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Rehab Measures: Australian Therapy Outcome Measures for Occupational Therapy

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Link to Instrument 

Title of Assessment

Australian Therapy Outcome Measures for Occupational Therapy 

Acronym

AusTOMs-OT

Instrument Reviewer(s)

Initial review and summary completed by Amanda Timmer and Carolyn Unsworth.

Summary Date

8/31/2016 

Purpose

The AusTOMs-OT is a measure of global functional outcomes for clients of all ages, all diagnoses and in all settings.

Description

·     Developed in Australia and is now used internationally (e.g. United Kingdom, Canada, New Zealand, Singapore, Sweden).

·     Therapists select from12 function-focused scales that match client goals as follows:

1.       Learning and applying knowledge

2.       Functional walking and mobility

3.       Upper limb use

4.       Carrying out daily life tasks and routines

5.       Transfers

6.       Using transport

7.       Self-care

8.       Domestic life- inside house

9.       Domestic life- outside house

10.    Interpersonal interactions and relationships

11.    Work, employment and education

12.    Community life, recreation, leisure and play

·     Each scale scores the client in relation to 4 domains: 

1.       Impairment

2.       Activity/ Limitation

3.       Participation/ Restriction

4.       Distress/ Well-being

·     Each domain is scored on a 6-point scale from 0 (low) through to 5 (high) with half points possible (providing 11 possible scores for each domain)  

·     Clients have a profile of scores for the 4 domains and scores are not summed

·     Change from start (goal start, or admission) are compared to scores on discharge (goal end, or discharge)

·     Administration instructions are detailed in the manual available on the website.

Area of Assessment

Activities of Daily Living; Functional Mobility; Life Participation; Occupational Performance; Social Relationships; Stress and Coping; Upper Extremity Function 

Body Part

Head; Neck; Upper Extremity; Back; Lower Extremity 

ICF Domain

Body Structure; Body Function; Activity; Participation 

Domain

ADL; Cognition; Emotion; General Health; Motor; Sensory 

Assessment Type

Performance Measure 

Length of Test

05 Minutes or Less 

Time to Administer

The therapist undertakes all usual diagnostic, occupational performance and goal setting assessments, and can then score the AusTOMs-OT outcome measures in under 5 minutes.

Number of Items

12 scale as listed above; each scale has 4 domains that are scored. Therapist chooses scales to reflect goals, so 1-3 scales are usually chosen. 

Equipment Required

None

Training Required

Yes

Type of training required

Reading an Article/Manual 

Cost

Free 

Actual Cost

Free

Age Range

Preschool Child: 2-5 years; Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Acquired Brain Injury; Arthritis; Cardiac Conditions; Cerebral Palsy; Chronic Obstructive Pulmonary Disease; Concussion; Fibromyalgia; Geriatrics; Hip Fracture; Knee Dysfunction; Lower Limb Amputation; Movement Disorders; Multiple Sclerosis; Neck Injury; Pain; Parkinson’s Disease; Peripheral Neuropathy; Pulmonary Disease; Spinal Cord Injury; Stroke; Traumatic Brain Injury; Vestibular Disorders 

Populations Tested

• Acquired Brain Injury
• Arthritis
• Cardiac Conditions
• Cerebral Palsy
• COPD
• Geriatrics
• Hip Fracture
• Knee Dysfunction
• Lower Limb Amputation
• Movement Disorders
• Multiple Sclerosis
• Parkinson’s Disease
• Spinal Cord Injury
• Stroke
• Traumatic Brain Injury

Standard Error of Measurement (SEM)

Fristedt et al. (2013) Swedish Version

 

Three reliability studies have been conducted. The SEM has been calculated for 2 scales, from the data from Fristedt (2013) with 15 therapists rating 6 cases for Scale 7 (Self-Care), and 3 cases for Scale 5 (Transfers).

 

Scale 7

  • Self-Care-Impairment: SEM= .406
  • Self-Care-Activity/ Limitation: SEM= .533
  • Self-Care-Participation/ Restriction: SEM= .492
  • Self-Care-Distress/ Well-being: SEM= .570

Scale 5

  • Transfers-Impairment: SEM= .559
  • Transfers-Activity/ Limitation: SEM= .424
  • Transfers-Participation/ Restriction: SEM= .487
  • Transfers-Distress/ Well-being: SEM= .527

Minimal Detectable Change (MDC)

Fristedt et al. (2013) Swedish Version

 

Three reliability studies have been conducted. The MDC (90%CI) has been calculated for 2 scales, from the data from Fristedt (2013) with 15 therapists rating 6 cases for Scale 7 (Self-Care), and 3 cases for Scale 5 (Transfers).

