Summary

Work functioning assessments (WFA) of physically impaired people are a regular part of occupational therapy clinical practice. WFA results serve to determine eligibility for rehabilitation, aid career-transition decision making or determine eligibility for income-replacement benefits. They can also be used to plan a back-to-work rehabilitation program or to adapt a workstation. However, there is enormous variability in WFA clinical practice, which raises questions about the overall quality of WFA results. Inaccurate or incomplete WFA results can have major adverse impacts, such as injury, and loss of job, income or self-confidence, on the health and quality of life of workers with physical impairments. One of the ways currently being proposed to reduce this variability and increase the quality of health care is the development and dissemination of evidence-based clinical practice guidelines, as they provide reliable information on which clinicians can base their decisions. To our knowledge, there are currently no clinical practice guidelines for occupational therapists on WFA.

The purpose of this study was to develop a clinical practice guideline for occupational therapists assessing the work functioning of people with physical impairments. It involved conducting a systematic review of the literature and using the results of the review to prepare a first draft of the guideline. That draft was presented to 24 occupational therapists specialized in WFA (four focus groups and two individual interviews). They were consulted on the format and clarity of the guideline, the appropriateness of each clinical recommendation presented in the guideline and whether the set of recommendations covered the field adequately. The focus group discussions and individual interviews were recorded and transcribed, and a qualitative content analysis was performed.

The consultation revealed that the guideline is easy to use. Most of the consultation participants said they concurred with the recommendations drawn from the review of the literature. Although they felt that some recommendations should have been more precise or more complete, they agreed that they covered the field comprehensively. They also confirmed the usefulness of the guideline to both novice and experienced occupational therapists.

To conclude, the study provided a view of current knowledge related to WFA and how it should be applied by occupational therapists. The feedback from experienced therapists helped us to be more precise and more complete with some recommendations and to produce a useful, quality clinical practice guideline.