1. 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

2. 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.

3. 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)

4. 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

5. 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)

6. 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)

7. 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)

8. 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

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

10. knowledge to action framework
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

11. 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 inquiry for participation
The remaining five participants completed the full study
Two were in inpatient therapists
Three were day rehabilitation therapists

12. 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

13. 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= , moderate; d>.60, large

14. 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

15. 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

16. 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

17. 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.

18. 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

20. references
Baum, C. M., & Law, M. (1997). Occupational therapy practice: Focusing on occupational performance. American Journal of Occupational Therapy, 51, 277–288. Center for Medicare Services. (2015). Improving Medicare Post-Acute Care Transformation Act of 2014 Data Standardization; Cross Setting Measures. Retrieved November 17, 2016, from Instruments/PostAcute-Care-Quality- Initiatives/IMPACT-Act-of2014-and-CrossSetting Measures.html. Chard, G. (2006). Adopting the Assessment of Motor and Process Skills into practice: Therapists' voices. British Journal of Occupational Therapy, 69, 50–57. Fisher, A. (1992). The Foundation— Functional measures, part 1: What is function, what should we measure, and how should we measure it? American Journal of Occupational Therapy, 46, 183–185. Fisher, A. & Jones, K. (2010). Assessment of Motor and Process Skills Vol. 1: Development, Standardization and Administration Manual, 7th Ed Three Start Press Inc. Gillen, G. (2013). A fork in the road: An occupational hazard? American Journal of Occupational Therapy. Gillen, G., Nilsen, D. M., Attridge, J., Banakos, E., Morgan, M., Winterbottom, L., & York, W. (2015). Effectiveness of interventions to improve occupational performance of people with cognitive impairments after stroke: An evidence-based review. American Journal of Occupational Therapy. Hocking, C. (2001). Implementing Occupation-Based Assessment. The American Journal of Occupational Therapy, 55(4),

21. references
Huijg, J. M., Gebhardt, W. A., Dusseldorp, E., Verheijden, M. W., van der Zouwe, N., Middelkoop, B. J., & Crone, M. R. (2014). Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implementation Science, 9(1), 33.
Kottorp, A. & Fisher, A. (2015). Evidence-based occupational therapy 2.0 – developing evidence for occupation. Journal of Japanese Association of Occupational Therapists, 34,
Lamb, A. (2016). The Power of Authenticity. American Journal of Occupational Therapy, 70(6),
Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016). Higher Hospital Spending on Occupational Therapy Is Associated with Lower Readmission Rates. Medical Care Research and Review.
Straus, S., Tetroe, J., & Graham, I.D. (2013). Knowledge Translation in Healthcare: Moving from Evidence to Practice. Wilet-Blackwell.
Tomori, K., Nagayama, H., Ohno, K., Nagatani, R., Saito, Y., Takahashi, K., Higashi, T. (2015). Comparison of occupation-based and impairment-based occupational therapy for subacute stroke: a randomized controlled feasibility study. Clinical Rehabilitation, 29(8), 752–762.
Wolf, T. J., Chuh, A., Floyd, T., McInnis, K., & Williams, E. (2015). Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: An evidence-based review. American Journal of Occupational Therapy.