| Summary: | 博士 === 國立中正大學 === 企業管理系研究所 === 104 === Background: Occupational therapy (OT) engagement of stroke patients can be defined as ‘the degree by which stroke patients follow and engage in the therapeutic programs designed by her/his occupational therapist at clinical setting or at home’. Previous studies have shown that the implementation and the effectiveness of therapeutic programs are highly affected by patients’ engagement. However, little research investigates OT engagement, limiting our understanding and promotion of engagement. There are three measures that assess patients’ rehabilitation engagements to date. However, these measures are not designed especially for stroke patients. In addition, these three measures have their limitations individually in clinical use, and the reliability and validity of these measures have not been fully verified. Notably, there is no reliable measure to assess the OT engagement of stroke patients yet; the shortcomings will hamper the master of clinicians and researchers in engagement, and impede the improvement of quality of OT treatment.
Purpose: to develop the Occupational Therapy Engagement Measure (OTEM), and further examine the reliability and validity of the OTEM.
Method: Three stages were planned. First, development of the instrument: We developed the OTEM through literature reviewing and interviewing experts and employing cognitive interview to further examine the items and rating scale of the OTEM, then we revised/finalized the OTEM. Second, validation of the psychometric properties of the OTEM: We recruited participants with stroke, who were assessed by their own therapists using the OTEM, and using exploratory factor analysis and confirmatory factor analysis to examine the internal consistency, construct validity and predictive validity of the OTEM. The final version of the OTEM will be decided on the basis of the results of the psychometric investigations. Third, to interview the OTs who have used the OTEM to investigate the clinical utility of the OTEM.
Results: A total of 16 OTs participated in the focus group. In the first stage, the OTEM with 16 items and 4-point-frequency scale has been developed. A total of 201 inpatients with stroke participated in the study of exploratory factor analysis of the OTEM. The results showed that the OTEM was uni-dimension with 6 items. A total of 217 inpatients with stroke participated in the study of confirmatory factor analysis of the OTEM. The results showed that the uni-dimension OTEM with 5 items had good construct validity. The users of the OTEM indicated that the multiple items of the OTEM improves the OT’s acknowledge of the multiple facets of the engagement, and the OTEM is suitable for patients with various diagnosis. In addition, the OTEM has potential to replace the item of engagement used in clinical setting at present.
Conclusion: The 5-item OTEM with good construct validity has been validated. The precise items of the OTEM are suitable used in clinical setting. The results of this study could be the basis of further studies to investigate the related factors and the clinical utility of the OTEM. In addition, the results of this study could be helpful to the OT to manage and monitor the level of engagement of the patients in therapeutic activities, and improve the factors those affect the engagement to promote the quality of therapy and therapeutic outcomes. Besides, the OTEM with sound reliability and validity has potential to replace the items related to the engagement which are used in clinical settings at present.
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