Occupational Therapy Medical Legal Reports, TLABC Conference, Mexico 2013

These are my rough notes on a very interesting discussion of the increasing need for standardization in assessment of home support services, return to work and future costs assessments. This just gives a taste for the developments in the field and new tools available. Beth Inglis' presentation was excellent. 

"Keeping it Clean" How to assess Home Support Services Beth Inglis, B.Sc. OT, B.Sc. In Occupational Therapist JR Rehab Services. Inc. TLABC Medical Legal Conference, Mexico 2013 "I am the person who assesses function in home and work."

 I do OT Medical Legal Report'

Goals of the cost of future care report -maximize function independent -maximize participation - prevent medical complications

Cost of Future Care Report Medical care

Diagnostics Medication Medical supplies Allied health etc.

 Most cost of future care reports assess level of support and assistance needed (Fischer, 2009) Award amounts for "housekeeping" are valued at approx 1/3 of the non pecuniary wary (Kara Naish, TLABC , March 2012)

 We need performance -based functional assessment to determine individuals ADL's , can't just rely on self report AMA Disability - impairment of body function or body structure WHO Presence of disability or disorder is not an accurate predictor of recipt of benefits, workperformance, return to work - diagnosis doesn't alone determine this

Consider two individuals - however activity limitations are quite difference - functional assessment - a tool to measure and verify the objectivity and validity of costly items such as home support services (Fischer 2009)

Best Performance based ADL Assessment of Motor and Prcess Skills (AMPS) -evaluates the quality of performance of personal and instrumental activites of daily living (IADL's) Tests a person in arelevant and family environment as he/she performs meaningful and chosen ADL tasks Has been standardized internationally and cross culturally on 148,000 persons Consists of over 120 standardized ADL tasks Measures 16 ADL Motor and 20 ADL Process Skills --ADL motor observable goal directed actions - walks, lifts, transfers, paces, stabilizes...etc. -ADL process - selecting, interacting, carrying out individual tasks, modifying task, - chooses, gathers tools, sequences, notice and respond, search and locate - how a person accomodates to problems - ie notice and respond, benefit from something that happened minutes earlier, do they accomodate and change with learning

Motor and Process skills are ranked from easier to harder Person chooses minimum of 2 ADL of the 120 potential Each motor and process skill is scored based on: Effort - physical difficulty, clumsiness, or fatigue Efficiency - disorganization or undersirabl use of time, space or objects Safety - risk for perosnal or environmental damage Independence - pysical or verbal assistance AMPS computer software generates an ADL motor and ADL process score for the person - compared to 95% age matched healthy person ADL motor cut off -where people have problems ADL skills are one of best predictors of return to community

Ecological Validity - testing something they've chosen in their environment 25% chance that a process score will differ in laboratory and home OT should evaluate in home Need to balance overprovision and underprovision....

 HOme making costs Frequence of homemaking servciess 2 hours/ week yearlly 3360 10 years 33,600, 20 years $67,200 8 hours / week yearly $13, 440 20 years $268,000 about 

Question and answer

 AMPS - $400 to $500 for report

 What about patients with variability where waxing and waning pain - OT assesses this by saying to them to do it 'the best you can now' not the way you used to.

 Dr. Armstrong - recommended that as a scientist he'd like to see 3 assessments to get mean standard deviation - answer - AMPs can be readministered

 Also question about testing at maximal medical ability when score would likely have more long term validity.