Occupational Therapy Assessments for Older Adults 100
Instruments for Measuring Occupational Performance - 1st
Edition
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Dedication
This book is in many ways dedicated to all those who in their own way allowed for its creation, such as my parents,
family, and professors, since it is from them that I learned the essence of occupational therapy. Here, I must also acknowl-
edge that after completing this manuscript the development of a special appreciation for all of the authors and researchers
involved in the advancement of standardized testing, and although I feel a certain affinity with those who spend many
hours developing and proving the validity of an assessment, my discourse here is in no way contemporary with their
essential work.
Contents
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Section 1 Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living
(IADLs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1: Activities of Daily Living (ADL) Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2: Activities of Daily Living Questionnaire (ADLQ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Chapter 3: Australian Therapy Outcome Measures (AusTOMs)—Third Edition . . . . . . . . . . . . 7
Chapter 4: The Frenchay Activities Index (FAI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Chapter 5: Instrumental Activities of Daily Living (IADL) Profile . . . . . . . . . . . . . . . . . . . . . . . 12
Chapter 6: Lawton Instrumental Activities of Daily Living (IADL) Scale . . . . . . . . . . . . . . . . . 14
Chapter 7: Melbourne Low-Vision Activities of Daily Living Index (MLVAI) . . . . . . . . . . . . . . 16
Chapter 8: Performance Assessment of Self-Care Skills (PASS) . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Chapter 9: Self-Assessment Parkinson's Disease Disability Scale (SPDDS) . . . . . . . . . . . . . . . . . 21
Chapter 10: Texas Functional Living Scale (TFLS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Section II Basic Activities of Daily Living (B-ADLs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 11: The Barthel Index (BI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chapter 12: Functional Independence Measure (FIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chapter 13: Katz Index of Independence in Activities of Daily Living . . . . . . . . . . . . . . . . . . . . 34
Chapter 14: Modified Barthel Index (MBI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Section III Balance and Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 15: Berg Balance Scale (BBS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Chapter 16: Brunel Balance Assessment (BBA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Chapter 17: Community Balance and Mobility Scale (CB&M) . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Chapter 18: Dynamic Gait Index (DGI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Chapter 19: Rivermead Mobility Index (RMI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Chapter 20: Timed Up and Go Test (TUG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Chapter 21: Tinetti Falls Efficacy Scale (FES) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Section IV Caregiver Level of Burden . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Chapter 22: Caregiver Strain Index (CSI) and Modified Caregiver Strain Index (mCSI) . . . . 63
Chapter 23: Zarit Burden Interview (ZBI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Section V Cognitive Impairment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Chapter 24: Allen Cognitive Level Screen (ACLS). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 25: Functional Assessment Staging Scale (FAST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 26: Mini-Cog Exam/Clock Drawing Test (CDT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Chapter 27: Mini-Mental State Examination (MMSE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Chapter 28: Montreal Cognitive Assessment (MoCA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Chapter 29: Short Orientation-Memory-Concentration Test or Short Blessed Test (SBT) . . . . 81
viii Contents
Section VI Levels of Consciousness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Chapter 30: Glasgow Coma Scale (GCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Chapter 31: JFK Coma Recovery Scale-Revised (CRS-R) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Chapter 32: Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) . . . . . . . . . . 91
Chapter 33: Rancho Los Amigos Levels of Cognitive Functioning Scale (RLAS)—
Third Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Chapter 34: Wessex Head Injury Matrix (WHIM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Chapter 35: Western Neuro Sensory Stimulation Profile (WNSSP) . . . . . . . . . . . . . . . . . . . . . . . 97
Section VII Cerebrovascular Accident (CVA) and Parkinson's Disease Specific Assessment . . . . . . . .101
