Top Occupational Therapy Assessments in Acute Care

Patients in the acute care setting are admitted with the goal of medical stability. Occupational therapists provide an important role not only in the physical rehabilitation of the patient while admitted to acute care, but also with providing the recommendations for post-acute care and discharge.

OT is especially qualified for making these recommendations, as we must consider the whole person, including their home environment and support system, when treating our patients. All of these factors are important in considering appropriate care after discharge.

Other team members will often look to therapy to help make the appropriate plan, and having an assessment with objective measures will provide the team, including the patient and family, with evidence to support plans for the next step.

Selecting appropriate occupational therapy assessments in acute care is not an easy task because of the complexities that are often present in this population. Patients are admitted to acute care with a wide range of diagnoses, including (but not limited to):

• Strokes
• Falls
• Elective orthopedic procedures (such as a hip, knee or shoulder replacement)
• Cardiac complications and procedures
• Generalized weakness and debility
• Amputations
• Wounds
• Respiratory failure
• Other traumatic event

Trauma patients present the additional challenge of falling into multiple categories whether it be a brain injury, orthopedic injury, respiratory complications, or wounds. In addition, each person admitted to the hospital may also bring additional co-morbidities that were present prior to his or her admission to acute care.

This is the reason that finding one standardized acute care assessment to cover all aspects related to the patient’s discharge is often a challenge for both the new and experienced OT.

Because of this, we have compiled a list of 10 assessments that can be administered in acute care settings in the areas of pain, ADL performance, balance, and cognition.

Pain Assessments 

The Stanford Pain Scale

Commonly used as a verbal assessment of pain within the acute care setting, the Stanford Pain Scale is easily understood and communicated among the interdisciplinary teams involved. It is an adapted approach to the most common pain scale, the numeric 0-10 ranking, with descriptions added to each value, such as very mild, distressing, and utterly horrible. This abstract scale may be more difficult for patients with impaired cognition.

Wong Baker Faces

Originally established to measure pain in children younger than 3, the Wong Baker Faces visual assessment is now used for children and adults alike. The assessment is often easier to comprehend than the abstract 1-10 scale.

Visual Analog Scale (VAS)

The Visual Analog Scale (VAS) can be presented in a variety of ways, but the most common is to present the patient with a horizontal line and allow them mark on this line to identify their perceived level of pain. The therapist would then measure from the left side of the line (in mm) and use the number as the “score”.

The VAS is the most sensitive to measure incremental differences in pain. It requires little training to administer and is easy to score. However, this assessment may be difficult to understand for older adults or those with cognitive or perceptual deficits.

ADL Assessments

Activity Measure of Post-Acute Care (AMPAC)

The AMPAC includes areas to assess mobility, ADLs and cognition. Although fairly comprehensive and easy to administer and score, this assessment is not free and there is a charge for clinical and commercial use. This assessment is effective in measuring progress and outcomes for therapy and hospital admissions.

Katz ADL Index

The Katz ADL Index is an observation based assessment measures the patient’s performance in the six self care areas of bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. This assessment is easy to administer and score, but is limited in its ability to show incremental changes in the patients’ performance.

Modified Barthel ADL Index

The Barthel Index (BI) measures the extent to which somebody can function independently and has mobility in their activities of daily living (ADL) i.e. feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, chair transfer, ambulation and stair climbing.

These 10 items can be measure either through self report or by direct observation, which could take approximately 20 minutes to administer. No additional training is required to administer.

Balance Assessments

Berg Balance Scale

The Berg Balance Scale measures static balance and fall risk in adults. This assessment requires a little more time, an estimated 15-20 minutes, but provides a thorough assessment of balance in a variety of static and dynamic positions. This assessment requires standard height chairs with armrests and without armrests, as well a stool or step and a ruler.

Depending on the acute care setting in which you work, space and environmental limitations are important to consider when choosing this balance assessment.

Timed Up and Go (TUG)

The Timed Up and Go assessment is used to measure mobility, balance, and fall risk in adults. This assessment requires the availability of a standard sized straight back chair with at least 9.8 feet (3 meters) of clear space to allow the patient to walk. This assessment also requires “regular footwear” and does allow the patient to use assistive devices as needed.

Many acute care patients do not bring their own assistive devices or shoes when admitted for acute medical issues, so it would be important to have their preferred assistive device available to score appropriately. This assessment is easily administered; the therapist uses a stopwatch to time how quickly the patient is able to safely (and normally) walk to the identified goal and then back to the chair. This time is used to identify patient’s fall risk.

Cognition Assessments

Mini Mental Status Exam

The Mini Mental Status Exam (MMSE) is a brief cognitive screening tool that provides a quantitative assessment of cognition, including areas of orientation, attention, memory, language and visual-spatial skills. The MMSE can be administered quickly, usually 10 minutes, and the score are interpreted to identify the presence of a mild, moderate, or severe cognitive impairment.

The St. Louis University Mental Status Exam (SLUMS)

The SLUMS on average takes approximately 7 minutes to administer (although it can take a bit longer depending on your patient). This assessment tests orientation, memory, attention, and executive function. The maximum score is 30 points, with cut off scores for dementia and mild neuro-cognitive impairments based on the patient’s education level.

Be sure to also check out the online training video provided on the SLUMS website if you’re unfamiliar with it.

Bonus OT Assessments in Acute Care

One area in which OT is often underutilized is in critical care. As OT continues to grow in this area and expand our presence in critical care, one assessment we can utilize is the:

Perme ICU Mobility Scale

The Perme ICU Mobility Scale takes a considerable amount of time depending on the patient, with an average of 15-60 minutes approximated for this assessment. Because of the limited assessments for patients in the ICU, however, it is an appropriate choice to provide a comprehensive evaluation of a patient’s mobility status starting with the ability to follow commands and cumulating in the distance the patient is able to walk in 2 minutes.

The score is derived from 15 items grouped into 7 categories: mental status, potential mobility barriers, functional strength, bed mobility, transfers, gait, and endurance. No additional training is required to administer this assessment, however you can find more info about it here. 

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What other OT assessments do you use in your acute care setting? Please share them in the comments!