Measuring the effectiveness of interventions when occupational performance is severely impaired

There has been a call for conceptually valid assessments to measure occupational performance with greater sensitivity. This opinion piece reasons that a broad-based tool is required to relate subtle shifts in occupational participation to changes in the therapeutic environment. It includes case vignettes from learning disability and dementia services to illustrate the progress that can be made in occupational participation. Improvements in participation were matched to indicators of change in existing assessment and intervention manuals, leading to the development of a new assessment. Future research will investigate the assessment's potential to measure progress when a person's occupational performance is severely impaired.