Assessments Used in Occupational Therapy

Practice: An Exploratory Study

Naser Mohammed Alotaibi, PhD, OT
Kathlyn Reed, PhD, OTR, FAOTA
Mohammed Shaban Nadar, PhD, OTR
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ABSTRACT. The purpose of this study was to explore the assessments

used in occupational therapy practice through identifying most com-
monly used assessments and the rationale for their use in different oc-
cupational therapy practice areas. The study utilized a nonprobability
convenience sample of 260 occupational therapy practitioners attending
the American Occupational Therapy Association’s annual conference.
For personal use only.

A descriptive survey research design was used for conducting this study.
The survey instrument addressed three major questions related to (a)
the area of practice, (b) the specific assessments used, and (c) reasons
for using the specific assessments. Descriptive statistics were utilized to
analyze the results. Results indicated most of the assessments used in
occupational therapy clinics target body structure and function. Assess-
ments were used due to their convenient availability in clinics, clinical

Naser Mohammed Alotaibi, PhD, OT, is Assistant Professor, Occupational Ther-

apy Department, Faculty of Allied Health Sciences, Health Sciences Center, Kuwait
University, Sulaibikhat, Kuwait.
Kathlyn Reed, PhD, OTR, FAOTA, is Associate Professor, Occupational Therapy
Department, Texas Woman’s University, Houston, Texas.
Mohammed Shaban Nadar, PhD, OTR, is Assistant Professor, Occupational Ther-
apy Department, Faculty of Allied Health Sciences, Health Sciences Center, Kuwait
University, Sulaibikhat, Kuwait.
Address correspondence to: Naser Mohammed Alotaibi, PhD, OT, Assistant Pro-
fessor, Occupational Therapy Department, Faculty of Allied Health Sciences, Health
Sciences Center, Kuwait University, P.O. Box 31470, Sulaibikhat, Kuwait 90805.
(E-mail: ot alotaibi@hsc.edu.kw).
Occupational Therapy in Health Care, Vol. 23(4), 2009
Available online at http://www.informaworld.com/OTHC


C 2009 by Informa Healthcare USA, Inc. All rights reserved.
302 doi: 10.3109/07380570903222583
 Alotaibi et al. 303

utility and standardization, client-centeredness, development by occupa-

tional therapists, being taught in school/fieldwork, and being satisfying to
insurance companies. Implications for occupational therapy education,
practice, and research are presented.

KEYWORDS. Assessment, occupation-based practice

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INTRODUCTION

Assessment is the first phase in rehabilitation by which health care

professionals collect baseline data from clients to determine their partic-
ular strengths and needs. Assessments are also essential to evaluate the
effectiveness of a particular treatment intervention with a specific client
population (Foto, 1998). In occupational therapy practice, the assessment
of clients is considered an integral part of the therapeutic process, as it
dictates the treatment intervention pertaining to the client’s specific goals
For personal use only.

based on assessed weaknesses and strengths. Assessments also provide

reliable outcome measures of occupational therapy services, which are
essential to support the competency and extension of the occupational
therapy services (Unsworth, 2000). In order for a therapist to utilize the
full benefits of an assessment, however, an appropriate assessment must
be matched with the appropriate client situation. Selecting the appropriate
assessment tool(s) as part of the clinical reasoning process plays a key role
in the clients’ treatment planning and implementation (Fleming, 1991).
Occupational therapy assessments should not only address impairment
level but also embrace a holistic focus on occupation (Christiansen, 1999;
Clark, 1993; Kielhofner, 2005; Wilcock, 2001; Wood, 1998). In congruence
with the International Classification of Functioning Disability and Health
(ICF), the main focus of occupational therapy assessments should also mea-
sure the client’s activity level and participation (World Health Organization,
2001). In addition, such assessments should be easy to administer, time
efficient, and easy to score (Scott, Unsworth, Fricke, & Taylor, 2006) as
well as incorporate sound psychometric properties (reliability, validity, and
responsiveness) which will contribute to evidence-based practice in occu-
pational therapy (Hayes, 2000; Tickle-Degnen, 2000). Finally, when select-
ing assessments to be used in occupational therapy practice, the population
suitability and the practice setting must be considered (Unsworth, 2000).
If one believes that theory guides clinical practice and shapes the ther-
apist’s decision-making process (Parham, 1987), critical understanding of
 304 OCCUPATIONAL THERAPY IN HEALTH CARE

