Jan Sandqvist

Construct validity of the Assessment of Work Performance (AWP)

The instrument Assessment of Work Performance (AWP 1.1) can be used to assess an individuals skills during work performance - how efficient and appropriate a client performs a work task. The instrument is currently used by over 300 assessors working in a variety of work rehabilitation settings in Sweden, and it has been used with over 10,000 clients. In this study, the construct validity of the AWP 1.1 was tested with 364 assessments of clients with a variety of various work-related problems assessed by six occupational therapists in a Social Insurance Office in Sweden between 2004 and 2005. Principal Component Analysis shows construct validity of the AWP 1.1. Further, the findings indicate that the instrument is sensitive and discriminates between clients, and no gender related patterns were identified.

Gaze-based assistive technology in daily activities in children with severe physical impairments–An intervention study

ABSTRACT Objective: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents’ satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention. Methods: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1–15 years) participated in gaze-based AT intervention for 9–10 months, during which period the gaze-based AT was implemented in daily activities. Results: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents’ satisfaction with the AT and with services was high. Discussion: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Eye gaze performance for children with severe physical impairments using gaze-based assistive technology—A longitudinal study

ABSTRACT Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

Work environment impact scale: Testing the psychometric properties of the Swedish version

BACKGROUND The Work Environment Impact Scale (WEIS) is an assessment that focuses on the fit between a person and his or her work environment. It is based on Kielhofners Model of Human Occupation and designed to gather information on how clients experience their work environment. OBJECTIVE The aim of this study was to examine the psychometric properties of the Swedish version of the WEIS assessment instrument. METHOD In total, 95 ratings on the 17-item WEIS were obtained from a sample of clients with experience of sick leave due to different medical conditions. Rasch analysis was used to analyze the data. RESULTS Overall, the WEIS items together cohered to form a single construct of increasingly challenging work environmental factors. The hierarchical ordering of the items along the continuum followed a logical and expected pattern, and the participants were validly measured by the scale. The three occupational therapists serving as raters validly used the scale, but demonstrated a relatively high rater separation index, indicating differences in rater severity. CONCLUSION The findings provide evidence that the Swedish version of the WEIS is a psychometrically sound assessment across diagnoses and occupations, which can provide valuable information about experiences of work environment challenges.

Euro-Education: Employability for all (EEE4all) Design and implementation of an international course for future health-care professionals

BACKGROUND Employment is a priority in the European Union, and it is essential to address the needs of individuals disadvantaged at the labour market on grounds such as ethnicity, age, gender or disability, to increase the opportunities for these groups to gain employment. The Council of the European Union recognize the important role of national organisations in increasing gender equality and the need to integrate a gender perspective in all policies. Gender equality perspectives should also, according to the EU Plan of Action and Gender Equality be integrated in education. OBJECTIVES To equip students in higher education with knowledge, about gender, age, disability and ethnicity in relation to employability, a European group initiated a project; Euro-Education: Employability for all (EEE4all). APPROACH The project, funded by the European Lifelong Learning Programme, was aimed to develop and implement four course modules, each relating to employability with different focus: gender, age, disability or ethnicity. In this paper design, implementation, and evaluation of the course focused on gender, provided by the Occupational Therapy Programme at Linkoping University, is described. CONCLUSIONS The students highlighted the importance of awareness and knowledge about gender theory and its application in relation to employability and client-centred approach.

Evaluating the psychometric properties of a clinical vocational rehabilitation outcome measurement: The assessment of work performance (AWP)

This study examined the validity and reliability of the Assessment of Work Performance (AWP) using Rasch analysis. The AWP was administered to 365 clients with a variety of work-related problems. Rasch analysis and principal component analysis were used to examine the appropriateness of the rating scales and unidimensionality of AWP items. The person-response validity, internal consistency, targeting appropriateness, and differential item function were also analyzed. The Rasch analysis confirmed the 4-point rating scale, and the item set met the criteria of unidimensionality. The AWP exhibited satisfactory person-response validity and internal consistency. Among the three subdomains, the targeting of item-difficulty was sufficient in the motor skills and process skills subdomains. Differential item functioning was found across gender and diagnoses. This study presented evidence to support that the AWP functioned as a reliable and valid assessment in assessing work performance.

