Occupational Therapists' Accuracy in Predicting Sensory,Perceptual-Cognitive,and Functional Recovery Post-Stroke

Abstract

The purpose of this study was to determine the degree to which occupational therapists correctly predicted sensory, perceptual-cognitive, and functional outcome for stroke patients admitted to a rehabilitation hospital. Therapists used an adapted form of the occupational therapy portion of the Patient Evaluation Conference System, a 12-item assessment measured on an 8-point scale. At admission, therapists performed initial assessments on 85 patients and assigned goal scores; before discharge patients were re-evaluated and their final scores were determined. The accuracy with which therapists correctly predicted the final score ranged from 52% to 76%. Therapists, when they erred, were more likely to predict a final score higher than the one the patient actually achieved (i.e., they were optimistic). Age of the patient, side of lesion, staff experience, and initial Adapted Patient Evaluation Conference System score were not associated with correctly predicting final score. Patients were categorized as dependent (scores of “0” to “4”) or independent (scores of “5” to “7”). The sensitivity and specificity of a goal of independence or dependence were investigated. Almost all patients who were independent at final evaluation had been correctly identified at the time of inital evaluation (the sensitivity of a goal of independence ranged from 95% to 100%). Also, patients predicted to remain dependent did so (the predictive value of a goal of dependence ranged from 91% to 100%). Occupational therapy departments should consider establishing procedures to determine and monitor the accuracy of the goals therapists set.