The Predictive Power of Narrative Data in Occupational Therapy Evaluation

OCT 1141H - Sept. 28, 2004. Additional Reading: The Predictive Power of Narrative Data in Occupational Therapy Evaluation Author: Simmons, D.C. et al. Source: The American Journal of Occupational Therapy Summary by: Nancy Mirza

Introduction  Few occupational therapy assessments include the environment or social role expectations of clients  OT’s may not have the necessary instruments to support a client-centered evaluation process  To establish a more client-centered approach, evaluations are needed that elicit narrative data to identify the valued occupations of individuals and to estimate the impact of illness or disability on these occupations  The Canadian Occupational Performance Measure (COMP) is one example of this type of instrument  Typical evaluation practices in settings for clients with physical disabilities focus mainly on performance component issues  For example, the Functional Independence Measure (FIM) is designed to identify the severity of disabilities  FIM scores are used to track client progress from initial evaluation to discharge  This data is used to predict discharge status based on the initial observation and score of the client  This prediction determines the estimated length of stay, directs the goals of rehabilitation, and assists in discharge planning  Accuracy is critical because so much is based on this prediction

Research Hypothesis  This study examined whether the addition of the COPM to the existing OT evaluation measures on a subacute nursing facility unit would increase the accuracy of the predictive FIM scores recorded by OT’s

Method  A prospective comparison design was used to determine the relations of two independent variables (FIM scores and FIM/COPM scores) to a dependent variable DFIM (FIM outcome prediction scores)  OT’s in a skilled nursing facility in the U.S. were used as participants  Participants were asked to record FIM predictive scores from the fist day observation, FIM/COPM scores from second day interview, and the final FIM discharge scores Results  Comparison statistics revealed a statistically significant difference between the standard FIM predictive score and the discharge FIM score  No statistically significant difference was found between the FIM/COPM predictive score and the discharge FIM score

Discussion  Use of a single evaluative instrument in therapy may limit the amount of relevant client data available to evaluate meaningful change  Findings of this study suggest that tools designed to capture client-relevant occupational roles enhance the accuracy of OT’s in predicting the functional level of clients at discharge  OT’s were more accurate in predicting the discharge status of clients when they used both the FIM and COPM evaluation methods  Accurate predictions are important in subacute settings since future client admissions are based on discharge predictions  OT’s are expected to predict how much service a client will require based on initial evaluation

Limitations  It cannot be inferred that the independent variables were the direct cause for changes in the dependent variable  The selection of a sample of convenience, and the fact that participants were all from the same facility makes the findings difficult to generalize  Characteristics of participating OT’s was not considered in data analysis

Conclusion  The use of the COPM is combination with the FIM enhances accuracy in prediction of outcomes for rehabilitation services for persons in adult physical disability settings