OT FACT Features

Feature Summary

OT FACT offers many powerful features for functional assessment software and report writing in occupational therapy. Version 2.0 runs on the Apple Macintosh Operating System and IBM – compatible computers with Microsoft Windows 95 or Windows 3.1 Operating Systems.

More Questions for Specialized Areas of Practice

Almost 1000 questions are now available in OT FACT to help provide more detail for specialized areas of practice.

Customizable Question Sets

Of the 950+ functional performance categories, less than 300 are core categories. This means that about 650 of the questions are optional to enable users to customize the question set for particular areas of practice.

Extended Demographics

Twenty-five basic demographic categories and thirteen extended demographic items are available for research, quality improvements activities, program evaluation, or even auto-merging of information into individually written reports.

Automatic Inclusion of Assessment Data into Reports

The auto-merge feature of OT FACT promotes efficient report writing. Auto-merge pulls data directly from the Demographic and OT Performance Modules and automatically places them into forms and formats you design.

Copy and Paste Features

The OT FACT Version 2.0 Report Module enables users to clip items from lists of commonly used words, phrases or sentences to develop individualized, efficient reports. A list of commonly used goals and treatment plans can be tapped to develop consistent yet comprehensive reports more rapidly.

Memo Templates

Memo fields are available in OT FACT Version 2.0 to provide a place to document detailed or additional information related to any question. These can also be utilized as templates to include data from other specialized evaluations.

Special Scoring Types

OT Fact Version 2.0 introduces new scoring capabilities to identify and document the specific effects of assistive technology as environment-free, and/or environment-adjusted. Additional advanced scoring protocols allow for self satisfaction, goal or co-variate scoring.

Dual Purpose Design

A primary concept of OT FACT design is that there are two competing purposes for performing functional assessment.

  1. Obtaining performance outcome measures.
  2. Diagnosing an individual’s functional deficits.

The difference between the two is critical to understand. An outcome measure is derived by administrators, accrediting agencies, quality review organizations, researchers, and funding agencies for program evaluation, quality assurance activities, research data collection, documentation of impact of therapy, quantification of need, etc. For these purposes, it is necessary to have valid and reliable outcome measures that are aggregate quantified figures; that is, one or a few numbers which summarize a person’s function.

On the other hand, therapists need to identify and track an individual’s functional deficits for organizing and implementing an appropriate treatment for optimizing function. For this purpose, summary functional performance information isn’t as helpful. Therapists need more detail to highlight the specific areas of functional deficit and to relate areas of deficit to higher levels of functional outcome. For example, not only does a therapist need to know whether an individual has a problem with independently dressing, but the therapist also needs to know why there is a problem. Is it a hand function deficit due to weakness? Is it because they select clothing inappropriate for the weather? An outcome measure quantifies the degree of the dressing problem. A diagnostic system helps explain why. An outcome measure summaries the amount of a functional problem. A diagnostic system leads to the formulation of treatment and intervention plans.

During the development of OT FACT, the design team refused to choose an outcome or diagnostic focus. The belief that a dual purpose system could be designed, combined with a theoretical base and innovative design techniques, led to the creation of a system which performs both outcome and diagnostic functions.

TTSS (Trichotomous Tailored Sub-Branching Scoring)

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). TTSS provides the mechanism for simple, straightforward responses that branch into sub-questions, but only as detailed as 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.

Scoring the OT FACT

OT FACT has both basic scoring and advanced scoring features. The basic scoring steps can be found in the Getting Started Manual.

The Advanced Scoring Features include:

  • Use of Question Memos for Additional Data
  • FIM Scoring
  • Self-Satisfaction Scoring
  • Goal Scoring
  • Co-Variate Scoring

Use of the Advanced Scoring Features are described in the main OT FACT Software Operation Manual in the program.

OT FACT Scoring Basics

Remember – OT FACT Does Not

  • Necessarily change any evaluation procedures.
  • Specifically delineate how you evaluate your client.
  • Have a standardized protocol for obtaining the data.

