AVAILABILITY, RELIABILITY, VALIDITY OF AMPS 1

The type and extend of use of occupational-based assessment in Occupational Therapy practice. Availability, Reliability, and Validity.

            The type of occupational-based assessment in Occupational Therapy practice that I choose is Assessment of Motor and Process Skills (AMPS). Fisher and Jones (2010) explain that the AMPS is an innovative observational evaluation designed to be used by occupational therapists to evaluate the quality of a person’s performance of activities of daily living (ADL) in natural, task-relevant environments. However, studies also proved that the mechanism of AMPS can also be applied in Instrumental Activities of Daily Living (IADL). AMPS are another type of assessment besides Modified Barthel Index and Canadian Occupational Performance Measure which can be used to evaluate change in occupational performance problems over time.

Fisher and Jones (2010) shows that the unique design of the AMPS allows the occupational therapist to compare the quality of performance of a person who performed different AMPS tasks each time he or she was evaluated. In a like manner, the AMPS can be used to compare performance among groups of persons who each performed a different set of AMPS tasks. The AMPS provides occupational therapists with a powerful and sensitive tool that can assist in planning effective interventions and documenting the effectiveness of occupational therapy interventions. The AMPS provides a vocabulary that the occupational therapist can use to describe the quality of a person’s occupational performance — what and how a person does what he or she needs and wants to do, given the demands of the ADL task and the resources and demands of the physical and social environment. Thus, the patient’s limitations can also be analysing by using this type of assessment as well as to prepare the occupational therapist in planning the next interventions to be given suitable for the patient.

McAdam et al. (2001) conduct a study involving thirty-six occupational therapists that completed a training course on the Assessment of Motor and Process Skills (AMPS), held in the West Midlands, took part in a follow-up evaluation. This examined the effectiveness of the AMPS training on the occupational therapy service delivery. Twenty-eight structured interviews were carried out with occupational therapists from the West Midlands region and eight postal questionnaires returned from occupational therapists outside the region. The outcome indicated that observation skills had improved and that the AMPS was an appropriate tool to use for the purposes of assessment, guiding intervention and measuring outcomes of occupational therapy. There were variations in the ease with which the AMPS was administered with different client groups, but 89% of the occupational therapists were still using the AMPS at 9 months following training across a range of services. The main difficulties encountered were a lack of access to a computer and the additional support needed for the AMPS to be fully integrated into clinical practice. The adaptability of the AMPS as a standardised assessment and outcome measure makes it a good choice of tool to use across an occupational therapy service.

The reliability of this assessment is proved by Oakley and Sunderland (1997) which help to explain the usefulness of the Assessment of Motor and Process Skills (AMPS) as an outcome measure of instrumental activities of daily living (IADL) in pharmacologic studies of people with Alzheimer's disease. The AMPS simultaneously measures motor and process skills and their effect on the ability of the person to perform familiar IADL tasks. They administered the AMPS to 11 Alzheimer inpatients in a 31/2-month, double-blind, placebo-controlled, crossover study of fluoxetine and selegiline administered as single agents and in combination with physostigmine. Results indicated that there was a significant difference in IADL ability among study conditions for process skills, but not for motor skills, thereby suggesting that the AMPS is useful as a sensitive outcome measure of IADL ability in drug trials with this population.

Lockhart and Lestage (2003) state that dementia is generally defined as “a state of serious emotional and intellectual deterioration” and affects memory, language, visuospatial skills, cognition and personality. Its prevalence increases markedly after 75 years of age; making it a disease of older persons. Hebert and Brayne (1995) proved that Alzheimer disease (AD), a progressive neurodegenerative disease, is one of the most prominent forms of dementia and accounts for 70% of all cases. The prevalence of AD has been estimated  to double every 5 years after the age of 65 and rises to 47% in people over 85 years of  age.

Besides that, Kirkley and Fisher (1999) proved that the alternate-forms reliability of the Assessment of Motor and Process Skills (AMPS) where alternate forms means different pairs of AMPS tasks, was studied with 91 people who have who had performed four AMPS tasks. Results support use of the AMPS activities of daily-living motor and process scales.  In addition to that, Doble et al. (1999) proved the findings of a study of 55 elderly adults support the test-retest reliability of the Assessment of Motor and Process Skills, it illustrate the utility of alternative methods for examining the reliability of individual subjects' measures, and indicate that not all test-retest differences represent measurement error.

