The Importance of Activity Analysis in Occupational Therapy
Activity analysis is the central function of occupational therapy. It is what makes us OTs.
Do you ever think about why and how you analyze activities?
Is it something that is just automatic for you, or do you use a formal system?
How often do you use activity analysis to prove that your treatments are effective?
This article will discuss some aspects of activity analysis and why we as OTs need to pay a bit more attention to it in our daily practice.
Why We Analyze Activity
Activity analysis has its roots in the job analysis techniques used by industry during World War I (Creighton, 1992). After the war, as injured soldiers received treatment to recover from their injuries, occupational therapists applied these techniques.
Crafts and other therapeutic activities were analyzed, and the components of those activities were used to pinpoint certain skills as the soldiers progressed during therapy.
Today the activity analysis process has been refined to include physical, perceptual, cognitive, psychological, social and cultural factors.
Example Case Study
Here is an example. An OT completes an initial evaluation with a 35-year-old woman who has a diagnosis of carpal tunnel syndrome. During the evaluation, the woman tells the OT that she cannot make her family’s favorite meal of lasagna with garlic bread.
The OT immediately begins asking questions to start analyzing this activity, so she can identify and problem solve what the barriers are to this task and why the task is important.
Why does the woman want to make lasagna?
The woman responds that it is her family’s favorite meal and one of the few times she can get her husband and four children around the dinner table all at once. She explains that she has Italian ancestry and the recipe was her grandmother’s. In this one question, the OT has established the psychological, social, and cultural significance of the task.
How does the woman make lasagna?
Here is where the OT asks specific questions about the process the woman uses to complete the task.
- What are the steps?
- What kind of kitchen tools does the woman use?
- How is the woman’s kitchen set up?
By asking these types of questions, the OT should be able to pinpoint the specific skills required to complete the task and which of those skills is limited by the woman’s carpal tunnel syndrome.
What is the biggest barrier to the activity?
In this example, it turns out that not only is the woman using her grandmother’s recipe, but she is also using her grandmother’s kitchen utensils. The utensils are antique and as a results are worn out and difficult to use and hold. By simply changing the utensils used to cook the lasagna to ones that are easier to use and hold, the activity is much easier to complete and the patient can get back to this important occupation.
The OT has established the physical, perceptual, and cognitive requirements of the task through this interview. She identified the primary barrier to the woman’s completion of the task which is the woman’s attempt to use inadequate kitchen utensils while battling the symptoms of carpal tunnel syndrome.
This very important detail about the utensils would not have come to light if the OT had not completed a detailed activity analysis. The example portrays an OT using an interview to complete an activity analysis, but OTs often observe activities as well.
Research Supporting the Use of Activity Analysis
Although activity analysis plays an important role in occupational therapy, the research supporting why and how it is used is not readily available. Most of the information about activity analysis is contained in occupational therapy textbooks.
A perusal of the American Occupational Therapy Association’s Evidence Exchange database reveals lists of research articles that target specific treatment modalities and therapeutic activities, but none that focus on activity analysis itself. A Google search pulls up articles discussing the importance of activity analysis, but no research studies that directly examine it.
Perhaps the process of activity analysis is simply an underlying function of our profession, and in a way a kind of common sense that has not been rigorously examined like other interventions would be. Regardless, it is a valuable tool and supported by the general body of occupational therapy work.
Still, more research on the use of activity analysis and its affect on therapeutic outcomes is needed.
Systematic Use of Activity Analysis
Another point to consider is how we use activity analysis. When I analyze an activity, I usually do it quickly in my head. It’s pretty much automatic.
But, is this the best way to analyze an activity? What am I missing by analyzing an activity in this manner?
Many OTs analyze activity in this same way, but a quick, informal analysis is probably not thorough and definitely not adequate when the need to prove the usefulness of the activity to others is required.
Yoshikawa (1993) conducted a survey of 100 fieldwork educators on their use of written activity analyses. Of the 37 who responded, only 2 used written activity analyses in daily practice. The other respondents indicated that while formal activity analysis is important, it is too time consuming for use from day to day.
Standardized Initial Evaluations
Using standardized initial evaluations that include activity analyses is one way to incorporate activity analysis into daily practice without expending too much extra time. ADL assessments are the best example of how activity analysis can be incorporated into a formal initial evaluation, as shown by evaluation tools such as the Klein-Bell Activities of Daily Living Scale or the Cleveland Scale of Activities of Daily Living.
Both assessment tools break down ADL tasks into their components and assign performance ratings to the components, giving the therapist a number to work from when helping a patient to improve ADL performance. Measurements like these are very important when referral sources and third-party payors want to see evidence of progress.
Given the importance of activity analysis in the profession of occupational therapy, we all need to give the practice a little more thought. If you are a student or a new occupational therapist, use activity analysis assignments to guide you as you gather materials to use in your practice.
If you have been analyzing activity for years, take a look at what you do and how you can improve and document it. Working to make the process of activity analysis a little more formal will benefit our patients, our practice, and the profession long term.
Creighton, C. (1992). The origin and evolution of activity analysis. American Journal of Occupational Therapy 46:45-48. doi:10.5014/ajot.46.1.45. Retrieved June 20, 2018 from https://ajot.aota.org/article.aspx?articleid=1876534.
Klein, R. M., & Bell, B. j. (1982). Selfcare skills: Behavioral measurement with Klein-Bell ADL Scale. Archives of Physical Medicine and Rehabilitation, 63, 335-338.
Patterson, M. B., Mack, J. L., Neundorfer, M. M., Martin, R. M., Smyth, K. A., and Whitehouse, P. J.(1992). Assessment of functional ability in Alzheimer disease: A review and a preliminary report on the Cleveland Scale for Activities of Daily Living. Alzheimer Dis. Assoc. Disord. 6: 145–163.
Yoshikawa, Hiromi, “The Use of Activity Analysis by Occupational Therapists in Treatment Decisions” (1993).Master’s Theses. 812. http://scholarworks.wmich.edu/masters_theses/812. Retrieved June 20, 2018 from https://scholarworks.wmich.edu/cgi/viewcontent.cgi referer=https://www.bing.com/&httpsredir=1&article=1848&context=masters_theses.