Validity and reliability of the Occupational Experience Profile.

BACKGROUND: This study was designed to evaluate the psychometric properties of a new tool, the Occupational Experience Profile (OEP). The OEP was designed to be used to evaluate people's levels of experiences of pleasure, productivity, restoration, and social connection during their occupational performances. AIM: To evaluate aspects of validity and reliability of the OEP Pleasure, Productivity, Restoration and Social connection scales. METHODS: Fifty-eight occupational therapy students each completed three OEPs. Many-faceted Rasch analyses were then used to examine rating scale structure, dimensionality, and reliability of each OEP scale. Pearson product moment correlations were used to evaluate the strength of the relationships among the four scales. RESULTS: Each of the four OEP rating scales demonstrated effective rating scale functioning. The OEP items on each scale demonstrated acceptable levels of item goodness of fit and worked together to define a unidimensional scale of occupational experiences. The four scales appear to measure different but interrelated constructs. CONCLUSION: The results provide preliminary evidence to support the validity and reliability of the OEP scales, but further research on larger and more diverse samples is recommended. SIGNIFICANCE: The OEP has the potential to be used in occupational therapy practice and research to evaluate how people experience their occupational performances.

Differential oxidative stress responses and tobacco-specific nitrosamine accumulation in two burley varieties.

Tobacco-specific nitrosamines (TSNAs) are carcinogens that accumulate in tobacco leaves during curing, storage, and processing, and their amounts in processed tobacco vary dependent on several intrinsic and extrinsic factors. Here, we assessed the hypothesis that there is a link between reactive oxygen species levels in leaves and TSNA formation during curing. First, we show that burley varieties KT 204LC and NCBH 129LC accumulate TSNAs to different levels but not as a result of a variety-specific abundance of TSNA precursors. Next, we measured the levels of reactive oxygen species, and we show that the variety that accumulates more TSNAs, NCBH 129LC, had significantly higher levels of hydrogen peroxide than KT 204LC. The NCBH 129LC also has more oxidatively damaged and glutathionylated proteins. Finally, we analyzed the antioxidant levels in KT 204LC and NCBH 129LC and their tolerance to oxidative stress. NCBH 129LC contained more of the essential antioxidant glutathione and was more tolerant to the oxidative stress-generating compound paraquat. Collectively, our data suggest that there is indeed a link between foliar oxidative stress parameters and the extent to which TSNAs accumulate in cured tobacco leaves.

Are the school version of the assessment of motor and process skills measures valid for German-speaking children?

BACKGROUND: There are no validated assessment tools for evaluating quality of schoolwork task performance of children living in German-speaking Europe (GSE). OBJECTIVE: To determine whether the international age-normative means of the School Version of the Assessment of Motor and Process Skills (School AMPS) are valid for use in GSE. METHODS: The participants were 159 typically-developing children, 3-12 years, from GSE. We examined the proportions of School AMPS measures falling within ±2 standard deviation (SD) of the international age-normative means, and evaluated for significant group differences (p < 0.05) in mean School AMPS measures between the GSE sample and the international age-normative sample using one-sample Z tests. When significant mean differences were found, we evaluated if the differences were clinically meaningful. RESULTS: At least 95% of the GSE School AMPS measures fell within ±2 SD of the international age-normative means for the School AMPS. The only significant mean differences were for 6- (p < 0.01) and 8-year-olds (p = 0.02), and only the 6-year-old school process mean difference was clinically meaningful. CONCLUSIONS: Because the only identified clinically meaningful difference was associated with likely scoring error of one rater, the international age-normative means of the School AMPS appear to be valid for use with children in GSE.

Constructing an Outcome Measure of Occupational Experience: An Application of Rasch Measurement Methods.

Rasch methods were used to evaluate and further develop the Daily Experiences of Pleasure, Productivity, and Restoration Profile (PPR Profile) into a health outcome measure of occupational experience. Analyses of 263 participant PPR Profiles focused on rating scale structure, dimensionality, and reliability. All rating scale categories increased with the intended meaning of the scales, but only 20 of the 21 category measures fit the Rasch rating scale model (RRSM). Several items also did not fit the RRSM and results of residual principal components analyses suggested possible second dimensions in each scale. More importantly, reliability coefficients were very low and participants could not be separated into more than one group as demonstrated by low person separation indices. The authors offer several recommendations for the next steps in the development of the PPR Profile as a health outcome measure of occupational experience.

Evaluating domains of everyday functioning in people with developmental disabilities.

