Letter to the Editor
2
Australian Occupational TherapyJournal (1996) 43,3 1-32 Dear Editor, I would like to contribute to the debate on assessments used by occupational therapists, raised by Mastenbroek in the December issue of the Australian Occupational Ther- apy Journal (1995). The issues regarding the use of impairment focused assessments by occupational therapists have been dis- cussed at length and need to be resolved if the profession of occupational therapy is to continue. If we are the experts in human occupations, then we must clearly use assessments that reveal information about the occupa- tional performance of our clients. Occupational therapists are wasting their time, and threatening the future of the profession, by focusing on impairment assessments. It is no longer viable for occupa- tional therapists to use neuropsychological batteries and make inferences about the functional performance of our clients. Our professional knowledge has advanced to a stage when more appropriate methods of assessment are available. In order to know which type of assessments should be used in practice, occupational therapists need to have a sound understanding of occupational therapy philosophy and theory. Recent developments such as the Model of Human Occupation (Kielhofner, 1995), the Symposium on Measurement and Assessment (American Journal of Occupational Therapy, 1993), and the writings of Unsworth (1993) and Fisher (1992, 1992a, 1993), have deepened our knowledge base of occupational perfor- mance and how it should be assessed. Occupational thera- pists should be using assessments that objectively measure occupational performance and demonstrate clinical effectiveness. The Arnadottir Occupational Therapy Neurobehav- ioural Evaluation (A-ONE; Arnadottir, 1990) was an advance on pen and paper tests; however when used, it assesses impairments and occupational performance as related factors. I would suggest that a more recent assess- ment, the Assessment of Motor and Process Skills (AMPS) by Fisher (1992), demonstrates an effective method of assessing skills in the context of meaningful occupations, specifically domestic activities of daily living. This objective assessment is grounded in theory, is mean- ingful for the client and simultaneously measures skills and performance, and observable output of the human system. We now have an assessment of occupational per- formance that can be used to demonstrate the effect of occupational therapy interventions. As do all other objective tests, the AMPS has its limi- tations. Common complaints are that the AMPS assesses domestic and not personal activities of daily living (ADL), also that domestic ADL is not relevant for all clients. Obviously the AMPS is not applicable to all clients seen by occupational therapists, it is also not ‘the’ assessment that would make our task much easier. However, the AMPS does provide occupational therapists with an assessment of occupational performance that is unique. The opportunity to develop a better assessment always exists. The choice is ours. We can learn from our profession’s history and embrace the ‘emerging paradigm of occupa- tion’ (Kielhofner, 1992), or we can lapse into kircular debate. If we are to be regarded as experts in human occu- pation outside professional circles, we must use assess- ments that measure occupational performance. References American Occupational Therapy Association Inc. (1993). Special Issue: Critical issues in functional assessment. American Journal of Occupational Therapy, 47. American Occupational Therapy Association Inc. (1993). Special Issue: Alternative strategies for functional assessment. American Journal of Occupational Therapy, 47. Arnadottir, G. (1990). The brain and behaviour: Assessing cortical dysfunction through activities of daily living. St. Louis: C.V. Mosby Company. Fisher, A. (1993). The assessment of IADL motor skills: An application of many-faceted rasch analysis. Ameri- can Journal of Occupational Therapy, 47,319. Fisher, A. (1992). Assessment of Motor and Process Skills (research ed. 6.1) Unpublished test manual. Colorado
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Transcript of Letter to the Editor
Australian Occupational Therapy Journal (1996) 43,3 1-32
Dear Editor,
I would like to contribute to the debate on assessments used by occupational therapists, raised by Mastenbroek in the December issue of the Australian Occupational Ther- apy Journal (1995).
The issues regarding the use of impairment focused assessments by occupational therapists have been dis- cussed at length and need to be resolved if the profession of occupational therapy is to continue. If we are the experts in human occupations, then we must clearly use assessments that reveal information about the occupa- tional performance of our clients.
Occupational therapists are wasting their time, and threatening the future of the profession, by focusing on impairment assessments. It is no longer viable for occupa- tional therapists to use neuropsychological batteries and make inferences about the functional performance of our clients. Our professional knowledge has advanced to a stage when more appropriate methods of assessment are available.
In order to know which type of assessments should be used in practice, occupational therapists need to have a sound understanding of occupational therapy philosophy and theory. Recent developments such as the Model of Human Occupation (Kielhofner, 1995), the Symposium on Measurement and Assessment (American Journal of Occupational Therapy, 1993), and the writings of Unsworth (1993) and Fisher (1992, 1992a, 1993), have deepened our knowledge base of occupational perfor- mance and how it should be assessed. Occupational thera- pists should be using assessments that objectively measure occupational performance and demonstrate clinical effectiveness.
The Arnadottir Occupational Therapy Neurobehav- ioural Evaluation (A-ONE; Arnadottir, 1990) was an advance on pen and paper tests; however when used, it assesses impairments and occupational performance as related factors. I would suggest that a more recent assess- ment, the Assessment of Motor and Process Skills (AMPS) by Fisher (1992), demonstrates an effective method of assessing skills in the context of meaningful
occupations, specifically domestic activities of daily living. This objective assessment is grounded in theory, is mean- ingful for the client and simultaneously measures skills and performance, and observable output of the human system. We now have an assessment of occupational per- formance that can be used to demonstrate the effect of occupational therapy interventions.
As do all other objective tests, the AMPS has its limi- tations. Common complaints are that the AMPS assesses domestic and not personal activities of daily living (ADL), also that domestic ADL is not relevant for all clients. Obviously the AMPS is not applicable to all clients seen by occupational therapists, it is also not ‘the’ assessment that would make our task much easier. However, the AMPS does provide occupational therapists with an assessment of occupational performance that is unique. The opportunity to develop a better assessment always exists.
The choice is ours. We can learn from our profession’s history and embrace the ‘emerging paradigm of occupa- tion’ (Kielhofner, 1992), or we can lapse into kircular debate. If we are to be regarded as experts in human occu- pation outside professional circles, we must use assess- ments that measure occupational performance.
References American Occupational Therapy Association Inc. (1993).
Special Issue: Critical issues in functional assessment. American Journal of Occupational Therapy, 47.
American Occupational Therapy Association Inc. (1993). Special Issue: Alternative strategies for functional assessment. American Journal of Occupational Therapy, 47.
Arnadottir, G. (1990). The brain and behaviour: Assessing cortical dysfunction through activities of daily living. St. Louis: C.V. Mosby Company.
Fisher, A. (1993). The assessment of IADL motor skills: An application of many-faceted rasch analysis. Ameri- can Journal of Occupational Therapy, 47,319.
Fisher, A. (1992). Assessment of Motor and Process Skills (research ed. 6.1) Unpublished test manual. Colorado
32 Letters
State University, Occupational Therapy Department, Fort Collins, Colorado.
Fisher, A. (1992a). Functional Measures, Part 1: What is function, what should we measure, and how should we measure it? American Journal of Occupational Therapy, 46,183.
Kielhofner, G. (1995). A model of human occupation: Theory and application (2nd edn). Baltimore: Williams and Wilkins.
Kielhofner, G. (1992). Conceptual foundations of occupa- tional therapy. Philadelphia: F.A. Davis Company.
Unsworth, C. (1993). The concept of function. British Journal of Occupational Therapy, 56,287.
Mastenbrock, I. (1995 December) Letter to the editor. Australian Occupational Therapy Journal, 42, p. 177.
Gerard Kennedy Austin & Repatriation Medical Centre
Heidelberg, Victoria, Australia
