Convergent Validity and Reliability of the Persian Version of the Bay Area Functional Performance Evaluation-Task-Oriented Assessment in People with Severe Psychiatric Disorders

Background: Functional performance plays an important role in the independence and participation of people with severe psychiatric disorders. The Bay Area Functional Performance Evaluation-Task-Oriented Assessment (BaFPE-TOA) is a tool that evaluates functional performance. The present study aimed to assess the convergent validity and inter-rater reliability of the BaFPE-TOA tool using the classic test theory. Methods: In this psychometric study, the population comprised people with severe psychiatric disorders. Participants were selected according to the inclusion criteria and convenience sampling. Consent to participate in the study was given by all participants. To examine the convergent validity, two tests, the BaFPE-TOA test and Kohlman Evaluation of Living Skills (KELS) test, were performed for 55 patients. To assess the inter-rater reliability, two examiners (occupational therapists) performed the BaFPE-TOA test for 26 patients simultaneously. Then, the Pearson correlation coefficient was used to examine convergent validity, and the intraclass correlation coefficient was used to assess inter-rater reliability. Results: Participants in this study comprised 44 men (81.8%) and 10 women (18.2%). The age of participants ranged from 22 to 69 years with a mean of 41.5 years (SD = 10.5). The Pearson correlation coefficient between the BaFPE-TOA and the KELS was good (r=0.74, p -value <.001). The Intraclass correlation coefficient and Pearson correlation coefficient between the two examiners showed a good relation (r= 0.75, p -value <0.001). Conclusion: The results showed that the Persian version of the BaFPE-TOA has acceptable convergent validity with KELS and inter-rater reliability that represents the suitability of this tool for use in the healthcare environment

Construct Validity Confirmation of Iranian Version of Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)

Objective: Schizophrenia generally has cognitive impairments. So, cognitive impairments can affect whole life's aspects, cognitive assessment helps develop treatment planning and obtain independency in Occupational performance areas. The goal of this study is supporting construct validity of the Iranian version of Lowenstein Occupational Therapy cognitive assessment (LOTCA) through comparison of cognition among schizophrenic patients and general population. Materials & Methods: This is a validity testing study that was performed on 737 person (237- patient & 500- general population `) in 20-60 age by comparative method. Samples were selected randomly accordance to research criteria. The tool was Lotca that asses six cognitive areas. Data gathered through demographic questionnaire and Lotca's scoring sheet and analyzed by Spearman correlation coefficient, Leven and Independent T-tests. Results: There was significant different in cognitive performance between schizophrenic patients and normal population in all subtests of LOTCA (P>0.001). Comparison of cognitive performance of inpatients and outpatients showed significant difference in orientation, visual perception, visu-motor organization, thinking operations attention and concentration (P>0.001). In females thinking operations (P=0.033) and attention and concentration (P=0.007) was higher than males. The mean scores of subscales in employed person significantly were higher than unemployed persons (P>0.001). Subscales scores has reduced with increasing of age. Married persons showed higher orientation (P=0.033). Also there was significant difference between level of education and desirability of seven subscales (P>0.001). Conclusion: Results supports and confirms the construct validity of Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) for cognitive status evaluation of schizophrenic patient

The Bay Area Functional Performance Evaluation-Task Oriented Assessment (BaFPE-TOA) in Severe Psychiatric Patients: A Psychometric Study

