT’s assess
13
Q
Steps of the organizing framework: CPPF
A
1st: Enter/Initiate
2: Set the stage
3. Assess/Evaluate
14
Q
Theory of client’s disability and corresponding frame of reference can guide choice of assessment
Theory of why OPI’s are happening and what we are going to focus on
A
Theoretical considerations
15
Q
Biomechanical: body movement
Compensatory: environment
Cognitive-Behavioural: Thoughts and emotions
A
OT Frame of reference
16
Q
COTO is an examples
They provide different stages for practicing as an OT
A
Guiding principles
17
Q
a systematic approach to assessment
should involve a standardized assessment tool
we gain more trustworthy information when we do this
A
measurement
18
Q
Client is actively involved in choices related to assessment, intervention and interpreting outcomes
Partnership that respects autonomy
A
Client-centered practice
19
Q
Method used to gather information about a clients ability to perform occupations
goals are to
1. learn about the clients
2. identify the OPI’s
3. establish trust
4. gather subjective information
5. understand values, strengths and interests
A
Interview
20
Q
we can hear the clients story and situations
we can communicate effectively to get the client to tell us their limitations
A
benefits on an interview
21
Q
- set up an inviting space
- prepare to listen
- Minimize distractions
- Housekeeping (informed consent, time, confidentiality, note taking)
- COTO standards
A
Beginning on an interview
22
Q
- Exploration of the client
- Gather information on OPI’s and Occupations
- Open ended questions, closed ended questions direct questions, indirect questions
- Allow for silence
A
Middle of an interview
23
Q
- refocus if you lose track of time
- Summarize to make sure you understand what client said
- Ask if you missed anything
- Come up next appointment
- “do you have any questions for me”
A
End on an interview
24
Q
- False reassurance
- Projecting personal values
- Giving advice
- Bombarding
- Abruptly changing the topic
- Inappropriate language
A
Pitfalls
25
- Keeps focus and helps ensure key issues are not missed
- Related assessments more explicitly to theoretical frameworks or models
- increased validity and reliability of responses
semi-structured interviews
26
What is COPM?
Canadian Occupational Performance Measure
27
An individual, evidence based, client-entered outcome measure designed to capture a clients self-perception of performance of everyday living overtime
it is not a goal setting tool, it is an OPI identification tool
Standardized assessment
COPM
28
semi-structured interview
visual rating scale
paper or online
How to COPM is administered?
29
1. demonstrated evidence based practice
2. demonstrates client-centred practice
3. enables the identification of OPI's
4. provides a vehicle for continuity of care
5. provides focus for reporting and documenting change
6. may improve continuity of care
Why use the COPM?
30
Clinical utility
- improves goal setting
Reliability
- Moderate to high
Validity
- Content validity
COPM Psychometric properties
31
1. identify OPI's
2. Rate and choose most important OPI's
3. Score performance and satisfaction
4. Reassessment
How to administer the COPM?
32
How do you identify OPI's in the COPM?
Using an interview in the first step (identifying OPI's)
33
Explain 2. Rate and choose most important OPI's
- you try to address the things they rate as most important
34
Explain 3. scoring in the COPM?
using the scoring card you :
1. ask the client to rate how they are currently performing on the OPI's they names
2. Ask the client to rate how satisfied they are with their performance on the OPI's they names
35
Explain 4. Reassessment
start from the beginning and get the client to rescore their performance and satisfaction
if it goes up by 2, it would be considered clinically significant
36
- keep an open mind
- explore less obvious occupations
- family members can be proxies
Clinical considerations to the COPM
37
- lack of uptake
- not acknowledging
- abrupt topic changes
- making assumptions
- failure to explore
Communication pitfalls during the COPM interview
38
The end result of clinical activity
What is an outcome?
39
An instrument that has been shown to measure desirable traits accurately
Outcome measure
40
Example of an outcome measure?
COPM
Use it to measure the outcome measure of clients in occupational therapy practice
41
Fundamental component of evidence based practice
helps us determine status at the start of an intention and if someone is actually improving
Improves clinical decision making, care and client outcomes
Why do we measure
42
How do we choose which assessment to use?
Instrument Evaluation Process
43
- Clinical Applicability
- Specificity
- Availability
- Time/Training Demands
- Acceptability to clients
- Cost
Factors to consider when determining if an assessment is clinically useful
44
test questions, methods and conditions for the administrating, scoring and interpretation of the results are consistent
Assessment allows for trustworthy comparison of score from one time to the next
When a test have very explicit instructions
What is a standardized assessment?
45
- Assessment manual
- instructions for administration
- Standardized equipement/questions
- Data on test construction, reliability, validity
- Normative data
How to tell if a test is standardized?
