Item-Level Analysis of the Revised Occupational Therapy Fieldwork Performance Evaluation Applied in Practice

Competency-based assessments for healthcare professionals are critical for safe and effective client outcomes. Rehabilitation clinical skill competency assessments must be validated and revised to produce safe and skilled practitioners. The revised American Occupational Therapy Association (AOTA) Fieldwork Performance Evaluation (FWPE) instrument measures occupational therapy student performance to determine readiness for practice. The assessment includes thirty-seven competencies that address both profession specific clinical skills and general professional behavior skills. The objective of this study was to use Rasch methods to explore the use of the revised FWPE in actual fieldwork practice and to determine the instrument’s psychometric properties when separating the item components into two distinct subdomains: General Health Professions Competences and Occupational Therapy-Specific Competencies. Internal construct validity and test reliability were analyzed using data from 149 occupational therapy students after completing their initial Level II A fieldwork clinical internship. This study examined the item difficulty hierarchy, item fit, person-fit to model, person separation index, person separation reliability coefficient, strata, ceiling and floor effect, and unidimensionality of the FWPE instrument as a whole and as two separate domains. With the exception of not meeting the criteria for unidimensionality, the full FWPE instrument and the Occupational Therapy-Specific Competencies subdomain showed acceptable item-level psychometrics for reliability and precision. While the General Health Professions Competencies subdomain showed good item-level psychometrics, it was below the criterion for reliability and only separated the sample into two strata. Results support the validity, reliability, and clinical use of the revised FWPE full instrument and the Occupational Therapy-Specific Competencies subdomain to measure entry-level clinical skill competencies in practice.

Establishing Normative Values for the Barnett Balance Assessment-Sit (BBA-SIT)

The purpose of this descriptive study was to collect quantitative, normative data for the Barnett Balance Assessment-Sitting (BBA-SIT), a newly-developed dynamic sitting balance assessment tool based on the Barnett Balance Assessment (BBA). The BBA-SIT was administered to a total of 180 participants (30 people in each of the following age categories: 18 - 29, 30 - 39, 40 - 49, 50 - 59, 60 - 69, and 70+) who did not have any current balance deficits. A review of normative data collected indicated no variation in the total assessment scores within and between groups. Future research on the BBA-SIT is needed with balance-impaired populations to determine if the BBA-SIT is sensitive enough to identify subtle differences in dynamic sitting balance in individuals with various levels of balance impairment.

Verbal Assistance within the Context of an IADL Evaluation

Objective: The aim of this study was to identify the types of verbal assistance that facilitate task progression in individuals with cognitive deficits secondary to traumatic brain injury (TBI). Methods: Two individuals with moderate-to-severe TBI needing verbal assistance to complete the “Obtaining Information task” of the Instrumental Activities of Daily Living Profile were selected. A qualitative conversational analysis was conducted on the complete verbatim of the interactions that occurred between the evaluator and each participant while planning how they would find the information. The evaluator provided the least possible assistance to observe the maximal levels of independence of each individual. Results and Outcomes: Six types of verbal assistance, offered in response to each participant’s specific problems, facilitated goal formulation for finding information: restarting, scaffolding, cueing, action priming, offer of a strategy, and explicit advice. Explicit advice that involved the therapist thinking for the person was only provided after numerous other types of more implicit assistance had failed to facilitate task progression. Conclusions: Therapists can facilitate task-related goal formulation and attainment in individuals with cognitive limitations using several types of well-adjusted verbal assistance.