Objective The Bay Area Functional Performance Evaluation-Task Oriented Assessment (BaFPE-TOA) is a standard test developed by Williams and Bloomer in 1977-1978 in order to evaluate functional performance. This test consists of five tasks (sorting shells, money and marketing, home drawing, block design, kinetic person design), twelve parameters (memory for written and verbal instructions, organization, attention span, evidence of disorder, ability to abstract, completion, errors, efficiency, motivation and compliance, frustration tolerance, self-confidence, general affective impression) and three components (cognitive, affective, and performance components). The purpose of this study was to translate the BaFPE-TOA in Persian and to evaluate the face and content validity, and internal consistency in patients with severe psychiatric disorders. Materials & Methods A non-experimental and methodological study was carried out in Tehran in 2017; the study population included adult patients diagnosed with severe psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this study, demographic questionnaire and BaFPE test were used. Convenience Sampling was done on patients who were admitted to Razi Psychiatric Hospital. In order to prepare the Persian version, the translation of the BaFPE-TOA test was carried out in accordance with the International Quality of Life Assessment (IQOLA) project, which included: 1. Translation of the original version into Persian; 2. Review by translators and professors; 3. Translation quality; 4. Translation of the Persian version into English; and 5. Comparison of the English version with the original version. The Persian version was assigned to five experts to evaluate the content validity in terms of simplicity, relevance, clarity, and necessity. The face validity of the test was performed on three patients and two healthy individuals in order to find difficulties in the understanding of words and phrases, the appropriateness of the items, the likelihood of ambiguity and inadequate perceptions of expressions or the lack of meaning in words. After confirmation, a Persian version of the test was performed on 55 patients with severe psychiatric disorders who qualified the inclusion criteria. Inclusion criteria for this study included: 1. People with psychiatric disorders based on DSM-5 and are listed in the medical records by a psychiatrist; 2. Over 18 years old; 3. Complete consent to enter the study; 4. Aability to write and read; 5. Lack of comorbidity (mental retardation, drug abuse); 6. Lack of physical constraints affecting the performance of specified tasks; 7 Lack of visual impairment or severe hearing loss. Cronbach’s alpha coefficient was used to evaluate the internal consistency with respect to the four options of the test. Data analysis was performed using SPSS v.16 software. Results Experts’ opinions about the quality of translation and replacement of words in the translation process were according to the IQOLA method. The face validity of the test according to the experts’ opinion and its association with healthy subjects and patients showed that the clarity and implementation of common language were of good quality. The content validity of the test was performed according to the opinion of the five experts in mental health; the Content Validity Ratio (CVR) and the Content Validity Index (CVI), were equal to one for all domains. The minimum acceptable value for content validity based on CVI and CVR indices was 0.80 and 0.99, respectively, which indicated validity of the content and the lack of impact of culture on the parameters, tasks, and components of the BaFPE-TOA test. The results of the Cronbach’s alpha coefficient for all fields was related to the twelve functional parameters, the three components, and the five tasks; the efficiency parameter was above 0.7 (the minimum acceptable value), indicative of the good internal reliability of this test. Conclusion According to the experts’ opinion, the Persian version of the BaFPE-TOA test has a proper translation, with acceptable face and content validity and internal consistency. Therefore, this test can be recommended for the evaluation of functional performance in patients with severe psychiatric disorders

Effect of Sensory Integration Therapy on Gross and Fine Motor Skills of 5-7 Years old Children with Down Syndrome

Objective: Children with Down syndrome have sensory integration dysfunction, and a range of physical problems and difficulties that may affect their motor development. The aim of present study was to determine effectiveness of sensory integration therapy on gross and fine motor skills of 5-7 years old children with Down syndrome.  Materials & Methods: Sixty 5-7 years old children were diagnosed as having Down syndrome, were selected by randomized sampling and participated in this experimental study. Each participant was assessed by researcher, that the assessment used was Peabody Developmental Motor Scales. The children were randomly assigned to the intervention (sensory integration therapy) and control groups. Sensory integration therapy was given to intervention group. Data were analyzed by Leven test, Independent T test and covariance analysis. Results: There was significant difference between pretest and post test scores of intervention and control groups in gross motor development (P<0.000), but in fine motor development there was significant difference between pretest and post test scores only in intervention group (P<0.001) and in control group it wasn’t significant (P=0.013). Also there was significant difference between two groups in gross and fine motor development (P<0.001). Conclusion: The results showed the sensory integration therapy were effective in gross and fine motor of children with Down syndrome. It was concluded that sensory integration therapy should be applied for children with Down syndrome who have gross and fine motor difficulties

Ethical Issues of Occupational Therapist in the Field of Mental Health

Objective: Occupational therapists working at mental health areas face more issues as compared to their colleagues working in other fields. The present study is aimed at exploring the experiences of the occupational therapists who envisage ethical issues in psycho-social rehabilitation. Materials & Methods: The present study is a 'qualitative study' in which 'content analysis' has been conducted. A 'purposive sample' consisting of twenty volunteer occupational therapists who work at mental health centers were selected. The participant’s ages ranged from 24 to 45(with average 34) years. The shortest and longest work’s experiences of the participants were one year and twenty years respectively. The participants discussed the major problems they had experienced in dealing with mentally ill people through focus group discussion (five sessions). Having the objective of the study in mind, the ethical issues were then extracted. Results: The most important ethical issue in dealing with mentally ill patient, as stated by the participants, was the therapist's insufficient knowledge of communicating and of employing the therapeutic services. The codes extracted from this study were grouped into four main categories, namely 'compatibility of therapy with the patient's characteristics', well-being of the patients and quality of services', 'compatibility of plans with the patients' condition' and finally 'the procedure of referring the patients for occupational therapy'. Conclusion: The findings of the study suggest that the occupational therapists working in the field of mental health care are encountered by many ethical issues and it is imperative for the occupational therapists to upgrade their knowledge and awareness in various fields in order to settle and overcome the foregoing ethical issues. Exposing these issues and sharing them with other professionals in an attempt to explore successful and safe approaches towards improving the rehabilitation of the mentally ill people is essential as well