Assessment, Intervention Planning, and Outcome Measurement
Domain 4 focuses on selecting assessments, building intervention plans, and measuring change. Items ask why a measure is appropriate, what a score means, and whether a goal can detect meaningful outcomes.
Core rules
- Match the assessment to purpose: screening, diagnosis, planning, monitoring, or outcome. Check reliability, validity, responsiveness, norms, administration burden, and cultural/language fit.
- Use multiple methods: interview, observation, standardized tests, records, and client-reported outcomes. A standardized score is not a treatment plan.
- Baseline before intervention. Write goals with observable behavior, conditions, and criterion; link each goal to an occupational profile and a measurable outcome.
- Measure at the level you target. Impairment measures do not prove participation gains. Use activity/participation measures and client priorities, such as the Canadian Occupational Performance Measure, when appropriate.
- Re-evaluate on a planned schedule; revise the plan when data show no progress or an adverse response.
Worked example
A worker with a wrist fracture wants to return to keyboarding. Grip strength is low, but the OT also measures typing tolerance, pain, and work station setup. The goal is to type for 30 minutes with pain no higher than 3/10 using a split keyboard and paced breaks. Outcome review uses minutes typed, pain rating, and work participation, not strength alone.
Traps
Using a test outside its validated population; treating a change score as automatically meaningful; writing goals with vague verbs such as improve; measuring only impairment; and failing to document baseline, reassessment, or discontinuation criteria.