the principles, beliefs, and concepts of theory contributes to the use of

appropriate assessments in the clinical environment. Thus, theory-driven
assessments are best used to identify the clients’ deficits and assess their
limitations and strengths in areas of occupational performance (Ikiugo
& Rosso, 2003; Lee, Taylor, Kielhofner, & Fisher, 2008). Additionally,
client-centered practice is considered a fundamental component of oc-
cupational therapy and should also be reflected in therapeutic assessment
and intervention. Therefore, when using occupational therapy assessments,
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occupational therapists are encouraged to target the clients’ own priorities

and center the treatment planning and intervention around those priorities
(American Occupational Therapy Association [AOTA], 2002; Kielhofner
& Forsyth, 2001) as well as base them on sound theoretical concepts.
In order to support best practice in occupational therapy, it is important
to identify the main assessments used in occupational therapy practice
and examine the rationale for their use. The purpose of this study was to
explore the assessment used in occupational therapy practice with the intent
to answer the following research questions: (1) What are the most common
assessments used in different occupational therapy areas of practice? (2)
For personal use only.

What are the reasons for using the occupational therapy assessments?

METHOD

Participants

The study used a nonprobability convenience sample of occupational

therapy practitioners attending the AOTA annual conference in Charlotte,
North Carolina. The researcher obtained an agreement letter from the
chair of AOTA’s annual conference committee, indicating approval for
conducting the study at the conference site. A convenience sample of
participants was voluntarily recruited upon their walk-ins to the Texas
Woman’s University booth located within the conference. The purpose of
the study was explained to the participants, and each participant gave an
informed consent to participate in the study. Inclusion criterion included
occupational therapy practitioners who were practicing at different clinical
occupational therapy practice settings. Occupational therapy educators,
researchers, and students were excluded from the study. The final sample
was comprised of 260 occupational therapy practitioners who voluntarily
participated by completing the survey.
 Alotaibi et al. 305

Study Design and Instrument

A descriptive survey research design was used for conducting this study.
Considering the busy environment of the AOTA conference and in order to
attract as many participants as possible to take part in the study, the survey
was intentionally made brief and quick to complete. The survey instru-
ment addressed three major questions related to (a) the area of practice,
(b) the specific assessments used, and (c) reasons for using the specific
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assessments.
Concerning the area of practice, participants were provided with a list
of different occupational therapy areas of practice and were instructed to
choose the predominant area that applied to them. Next, a list of 115 dif-
ferent occupational therapy assessments was provided to the participants
to choose from, and they were verbally instructed to choose more than one
practice area if applicable. The assessments were sorted alphabetical to al-
low easy localization of target assessments. The list of assessments used in
this study covers the major assessments utilized by occupational therapists
across all domains of occupational therapy practice areas. The list of assess-
For personal use only.

ments was assembled by reviewing major occupational therapy references

and by consulting experienced occupational therapy educators, followed
by forming a focus group of four experienced occupational therapists. Par-
ticipants then had to choose the reason(s) for utilizing those assessments.

Data Analysis

The survey results were analyzed using the Statistical Program for the
Social Sciences (SPSS, Version 16.0) software program. Descriptive statis-
tics were utilized to analyze the results. The primary analysis in the study
was used to identify the frequency and percentage of assessments used as
well as the reasons for their use in occupational therapy clinics.

