The total list of 950-plus functional assessment questions is connected by more than 100 hierarchical decision nodes. Therapists and rehabilitation administrators viewing the assessment are initially stunned at the prospect of navigating through a system so large and complex. Since one of the goals of OT FACT, however, is to provide an efficient mechanism for documenting the functional assessment of an individual, a simplification technique is used. Most functional assessments have dealt with these issues by narrowing the scope of the instrument or by selecting only the statistically salient set of functional items.
OT FACT addresses efficiency with a trichotomous (three-choice) scale called TTSS (Trichotomous Tailored Sub-Branching Scoring) is used for scoring. TTSS provides the mechanism for simple, straightforward responses that branch into sub-questions, but only as detail is needed. The therapist scores each of the functional areas as No Deficit, Partial Deficit, or Total Deficit. For example, on Level 2, "Functional Activities of Performance," No Deficit signifies total independence in the given activity or subtask, while Total Deficit signifies full dependence. Partial Deficit is simply defined as something in between No Deficit and Total Deficit. Total or No Deficit choices advance the question set to the next major question. Partial Deficit scoring branches the evaluator into questions of greater detail to help describe where performance breaks down. The rationale for this trichotomous scaling is two-fold. First, it allows scaling to be consistent throughout OT FACT. Second, it is very easy to conceptualize, so that a therapist can respond rapidly when examining any particular area of function. Not Applicable and Not Examined responses are also legitimate responses in this scaling system. Figure 2 portrays the five legal responses and their definitions for use.
All clients do not require detailed evaluation in all 950-plus areas of function. For example, for a patient with a hand trauma, many of the cognitive areas of functional deficit need only to be screened, and do not require extensive, detailed evaluation. Further, when a patient is seen to be totally independent or totally dependent on a gross level in an activity domain, there is no need to proceed item by item to assess and report every detail of function within that domain. As another example, a patient who is semi-comatose in intensive care is easy to assess in the dressing activity. The patient will have a total deficit. In that situation, there would be no sense in proceeding in more detail to determine whether the patient can select appropriate clothing, obtain and put away clothing, don and doff the clothing articles, use the clothing fasteners, and manage peripheral clothing items. Thus, OT FACT has incorporated a decision node as a screening element.
TTSS
2 (No Deficit): should be selected if the person's performance in the question meets all defined criteria.
1 (Partial Deficit): should be selected if the person's performance in the question meets some, but not all of, the defined criteria.
0 (Total Deficit): should be selected if the person's performance in the question meets none of the defined criteria.
NA (Not Applicable): should be used for any question not applicable to the client being assessed. For example, "Employment and Volunteer Preparation Activities" for a 6- year-old-boy would properly score an NA. Questions are applicable if there is any uncertainty as to their applicability status.
NE (Not Examined): should be used when the setting or the particular circumstances prevent assessing the client in that question.
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