Background of OT FACT

The Need For A Comprehensive Functional Assessment:

A good functional assessment is an important component in the rehabilitation and habilitation of persons with disabilities. Without adequate assessment and integrated documentation of functional outcome, status and progress cannot be observed.

A study performed by the Standardized Assessment Committee of the American Occupational Therapy Association (AOTA) in the early 1980’s revealed that occupational therapists were using a countless variety of functional assessments, many of which were “homemade” and unpublished. Review of key professional training textbooks in occupational therapy shows that there are over 50 published functional assessments commonly being reported and taught to new occupational therapists. This is no surprise in occupational therapy: therapists practice in virtually all health and educational settings, with virtually every type of disability.

Unfortunately, the variety of assessment available only complicates occupational therapy documentation and reporting of functional status and progress. Occupational therapy has no standardized model for aggregating functional assessment data into a total reporting system.

Furthermore, the need for efficient and cost-effective occupational therapy service delivery places additional pressure on occupational therapy practice. Funding agencies, accreditation commissions and health care administrators are requiring therapists to quantitatively consolidate information from comprehensive occupational therapy evaluations into simple reports which highlight individuals’ skills and deficits, resulting disabilities, and ability to function in daily living, educational, vocational, and recreational activities.

In 1979, AOTA formally recognized the need for a profession-wide document which would help delineate the diverse and numerous functional areas in which occupational therapists evaluate and treat their clients. The AOTA Uniform Terminology document was the result. A few years later, the Uniform Terminology was modified to become the Comprehensive Evaluation Checklist to assist therapists in organizing their evaluations. In the mid 1980’s, the Standardized Assessment Committee of the American Occupational Therapy Association, in conjunction with AOTA, funded two projects to develop standardized methodologies for occupational therapists to interview individuals and to quantify functional performance. One of these projects directly led to the development of OT FACT.

History of OT FACT

Development of OT FACT began with a review of the literature, to ascertain whether there were any existing functional assessment packages which would meet the need of the occupational therapy profession. It was clear to the development team that locating the proper assessment or finding an assessment that could be modified to meet the needs of the profession would be preferable to developing a new functional assessment from the ground up. Investigations of the countless numbers of functional assessments being used throughout the profession, however, showed that current functional assessments tended to be limited in scope in at least one of four ways.

  • Specific populations: since many functional assessments are devised within a particular treatment setting, the content tended to reflect only a focused population sample.
  • Specific settings: for example, the Klein-Bell ADL Scale, which goes into substantial detail in bathing, toileting, and personal hygiene activities, is not oriented to higher-level functioning outpatients who might be seen.
  • Specific functional areas: some functional assessments target fine motor skills or gross motor skills, while others examine higher-level functions such as home-making and community living skills.
  • Non-standardized: some functional assessments have attempted a fairly global approach in the populations they target, the settings in which they are applicable, and the functional areas which they address. However, these global assessments tend to give up standardization of administration and fail to meet reliability and validity requirements, due to their open orientation.

Since existing functional assessment instruments did not appear to be satisfactory, the developers of OT FACT determined that a new design was necessary. The AOTA Uniform Terminology served as a basis for the resulting hierarchical model.

A key concept used for the design and development of OT FACT has been a multi-phase, iterative revision cycle using feedback from the field. The current OT FACT is the result of five major revisions and numerous sub-revisions within each major version. The three-year core development timeline included surveying fieldwork supervisors and presenting the conceptual framework and terminology of the functional assessment to dozens of regional groups throughout the country and at national conferences. In all cases, feedback was solicited regarding the design of OT FACT. This extensive feedback was incorporated into each subsequent version of the system.

Pilot field tests were also run on both a local and national basis to obtain data for clarifying and revising instructions for administering OT FACT. Finally, a nation-wide field test provided preliminary investigations of validity and reliability issues of the assessment, as well as finalizing the administrative features of the system.

The field testing confirmed that the functional assessment approach was effective and stimulated activity in several areas of further development. Much of the research and development effort in 1989 and 1990 focused on computerizing the system. Computerization served three purposes. First of all, it increased the efficiency of the assessment. Secondly, it improved the face validity of the system; many practitioners did not require a majority of the pages of the system, so it seemed to them as if it was not targeted for their population. Thirdly, computerization allows a revolutionary new approach to assessment permitting consistency across the profession, yet tailoring assessments for every specialty area.

Since the release of the computerized OT FACT Version 1.0 in 1990-91, the paper and pencil version has become obsolete. Immediately after the release of version 1.0 of OT FACT, development of Version 2.0 was initiated to better target the needs of specialty areas and to utilize computer technology for assistance with report and documentation needs (enable faster report generation from within the OT FACT program). OT FACT Version 2.0 is designed for the Apple Macintosh and IBM compatible computers running Microsoft Windows. A number of advanced features had been included in OT FACT Version 2.0 for the Macintosh.