Ebook Measuring occupational performance (3/E): Part 2

11
WHO ARE THE CLIENTS?

Law M, Baum C, Dunn W, eds. Measuring Occupational Performance:
Supporting Best Practice in Occupational Therapy, Third Edition (pp 201-237).
© 2017 SLACK Incorporated.


Figure 11-1. PEOP.

UNDERSTANDING THE
NARRATIVE AND THE PERSON


IMPORTANT ISSUES TO CONSIDER
WHEN ASSESSING WORK PERFORMANCE


UNDERSTANDING THE JOB AND THE
WORK ENVIRONMENT


ASSESSING THE CLIENT’S
WORK ABILITIES AND LIMITATIONS


ASSESSMENT MEASURES OF
WORK PERFORMANCE

MODELS OF PRACTICE USEFUL IN
WORK ASSESSMENT AND REHABILITATION


Figure 11-2. Kaskutas Model of Work Performance.

AFTER THE ASSESSMENT



Table 11-1

O*NET CATEGORIES FOR WORK
Abilities

Definition

Groupings

Enduring attributes of the individual that influence
performance

Cognitive abilities: 21 abilities, such as deductive reasoning, oral comprehension,
visualization, memorization, problem sensitivity
Physical abilities: 9 abilities, such as dynamic flexibility, stamina, static strength
Psychomotor abilities: 10 abilities, such as finger dexterity, reaction time, speed of
limb movement
Sensory abilities: 12 abilities, such as far vision, sound localization, auditory attention

Knowledge Organized sets of

principles and facts
in general domains

Subject categories: 33 categories, such as fine arts, clerical, mathematics, mechanical, psychology, sales/marketing, education, administration, design, accounting,
building

Skills

Developed capacities that facilitate
learning or the more
rapid acquisition of
knowledge

Basic skills: 10 skills, such as active listening, critical thinking, learning strategies,
writing
Complex problem solving skills: identifying complex problems and reviewing related
information to develop and evaluate options and implement solutions
Resource management skills
Social skills: coordination, persuasion, negotiation, instructing, service orientation,
social perceptiveness
Systems skills: judgment/decision making, systems analysis, systems evaluation
Technical skills: 11 skills, such as installation, programming, repairing, troubleshooting, technology design

Work
Activities

General types of job
behaviors occurring
on multiple jobs

Information input: 5 activities, such as getting information, monitor processes/
materials/surroundings
Interacting with others
Mental processes
Work output

Work
Context

Physical and social
factors that influence the nature of
work

Interpersonal relationships
Physical work conditions
Structural job characteristics

Work
Values

Global aspects of
work that are important to a person’s
satisfaction

Achievement
Independence
Recognition
Relationships
Support
Working conditions

Table 11-2

PHYSICAL DEMAND CHARACTERISTICS OF WORK
Occasional 0% to 33% Frequent 34% to 66%

Constant 67% to 100% Energy Requirement

Sedentary

10 lbs

Negligible

Negligible

1.5 to 2.1 mets

Light
Medium
Heavy
Very heavy

20 lbs

10 lbs

Negligible

2.2 to 3.5 mets

20 to 50 lbs

10 to 25 lbs

10 lbs

3.6 to 6.3 mets

50 to 100 lbs

25 to 50 lbs

10 to 20 lbs

6.4 to 7.5 mets

Over 100 lbs

Over 50 lbs

Over 20 lbs

Over 7.5 mets

Reprinted with permission from Matheson L, Matheson M, Grant J. Development of a measure of perceived functional ability. J Occup
Rehabil. 1993;3(1):15-30.

Table 11-3

ASSESSMENT METHOD/MEASURES OF PERSON-LEVEL FUNCTIONS
Person-Level Functions
Cognition
Executive function
Self-awareness

Assessment Method/Measure
Montreal Cognitive Assessment
Executive Function Performance Test, Test of Everyday Attention
Patient Competency Rating Scale, Awareness Questionnaire, Self-Awareness of Deficits
Interview, Gage Self-efficacy Scale

Motor
Strength/endurance
Flexibility
Manual material handling
Positional tolerance
Manipulation/coordination

Grip/pinch, manual muscle testing, isokinetic testing, muscle endurance test
Gross body screen, goniometry, inclinometry, sit and reach test, estimation
EPIC Lift Capacity Test, Gibson Approach
Gross Screen of job specific positional tolerance testing
Crawford Small Parts, Minnesota Rate of Manipulation, 9-hole, Jebsen Hand Function,
Purdue Pegboard, O’Connell Finger Dexterity