46
1. description measures
2. predictive measures
3. evaluative measures
3 aspects of instrument purpose
47
describes the status of the person or group
describes the person or group occupational repertoire
information collected can be use to identify problems and to evaluate the needs/plan intervention
Descriptive measures
48
predicts the client future status
predicts something specific about the client
can be used to screen individuals to determine their eligibility for intervention or benefit from a program
Predictive measures
49
50
an instrument that has been shown to measure desirable traits accurately
EX: COPM: used to measure the _____ of clients in occupational therapy practice
what is outcome measure?
51
Fundamental component of evidence based practice
Helps us determine status at the start of intervention, if someone is actually improving, and if improved by the end of intervention
Improves clinical decision-making, care and client outcomes
Why do we measure outcomes?
52
How do we choose which assessment to use?
Using the instrument evaluation process
53
- Clinical Applicability
- Specificity
- Availability
- Time/Training demands
- Acceptability to clients
- Cost
How to determine is an assessment in clinically useful?
54
test questions, methods and, conditions for the administrating, scoring and, interpretation of the results is constant
Assessment allows for trustworthy comparison of scores from one time to the next
A test that has very explicit instructions
What makes an assessment standardized?
55
1. Assessment Manual
2. Instructions for administration
3. Standardized equipment/questions
4. Data on test construction, reliability, validity
5. Normative data
How to tell if a test is standardized?
56
- descriptive measures
- predictive measures
- evaluative measures
3 aspects of instrument purpose
57
describes the status of the person or group
describes the person or groups occupational repertoire
can be used to classify am individual via comparison with norms
information collected can be used to identify problems and to evaluate the need/plan for intervention
Descriptive Measures
58
predict the clients future status
used to predict something specific about the client
often have norms that can be used to screen individuals to determine eligibility for intervention or benefit from a program
Predictive Measures
59
Evaluate the change in status of a client overtime
used at more than one point
must be sensitive to change
EX: COPM
Evaluative Measures
60
instrument development process
- the way the instrument was constructed and developed
Item inclusion and exclusion
- does the instrument include questions would would expect to see?
scaling/weighting
- How does the scoring work? How is the total weighted?
Test Construction
psychometric properties
61
measures of the average or typical performance from the basis of how instrument scores are interpreted
involves comparing an examinee's test score to scores obtained by people included in a normative sample
important to consider characteristics of the sample
Norm-Referenced Measures
62
trustworthiness of a measure and it's results
A reliable measure yields dependable and consistent measurement of what you are trying to remember
Reliability
psychometric properties
63
the difference between the true value of a phenomena and its measured value
caused by factors that are irrelevant to what is being measured by the test and having an unpredictable effect on the test scores
measurement error
64
fatigue
anxiety
distraction
motivation
instructions
factors that cause measurement error
65
1. test construct
- test questions worded unclear, instructions unclear, scoring
2. test administration
- test environment issues, test-taker motivation/attention, examiner-related variables
3. test scoring
- scoring by hand vs computer, level of training, subjectivity
4. test interpretation
Sources of measurement error
66
- choose an assessment with strong psychometric properties
- pilot-test assessment and instructions
- follow standardized instructions
- train admin
- making observations
- keep test environment and equipment as similar as possible
- double check data
Tips to minimize measurement error
67
68
what does poor reliability look like
0.1
69
what does high reliability look like
0.9
69
- Pearson product moment correlation coefficient (r)
- Intra-class correlation coefficient (ICC)
- Spearman rank-order coefficient (rho_
- Kappa Statistic (k)
- Cronbach's Alpha
Statistics to measure reliability correlations
70
stability of the measure overtime
determine by calculating the agreement of scores at two different times for a characteristic that has not changed
ICC>0.70 would be acceptable
Test-retest
70
test-rest
inter-rater
internal consistency
Measures of reliability
71
health assessment questionnaire
- r=0.87-0.99
reintegration to normal living index
- r=0.12
Examples of test-retest
72
The degree to which the scores by different raters yield the same results
Applies to assessments where test administrators assess the results
determined by having several measures of the same phenomena
descriptive, predictive and evaluative assessments should have this
inter-rater reliability
73
kitchen task assessment
- r=0.85
Example of inter-rater reliability
74
The degree of interrelatedness among the items of an instrument
used to determine if items on the test are consistent or not
Internal consistency
75
Barthel Index
