**2. Relevance of assessment in occupational therapy**

Occupational therapy focuses on occupations, i.e., everything a person does from the morning when they wake up until the evening when they go to sleep. This involves many different activities that each person does in his or her own unique way. Rehabilitation to occupations therefore means having individualised goals. The OT treatment is indeed individualised and varied.

There are no treatment protocols but reference models that guide the therapist in defining the objectives and setting the treatment. Goal setting is based on the person's needs, taking into account the value the person places on the activities and their perception of the urge to recover them. The occupational therapist will negotiate treatment goals with the patient based on occupations that are meaningful to the person.

It is therefore necessary to be able to identify occupational needs, which is why it is important to use assessment tools and outcome measures. Assessing needs in a pre- and post-intervention phase of OT means monitoring the change in the person, and thus verifying the impact and effectiveness of the treatment itself. Assessing also means tailoring the treatment to the person's characteristics, needs and wishes. The evaluation serves to establish goals that are a priority for the individual. The most important part is the individual's perceived functioning and disability, regardless of the diagnosis. Finally, evaluation means being able to show the results of one's work to the scientific community, sharing experiences and promoting evidence-based practice.

#### **2.1 Occupational therapy assessment characteristics**

Both performance in everyday life and occupational problems encountered can be assessed. The focus of the evaluation in occupational therapy remains on the needs of the person. This evaluation is done using a variety of tools, semistructured interviews, collection of stories, or similar, all aimed at getting to know the person and establishing a good therapeutic relationship. The advantage is that the person feels listened to, at the centre of their treatment, welcomed and projected into his or her reality even outside the context of the illness. This has a positive impact on treatment compliance and motivation. The more motivation/ desire a client has to engage in activities, the better he/she will be able to cope with the impairment [2].

#### **2.2 Some occupational therapy-specific evaluation tools**

Among the most widely used tools in Occupational Therapy is the Canadian occupational performance measure (COPM) [3]. COPM is a semi-structured interview, which allows the analysis of the areas of self-care, productivity and leisure time of the person, identifying problems that may arise within the normal routine. In addition to being a cognitive tool that helps to establish the therapeutic relationship, it also helps the patient and therapist to establish, or rather to negotiate, the objectives of the occupational therapy treatment. It is also an outcome measure as it scores the patient's subjective perception of the performance of the activities and the degree of satisfaction in performing them.

The post-treatment evaluation makes it possible to understand if the objectives have been achieved or if it is necessary to modify the action plan. By providing this evaluation with two measurement times (an initial and a final one) it allows to understand if the treatment leads to a clinically significant result for the patient, that is a real positive change in daily activities and autonomy. This instrument is

non-dependent from the pathology, it can be administered to the person or to the patient's caregiver. Another tool is the daily diary (Activity Daily Log). The Activity Daily Log allows the person to collect his/her occupations reflecting on the time spent performing them and the emotions felt while doing so. The collection of these activities will serve as a starting point for goal setting. It is a widely used tool for orthopaedic patients [4] and patients with chronic fatigue [5].

Both tools allow an assessment aimed at collecting the person's own needs and guarantee a person-centred practice, favouring the therapeutic relationship.

### **2.3 Results of a study on the occupational needs of complex sub-acute patients**

The cross-sectional observational study "Occupational therapy for complex inpatients with stroke: identification of occupational needs in post-acute rehabilitation setting" [6] identifies the characteristics and occupational needs of stroke inpatients who are considered as "complex", focusing on function and ability, regardless of diagnosis. In this study, the occupational therapist identified occupational needs through the COPM.

The results found that the enrolled patients were dependent in basic activities of daily living (ADLs), limited in instrumental ADLs and easily fatigued. Their occupational needs were related to self-care (75%) and, to a lesser extent, productivity (15%) and leisure time (10%). According to the results of the inpatient survey, the rehabilitation process should primarily address self-care needs, followed by productivity and leisure time activities.

Despite the small sample size, this study described the patterns of occupational needs in complex stroke patients and pointed out that, although to a lesser extent than self-care needs, productivity and leisure issues also arise in the early post-acute phase.

Client-centred rehabilitation programmes must address self-care needs, as well as focusing on the recovery of family and social roles, both in the productive and leisure sectors.

Addressing these needs helps the patient to project himself into the home dimension, boosting motivation, recovering his role in the community and occupying time in a meaningful way.
