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Keywords:

  • International Classification of Functioning, Disability and Health (ICF);
  • Clinical occupation-based instruments;
  • Occupational therapy

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES

Objective

To compare the content of clinical, occupation-based instruments that are used in adult rheumatology and musculoskeletal rehabilitation in occupational therapy based on the International Classification of Functioning, Disability and Health (ICF).

Methods

Clinical instruments of occupational performance and occupation in adult rehabilitation and rheumatology were identified in a literature search. All items of these instruments were linked to the ICF categories according to 10 linking rules. On the basis of the linking, the content of these instruments was compared and the relationship between the capacity and performance component explored.

Results

The following 7 instruments were identified: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, the Sequential Occupational Dexterity Assessment, the Jebson Taylor Hand Function Test, the Moberg Picking Up Test, the Button Test, and the Functional Dexterity Test. The items of the 7 instruments were linked to 53 different ICF categories. Five items could not be linked to the ICF. The areas covered by the 7 occupation-based instruments differ importantly: The main focus of all 7 instruments is on the ICF component activities and participation. Body functions are covered by 2 instruments. Two instruments were linked to 1 single ICF category only.

Conclusion

Clinicians and researchers who need to select an occupation-based instrument must be aware of the areas that are covered by this instrument and the potential areas that are not covered at all.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES

Although the focus of the medical model is to treat a specific disease condition of an ill person, the biopsychosocial model in health care aims at a holistic, multidimensional, and multidisciplinary understanding of health and health-related conditions. The biopsychosocial model is increasingly applied in health care systems all over the world, especially in rehabilitation medicine (1). In a biopsychosocial understanding of health, the ability of the individual to engage in activities and to participate in society determine the daily functioning of the individual, as well as a possible disability.

There have been 2 major conceptual frameworks in the field of functioning and disability: the International Classification of Impairment, Disability and Handicap (ICIDH) (2) and the functional limitation, or Nagi, framework (3). Contrary to the ICIDH, the Nagi framework was not accompanied by a classification. Contrary to both the ICIDH and the Nagi framework, the current framework of disability—the World Health Organization International Classification of Functioning, Disability and Health (ICF)—now focuses on function instead of impairment. The holistic, biopsychosocial approach in rehabilitation medicine is addressed by the ICF (4). The ICF is being increasingly applied in clinical research and clinical practice in rehabilitation all over the world (1). The overall aim of the ICF classification is to provide a unified and standard language for the description of health and health-related conditions in rehabilitation and a common framework for all health professions (4). The ICF has 2 parts, each containing separate components. Part 1 covers functioning and disability and includes the components body functions (b), body structures (s), and activities and participation (d). Part 2 covers contextual factors and includes the components environmental factors (e) and personal factors (Figure 1). The latter category is not “coded” but rather a verbal description is added to the category coding. Activity is defined as the execution of a task or action by an individual in the ICF, whereas participation is the person's involvement in a life situation (4).

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Figure 1. The model of the International Classification of Functioning, Disability and Health (ICF). The model shows the relationship between the parts of the ICF classification: health conditions; body functions (b) and structures (s); activities and participation (d); and the contextual factors that include the components environmental factors (e) and personal factors. Modified from the World Health Organization (4).

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Activity and participation are core aspects of occupational therapy. Occupational therapists understand activity and participation from an occupational perspective: Occupational therapists consider meaningful occupations of individuals as a contribution to health and apply these meaningful occupations in their treatment (5–8). Occupation includes everything that a human being does, such as physical, mental, social, and rest occupations and occupations for productivity, leisure, and self care. Nelson (9) describes occupation as the relationship between occupational form (the environmental-physical and sociocultural dimension) and occupational performance (the active doing of the individual). Occupational form is related to meaning and occupational performance is linked to purpose.

