Introduction
Occupational therapists are concerned with enabling people to perform the daily life tasks they need, want, or are expected to perform for fullest possible integration into community living and participation in society. Children with developmental coordination disorder (DCD), disorders of attention (e.g., attention-deficit/hyperactivity disorder, ADHD), specific learning disabilities (LD) (e.g., speech and language disorders, specific reading disabilities), and sensory integrative dysfunction (SI) have problems performing personal and instrumental activities of daily living (ADL) tasks at home or school, and that can limit their full integration and participation in their homes and school lives. There is a need, therefore, to identify their specific problems with ADL task performance so as to be able to develop effective interventions. Not only, there is a need for evidence related to effectiveness of occupational therapy interventions for children with ADHD, DCD, LD, and SI, but also a need for valid occupational-therapy-specific evaluation tools for use with children.
Purpose
The purpose of this research project was to contribute evidence to support the valid use of the Assessment of Motor and Process Skills (AMPS) with children, including children living in Middle Europe. More specifically, we aimed to evaluate validity evidence from different sources related to the use of the AMPS in occupation-based and occupation-focused evaluation and intervention.
Method
This research project consisted of four studies, implemented in two phases. Phase one focused on evaluation of a) validity evidence of the AMPS scales in relation to internal structure and stability of item difficulty calibration values for a Middle European sample compared to samples from other world regions (Study I); b) the stability of the mean AMPS measures between typically-developing children from Middle Europe and from other world regions (Study II); and c) the sensitivity of the AMPS measures to discriminate between typically-developing children and children with and at risk for ADHD, DCD, LD, and SI (Study III). Participants for phase one were from both Middle Europe and from other world regions and they were selected from the AMPS database, Ft. Collins, Colorado, USA. Data were analyzed using many-facet Rasch analyses, ANOVAs, regression analyses, related post-hoc tests, and effect size calculations. Phase two of the research project focused on evaluating feasibility of a larger randomized controlled trial (RCT) implemented in a Swiss setting using the of the AMPS and the Canadian Occupational Performance Measure (COPM) as a standardized outcome measures (Study IV). Data were analyzed based on feasibility objectives and the principles of deductive content analysis.
Results
In Study I, data for 1346 participants from Middle Europe and 144,143 participants from other world regions were analyzed. The participants were between the ages of 3 and 103 years, and they were well or had a variety of diagnoses. The results revealed that overall the item difficulty calibration values of the AMPS remained stable and that only one out of 36 ADL items of the AMPS demonstrated DIF, but this DIF did not lead to DTF (i.e., all measures fell within 95% confidence bands).
In Study II, data for 11,189 typically-developing children from Middle Europe and other world regions who were between the ages of 2 and 15 were analyzed. The results of ANOVAs revealed significant effects for mean ADL motor and for ADL process ability measures by region and a significant age by region interaction effect for mean ADL process ability. Out of 168 estimated contrasts between Middle Europe and the other world regions for mean ADL motor and ADL process ability, only seven were statistically significant (4.17%), and only two were more than ±1 SE from the international means.
In Study III, regression analyses of data for 10,998 children, 4 to 15 years, who were typically-developing or with ADHD, DCD, LD, and SI, revealed significant age by group interaction effects. Post hoc t tests revealed significant group differences in ADL ability at all ages beyond the age of 4. ADL process ability effect sizes were moderate to large at all ages and ADL motor ability effect sizes were mostly moderate to large age 6 and above.
In Study IV, 17 Swiss children with ADHD and DCD were included. The analyses of feasibility revealed both, strengths and problems that were related to recruitment, randomization, retention, inclusion and exclusion criteria, data collection methods, required resources, stakeholders commitment, researchers’ competences, study protocol, criteria for statistical and clinical significance and the research design.
Conclusion
This research project provided evidence to support the validity of the AMPS measures and scales when used to evaluate quality of ADL task performance of persons from Middle Europe. Additionally, this research project provided evidence that the international age-normative means of the AMPS are likely applicable to children from Middle Europe. Moreover, the findings supported the sensitivity of the AMPS measures to discriminate between typically-developing children and children with and at risk for ADHD, DCD, LD, and SI. When it comes to implementation of the AMPS in the context of a feasibility study, the findings indicated that there are considerable challenges when it comes to implementing an RCT in clinical practice that need to be considered when planning further studies. Publications:
