Date Presented 04/22/21
OTs are trained to identify cognitive impairments in individuals diagnosed with specific diseases or who have sustained injuries or experienced a neurological event such as stroke. However, the presenters’ research demonstrates that OTs are underutilizing formal cognitive assessments and more often relying on observations and screening tools. Presenters discuss survey findings, setting influences, and potential solutions for OTs to increase the use of cognitive assessments in practice.
Primary Author and Speaker: Amanda J. Blattman
Contributing Authors: Jacqueline Schechter, Anne Spence, Susan S. Hayashi, Kara Sauerburger, Molly Houdeshell, Jennifer Henry, Judith Lieu, Robert Hayashi, and Allison King
BACKGROUND: Hospitalized individuals, especially those with neurological diagnoses, may have cognitive impairments that impact IADLs such as financial or medication management. Occupational therapists’ use of cognitive assessments (CA) to identify cognitive impairment (CI) is essential to client well-being. Through the utilization of CAs, occupational therapists are positioned to improve client quality of life in at least three ways. First, through the accurate identification of CI. Second, the consistent use of CAs over time captures changes in cognition, performance, participation, and data can provide evidence of therapeutic achievement. Third, use and documentation of CAs can substantiate or justify the need for ongoing services. The aim of this study was to survey occupational therapists to understand the use of non-standardized, screening tool, and standardized tests to assess CI in various clinical settings. This presentation describes occupational therapists’ use of CA over a 6 month period on a healthcare campus. Respondents’ use of CA results to substantiate recommendations (e.g., family education, safety, discharge disposition, return to driving) was also investigated.
METHOD: An anonymous 10-question online survey was emailed to 57 occupational therapists at a large healthcare campus in 3 practice settings: acute hospital, neurological rehabilitation, and outpatient. 28 individuals (49% survey return) completed the survey. Questions included use of standardized, non-standardized, and screening CA, in the prior 6 months, regarding frequency of use and usefulness for informing occupational therapist’s recommendations and clinical decision-making.
RESULTS: 82% of reported tests administered were non-standardized or screening assessments and 18% were standardized assessments. Trends for use of non-standardized/screens over standardized tests appeared related to time constraints and productivity demands. Results are contextualized using a framework that outlines potential situational influences of practice settings on frequency of CA use and their usefulness for clinical decision-making.
CONCLUSION: Across practice settings on a large healthcare campus, occupational therapists reported utilizing CA in each practice setting. In all practice settings, therapists more often implement non-standardized assessments and screening tools compared to standardized assessments to assess cognitive status. This study highlights differences in practice habits between settings and the underutilization of CA across the continuum of care to make clinical decisions including, but not limited to, discharge recommendations, safety, driving recommendations and family education. This discovery further supports the notion that occupational therapists are restricting their scope of practice by overlooking and/or not prioritizing cognition. AOTA’s statement on cognition purports that ‘cognitive functioning is always embedded in occupational performance (ADL’s, IADL’s) and cannot be accurately understood in isolation’. As such, occupational therapists should implement assessments as part of routine care for clients to better meet the societal needs of clientele. With the implementation of these standardized and functional tests, which has clients actually perform an activity (e.g. medication management) the ecological validity of the testing situation will be heightened and occupational therapists will have more concrete information regarding clients’; abilities and allow them to make more informed recommendations. Perhaps the middle ground between formal bottom-up cognitive assessments and overuse of cognitive screens and observation information is in the administration of function or performance-based cognitive assessments.
References
Burns, S., & Neville, M. (2016). Cognitive Assessment Trends in Home Health Care for Adults With Mild Stroke. American Journal of Occupational Therapy, 70(2).
Duncan, E. A., & Murray, J. (2012). The barriers and facilitators to routine outcome measurement by allied health professionals in practice: A systematic review. BMC Health Services Research, 12(1), 96. https://doi.org/10.1186/1472-6963-12-96
Morrison, M. T., Edwards, D. F., & Giles, G. M. (2014). Performance-Based Testing in Mild Stroke: Identification of Unmet Opportunity for Occupational Therapy. American Journal of Occupational Therapy, 69(1), 6901360010. https://doi.org/10.5014/ajot.2015.011528
Sansonetti, D., & Hoffmann, T. (2013). Cognitive assessment across the continuum of care: The importance of occupational performance-based assessment for individuals post-stroke and traumatic brain injury. Australian Occupational Therapy Journal, 60(5). https://doi.org/10.1111/1440-1630.12069