Chapter 36: Hoehn and Yahr Staging Scale of Parkinson's Disease (HY Scale) . . . . . . . . . . . . 103
Chapter 37: Modified Rankin Scale (MRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Chapter 38: Movement Disorder Society-Unified Parkinson's Disease Rating Scale
(MDS-UPDRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Chapter 39: National Institutes of Health Stroke Scale (NIHSS) . . . . . . . . . . . . . . . . . . . . . . . . 109
Chapter 40: Orpington Prognostic Scale (OPS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Chapter 41: Stroke Impact Scale (SIS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Section VIII Dexterity Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
Chapter 42: Box and Block Test (BBT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Chapter 43: Functional Dexterity Test (FDT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Chapter 44: Grooved Pegboard Test (GPT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Chapter 45: Minnesota Manual Dexterity Test (MMDT) and Minnesota Rate of
Manipulation Test (MRMT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Chapter 46: Nine Hole Peg Test (NHPT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Chapter 47: O'Connor Finger and Tweezer Dexterity Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Chapter 48: Purdue Pegboard Test (PPT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Section IX Driving Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Chapter 49: Adelaide Driving Self-Efficacy Scale (ADSES) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Chapter 50: Fitness to Drive Screening Measure (FTDS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Chapter 51: Performance Analysis of Driving Ability (P-Drive) . . . . . . . . . . . . . . . . . . . . . . . . . 143
Section X Executive Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
Chapter 52: Behavior Rating Inventory of Executive Function—Adult Version
(BRIEF-A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Chapter 53: Executive Function Performance Test (EFPT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Chapter 54: Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) I
and II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chapter 55: Perceive, Recall, Plan, and Perform System of Task Analysis (PRPP) . . . . . . . . . 155
Chapter 56: Trail Making Test (TMT). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Section XI Feeding and Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter 57: Edinburgh Feeding Evaluation Questionnaire (EdFED-Q) . . . . . . . . . . . . . . . . . . 165
Chapter 58: McGill Ingestive Skills Assessment (MISA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Chapter 59: Mini Nutritional Assessment—Short Form (MNA-SF) . . . . . . . . . . . . . . . . . . . . . 169
Chapter 60: Minimal-Eating Observation Form—Version II (MEOF-II) . . . . . . . . . . . . . . . . . 171
Contents ix
Section XII Memory Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Chapter 61: Rivermead Behavioural Memory Test (RBMT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Chapter 62: Wechsler Memory Scale—Fourth Edition (WMS-IV) . . . . . . . . . . . . . . . . . . . . . . 179
Section XIII Mental Health Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Chapter 63: Beck Anxiety Inventory (BAI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Chapter 64: Beck Depression Inventory-II (BDI-II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Chapter 65: Cornell Scale for Depression in Dementia (CSDD) . . . . . . . . . . . . . . . . . . . . . . . . . 189
Chapter 66: General Health Questionnaire (GHQ-12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Chapter 67: Geriatric Depression Scale—Short Form (sfGDS) . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Section XIV Motor Function—Global . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Chapter 68: Assessment of Motor and Process Skills (AMPS) . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Chapter 69: Chedoke-McMaster Stroke Assessment (CMSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Chapter 70: Fugl-Meyer Motor Assessment (FMA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204
Chapter 71: Motor Assessment Scale (MAS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Section XV Motor Function—Upper Extremity Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211
Chapter 72: Action Research Arm Test (ARAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Chapter 73: Arm Motor Ability Test (AMAT-9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Chapter 74: DASH (Disability of the Arm, Shoulder and Hand) Outcome Measure . . . . . . . 217
Chapter 75: Michigan Hand Outcomes Questionnaire (MHQ) . . . . . . . . . . . . . . . . . . . . . . . . . 219
Chapter 76: Motor Activity Log (MAL). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Chapter 77: QuickDASH (Disability of the Arm, Shoulder and Hand) Outcome