RESULTS

Characteristics of Participants and Practice Areas/Settings

The average time taken to complete the survey was about 5 minutes. Of
the 300 surveys distributed, 274 were returned completed (response rate of
91.3%), out of which 260 surveys were considered for analysis and 14 were
excluded due to incomplete data. The only demographic characteristic in-
cluded in the survey was the state in which the participant was practicing,
 306 OCCUPATIONAL THERAPY IN HEALTH CARE

TABLE 1. Number of Respondents Per State of Practice of

Occupational Therapya

State No. State No.

California 2 North Carolina 2

Colorado 4 North Dakota 4
Delaware 4 Ohio 1
District of Columbia 3 Oklahoma 13
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Florida 2 Oregon 59
Hawaii 11 Pennsylvania 1
Idaho 12 South Carolina 8
Kansas 3 South Dakota 1
Kentucky 4 Utah 9
Louisiana 1 Virginia 1
Maryland 5 Washington 12
Michigan 3 Wisconsin 10
Mississippi 9 Wyoming 20
Missouri 5 Vermont 1
Montana 6 Virginia 19
Nebraska 3 Washington 3
For personal use only.

New Hampshire 1 West Virginia 3

New Mexico 1 Wisconsin 4
New York 1 Wyoming 1
a Total respondents = 252. (Eight respondents did not fill out their state of practice.)

incorporating the views of occupational therapy practitioners from differ-

ent regions of the United States. The study sampling was heterogeneous,
representing 38 different states (Table 1).
Respondents practiced in a variety of areas (Figure 1), with the highest
percentages of participants being in the practice areas of geriatrics (30.8%),
pediatrics (29.6%), and physical disability (27.3%) followed by hand ther-
apy (9.6%) and mental health (6.9%). The lowest percentages were in the
practice areas of industrial rehab (less than 1%) and community-based
therapy (1.5%). As for specific settings, the highest percentage of partici-
pants were in school system (15.8%), skilled nursing facility (15.4%), and
home health (10%) followed by both nursing home and early childhood in-
tervention (6.2%) and private practice (5.8%). The lowest percentage was
in the neonatal intensive care setting (2.3%). Due to the low number of par-
ticipants in the areas of industrial rehab and community practice, the data
for these practice areas were excluded from the analysis. The frequency
of assessments used in main practice areas is provided in Table 2. The
percentages of the top 10 assessments used in main occupational therapy
practice areas are provided in Table 3.
 Alotaibi et al. 307

FIGURE 1. Number of respondents per practice area/setting (N = 260).

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For personal use only.

Reasons for Using the Assessments in Occupational Therapy Clinics

Table 4 summarizes the reasons for using occupational therapy assess-

ments in main practice areas. The most frequent reason cited for using
assessments in most practice areas was availability of the assessment in
the occupational therapy setting (65.8%). In contrast, the least cited reason
for using assessments in the clinics was due to the new development of the
assessment (<2%). Overall, more than 35% of the participants in all prac-
tice areas supported the use of assessments due to their clinical utility such
as the ease of administration and scoring and time efficiency. Similarly,
almost the same percentage of participants indicated using assessments
due to their standardization (i.e., reliability and validity).
Over 20% participants reported using the assessments because of the
popularity of their use across similar settings, whereas less than 10%
of participants indicated that assessments were used because they were
recommended by other facilities. More than 10% of the participants docu-
mented that assessments were used in the clinics because they satisfy the
requirements of insurance companies for payment. The same percentage
of participants used assessments because they were theory driven. Ap-
proximately 30% of the participants reported “client centeredness” to have
contributed to their use of assessments in the clinics. Being developed
by occupational therapists (18.5%) and taught in school/fieldwork (16%)
were other two reasons for participants’ selection of assessments.
 308 OCCUPATIONAL THERAPY IN HEALTH CARE

TABLE 2. Frequency of Use of Assessments Used in Major Occupational

Therapy Practice Areas

Physical Mental Hand

Area of Practice Pediatrics Geriatrics Disability Health Therapy

Adolescent Role Assessment 1 1

Adolescent Role Profile 1 1
Aesthesiometer 2 2
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Allen Cognitive Levels (Allen Lacing Test) 30 18 13

