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Significance of Objective Assessments for Treatment Outcomes

publication date: Apr 26, 2017
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author/source: Terri Gorman OTR

Guest blog post by Terri Gorman, OTR

 

     “Are we ever going to do anything besides assess and evaluate patients when we get out into the real world and become occupational therapists?”

     More than 24 years ago this was a question that my college classmates and myself asked each other during study groups and breaks between classes as we were speculating why we were being instructed so much about assessments. Many of us felt somewhat overwhelmed at times, (and a bit discouraged) at the prospect of everything being based on assessment and evaluation.

     Prior to admission into the OT program we had been required to spend a great deal of time in various OT settings “shadowing” occupational therapists to fully understand the occupation. College OT programs were highly competitive with limited admissions for each class, and the program directors and interviewing professors wanted to make sure that the limited spots were not to be used up by a single soul that was not absolutely certain that this was the career for him/her. At the beginning of our OT class curriculum, some of us would share how it seemed that all we were learning was how to assess and evaluate with very little instruction or learning about treatment, and yet we had not observed that during our “shadowing/volunteering” days when we had decided that this was indeed the career for us. Oftentimes we would fret about the lack of treatment instruction, and whether we would know what to do for treatment.

     OT (occupational therapy) is a broad and nebulous field of study that serves all ages and backgrounds, and OT’s work in a variety of settings and situations. Clients are assessed and treated always in a holistic manner, and in individual and group settings. Throughout the lifespan, humans engage in “occupations” on a daily basis – meaningful everyday activities, and when there is any disruption in those daily occupations, OT may be of benefit. Occupational Therapy will celebrate 100 years since the profession began on March 15, 2017, a profession which was borne out of the need for rehabilitation of the mind, body & spirit of returning WW1 veterans with so many in need of rehabilitation for emotional, physical and spiritual disabilities.

     Even by the time of graduation, many of us were still questioning the heavy emphasis placed on assessment and evaluation and what seemed to be the lack of instruction and education for treatment. Many of us were still concerned about what we would do for treatment. Fast forward to today, and as I reflect on my career as an OT who has completed approximately 75 continuing education courses on multiple and varied subjects since my college graduation, and have also completed 10 Upledger International CranioSacral Therapy training courses, I realize that treatment without objective assessments and evaluations and subsequent outcomes are not standardized, reliable, valid or measurable.

     This leads me to technical definitions of standardized, reliable, valid and measurable. For an assessment to be standardized, it must be administered and scored in a predetermined, standard manner. There are two major kinds of standardized tests: aptitude tests and achievement tests. Standardized aptitude tests predict how well students (or takers of the tests/assessments) are likely to perform in some subsequent setting. Test reliability refers to the degree to which a test is consistent and stable in measuring what it is intended to measure. Most simply put, a test is reliable if it is consistent within itself and across time. Test validity is the extent to which a test (such as a chemical, physical or scholastic test) accurately measures what it is supposed to measure. Validity is generally considered the most important issue in psychological and educational testing because it concerns the meaning placed on test results. And lastly to define and delineate measurable outcomes versus “outcomes or goals,” one could state that goals are general, broad, often abstract statements of desired results. Measurable outcomes are more specific, narrow and express a benefit or “added value” that a client can demonstrate upon completion of a course of therapy treatment.

     Prior to being accepted into the clinical occupational therapy program I was required to take an introductory statistics course. Once again, I questioned the reasoning for this (as did many of my classmates) and believed it was yet another scheme for the university to glean more of my money by making me take unnecessary prerequisite courses just to pad the pockets of the college. I had heard the groans and moans of many students who had struggled and fought their way through this introductory course, and I could not imagine in my wildest dreams why an occupational therapist would need statistics. As it turned out, I had a delightful instructor who really made the course come alive and simplified (as much as statistics can be made easier) and I sailed through the course with a good grade and retaining my 3.96 GPA—which made me a happy camper and a supporter for statistics classes. But, at the end of the class I continued to lack understanding of how I would ever use statistics as an OT, particularly since I was focused on treatment of patients and how I was going to facilitate rehabilitation and not worry about topics like test reliability and all that research stuff. During the clinical OT program, I had a class on management where we did revisit statistical analyses and I was also required to complete and participate in several research projects, many of them as group projects as the university placed a heavy emphasis on cooperative learning. I am almost ashamed to admit that I still did not see what all the fuss was about evaluation, assessment and measurable outcomes.

     Suffice it to say that I now understand that a thorough evaluation that includes objective assessments serves several purposes to any treatment plan (regardless of the type of therapy you are providing) including, but not limited to:

  1. Guides treatment—the area I have always been the most concerned about
  2. Establishes baselines for physiologic and/or functional levels to determine risk and subsequent need for therapy, measures the degree of disability, assesses disease progression and helps to establish goals
  3. Objective measures are used to analyze and demonstrate progress toward goals, determine needed changes to the plan of care and assess the need for continuation of therapy
  4. Creates a common language, enabling more effective communication with patients, physicians, other healthcare providers and payers
  5. Promotes best practices by serving as a benchmark at all levels in individual therapy clinics, departments, regional performance areas and national comparisons by providing a data bank for research.

 

Editor's note:

Terri's passion for incorporating measurements and assessments into the manual therapy setting is fantastic topic for any bodymindspirit practitioner to help bridge the gap between the art and science of clinical work. The Idea Crucible is pleased to be hosting Terri for the June Featured Article of the Month where she will begin diving deeper into the topic, including what objective measurements a bodymindspirit practitioner might use in private practice.

Please watch this space for her June Featured Article of the Month!