All health professionals are under increasing pressure to evaluate their treatment and to produce studies about evidence and efficacy to justify their interventions. To explore the relationship between existing occupation-based instruments and the ICF is of utmost importance for occupational therapists and other health professionals in adult rheumatology and rehabilitation when they search for an outcome measure for an occupation- or activity-based intervention. If the ICF is used as a common framework and classification for rehabilitation intervention and care in the future, health professionals must know how they can assess the categories in the ICF that they target in their intervention. If clinicians search for instruments for assessing specific ICF categories, they must know which ICF categories are covered by which instrument. By linking instruments to the ICF, additional information about the instruments is generated that could be used for further development. In adult rheumatology and musculoskeletal rehabilitation, the relationship between occupation-based instruments and the ICF has not been explored.

The link between instruments that are used in practice and the ICF could improve the communication and understanding between health professionals because the ICF is intended to be used as a unifying model and common language in all health professions. It could show the specific focus of some instruments that are used by certain professional groups. It could also help to clarify the focus and perspective of different health professionals working together in multidisciplinary teams. It is important that different health professionals are familiar with each other's focus and perspective. Understanding each other's focus and perspective could enhance the quality of multidisciplinary team care in rheumatology.

The objective of this article was to explore the relationship of clinical, occupation-based instruments that are used in adult rheumatology and musculoskeletal rehabilitation in occupational therapy to the ICF. The specific aims were to examine the content of these instruments by linking them to the ICF, to explore which concepts of the instruments were covered by the ICF, to compare the content of these instruments based on the ICF, and to evaluate the differences between these instruments.

METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES

Search strategy.

A structured literature search was undertaken. The following databases were used for the literature search: CINAHL R (1982–1998 and 1999–2003), AMED (1985–2003), Medline (1967–2003), OTD-Base (1970–2003), and the literature register of the Vienna University ALEPH (1989–2003). The following key words were used in combinations: instrument, measure, assessment, functional assessment, outcome, occupational therapy, occupational performance, occupation, activity, muscoloskeletal care, rehabilitation, and rheumatology. If an instrument was found in the literature, specific articles on validity and reliability of the instrument were searched. If the instrument was not validated, the instrument was not included.

The criteria for inclusion of the instruments were as follows: 1) clinical instruments that assess occupation, occupational performance, or functional performance; 2) established validity; 3) commonly used in adult rheumatology or musculoskeletal rehabilitation by occupational therapists; 4) publication in a peer-reviewed journal; and 5) existence of an English version of the instrument.

Whether an instrument was valid or not was judged according to whether validity of the instrument was established in the literature. Every instrument had to be validated in rheumatology or musculoskeletal rehabilitation. Instruments that intend to measure functional performance only (as described by the authors of the measurement) were also included if they relate to a task because theses instruments are commonly used in practice in occupational therapy in adult rheumatology or musculoskeletal rehabilitation. Whether the instruments were used commonly in rheumatology and musculoskeletal rehabilitation was judged according to the opinion of 3 expert occupational therapists and 2 expert rheumatologists who work in different settings in Europe.

We chose to include not only measures of occupational performance but also measures of functional performance because they provide important information regarding limitations in occupational performance. According to Townsend (8), occupational performance can be defined as the result of the dynamic relationship between the person, the environment, and the occupation. It refers to the ability to choose and satisfactorily perform meaningful occupations that are culturally defined, and appropriate for looking after one's self, enjoying life, and contributing to the social and economic fabric in the community. Occupations are groups of activities and tasks of everyday life.

Functional performance can be defined as the ability to conduct a specific task that could be related to daily living activities, for example picking up small objects or writing a sentence. It is important to note that measures of occupational performance and measures of functional performance typically differ in an important aspect. Although measures of occupational performance refer to what an individual does in his or her current environment, measures of functional performance refer to an individual's ability to execute a task or an action in a standardized environment (4). This difference is addressed in the ICF in the distinction of performance and capacity.

Linking to the ICF.