Gantschnig, B. E. (2010). Das Assessment of Motor and Process Skills (AMPS) und dessen Einsatz in der Neurologie und anderen Fachbereichen der Ergotherapie. [The Use of the Assessment of Motor and Process Skills (AMPS) in Neurology and other disciplines of Occupational Therapy]. Ergotherapie. Fachzeitschrift des Verbandes der ErgotherapeutInnen Österreichs (ERGO Austria), 4/2010, 28-32. Gantschnig, B. E., & Page, J. (2010). Handeln im Alltag erfassen und kommunizieren - das Assessment of Motor and Process Skills (AMPS) [Assessing and communicating daily occupations - the Assessment of Motor and Process Skills (AMPS)]. [Assessing and communicating daily occupations - the Assessment of Motor and Process Skills (AMPS)]. Ergotherapie. Fachzeitschrift des ErgotherapeutInnen-Verbandes Schweiz (EVS), 2010(8), 43-46. Gantschnig, B. E., Page, J., & Fisher, A. G. (2011). Validität des Assessment of Motor and Process Skills (AMPS) für die Anwendung bei Klienten in Mitteleuropa. Paper presented at the 3. Kongress der Ergotherapie in der Schweiz. Handeln. Gestalten. Leben: Ergotherapie, Olten. Presentation retrieved from Gantschnig, B. E., Page, J., & Fisher, A. G. (2012a). Aktivität und Partizipation standardisiert erfassen: das Assessment of Motor and Process Skills (AMPS) und seine Anwendung in Mitteleuropa. Paper presented at the Overtüre. Swiss Concress of Health Professions, Winterthur. Oral Presentation retrieved from www.schp.ch/data/documents/SCHP12_Programm_klein.pdf Gantschnig, B. E., Page, J., & Fisher, A. G. (2012b). Cross-regional validity of the Assessment of Motor and Process Skills (AMPS) for use in Middle Europe. Journal of Rehabilitation Medicine, 44, 151-157. doi: 10.2340/16501977-0915 Gantschnig, B. E., Page, J., & Fisher, A. G. (2012c). Cross-regional validity of the Assessment of Motor and Process Skills (AMPS) for use in Middle Europe. Paper presented at the 9th Congress of Occupational Therapy: Occupation Diversity for the Future, Stockholm. Poster Presentation retrieved from www.cotec2012.se Gantschnig, B. E., Page, J., Nilsson, I., & Fisher, A. G. (2012). Detecting Activities of Daily Living Differences Between Children With and Without Mild Disabilities. Paper presented at the International AMPS Symposium 2012. Implementing occupation-focuses and occupation-based services, Kopenhagen. Oral Presentation retrieved from www.innovativeotsolutions.com/content/ Gantschnig, B. E., Page, J., Nilsson, I., & Fisher, A. G. (2013). Detecting Differences in Activities of Daily Living Between Children With and Without Mild Disabilities. American Journal of Occupational Therapy, 67, 319-327. doi: dx.doi.org/10.5014/ajot.2013.007013 Gantschnig, B. E. (2014). Occupation-based and occupation-focused evaluation and intervention with children. A validation study of the Assessment of Motor and Process Skills (AMPS) (Dissertation). Umeå: Print & Media, Online Version www.diva-portal.org/smash/record.jsf;jsessionid=d42439be35f2be8d4b877af420cd. Aegler, B., Heigl, F., & Gantschnig, B. E. (2014). AMPS - Erfahrungen aus Praxis und Forschung / Expériences issues de la pratique et de la recherche. [AMPS - Experiences in Practice and Research]. Ergotherapie, 4, 6-13. Gantschnig, B. E., Nilsson, I., Fisher, A. G., Kuenzle, C., & Page, J. (2015). Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention. Scandinavian Journal of Occupational Therapy, 1-12. doi: 10.3109/11038128.2015.1115548 Gantschnig, B. E., Fisher, A. G., Page, J., Meichtry, A., & Nilsson, I. (2015). Differences in activities of daily living (ADL) abilities of children across world regions: a validity study of the assessment of motor and process skills. Child: Care, Health and Development, 41(2), 230-238. doi: 10.1111/cch.12170 Gantschnig, B. E. (2015a). Aktivitäten des täglichen Lebens standardisiert erfassen – geht das? Paper presented at the Rehabilitations Symposium Activity, Activity, Activity, Affoltern am Albis. www.sar-reha.ch/fileadmin/user_upload/Files/Dokumente/veranstaltungen/150720_SVPR_Programm_Symposium2015.pdf Gantschnig, B. E., Page, J., Nilsson, I., & Fisher, A. G. (2015). Unterschiede in der Durchführung von Aktivitäten des täglichen Lebens (ADL's) von Kindern mit und ohne Behindertung. Paper presented at the 4. Schweizerischer Ergotherapie-Kongress des EVS, Bern. Poster retrieved from www.ergotherapie.ch/resources/uploads/Verband/Kongress%202015_Programm_d%20und%20f.pdf Gantschnig, B. E., Gonin, U., & Page, J. (2015). Workshop Interventionsstudien - Praxis und Forschung Hand in Hand [Intervention studies - a colloaboration of clinicians and researchers]. Paper presented at the 4. Schweizerischer Ergotherapie-Kongress des EVS, Bern. www.ergotherapie.ch/resources/uploads/Verband/Kongress%202015_Programm_d%20und%20f.pdf Gantschnig, B. E. (Producer). (2015, 11. Mai). Die Anwendung von validen und praktikablen Assessments in der Ergotherapie - Das AMPS als Beispiel. Medroom. [Online Workshop] Retrieved from ergotherapie.medroom.at/p.php Gantschnig, B. E., Nilsson, I., Fisher, A. G., Kuenzle, C., & Page, J. (2016). Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention. Scandinavian Journal of Occupational Therapy, 23(4), 260-271. doi: 10.3109/11038128.2015.111554 Gantschnig, B. E. (2016, 3rd May 2016). Die Durchführung von Aktivitäten des täglichen Lebens standardisiert erfassen - Wie geht das? Paper presented at the EBP Forum, Bern. Gantschnig, B. E., & Heigl, F. (2017). Standardisierte Erfassung der Ausführung von Aktivitäten des Täglichen Lebens (ADL’s). Die Anwendung des Assessment of Motor and Process Skills (AMPS) in Psychiatrie, Neurologie und anderen Fachbereichen. Schweizer Zeitschrift für Psychiatrie&Neurologie(04/2017), 13-16.