OBJECTIVE: To examine the relationship among (a) quality of activities of daily living (ADL) task performance, (b) quality of social interaction, and (c) the extent of discrepancy between the person's and the occupational therapist's perspectives; and explore patterns of strengths and challenges among people with developmental disabilities (DD). METHODS: Fifty-eight adults with different types of DD, living in northern Sweden, were evaluated using the Assessment of Motor and Process Skills (AMPS), the Evaluation of Social Interaction (ESI) and the Assessment of Compared Qualities - Occupational Performance (ACQ-OP) and Assessment of Compared Qualities - Social Interaction (ACQ-SI). The relationships among assessments were analysed using Pearson correlation analyses. Cluster analysis was used to group participants based on their evaluation results. Results The quality of ADL task performance and the quality of social interaction demonstrated weak to moderate positive relationships while the ACQ-OP and ACQ-SI demonstrated a strong positive relationship. The cluster analysis resulted in identifying three distinct groups that differed significantly from one another. CONCLUSION: The findings support the clinical use of multiple assessment tools, including observation and self-report, to evaluate different aspects of occupational performance. Comprehensive and relevant evaluation supports collaborative goal setting and intervention planning.

Is it possible to develop a cross-country test of social interaction?

OBJECTIVE: The Evaluation of Social Interaction (ESI) is used in Asia, Australia, North America and Europe. What is considered to be appropriate social interaction, however, differs amongst countries. If social interaction varies, the relative difficulty of the ESI items and types of social exchange also could vary, resulting in differential item functioning (DIF) and test bias in the form of differential test functioning (DTF). Yet, because the ESI scoring criteria are designed to account for culture, the ESI should be free of DIF and DTF. The purpose, therefore, was to determine whether the ESI demonstrates DIF or DTF related to country. METHODS: A retrospective, descriptive, cross-sectional study of 9811 participants 2-102 years, 55% female, from 12 countries was conducted using many-facet Rasch analyses. DIF analyses compared paired item and social exchange type values by country against a critical effect size (±0.55 logit). DTF analyses compared paired ESI measures by country to 95% confidence intervals. RESULTS: All paired social exchange types and 98.3% of paired items differed by less than ±0.55 logit. All persons fell within 95% confidence intervals. CONCLUSIONS: Minimal DIF resulted in no test bias, supporting the cross-country validity of the ESI.

Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention.

BACKGROUND: Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials. AIM: To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT. MATERIAL AND METHODS: A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories. RESULTS: Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design. CONCLUSION: The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.

Occupation-centred, occupation-based, occupation-focused: same, same or different? Previously published in Scandinavian Journal of Occupational Therapy 2013; 20: 162-173.

BACKGROUND: Since the beginning of the occupational therapy profession, engagement in occupation has been valued as the primary therapeutic agent as well as the goal of intervention. While there are few today who would not support this idea, occupational therapists continue to struggle with implementing their beliefs through "what we do" and "how we do it". Contributing to this problem is their failure to use terminology in a manner that clearly defines what and how occupational therapists do what they do in occupational therapy research, education, and practice. METHODS: The author will, therefore, first discuss some key occupational therapy terms and propose that they represent an occupation-related taxonomy that can be used to more clearly define and describe for occupational therapists and others what they do and how they do what they do as occupational therapists. Then, with a goal of fostering critical self-reflection among occupational scientists and occupational therapy researchers, educators, and practitioners, the author will go through the stages of the occupational therapy process outlined in the Occupational Therapy Intervention Process Model (OTIPM) and demonstrate how a more precise use of this occupation-related taxonomy can facilitate maximizing the power of occupation in practice.

Occupation-focused interventions for well older people: an exploratory randomized controlled trial.

OBJECTIVE: The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions. METHODS: One hundred and seventy seven persons, 77-82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen's d, were calculated. RESULTS: While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small. CONCLUSIONS: The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.

Exploring perceptions of occupational competence among participants in Individual Placement and Support (IPS).

OBJECTIVE: The purpose of this study was to explore perceptions of occupational competence and occupational value among a group of clients engaged in Individual Placement and Support (IPS). METHODS: The Occupational Self-Assessment (OSA), based on the Model of Human Occupation, was used with 65 men and women with mental illness, and 45 of these completed the study. RESULTS: Rasch analyses showed that the participants perceived "Managing my finances", "Managing my basic needs", and "Doing activities I like" as the most valued occupations. Most competence was perceived in "Taking care of myself". Among the occupations where the participants perceived least competence, "Getting done what I need to do" and "Accomplishing what I set out to do" were the occupations that most stand out. Significant differences were also found between perceived competence and value in most of the occupations. CONCLUSIONS: Beyond those occupations valued as most important among the participants, it is essential also to pay attention to those in which they perceived least competence, as they are important for being able to achieve a desired occupation. Support related to perceptions of occupational competence can contribute to enabling clients in IPS to master a desired working life.

