Evidence of determining clinical utility in the development of assessments in occupational therapy: a scoping review

Abstract

Occupational therapists rely on information gained from standardised assessments, screening instruments, and clinical observations to determine a client’s strengths and weaknesses (American Occupational Therapy Association [AOTA], 2020; Brown, 2010; Foxcroft & Roodt, 2013; Kramer et al., 2009; Richardson, 2010). The information gained from the assessment will be used for planning of intervention and discharge, writing of reports and documentation, as well as applying for funding from medical aids (Alotaibi et al., 2009; Asaba et al., 2017; Benson & Clark, 1982; Scott et al., 2006; Unsworth, 2000). Clinical practice is therefore demanding assessments that are not only psychometrically sound but are appropriate to the context in which they are used (Bossuyt et al., 2012; Foxcroft et al., 2004; Glover & Albers, 2007; Nalder et al., 2017). Clinical utility can be described as how useful and appropriate the assessment is within a specific setting (Benson & Clark, 1982; Lesko et al., 2010; Macy, 2012; Nalder et al., 2017). This is especially important within the South African context, where occupational therapists often use assessments that were developed in the Global North. During assessment development, validity and reliability are often the only factors determined to establish the psychometric properties of an assessment (Benson & Clark, 1982; Salmond, 2008; Switzer et al., 1999). However, it is essential to determine the clinical utility of an assessment during the psychometric testing phase in assessment development. This will allow the developer to adjust the assessment to suit the characteristics and needs of the population and context (Bowyer et al., 2012).

A scoping review was conducted to determine whether there is evidence of clinical utility being determined as part of psychometric testing during assessment development in occupational therapy. The study aimed to map the available literature on clinical utility in occupational therapy and identify possible gaps within the existing literature. A comprehensive search of published and unpublished literature between January 2005 and December 2020 was conducted. The search yielded 38 applicable studies.

The results of the study indicated an increase in the number of studies done on the clinical utility of assessments within the last 10 years. The majority of the studies were conducted in Global North countries including Australia, the United States of America, and the United Kingdom. The included studies used a variety of study designs, including qualitative, quantitative, and mixed method research designs. The study also included both systematic and literature reviews. However, these designs often did not include the context for which the clinical utility was being determined. A wide variety of components of clinical utility were included within the research, emphasising the lack of a standardised definition as well as a process for establishing the clinical utility. Limited studies on clinical utility were conducted during the assessment development process. Studies were mostly conducted when an already developed assessment was used in a different context to which it was initially developed. None of the included research was conducted in South Africa. Therefore, the results from the Global North cannot be generalised to the diverse context and rich cultural population of South Africa, which forms part of the Global South.