Participation-focussed evaluation: Impact on practice

Abstract

Evaluation is a keystone in the process of rehabilitation that is used to plan and monitor holistic, client-centred, goal-directed programs. However, many common assessment tools do not fit well with the specific expertise of occupational therapists (OTs). Dynamic assessment uses interactions with clients as a context to both observe current performance and test possibilities for intervention. In this way, OTs may substantiate their clinical reasoning. Methods. This study aimed to examine OTs’ implementation of a dynamic assessment of participation called COMPLEAT©. Participants were 14 OTs with varied experience, and 29 of their younger adult (<65 years) clients with diverse aetiologies and sequelae of brain injury. Data were collected from multiple sources in a process from introducing the OTs to COMPLEAT© and providing basic training, to interpreting their observations. Two phases of analyses examined the sociocultural influences on the implementation of COMPLEAT©, and the strategies used with clients of varying levels of participation restriction. Results. From a sociocultural perspective, the OTs (i) facilitated their clients’ participation through both direct responses and enabling environmental supports, (ii) brought to the process experiences and views on working with clients and using standardised assessments, and (iii) utilised COMPLEAT© according to their roles and experience. Overall, they facilitated participation using complex combinations of responses according to clients’ levels of participation restriction. Conclusions. Dynamic assessment, and COMPLEAT© in particular, has application to substantiating OTs’ clinical reasoning and expertise in participation. With this evidence, OTs might promote a focus on participation within their rehabilitation teams, consolidate their teams’ perceptions of their roles, and further develop assessments that support the planning and implementation of interventions consistent with the theoretical foundations of OT.