Detecting differences in activities of daily living between children with and without mild disabilities.

OBJECTIVE: We evaluated whether the Assessment of Motor and Process Skills (AMPS) measures are valid for detecting differences in activities of daily living (ADL) ability among children with and without mild disabilities. METHOD: Retrospective data from the AMPS database were analyzed using many-facet Rasch analyses and forced regression analyses to evaluate for significant group differences. RESULTS: Regression analyses of data for 10,998 children ages 4-15 who met the inclusion criteria revealed significant Age × Group interaction effects (B ≥ 0.23, T ≥ 6.20, p ≤ .001). Post hoc t tests revealed significant group differences in ADL ability at all ages beyond age 4. ADL process ability effect sizes were moderate to large at all ages, and ADL motor ability was mostly moderate to large at ages 6 or older. CONCLUSION: These findings support the validity of the AMPS measures when used to identify ADL problems among children with mild disabilities.

Occupation-centred, occupation-based, occupation-focused: same, same or different?

BACKGROUND: Since the beginning of the occupational therapy profession, engagement in occupation has been valued as the primary therapeutic agent as well as the goal of intervention. While there are few today who would not support this idea, occupational therapists continue to struggle with implementing their beliefs through "what we do" and "how we do it". Contributing to this problem is their failure to use terminology in a manner that clearly defines what and how occupational therapists do what they do in occupational therapy research, education, and practice. METHODS: The author will, therefore, first discuss some key occupational therapy terms and propose that they represent an occupation-related taxonomy that can be used to more clearly define and describe for occupational therapists and others what they do and how they do what they do as occupational therapists. Then, with a goal of fostering critical self-reflection among occupational scientists and occupational therapy researchers, educators, and practitioners, the author will go through the stages of the occupational therapy process outlined in the Occupational Therapy Intervention Process Model (OTIPM) and demonstrate how a more precise use of this occupation-related taxonomy can facilitate maximizing the power of occupation in practice.

Sensitivity of the evaluation of social interaction measures among people with and without neurologic or psychiatric disorders.

OBJECTIVE: To determine whether the Evaluation of Social Interaction (ESI) is sensitive enough to differentiate between people without identified diagnoses and those with neurologic or psychiatric disorders in terms of their observed quality of social interaction. METHOD: Participants were age 16-69 and were without identified diagnoses (n = 304) or had neurologic (n = 77) or psychiatric (n = 104) disorders. They were evaluated using the ESI. RESULTS: Nonparametric Kruskal-Wallis tests and post hoc Mann-Whitney U tests revealed that the group without identified diagnoses had significantly better quality of social interaction than did either group with disabilities (Us = 3,172 and 3,189, respectively; p ≤ .001). CONCLUSION: The ESI is sensitive with regard to detecting differences in quality of social interaction among groups expected to differ, suggesting that it is valid for use when the desired purpose is to identify people with diminished quality of social interaction.

Cross-regional validity of the assessment of motor and process skills for use in middle Europe.

OBJECTIVE: To evaluate cross-regional validity of the Assessment of Motor and Process Skills (AMPS) with a specific focus on valid use with Middle Europeans. DESIGN: Descriptive cross-regional validation study. PARTICIPANTS: A total of 1346 participants from Middle Europe and 144,143 participants from North America, UK/Ireland, the Nordic Countries, other Europe, Australia/New Zealand and Asia, between the ages of 3 and 103 years, in good health and with a variety of diagnoses, were selected from the AMPS database. METHODS: Many-facet Rasch analysis was used to analyse participant raw data, and effect sizes were used to evaluate for differential item functioning. Evaluation for differential test functioning was also implemented. RESULTS: None of the 20 activity of daily living process items, and only one of the activity of daily living motor items demonstrated differential item functioning. The activity of daily living motor item Aligns exceeded the significant effect size criterion of ± 0.55 logit, but the significant differential item functioning did not lead to differential test functioning (i.e. all measures fell within the 95% confidence bands). CONCLUSION: This study provides further evidence of validity of the AMPS when used to evaluate quality of daily living performance across world regions. The AMPS measures can be used as objective indices of activity of daily living ability in rehabilitation settings and in international collaborative research related to activity of daily living task performance.

Neurobehavioral functions evaluated in naturalistic contexts: Rasch analysis of the A-ONE Neurobehavioral Impact Scale.