Arnadottir OT-ADL Neurobehavioral 1
Evaluation (A-ONE)
Assessment of Communication and 4 2 4
Interaction Skills
Assessment of Living Skills and Resources 10 4 3
Assessment of Motor and Process Skills 4 10 8 4
Assessment of Occupational Functioning 9 3 3
Barth Time Construction 1 3
Bayley Scales of Infant Development 13
Behavioral Inattention Test 2 1
Beery–Buknetica Visual Motor Impairment 37 3 1 1
For personal use only.

Brain Injury Visual Assessment for Adults 3 6

(biVABA)
Box and Block Test 1 4 2
Bruininks–Oseretsky Test of Motor 51 2 7
Proficiency
COPM 8 15 18 7 5
Child Occupational Self-Assessment 4
Children’s Assessment of Participation 3
Children’s Handwriting Evaluation Scale 18
Client-Oriented Role Valuation 4 3 2
Clinical Observation of Motor and Postural 8 9 6 1
Skills
Cognitive Adaptive Skills Evaluation 8 3 2
Cognitive Assessment of Minnesota 3 5 1
Cognitive Performance Test 11 5 3
Community Integration Measure 1 1
Comprehensive Occupational Therapy 6 2 2
Evaluation (COTE)
Kid-COTE 1
Contextual Memory Test 1 2
Crawford Small Parts Test 1 2
Denver Developmental Screening Test 4 3
Developmental Hand Skills Evaluation 7
Developmental Test of Visual Perception–2 14 1 3
Disability of Arm, Shoulder, and Hand 4 4 1 4
Discriminator 1 2 3
Downey Hand Sensitivity Test 1 1
(Continued on next page)
 Alotaibi et al. 309

TABLE 2. Frequency of Use of Assessments Used in Major Occupational

Therapy Practice Areas (Continued)

Physical Mental Hand

Area of Practice Pediatrics Geriatrics Disability Health Therapy

Driving Rehabilitation 3 4 4
Dynamometer 14 38 37 2 18
Evaluation Tool of Children’s Hand Writing 18 1
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Functional Capacity Measure 3 9 1 2

Functional Dexterity Test 3 6 5 2 4
Functional Independence Measure 2 30 34 1 6
Goniometer 23 45 36 5 15
Grooved Peg Test 9 8 2 3
Hand Tool Test (Bennett) 2 2
Handwriting Without Tears 45 2 3
Hawaii Early Learning Profile 19 1
Home Environment Assessment Protocol 5 3 1
Home Falls and Accidents Screening Tool 9 3 2
Impact on Participation and Autonomy 2
Independent Living Scales 1 3 1 5
For personal use only.

Interest Check List 8 6 4 1

Jebsen–Taylor Hand Function Test 3 5 8 1 4
Kitchen Task Assessment 8 4 2
Klein–Bell ADL Test 2 1
Kohlman Evaluation of Living Skills 5 21 20 11 3
Leisure Satisfactory Questionnaire 1 1
Leisure Diagnostic Battery 2
Loewenstein Occupational Therapy 1 5 1 1
Cognitive Assessment (LOTCA)
LOTCA Geriatric (LOTCA-G) 5 2 1
Miller Assessment for Preschoolers 12
Minnesota Handwriting Assessment 7 1 1
Minnesota Rate of Manipulation Test 13 15 4
Moberg Picking Up Test 1 6 4
MOHO Screening Tool 4 3 5
Motor-Free Visual Perception Test–3 28 15 4 2
National Institute of Health Activity Record 1
Nine-Hole Peg Test 4 38 41 3 12
Occupational History 3 12 22 2 5
Occupational Performance History 7 4 1
Interview–II
Occupational Questionnaire 8 5 3 2
Occupational Role History 1 8 8 2
Occupational Self-Assessment 1 8 4 4
Occupational Therapy Psychosocial 1 1
Assessment of Learning (OT-PAL)
O’Conner Tweezer Test 2 4 1 3
Peabody Developmental Motor Scales 51 2
Pediatric Evaluation of Disability Index 8
(Continued on next page)
 310 OCCUPATIONAL THERAPY IN HEALTH CARE

