Assessments and Outcome Measures

Whilst the value of using outcome measures is well recognised, deciding on an appropriate measure can be a somewhat daunting prospect.

The Allied Health Professions (AHP) Outcome Measures UK Working Group, a cross-disciplinary group representing a number of professional bodies (including RCOT), has developed a checklist, Key questions to ask when selecting outcome measures: a checklist for allied health professionals, to assist individual AHPs and teams with selecting outcome measures.

The checklist is intended to guide discussions and support decision-making. It contains some key questions to ask when considering which outcome measure is most suitable for your area of practice.

The checklist is available to download from the RCSLT website.

Search the RCOT Library catalogue for assessment and outcome measure related resources, including the following e-books:

• Asher IE ed (2014) Asher’s occupational therapy assessment tools: an annotated index. 4th ed. [e-book]. Bethesda, MD: AOTA Press.
• Bortnick K (2017) Occupational therapy assessments for older adults: 100 instruments for measuring occupational performance. [e-book]. Thorofare, NJ: Slack Incorporated. 
• Bowling A (2017) Measuring health: a review of subjective health, well-being and quality of life measurement scales. [e-book]. London: Open University Press.
• Fawcett AJL (2007) Principles of assessment and outcome measurement for occupational therapists and physiotherapists: theory, skills and application. [e-book]. Chichester: John Wiley.
• Hemphill BJ, Urish CK (2020) Assessments in occupational therapy mental health: an integrative approach. 4th ed. [e-book]. Thorofare, NJ: Slack Incorporated. 
• McDowell I (2006) Measuring health: a guide to rating scales and questionnaires. 3rd ed. [e-book]. Oxford: Oxford University Press.

Access the Library Catalogue

Membership of an RCOT Specialist Section can be very useful when considering which assessments or outcome measures are most suitable for your needs. For example, it may be helpful to liaise with other members through a clinical forum about outcome measures used in your area of practice.

Find out more About Specialist Sections

The Montreal Cognitive Assessment (MoCA) website states that, to ensure consistency and accuracy, training and certification to administer and score the MoCA Test has been mandatory since 1^st September 2019. 

Further details are available on the following sections of the MoCA website:

• Training & Certification
• Terms of Use 
• FAQ
• Permissions

The Royal College of Occupational Therapists (RCOT) advises that training and certification to use an assessment/outcome measure should be undertaken if this is mandatory.

It is not uncommon for assessments and outcome measures to have cost and training implications; indeed, training can help ensure that an assessment/outcome measure is administered and scored accurately and consistently. RCOT does not make specific recommendations about what assessments/outcome measures individual practitioners or teams should use, nor do we discriminate against particular assessments/outcome measures based upon there being a cost implication.  

We would suggest that you seek further advice from the training or information governance department/legal teams within your organisation if necessary.

When selecting any assessment/outcome measure, it is important that you use your own clinical reasoning, taking into consideration the needs of the people you are working with and the parameters of your service.

In making a decision about whether you will use a particular assessment/outcome measure (including the MoCA) within your service, and therefore invest in any associated training and certification, you may wish to consider some general factors such as:

• The reliability, validity and responsiveness of the assessment/outcome measure.
• Whether it has been validated for use with a UK population, and for the client group you are working with.
• Whether the handling and storage of data complies with the General Data Protection Regulation (GDPR) and other data protection/information governance requirements.

To help you select an outcome measure you may find it helpful to use Key questions to ask when selecting outcome measures: a checklist for allied health professionals produced by the Allied Health Professions (AHP) Outcome Measures UK Working Group, a cross-disciplinary group representing a number of professional bodies including RCOT. It is available to download from the RCSLT website here.

This section contains FAQs about assessments and outcome measures, of particular relevance to the context of COVID-19, accompanied by information intended to help inform your decision making.

When considering this information, it is important that you use your clinical reasoning skills, taking into consideration the needs of the people you are working with and the parameters of the service. Practitioners/teams should seek further guidance from their organisation/employer where necessary, for example by contacting information governance, legal and/or infection control departments.
 

In view of COVID-19, should I use a standardised assessment or outcome measure?

Use of standardised assessments and outcome measures can offer many advantages, including helping us to evaluate the effectiveness of interventions and the impact or value of services. However, given the context of COVID-19 the decision about how best to assess the person’s needs requires careful consideration, particularly in terms of promoting the safety and wellbeing of all involved. As always, it is important to ensure that assessment and intervention is person-centred and acceptable to the individual.