 

Scale 7

  • Self-Care-Impairment: MDC= .95
  • Self-Care-Activity/ Limitation: MDC= 1.24
  • Self-Care-Participation/ Restriction: MDC= 1.14
  • Self-Care-Distress/ Well-being: MDC= 1.33

 

Scale 5

  • Transfers-Impairment: MDC= 1.30
  • Transfers-Activity/ Limitation: MDC= .99
  • Transfers-Participation/ Restriction: MDC= 1.13
  • Transfers- Distress/ Well-being: MDC= 1.23

Minimally Clinically Important Difference (MCID)

A change of .5 to 1 point on any of the 4 domains of the AusTOMs-OT scale is considered clinically important.

 

Distribution Approach:  Mixed population: .5 to .61 point (Unsworth, 2015; n=787; Mean Age=71.52 (14.71)

  • Most participants had a primary diagnosis from one of the following five ICD-10 disorder codes: Disease of the Musculoskeletal System (ICD-10 code M), Disease of the Circulatory System (ICD-10 code I), Disease of the Nervous System (ICD-10 code G), Disease of the Respiratory System or Injury, Poisoning and Certain Other consequences of External Causes (ICD-10 code S).

Criterion approach: Allied health therapists: 1 point (Unsworth, 2015; n=30 (n=25 occupational therapists); Mean Age=71.52 (14.71); Participants most commonly had between 11 and 20 years’ experience in their respective disciplines (43.3%, n=13), with 30% (n=9) with 10 years’ experience or less and 20% (n=6) with 21–30 years’ experience. 

  • Participants reported using AusTOMs – OT frequently, with the most common responses being at least once a week (43.3%, n=13), least once a day (13.3%, n=9) and at least once a month (10%, n=3).

Cut-Off Scores

Not aAplicable

Normative Data

Change data has been published for clients with Diseases of nervous system, circulatory system, musculoskeletal system and Injury/poisoning (Unsworth, 2005b; Abu-Awad, 2014; Chen, 2015).

Test-retest Reliability

Fristedt (2013) studied Scale 7. Self-Care and Scale 5 (Transfers) with 7 OTs rating 6 or 3 cases (respectively) with a range of conditions including: spinal cord injury, amputation, schizophrenia, hip replacement, muscle disease, and cancer.

 

Scale 7. Self-Care-Impairment:

  • Adequate: (ICC = .70)

Scale 7. Self-Care-Activity/ Limitation:

  • Excellent: (ICC = .77)

Scale 7. Self-Care-Participation/ Restriction:

  • Excellent: (ICC = .80)

Scale 7. Self-Care-Distress/ Well-being:

  • Excellent: (ICC = .87)

Scale 5. Transfers-Impairment:

  • Excellent: (ICC = .83)

Scale 5. Transfers-Activity/ Limitation:

  • Excellent: (ICC = .85)

Scale 5. Transfers-Participation/ Restriction:

  • Excellent: (ICC = .89)

Scale 5. Transfers-Distress/ Well-being:

  • Excellent: (ICC = .92)

Interrater/Intrarater Reliability

Fristedt (2013) as reported above studied interrater and intrarater reliability.  Scott (2006) also studied Scale 7. Self-Care with 7 OTs rating 15 client case studies with a range of conditions including: stroke, acquired brain injury, arthritis, spinal cord injury, amputation, schizophrenia, depression, dementia, Parkinson’s Disease, burns and cerebral palsy.

 

Scale 7. Self-Care-Impairment:

  • Excellent: (Fristedt ICC = .76)
  • Adequate: (Scott ICC = .74)

Scale 7. Self-Care-Activity/Limitation:

  • Excellent: (Fristedt ICC = .80)
  • Excellent: (Scott ICC = .87)

Scale 7. Self-Care-Participation/Restriction:

  • Excellent: (Fristedt ICC = .78)
  • Excellent: (Scott ICC = .86)

Scale 7. Self-Care-Distress/Well-being:

  • Excellent: ( Fristedt  ICC = .85)
  • Excellent: (Scott ICC = .91)

Fristedt (2013) reported ICCs between .58 and .93 for the Intrarater reliability of the 15 raters across the case studies, for the 12 AusTOMs scales. 

Internal Consistency

Not Applicable

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Unsworth (2004) found scores on several AusTOMs-OT Scales and domains correlated with the EQ-5D: 

  • Adequate: Upper limb scale and EQ-5D (r=0.70)
  • Excellent: Self care scale and EQ-5D (r=0.74)

Content Validity

Established through focus groups to develop the 12 scales (Perry 2004) and Unsworth (2005a).

Face Validity

See Above

Floor/Ceiling Effects

Not Esablished

Responsiveness

All 12 scales found to be responsive for each of the 4 domains of Impairment, Activity, Participation and Distress/ Well-being for n=466; Age range for the 354 adults X=62.910,SD 20.370  and for the 106 children X=10.36, SD 26.365) (age missing for 6 adults) (Chen, 2015).