Physiology
Resting/exercise vital signs
Cardiopulmonary endurance

Perceived exertion
Fatigue

Blood pressure, heart rate, respiration rate, oxygen saturation
Rockport Walking test, 6-minute walk test, YMCA 3-minute step test
Borg’s perceived rate of exertion scale, talk test
Multidimensional Assessment of Fatigue Scale

Psychological/Emotional
Depression
Fear avoidance
Anxiety

Beck Depression, Center for Epidemiologic Studies Depression Scale
Fear Avoidance Beliefs Questionnaire
Hopkin’s Symptom Check List, State-Trait Anxiety Inventory

Sensory
Pain

University of Alabama Pain Behavior Scale, Brief Pain Inventory, Ransford Pain diagram,
Visual analogue scale, Roland Morris Disability Questionnaire, Dallas Pain Questionnaire,
McGill Pain Questionnaire, Pain Disability Index
(continued)


Table 11-3 (continued)

ASSESSMENT METHOD/MEASURES OF PERSON-LEVEL FUNCTIONS
Person-Level Functions

Sensory

Assessment Method/Measure

Touch Sensation

Light touch, Semmes-Weinstein Monofilaments, Moberg pickup test, vibrometry
threshold tests, touch pressure, pain, temperature, static and moving 2-point discrimination, proprioception
Acuity, visual field, eye dominance, scanning, color vision, depth perception
Ability to follow directions and answers interview questions
Berg Balance Test, Get up and go, Tinetti Balance Screen
Scratch and Sniff test, job-related smell test

Vision
Audition
Balance
Olfaction

Table 11-4

ASSESSMENTS FOR WORK PERFORMANCE AT THE ENVIRONMENT AND OCCUPATIONAL LEVEL
Environment Level Measures
•
•
•
•

Work Environment Impact Scale
Job Content Questionnaire
Job Requirements and Physical Demands Survey

American Conference of Governmental Industrial
Hygienists’ Threshold Limit Value for Hand-Activity
Level

•
•
•
•

Work Organization Assessment Questionnaire
Work Organization Assessment Tool
Moos Work Environment Scale
Physical measures (force gauge, tape measure, scale)*

•
•
•
•
•
•
•
•
•
•
•
•
•

Personnel Test for Industry—Oral Directions Test
Roland Morris Disability Questionnaire

Self-Directed Search
Spinal Function Sort
Valpar Work Samples
Vermont Disability Question
Wonderlic Personnel Test
Work Ability Index
Work Confidence Measure*
Work Instability Scale
Work Limitations Questionnaire
Work Productivity and Impairment Questionnaire
Worker Role Interview

Occupation Level Measures
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Assessment of Work Performance
Canadian Occupational Performance Measure

Career Assessment Inventory
Dialogue About Ability Related to Work
Disability Arm Shoulder Hand Work Module
Functional Abilities Confidence Scale
Feasibility Evaluation Checklist*
Job Content Questionnaire
Job Performance Measure*
Need for Recovery After Work
Occupational Questionnaire
Occupational Performance History Interview
Occupational Role Questionnaire
Occupational Self-Assessment

*Non-standardized assessment


Table 11-5

ASSESSMENTS FOR WORK PERFORMANCE AT THE ENVIRONMENT AND OCCUPATIONAL LEVEL
Productivity
•
•
•
•
•
•
•
•
•

Safety

Quality of productivity
Quantity of productivity
Attendance
Timeliness
Workplace tolerance
Workplace instructability
Workplace memory
Follow through with accepted direction
Concentration

•
•
•
•
•
•
•
•
•

Timeliness
Workplace instructability
Adherence to safety rules
Use of proper body mechanics
Workplace safety—audition
Workplace safety—vision
Workplace safety—sensation
Workplace safety—balance

Use of protective behavior

Interpersonal Behavior
•
•
•
•

Accept direction from supervisor
General worker attitude
Follows dress code
Adjusts to different supervisors or supervisory styles

• Response to fellow workers
• Response to customers
• Response to change

Table 11-6

CONSTRUCTS AND ASSESSMENT FOR WORK
Person-Level Functions
Cognition
Executive function
Self-awareness

Assessment Method/Measure
Montreal Cognitive Assessment
Executive Function Performance Test, Test of Everyday Attention
Patient Competency Rating Scale, Awareness Questionnaire, Self-Awareness of Deficits
Interview, Gage Self-efficacy Scale

Motor
Strength/endurance
Flexibility
Manual material handling
Positional tolerance
Manipulation/coordination

