American Journal of Occupational Therapy

The area of work evaluation is fertile ground for future research and development by occupational therapists. Current evaluations of work range from standardized work evaluations associated with vocational rehabilitation to highly technical physical capacity and work capacity instrumentation and equipment often associated with sports medicine. In addition, methods used to identify pain and abnormal illness behavior add the psychosocial component of work evaluation. The limitations of most of the traditional approaches to work evaluations are their lack of focus on the actual work environments and on the meaning of work to persons. Occupational therapy can play an important and unique role in linking work evaluations to psychosocial and environmental variables and in formulating comprehensive theoretical models of work that should improve and refine present work evaluations.

For occupational therapy to provide a holistic view of meaningful activity, we must understand the relationship between physical, psychological, and social variables, especially as they affect our psychosocial evaluations and treatment. Existing definitions of psychosocial variables are unclear and, for occupational therapy practice, must be linked to activity and occupational performance.

Occupational therapists need to become more educated about the uses and limitations of psychosocial instruments and to develop new instruments that address the central tenets of occupational therapy by focusing on whether or not a person is able to do what is necessary and fulfilling. Further, understanding what is meant by meaningful activity and what people need to accomplish it will advance our effectiveness in occupational therapy assessment and practice.

This paper discusses current perspectives on play and leisure and proposes that if play and leisure are to be accepted as viable occupations, then (a) valid and reliable measures of play must be developed, (b) interventions must be examined for inclusion of the elements of play, and (c) the promotion of play and leisure must be an explicit goal of occupational therapy intervention. Existing tools used by occupational therapists to assess clients’ play and leisure are evaluated for the aspects of play and leisure they address and the aspects they fail to address. An argument is presented for the need for an assessment of playfulness, rather than of play or leisure activities. A preliminary model for the development of such an assessment is proposed.

In the 1970s, occupational therapy assessments tended to focus on physical performance component (PPC) evaluations such as strength and range of motion; assessment of occupational performance played a secondary role. Given changes within and outside the profession of occupational therapy, it is time for the assessment of occupation and role performance to assume a primary role, while PPC evaluation should shift to a secondary role. Although PPC evaluations may be less prominent than in the past, they will continue to play an important role in occupational therapy practice and research. Therapists need to be critical consumers of PPC measurement tools because many require further development to validate their use for occupational therapy purposes.

Current assessments of simple activities of daily living (ADL) and more complex, instrumental activities of daily living (ADL) could be improved. These assessments are criticized because there are so many different tests for various diagnostic populations, because they rely on self-report rather than observation, because they are based on such varied conceptual frameworks, because they are often cumbersome and lengthy to administer, and because they often rely on outdated or specific cultural perspectives. Improvement of ADL and IADL assessment lies in making them more contextual and client specific, (i.e., by addressing clients’ needs in real-life contexts that consider roles, culture, varying environments, and developmental stage).