2018-03-16

1

https://www.dropbox.com/s/j3fbduo72xaferq/Screenshot%202017-05-02%2019.06.44.png?dl=0

I N C O S T O F F U T U R E C A R E / L I F E C A R E P L A N N I N G

MODULE 2 – PREPARATION & ASSESSMENT

TOPIC 4 –STANDARDIZED ASSESSMENT

1

2

ROM Coordination Special Tests

MMT Balance Flexibility

Musculoskeletal Evaluation

Positional and Mobility Testing

Walk, Sit and Stand

Neck and Back

Positioning

Low-Level Work

Tolerance

Stair / Ladder / Other

Upper Limb Coordination

Reaching, Handling, Fingering and Feeling

Strength EnduranceLift, Carry, Push and Pull Grip Work

Simulation

Circuit Testing

Metabolic Endurance Testing

(MET)

OPINION

Understand Client

Understand Client’s Current

Situation

Form Opinion Re: Future Care

Needs

3

2018-03-16

2

LEARNING OBJECTIVES

1. Define standardized assessment

2. Describe common standardized assessments used in CFC/LCP and how to chose assessments

3. Practice data analysis & interpretation (norms and observations)

4.

5.

Understand when and why to bring assessment into clinic

4

Interpretation of cross correlation of function

STANDARDIZED ASSESSMENT

5

WHY USE?

• Clear, objective data and score

• Can be described in terms of a percentile

• Context by comparing

• They can be described by their psychometric properties

6

2018-03-16

3

PSYCHOMETRIC PROPERTIES

•Reliability

•Validity

•Sensitivity

•Specificity

7

RELIABILITY

• The overall consistency of a test.• Will it produce the same results, given the same set of conditions?• “Reliability: ‘Does the test provide a consistent measure?’

Internal consistency = the extent to which the items of a test measure various aspects of a common characteristic (e.g., “memory”). Do the items/subtests of the measure consistently measure the same aspect of cognition as each other?

• Test-retest reliability = the extent to which the measure consistently provides the same results when used a second time (re-test). Parallel-form reliability would involve 2 different/alternate versions of the same test. (Intra-rater reliability)Inter-rater reliability = the extent to which two or more raters (assessors) obtain the same result when using the same instrument – do they produce consistent results?”

(Vancouver Coastal Health Occupational Therapy Cognitive Assessment Inventory, 2014 update)

8

VALIDITY

• The degree to which a test accurately measures what it is supposed to measure

• For example:• Strength Test

• Cognitive Assessment

9

2018-03-16

4

CRITERION VALIDITY

• “…extent to which a new measure is consistent with a gold standard criterion (i.e., a previously validated measure)

• For Concurrent validity: the measures are administered at approximately the same time.

• For Predictive validity: typically one measure is administered at some time prior to the criterion measure (to examine whether the measure can predict, or correlate with, the outcome of a subsequent criterion event). Note: poor concurrent validity would suggest that the tests being compared measure different constructs; adequate concurrent validity suggests some shared variance in the constructs being measured; and excellent concurrent validity suggests that the tests measure very similar constructs. If 2 tests are highly correlated with each other, then one would want to question the need for having both tests – you would then want to determine other ways in which one test might be more superior than the other (for example, one takes less time to administer)”

(Vancouver Coastal Health Occupational Therapy Cognitive Assessment Inventory, 2014 update)

10

CONSTRUCT VALIDITY

• “Construct validity = the extent to which a test can be shown to measure a construct, e.g. “memory” or “cognition for everyday function”. The construct validation process may be used when a gold standard (previously validated criterion) does not exist, thus, when one cannot test for concurrent validity. Convergent validity is the extent to which a test agrees with another test (or test) believed to be measuring the same attribute. Discriminant validity is the extent to which tests that are supposed to be unrelated are, in fact, unrelated (i.e., measure different things). Group differences refers to: “Does the measure allow you to differentiate between 2 or more populations?” for example as determined by analyzing for statistically significant differences between the groups on the measure.”

(Vancouver Coastal Health Occupational Therapy Cognitive Assessment Inventory, 2014 update)

11

SENSITIVITY & SPECIFICITY

• Sensitivity: Describes the ability of an assessment to detect the presence of a characteristic, skill, impairment, disease or condition and that it measures it accurately

• Specificity: Describes the ability of an assessment to differentiate and exclude a condition or impairment when it is not present

(Vroman & Steward, 2014)

12

2018-03-16

5

OTHER CONSIDERATIONS

• Ecological Validity: “Does the measure reflect behaviours/function that actually occur in natural/everyday settings?” (Vancouver Coastal Health Occupational Therapy Cognitive Assessment Inventory, 2014 update)

• Clinical Utility: How user friendly is it? How long does it take to administer? How clear are the instructions? How appropriate is it for overall use?

(Boniface, Seymour; Using Occupational Therapy in Practice; 2012)

13

NON STANDARDIZED???