Grip/pinch, manual muscle testing, muscle endurance test
Gross total body screen, goniometry for select joints
EPIC Lift Capacity Test, Gibson Approach
Gross screen of job specific positional tolerance testing
Crawford Small Parts, Minnesota Rate of Manipulation

Physiology
Resting/exercise vital signs
Cardiopulmonary endurance
Perceived exertion
Fatigue

Blood pressure, heart rate, respiration rate, oxygen saturation
Rockport Walking test, 6-minute walk test, YMCA 3-minute step test
Borg’s perceived rate of exertion scale, talk test
Need for Recovery After Work Instrument
(continued)


Table 11-6 (continued)

CONSTRUCTS AND ASSESSMENT FOR WORK

Person-Level Functions
Psychological/Emotional

Assessment Method/Measure

Depression
Fear avoidance
Anxiety

Beck Depression, Center for Epidemiologic Studies Depression Scale
Fear Avoidance Beliefs Questionnaire
Hopkin’s Symptom Check List, State-Trait Anxiety Inventory

Sensory
Pain

University of Alabama Pain Behavior Scale, Brief Pain Inventory, Pain diagram, 0 to
10 rating scale, Visual analogue scale, Roland Morris Disability Questionnaire, Dallas
Pain Questionnaire
Light touch, Semmes-Weinstein Monofilaments, Moberg pickup test, vibrometry
threshold tests, touch pressure, pain, temperature, static and moving 2-point discrimination, proprioception
Visual acuity (Snellen), visual field testing, eye dominance, visual scanning
Ability to follow directions and answers interview questions
Berg Balance Test, Get up and go, Tinetti Balance Screen
Scratch and Sniff test, job-related smell test

Touch Sensation

Vision
Audition

Balance
Olfaction

Spirituality
Social Capital
Social Support
Work Requirements
Physical Environment

Hope Questions, FICA Spiritual Assessment Tool, Spiritual Well-Being Scale
Life Stressors and Social Resources Inventory, Kouvonen’s measure
Social Support Inventory for People with Disabilities
Job Content Questionnaire, Work Environment Scale
Observational Checklist during Onsite Job Analysis, OSHA tool, NIOSH Revised Lift
Equation, Rapid Upper Limb Assessment, Rapid Entire Body Assessment, Job Strain Index

Table 11-7

OCCUPATION LEVEL WORK ASSESSMENT TABLES IN CHAPTER
Occupation Level Measures
•
•
•
•
•
•
•
•
•
•

•
•
•

Assessment of Work Performance
Career Assessment Inventory
Dialogue About Ability Related to Work-DOA
Disability Arm Shoulder Hand Work Module
Functional Abilities Confidence Scale
Feasibility Evaluation Checklist
Job Content Questionnaire
Need for Recovery After Work
Occupational Questionnaire
Occupational Performance History
Interview
Occupational Role Questionnaire
Occupational Self-Assessment

•
•
•
•
•
•
•
•
•
•
•
•

Personnel Test for Industry-Oral Directions Test
Roland Morris Disability Questionnaire
Self-Directed Search
Spinal Function Sort
Valpar Work Samples
Vermont Disability Question
Wonderlic Personnel Test
Work Ability Index
Work Instability Scale
Work Limitations Questionnaire
Work Productivity and Impairment Questionnaire
Worker Role Interview


Table 11-8

ASSESSMENT OF WORK PERFORMANCE
Source
Key References
Purpose

Sandqvist28
Sandqvist and Henriksson29; Sandqvist et al30; Kielhofner31
• Assesses individual’s observable working skills
• Provides information regarding how efficiently and appropriately the client performs a
work activity.

Type of Client

• Individual with various kinds of working clients. It is not limited to any particular diagnosis
or deficits, nor does it target any specific tasks or contexts.

Test Format

• Observation instrument where the client plays an active role in selecting work tasks and
work environment to evaluate the client’s performance.

Procedures

• The assessor observes the client perform a work task. The assessor makes notes regarding
the client’s performance on 14 different skills and ranks the performance on a 4-point ordinal rating scale (1 = incompetent performance; 4 = competent performance).

Time Required

• May be used by occupational therapists or other professionals familiar with assessing work
functioning.
• Testing time may vary from a few hours to weeks, depending on client’s work demands.

Standardization

• Administration manual available for $40.00. Assessor needs to have experience examining
work performance.