In the ICF classification, the letters b, s, d, and e, which refer to the components of the ICF, are followed by a numeric code starting with the chapter number (1 digit), followed by the second (2 digits), third, and fourth levels (1 digit each). The component letter with the suffix of 1, 3, 4, or 5 digits corresponds with the code of the so-called categories. Categories are the units of the ICF classification. Within each chapter, there are individual 2-, 3-, or 4-level categories. An example selected from the component body functions (b) would result in the following code: b2 sensory functions and pain is the first level, b280 sensation of pain represents the second level, b2801 pain in body part corresponds with the third level, and b28013 pain in back corresponds with the fourth level.

Within each component, the categories are arranged in a stem/branch/leaf scheme. Consequently, a lower level category shares the higher level categories to which it belongs, i.e., the use of a lower level (more detailed) category automatically implies that the higher level category is applicable, but not the other way around. At the end of each embedded set of third- or fourth-level categories and at the end of each chapter, there are other specified categories (uniquely identified by the final code 8) and unspecified categories (uniquely identified by the final code 9). These unspecified categories are used if the item in the measurement is not explicitly specified.

To compare the content of the identified instruments on the basis of the ICF and to examine the differences, every item of the instruments was linked to the appropriate ICF category. Linking rules have been developed to link health-status measures to the ICF in a specific and precise manner (10). On the basis of these linking rules, each item of an instrument should be linked to the most detailed ICF category. If the content of an item was not explicitly named in the corresponding ICF category, the other specified option at the third and fourth coding level of the ICF classification was linked. If the content of an item was more general than the corresponding ICF category, the code of the higher level was linked. If an item was not contained in the ICF classification, this item was assigned an nc code (not covered) (10).

In addition, for each item linked to category d (activity and participation), it was examined whether the item refers to a task (capacity) or to life involvement (performance) according to the ICF model. Capacity refers to an individual's ability to execute a task or an action in a standardized environment, and performance describes what an individual does in his or her current environment (4). The judgment was made by 2 health professionals according to the description or definition of the item of the instrument in the literature.

Consensus between health professionals was used to decide which ICF category should be linked to each item of the instruments. To resolve disagreement between the 2 health professionals concerning the selected categories, a third person trained in the linking rules was consulted. In a discussion led by the third person, the 2 health professionals that linked the item stated their pros and cons for the linking of the concept under consideration to a specific ICF category. Based on these statements, the third person made an informed decision.

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES

Literature search.

Literature was included for further analysis if it either described an instrument used in rheumatology and musculoskeletal rehabilitation based on occupation, occupational performance, or functional performance in detail or if it described its validity or reliability. Books were only included if they referred to a publication in a peer-reviewed journal. From the literature review, 24 relevant articles and 3 books were selected for further analysis.

The following instruments were identified in the analyzed articles and selected for inclusion for our study: Canadian Occupational Performance Measure (COPM), Assessment of Motor and Process Skills (AMPS), Sequential Occupational Dexterity Assessment (SODA), the Jebsen Taylor Hand Function Test (JT-HF), the Moberg Picking Up Test (MPUT), the Button Test (Button), and the Functional Dexterity Test (FDT). The FDT was included as an example for other pegboard tests that measure exactly identical functions, e.g., the Purdue Pegboard Test (11). The FDT was chosen as an example for other pegboard tests because a peer-reviewed publication on validity in musculoskeletal rehabilitation was found only for the FDT.

Instruments.

Canadian Occupational Performance Measure.

The COPM evaluates the performance, satisfaction, and importance of up to 5 problems that the individual has to identify in the areas of self care, productivity, and leisure. Each area is divided into 3 more specific items. Individuals rate their performance and satisfaction on the self-selected activities on a 10-point Likert scale. The COPM is a semiindividualized, client-centered instrument that is based on the underlying Canadian Model of Occupational Performance. The test–retest reliability has been documented at 0.63 for performance and 0.84 for satisfaction. Validation studies have been done in a variety of clinical fields. Average time to administer the test is 40 minutes (12–15).

The Assessment of Motor and Process Skills.

The AMPS evaluates motor and process skills (in 2 different scales) and assesses their impact on clients' ability to perform personal and instrumental activities of daily living. The AMPS is a semiindividualized, client-centered, task-oriented functional assessment. The client must select an activity from a specific list of calibrated activities. Reliability has been demonstrated (intrarater r = 0.93, test–retest motor r = 0.88, process r = 0.86). Studies show cross-cultural validity and validity in adult rehabilitation. Average time to administer is 30–60 minutes (16–22).

