Principles of Assessment and Outcome Measurement for Occupational Therapists and Physiotherapists (eBook)

Alison Laver-Fawcett, PhD, OT(C)), DipCOT, SROT currently Modernisation Manager, Service Development (Provider Services) and Interim Professional Lead for Occupational Therapy, North Yorkshire and York Primary Care Trust.

Principles of Assessment and Outcome Measurement for Occupational Therapists and Physiotherapists 3
Contents 9
Contributors 15
Foreword Professor Jenny Butler 17
Preface 19
Acknowledgements 21
Introduction 25
Occupational Therapy and Physiotherapy 26
Labels Used for Providers and Recipients of Therapy Services 27
The Importance of the Selection and Application of Terminology in Practice 27
Definitions of Key Terms 28
Summary of Definitions 36
1 The Importance of Accurate Assessment and Outcome Measurement 39
Chapter Summary 40
Assessment as a Core Part of the Therapy Process 40
The Impact of Health and Social Care Policy on Assessment Practice 41
The Demand for Evidence-based Practice 42
So How Do You Track Down the Best Evidence? 44
Levels of Evidence and Grades of Recommendations 45
The Application of Standardised Assessments 46
The Use of Standardised Versus Non-standardised Assessments 47
Benefits of Applying Standardised Measures 49
The Requirement to Demonstrate Effectiveness 50
A Focus on Client-centred Practice 52
The Use of Standards, Protocols, Guidelines and Care Pathways 53
The Complexity of Assessment 56
The Nature of Therapeutic Practice 57
The Nature of Human Occupation and Occupational Performance 58
The Complexity of Measuring Human Function 60
The Influence of the Level of Task Demand 62
The Impact of Familiarity on Performance 63
The Influence of Environment on Performance 63
The Constraints of the Practice Setting 66
Conclusion 66
2 Methods of Assessment and Sources of Assessment Data 69
Chapter Summary 70
Methods of Data Collection 70
Introduction to Sources of Assessment Information 72
Self-report 72
Interviewing as a Means of Collecting Self-report Data 75
Communication, Insight and Capacity Issues 78
Cultural Issues and Self-report Data Collection 79
Examples of Self-report Assessments 80
Proxy Report 81
Examples of Assessments that Use Information from a Proxy 83
Measures that Assess the Proxy 84
Observational Assessment Methods 86
Examples of Observational Assessment 88
Combining Methods 89
Examples of How Therapists Combine Different Assessment Methods 89
Documentation 90
Confidentiality 93
Further reading 94
Case Study: ‘Scott’ 94
Reflecting on the Data-collection Methods You Use in Your Practice 113
Study Questions 113
3 Purposes of Assessment and Measurement 115
Chapter Summary 116
Timing of Assessment in the Therapy Process 116
Introduction to Purposes of Assessment 120
Descriptive Assessments 120
Discriminative Assessments 121
Predictive Assessments 123
Evaluative Assessment 124
Assessment for Particular Purposes 126
Sharing Your Purpose 136
Case Vignette: ‘Mr Smith’ 136
Service Evaluation 140
Case Study: Service Evaluation – The Memory Activity and Self Help Group 149
Reflecting on Purposes of Assessment in Your Own Practice 156
Study Questions 157
4 Levels of Measurement 159
Chapter Summary 160
What is Measurement? 160
What is Measurement Theory? 160
The Assignment of Numbers for the Purposes of Assessment 162
What are Levels of Measurement? 162
Nominal Scales 163
Ordinal Scales 164
Interval Scales 167
Ratio Scales 169
Application of Different Levels of Measurement 170
Guttman Scaling 173
Rasch Analysis 173
Applying Concepts of Levels of Measurement to Your Own Practice 174
Study Questions 174
5 Standardisation and Test Development 175
Chapter Summary 176
Standardised Assessments 176
Why Should Therapists Use Standardised Tests? 176
What is a Standardised Test? 177
What is an Un-standardised Assessment? 178
Standardisation 178
Test Construction Decisions 183
Criterion-referenced Tests 184
Norm-referenced Tests 185
Criteria for Judging Norms 186
Terminology Related to Norm-referenced Tests 187
Training and Interpreting Standardised Test Scores 191
Psychometric Properties 192
Worksheets 192
Study Questions 192
6 Validity and Clinical Utility 193
Chapter Summary 194
Definition of Validity 194
Content Validity 195
Construct Validity 197
Criterion-related Validity 201
Other Types of Validity 204
Establishing the Overall Validity of a Test 205
Face Validity 206
Clinical Utility 208
Examining Validity and Clinical Utility Issues: Test Examples 211
Applying Concepts of Validity to Your Own Practice 215
Study Questions 215
7 Reliability 217
Chapter Summary 218
Introducing the Concept of Reliability 218
Defining Reliability 218
Reliability Coefficients and Standard Error of Measurement 219