 

Change from admission to discharge for clients, Using Wilcoxon Signed Ranks Test, all significant, p<.001, for mixed client population including:

  • n=104 acquired neurology
  • n=56 orthopaedic
  • n=50 burns and plastics
  • n=47 mental illness
  • n=39 spinal (Unsworth, 2005a)
  • n= 289 patients with stroke, X age= 63.4 SD 12.

Professional Association Recommendations

British College of Occupational Therapists: Research briefing: Measuring Outcomes, November 2015

Considerations

Draws on ICF terminology (WHO, 2001) and Therapy Outcome Measures by Pam Enderby and Alex Johns, who were associate researchers for the development of AusTOMs-OT.

Bibliography

Abu-Awad, Y., Unsworth, C.A., Coulson, M., & Sarigiannis, M. (2014). Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to measure client participation outcomes.  British Journal of Occupational Therapy, 77 (2), 44-49.

Chen, Z., & Eng,J.Y. (2015). Use of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) in an early supported discharge program for stroke patients in Singapore. British Journal of Occupational Therapy, 78(9), 570-575.

Fristedt, S., Elgmark, E. & Unsworth, C.A. (2013). The inter-rater and test-retest reliability of the Self-care and Transfer scales and intra-rater reliability of all scales of the Swedish translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S). Scandinavian Journal of Occupational Therapy, 20, 182- 189.

Morris, M., Perry, A., Unsworth, C., Skeat, J., Taylor, N., Dodd, K., Duncombe., D., & Duckett, S. (2005).  Reliability of the Australian Therapy Outcome Measures for quantifying disability and health. International Journal of Therapy and Rehabilitation, 12(8), 340-346.

Perry, A., Morris, M., Unsworth, C., Duckett, S., Skeat, J., Dodd, K., Taylor, N. & Riley, K. (2004).  Therapy Outcome Measures for Allied Health Practitioners in Australia: The AusTOMs.  International Journal for Quality in Health Care, 16(4), 285- 291.

Scott, F., Unsworth, C.A., Fricke, J., Taylor, N. (2006). Reliability of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs – OT) Self-care scale. Australian Occupational Therapy Journal, 53, 265- 276.

Skeat, J., Perry, A., Morris, M., Unsworth, C., Duckett, S., Dodd, K., Taylor, N. (2003).  The use of the ICF framework in an allied health outcome measure:  Australian Therapy Outcome Measures (AusTOMs). In Australian Institute of Health and Welfare, ICF Australian user guide. Version 1.0.  (pp. 77- 81). Canberra: Australian Institute of Health and Welfare.

Unsworth, C.A. (2008). Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) to measure outcomes for clients following stroke. Topics in Stroke Rehabilitation, 15 (4), 351- 364.

Unsworth, C.A. (2005a). Measuring outcomes using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs - OT):  Data description and tool sensitivity. British Journal of Occupational Therapy, 68(8), 354- 366.

Unsworth, C.A., Bearup, A., & Rickard, K. (2009). A benchmark comparison of outcomes for clients with upper limb dysfunction following stroke using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). American Journal of Occupational Therapy, 63(6), 732- 743.

Unsworth, C.A., Coulson, M., Swinton, L., Cole, H., & Sarigiannis, M. (2015). Determination of the minimum clinically important difference on the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT)?  Disability and Rehabilitation, 37(11), 997-1003.

Unsworth, C., Duckett, S., Duncombe, D., Perry, A., Skeat, J.,  Taylor., N. (2004). Validity of the AusTOM Scales:  A comparison of the AusTOMs and EuroQol-5D. Health and Quality of Life Outcomes, 2, 64-75.

Unsworth, C.A., & Duncombe, D. (2004). AusTOMs for Occupational Therapy. La Trobe University, Melbourne.

Unsworth, C.A., & Duncombe, D. (2007). AusTOMs for Occupational Therapy (2nd ed.). La Trobe University, Melbourne.

Unsworth, C.A., & Duncombe, D. (2014). AusTOMs for Occupational Therapy (3rd ed.). La Trobe University, Melbourne.

Unsworth, C.A., & Duncombe, D. (2005b). A comparison of client outcomes from two acute care neurological services using self-care data from the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs - OT). British Journal of Occupational Therapy, 68(10), 477- 482.

Unsworth, C.A., & Duncombe, D. (2011). AusTOMs for Occupational Therapy.  Swedish Translation undertaken by Fristedt, S., Jonsson, L., Londos, Y., & Timen, E. Swedish Occupational Therapy Association, Stockholm, Sweden.

Unsworth, C.A., & Duncombe, D. (2014). AusTOMs for Occupational Therapy.  Arabic Translation undertaken by Awad, A.  La Trobe University, Melbourne.

Year published

2004 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/28/2016 11:38 AM  by Jason Raad 
Last modified at 11/1/2016 5:17 PM  by Jason Raad