• Consider how any test could be used using a non standardized administration

• Important considerations:• Why?

• When & how to document?

• Comparing to norms

• How to modify?

14

SOME PROS AND CONS

Pros:

• Their psychometric properties!

• Normed based populations to which you can make comparison(s).

• Once you become familiar, can be relatively easy to administer

Cons:

• May have weak psychometric properties

• Time to administer

• Must be done exactly as outlined

15

2018-03-16

6

CHOOSING THE ASSESSMENT(S)

Is there a right or wrong?

Is there a comprehensive list?

Devote time to consider, prior to assessment

Consider psychometric properties

16

CHOOSING THE ASSESSMENT(S)

Consider norms available (e.g. age, gender, diagnosis)

Your qualifications to administer (e.g. level A, B, C)

Your own familiarity

Meaningfulness, time & environment

17

18

2018-03-16

7

19

• QUALIFICATION LEVEL A:• There are no special qualifications to purchase these products.• QUALIFICATION LEVEL B:• Tests may be purchased by individuals with:• A master's degree in psychology, education, occupational therapy, social work, counseling, or in a field closely

related to the intended use of the assessment, and formal training in the ethical administration, scoring, and interpretation of clinical assessments.

• OR• Certification by or full active membership in a professional organization (such as ASHA, AOTA, AERA, ACA, AMA,

CEC, AEA, AAA, EAA, NAEYC, NBCC) that requires training and experience in the relevant area of assessment.• OR• A degree or license to practice in the healthcare or allied healthcare field.• OR• Formal, supervised mental health, speech/language, occupational therapy, social work, counseling, and/or

educational training specific to assessing children, or in infant and child development, and formal training in the ethical administration, scoring, and interpretation of clinical assessments.

• QUALIFICATION LEVEL C:• Tests with a C qualification require a high level of expertise in test interpretation, and can be purchased by

individuals with:• A doctorate degree in psychology, education, or closely related field with formal training in the ethical

administration, scoring, and interpretation of clinical assessments related to the intended use of the assessment.• OR• Licensure or certification to practice in your state in a field related to the purchase.• OR• Certification by or full active membership in a professional organization (such as APA, NASP, NAN, INS) that

requires training and experience in the relevant area of assessment. (http://www.pearsonclinical.com/psychology/qualifications.html)

COMMON ASSESSMENTS

• Interview

• Strength

• Fingering

• Balance

• Function

• Cognitive

20

INTERVIEW

21

2018-03-16

8

GRIP & PINCH STRENGTH

• Jamar Dynamometer: 1.25 to 3.25 inches

• Jamar Pinch Gauge

22

23

PURDUE PEGBOARD

• measures speed and dexterity for placing and assembling small objects (e.g. pins 1 inch long and 1/8” diameter), both unilaterally (one arm) and bilaterally (two arms).

24

2018-03-16

9

COMPLETE MINNESOTA DEXTERITY TEST

• is used to evaluate manual dexterity of the arms and hands. This test involves manipulating objects that are approximately checker size.

25

BALANCE

• Eyes open, eyes closed & compare to norms (Bohannon, et al. Journal of Physical Therapy

Volume 64 / Number 7 July 1984.)

26

Decade Eyes Mean ± s

20 –29 Opened 30.0 ...

20 –29 Closed 28.8 2.3

30 – 39 Opened 30.0 ...

30 – 39 Closed 27.8 5.0

40 – 49 Opened 29.7 1.3

40 – 49 Closed 24.2 8.4

50 –59 Opened 29.4 2.9

50 –59 Closed 21.0 9.5

60 – 69 Opened 22.5 8.6

60 – 69 Closed 10.2 8.6

70 –79 Opened 14.1 9.3

70 –79 Closed 4.3 3.0

BERG BALANCE SCALE

• This scale is a standardized assessment tool used to evaluate an individual’s balance for various activities (i.e.: standing, walking, turning, stepping, retrieving an item from the floor, etc.).

• 41-56 = low fall risk

21-40 = medium fall risk

0-20 = high fall risk

27

2018-03-16

10

28

COMMUNITY BALANCE & MOBILITY SCALE

• CBMS

• an evaluation designed to assess balance and mobility in clients with traumatic brain injury who are ambulatory but have persistent balance problems. There are 13 items that encompass a broad range of balance and mobility tasks. Performance is rated out of a total of 96 and then compared with age-related reference values.

29

FIM & FIM + FAM

•Functional Independence Measure (FIM)

•Functional Assessment Measure (FIM + FAM)

30

2018-03-16

11

COGNITIVE

• Montreal Cognitive Assessment (MoCA)

• Mini Mental Status Exam (MMSE)

• Rivermead Behavioural Memory Test (RBMT)

• Cognitive Assessment of Minnesota (CAM)

• Test of Everyday Attention (TEA)

• Repeatable Battery for the Assessment of Neurological Status (RBANS)

• Cognitive Competency Test (CCT)

31

COGNITIVE

• Multiple Errands Test• Executive function

• Everyday function

• Community

• Adapted for various areas

• Number and types of errors are recorded

• CON: takes some prep if unfamiliar with area

32

INDEPENDENT LIVING SCALES

33

2018-03-16

12

CLINIC?