Sequential Occupational Dexterity Assessment.

The SODA is an instrument designed specifically for persons with rheumatoid arthritis to measure bimanual hand dexterity. The intention is to measure the consequences of the disease on functional performance and activity. The SODA includes 12 task items, e.g., writing a sentence (item 1) and pouring water into a glass (item 10). Test–retest reliability has been documented at 0.93. Validity has been demonstrated in rheumatology in relation to demographic variables and the Disease Activity Score. Average time to administer is 20 minutes. A short version with 6 items exists (23, 24).

The Jebsen Taylor Hand Function Test.

The JT-HF is a hand function test with 7 items. It is a unilateral test because it tests 1 hand after the other. It includes items such as simulated feeding (item 4) and picking up large, light objects (item 6). Reliability has been documented at 0.60–0.99. The JT-HF has been validated in adult rheumatology and rehabilitation. Average time to administer is 60 minutes (25).

The Button Test.

The Button Test is an instrument that measures sensory and motor hand function. It is a bilateral, but single-handed test. It assesses the ability to manipulate and unbutton and rebutton 5 buttons (with one hand at a time) while time is taken with a stopwatch. The standard protocol requires a standardized button board that has to be placed on the table in front of the individual. Reliability has been documented at 0.80. Validity has been established in rheumatology. Average time to administer is 10 minutes (26–28).

Moberg Picking Up Test.

MPUT is a unilateral measurement of hand function. It assesses the picking up function of both hands. MPUT consists of 12 small objects that have to be picked up with one hand while time is taken with a stopwatch. A standard protocol has been established and intrarater reliability has been found to be 0.87. When administered blindfolded, MPUT has been described to assess sensory function grip of the hand (29). When administered with open eyes, validity has been demonstrated in persons with inflammatory joint diseases in comparison with consensus core set measures in rheumatology. Average time to administer is 5 minutes (30).

The Functional Dexterity Test.

The FDT measures hand dexterity on one specific item: to take 16 pegs out of a board, turn them once and place them back in their place in the board. Time is taken with a stopwatch. Interrater reliability has been demonstrated at 0.62 for uninjured hands and 0.82 for injured hands. Validity has been established in adult rehabilitation (31).

Linking to the ICF.

The 86 items of the 7 instruments were linked to 53 different ICF categories. Items were linked to 8 categories of the component body functions and to 45 categories of the component activities and participation. No items were linked to the components body structures, environmental factors, or personal factors. Five items from the AMPS could not be linked to the ICF and were coded nc (Table 1). These 5 items included the following: calibrates and flows from the motor skills group and restores, heeds, and benefits from the process skill group.

Table 1. Links between the ICF categories and the instruments*
ICF categoryCOPMAMPSSODAJT-HFMPUTButtonFDT
  • *

    All items attributed with a capacity perspective, unless othewise noted. ICF = International Classification of Functioning, Disability and Health; COPM = Canadian Occupational Performance Measure; AMPS = Assessment of Motor and Process Skills; SODA = Sequential Occupational Dexterity Assessment; JT-HF = Jebson Taylor Hand Function Test; MPUT = Moberg Picking Up Test; Button = Button Test; FDT = Functional Dexterity Test.

  • A performance perspective was attributed to these items.

  • Both performance and capacity levels were attributed to these items.

