Principles of Assessment and Outcome Measurementfor Occupational Therapists and Physiotherapists - Theory, Skills and Application
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More About This Title Principles of Assessment and Outcome Measurementfor Occupational Therapists and Physiotherapists - Theory, Skills and Application


This textbook on assessment and outcome measurement is written for both occupational therapy and physiotherapy students and qualified therapists. It begins by defining what is meant by assessment, outcome, evaluation and measurement and discussing the complexity of therapy assessment and measurement, including the challenge of measuring human behaviour and the impact of factors such as task demand and context, including the environment. Methods of data collection (e.g. observation, interview, standardised testing) and sources (e.g. self-report, proxy) for collecting information about clients are then reviewed, and the main purposes of assessment (e.g. descriptive, evaluative, predictive, discriminative) presented. The book then addresses the topics of standardisation, levels of measurement, reliability, validity and clinical utility. There is a chapter describing and applying models for categorizing levels of function to aid assessment and measurement. The concept of clinical reasoning and reflective practice is then explored. Application of principles is supported through detailed case studies and worksheets and the criteria for test critique and guidelines for choosing a particular assessment approach are discussed.


Alison Laver-Fawcett, PhD, OT(C)), DipCOT, SROT currently Modernisation Manager, Service Development (Provider Services) and Interim Professional Lead for Occupational Therapy, North Yorkshire and York Primary Care Trust.


Introduction (Alison Laver Fawcett, PhD, DipCOT).

Occupational Therapy and Physiotherapy.

Labels used for providers and recipients of therapy services.

The importance of the selection and application of terminology in practice.

Definitions of key terms.

Summary of definitions..

Chapter 1:The importance of accurate assessment and outcome measurement (Alison Laver Fawcett, PhD, DipCOT).

Chapter summary.

Assessment as a core part of the therapy process.

The impact of health and social care policy on assessment practice.

The demand for evidenced-based practice.

Implementation of evidence-based practice.

Levels of evidence and grades of recommendations.

The application of standardised assessments.

The use of standardised versus non-standardised assessments.

Benefits of applying standardised measures.

The requirement to demonstrate effectiveness.

A focus on client-centred practice.

The demand for robust clinical governance.

The use of standards, protocols, guidelines and care pathways.

The complexity of assessment.

The nature of therapeutic practice.

The nature of human occupation and occupational performance.

The nature of human function and the complexity of measuring functional outcomes.

The influence of the level of task demand.

The impact of familiarity on performance.

The influence of environment upon performance.

The constraints of the practice setting.


The Big Question.

Chapter 2: Methods of assessment and sources of assessment data(Alison Laver Fawcett, PhD, DipCOT, Sally Payne, MSc, BSc, DipCOT and Claire Howell, BScOT (Hons)).

Chapter summary.

Methods of data collection.

Sources of Assessment Information.


Interviewing as a means of collecting self-report data.

Communication, insight and capacity issues.

Cultural issues and self-report data collection.

Examples of self-report assessments.

Proxy report.

Examples of assessments that use information from a proxy.

Measures that assess the proxy (e.g. Care-giver and parent burden scales).

Observational assessment methods.

Examples of observational assessment.

Combining methods.

Examples of how therapists combine different assessment methods.



Further reading.

Case Study: Scott, by Sally Payne and Claire Howell.

Reflecting on the data collection methods you use in your practice.

Study questions.

Chapter 3: Purposes of assessment and measurement (Alison Laver Fawcett, PhD, DipCOT and Karen Innes, BSc OT, DMS, Cert Counselling).

Chapter summary.

Timing of assessment in the therapy process.


Initial Assessment.

Information Gathering.

Initial Assessment.

Ongoing evaluative assessment.


Purposes of assessment.

Descriptive assessments.

Discriminative assessments.

Predictive assessments.

Evaluative assessment.

Assessment for particular purposes.

Capacity assessment.

Assessment for tribunals.

Risk assessment.

Needs assessment - considering wider populations.

Sharing your purpose.

Case vignette: Mr Smith.

Service Evaluation.

Service Structures.



Service outcomes.

Service inputs.

Beginning a service evaluation.

Case study: service evaluation - The Development and initial evaluation of a Memory Activity and Self Help (MASH) Group by Karen Innes and Alison Laver Fawcett.

Reflecting on purposes of assessment in your own practice.

Study questions.

Chapter 4: Levels of measurement (Alison Laver Fawcett, PhD, DipCOT).

Chapter summary.

What is measurement?

What is measurement theory?

The assignment of numbers for the purposes of assessment.

What are levels of measurement?

Nominal Scales.

Ordinal Scales.

Interval Scales.

Ratio Scales.

Application of different levels of measurement - issues to consider.

Guttman scaling.

Rasch analysis.

Applying concepts of levels of measurement to your own practice.

Study questions..

Chapter 5: Standardisation and test development (Alison Laver Fawcett, PhD, DipCOT).

Chapter summary.

Standardized assessments.

Why should therapists use standardised tests?

What is a standardised test?

What is an un-standardised assessment?


Test construction decisions.

Criterion-referenced tests.

Norm-referenced tests.

Criteria for judging norms.

Obtained score.

Raw score.

Frequency distribution.



Normal distribution.

Standard deviation.

Percentile Values.

Percentile rank.

Training and interpreting standardised test scores.

Psychometric properties.


Study questions.

Chapter 6: Validity and clinical utility (Alison Laver Fawcett, PhD, DipCOT).

Chapter summary.

Definition of validity.

Content validity.

Construct Validity.

Factorial Validity.

Discriminative validity.

Criterion-related validity.

Concurrent validity.

Predictive validity.

Other types of validity.

Definition of Ecological validity.

Definition of External validity.

Establishing the overall validity of a test .

Face Validity.

Clinical utility.



Energy and effort.



Examining validity and clinical utility issues: test examples.

Applying concepts of validity to your own practice.

Study questions.

Chapter 7: Reliability (Alison Laver Fawcett, PhD, DipCOT.)

Chapter summary.

Introducing the concept of reliability.

Defining reliability.

Reliability coefficients and standard error of measurement.

Level of significance.

Error of measurement.

Standard error of measurement (SEM).

Confidence interval.

Types of reliability.

Test-retest reliability.

Inter-rater reliability.

Intra-rater reliability.

Rater severity.

Parallel form reliability (equivalent or alternate form).

Internal consistency.

Methodological issues.

Test specificity.

Test sensitivity.

Floor and ceiling effects.

Reliability statistics.

The statistic used to calculate the level of reliability can impact the results.

Percentage agreement (P).

Intra class correlation coefficients (ICC).

Pearson product-moment correlation coefficient.

Cohen's Kappa (K).

Comparing statistical methods for evaluating reliability.

Examining reliability data: test examples.


Applying concepts of reliability to your own practice.

Study questions.

Chapter 8: Test administration, reporting and recording (Alison Laver Fawcett, PhD, DipCOT and Rachael Hargreaves, BSc(Hons) SROT).

Chapter summary.

Steps in the Test Administration Process.

Step 1: Preparation for testing.

Gaining consent to assess.

Test selection.

Organising the environment.

Preparing tools, materials and equipment.

Timing your assessment.

Clarifying Expectations.

Step 2: Test administration.

Developing rapport.

Using standardised tests.

Following standardised procedures.

Use of prompting and cues.

Step 3: Scoring.

Step 4: Analysis of scores.

Step 5: Interpreting test scores.

Step 6: Decision making in light of the interpretation of test scores.

Step 7: Client feedback about the test results and implications.

Step 8: Recording and reporting results.

Headings for writing a report on a standardised test administration.

Record keeping.

Electronic care records.


Case example: James’ Assessment of Motor and Process Skills (AMPS) report by Rachel Hargreaves.


Study questions.

Chapter 9:Applying models of function to therapy assessment and measurement (Alison Laver Fawcett, PhD DipCOT and David Jelley).

Chapter Summary.

Why use models?

The complexity of human function.

General systems theory and the hierarchy of living systems.

International Classification of Impairment, Disability and Handicap.

Wade’s (1988) 4-level model for people with stroke.

Five Level Model of Function and Dysfunction.