- r=0.87=0.92
example of internal consistency
76
extent to which the assessment measure what is intended to measure
validity
77
- Face
- Content
-Criterion (concurrent and predictive)
- Construct (convergent, divergent, discriminative)
- Responsiveness
Types of validity
78
As assumption of validity based on a measures appearance
least reliable validity `
Face validity
79
the degree to which the instrument items are a comprehensive reflection of what the instrument reports to be measuring
an assessment contains all content it should for what it is measuring
Content validity
80
Extent to which the scores of an assessment relate to gold standard or a valid external criterion
assessed by correlating the scores of a sample of individuals on the predictor with the scores on the criterion
Criterion validity
81
Criterion data collected at the same time as the dad on the predictor side
EX: TB Skin test ( skin test= predictor, chest x-ray= criterion)
Concurrent validity within Criterion validity
82
Criterion data collected after the predictor test was administered
EX: scores on MCAT= predictor, predicted performance in medical school= criterion
Predictive validity within criterion validity
83
The degree to which the scores of an assessment are consistent with a hypothesis about how they should be performed
Based on testing a measure against an idea that is based on a theory
Most interesting and difficult of all validities
Construct validity
84
the degree to which the scores of an assessment are consistent with a hypothesis that the assessment will correlate with another measurement
EX: COPM scores will correlate with RNLI scores
- COMP performance scores and the RNLI scores: r=0.72
- COPM ratification scores and the RNLI scores: r=0.93
convergent validity within Construct validity
85
86
The degree to which the scores of an assessment are consistent with a hypothesis that the assessment will not correlate with another measurement
EX: COPM performance scores will not correlate with standardized performance measures that are not client reported
- Barthel index: r=-0.025
- Rankin scale: r=0.209
Divergent validity within Construct validity
87
The degree to which the scores of an instrument are consistent with a hypothesis concerning the differences between groups
Discriminative validity within Construct validity
88
the ability of an assessment to detect change overtime in what it reports to be measuring
It is done by taking a group that does in face change and seeing fi the measure picks up on the change
Results expressed in effect size
Responsiveness validity
89
Minimal Detectable Change (MDC)
Minimal Clinically Important Differences (MCID)
Responsiveness Validity Concepts
90
what amount of change, taking error into account, means that the change has actually occurred
Minima Detectable Change
91
What a patient would notice to be a meaningful change
Minimal Clinically Important Differences
92
The degree to which the performance of an item on a translated/culturally adapted measure are an adequate reflection of the performance of the items in the original version of the assessment
Cross-cultural validity
93
The degree to which a measure reflects real life
Ecological validity
94
1. obtain a copy of that measure
2. refer to books that evaluate the measure
3. read literature
4. check the wide-range of literature
5. follow a template for evaluation and do your own evaluation
Tips for how to evaluate a measure
95
- use search engines
- textbooks
- library database
- measurement cupboard
how to find an assessment
96
questionnaire that ask about symptoms and the ability to do certain things
a good assessment
DASH
Disabilities of the arm, should and hand
97
- it matters
- characteristics
- helps with occupational engagement
- in line with OT models (CMOP-E, PEO)
- embedded in OT competencies (C3.6)
- In line with current best practice
Why we assess the environment
98
- Environment is one of the 3 core constructs
- OT's are interested in aspects of the environment and how they relate to occupation
- Assessments of the physical, institutional, cultural environment is a role of an OT because it related to a persons occupational engagement
Using CMOP-E to assess environment
99
- The greater the overlap, the more optimal the occupational performance will be
- by changing the environment, there is more overlap which leads to better occupational performance
Using PEO to assess environment
The Person-Environement Occupation Model
100
- CASE
- CAFI (Child and Adolescent Factors Inventory )
- CASP (Child and Adolescent Scale of Participation)
Examples of environmental assessment
101
used to assess physical, cognitive and psychosocial characteristics
CAFI (Child and Adolescent Factors Inventory )
102
used to assess the Childs participation in certain occupations
CASP (Child and Adolescent Scale of Participation)
103
- practice setting
- whose perspective? Childs, parents, teacher, OT?
- Wording- deficit vs strength based
- Stand alone of complimentary use
considerations for selecting an OT paediatric environmental assessment
104
- psychometrics
- cost/accessibility
- Training/Certification
- Completion/scoring time
- Format/Methods (interview, self-report?)
- Population (would it be useful for a child with learning disabilities)
- Domains assessed
general considerations for selecting an environmental assessment
105
- Whose perspective (child, parent, teacher, OT?)