Initial evaluation of psychometric properties of a structured work task application for the Assessment of Work Performance in a constructed environment

Abstract Purpose: The Swedish Social Insurance Administration has developed a new assessment tool for sickness insurance. This study is a part of the initial evaluation of the application, called the Assessment of Work Performance, Structured Activities, and focuses on evaluation of the psychometric properties of social validity, content validity, and utility. Materials and methods: This was a qualitative study using semi-structured telephone interviews with occupational therapists. A convenience sample was used and participants who fulfilled inclusion criteria (n = 15) were interviewed. Data were analyzed using content analysis with a directed approach. Results: The results indicate that the application provides valuable information and that it is socially valid. Assessors found work tasks suitable for a diverse group of clients and reported that clients accepted the assessments. Improvements were suggested, for example, expanding the application with more work tasks. Conclusion: The instrument has benefits; however, further development is desired. The use of a constructed environment in assessments may be a necessary option to supplement a real environment. But depending on organizational factors such as time and other resources, the participants had different opportunities to do so. Further evaluations regarding ecological validity are essential to ensure that assessments are fair and realistic when using constructed environments. Implications for rehabilitation This study indicates that assessment in a constructed environment can provide a secure and protected context for clients being assessed. Psychometric evaluations are a never-ending process and this assessment instrument needs further development. However, this initial evaluation provides guidance in development of the instrument but also what studies to give priority to. It is important to evaluate social validity in order to ensure that clients and assessors perceive assessment methods fair and meaningful. In this study, participants found the work tasks appropriate and usable when assessing their clients but client’s perspective must also be included in following studies. This assessment instrument is the only activity-based assessment instrument within the Swedish Social Security Insurance. Psychometric evaluations are important since it affects so many individuals in Sweden.

Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context

Abstract Purpose: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists. Materials and methods: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis. Results: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to. Conclusions: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits. Implications for rehabilitation The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome. What is considered fair differs between assessing professionals and persons being assessed. Professionals may influence the perceptions of fairness through their way of communication. Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.

AB1248-HPR Work Ability in Patients with Polymyositis and Dermatomyositis: An Explorative and Descriptive Study

Background Polymyositis (PM) and dermatomyositis (DM) are characterized by muscle weakness which affects activity and participation. Work and leisure are the activities patients with PM/DM perceive as most limited. Previous studies addressing work in terms of how many are employed and degree of sick-leave. No study has investigated the self-rated work ability or how the work environment affects the ability to work in these patients. Objectives This study aimed to investigate the work situation, work ability, work-related risk factors, and influence of the physical and psycho-social work environment in patients with polymyositis (PM) and dermatomyositis (DM). Methods Patients with PM/DM were assessed using the Work Ability Index (WAI), and the Work Environment Impact Scale (WEIS). Results Forty-eight patients (PM n=25 and DM n=23) participated (women/men: 29/19) with a mean age of 54 years (range 28-67 years, SD.10) and mean disease duration of nine years (SD.9). Forty-four percent worked full-time, 31% part-time and 25% were on full-time sick leave. More than 50% self-rated work ability as “poor” or “less good”. Physically strenuous work components were present “quite to very often” in 23-79% and more in patients on sick leave ≥2 years. For those working, the interfering factors in the work environment concerned task and time demands. Supporting factors concerned meaning of work, interactions with co-workers and others. Self-rated work ability correlated moderately–highly positive with percentage of full-time employment, work-related risk factors and opportunities and constraints in the work environment. Conclusions Poor self-rated work ability is common in patients with PM/DM indicating a need to identify interfering risk factors and support patients to enhance work performance. Disclosure of Interest None declared

Evaluation of occupational performance and pain intensity: before and after back surgery and rehabilitation

Abstract Objective: The study had a descriptive, longitudinal design and evaluated occupational performance and pain intensity in daily occupations for patients with low back pain (LBP), assessed preoperatively, and at six and 12 months after surgery and rehabilitation. Methods: Patients were assessed by surgeons and occupational therapists (OTs) to determine whether surgery was required. The OTs used the Assessment of Pain and Occupational Performance (POP) instrument. The POP measures 36 occupations in two dimensions: occupational performance and pain intensity. Patients with specific LBP (n = 97) were included. Results: Preoperatively, 23 occupations showed lower performance and “severe pain”. At six months, 27 occupations were performed “without restriction” (p = n.s. - < 0.001) and without pain or with “mild pain” (p < 0.001). A comparison of preoperative values with those at 12 months showed that 35 occupations were significantly changed on both scales, and 31 occupations were performed “without restriction” (p < 0.01–< 0.001) and “without pain” (p < 0.001). Conclusions: The results indicate significant improvements between baseline, six months, and 12 months. Moreover, when occupational performance and pain intensity were separately identified, it was shown that patients had regained their performance at an ordinary level without pain. This underlines the added value of differentiating between disability and pain.