Standard Error of Measurement and Confidence Interval 220
Introduction to Types of Reliability 221
Test–retest Reliability 221
Inter-rater Reliability 222
Intra-rater Reliability 223
Rater Severity 223
Parallel Form Reliability (Equivalent or Alternate Form) 223
Internal Consistency 223
Methodological Issues 224
Test Specificity 225
Test Sensitivity 226
Floor and Ceiling Effects 228
Reliability Statistics 229
The Statistic Can Affect the Result 230
Comparing Statistical Methods for Evaluating Reliability 232
Examining Reliability Data: Test Examples 232
Conclusion 235
Applying Concepts of Reliability to Your Own Practice 235
Study Questions 236
8 Test Administration, Reporting and Recording 237
Chapter Summary 238
Step 1: Preparation for Testing 238
Step 2: Test Administration 243
Step 3: Scoring 248
Step 4: Analysis of Scores 248
Step 5: Interpreting Test Scores 248
Step 6: Decision-making in Light of the Interpretation of Test Scores 248
Step 7: Client Feedback About the Test Results and Implications 249
Step 8: Recording and Reporting Results 249
Case Study: James’s Assessment of Motor and Process Skills (AMPS) Report 252
Worksheet 256
Study Questions 256
9 Applying Models of Function to Therapy Assessment and Measurement 257
Chapter Summary 258
Why Use Models? 258
The Complexity of Human Function 259
General Systems Theory and the Hierarchy of Living Systems 260
International Classification of Impairments, Disabilities and Handicaps 264
Wade’s Four-level Model for People with Stroke 267
Five-level Model of Function and Dysfunction 268
International Classification of Functioning, Disability and Health 276
Applying the International Classification of Functioning, Disability and Health to Therapy Assessment 280
Top-down Versus Bottom-up Assessment Approach 285
Conclusion 287
Case Study: ‘Mary’ 287
Worksheets 303
Study Questions 304
10 The Importance of Clinical Reasoning and Reflective Practice in Effective Assessment 305
Chapter Summary 306
Clinical Reasoning as an Essential Component of Practice 306
Clinical Judgement and Clinical Reasoning 308
Scientific Reasoning 309
Diagnostic Reasoning and the Therapy Diagnosis 312
Problem-orientated Clinical Reasoning Process 315
Therapy Diagnosis 319
Introduction to Other Forms of Reasoning 323
Interactive Reasoning 323
Conditional Reasoning 324
Narrative Reasoning 324
Pragmatic Reasoning 327
Ethical Reasoning and Moral Reasoning 329
Reflective Practice 329
Reflective Practice as a Component of Continuing Professional Development 331
Cognitive Dissonance 334
Novice to Expert Continuum 338
Further Reading 341
Case Study: Mrs Ellis’ Initial Assessment Process 342
Worksheet 358
Study Questions 359
11 Implementing the Optimum Assessment and Measurement Approach 361
Chapter Summary 362
Improving Assessment and Measurement Practice: Where to Begin? 362
Improving Your Assessment Process 366
Selecting Tests 369
Test Critique 374
Obtaining Permission to Use a Test for Your Clinical Practice or for Research 384
Modifying a Standardised Test 384
Linking Improving Your Assessment Practice to Continuing Professional Development 384
Assessment and Outcome Measurement Goals for Effective Practice 385
Conclusion: Achieving an Effective and Efficient Assessment 388
Study Questions and Tasks 389
12 The Final Case Study ‘Carol’: Experience of a Chronic Pain Service 391
Introduction to the Therapists and the Chronic Pain Service 392
Standardised Measures Used in the Service 393
Introduction to the Case: ‘Carol’ 394
Referral 394
Initial Assessment 394
Multidisciplinary Team Half-day Clinic Assessment Process 396
Medical Assessment 397
Physiotherapy Assessment 397
Occupational Therapy Assessment 399
Multidisciplinary Team Meeting with Carol 403
Individual Treatment Sessions with the Physiotherapist 404
Individual Treatment Sessions with the Occupational Therapist 405
The Group Intervention Programme: Turnabout 406
Outcome Measurement and Discharge 409
First Follow-up Evaluation 409
Six-month Follow-up Evaluation 410
Service Review 411
Brief Answers to Study Questions 413
Worksheets 419
Glossary 443
List of Abbreviations 451
References 455
Index 479

"This book provides a comprehensive guide to the background,
rationale and utilization of assessment and outcome measurement. It
justifies the importance of taking a robust approach towards
outcome measurement, and contains sections on validity, reliability
and the often-overlooked aspect of clinical utility."
(Physiotherapy Journal, March 2010)

"...this is one book that I bought for myself as soon as it was
published." (British Journal of Occupational Therapy,
February 2008)

"This is a useful textbook for occupational therapists and
physiotherapists or those studying to become one." (Occupational
Health, March 2008)