Pamela Eakin

Assessments of Activities of Daily Living: A Critical Review

Occupational therapists are prolific creators and users of assessments. However, many of us accept an ‘assessment’ form at face value without really considering the reliability or validity of the assessment method. The use of unreliable assessments seriously diminishes the credibility of the profession. Unfortunately, testing assessments for reliability and validity is time consuming. Therefore, it is suggested that occupational therapists make use of the many published assessments, which already provide evidence of their reliability and validity.

Pressure mapping systems: reliability of pressure map interpretation

Background: Pressure mapping systems offer a new technology to assist with pressure care assessment. Data output from such systems can be presented in three forms: numerical data, a three-dimensional grid and a colour-coded pressure map. Objectives: To (1) investigate whether sole use of the pressure map was a reliable method of interpreting interface pressures when compared with use of the numerical data; (2) establish the inter and intra-rater reliability of using pressure maps to assess pressure and determine whether reliability depended upon system operator experience; and (3) examine whether reliability extended to the range of seating surfaces being tested. Design: A reliability study assessing the ranking of pressure maps recorded by the Force Sensing Array pressure mapping system. Setting: A university occupational therapy department and a community NHS trust. Subjects: Fifteen occupational therapists with experience in pressure mapping and 50 occupational therapy students with no practical experience of pressure mapping. Interventions: Two sets of pressure maps were pre-recorded with an able-bodied adult seated on a variety of surfaces, with maps on each individual surface recorded over a 20-minute period at 2-minute intervals. Subjects ranked both sets of maps in terms of ‘best to poorest’ distribution of pressure. Main outcome measures: Rank orders of (1) pressure maps; (2) average interface pressures (mmHg); (3) maximum interface pressures (mmHg). Results: The use of pressure maps to interpret interface pressures was a reliable method. Significant agreement existed within (p < 0.001) and between groups of operators and reliability extended over the range of seating surfaces tested. Conclusions: The practice of using pressure maps to interpret interface pressures in seating as opposed to using the associated numerical data can be supported. This was shown to be a reliable method of assessment by both experienced and less experienced operators across a range of seating surfaces.

Problems with Assessments of Activities of Daily Living

This is the second of two articles addressing the design and use of assessments of activities of daily living (ADL). The first article reviewed 15 published ADL assessments and evaluated their usefulness for occupational therapists together with any evidence for their reliability and validity. The importance of using standardised assessments was stressed. This second article explains what is meant by terms such as reliability, validity and operationalisation. It details the consequences of using assessments in which these terms are misunderstood or, even, totally absent.

College of Occupational Therapists: Research and Development Strategy

The role of research in occupational therapy has been widely debated over the last two years within the profession. The outcome has been the production, by the Research and Development Committee, of the Research and Development Strategy for the College of Occupational Therapists. The strategy addresses how the College of Occupational Therapists can help to support occupational therapists as research consumers, as participants in research and as proactive researchers.

The Definition of Disability

Occupational therapists are heavily involved in trying to solve the problems of disabled people and meet their long-term needs in the community. However, the efficacy of occupational therapists in solving these problems is related to the definitions of disability that they use. Being defined as disabled makes a person ‘eligible’ for the receipt of various resources. Viewed objectively, are the definitions used any help in resolving the problems of a disabled person in the community? This article implies that they may not be as helpful as occupational therapists think.

The Casson Memorial Lecture 1997: Shifting the Balance — Evidence-Based Practice

The Casson Memorial Lecture 1997, given on 27 June at the 21st Annual Conference of the College of Occupational Therapists, held at the University of Southampton.

The Community Dependency Index: A Standardised Assessment of Need and Occupational Therapy

Key elements of the Governments community care policy are the assessment of disabled peoples needs and the measurement of the outcome of any services provided. This article describes the development of a standardised assessment which could be used by community occupational therapists both to assess the level of need and to measure outcome in relation to occupational therapy.

Occupational Therapy in Stroke Rehabilitation: Implications of Research into Therapy Outcome

The results of research studies into the outcome of therapy in stroke rehabilitation were reviewed in the first article. It was found that research has not consistently supported current approaches to treatment. In this second article, the implications of the research for the practice of occupational therapy are outlined. In addition, the different perspectives of physiotherapy and occupational therapy in their approaches to the treatment of stroke patients are discussed.

The Barthel Index: Confidence Limits

Shah and Cooper, in their ‘Commentary’ (BJOT February 1993), state that ‘rehabilitation workers can feel confident in advocating the use of the BI, as modified by Shah et al in 1989, as the preferred measure of ADL’. The evidence they present in their commentary fails to support this assertion.

Shifting the Balance - Evidence-Based Practice

As the title of the lecture implies, a shift of emphasis is required in relation to the basis of occupational therapy practice. That is, the balance needs to shift from custom and practice therapy towards therapy that has been demonstrated as being effective and beneficial to the client or user of our services. It would be easy to suggest that evidence-based practice is hard to find because there has been relatively little research into occupational therapy. However, I think that we are probably making assumptions about the lack of evidence for what we do. Certainly I did, when I started work on my doctorate, in 1987, on the effectiveness of community occupational therapy services. At that time, I was still an occupational therapy practitioner, with 10 years’ experience. I began my research study with the assumption that activities of daily living (ADL) were so diverse that it was not possible actually to measure a client’s performance or improvement in this area. I had therefore assumed that there were no standardised measures of ADL available and, indeed, I had not come across any in my 10 years of practice up to that time. Out of necessity (I had to find some way of measuring change in my subjects’ performance), I carried out a literature search in the hope of finding suitable assessments to use in my study. To my surprise I found, in the medical literature, a great number of published assessments relating to ADL, particularly self-care assessments. Not only that, I discovered that self-care assessments were a very common method of measuring the outcome of medical services and rehabilitation programmes. The disappointing aspect to my discovery was that few, if any, of the authors of the published ADL assessments were occupational therapists (Eakin 1990). Given that there were, after all, so many assessments to choose from for my study, I embarked upon a critical review of the published assessments to decide which ones would best suit my purpose. The process of developing my critical skills led me into a new world of measurement theory, concepts of disability, political and economic strategies and perspectives on professional power. The outcome of all this was the realisation, and confirmation, that occupational therapy is flexible, open and adaptive in its approach and can, therefore, use evidence from a variety of disciplines to support and improve practice. Just because occupational therapy, per se, has not been specifically researched in any great depth so far, it does not mean that we cannot use evidence generated by other more research-active disciplines. The limited perspective of many health-related disciplines was noted by Streiner and Norman (1989) who stated that: