Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

Abstract

Background: With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments. Method: An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR ¼ 36%) Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%). Conclusion:The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice. ARTICLE HISTORY

The conflicted practice: Municipal occupational therapists’ experiences with assessment of clients with cognitive impairments

“…The standardized assessment tools preferred by the participants were tools perceived as time efficient, easy to manage and by request by their colleagues. They participants emphasized that they needed tools that were quick and easy to manage, as reported in previous studies (1,4,6,8,11,(13)(14)(15)(16). The participants did however reflect upon the results of these assessments and for what they could be used.…”

“…Norwegian OTs work with multiple client groups (15), within different fields and areas (28), and municipal care OT is a central and growing profession as in other parts of the world (29)(30)(31). Within municipal care, the group of young service recipients with long-term and complex somatic disorders, such as multiple sclerosis (MS), Parkinson's disease, epilepsy, stroke, brain injuries and brain tumors has doubled in the past 10 years (32,33).…”

“…A recent study investigated the practice of Norwegian OTs related to clients with cognitive impairments in the context of municipal service, and the results indicated challenges in regards to the preferred methods and standardized assessment tools used by OTs. One of the most frequently used methods was observation of occupational performance, however, the occupation based standardized assessment tools were not generally used, indicating that most of the observations done were unstructured (15). A prerequisite for development of any profession is said to be the critical evaluation of the current practice (36) and the OT profession has been critiqued for not having done that extensively (37,38).…”

“…On the other hand, several participants found the AMPS to be a difficult tool to use, as they perceived it as too rigid to be suitable to use in the context of their practices. A recent study investigating the practice of Norwegian OTs in municipal practice found that standardized observational assessment tools such as the AMPS (47), PRPP (48) and the A-ONE (50) were used, although to a limited extent (15). So why is it that the OTs are so reluctant to use the standardized observation based assessments in their practices?…”

“…OTs use a variety of methods during the assessment process, such as interviews, cognitive screening tools, performancebased assessments and specific cognitive measures (3). Several research studies have investigated OTs' pattern of practice related to assessment of clients with cognitive impairments (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Although top--down assessments are often non--standardized, such as informal interviews and unstructured observation (1, 4, 7-12, 14, 15), they are considered as more important for OTs than standardized, bottom--up assessments (1,4,10).…”