TABLE 2. Frequency of Use of Assessments Used in Major Occupational

Therapy Practice Areas (Continued)

Physical Mental Hand

Area of Practice Pediatrics Geriatrics Disability Health Therapy

Pediatric Interest Profile 1

Pediatric Volitional Questionnaire
Pinch Meter 12 25 31 4 14
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Preschool Visual Motor Integration 7

Assessment
Purdue Pegboard Test 4 8 20 3 8
Rabideau Kitchen Evaluation
Reintegration to Normal Living Index 1
Role Activity Performance Scale 2 1
Role Change Assessment
Role Check List 1 6 5 6 2
Rolyan Stereognosis Test 3 3 1
Routine Task Inventory 6 2 3
Safety Assessment of Function and the 5 1
Environment for Rehabilitation
For personal use only.

Safety and Functional ADL Evaluation 5 3 2

(SAFE)
School Function Assessment 15
School Setting Interview 2
Semmes–Weinstein Monofilaments 11 16 9
Sensory Integration Praxis Test 19
Sensory Profile 53 1 6 4
Shore Handwriting Screening 2
Stress Management Questionnaire 2 1 1
Test of Gross Motor Development 3 2
Test of Legible and Writing 2
Test of Visual Motor Skills–Revised 27 3 2 1
(TVMS-R)
TVMS–Upper Level (TVMS-UL) 9 1 1 1 1
Test of Visual Perceptual Skills 28 3 3
(Non-Motor)–Revised (TVPS(n-m) R)
T VPS (n-m)(UL)R 7 1 1
Tolgia Category Assessment 1 1
Touch-Test Sensory Evaluators 2 1 1
Valpar Component Work Samples 1 5 1 2
Vancouver Scar Assessment 1
Volitional Questionnaire 1 1
Volumeters 6 12 6
Weinstein Enhanced Sensory Test 3 5
Wepman’s Auditory Discrimination Test
Westmead Home Safety Test
Work Environment Impact Scale 1
Worker Role Inventory 3 2 1

TABLE 3. Percentages of Top 10 Assessments Used in Main Occupational Therapy Practice Areas
Geriatrics
Goniometer (56.3%)
Dynamometer (47.5%)
Nine-Hole Peg Test (47.5%)
Pinch Meter (31.3%)
Allen Cognitive Levels
(37.5%),
Functional Independence
Measure (37.5%)
Kohlman Evaluation of Living
Skills (26.3%)
COPM (18.8%)
Motor-Free Visual
Perception Test–3 (18.8%)
Minnesota Rate of
Manipulation Test (16.3%)
311
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Pediatrics
Sensory Profile (68.8%)
Bruininks–Oseretsky Test of
Motor Proficiency (66.2%)
Peabody Developmental Motor
Scales (66.2%)
Handwriting Without Tears
(58.4%)
BeEry–Buktenica VMI (48.1%)
Motor-Free Visual Perception
Test-3 (36.4%)
TVPS(n-m)R (36.4%)
TVMS-R (35.1%)
Goniometer (29.9%)
Hawaii Early Learning Profile
(24.7%)
For personal use only.
Physical Disability
Nine-Hole Peg Test (57.7%)
Dynamometer (52.1%)
Goniometer (50.7%)
Functional Independence
Measure (47.9%)
Pinch Meter (43.7%)
Occupational History (31%)
Kohlman Evaluation of Living
Skills (28.2%)
Purdue Pegboard Test
(28.2%)
Allen Cognitive Levels
(25.4%)
COPM (25.4%)
Hand Therapy Mental Health
Dynamometer (72%) Allen Cognitive Levels
(72.2%)
Goniometer (60%) Kohlman Evaluation of Living
Skills (61.1%)
Pinch meter (56%) COPM (38.9%)
Nine-Hole Peg Test (48%) Role Check List (33.3.%)
Semmes–Weinstein Independent Living Skills
Monofilaments (36%) (27.8%)
Purdue Pegboard Test (32%) MOHO Screening Tool
(27.8%)
Functional Independence Assessment of
Measure (24%) Communication and
Interaction Skills (22.2%)
Volumeter (24%) Assessment of Motor and
Process Skills (22.2%)
COPM (20%) Interest Check List (22.2%)
Handwriting Without Tears Occupational History
(20%) (22.2%)
 312 OCCUPATIONAL THERAPY IN HEALTH CARE