Measure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Chapter 78: Wolf Motor Function Test (WMFT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Section XVI Muscle Tone and Spasticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter 79: Modified Ashworth Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Chapter 80: Tardieu Scale of Spasticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Section XVII Occupational Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Chapter 81: Assessment of Life Habits (LIFE-H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Chapter 82: Canadian Occupational Performance Measure (COPM) . . . . . . . . . . . . . . . . . . . .242
Chapter 83: Functional Behavior Profile (FBP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .244
Chapter 84: In-Home Occupational Performance Evaluation (I-HOPE). . . . . . . . . . . . . . . . . .246
Chapter 85: Independent Living Scales (ILS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .248
Chapter 86: Kitchen Task Assessment (KTA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Chapter 87: Kohlman Evaluation of Living Skills (KELS)—Fourth Edition . . . . . . . . . . . . . . . 252
Chapter 88: Measure of the Quality of the Environment (MQE) . . . . . . . . . . . . . . . . . . . . . . . . 255
Chapter 89: Model of Human Occupation Screening Tool 2.0 (MOHOST) . . . . . . . . . . . . . . . 257
Section XVIII Pain Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Chapter 90: McGill Pain Questionnaire (MPQ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Chapter 91: Mini Suffering State Exam (MSSE). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Chapter 92: Pain Assessment Checklist for Seniors With Limited Ability to Communicate
(PACSLAC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
x Contents
Section XIX Quality of Life (QoL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Chapter 93: DEMQOL and DEMQOL-Proxy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Chapter 94: EQ-5D and EQ-VAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Chapter 95: Stroke Specific Quality of Life Scale (SS-QOL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Chapter 96: World Health Organization Quality of Life—Abbreviated Version
(WHOQOL-BREF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Section XX Vision and Visual Perceptual Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Chapter 97: Beery-Buktenica Developmental Test of Visual Motor Integration—Sixth Edition
(Beery VMI-6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Chapter 98: Developmental Test of Visual Perception—Adolescent and Adult
(DTVP-A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288
Chapter 99: Motor-Free Visual Perception Test—Third and Fourth Editions (MVPT-3
and 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Chapter 100: National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) . . . . 292
Chapter 101: Occupational Therapy Adult Perceptual Screening Test (OT-APST) . . . . . . . . . 295
Chapter 102: Ontario Society of Occupational Therapists Perceptual Evaluation
(OSOT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
Chapter 103: Rivermead Perceptual Assessment Battery (RPAB) . . . . . . . . . . . . . . . . . . . . . . . .300
Section XXI Work Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Chapter 104: Work Ability Index (WAI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Chapter 105: Worker Role Interview 10.0 (WRI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
Appendix: Applied Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Acknowledgments
Special thanks to Soo Borson, MD, Professor Emerita, University of Washington School of Medicine, Affiliate
Professor, University of Washington School of Nursing Dementia Care Tools—Research and Consulting; Suryakumar
Shah, PhD, OTD, MEd, OTR, FAOTA, Professor Emerita of Occupational Therapy, AT Still University, Mesa, Arizona;
and Roger Watson BSc, PhD, RN, FRSB, FFNMRCSI, FRSA, FHEA, FEANS, FRCP Edin, FRCN, FAAN, Professor of
Nursing, Faculty of Health & Social Care, The University of Hull, Hull, UK for their valuable feedback; Brien Cummings,
Acquisitions Editor and the SLACK Incorporated team for their help in bringing this project to fruition; and finally, Emily
Densten, Project Editor, editor of this work.
About the Author
Kevin Bortnick, OTD, OT/L is an occupational therapist, researcher, and author. He holds a clinical doctorate in
occupational therapy from the University of St. Augustine for Health Sciences in St. Augustine, Florida as well as a
master’s degree from Barry University in Miami Shores, Florida. Raised in Michigan, where he received his under-
graduate training in General Studies from the University of Michigan—Ann Arbor, he naturally enjoys the outdoors
and conservation. He is currently involved in neurocognitive disorder-related research and is working on his next book.
You can follow him on Facebook with the same name.