Reliability
Validity

• Not reported
• Questionnaire was answered by 67 respondents who had previously used the AWP in work
rehabilitation settings in Sweden. The majority of respondents (63%) believed that the

AWP examined all potential working skills “to a great extent.”30

Table 11-9

CAREER ASSESSMENT INVENTORY
Source

/>
Key References
Purpose
Type of Client
Test Format
Procedures

Johansson32
• Occupational interest inventory for college-bound or non-college-bound individuals
• 15 years of age or older; 8th grade reading level or above.
• Paper and pencil or computer based administration.
• Each individual is given test booklet and data collection form. The test is not timed
and there are 370 items. All questions on 5-point rating scale. Non-completion of up to
25 items will have little impact on overall patterns or results.

Time Required

• No specific training required, but must be familiar with administration manual.
• 35 to 40 minutes to complete.

Standardization

• Standardization of scales was developed through mailing 900 representatives from various

occupational groups. These scales have been standardized and updated.

Reliability

• Test-retest reliability ranged from 0.91 to 0.96 for general theme scales, 0.88 to 0.95 for
basic interest scale, 0.81 to 0.96 for the occupational scales.

Validity

• Internal consistency coefficient between 0.89 and 0.92.


Table 11-10

DIALOGUE ABOUT ABILITY RELATED TO WORK
Source
Key References
Purpose

Linddahl et al33
Linddahl34; Norrby and Linddahl35
• The purpose is to provide support for both the client and therapist in assessing the client’s
ability to work and rehabilitate. Follows the Model of Human Occupation.

Type of Client
Test Format

• Working age individuals involved in both paid and unpaid activities.

Procedures

• Client assesses self, therapist assesses client, then discussion occurs between client and
therapist about therapist’s interpretation of the client’s ability.

Time Required

• Not noted

Standardization
Reliability

• Has been studied widely in the US and Sweden.

Validity

• 29 of 34 items showed acceptable goodness-of-fit statistic MnSq values from > 0.6 to < 1.4
in association with Z values from −2 to 2. Five items that did not fit well were revised.33

• Two sections: Client self-assessment and professional’s objective assessment focusing on
the individual’s working ability.
• Followed by a dialogue to distinguish goals related to the return-to-work process based on
client’s preference.

• Spearman Rank Correlation test for most items r = 0.51 to 0.75. Percentage of agreement
93.1% to 96.5%35

Table 11-11

DISABILITIES OF THE ARM, SHOULDER, AND HAND (DASH): WORK MODULE
Source

Key References
Purpose

Solway et al36; For full DASH assessment and scoring instructions: />Hudak et al37; Marx et al38; Beaton et al39,40; Kennedy et al41; Hunsaker et al42
• Assesses the impact of upper extremity disorders on work performance
• The Work DASH is an optional module of the full DASH (30 items)

Type of Client

• Individuals with upper extremity disorders who are currently employed or for whom the
worker role is important

Test Format

• 4-item questionnaire self-report survey based on a 1-week recall period. (Psychometrics
not tested for test administration by proxy or telephone.)

Procedures

• Client is provided a paper version of the survey; there is no time limit. The questionnaire
should be completed with no assistance from others (family, friends, or clinicians).

Time Required

• 4 questions, 1 to 2 minutes to complete. Proctors should be familiar with testing procedure
specified in user manual.

Standardization

• The user manual describes procedures for proctoring and scoring exam. The administration procedures were jointly developed by the Institute for Work and Health, Ontario

Canada and the American Academy of Orthopedic Surgeons, Rosemont Illinois.

Reliability

• Internal Consistency: Cronbach Alpha = 0.8943
(continued)


Table 11-11 (continued)

DISABILITIES OF THE ARM, SHOULDER, AND HAND (DASH): WORK MODULE
Validity

•
•
•
•

Spearman correlation coefficients when compared to similar measures
Work Instability Scale for Rheumatoid Arthritis (RA-WIS): 0.52
Work Limitations Questionnaire (WLQ-16): -0.59
Stanford Presenteeism Scale (SPS): -0.3443

Strengths

•
•
•
•
•

Widely used in research and clinical practice
Established norms
Quickly and easily administered
Short completion time
No formal training required

Weaknesses

• Little psychometric testing done on the Work DASH alone
• Assessment is self-report

Table 11-12

FUNCTIONAL ABILITIES CONFIDENCE SCALE
Source
Key References
Purpose

/>Williams et al44,45
• To measure the degree of self-efficacy or confidence a patient exhibits with various movements or postures

Type of Client
Test Format
Time Required
Standardization

• Client able to complete questionnaire.

