Validity and clinical utility of the Personal Care - Participation Assessment and Resource Tool (PC-PART)

Inpatient rehabilitation aims to facilitate people’s functional recovery and return to participation in daily life roles and occupations. A critical aspect of rehabilitation is enabling people’s accomplishment of activities of daily living (ADL) required for community life. Functioning in ADL is typically assessed by occupational therapists in preparation for discharge to community living using a combination of standardised and non-standardised assessment methods. Typically used standardised assessments are important but their measurement constructs are limited in scope compared to the measurement needs of the rehabilitation context. The International Classification of Functioning, Disability and Health (ICF) provides a useful internationally recognised framework to help clinicians conceptualise and operationalise measurement of the breadth of human health status and functioning. In accordance with this framework, the Personal Care-Participation Assessment and Resource Tool (PCPART) aims to measure service-users’ participation restrictions in ADL required for community life, an aspect of functioning not typically measured in rehabilitation settings. The PC-PART may fill an important measurement gap in rehabilitation and contribute to comprehensive and clinically meaningful measurement of outcomes that are relevant to service-users’ life situations

The international classification of functioning, disability and health (ICF): revisting its relevancy for occupational therapy

The occupational therapy community has been receptive to the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) published in 2001. Building upon results of a survey (2008–2009) and subsequent workshop (2010) conducted by the World Federation of Occupational Therapists on the use and utility of the ICF for occupational therapists, this paper addresses some of the opportunities and challenges to strengthening the use of the ICF in occupational therapy practice. Attaining further clarity on the relationship of occupational therapy concepts and the ICF and developing crosswalk tables to exemplify linkages between occupational therapy terminology and the ICF will strengthen utility of the ICF for occupational therapy. Enhanced clarity about the concepts within occupational therapy that correspond to the ICF will ultimately assist other professions and disciplines in their understanding about occupational therapy and occupational therapists’ roles in health and related systems

Funeral industry workers’ work health and safety in Australia and Ireland

Funeral workers (FWs) work within increasingly medicalized and commodified death-management systems. This study explored Worker Health and Safety (WHS) impacts in contemporary death management on Australian and Irish FWs. Mixed methods combined a survey and interviews. Survey data were descriptively summarized, interviews thematically analyzed, and a schematic systems model developed of the combined results. Survey participants (n = 45) reported psychosocial hazards from work pressures, competition, and fatigue. Psychosocial hazards were more frequently reported than physical hazards by Australian FWs. Physical hazards were of greater concern to Irish FWs. Themes from 11 interviews were: Personal Attributes, Work Demands, and Socio-Cultural Context. All FWs reported conflicts between individual capacities, work demands, and resources, resulting in hazardous personal states including difficulty sleeping and stress. Respectfully manually handling human remains and “event management” demands for increasingly elaborate funerals created negative WHS impacts. This research informs risk management for FWs and other workers in the increasingly complex death-care industry

Measurement of activity limitations and participation restrictions: Examination of ICF-linked content and scale properties of the PC-part and FIM instruments

Purpose: To explore the operationalization of activity and participation-related measurement constructs through comparison of item phrasing, item response categories and scoring (scale properties) for two separate instruments targeting activities of daily living. Method: Personal Care Participation Assessment and Resource Tool (PC-PART) item content was linked to ICF categories using established linking rules. Previously reported ICF-linked FIM content categories and ICF-linked PC-PART content categories were compared to identify common ICF categories between the instruments. Scale properties of both instruments were compared using a patient scenario to explore the instruments’ separate measurement constructs. Results: The PC-PART and FIM shared 15 of the 53 level two ICF-linked categories identified across both instruments. Examination of the instruments’ scale properties for items with overlapping ICF content, and exploration through a patient scenario, provided supportive evidence that the instruments measure different constructs. Conclusions: While the PC-PART and FIM share common ICF-linked content, they measure separate constructs. Measurement construct was influenced by the instruments’ scale properties. The FIM was observed to measure activity limitations and the PC-PART measured participation restrictions. Scrutiny of instruments’ scale properties in addition to item content is critical in the operationalization of activity and participation-related measurement constructs

Measurement properties of the Personal Care Participation Assessment and Resource Tool: A systematic review

