Assessment in physical rehabilitation: Current realities, impending challenges, and the empowering capacity of a client-centred measure

Background: Alternatives to deficit-focused measures which dominate rehabilitation are needed for client-centred practice (CCP) (Blaga & Robertson, 2008; Custer et al., 2013; Doig et al., 2015; Murray et al., 2015). The... [ view full abstract ]

Background: Alternatives to deficit-focused measures which dominate rehabilitation are needed for client-centred practice (CCP) (Blaga & Robertson, 2008; Custer et al., 2013; Doig et al., 2015; Murray et al., 2015). The Self-Assessment of Role-performance and ADL-abilities (SARA™) was purposefully developed as a client-centred alternative to procedure-centred approaches (Watkins et al., 2015).
Theoretical underpinning: The SARA’ ™ embodies principles from the Respect Model of Client-Centred Occupational Therapy (Hammell, 2015) and empowerment theory (Fleming-Castaldy, 2014) to shift power to clients.
Technique: The SARA™ is a standardized measure which obtains clients’ expectations for therapy, perceptions about abilities and participation, and satisfaction with treatment (Watkins et al., 2015).
Evaluation: Studies have established the SARA’s™ reliability, validity, and efficacy as an outcome measure for diverse populations (Blaber, et al., 2015; Watkins et al., 2015). Clinical research continues.
Practice Application: The sole use of performance-based instruments is the antithesis of CCP. Because a singular focus on performance diminishes people, therapists have an ethical responsibility to seek the client’s voice (Franits, 2005). However, time constraints, incongruence between client and therapist goals, and reductionist work cultures limit therapists’ consideration of clients’ aspirations (Gupta, & Taff, 2015; Hammell, 2015; Murray et al., 2015). The SARA’s™ addresses these barriers by obtaining clients’ autonomous goals in a timely manner (Watkins et al., 2015). The resulting client-directed discussion of personally acceptable interventions facilitates occupational well-being (Doble & Sanitha, 2008). The SARA’s™ efficiently enables value-based CCP and meets increasing demands for data-driven decision making and measureable outcomes (Leland et al, 2015; Schaaf, 2015).