Tuesday, 2 October 2012

Thoughts on a BJOT Article: Activity and Participation - self assessment according to the ICF.

The September edition of the British Journal of Occupational Therapy arrived on my doorstep this week and I was excited to see more articles about Mental Health Practice. One article in particular caught my eye so I decided to read it and share my thoughts on it as my latest blog post.

The chosen article:

'Activity and Participation - self assessment according to the International Classification of Functioning: a study in mental health.' by Lena Haglund and Susanne Faltman (2012)

The aim of the study was to explore the use of adding a fifth element to the International Classification of Functioning, Disability and Health (ICF) in order to utilise clients experience of satisfaction and enjoyment in activity and participation.

An important requirement in OT and rehabilitation as a whole is to work in a client centred way taking into consideration the needs and views of the individuals we, as health professionals, work with. Using self-assessment reflects that standpoint since the clients themselves make the assessment and convey their views and experiences of how they perceive their ability to handle their situation.

Research indicates that the client’s engagement and participation is decisive to the outcome of the rehabilitation. Consequently, it is important to develop tools with which the clients can highlight their own opinions regarding their everyday life. To manage everyday life, humans need to be engaged and to find satisfaction and meaning in the actions and tasks included in their daily life (Bejerholm 2007).

Twenty-nine clients with schizophrenia and other forms of psychosis participated in the study by using a self-assessment which was then linked to the Activity and Participation qualifier sections.

Currently the ICF component Activity and Participation consists of four qualifiers. The first qualifier describes performance, that is, what a person does in the current environment, which also includes the overall societal context and can be understood as ‘involvement in a life situation’ or ‘the lived experience’
of people in their actual context. Performance can involve assistance, such as technical aids. The second qualifier is about capacity. This describes the client’s ability to execute a task or action. It is intended to indicate the highest probable level of functioning in a given situation. The third and fourth qualifiers make it possible to code capacity with assistance and performance without assistance (WHO 2001).
As proposed by the study the fifth qualifier would make it possible for the rehabilitation process to reflect clients views.

The results of the study revealed that the ‘Major life area’ was rated with the most dissatisfaction and displeasure by the clients. ‘Communication’ and ‘General task and demands’ also had low ratings. ‘Self-care’ was rated with the most satisfaction and enjoyment. There was a correlation between the assessments made by the occupational therapist and the nursing staff, but their assessments differed from those made by the clients. 

The study indicates the importance of using self-assessment when understanding everyday life as presented in the ICF, and the importance of using different assessment methods to gain a broad picture of clients. Below are some of my thoughts on the strengths and limitations of this article and on using self assessment in Mental Health:

  • The study was conducted in Sweden and so results may had differed had the study been conducted in the UK.
  • The ICF assessment is long and complicated. The clients self assessment used in the study was a combination of two constructed assessments consisted of a seven-page list of 248 categories each - my concern is with how many clients would actually be able to sit and complete the assessments effectively and in one setting, or have the motivation to do so. 
  • The results of the ICF assessment are not particularly accessible or easy to understand.
  • One trouble which I have found with combining self assessments with professional assessments is the potential difficulty in sharing the professional assessment results when the clients disagree and/or perceive their abilities differently.
  • As mentioned above it is crucial to include clients throughout the rehabilitation process and using self assessment is a powerful tool to doing this. 
  • Allows greater insight for the professionals into the clients, for example in areas of insight and cognitive areas.
  • Helps professionals to gain a therapeutic rapport with clients as they feel respected being able to have an active part in their rehabilitation.
  • Using the ICF framework and assessment allows for greater MDT working as a range of professionals are familiar with it and it also shows the significance of Occupational Therapy. 
If you are able to read the article than I would recommend you do as it is a interesting insight into just one way of how professionals can encourage and support client participation in their rehabilitation process.

Happy OTuesday,


Bejerholm U (2007) Occupational perspectives on health in people with schizophrenia. Unpublished PhD thesis. Lund: Lund University.

Haglund L, Faltman S (2012) Activity and Participation - self assessment according to the International Classification of Functioning: a study in mental health. British Journal of Occupational Therapy, 75(9), pp.412-418.

Word Health Organisation (2001) International Classification of Functioning, Disability and Health (ICF). Geneva:WHO.

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