OBJECTIVE: The fact that different neurobehavioral impairments affect daily life task performance of clients with different neurological diagnoses currently restricts between-group comparisons in rehabilitation. The purpose of this study was to determine whether a single neurobehavioral impact scale could be constructed for use with different diagnostic groups. METHODS AND RESULTS: Rasch analysis of 422 clients (diagnosed with CVA and dementia) demonstrated that 29 of 55 items from the A-ONE Neurobehavioral Scale could be used to construct a short-form, Common Scale. CONCLUSIONS: While the use of different and longer diagnostic-specific scales versions may be more useful clinically, the short-form, Common Scale has the potential to be used in research focusing on comparison of groups. Further research will be needed to validate the common, short version.

Gender differences in quality of schoolwork task performance among typically developing students and students at risk of or with mild disabilities.

AIM: As no studies have examined for gender differences in quality of schoolwork task performance, the purpose of this study was to examine whether there is a gender difference in quality of schoolwork task performance among students at risk of or with mild disabilities, and to compare any identified differences to those that might exist among their typically developing peers. METHODS: The participants were 2510 students (typically developing = 412 girls, 422 boys; at risk = 147 girls, 379 boys; mild = 242 girls, 901 boys), 4-10 years of age. Schoolwork task performance was measured using the School Version of the Assessment of Motor and Process Skills (School AMPS). RESULTS: Regression analyses revealed no significant gender or age-by-gender interaction effects for any of the three groups (typically developing, at risk, mild). INTERPRETATION: The results, focused on occupational performance, complement prior research that has focused on examining for gender differences in behaviour, academic achievement, and coordination among students with mild disabilities. These results also suggest that current School AMPS normative values, based on combined gender means, are valid.

Reliability of the school AMPS measures.

AIM: The purpose of this study was to use a variety of methods to evaluate and cross-validate the reliability estimates of the quality of schoolwork performance measures in the School Version of the Assessment of Motor and Process Skills (School AMPS) (1). METHODS: Split-half reliability was estimated based on School AMPS data from 6 194 students who had performed at least two school AMPS tasks. Two different split-half methods were used: splitting the School AMPS items vertically and splitting them horizontally. The Rasch equivalent of Cronbach's alpha for the full School AMPS evaluation and standard error of measurement (SEm) were also considered. RESULTS: All three methods yielded high reliability coefficient estimates (r ≥ 0.70) and overall SEm was low. CONCLUSIONS: From a practice perspective, the results of this study are of clinical importance as they provide evidence that occupational therapists can have confidence in the consistency of the School AMPS measures when they are used in the process of making decisions about individual students, planning interventions, and later performing follow-up evaluations to measure the outcome.

Cross-regional validation of the School Version of the Assessment of Motor and Process Skills.

OBJECTIVE: The objective was to determine whether the School Version of the Assessment of Motor and Process Skills (School AMPS) is valid when used to evaluate students in different world regions. METHOD: Participants were 984 students, ages 3-13 yr, from North America, Australia and New Zealand, United Kingdom, and the Nordic countries, matched for age and diagnoses. We used FACETS many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant differential item functioning (DIF) and differential test functioning (DTF). RESULTS: Four School AMPS items demonstrated DIF but resulted in no DTF. CONCLUSION: This study provided support for occupational therapists using the School AMPS to evaluate students' quality of schoolwork task performances across regions because the School AMPS measures are free of bias associated with world region.

Difference in impact of neurobehavioural dysfunction on Activities of daily living performance between right and left hemispheric stroke.

OBJECTIVE: To explore whether persons with right- and left-sided cerebrovascular accidents differ significantly in mean impact of neurobehavioural impairments on ability to perform activities of daily living. DESIGN AND SUBJECTS: Retrospective study of data from 215 persons (103 right-sided, 112 left-sided cerebrovascular accident). The Activities of daily living-focused Occupation-based Neurobehavioral Evaluation was used to evaluate ability on an activities of daily living scale and the impact of neurobehavioural impairment on ability on another scale. METHODS: To control for possible differences in activities of daily living ability between groups, analysis of covariance, with activities of daily living ability as a covariate, was used to test for a significant difference in impact of neurobehavioural impairments on activities of daily living ability between groups. RESULTS: Expected moderate correlation (r = -0.57) was obtained between activities of daily living ability and neurobehavioural impact measures, and there was no difference in mean neurobehavioural impact measures between groups (F [1, 212] = 2.910, p = 0.090). CONCLUSION: This study is the first to explore directly the impact of neurobehavioural impairment on activities of daily living ability. While persons with right-sided and left-sided cerebrovascular accidents may differ in type of neurobehavioural impairments, direct evaluation of the impact of such impairments on activities of daily living ability reveals no difference between groups.