Introduction
The role of measurement is extremely important and much has been written about the potential benefits of outcome
measures, which are typically defined as tools used to document change in one or more constructs over time, help to
describe the client's problem, formulate a prognosis, as well as to evaluate the effects of occupational therapy intervention
(Jette, Halbert, Iverson, Miceli, & Shah, 2009; Law & Letts, 1989). They are used in research, program evaluation, quality
improvement, case management, and utilization review, as well as cost containment therapy practice. Additionally, many
such instruments have been developed for use for persons with particular conditions such as traumatic brain injury, stroke,
visual perceptual deficits and cognitive impairment, as well as disorders relating to the shoulder, arm, and hand (Jette et
al., 2009; Wedge et al., 2013). Outcome measures occupy a unique place in the therapeutic process; in particular, at the
beginning or evaluation phase as well as at the end when therapy outcomes are examined and decisions are made about
future interventions (American Occupational Therapy Association [AOTA], 2014). The Occupational Therapy Practice
Framework: Domain & Process, 3rd edition (AOTA, 2014), which is the guiding document of the occupational therapy
profession, discusses the use of outcome measures at length and uses the phrase outcome measure no less than 4 times,
standardized assessment once, and the word assessment in association with measurement over 10 times. The Framework
considers them to be essential to practice because they not only identify and measure client contexts and environments
but the activity demands and client factors that influence performance skills and performance patterns (AOTA, 2014). The
Framework also points out that quantitative assessment is the preferred method over qualitative or non-standardized when
available, because they are intrinsically designed to provide objective data about the supports and hindrances to perfor-
mance. However, it must be noted that each type can purvey unique information and both can aid in the development and
refinement of hypotheses about client occupational performance, their strengths and limitations, as well as assist in the
creation of goals to address desired outcomes (AOTA, 2014). Many adjectives are used that loosely describe the phenom-
enon of measurement such as scale, rating scale, or screen, which is a type of instrument designed to quickly determine if
further investigations are warranted and since the occupational therapist will encounter each in research and practice, the
following pages can help in that endeavor by providing an in-depth review of 100 instruments, which for the most part are
standardized; however, some non-standardized instruments and quick screens are explored as well, testifying to the fact
that measurement of client traits is a vibrant and dynamic field encompassing many perspectives. The book is organized
by function (i.e., what it is that is being measured, such as upper extremity motor function or driving ability), which is
in contrast to other possible arrangements like by condition, where major headings might have included cerebral palsy or
carpal tunnel syndrome or by clinical setting, where sections titled skilled nursing or out-patient rehabilitation would have
been created or finally, by type of scale such as self-report questionnaires and activity-based rating scales. Although each
taxonomy had its appeal, function seemed best able to account for all of the confounding variables relative to the possible
arrangement of 100 assessments. However, it must be noted that several (less than 7) did not fit neatly into the function
taxonomy such that they were condition specific and pertained to 3 conditions in particular: Parkinson’s disease (PD;
2 assessments) and stroke/cerebrovascular accident (CVA; 4 assessments), which were included as a single section titled,
"Cerebrovascular Accident and Parkinson’s Disease Specific Assessment" as well as one assessment that measures vision
related issues and was included in the section titled "Vision and Visual-Perceptual Assessment." This is not to say that
other outcome measures within the book should not be used with persons who have those conditions as a number of other
scales will still be applicable, such as the 10 or so items that measure activities of daily living or those that quantify motor
performance for persons with PD or CVA.
Many assessments were given consideration for inclusion but it was those that had a preponderance of evidence in sup-
port of their use including an amount of research, peer-reviewed citations, and general acceptance within the field of occu-
pational therapy that were included. Thus, the choices are narrowed with information presented to the reader in the form
of a classification system which may include anywhere from 2 to 10 assessments for each section. A several page discourse
per measure then discusses its various properties. The reader is then left to decide which assessment is best and for what
situation, which may include such considerations as the time needed to administer and score the measure; the need for
specialized equipment or training; the ease of obtaining a copy of the scale, such as its cost and copyright issues; its clinical
utility; and its psychometric properties, where aspects of validity and reliability as well as others are discussed (Potter et
al., 2014). Considering the amount and type of information purveyed, there are numerous scenarios where this book would
have value, such as the fast-paced clinical setting where there is little time to conduct a thorough review of the literature
let alone access a database to examine the evidence. At its most basic is the transactional relationship between client and
clinician, where according to Unsworth (2000), measuring outcomes involves two parts: demonstrating that client change
occurred (the ability to document change through some form of measurement) and attributing the change to therapeutic
intervention (therapy effectiveness). Therefore, when the clinician is able to demonstrate through, preferably standardized,
xvi Introduction
measurement that change is due to therapy and not spontaneous recovery or other factors, then therapy effectiveness has
been demonstrated. This has numerous ramifications of which the most notable may be for reimbursement.