• When and how to decide

• Pros

• Cons

• Examples: • Doll Chair Assembly Test (DCAT)

• Epic Lift

• Matheson Panel System

• Valpar Tests

• Crawford Small Parts Coordination Test

• Lafayette Hand Tool Dexterity Test

34

CROSS CORRELATION

• Pulling it all together

• Continue to always review effort and reliability of reports of pain and disability

• Compare standardized and non standardized

35

36

Non Standardized

Standardized

2018-03-16

13

HOMEWORK

1. Provide grip strength results (use following 3 slides), and compare to norms.

2. Select an area of function. Describe one standardized assessment/test and one non standardized that could be used to correlate results for that area of function.

COMPLETE before moving onto MODULE 3/Topic 1

Please email to cfclcpcourse@roymatheson.com

37

RESULTSAVERAGE 3 TRIALS, KILOGRAMS

Right Hand

•Rung 1: 16.7 kg

•Rung 2: 25.7 kg

•Rung 3: 16.3 kg

•Rung 4: 13.7 kg

•Rung 5: 9.0 kg

Left Hand

•19.3 kg

•26.7 kg

•23.0 kg

•24.7 kg

•18.7 kg

38

39

Women

Age N Mean Mean SD SD SE Low Low High High

(lbs) (kg) (lbs) (kg) (lbs) (kg) (lbs) (kg)

20 to 24 R 26 70.4 31.9 14.5 6.6 2.8 46 20.9 95 43.1

L 61 27.7 13.1 5.9 2.6 33 15.0 88 39.9

25 to 29 R 27 74.5 33.8 13.9 6.3 2.7 48 21.8 97 44.0

L 63.5 28.8 12.2 5.5 2.4 48 21.8 97 44.0

30 to 34 R 26 78.7 35.7 19.2 8.7 3.8 46 20.9 137 62.1

L 68 30.8 17.7 8.0 3.5 36 16.3 115 52.2

35 to 39 R 25 74.1 33.6 10.8 4.9 2.2 50 22.7 99 44.9

L 66.3 30.1 11.7 5.3 2.3 49 22.2 91 41.3

40 to 44 R 31 70.4 31.9 13.5 6.1 2.4 38 17.2 103 46.7

L 62.3 28.3 13.8 6.3 2.5 35 15.9 94 42.6

45 to 49 R 25 62.2 28.2 15.1 6.8 3 39 17.7 100 45.4

L 56 25.4 12.7 5.8 2.5 37 16.8 83 37.6

50 to 54 R 25 65.8 29.8 11.6 5.3 2.3 38 17.2 87 39.5

L 57.3 26.0 10.7 4.9 2.1 35 15.9 76 34.5

55 to 59 R 25 57.3 26.0 12.5 5.7 2.5 33 15.0 86 39.0

L 47.3 21.5 11.9 5.4 2.4 31 14.1 76 34.5

60 to 64 R 25 55.1 25.0 10.1 4.6 2 37 16.8 77 34.9

L 45.7 20.7 10.1 4.6 2 29 13.2 66 29.9

65 to 69 R 28 49.6 22.5 9.7 4.4 1.8 35 15.9 74 33.6

L 41 18.6 8.2 3.7 1.5 29 13.2 63 28.6

70 to 74 R 29 49.6 22.5 11.7 5.3 2.2 33 15.0 78 35.4

L 41.5 18.8 10.2 4.6 1.9 23 10.4 67 30.4

75+ R 26 42.6 19.3 11 5.0 2.2 25 11.3 65 29.5

L 37.6 17.1 8.9 4.0 1.7 24 10.9 61 27.7

All R 318 62.8 28.5 17 7.7 0.96 25 11.3 137 62.1

Subjects L 53.9 24.4 15.7 7.1 0.88 23 10.4 115 52.2

Adult Grip Strength, MathiowetzAverage Performance of All Subjects on Grip Strength (pounds and kilograms)

2018-03-16

14

GRIP STRENGTH NORMS

Grip Strength

Ms. Client’s grip strength, who is right handed, results are as follows. Her right hand grip strength was X kilograms, while her left hand grip strength was X kilograms. When compared to age and gender norms, her right hand grip strength was X, and her left hand grip strength was X.

40

STANDARDIZED ASSESSMENT RESOURCES

• http://www.wrha.mb.ca/professionals/cognition/files/VancouverCoastal.pdf

• https://mh4ot.com/resources/ot-assessment-index/

• https://www.aota.org/~/media/Corporate/Files/Advocacy/Reimb/News/AOTAG-CodeChart2013.pdf

• https://www.strokengine.ca/assess/

• https://www.pearsonclinical.com

Web Links as of: March 2018

41