#OTalk – 21st May 2019 – Why aren’t all occupational therapists using standardised assessments routinely in practice?

This week’s #OTalk is on the topic of using standardised assessments routinely in practice and will be hosted by Dr Alison Laver-Fawcett (@alisonlaverfaw) from York St John University and Professor Diane Cox (@dianecox61) in the UK.

Here’s what Alison and Diane had to say:

In the early 1990s, as part of her PhD studies, Alison undertook a small survey of occupational therapists to explore their use of standardised and unstandardised assessments with people with neurological diagnoses. Results (n = 29 OTs) indicated that 93% of OT respondents were using informal observation of ADL, rather than standardised assessment, to assess for perceptual deficits (Laver, 1994). Back then there were a limited number of assessments developed by occupational therapists to choose from, but nearly 30 years later many occupational therapists have been involved with the development and evaluation of standardised assessments and we have evidence of their reliability, validity, sensitivity and clinical usefulness. A look through Asher’s (2014) annotated index of occupational therapy assessment tools reveals that occupational therapists now have 100s of tests to choose from, many of which have been developed by occupational therapists. Yet standardised assessments do not appear to be routinely used in all areas of occupational therapy practice. Why is that?

But nearly 20 years later, a survey of 109 Irish occupational therapists (Stapleton and McBreaty, 2009) still found that “..the consistency of [standardised assessment’ use tended to be low. The barriers to a more consistent use of standardised assessments and outcome measures included time restraints, the unsuitability of the available measures and a lack of sensitivity of the available measures to capture the effectiveness of occupational therapy’ (p55).

Whilst, a much larger study of 794 occupational therapists in the USA (Piernik-Yoder and Beck, 2012, p97) found that paediatric occupational therapists used standardised assessments more than colleagues working with adult patients. They reported: ‘With regard to administrating of standardized assessments, 393 (49.5%) respondents reported that the most common modification they make is to administer portions of standardized assessments, whereas 221 (27.9%) indicated they modify the instruction when administering standardized measures. However, 106 (13.4%) respondents specified they administer standardized measures out of the age range for which the measure is intended, and 66 (8.3%) reported they modify test materials.’

Often students returning from placement report that OTs are using an assessment that has been developed ‘in house’ in the service to fit the particular needs of the client group and the service. Or students report a standardised assessment was being using but in a modified form. Why do some OTs need to modify standardised assessments to make them useful in practice?

The College of Occupational Therapists’ (2017) in their ‘Position Statement: Occupational therapists’ use of standardized outcome measures’ encourages the use of standardised measures and states that ‘without accruing data from such sources the evidence-base to support the value of occupational therapy will fail to grow and the profession will be challenged to produce the robust information that will be essential to support future commissioning of occupational therapy services’ (p1.). So why aren’t all occupational therapists using standardised assessments routinely in practice?

Whether you are an experienced researcher, a clinician or a student please join us  for this #OTalk twitter chat and share your ideas and experience.

Suggested talking points and discussion questions to focus our chat:

1. What standardised assessments do your use – why do you choose to use this / these assessments?
2. How often do you use standardised assessments in practice?
3. Do you use standardised assessments routinely/regularly in your practice? Why or why not?
4. Did you go on any training to learn to administer any of the standardised assessment
you use – what test was the training for and what did the training comprise?
5. Do you make modifications to standardised assessments? If yes, is this to the
instructions or to the materials or you use a portion of the assessment, or administer it but don’t use the scoring?
6. What are the barriers to implementing standardised assessments in practice?
7. What factors support you to use standardised assessments regularly in your
practice?

References:
Asher, I E. (2014) Asher’s Occupational Therapy Assessment Tools: An Annotated Index 4 th ed. Bethesda: American Occupational Therapy Association.

Laver, A J. (1994) The Development of the Structured Observational Test of Function (SOTOF) PhD Thesis. Guildford, University of Surrey.

Piernik-Yoder, P., Beck A (2012) The Use of Standardized Assessments in Occupational Therapy in the United State. Occupational Therapy in Health Care, 26(2–3):97–108.

Stapleton, T., McBreaty, C. (2009) Use of Standardised Assessments and Outcome Measures among a Sample of Irish Occupational Therapists Working with Adults with Physical Disabilities. British Journal of Occupational Therapists, 72 (2) 55-64. Available from: https://journals.sagepub.com/doi/10.1177/030802260907200203 [accessed
17.2.2019]

POST CHAT

Host: Dr Alison Laver-Fawcett (@alisonlaverfaw) and Professor Diane Cox (@dianecox61)

OTalk Support: Rachel @otrach

Online Transcript

#OTalk Transcript May 21st 2019

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