Elements Included in the Review of Each Outcome Measure
The following are the elements included in the review of each measure:
Description: A brief record of the measure.
Psychometrics: A review of the level of research evidence that either supports or does not support the instrument,
including such items as inter-rater, intra-rater, and test-retest reliabilities, as well as internal consistencies and con-
struct validities among others.
Advantages: Synopsis of the benefits of using the measure over others including its unique attributes.
Disadvantages: A summary of its faults. For example, the amount of research evidence may be limited or the mea-
sure may be expensive.
Administration: Information regarding how to administer, score, and interpret results.
Permissions: How and where to procure the instrument, such as websites where it may be purchased or journal
articles or publications that may contain the scale.
Summary: A brief summation of important information.
Contact: Includes authors, organizations, and downloads.
The Role of Outcome Measures in Evidenced-Based Practice
The Centennial Vision (Hopper, 2010) of the occupational therapy profession outlines the need to advance competen-
cies in areas of research, theory, and evidenced-based practice (EBP) to better meet the occupational needs of weakened
populations. The utilization of EBP and outcome measures, in particular, are ways for clients to receive the best level of
care (Hooper, 2010; Lyon, Brown, & Tseng, 2011). EBP is becoming increasingly important and most would agree that it
is the procedure whereby the clinician incorporates the use of current, high quality empirical evidence, clinical expertise,
and patient values when making decisions and recommendations resulting in the presentation of the most appropriate and
efficient services to his or her clients. It requires the synthesis of information from different theoretical perspectives, the
creation and exchange of knowledge from sources such as colleagues and professors, as well as a necessary understand-
ing of the methods used to conduct needs assessments and to make appropriate recommendations based on their results.
Grounded in scientific method, it is a process that embraces (1) the development of clinical questions, (2) the assimilation
of the best available evidence in order to answer those questions, (3) a systematic and critical appraisal of the evidence,
(4) applying evidence to clinical problems, and lastly, (5) the evaluation and revision of the previous steps to identify
areas of change for future applications, signifying that knowledge is an uncertain and continuous process that requires
participation and continual revision, reflecting its temporary and historical nature (AOTA, 2010; Hooper, 2010; Upton,
Stephens, Williams, & Scurlock-Evans, 2014).
The incorporation of EBP into practice allows the clinician to remain up to date with health care trends and efficien-
cies, stay informed of current perspectives, and understand the methodologies for measuring individual, program, and
system outcomes that affect health, well-being, and participation (AOTA, 2010; Thomas & Law, 2013). EBP is also client
centered because it takes into account the various competing influences unique to the client and how they affect occupa-
tional performance, such as the client’s values, beliefs, spirituality, sense of efficacy, and the dynamic interactions between
the individual, family, community, and social systems. Working in specialized teams, a supportive environment, having
access to research that this book provides as well as holding an advanced degree or having professional autonomy tend
to support the use of EBP. Conversely, a lack of understanding about the reasons for involvement in research and poor
organization may inhibit its use. A 2013 survey of 473 occupational therapists that examined attitudes, skills, and behav-
iors toward EBP found that the majority of clinicians perceived EBP to be useful in daily practice and that it improved
client-centered care; however, findings also suggested that clinicians predominantly relied on their own clinical expertise
to guide clinical decision making, using clinical reasoning based on research evidence less than half of the time (Graham,
Robertson, & Anderson, 2013). Other results of that study found that it placed too much demand on workload as well as
the perception that there was insufficient relevant evidence available with the most cited perceived barriers to implement-
ing EBP being lack of time, lack of sufficient relevant research, and inadequate access to research literature, all issues
Introduction xvii
addressed by this book (Graham et al., 2013). Those results almost uniformly concurred with an earlier survey by Bennet
et al. (2003) that also found that respondents thought that lack of skills in locating research evidence, lack of computing
resources, lack of access to research literature as well as the perception that there was not enough evidence in occupational
therapy were significant factors that frequently affected its implementation into practice.