Purpose: To systematically review research investigating measurement properties of the Personal Care Participation Assessment and Resource Tool (PC-PART), formerly the Handicap Assessment and Resource Tool (HART). Data sources: Seven databases were searched using (i) HART or PC-PART terms and (ii) known authors. Reference list searches, citation searches and author contact were secondary search methods. Study selection: Searches retrieved 492 articles. Those investigating at least one HART or PC-PART measurement property were selected. Three articles met review criteria. Secondary searching produced four additional studies. Data extraction: Two reviewers independently critiqued each article, using published quality criteria for (i) study methods and (ii) each measurement property. Results: There was positive evidence supporting content validity of the PC-PART in adult in-patient and community based, sub/acute health settings. Clinical utility was largely supported. There was inconclusive evidence for inter-rater reliability, construct validity and responsiveness. Conclusions: The PC-PART shows promise as a clinically relevant and useful assessment to aid decision making about admission or discharge from health care settings. Further research is needed to establish the PC-PART's place in clinical practice across a range of patient groups and settings using sound methods to investigate structural validity, reliability, criterion validity, construct validity, clinical utility and responsiveness

Worker experiences of the work health and safety impacts of exposure to dying and death in clinical settings : A qualitative scoping review

Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually

Linking occupational therapy models and assessments to the ICF to enable standardized documentation of functioning

Background. The International Classification of Functioning, Disability and Health (ICF) can serve as reference for standardized documentation of health in clinical practice. Purpose. This study aims to bridge the gap between the ICF and occupational therapy specific concepts, represented by occupational therapy models and their derived assessments. Method. Occupational therapy assessments in relation to their models were systematically linked to the ICF, and a compatibility analysis was conducted. To strengthen reliability of the linkings, feedback from the respective assessment hosts was obtained. Findings. Linking tables were developed for the Assessment of Motor and Process Skills, the Canadian Occupational Performance Measure, and the Model of Human Occupation Screening Tool. Similarities and differences between the ICF and the three assessments and their associated models show how they differ from and complement each other. Implications. The findings of this study lay the foundation for standardized documentation in occupational therapy and enhance the practicability of the ICF

Responsiveness, construct and criterion validity of the Personal Care-Participation Assessment and Resource Tool (PC-PART)

Background: The Personal Care-Participation Assessment and Resource Tool (PC-PART) was designed to measure participation restrictions in activities of daily living required for community life. Rasch analysis has confirmed that the PC-PART contains two unidimensional scales providing interval-level measurement: the Self Care and Domestic Life scales. This study investigated validity and responsiveness of these PC-PART scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) approach. Methods: Thirteen hypotheses about Self Care and Domestic Life scale scores were established prior to conducting the analyses. Data from a prospective randomized controlled trial of additional (weekend) inpatient rehabilitation in Melbourne, Australia, were used. The 996 participants had a mean (SD) age of 74 (13) years and were admitted with orthopaedic (n = 581), neurological (n = 203) or other disabling impairments (n = 212). Self Care and Domestic Life scores were compared to functional independence (FIM), comorbidity (Charlson Comorbidity Index), whether activities of daily living goals were met, and discharge destination. Results: Low to moderate correlations between FIM and PC-PART scales’ scores supported hypotheses that the PC-PART measures a different construct from functional independence: Self Care r s -0.52(95 % CI -.46 to -.57) and Domestic Life r s -0.32(95 % CI -.25 to -.38). The scales had low to moderate discriminative ability for discharge destination, with the area under the curve for Self Care, 0.70 (95 % CI 0.62-0.78), and Domestic Life, 0.72 (95 % CI 0.64-0.80). The discharge to community living cut-off scores for Self Care: 5.50 (sensitivity .83, specificity .53) and Domestic Life: 7.50 (sensitivity .75, specificity .60), represented patients having no participation restrictions. Change scores from admission to discharge demonstrated larger effect sizes for the Self Care (1.67) and Domestic Life (1.50) scales than for the FIM (1.10), supporting hypotheses about responsiveness. Ten of the 13 hypotheses were supported. Conclusions: This study provided evidence supporting construct validity, criterion validity and responsiveness of the PC-PART Self Care and Domestic Life scales for inpatient rehabilitation. Clinicians, managers and researchers who wish to measure the patterns and extent of people’s participation restrictions in activities of daily living and the associated burden of care, before and/or after intervention, can be somewhat confident about the PC-PART’s validity and responsiveness for this purpose. Trial registration: Data used in this research were gathered during a registered randomized controlled trial: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213