Reliability

Validity

• ICC = .94

Strengths

• Strong psychometric properties. Systematic review of self-report health-related work outcome measures for patients with musculoskeletal disorders gave the FAC the highest quality ratings of all measures identified (6 constructs reviewed were content and construct
validity, internal consistency, test-retest reliability, responsiveness, and ease of scoring)45

Weaknesses

• Only available in English. Focuses on confidence in physical abilities only, not social, cognitive, or self-management abilities

• Pen/paper
• 15 questions, 10 minutes to complete
• Standardization performed with group of 20 subjects to measure test-retest reliability and
to 94 subjects for validity testing
• Discriminant: baseline scores and 3-week scores judged by clinicians demonstrated ability
to discriminate ability to work
• Responsiveness to change: able to detect gains in all aspects of physical conditioning over
3-week program. Strong within-group change for subjects with and without back injuries,
effect size of .49 was positive and in direction and moderate in magnitude (change of
13 units on 100-point scale represents clinically important differences)
• Convergent validity: moderate positive correlations with Resumption of Activities of Daily
Living Scale and inversely with Roland-Morris scale score, slight relationship with Physical
Self-Efficacy Scale44


Table 11-13

FEASIBILITY EVALUATION CHECKLIST (FEC)
Source

Program in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park,
St. Louis, 63108

Key References
Purpose

Matheson et al46
• Designed to evaluate the presence of behavioral requirements all employers in the competitive labor market have of any employee. These include attendance, timeliness, workplace tolerance, and ability to accept supervision.

Type of Client
Test Format
Procedures

• Adolescents and adults for whom the worker role is pertinent.

Time Required

• 5 to 10 minutes

Standardization

• The administration procedures were developed at the Work Preparation Center at Rancho
Los Amigos Hospital in Downey, California.

Reliability

• Matheson47 used a simple scoring system to identify the number of items that were rated

“non-feasible” with 43 industrial rehabilitation clients. Over a 24-hour interval, the FEC demonstrated a reliability coefficient of 0.78.

Validity

• The items for the FEC were identified by employers and rehabilitation placement specialists
in a survey conducted at Rancho as those that most often cause a return to work attempt by
a disabled client to result in failure. Altogether, 53 items were identified. These were grouped
and items that overlapped were consolidated to provide the current set of 21 items.

Strengths

• Has been used in a wide variety of rehabilitation settings since its introduction.
• Can be used by professional raters, paraprofessional raters, and for self-rating by clients.

Weaknesses

• Need to observe client for a full workday over multiple days in work environment or simulated work environment.

Final Word

• Can be used to evaluate first steps in the return to work process. Requires more validity
testing.

• 21-item behavior rating scale. Each item is briefly described on the scale.
• 21 factors in the FEC are measured by observation of the evaluee in an actual or simulated
work environment, often in a sheltered workshop or at a therapeutic workstation. The
work environment must be structured to approximate the temporal demands of work,
requiring regular daily attendance and adherence to a set schedule.

Table 11-14

JOB CONTENT QUESTIONNAIRE (JCQ)
Source
Key References
Purpose
Type of Client
Test Format

Karasek48
Cheng et al49; Ostry et al50; Karasek et al51,52; Storms et al53
• Measure perceptions of social and psychological characteristics of jobs for assessments of
work quality at both the level of the individual and system or organizational level.
• Individual workers and work organizations.
• Self-report instrument of 49 questions organized along 5 scales: 1) decision latitude, 2) psychological demands, 3) social support, 4) physical demands, 5) job insecurity
(continued)


Table 11-14 (continued)

JOB CONTENT QUESTIONNAIRE (JCQ)
Type of Client
Procedures

• Rate statements about their jobs using a 4-point scale (1 = fully agree/very unlikely;
4 = fully disagree/very likely). Scores are summed within 5 scales and are often collapsed
into dichotomous scores for interpretation of high and low. Scores can be compared to
national scale scores or norms from US and Sweden by sex, occupation, and industry (eg,
compare findings in a plant to national averages).

Time Required

• JCQ takes 15 minutes to complete.

Standardization

• JCQ has a manual with norms and has been translated in over 12 languages. International
board of researchers decides on policy and developmental issues. It has short directquestioning format (subscales condensed into 1 question) and validated in Holland as a
potential screening tool.

Reliability

• Cronbach’s alpha were 0.71 and 0.76, with one notable item-to-total Pearson correlation of
0.21 for control subscale “repetitive work.” Psychological Demands scale has consistently
scored lower than other scales (ie, 0.57 to 0.67 in 4 different samples).