Factors Influencing the Incorporation of Evidence-Based Practice
The following factors influence the incorporation of EBP:
Support
Expands knowledge and furthers clinical reasoning
Effect on reimbursement
Team work (multidisciplinary)
Validation of the learned experience
Provides a rationale for treatment
Discussion of EBP viewpoints
Participation in EBP-related activities
Organizational support
Amount of available research
Professional autonomy
Access to research
Advanced degree
Influence of the facility/mandated use
Patient suitability
Best practice guidelines
Inhibit
Cost of continuing education/workshops
Perceptions of low research applicability
Poor research skills
Inability to interpret findings
Inability to translate research into practical use
Poor communication
Continually changing nature of evidence
Competing evidence
Complicated testing methodologies
Reliance on clinical experience
Lack of motivation
Could be considered unpaid work
Size of case load
Implementation of Evidence-Based Practice
The realization of EBP has become a priority for not only occupational therapy but also for health care professionals in
general, as changes in how health care is administered have occurred as a result of increasing costs, reduced staffing, man-
aged care systems, and shorter hospital stays, all of which have served to increase clinician and department accountability
(Lin, Murphy, & Robinson, 2010). As clinicians are under more pressure to justify their services, not including EBP in
xviii Introduction
results can affect reimbursement as well. One way for the practitioner to embrace EBP is to have readily available, relevant,
and concisely summarized information if it is to become integrated into practice, which, in many ways, is what this book
can help to accomplish. Furthermore, greater communication and collaboration among all stakeholders must occur as
there is evidence to suggest that knowledge translation requires multiple processes and coordinated efforts and everyone
from practitioners to employers have a role in increasing the transfer of knowledge into practice (Lin et al., 2010). du Toit
and Wilkinson (2011) propose a unique method for promoting EBP to counter the problems mentioned previously by sug-
gesting that EBP, in and of itself, be viewed as an occupation whereby it encourages the specific roles, values, and habits
associated with occupational therapy, which can facilitate its integration at all levels of the profession. By identifying EBP
as occupation, its engagement is done in order to fulfill the essential desire to learn something, satisfy curiosities and cre-
ativity, develop critical thinking abilities and improve one’s understanding of a topic as well as to answer clinical questions.
The culmination of EBP, within the academic and professional environment, supports the interpretation, internalization,
application, and generation of new research as well as the gathering of factual information from outcome measures (Isaak
& Hubert, 1999). EBP as occupation also allows individuals and systems to respond and perform consistently over time,
which creates opportunities to recognize the positive experiences while engaging in it and, more importantly, facilitates
the development of customs and traditions associated with a research culture and an enhanced occupational identity as
a composite sense of who one is and who one wishes to become as an occupational being, which is generated from one’s
history of occupational participation (Isaak & Hubert, 1999).
As the translation of research into practice can be a complex process, another framework for the reader to consider may
be implementation science (IS), which is the scientific study of methods to promote the systematic uptake of research find-
ings and other EBPs, like the use of outcome measures, into clinical practice in order to improve the quality and effective-
ness of health care (Clark, Park, & Burke, 2013). Understanding the barriers and facilitators that influence the successful
implementation of evidence is critical as there is research to suggest that 30% to 45% of patients receive a wide range of
professional programs and services that are not based on scientific evidence and 20% to 25% of that care is not needed
or may be potentially harmful (Center for Research in Implementation Science and Prevention [CRISP], 2016; Clark et
al., 2013). Since increasing the number of evidenced-based interventions that translate into practice can have a direct
and positive impact on public health, the steps needed for IS in general to be successful include problem recognition,
followed by the acquisition, incorporation, and evaluation of the responding innovation into practice (Craik & Rappolt,
2003). The Model of Research Utilization in Occupational Therapy by Craik and Rappolt (2003), which includes aspects
of Occupational Performance Process Model by Fearing et al. (1997) as well as Knott and Wildavsky’s (1980) Stages of
Knowledge Utilization, further enumerates the IS theory within the occupational therapy context by suggesting that first,
interactions between client and practitioner occur, followed by a period of reflection in which the practitioner considers
his or her skills and knowledge base to make informed decisions and actions regarding the client’s condition. If the answer
upon that reflection is no (i.e., unable to make informed decisions and actions), then the research utilization process
begins. This is a multi-stage event encompassing an acquisition stage where the search for and acquisition of research
evidence begins, which may include appropriate outcome measures to use, followed by the cognition stage, which entails
a critical analysis of that evidence. The next stage is called the effort stage where questions such as how the new evidence
applies to the client are answered as well as case applications contemplated. The final stage is the adoption stage where the
clinician hypothesizes occupational outcomes based on the new found evidence, which may also include consultation with
peers to gain further insight into how the gathered evidence may be used with this and other clients.