TABLE 4. Reasons for Using a Specific Assessment in Occupational Therapy

Clinics

Areas of Practice
Rationale for
the use of Physical Mental Hand
specific assessments Geriatrics Pediatrics Disability Health Therapy

Available in the setting 71.3% 71.4% 69% 33.3% 84%

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Used in school/fieldwork 18.8% 32.5% 15.5% 5.6% 8%

Developed by occupational 17.5% 15.6% 15.5% 27.8% 16%
therapist
Standardized 30% 49.3% 32.4% 33.3% 60%
Follows a specific frame of 15% 11.7% 8.5% 16.7% 4%
reference
Easily administered 45% 41.6% 60.6% 44.4% 44%
Easily scored 40% 39% 46.5% 27.8% 48%
Time efficient 41.3% 33.8% 52.1% 44.4% 32%
Satisfies insurance companies 13.8% 9.1% 16.9% 5.6% 16%
Client centered 32.5% 28.6% 26.8% 50% 12%
Recommended from other 8.8% 6.5% 9.9 5.6% 4%
For personal use only.

facilities
New 0% <1% <1% 0% 4%
Known for its wide usage 22.5% 24.7% 23.9% 22.2% 20%
across Similar settings

DISCUSSION

The aim of this study was to explore the assessments used in different
occupational therapy practice areas and to identify the reasons for us-
ing the assessments. Findings of the present study indicate that most of
the assessments used in occupational therapy clinics target body structure
and function, particularly in the practice areas of pediatrics, geriatrics,
physical disability, and hand therapy. Although assessing impairments to
identify factors that impede functional performance is important, many
occupational therapy leaders believe that the emphasis of impairment-
based assessment (bottom-up approach) should not be the main focus of
occupational therapy assessments (Fisher, 1998; Kielhofner, 2009; Math-
iowetz, 1993; Reilly, 1962; Rogers, 1983; Trombly, 1995). For example,
the impairment-based assessments should only be used as necessary when
deficits in performance component skills are directly related to limita-
tions in occupational performance (Fisher & Short-DeGraff, 1993). There-
fore, occupational therapists are highly encouraged to focus on the use of
 Alotaibi et al. 313

assessments that are occupationally focused, thus reflecting true occupa-

tional therapy practice (Fisher & Short-DeGraff, 1993).
Awareness of the most commonly used assessments within occupational
therapy practice areas and the rationale for using such assessments are in-
formative to occupational therapy practitioners as well as educators. This
information helps in explaining the current practice focus of assessments.
For example, of the most commonly used assessments in the pediatrics
practice area, it was noted that the predominant focus of the assessments
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was on motor skill development and visual perceptual abilities; hence,

the assessments are impairment focused. Occupational therapists working
in the area of pediatrics may need to change their focus to assessments
that are occupationally based. Coster (1998) emphasized the need to de-
velop assessments that reflect how the child’s occupational engagement is
affected as opposed to merely focusing on the child’s underlying impair-
ment. The health care system demands that the outcomes of our services be
measured in terms of the client’s occupational performance (Mathiowetz,
1993), which is the focal belief of our profession. Occupational therapists
working in any practice area should be encouraged to reflect on this belief
For personal use only.

within their own practice.