- Wording (deficit vs strength based)
- Stand alone of complementary use
paediatric considerations for selecting an environmental assessment
106
What does AMPS stand for
Assessment of motor and process skills
107
Standardized evaluation of ADLS
It is unique because it is standardized
AMPS
108
1. OT performs an interview and learns what tasks the client wants to priotrize
2. The OT observes the client doing at least 2 of the tasks and evaluates the quality of the task performed
3. OT scores the quality of the observed tasks performance using criteria from the manual
4. OT enters scores into computer software and generates report
AMPS process
109
- we are attending to occupational performance skills
What are looking at when using AMPS
110
the smallest units of observable goal directed actions that are linked together one by one in the process of building a task performance
Occupational performance skills
111
what are the 2 categories of AMPS
1. ADL motor skills
2. ADL process skills
112
Goal-directed task action observed when the person:
- Moves around the task environment
- Interacts with and moves task objects
ADL motor skills
113
Goal-directed task action observed when the person
- Selects, interactions and, uses a task tool or material
- carries out individual actions and steps of the task in a spatial-temporally effective manner
- prevents task performance problems from reoccurring by finding another way
Adaption is very important
ADL process skills
114
4= competent performance
3= questionable performance
2= ineffective performance
1= unacceptable performance
AMPS scoring criteria
115
1. Severity of the OT
- The OT must be training to administer
2. Adjusts for the challenges of the task that the person did
3. Difficulty of the item or specific motor or processing Skills
- All people are more likely to get lower scores on harder tasks
AMPS software adjusts the persons score for 3 things
116
1. to share with client or other party
2. goal setting and intervention
3. demo states effectives or intervention
why AMPS results come in several reports
117
supports our clinical judgement of someones needs for assistance when living in the community
ADL process: <1.0
ADL motor: <1.5
Person would need assistance
ADL process: <0.7
ADL motor: <1.0
Person would need maximal assistance
AMPS
118
- if the person is under the age of 2 or the person has no desire/need to engage in ADLS
only reason you shouldn't consider using the AMPS
119
the meaning and satisfaction derived from taking care of yourself
foundation for participation in other types of occupations
ADLS
Activities of Daily Living
120
2 types of ADLS
BADL nad IADL
121
Examples of BADL'S
Basic Activities of Daily Living
- eating
- dressing
- grooming
- toileting
- functional mobility
- communication
122
FIM= functional independence measure
WEEFIM= fim for children 6mos-7 years
measures used in assessing BADL'S
123
measures the severity of disability in terms of the need for assistance
used in rehabilitation settings
measure 18 items in 6 areas
1. Self-Care
2. Sphincter Control
3. Mobility
4. Locomotion
5. Communication
6. Social Cognition
Higher score= more independence
FIM
Functional Independence Measure
124
1: Motor Self-Care Based Tasks
2: Cognitive Self-Care Based Tasks
FIM and WEEFIM subscales
125
is the FIM a good test?
Yes
126
Examples of IADL's
Instrumental Activities of Daily Living
- managing money
-using phone
- taking medications
- travelling
- shopping
- preparing meals
- laundry
- housekeeping
127
KELS= Kohlmans Evaluation of Living Skills
measure used in assessing IADL's
128
assess IADL skills required for community living
can be used with adults of all ages
17 items address these areas
1. Self-Care
2. Safety and Health
3. Money Management
4. Community mobility and telephone
5. Employment and leisure participation
Higher score= less dependence
KELS
Kohlmans Evaluation of Living Skills
129
2 ADL measures
1. Diagnosis Specific
2. Generic
130
allows for comparison to be made between groups with different diagnoses
may not be as sensitive to particular problems associated with a specific diagnosis
Generic ADL Measures
131
Examples of Generic ADL Measures
FIM
KELS
Barthel Index
132
Items only address ADL skills that tend to be affected by that diagnosis and this may not be sensitive to change
cannon compare disability levels across diagnoses
Diagnosis -Specific ADL Measures
133
Example of Diagnosis -Specific ADL Measures
DASH
134
1: Observational Assessment
2: Self-Report
3: Proxy Report
4: Chart Review
Approaches to collecting ADL information
135
Pro: Accurate, detect unsafe methods, determine reason tasks can't be performed, guide intervention
Con: Time consuming, costly, inconsistent performance day-to-day, need specific environment, might need training
pros and cons of observational assessment
136
pro: easy, fast, inexpensive, good for screening, gets clients perspective
con: validity is controversial, doesn't capture what client is capable of
pros and cons of self-reporting
137
pro: easy, fast, inexpensive, allows for inclusion with range of clients
con: limited research, don't know how valid on an answer is being given
pros and cons of proxy reports
138
pro: easy and fast
con: depends on the quality and the sounds may not be included
pros and cons of chart reviewing
139
most ADL assessments ask the dame set of items for everyone which makes assumptions about "typical activities"
IADLS can be individualized
what a person does for ADLS is influenced by gender, culture, roles and environment
Psychometric and Clinical Issues of ADL measures
140
important to consider this if you are using an assessment for predictive measures
try to assess an environment as close to real environment if possible
generalizing to real-world setting in ADL measures
141
many current ADL scales are reflective of North American values of independence and individualism
construction and scoring don't often reflect different cultures
philosophical underpinnings in ADL measures