Description of the NCMRR five levels of Function / Dysfunction.

International Classification of Functioning, Disability and Health (ICF).

Applying the ICF to therapy assessment.

‘Top-down’ versus ‘bottom-up’ assessment approach.


Case Study: Mary, by David Jelly and Alison Laver Fawcett.


Study questions.

Chapter 10: The importance of clinical reasoning and reflective practice in effective assessment (Alison Laver Fawcett, PhD, DipCOT and Karen Innes, BSc OT, DMS, Cert Counselling).

Chapter Summary.

Clinical reasoning as an essential component of practice.

Clinical judgement and clinical reasoning.

Scientific reasoning.

Deductive reasoning.

Inductive reasoning.


Procedural reasoning.

Diagnostic reasoning and the therapy diagnosis.

Problem-orientated clinical reasoning process.

Problem setting.

Framing the problem.

Delineating the problem.

Pattern recognition, hypotheses and heuristics.



Therapy diagnosis.

Diagnostic statement.

Descriptive component.

Explanatory component.

Cue Component.

Pathologic component.

Other forms of reasoning.

Interactive reasoning.

Conditional Reasoning.

Narrative reasoning.

Client / Therapist stories.

Prospective treatment story.

Therapists sharing stories.

Pragmatic reasoning.

Ethical reasoning / moral reasoning.

Reflective practice.

Reflective practice as a component of continuing professional development.

Cognitive dissonance.

Novice to Expert continuum.

Further reading.

Case study: Mrs Ellis’ Initial Assessment Process by Karen Innes and Alison Laver Fawcett.


Study Questions.

Chapter 11:Implementing the optimum assessment and measurement approach (Alison Laver Fawcett, PhD, DipCOT).

Chapter summary.

Improving assessment and measurement practice: where to begin?

Analysing your current assessment practice.


Mapping your current assessment and measurement process.

Improving your assessment process.

PDSA cycle approach.


Selecting tests.

Exploring the literature for examples of tests and test critiques.

Example reviews and critiques in books.

Example reviews and critiques in journal articles.

Test Critique.

Questions for undertaking a Test Critique.

An example Test Critique: The Parenting Stress Index (PSI).

Obtaining permission to use a test for your clinical practice or for research.

Modifying a standardised test.

Linking improving your assessment practice to continuing professional development.

Assessment and outcome measurement goals for effective practice.

Conclusion: achieving an effective and efficient assessment.

Study questions and tasks.

Chapter 12: The Final Case Study: ‘Carol’ experience of a Chronic Pain Service (Alison Laver Fawcett, PhD DipCOT, Gail Brooke, Dip Phys, Cert in Health Service management, and Heather Shaw, DipCOT).

Introduction to the therapists and the Chronic Pain service.

The Chronic Pain Service.

Standardised measures used in the service.

Introduction to the Case ‘Carol’.


Initial assessment.

Multi-disciplinary team (MDT) half-day clinic assessment process.

Physiotherapy assessment.

Occupational therapy assessment.

Description of the therapy diagnosis / problem.

Multi-disciplinary team meeting with Carol.

Summary of the results other team members’ assessments.



Carol’s Individual Treatment Plans: Occupational Therapy.

Carol’s Individual Treatment Plans: Physiotherapy.

Individual treatment sessions with the physiotherapist.

Individual treatment sessions with the occupational therapist.

The Group intervention programme: Turnabout.

Carol’s Completion Story.

Carol’s Goal Planning.

Outcome measurement and discharge.

First follow-up evaluation.

Six month follow-up evaluation.

Carol’s COPM change scores.

Service Review.

Brief answers to study questions.






"This book provides a comprehensive guide to the background, rationale and utilization of assessment and outcome measurement. It justifies the importance of taking a robust approach towards outcome measurement, and contains sections on validity, reliability and the often-overlooked aspect of clinical utility." (Physiotherapy Journal, March 2010)

"...this is one book that I bought for myself as soon as it was published." (British Journal of Occupational Therapy, February 2008)

"This is a useful textbook for occupational therapists and physiotherapists or those studying to become one." (Occupational Health, March 2008)