Barbara M. Doucet, Sharon A. Gutman; Quantifying Function: The Rest of the Measurement Story. Am J Occup Ther 2013;67(1):7-9. doi: 10.5014/ajot.2013.007096.
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We have wasted time and resources arguing over personal agendas that have split the profession.
Function must be defined and measured by discrete body impairments, activity limitations, and participation restrictions in accordance with the needs of the client and clinical setting and with the client’s stage of rehabilitation and readiness to address specific types of problems. Although the segregation of evaluation into top-down and bottom-up approaches has provided insight on the variety of occupational therapy clinical reasoning styles, it has not served the profession to promote one over the other when both are necessary.
To reimburse services, insurers want evidence that intervention facilitates progress in the performance of functional daily life activities that are meaningful to society. Occupational therapy assessments that focus on occupation-based terminology that is not readily understood by insurers and the larger society may not adequately demonstrate the profession’s value.
Client progress must be demonstrated through objective, measurable outcomes assessed by reliable and valid instruments. The continued reliance on unstandardized instruments to measure client outcomes does two things: (1) It reduces the credence and legitimacy of our practice in the eyes of insurers and colleagues, and (2) it fails to contribute to a database of client outcomes that can be used to support the effectiveness and cost- and time-efficiency of occupational therapy services.
The Fugl–Meyer Motor Assessment (Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975), a commonly used research instrument, can be used for clients with stroke to delineate movement patterns that are present or identify pathological reflex activity in the upper and lower extremities. Occupational therapists can use the upper-extremity subsection to quantify body impairment present and repeat the measure throughout the course of treatment to objectively measure progress.
The Functional Test for the Hemiplegic Upper Extremity (Wilson, Baker, & Craddock, 1984) and the Wolf Motor Function Test (Wolf et al., 2001) are two task-based measures that can provide quantifiable data on the ability of a person with stroke to perform simple daily tasks. These tools articulate specific activity limitations by having the client perform tasks such as inserting a pillow into a pillowcase, pouring water out of a pot, folding a towel, or holding a handled bag. These tools require approximately 30 min to administer and can provide essential, measurable data.
The Assessment of Motor and Process Skills (AMPS; Fisher & Bray Jones, 2010) is another task-based tool that provides objective scoring of the performance of everyday, familiar tasks. More than 100 tasks have been standardized for the AMPS, and the client performs two tasks of his or her choice. A certified rater scores motor components of the performance, such as the movement quality of the client, and process components, such as the ability to follow directions or recall the steps of the task. The AMPS has undergone extensive reliability and validity testing with a variety of populations and uses Rasch analysis to provide a total score that closely represents the client’s true performance on activities of daily living. The AMPS uses meaningful, occupation-based tasks and can be immensely effective in demonstrating whether our interventions translate to function.
The Canadian Occupational Performance Measure (COPM; Law et al., 1990) is specific to the discipline of occupational therapy and has a heavy focus on performance of daily life roles and activities. This measure not only assesses aspects of a person’s participation in daily activities but also, more important, can define the five most important tasks the client wishes to resume. A unique aspect of the COPM lies in its ability to identify the value that the client places on reengaging in those activities. With such data, we can begin to quantify participation.
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