Validity

• Scales are based on Karasek’s demand/control model of job strain development. Items
derived statistically from survey data collected for the US Department of Labor. Core set of
27 questions developed on a pooled sample of 4,900 respondents. To increase efficiency,
utility, and applicability, test has had multiple revisions. For criterion validity, individual
subscales of the Dutch version correlated significantly with 7 criterion variables, including a
General Health Questionnaire.
• For construct validity, Karasek et al52 established cross-national validity in United States,
Canada, Netherlands, and Japan across wide occupational spectrum (16,601 participants)
and ages; conditions in modern industrial nations are more consistent across national
boundaries than across occupational groups; consistent ability to discriminate occupation.
Scores predictive of job-related illness development (eg, psychological distress, coronary
heart disease, musculoskeletal disease, reproductive disorders) in several countries52 and
confirmed constructs of Karasek’s demand/control model.51

Strengths

•
•
•
•

Weaknesses

• For comprehensive assessment of stress, would need to add measure of non–job-related
stress.
• For coping with stress, would need to add personality scales.
• Demand/control model does not account for cognitive appraisal of events.
• Psychological Demands subscale consistently performs weaker than other subscales.
• Organizational-level job factors not included.
• Usage fee required in some instances. The JCQ is provided with research documentation to
most users free of charge, but commercial use and large research studies pay a usage fee.
Approval required from author prior to using; contact JCQ Center at .

Final Word

• Well-standardized tool with broad application and use.

Well standardized for multiple cultures
Can be self-administered with minimal assistance
Has theoretical basis that allows application in social policy and organizational change.
Used broadly in many different settings both to analyze effect of job characteristics on
individual’s relative risk of job-related illness development, and testing of social policy
effect on worker group’s activation, motivation, and job satisfaction.

Table 11-15

NEED FOR RECOVERY AFTER WORK (NFR)
Source
Key References
Purpose

van Veldhoven54

Type of Client
Test Format

• Any worker

Procedures
Time Required

• Evaluee completes the 11 yes/no questions

Standardization
Reliability

• The Dutch version has been widely studied, but the English version is less researched

Validity

• Correlates with the Utrecht Burnout Scale at .84 in occupational physicians60 and .75 in
policemen.60 Prospective correlation with accidents found a RR = 2.28 for workers in the

highest tertile on NFR compared to those in the lowest tertile (95% CI = 1.4 to 3.66).61
High baseline NFR scores were associated with an increased risk for subsequent sickness
absence (OR = 2.19, 95% CI 1.13 to 4.24) after adjustment for age, previous sickness absence,
marital status, educational level, and company size.62

Strengths

• Simple scale that is quick and easy to administer and score
• Widely researched

Weaknesses

• Does not measure fatigue at work
• Not widely researched in the US

Sluiter et al55; van Veldhoven and Broersen56
• Need for recovery after work is based upon the Effort-Recovery Model.57 Job demands
produce load effects (emotional, cognitive, and behavioral) that are reversed when work
stops. The NFR is the English version of the Dutch Questionnaire on the Experience and
Assessment of Work.
• 11-item dichotomous self-report scale that measures severity and duration of symptoms
indicating that the respondent is not fully recovered from work effort
• 5 minutes
• Rho = .87.58 Cronbach’s alpha = .88.56 Test-retest reliability = .55 to .69 in truck drivers and
.48 to .80 in nurses.59

Table 11-16

OCCUPATIONAL PERFORMANCE HISTORY INTERVIEW II (OPHI-II)
Source

Key References
Purpose

Kielhofner et al63
Kielhofner et al64,65; Mallinson et al66
• Designed to assess 3 constructs of occupational adaptation: occupational identity, occupational competence, and the impact of occupation behavior settings

Type of Client
Test Format

• Occupational therapy clients who are capable of responding to an in-depth interview

Procedures

• Interview administered by occupational therapist. It consists of 3 rating scales
(Occupational Identity, Occupational Competence, and Occupational Behavior Settings)
and the Life History Narrative (qualitative data from interview)

Time Required

• OPHI-II takes approximately 1 hour

• Semi-structured interview. Focuses on the following thematic areas: occupational roles, daily
routine, activity/occupational choices, critical life events, and occupational behavior settings

(continued)


Table 11-16 (continued)

OCCUPATIONAL PERFORMANCE HISTORY INTERVIEW II (OPHI-II)
Standardization

• Manual available from AOTA provides rating scales and suggests possible sequence and
format of questions

Reliability

• Rater separation statistics indicated that raters have the same degree of severity and leniency
• Test-retest validity was not reported; however, data for original OPHI showed poor to adequate test-retest reliability (r = 0.31 to 0.68)

Validity

• For content validity, using RASCH analysis methods, strong evidence that test items captured underlying traits. Low percentage of misfit statistics (8% to 9%) indicate validity
across different subjects. For construct validity, separation statistics indicate OPHI-II can
detect meaningful differences between persons and levels of competence.