Body functions
 b130 Energy and drive functions, unspecified 1     
 b1643 Cognitive flexibility 3     
 b1649 Higher level cognitive functions, unspecified 4     
 b2801 Pain in body part  12    
 b7359 Muscle tone functions, unspecified 1     
 b7409 Muscle endurance functions, unspecified 2     
 b7658 Involuntary movement functions, unspecified 1     
 b7609 Control over voluntary movement functions: unspecified 1     
Activity and participation
 d160 Focusing attention 1     
 d170 Writing  11   
 d177 Making decisions 1     
 d179 Applying knowledge, other specified and unspecified 1     
 d2108 Undertaking a single task, unspecified 5     
 d3609 Communication, unspecified1      
 d4109 Changing basic body position, unspecified 1     
 d415 Maintaining a body position, unspecified 1     
 d4209 Transferring oneself, unspecified1      
 d4300 Lifting 1     
 d4309 Lifting and carrying, unspecified 1     
 d4400 Picking up  2112 16
 d4401 Grasping  31   
 d4402 Manipulating 111 516
 d4408 Fine hand use, other specified  12   
 d4409 Fine hand use, unspecified 1     
 d4453 Turning or twisting the hands or arms  1    
 d4458 Hand and arm use, other specified  31   
 d4459 Hand and arm use, unspecified 3     
 d4509 Walking, unspecified 1     
 d4709 Using transportation, unspecified2      
 d499 Mobility, unspecified11     
 d5100 Washing of body parts  1    
 d5109 Washing oneself, unspecified1      
 d5102 Drying oneself  1    
 d5209 Caring for body parts, unspecified1      
 d5409 Dressing, unspecified1      
 d599 Self care, unspecified1      
 d629 Acquisition of goods and services, unspecified1      
 d6309 Preparing meals, unspecified1      
 d6409 Doing housework, unspecified1      
 d649 Household tasks other specified and unspecified1      
 d6509 Caring for household objects, unspecified1      
 d839 Education, other specified and unspecified1      
 d8459 Acquiring, keeping, and terminating a job, unspecified1      
 d859 Work and employment, other specified and unspecified1      
 d879 Economic life, other specified and unspecified1      
 d9109 Community life unspecified1      
 d9200 Play1      
 d9201 Sports1      
 d9202 Arts and culture1      
 d9203 Crafts1      
 d9204 Hobbies1      
 d9205 Socializing1      
 d9209 Recreation and leisure, unspecified2      
Not covered 5     

Table 1 shows the comparison of the items in the instruments using the ICF categories as a reference and ordered by component. The numbers in the table represent the frequencies with which the ICF categories were addressed in the different instruments. A higher number indicates that several items from a specific instrument were linked to the same ICF category. For example, the category b1643 cognitive flexibility was linked to the following 3 items in the AMPS: navigates, accommodates, and adjusts in the process skill group.

The areas covered by the occupation-based instruments differ importantly. Body functions are covered only in the AMPS and the SODA, whereas the SODA specifically covers b2801 pain in body part and the AMPS addresses a broader number of functions, including mental- and mobility-related functions. All the other instruments focus on the component activities and participation. Items from 4 of these instruments (JT-HF, MPUT, Button, and FDT) were linked to categories from Chapter 5, mobility. Button and MPUT were linked to 1 single ICF category. The JT-HF and the SODA cover a broader spectrum in Chapter 5, mobility. Especially, the categories d440 fine hand use and d445 hand and arm use are addressed.

The COPM covers a large spectrum in Chapters 5 (self care), 6 (domestic life), 8 (major life areas that includes education, work and employment, and economic life) and 9 (community and social and civic life). For 21 items of the COPM, a performance perspective was differentiated; for 4 items, a capacity and performance perspective was attributed; all other items were found to have a capacity perspective (Table 1). The linking table of the COPM was included as an example for the linkage procedure (Table 2). The SODA covers a smaller spectrum than the COPM, but seems to be a usable complement for the COPM because it exclusively covers other categories than does the COPM. The SODA was linked to a larger spectrum of ICF categories than the JT-HF. Nevertheless, both instruments address concepts within Chapter 5, mobility.

Table 2. Canadian Occupational Performance Measure (COPM)*
COPM itemICF categoryC and P
  • *

    ICF = International Classification of Functioning, Disability and Health; C = capacity; P = performance.

