The primary focus of occupational therapy is promoting the health and wellbeing of individuals who present with occupational performance dysfunction, activity limitations or participation restrictions (College of Occupational Therapists 2004). When therapists initially see a client, they take an occupational history and usually complete some type of assessment. The assessment component of service delivery can include informal clinical observations and formal standardised tests. Coster (2008, p743) stated: ‘In many areas of occupational therapy practice, quantitative measures are required to document need for services and, increasingly, quantitative measures are required to document the value of these services in terms of the outcomes achieved.’ Therapists must be confident that the tests and measures that they use to evaluate clients are assessing what they purport they do in a rigorous and robust manner. In other words, the tests and measures must exhibit a high degree of construct validity. Assessment tools have been classified as bottom-up and top-down (Weinstock-Zlotnick and Hinojosa 2004). Bottom-up assessments are the traditional instruments that look at isolated, decontextualised components of occupational performance (such as whether a child can shift pegs in a board or place coins inside a small container), whereas top-down assessments look at individuals in their day-to-day real life contexts (such as whether a child is able to access the neighbourhood playground if he or she is confined to a wheelchair). Top-down assessments often take into consideration the person, the environment and the occupation. How do we ensure the construct validity of both bottom-up and top-down assessments?
Read full abstract