Strengths

•
•
•
•

Weaknesses

• Therapist, rather than client, assigns the scores
• Presumes therapist familiarity with Model of Human Occupation
• Administration may be time consuming

Final Word

• Client-centered assessment for establishment of clinical goals. Most appropriate when
therapy can be structured to maximize knowledge of client’s life history

OPHI-II can be readily learned through the manual and used with a wide variety of clients.
Validity evidence is stronger than the original OPHI
Based on well-known theory
Intervention plan can be developed from assessment results

Table 11-17

OCCUPATIONAL ROLE QUESTIONNAIRE
Source
Key References
Purpose
Type of Client
Test Format
Procedures

Kopec and Esdaile67
Amick et al68
• To study chronic condition effects on occupational role, specifically in the workplace
• 18 years old and older
• 8-item self-report questionnaire
• 2 subscales with 4 items in each scale. One scale is the productivity/job performance scale;
the other is a satisfaction with work scale. Scales are aggregated into a single summary scale

Time Required

• 10 minutes

Standardization
Reliability
Validity

• The scales have sound psychometric support. Available in both French and English
• Internal consistency, alpha = 0.88), test-retest reliability (0.91), and correlates with pain (r5)
• The items have face validity; identifies 2 distinct factors


Table 11-18

OCCUPATIONAL SELF ASSESSMENT (OSA)
Source
Key References
Purpose

Baron et al69
Taylor et al70; Kielhofner et al71; Keller et al72
• Outcome measure intended to be assessed at initial evaluation and follow-up to create a
client-centered therapy plan
• Designed to capture clients’ perceptions of their own occupational competence and of the
occupations they consider important
• Used to plan and establish priorities for occupational goals
• Assess client progress and program effectiveness

Type of Client

• Ability to self-reflect and have a higher level of functioning and some insight. OSA requires

basic reading skills and the ability to collaborate in goal-setting tasks. There are no cultural
background limitations. Designed for individuals over the age of 12 years; however, the COSA
(children’s version) is available for ages 12 years and younger.

Test Format

• OSA has 2-part self-rating form and 3 content areas with the following subcontent areas: 1)
Skills/Occupational Performance; 2) Habituation—Habits, Roles; 3) Volition—Personal Causation,
Values, Interests. There are 8 steps: create appropriate context for administration, communicate
intent of the OSA to the client and explain instructions, have client self-administer and complete the rating forms, review OSA with client, collaborate to identify therapy goals and strategies, complete planning, implement occupational therapy services form with client, and complete OSA key forms. For comparison of progress, have client complete OSA follow-up form.

Procedures

• The preferred setting is client-based. If clients will do better and be able to reflect on their
answers, assigning it as “homework” may suit the client. If the client would do better given
time during therapy so the client can ask questions then that can be done as well. It is
important that the client has sufficient time to reflect in a quiet, private area.

Time Required

• 10 minutes for client to fill out. Approximately an additional 15 minutes for the therapist to
discuss possible goals
• Manual for training/administration: $40.00

Standardization

• OSA user’s manual

Table 11-19

PERSONNEL TESTS FOR INDUSTRY: ORAL DIRECTIONS TEST (ODT)
Source
Key References
Purpose
Type of Client

Langmuir73
Angoff and Thorndike74; Doppelt and Seashore75; Wolfe and Davis76
• Assess an individual’s ability to follow oral directions.
• Designed for selection of applicants, adolescent or adults. It is especially effective in identifying more able individuals in low educational levels

Test Format
Procedures

• Paper and pencil test

Time Required

• Proctors should be familiar with test and procedures, which are explained in the manual.
• Test lasts 15 minutes.

• The ODT is a recorded test. Proctors should provide answer sheets and pencils, and ensure
that volume is loud enough for participants.

(continued)


Table 11-19 (continued)

PERSONNEL TESTS FOR INDUSTRY: ORAL DIRECTIONS TEST (ODT)

Standardization
Reliability

• Administration manual describes procedures for proctoring and scoring exam.

Validity

• For construct validity, ODT had a correlation of .70 Wechsler Adult Intelligence Scale (WAIS)
for various groups of prison inmates and vocational rehabilitation clients. For concurrent
validity, the correlation between ODT and Short Employment tests ranged from .30 to
.49. Wolfe and Davis76 found that the ODT and Wesman had a correlation coefficient of
.67, while the ODT and WAIS full-scale IQ had a correlation coefficient of .86 and Wesman
Verbal Test.