Step 1A: self care  
 Personal care (e.g., dressing, bathing, feeding, hygiene)d599 Self care, unspecifiedC, P
 d5409 Dressing, unspecifiedC, P
 d5109 Washing oneself, unspecifiedC, P
 d5209 Caring for body parts, unspecifiedC, P
 Functional mobility (e.g., transfers, indoor, outdoor)d499 Mobility, unspecifiedP
 d4209 Transferring oneself, unspecifiedP
 Community management (e.g., transportation, shopping, finances)d629 Acquisition of goods and services, unspecifiedP
d4709 Using transportation, unspecifiedP
 d879 Economic life, other specified and unspecifiedP
Step 1B: productivity  
 Paid/unpaid work (e.g., finding/keeping a job volunteering)d8459 Acquiring, keeping, and terminating a job, unspecifiedP
P
 d895 Work and employment, other specified and unspecifiedP
P
 Household management (e.g., cleaning, laundry, cooking)d6309 Preparing meals, unspecifiedP
d6409 Doing housework, unspecifiedP
 d649 Household tasks, other specified and unspecifiedP
 d6509 Caring for household objects, unspecifiedP
 Play/school (e.g., play skills, homework)d9200 PlayP
 d839 Education, other specified and unspecifiedP
Step 1C: leisure  
 Quiet recreation (e.g., hobbies, crafts, reading)d9209 Recreation and leisure, unspecifiedP
 d9204 HobbiesP
 d9203 CraftsP
 Active recreation (e.g., sports, outings, travel)d9209 Recreation and leisure, unspecifiedP
 d9201 SportsP
 d9202 Arts and cultureP
 d4709 Using transportation, unspecifiedP
 Socialization (e.g., visiting, phone calls, parties, correspondence)d9205 SocializingP
d9109 Community life, unspecifiedP
 d3609 Communication, unspecifiedP
Step 2 (involved in Step 1A, 1B, and 1C)The client has to rate each activity for importance from 1 to 10 (with 1 being “not important at all”) and for the level of current performance and satisfaction also from 1 to 10 (with 1 being “not able to do it” and “not satisfied at all”). 

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES

The ICF covers the concepts that are represented by these 7 occupation-based instruments in musculoskeletal rehabilitation. It was possible to link all items to the ICF, except 5 items that were not covered. The perspective of capacity or performance could be attributed to every item from category d (activity and participation) of the ICF.

All 7 instruments were found to be etiologically neutral because they do not bridge to the health condition that causes the disability. For example, the first item in the COPM is personal care. The COPM does not question about the reason for the disability, nor about an underlying health condition. The item was linked to the d category self care on the activity and participation level of the ICF. The first item of the SODA is writing a sentence, which was linked to d170 writing. The patient has to rate the ability and the level of pain when performing the task, but there is no question about the causal relationship to the underlying health condition. This is different from condition-specific instruments because they often bridge between an impairment and a health condition, such as, for example, the self-administered Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for hip and knee osteoarthritis: Item B.1 in the WOMAC asks about morning stiffness associated to the left knee. This item bridges to the health condition osteoarthritis (in the left knee), and is thus specific for this health condition. Based on these results, the ICF proved to be useful for examining these instruments because it provides future methodologic suggestions. It may be interesting to repeat this kind of analysis for instruments that are used in other fields of occupational therapy and that are based on occupational or functional performance to find out whether all these instruments are disease neutral. Our hypothesis is that if occupational therapists focus on the occupational problems of their patients independent of their health condition, they might need disease-neutral assessments. Further research is suggested.