Both models discussed suggest that systemic modifications need to occur, which includes not only practitioners,
therapy departments, and organizations but also how research is conducted, because a key concept of the IS model is
that for an intervention or an outcome measure to work it must have reach and in order to have reach it must be able
to expedite the implementation process (CRISP, 2016). It must also be designed to possess real-world practicality and
be readily transferable to a wide range of practice settings. Similarly, outcome measures that are embedded within the
World Health Organization’s International Classification of Functioning, Disability, and Health (WHO-ICF) framework
are also desirable as there is an impetus for numerous health professions to adopt a universal view of the disablement
process through the continued development and acceptance of the world-wide taxonomy that the WHO-ICF espouses.
Conversely, interventions and outcome measures that are viewed as too intensive, demanding too much time or effort, and
not adequately packaged or manualized are less likely to be implemented (Clark et al., 2013). Finally, by moving away from
traditional models where research findings are generated in a laboratory-like setting and then transmitted to the clinician,
an open bi-directional relationship between researcher and practitioner can help to produce research that is relevant to
practice (Lencucha, Kothari, & Rouse, 2007). This is achieved through increased involvement in research by practitioners
and alludes to the realization of knowledge translation as the end product will take into account their unique practice
knowledge. The final concept of the researcher/practitioner model is the belief that as the practitioner once again has
clinical practice back at the forefront communities of knowing within the profession can develop as they work with others
Introduction xix
to support the interpersonal, cultural, and environmental factors that influence person-to-person knowledge sharing
with the conscious understanding that knowledge is both an empirical and social concept, embedded within community
(Lencucha et al., 2007).
TABLE I-1
Appraising the Evidence
Much of this book delivers fairly basic information where the reader will be able to make interpretations without
much consideration; however, the psychometrics section can be technical because the development and validation of an
assessment can be a rigorous scientific process, thus many research examples are given. Accounting for all of the possible
variables when examining the properties or validating the utility of an assessment can be difficult if not unattainable.
Therefore, the reader should consider the evidence presented as a whole and decide how best to internalize the informa-
tion as several methodologies might be considered. A study by Law and Letts (1989) suggests that the clinician consider six
critical review questions when deciding whether or not to use an outcome measure with the first being, what is the purpose
of the scale? As outcome measures are typically designed to quantify information for one of three purposes: description,
prediction, or evaluation. Second, is the scale clinically useful? This may include such considerations as its cost, time to
administer, acceptability, and in what format the measure is delivered. Then, is it a questionnaire completed by proxy or
through an interview or is it a performance-based rating scale? Next, is the instrument’s construction adequate? This
may entail an examination of item selection methodology, the level of measurement purveyed, or what type of scoring
paradigm is used. Fifth, is it standardized and if so what is the level of research pertaining to it? Finally, is the scale both
reliable and valid? Where reliability would be the estimate of the extent to which the instrument is measuring the true
difference between different constructs and may include several subtypes that as a whole will establish its reliability, such
as the level of its internal consistency, inter-rater and intra-rater reliability, and test-retest reliability, whereas validity could
be considered the degree to which an assessment measures what it is intended to measure.
