University of Illinois-Chicago Impact of using a Knowledge Translation Framework to Increase Utilization of the Assessment of Motor and Process Skills in a Rehabilitation Setting University of Illinois-Chicago Bridget Hahn, MS, OTR/L OTD Candidate Advisor: Dr. Heidi Fischer  Committee Members: Dr. Anders Kottrop Dr. Piper Hansen

Project objective To determine the impact of multimodal knowledge translation interventions on utilization of the Assessment of Motor and Process Skills in a rehabilitation setting.

Why the assessment of motor and process skills? Developed in response to the need for standardized, psychometrically sound ,client-centered, performance and occupation-based assessment Demonstrated reliability and validity across various cultures and diagnostic groups Intensive standardization process, including 45 hour training and 10 calibration assessments Examines the quality of a person’s performance of ADL and IADL in a natural task environment (Fisher & Jones, 2010)

Meet third party payer requirements background Occupational Therapists must manifest occupation beginning with assessment and throughout the therapy process to: Meet third party payer requirements Establish the profession’s unique value Maximize client outcomes

Meet third party payer requirements (CMS, 2015; Rogers et al., 2016) Background: Policy Occupational Therapists must manifest occupation beginning with assessment and throughout the therapy process to: Meet third party payer requirements (CMS, 2015; Rogers et al., 2016)

Background: Occupational therapy’s distinct value Occupational therapy's distinct value is to improve health and quality of life through facilitating participation and engagement in occupations, the meaningful, necessary, and familiar activities of everyday life. AOTA, 2015 (Fisher, 1992; Baum & Law, 1997; Hocking, 2001; Gillen, 2013, Kottrop & Fisher, 2015; Lamb, 2016)

Background: client outcomes Occupational Therapists must manifest occupation throughout the therapy process to: Maximize client outcomes (Gillen, et al, 2015; Wolf, et al, 2015; Toromori, 2015; Rogers et al., 2016)

Why the knowledge translation intervention? Barriers to clinical utilization of the AMPS exist in practice (Chard, 2000, 2004, 2006). Chard’s 2006 article found of 22 AMPS trained therapist: Two fully embedded use within their teams Eight adopted within their practice Ten were undecided Two did not continue to use

Why the knowledge translation intervention? Barriers included (Chard 2000, 2004, 2006): Time constraints Support in workplace Client-related difficulties Therapists attitudes and beliefs

knowledge to action framework E-mail Check Ins Follow-up Survey Participant Driven Community of Practice AMPS Use in a Rehabilitation Setting Survey Workshop Discussion Self-Study Workshops Facilitator Driven knowledge to action framework knowledge to action framework Straus et al, 2013

Method: Participants Eight known AMPS trained therapists at Shirley Ryan Abilitylab at time of study. One was the facilitator One did not have a primary clinical role One never replied to e-mail inquiry for participation The remaining five participants completed the full study Two were in inpatient therapists Three were day rehabilitation therapists

method Concurrent Strategies: Inclusion of AMPS in Medical Record Pre-Intervention Survey Online Self Study Workshop One Workshop Two Post-Intervention Survey Developed to assess barriers, facilitators, and utilization of the AMPS Select questions were previously validated as the Detriments of Implementation Behavior Questionnaire (DIBQ) (Huijg, et al, 2014) Readings and reflection questions to engage participants Critical discussion and problem solving Case study Action plan to complete an AMPS Matched with peer partner Critical discussion and problem solving Case study Action plan to complete an AMPS Concurrent Strategies: Inclusion of AMPS in Medical Record Software Installed Facilitator Check-ins Protected Treatment Time Leadership Collaboration Evaluate interventions

results Effect Size of DIBQ Based Survey Questions Question Pre  Post Effect size Question mean d 1) I know how to deliver the AMPS following the guidelines 5.000 5.200 0.199 2) I am confident I can deliver the AMPS following the guidelines 0.000 3) For me delivering the AMPS is useful 5.250 6.000 0.723* 4) For me delivering the AMPS is worthwhile 4.800 1.096* 5) If I deliver the AMPS, it will be easier to deliver occupation-based treatment 4.600 6.600 1.558* 6) The AMPS is compatible with my daily practice 3.400 0.894* 7) The AMPS has advantages over standard delivery of assessments 8) At the hospital there is good collaboration between professionals who deliver the AMPS 3.200 5.400 1.104* 9) I can count on support from others whom deliver the AMPS when delivering the AMPS is challenging in my practice 4.000 0.560* 10) I have the resources I need to deliver the AMPS during daily practice 2.400 4.400 1.146* 11) I have a clear plan of which patients I will deliver the AMPS with, how I will document and communicate the results to the team 2.800 1.075* *indicates moderate to large effect size d= .35-.60, moderate; d>.60, large

results Frequency of Barriers Identified Pre-Survey (n=5) Post-Survey Time 4 Preparation   Scoring Resources 5 3 Software Space Task Materials Scheduling 2 Client Selection 1 Age Institution Preference for other outcome measures AMPS Delivered   3 Months prior to Workshop Initial Intervention – Post-Survey Frequency (n=5) Zero 3 One - Three 1 4 Six- Ten Greater than Ten

Sustainability Participants identified ongoing monthly meetings and ongoing facilitator leadership to increase sustainability of study results (development of a community of practice) Meetings have occurred monthly since the last workshop in July, for a total of three additional sessions

DIBQ not validated for use with only 11 items limitations Small sample size Short time period DIBQ not validated for use with only 11 items

Conclusions & Clinical implications Results support use of a multi-modal intervention tailored to address barriers identified by participants is effective to decrease barriers and increase utilization of the AMPS in practice for this small group of participants. Clinical implications include future collaboration with the AMPS educators to develop a community of practice for recently trained AMPS therapists.

Future research Exploration of AMPS results in traumatic vs non-traumatic SCI Exploration of clinicians perspective on how AMPS results inform practice in comparison to other regularly used, more cost-effective measures

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