Psychometric Properties and Descriptive Characteristics of Clients by Using Two Theory-based Assessments
thesisposted on 21.06.2016, 00:00 by Chia-Wei Fan
In the field of occupational therapy, few studies have examined clients' experiences of rehabilitation from the perspectives of occupational participation and therapeutic communication (i.e., use of self). This dissertation explored these important aspects of therapy utilizing Kielhofner's (2008) Model of Human Occupation and Taylor's (2008) Intentional Relationship Model. The overarching purpose of this dissertation is two-fold. Firstly, it applies Rasch Analysis to examine the psychometric properties of two theory-based assessments- the Model of Human Occupation Screening Tool (MOHOST) and the Clinical Assessment of Modes (CAM). Secondly, this dissertation provides insight into the occupational and interpersonal characteristics of occupational therapy clients using these two assessments. Study I Methods Clinical information including the MOHOST, Health of Nation Outcome Scales (HoNOS) and Historical, Clinical, Risk-Management – 20 (HCR-20) were collected on 489 patients in low and medium secure units across six trusts in England. Seventy-eight occupational therapists participated in this study. The independent t-test and correlation analysis were employed to examine relationships between risk factors, symptom profiles, and occupational participation. The regression analysis was used to examine clients’ occupational participation changes over time. Results & Conclusions Clients in low security settings had higher occupational participation than clients in medium secure settings. Clients’ current risk factors and some items in HoNOS were associated with their participation. Findings in this study also indicated improvements in clients' occupational participation over time during the 2-year follow-up. These results can be used to inform occupational therapy pathways and protocols. Findings also confirmed that the MOHOST is a valid and reliable assessment for a forensic population. Study II Methods The CAM was administered to 110 neurological and orthopedic clients who were receiving rehabilitation services at the University of Illinois at Chicago Hospital and Health Care System (UICHHS). Thirty-eight therapists and students (including OT, PT and ST) participated in this study. Rasch analysis was used to examine the appropriateness of the rating scales and unidimensionality of the six modes in CAM. The internal consistency, targeting appropriateness and inter-rater reliability were analyzed as well. Results & Conclusions The Rasch analysis confirmed the item set in six modes meet the criteria of unidimensionality. The four version of CAM exhibited satisfactory construct validity and internal consistency. The CAM observational version demonstrated strong inter-rater reliability. Additionally, the CAM showed that clients and therapists differed in their perceptions on therapeutic communication modes. Findings from this study indicated that all four versions of the Clinical Assessment of Modes, a client and therapist self-report and observational measure derived from the Intentional Relationship Model, demonstrated strong validity and reliability.