Development of an outcome measure based on motivation and action for occupational therapists in neurological rehabilitation

Abstract

Motivation is a crucial determinant of the outcome of rehabilitation in patients following an ABI. Their level of motivation therefore requires close monitoring during assessment and treatment. Occupational therapists also require a way in which the effectiveness of their services can be measured. There is however a lack of an assessment tool or outcome measure specifically designed for the field of neurology that directly assesses a patient’s level of motivation, while also including their occupational engagement. The purpose of this study was to close this gap in neurological rehabilitation by developing an outcome measure that assesses a patient’s motivation, while also addressing their corresponding action and therefore their engagement in occupations. The outcome measure had to be grounded in a theoretical framework that covers motivation and action. The Vona du Toit Model of Creative Ability (VdTMoCA) was chosen as the theoretical framework as it allows therapists to describe a patient’s participation in everyday occupations according to their motivation and action. The Model provides therapists with a list of consecutive levels on which patients can function. This provides therapists with a means to measure baseline performance, track the progress of patients and calculate the effectiveness of intervention. A qualitative research design was selected to guide this study. Two objectives were set for the development of the outcome measure. Domain descriptors for the outcome measure, according to the first six levels of Creative Ability, emerged to fulfil the first objective. This was achieved through the use of focus groups held with occupational therapists working in neurological rehabilitation. The design and development of the framework for the outcome measure and the transfer of the data into the measure was a theoretical process and fulfilled the second objective. During data analysis, themes and substantiating codes emerged for all the domains within each level of Creative Ability. The themes that emerged for the domains “Motivation” and “Action” are as follows. In the level of Tone, “Motivation”: motivationally blank, physiological maintenance; “Action”: pre-destructive, reflexive and involuntary. In the level of Self-Differentiation, “Motivation”: egocentric and to differentiate self from the environment in order to establish body boundaries; “Action”: destructive, incidentally constructive and emergence of participation. In the level of Self-Presentation, “Motivation”: to present self, unsure and externally motivation; “Action”: Explorative, facilitated and 1-2 steps. In the level of Passive Participation, “Motivation”: directed to the attainment of skills and establishing rules and norms, externally motivated; “Action”: skill or product centred, therapist directed, safe and 2-4 steps. In the level of Imitative Participation, “Motivation”: intrinsically motivated to achieve something; “Action”: imitative, norm directed and 7-10 steps. In the level of Active Participation, “Motivation”: directed to the improvement of self; “Action”: with originality and transcends the norms. The outcome measure that was developed was named the Motivation and Action in Neurological Rehabilitation Outcome Measure (MANROM). Recommendations regarding the investigation of the psychometric properties were formulated to eventually market the MANROM as a reliable and valid outcome measure for occupational therapists in neurological rehabilitation.