The content of the occupation-based instruments differs importantly (Table 1), and some areas are not covered at all. No item was found to be related to the ICF chapter personal factors. Environmental factors are included in part 2, contextual factors, in the ICF. In all 7 measurements, environmental factors are not explicitly covered. For example, the COPM does not explicitly ask about environmental factors. It may be argued that environmental factors are implicitly represented in the COPM items because the underlying theoretical model of occupation, the Canadian Occupational Performance Model, includes environmental factors as an important component of meaningful occupation. The manual of the COPM suggests that it is essential for the therapist to use their interview skills when performing the COPM. The COPM is understood as initial assessment for the therapeutic process that focuses on the underlying factors for the problem areas (14). From this perspective, it could be argued that some of the items might target environmental factors in addition to their main component: For example, the item community management: transportation in addition to d4709 using transportation, unspecified, could be linked to the environmental factor e5409 transportation services, systems and policies, unspecified as a basis and as a relevant factor under using transportation (in the activity and participation component). But because the environmental factors are not explicitly addressed in the instrument, the item was linked only to the activity and participation component of the ICF in our study. Environment is a major contribution to occupation. It can be discussed whether the measurement of occupation or occupational performance should include environmental factors explicitly to cover a broader perspective of occupation and to guarantee a certain aspect of reliability of its use. However, the COPM is ambiguous in a certain aspect: a client who identifies a present problem in the COPM might relate the problem to an environmental component or a personal component due to the individualized nature of the problem. Because of this ambiguity, we decided according to the linking rules to link only what was explicitly mentioned in the COPM.

It is important for health professionals to make a distinction between capacity and performance for each category if they want to differentiate between occupational and functional performance. Only the COPM was found to address the performance component of the ICF because all other instruments involve the execution of tasks in test environments. Instruments that focus only on specific areas of functional performance (such as MPUT, Button, FDT) cover only a very narrow and specific field of ICF components.

Pegboard tests do not reflect occupation. However, at least according to the definition of the ICF, pegboard tests refer to activities. Accordingly, we linked the FDT to the ICF categories d4400 picking up and d4402 manipulating. The intuitive objection against the attribution of the pegboard test comes from the fact that the patient performs the task in a test environment that refers to a standard situation and not to the performance in real life. In the ICF, the pegboard test therefore describes a capacity rather than a performance. Such instruments could be used to assess the specific category that is covered. These instruments might be adequate measures for the underlying components of occupational performance as a possible outcome of treatment. To cover a broader spectrum of ICF categories, one could use the COPM in addition to instruments that assess underlying functions for occupational performance, such as the AMPS. The AMPS covers a variety of body functions and could be used as an instrument if this is considered a relevant outcome for the treatment.

The AMPS uses a task that the individual has to perform to evaluate the motor and process skill items. Different from the COPM, in which the items were attributed a participation perspective, the items in the AMPS were linked to the activity perspective only because in administering the AMPS, the therapist sets up the environment either in the clinic or at home and the individual has to perform the chosen task.

In our linking process, it turned out to be highly useful to discuss the linking between different professional groups. In adult rehabilitation and rheumatology, occupational therapists apply and add a specific perspective to the rehabilitation team when they use the components and categories of the ICF: engagement in meaningful occupations. Assessment should then be on this level as well. By linking the items of the analyzed instruments to the ICF, it became obvious that the occupation-based instruments are intended to be used in this specific perspective. The specific perspective of occupational therapists might be represented by the underlying conceptual models, such as the Canadian Model of Occupational Performance, which is the underlying model of the COPM (12). Occupational therapists might use these models in addition to the ICF when they work in multidisciplinary teams.

For the use of more complex instruments (such as the AMPS), a training course is a requirement to address all the relevant issues. Some of the instruments (such as SODA, JT-HF, MPUT, Button, or FDT) were found to be mostly related to functional performance. It can be questioned whether these instruments address a too narrow spectrum of ICF categories to give a comprehensive picture of occupation and treatment outcome. But if these instruments are only used to assess the specific category that is addressed or if they are used to assess underlying factors for occupational performance (for example in the MPUT, Button, or FDT the categories d4400 picking up and d4402 manipulating), these measures could be highly useful.

In conclusion, the ICF proved to be very useful for examining clinical occupation-based instruments. Clinicians and researchers who need to select an occupation-based instrument must be aware of the areas that are covered by this instrument and the potential areas that are not covered at all. This content comparison based on the ICF could enable occupational therapists, other health professionals, and researchers in rheumatology to choose the adequate instrument that covers the area of problem and treatment to evaluate a specific outcome. It could also serve as a basis for further development of occupation-based instruments in occupational therapy in musculoskeletal rehabilitation.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. REFERENCES
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