Awareness of the assessments primarily used by occupational therapy
practitioners also provide insight to occupational therapy educators regard-
ing the value of educational content provided in their programs and whether
the assessments reflect relevant and timely occupational therapy practice.
This information is critical to support relevant occupational therapy prac-
tice and ensure appropriate services for the occupational therapy clients
(Provident, 2006). Occupational therapy educators need to review the as-
sessment content in their curriculum content to incorporate key current
occupational therapy practice patterns.
The rationales for using specific assessments in occupational therapy
practice settings are particularly important to occupational therapy educa-
tors and practitioners. The most cited reason for using assessments was
“their availability in the clinic.” This rationale means that new occupational
therapy graduates are likely to use assessments that are readily available
in the clinic. This is not only a weak rationale but also dangerous to the
quality of service of the profession. The results of the present study imply
that less relevant or appropriate assessments could be used in clinics with
little attention given to whether they are occupationally based assessments
or not. Such practice, based on availability rather than appropriateness, can
threaten the focal values and identity of the occupational therapy profes-
sion. To illustrate this point, the results of this study show that one of the
most frequently mentioned assessments in the practice areas of geriatrics,
 314 OCCUPATIONAL THERAPY IN HEALTH CARE

physical disability, and hand therapy was the Nine-Hole Peg Test. This test
measures speed and a degree of accuracy in performing fine motor skills
but is very limited in assessing occupational performance. Speed alone
cannot predict whether the client would be able to dress himself/herself in-
dependently. Hence, using such an assessment is not suitable for accurately
reporting the functional status or occupational performance level of clients.
Assessments that include the criteria of clinical utility such as being
“easily administered,” “easily scored,” and “time efficient” cumulatively
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accounted for over 35% of the reasons for using assessments. As mentioned
by Scott et al. (2006), these reasons are more efficient and practically rele-
vant. Hayes (2000) and Tickle-Degnen (2000) emphasized the need for in-
corporating psychometrically sound assessments within occupational ther-
apy practice, thus promoting occupational therapy evidence-based practice.
That was evident, as more than 35% of the participants reported “standard-
ization of assessments” as a criterion for choosing assessments in their
clinical environment. It is disappointing that this percentage is rather low,
as occupational therapy students and practitioners need to recognize the
value of having sound psychometric instruments in their practice.
For personal use only.

Less than 10% of the participants mentioned that they used the assess-
ments because they were “recommended by another facility.” However,
more than 20% of the participants indicated that the reason for using an
assessment was its “popularity across similar settings.” Unfortunately, pop-
ularity does not necessarily indicate quality, and a popular assessment is
not always compatible with occupational therapy practice principles. More
than 10% of the participants rationalized using assessments to “satisfy in-
surance companies”. Such reason would not contradict the principles of
using assessments in occupational therapy clinics given that these assess-
ments address the relevant occupational therapy practice appropriately.
Almost none of the participants reported using assessments just be-
cause they were “new.” Educators should consider which newly developed
assessments to teach or introduce these assessments to students and practi-
tioners, especially if they reflect relevant occupationally based assessments.
Collaboration between occupational therapy educators and clinicians are
extremely important, as this would enforce the use of deep-rooted and
well-established occupational therapy assessments. A fundamental belief
in occupational therapy is the value of theory in guiding practice and its
vital role in the clinical reasoning process (Parham, 1987). Thus, over 10%
participants indicated that being “theory driven” was the reason for using
an assessment. This reason was more clearly apparent in the mental health
practice area as evidenced by the use of assessments developed under
the framework of the Model of Human Occupation (MOHO), i.e., Role
 Alotaibi et al. 315

Check List, Interest Check List, and MOHO Screening Tool. The Canadian
Occupational performance Measure (COPM), a well-established occupa-
tionally based and client-centered assessment, was shown to be strongly
used in all practice areas (except pediatrics), reflecting its robustness. This
assessment, as theoretically based, standardized, and having good clinical
utility, is an excellent example that should be the assessment of choice of
occupational therapists. This objective can be achieved through emphasiz-
ing the value of such assessments to students in educational settings and
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through extensive collaborations between occupational therapy educators

and practitioners.

