Academic journal article
By Bowyer, Patricia; Lee, Jenica; Kramer, Jessica; Taylor, Renee R.; Kielhofner, Gary
British Journal of Occupational Therapy , Vol. 75, No. 1
Assessment is a critical step in the occupational therapy process. Many judgements and decisions rely upon good assessment. Good assessment is critical to formulating a treatment plan (including goals and strategies of therapy) (Duncan and Hagedorn 2006), documenting therapy outcomes (Payne 2002) and determining clients' needs for services, entitlements to benefits and access to supports (American Occupational Therapy Association 2002, World Federation of Occupational Therapists 2004).
There has been an emphasis in the past few decades on the development of evidence-based occupational therapy assessments, especially those that reflect the field's unique focus on occupation. This involves using assessments that reflect a top-down perspective, or an integrative vision of the client that includes his or her strengths, motives, habits, skills and environmental influences (Kielhofner 2008). Additionally, endorsement of the field's unique focus on occupation involves using assessments that are occupation focused and theory informed (Kielhofner 2008).
Assessments that are occupation focused can generate a profile of clients that is global in nature. Occupation-focused assessments stand in contrast to assessments that focus solely on an impairment. Such assessments may be criticised for being reductionistic in that they produce a vision of a client that is limited to how far an extremity will move or to the strength of a particular extremity. A holistic, occupation-focused assessment provides a structured format for a practitioner to assess the overall abilities or difficulties that are having an impact upon a client's life participation. Finally, a focus on occupation requires that any assessment that is utilised has established evidence for use through psychometric development or outcomes research (Duncan and Hagedorn 2006, Kielhofner 2008).
Despite these efforts, the literature suggests that many occupational therapists are accustomed to using traditional bottom-up, impairment-oriented assessments that are not congruent with occupation-based theoretical models (National Board for Certification in Occupational Therapy [NBCOT] 2004). Moreover, some use home-grown assessments that lack evidence of
psychometric soundness (NBCOT 2004, Lee et al 2008). The literature identifies a number of reasons for the limited uptake of evidence-based occupational therapy assessments. One common barrier involves the resources available to practitioners to support assessment use. This includes lack of exposure to available assessments and related resources, limited time for administration, absence of ample training in assessment administration, and lack of managerial support (Strong et al 2004, Blenkiron 2005, Lee et al 2008).
Another barrier to using evidence-based, occupation-focused assessments may lie in the perceived usefulness of these kinds of assessments in practice. Practitioners indicate that the flexibility of assessment procedures and the extent to which an assessment can be individualised are important variables in deciding whether to use an assessment (Strong et al 2004, Blenkiron 2005). For example, practitioners have expressed a preference for non-standardised measures because they found them quicker, easier to use, and more relevant to client needs than their standardised counterparts (Blenkiron 2005).
Although it is common to consider barriers to the use of assessments in terms of practitioners' decision making, it is worth considering how the typical process of developing assessments might also be a barrier. Assessments are typically created by academics who have the research training to conduct necessary psychometric studies. The psychometric standards used to create evidence-based assessments emphasise statistical characteristics rather than the usefulness of an assessment within a clinical context. For example, Chung et al (2010) developed an assessment to assess quality of life after prostate cancer. …