• For internal consistency, split half reliability ranged from .73 to .86.
• Between the first and second testing, test-retest reliability ranged from .79 to .93. Testretest reliability for 1160 participants from the Dayton VA Center Domiciliary was .88

Table 11-20

ROLAND MORRIS DISABILITY QUESTIONNAIRE (RDQ)
Source
Key References

Roland and Fairbank77
Stratford et al78; Smeets et al79; Artus et al80; Wilkens et al81; Lamb et al82; Hay et al83; Mannion
et al84

Purpose
Type of Client
Test Format

Procedures

• Assesses physical disability due to low back pain (LBP)

Time Required

• 5 minutes

Standardization

• Translations are available in Arabic (Egyptian), Bulgarian, Chinese, Croatian, Czech, Danish,
Dutch, English (Canadian, US, Australian), Flemish, French, German, Greek, Hungarian,
Icelandic, Iranian, Italian, Japanese, Korean, Norwegian, Polish, Portuguese, Brazilian
Portuguese, Moroccan, Romanian, Russian, Spanish, Argentinean, Columbian, Mexican,
Puerto Rican, Venezuelan, Swedish, Thai, Tunisian, and Turkish, as well as for India (Hindi,
Kannada, Marathi, Tamil, Telugu, Urdu). Several of these versions have not been validated.

Reliability

• For internal consistency, r = .84 to .96.77 For test-retest, r = .83 to .91.77 Pearson’s correlation
coefficients for test–retest in patients with acute/subacute LBP are 0.91 for the same day,
0.88 for 1 week, and 0.83 for 3 weeks. In patients with chronic LBP, a correlation coefficient
of 0.72 (interval 2 days to 6 months) was found.77

• Client presenting with low back pain
• Self-report with 24 questions
• Indicate whether the statement related to back pain is true to you during that day. Scores
range from 0 (no disability) to 24 (maximal disability). Lower scores indicate less disability,
whereas higher scores represent greater disability.

(continued)


Table 11-20 (continued)

ROLAND MORRIS DISABILITY QUESTIONNAIRE (RDQ)
Validity

• For construct validity, RDQ scores correlate moderately to strongly with other self-reported
disability measures: Quebec Back Pain Disability Scale (r = 0.60), Back Pain Functional
Scale(r = 0.79) , Aberdeen Back Pain Scale (r = 0.68), Isernhagen Works Systems Functional
Capacity (r = 0.20), EuroQol (r = 0.50).85-87

Strengths

• The RDQ is the most comprehensively validated measure in low back pain.
• It is short, simple to complete, and readily understood by patients and clinicians.
• Psychometric properties are acceptable to good and the RDQ is available in many language versions. It can be used in patients with acute, subacute, and chronic LBP, and has
been translated and validated in multiple languages.

Weaknesses

• There is some evidence that the RDQ does not provide a sufficient spread of items representing activities on a continuum from easy to hard.
• The poor fit of some items to the factor “disability” needs further attention. None of the
versions have sufficient items of higher difficulty to assess persons with low levels of disability, making it inadequate for assessing function in patients with little disability

Final Word

• The administrative and respondent burden is very low. RDQ scores and changes scores
must be interpreted with caution due to poor-fitting items and the fact that the RDQ does

not appear to have interval-level properties. It is inadequate for use in patients with little
disability.

Table 11-21

SELF-DIRECTED SEARCH (SDS)
Source
Key References
Purpose

PAR (Psychological Assessment Resources, Inc), PO Box 998, Odessa, Florida, USA, 33556
SDS88
• Designed to help individuals discover and evaluate potential career interests and future
planning for education (eg, college, training)

Type of Client

• Clients who are capable of completing an in-depth inventory. High school/college students, adults, and those with a fourth grade reading level or above

Test Format

• Self-administered questionnaire; computerized administration available, can be administered individually or in groups

Procedures
Time Required

• Each individual is given test booklet and self-completes it

Standardization
Reliability

• Standardized using a sample of 1739 people

Validity

• SDS results have been supported by over 500 research studies
• Concurrent validity was 54.7%, higher than the average range found in interest inventories

• No specific training required, but must be familiar with administration manual
• 25 to 35 minutes to complete
• 20 minutes to complete online
• Internal consistency coefficients for Activities, Competencies, and Occupation scales
ranged from 0.72 to 0.93. Test-retest reliability ranged from 0.78 to 0.98