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Evidence-Based Practice - A critical discussion of occupational therapy practice with a focus on assessments

Essay 2008 23 Seiten

Didaktik - Englisch - Sonstiges


Table of contents

Section 1
Summarised Context and Client Details

Section 2
Critical discussion of occupational therapy practice
The FACE Overview Assessment
Client Example One: Mrs X.
Main focus of FACE.
Clinical Utility and Acceptability of FACE.
Validity and Reliability
Usefulness and Client-centredness
Interprofessional teamworking and the OT role
Informal Kitchen Assessment
Client Example Two: Mr. Y.
Focus of the informal kitchen assessment
Cinical Utility and Acceptability
Validity and Reliability
Usefulness and Client-centred practice
Interprofessional teamworking and the OT role

Section 3
References & Appendices

Section 1

Summarised Context and Client Details

This assignment maintains confidentially at all times, in accordance with the

Data Protection Act (1998)

Context Summary Sheet

Placement Setting

The team is based in an NHS teaching PCT. Practice takes place in the community and/or in the hospital gym or therapy rooms.

Overarching philosophy of care/NHS frameworks/standards

The overarching philosophy of care is based on the Social Model of Disability (Oliver 1983) and the empowerment of the client in enhancing his/her level of independence, which may consequently prevent hospital admission. A key paper used in this setting is theNSF for Older People(Department of Health 2001) particularly its second standard: client-centred care.

Client population & health needs (age range, ethnicity, service user profile)

The profile of a typical service user describes an adult experiencing a long-term neurological condition. Health needs vary but typically include the need for adaptive equipment in order to improve self-care skills.

Pattern and types of referrals to occupational therapy

The service accepts referrals from health or social care professionals for clients requiring greater than 12 weeks of therapy intervention. Clients with a progressive neurological condition who are known to the team can self refer. Incoming referrals (by letter, fax or phone call) are triaged according to the service criteria and client information. Referrals for OT are often in conjunction with referrals for other types of therapy.

Overarching models of practice/frames of reference/approaches

Models of practice, as well as frames of references (FOR), were not specified. Generic models mentioned in the context of the setting were the Personal Adaptation through Occupation Model (Reed and Sanderson 1992) and the Social Model of Disability (Oliver 1983). The team seemed to follow the rehabilitative, biomechanical and client-centred FOR as well as the compensatory, physical and client-centred approach (Seidel 2003; Parker 2006; Turner 2002).

OT specific assessments used in the setting (List)

- Assessment of Motor and Process Skills (AMPS)
- Bathing/kitchen/ADL assessments
- Assessment of use of public transport
- Assessment of use of equipment (e.g. hoist)

Generic assessments used in the setting (List)

- Functional Analysis of the Care Environment (FACE) Overview Assessment (initial assessment in this setting)
- Goal Attainment Scale (GAS)
- Manual Handling Risk Assessment Form
- 9 Hole Peg Test
- Berg Balance Score
- Barthel Index (BI)
- Assessment of mobility and transfers
- Jebsen Hand Function Test
- Rivermead Behavioural Memory Test (RMBT)
- Rivermead Perceptual Assessment Battery (RPAB)


Practice environment including OT team, typical timeframe for referral and assessment, recording & reporting of assessment data

The team is run by a Band 8b occupational therapist (OT). It consists of three to four Band 6 and 7 occupational therapists (OT), physiotherapists (PT) and speech and language therapist (SLT). It also employs a disability counsellor, rehabilitation assistants, a consultant for allied health professionals in neurological rehabilitation and an administrator.

Treatment is goal-orientated and not time-limited. Recording of the data is carried out in accordance with the Trust’s standards for clinical documentation using the SOAP format.

Typical OT interventions/treatments used in the setting; individual and/or group based (List)

- Provision of adaptations/adaptive equipment and usage training.
- Provision/fabrication of upper limb splints and some hand therapy.
- Practising functional tasks and mobility/transfer skills at home and/or during individual or group session in gym.
- Education on the client’s condition.
- Advice and guidance to client and caregivers on coping strategies, exercises, external support services etc.

Any precautions of contra-indications given the context and client group

Some aspects highlighted on the FACE form used as a generic single assessment tool do not fall into the range of each therapist’s specific responsibilities and were said to require special training.

Section 2

Critical discussion of occupational therapy practice

The assessment/measurement of occupational performance and its components


In the light of the ongoing discussion on the value of integrating reliable evidence into the clinical reasoning process of health care practitioners (Sacket et al., 1996; Taylor, M.C. 1997; Tickle-Degnen 2000) as well as on the importance of clarifying and pursuing a client-centred care approach within occupational therapy (OT) practice (College of Occupational Therapists 2005; Sumsion 2000) this paper presents a critical discussion on two occupational performance assessments that were commonly used by the community neurological rehabilitation team.

The discussion contains a critique on the Functional Analysis of the Care Environment (FACE) Overview Assessment and will refer to its use on a particular client. It will include two study reports: a New Zealand review and comparison of assessment tools (Martin & Martin 2003) and a technical review of assessment tools and consultations with stakeholders carried out by the Australian Institute for Primary Care (AIPC 2004). This will be followed by a short critique on an informal kitchen assessment that was used on a second client.

The definitions and structure of the following critical discussion will be largely based on the criteria suggested within Laver Fawcett’s (2002) framework. Furthermore the discussion will attempt to integrate an evaluation of the apparent level of consistency of the assessments with OT theory.



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Evidence-Based Practice Occupational Therapy Assessments



Titel: Evidence-Based Practice  -  A critical discussion of occupational therapy practice with a focus on assessments