In deciding whether to use a standardised tool at this time, practitioners/teams/services will need to consider the advantages (e.g. quick and reliable tool that speeds up accurate assessment) and risks involved (e.g. lengthy, can only be administered face to face). Another important factor to consider is how effectively any test materials used can be sanitised.

Whilst some assessments and outcome measures can be administered remotely and therefore reduce risk in terms of personal contact, you will still need to consider whether administration is necessary and appropriate to the person’s needs and circumstances. For example, a lengthy or physically demanding assessment may not be suitable for a person experiencing post-viral fatigue.

You may decide to continue using your usual standardised assessment/outcome measure, identify alternative tools, or conclude that it would be more appropriate to assess the person’s needs without the use of standardised tools. 
 

When carrying out a standardised assessment/outcome measure in person, will use of personal protective equipment (PPE) invalidate the results?

Information about administration of an assessment/outcome measure can usually be found in the manual/on the website. It is important to be aware that varying the administration may mean that you can no longer validly compare the individual’s results with established norms.  

Whilst use of PPE may not correspond with the usual method of administering an assessment/outcome measure, it is vital that the safety of the individual and practitioner is maintained through use of PPE where necessary. You will therefore need to use your clinical reasoning to decide whether it is appropriate to administer it, considering factors such as:

• Whether the benefits of administering the assessment/outcome measure outweigh any compromises to standardisation.
• Whether there are any consequences or risks associated with reporting on results that may be affected by not following the usual administration procedure.

If you decide that it is appropriate to administer a particular assessment/outcome measure, it would be advisable to note any deviation from normal administration (such as use of PPE) and other factors that may impact on results (such as post-viral fatigue) when interpreting and reporting on it.
 

How can assessments be administered remotely?

Remote assessments may be carried out in a variety of ways from, for example, simply asking questions via a phone call or sending a self-report questionnaire in the post, through to use of video conferencing/screen sharing technology (such as Zoom, Microsoft Teams, FaceTime) or outcome measures that can be completed electronically/online.

Remote assessments need to be carefully planned and risk assessed. Factors to consider include:

• Is a remote assessment acceptable to the person/their household?
• Does the person have access to a telephone/the internet/technology?
• Does the person have the necessary skills/support to use the technology?
• How can the person’s privacy be maintained (e.g. is there a private space available to make a video or telephone call)?
• Which technologies will best meet the person’s preferences and needs (for example, be both acceptable to and suitable for a person with visual or hearing loss)?
• Is use of technology likely to impact on the results (e.g. cause anxiety or distraction)?
• Will it present risks (e.g. of falling if carrying/operating a handheld device)?
• Do you have a plan for what to do in the event of an incident during a remote session (such as someone becoming unwell or distressed)?

It is important to consider:

• Which technologies (including hardware and software) your organisation/employer supports use of.
• Whether the technologies comply with data protection and information governance requirements (including the General Data Protection Regulation [GDPR] and Data Protection Act 2018)  
• Whether adequate security measures are in place (for example: a secure internet connection, password protection for video conference sessions).
   

How do I know if a standardised assessment/outcome measure can be administered remotely?

The manual or official website for the assessment/outcome measure may contain details of whether it can be completed electronically/online. For example, there is a web-app version of the COPM , a remote administration version of the Oxford Cognitive Screen​ and the Montreal Cognitive Assessment (MoCA) website contains information about remote testing, available here (telemedicine article, 25 April 2022) and In their FAQs section.

Please also see the FAQ ‘How can assessments be administered remotely?'
 

Where can I find further information?

When selecting an assessment or outcome measure, you may find it helpful to use Key questions to ask when selecting outcome measures: a checklist for allied health professionals produced by the Allied Health Professions (AHP) Outcome Measures UK Working Group, a cross-disciplinary group representing a number of professional bodies, including RCOT. It is available to download from the RCSLT website here. 

You may also find the following RCOT webpages helpful:

• Digital occupational therapy
• Keeping Records and the Keeping Records guidance for occupational therapists (4^th ed, 2018) which includes information relating to digital care records and digital data (such as images and films).
• Informatics This page contains information about the importance of informatics at individual, service and organisational, and national levels. The national level section contains information relating to each of the four nations of the UK, including key contacts.