Moreover, another Doble et al. (1994) journal also proved the use of AMPS. The journal explain the Assessment of Motor and Process Skills (AMPS) is an observational measure of functional competence in instrumental activities of daily living (IADL) that was designed to overcome the limitations of self-reports and proxy reports. The AMPS allows simultaneous evaluation of the underlying motor and process (organizational/adaptive) skills necessary for competent task performance. They examined the IADL performance of 22 community-dwelling patients with mild to moderate Multiple Sclerosis (MS) in comparison to nondisabled subjects matched for age and gender. Functional competence of the MS subjects, as measured by the AMPS, was poorer than that of the control group. Many MS subjects who would not have been expected to have IADL difficulties on the basis of ratings of neurologic impairment were impaired in their IADL performance. For some patients, IADL impairment reflected deficits in their motor and process skills, whereas for others, process skill impairments alone were responsible for deficient task performance.

Multiple Sclerosis Society of Canada (2008) explains that Multiple Sclerosis (MS) is a disease that may affect the brain, spinal cord and optic nerves (central nervous system). MS is thought to be an autoimmune illness, which means that the immune system incorrectly identifies the body’s own tissue as a target of attack. In the case of MS, the immune system attack affects myelin, the fatty coating that protects the nerve fibres of the central nervous system. Damaged myelin may form scar tissue (sclerosis). Often the nerve fibre itself may be affected. When any part of the myelin coating or nerve fibre is damaged, messages moving through the central nervous system can be disrupted. Damaged areas are often called “lesions” or “plaques”.

McNulty and Fisher (2001) explain the validity of this assessment by evaluating the ability in activities of daily living (ADL) of 20 participants with the AMPS before discharge from an inpatient psychiatric unit. Within approximately two weeks of their discharge, the participants' home safety was evaluated within their home settings using the Safety Assessment of Function and the Environment for Rehabilitation. To form a basis for comparison, a second administration of the AMPS was administered concurrently with the home safety evaluation. Moderate positive relationships were found between ADL motor and ADL process ability and home safety in both the clinic and the home; however, analyses of the sensitivity, specificity, and overall predictive values revealed that home ADL process ability was the best predictor of home safety for participants who were categorized as less safe in the study. Findings suggest that clinic ADL evaluations using the AMPS give a reasonable estimate of home safety for participants categorized as having more home safety risk. For participants categorized as having less home safety risk, clinic ADL evaluation using the AMPS produced significantly less accurate estimates than ADL evaluations conducted in the home. These results indicate that home safety estimates may be most accurate if they are based on home rather than clinic ADL process ability measures.

Bernspång and Fisher (1995) conduct a study on the validation of the AMPS for use in Sweden. AMPS is an observational assessment of the extent to which motor and process skill deficits impact on domestic or instrumental daily living task performance (IADL). The validity of the AMPS scales was evaluated in terms of (a) unidimensionality of the items and tasks that comprise each scale, (b) person response validity, and (c) the ability of the scales to differentiate among clients of varying levels of functional ability. The results of a multi-faceted Rasch analysis revealed overall scale and individual response validity of both AMPS scales. The AMPS motor and process scales also differentiated significantly between clients who were judged to be independent, to require minimal assistance, or moderate to maximum assistance in order to live in the community. The results of this study support the validity of using the AMPS evaluation technique in Sweden.

Ay-Woan Pan and Fisher (1994) also proved the validity of the Assessment of Motor and Process Skills (AMPS) by evaluating a heterogeneous sample of subjects with psychiatric disorders. Sixty subjects, ranging in age from 16 to 72 years, participated in this study; 30 were persons without disorders living in the community; 30 had diagnosed psychiatric disorders. Two univariate F tests were used to test the hypothesis that mean AMPS measures would differ significantly between the group with and the group without psychiatric disorders. The hypothesis was supported for both AMPS motor and process scale measures. As would be expected among a sample that includes many higher functioning persons, many subjects with psychiatric disorders did just as well as subjects in the group without psychiatric disorders. Motor as well as process skill abilities of persons with psychiatric disorders were evaluated. Because the AMPS provides more specific features than other global functional instruments, it can help clinicians plan treatment and intervention more effectively. Further examination of the motor and process skill deficits within and among diagnostic subgroups and of the effect of medication and prolonged hospitalization on AMPS motor and process abilities is indicated.

In conclusion, AMPS is a suitable occupational-based assessment in Occupational Therapy practice because it has evidence of availability, reliability and validity. The assessment of occupational performance can take place at different stages of the occupational therapy process (such as initial referral or during the intervention process) and in different settings (such as in the client’s home, school, hospital, community locations). Assessment is necessary to establish a baseline of a client’s occupational performance skills which may include activities of daily living such as play and leisure, self-care and etc. on which service planning and therapy intervention can be based. Assessment is vital to inform our decisions regarding specific clients and programs.

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