Implications to Occupational Therapy Education, Practice, and

Research

The present study has several implications to occupational therapy ed-

ucation, practice, and research. First, occupational therapy schools need
to pay close attention to their curriculum content in regard to assessments
For personal use only.

applied in their programs. The assessments taught in schools should be

periodically reviewed and compared to the ones utilized in the practice set-
tings. Second, consistent and ongoing collaboration between occupational
therapy educators and practitioners should be emphasized. In particular,
the focus of collaboration should be related to the usability, practicality, and
relevance of assessments taught in occupational therapy schools and used
in practice settings. Educators and practitioners need to be the decision
makers and leaders of change towards obtaining clinically relevant, func-
tionally oriented, and occupationally based assessments that eventually
meet the specific needs of different client populations. Third, assessment-
based review committees could be established by occupational therapy
schools and practice settings, which in turn should coordinate with their
national occupational therapy associations and accrediting bodies. The
main role of these committees would be to reach a consensus in identify-
ing universal criteria of assessments taught in occupational therapy schools
and used as a guide for students, which ultimately would be passed on to
occupational therapy practice environment. Fourth, occupational therapy
researchers can participate in linking education to practice through publica-
tions about occupation-based assessment development and use at national
and international levels. This information would contribute to knowledge
acquisition regarding types of assessments useful in practice and should be
taught in schools. In addition, researchers can help identify the prevalence
and analyses of assessments and promote the discussion of newly raised
 316 OCCUPATIONAL THERAPY IN HEALTH CARE

issues related to assessments in occupational therapy. In response, refine-

ment of assessments can be achieved, which will contribute to facilitating
the advancement of occupational therapy education and practice.

STUDY LIMITATIONS

The present study has several limitations. First, the sample size was
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relatively small. Second, the sample was not inclusive of all occupational
therapists but was rather restricted to occupational therapy practitioners
attending AOTA’s annual conference (a nonprobability sample of conve-
nience), thus limiting the generalizability of the study findings. Third, other
than the state in which respondents practiced, no additional demographics
were obtained. Other demographics, such as level of education, length of
experience, age, gender, and workload could have enriched the data and
provided valuable details to the study findings. Fourth, though the survey
was closely reviewed by occupational therapy experts, it was not piloted
to occupational therapy practitioners prior to conducting the study.
For personal use only.

CONCLUSION AND RECOMMENDATIONS

This exploratory study was an attempt to determine what assessments

are currently being used and why. This study suggests that currently most
assessments are based on impairments and that practitioners use what is fa-
miliar. Although emphasis in occupational therapy school programs should
be given to the assessments used in occupational therapy clinics, educa-
tors need to ensure that the focus of assessments are functionally oriented
and use occupationally based perspective because of theoretical tenets of
the profession. Impairment-based assessments should be used primarily
in conjunction with functional and occupation-focused assessments and
be directly related to the cause of clients’ disabilities. It is suggested that
increased collaboration between occupational therapy educators and prac-
titioners is needed to support best practice in occupational therapy and
through the evaluation of best assessments, which might be possible. If the
ideal occupational therapy assessments are clinically relevant, function-
ally oriented, client centered, standardized, and occupationally focused,
it is recommended that researchers build upon this exploratory study and
address the value of having sound psychometric properties of occupational
therapy instruments and develop additional instruments that meet that need.
The process of reviewing, analyzing, and promoting optimum occupational
 Alotaibi et al. 317

therapy practice is ongoing and requires mutual efforts among occupational

therapy educators, practitioners, and researchers.
Declaration of interest: The authors report no conflicts of interest. The
authors alone are responsible for the content and writing of the article.

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Received: 07/10/2009
Revised: 07/30/2009
Accepted: 07/30/2009