OT FACT Does

  • Have specific scoring procedures and criteria for scoring.
  • Orient the therapist to be observant of specific data.
  • Help you identify what specific functions should be observed.
  • Sequence the evaluation process in an efficient and comprehensive manner.
  • Break functional performance down into questions, sub-questions, and sub-sub-questions. This branching capability adds to clarification of items.
  • Assume that functional performance has a strict, criterion based validity. There is an absolute floor and ceiling score for functional performance: 0%-100%.
  • Utilize a dynamic question set to allow for the variability of functional performance required of each individual. Percent function is normalized.

Trichotomous Scoring

A trichotomous (three-choice) scale is used for scoring throughout OT FACT.

  • Is there a deficit? Yes or No
  • If there is a deficit, is it Partial or Total?

For most of the OT FACT scoring types, the following general definitions apply:

  • <2> (No Deficit) — Performance meets all criteria of the question.
  • <1> (Partial Deficit) — Performance meets some, but not all of the criteria.
  • <0> (Total Deficit) — Performance meets none of the criteria.

Two additional choices are also available on most levels of the Performance Outline. They are:

  • <space> (Not Applicable) — remember: a question is applicable if there is ANY uncertainty in its applicability status!
  • <?> (Not Examined) — remember: any NE entries prevent OT FACT from computing sub-total scores. It considers them “missing data.” Summaries and graphs will display a question mark (?) to represent this incompleteness.

Note: These definitions change slightly depending on the scoring type selected. This is because the variety of scoring types consider performance in different contexts. The scale, however, is the same trichotomous scoring. Please read and study the scoring types. They must be fully understood to use them competently.

Not Applicable (NA) Scoring

One of the unique features of OT FACT is that many of the OT FACT questions can be scored not applicable. When this happens, OT FACT computationally removes the question from the OT FACT sets of questions to make one hundred percent function which has been individualized for the person in their particular setting. Gender, age, and setting specific questions are those types of questions which are most often scored as not applicable.

Note: If there is any uncertainty whether an individual question is applicable or not applicable, the tie always goes to having the question as applicable.

Environment-Free Scoring

Use this scoring to quantify an individual’s intrinsic performance. This is, in essence, the performance of an individual who has no accommodation. No type of adaptive equipment or environmental assistance is considered when assigning scores.

  • <2> (No Deficit) — Performance meets all criteria of the question without any external need for intervention.
  • <1> (Partial Deficit) — Performance meets some, but not all of the criteria.
  • <0> (Total Deficit) — Performance meets none of the criteria.

Two additional choices are also available on most levels of the Performance Outline. They are:

  • <space> (Not Applicable) — remember: a question is applicable if there is ANY uncertainty in its applicability status!
  • <?> (Not Examined) — remember: any NE entries prevent OT FACT from computing sub-total scores. It considers them “missing data.” Summaries and graphs will display a question mark (?) to represent this incompleteness.

Use of the Assistive Technology Memo Field and the Assistance Required Memo Field is usually not appropriate when scoring intrinsic performance.

Use the Question Memo for any question to record pertinent details which support your scoring choice.

It is intended that scores are obtained by observed or tested performance rather than by interview or self-score. In situations where observation is impractical, other methods may be used, (e.g., patient report, information from other disciplines) however, the method should be documented.

Environment-Adjusted Scoring

Use this scoring to quantify an individual’s independent functional performance with the use of adaptive equipment or with a specifically structured environment which enhances independence. For reliable scoring it is recommended to use the Assistive Technology Memo Field and/or the Assistance Required Memo fields to clarify the environmental assistance.

  • <2> (No Deficit) — Performance meets all criteria of the question.
  • <1> (Partial Deficit) — Performance meets some, but not all of the criteria.
  • <0> (Total Deficit) — Performance meets none of the criteria.

Two additional choices are also available on most levels of the Performance Outline. They are:

  • <space> (Not Applicable) — remember: a question is applicable if there is ANY uncertainty in its applicability status!
  • <?> (Not Examined) — remember: any NE entries prevent OT FACT from computing sub-total scores. It considers them “missing data.” Summaries and graphs will display a question mark (?) to represent this incompleteness.

Use the question Assistive Technology, and/or Assistance Memo Fields as appropriate to detail qualitative support for scores.

It is intended that scores are obtained by observed or tested performance rather than by interview or self-score. In situations where observation is impractical, other methods may be used, (e.g. patient report, information from other disciplines) however, the method should be documented.