Reasons for Conducting a Complete Subjective Health Assessment
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In the first part of this three-part series the SOAPIER (Subjective; Objective; Analysis; Plan; Intervention; Evaluation; Re-assessment) tool was introduced, and the subjective assessment highlighted as critical in enabling the identification of clinical and biopsychosocial flags that could affect care planning and success. Here we move on to consider another part of the subjective assessment as we focus on populating a patient’s ‘SIN factor’ for the primary complaint, i.e. ‘Severity, Irritability and Nature’ of the problem. This will inform how the objective assessment should be performed to fulfil a hypothetico-deductive approach, with sensitive and specific tests being selected and undertaken. As a result, truer positive/negative results are obtained to help the podiatrist arrive at a clinical impression or ‘working diagnosis’. This article explores the use of the SIN factor and discusses the components of pain models frequently applied in physiotherapy, where there may be pain typical of a particular source, or where several sources of pain are contributing to the patient’s primary complaint.
Biopsychosocial model
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Podiatrist
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In this paper I investigate one aspect of the validity of a certain type of subjective assessment of health and illness or as they are sometimes called Health-Related Quality of Life (HRQoL) measures. These assessments are typically a series of questions directed to individual patients in the form of a questionnaire and their aim is to discover the subjective experience of a cohort of people at different times, for instance before and after a surgical intervention. These measurements can be, and often are used in conjunction with clinical assessments to gain information on health outcomes for policy implementation or revision. For example, to determine which hospitals or surgeons are doing well and which ones are doing poorly or to determine which interventions are most effective.
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Abstract Quality of life assessment is a central element of clinical trials and related forms of evaluative research. Early efforts to establish appropriate methods of measuring quality of life drew on psychometric principles and emphasised the need for validated measures. However, it is increasingly clear that, whilst still a central requirement of quality of life measures, validity needs to be emphasised alongside a number of other essential properties that have become clearer as the field has developed. Moreover formal psychometric methodology has to be adapted to take account of the specific needs of evaluative research. Research is beginning to develop more appropriate methods of outcome assessment in this area. Further lines of research are suggested to examine psychometric with other approaches to measurement of health-related quality of life.
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ABSTRACT The process of assessing students on clinical placements has to date been under‐researched. In particular, while the involvement of subjective judgements in assessing students has been discussed in the literature, there has been no attempt to look for systematic evidence. This paper comprises the first attempt to relate judgement theory to the assessment of vocational education. Preliminary results demonstrate that physiotherapy assessors made subjective judgements of their students, that these contributed to the determination of assessment grades, and that in certain cases these judgements were erroneous. The relationship of these subjective judgements to the awarding of grades via a supposedly objective assessment instrument is not yet known. Given the widespread use of such assessment instruments across different professions, the question raised is whether all observational assessment systems suffer from similar problems. If students are being judged on criteria not included on assessment instruments, perhaps the other criteria being used need to be made more explicit.
Judgement
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Two different objectives of psychological assessment procedures are identified. It is suggested that excessive caution in interpreting and reporting the results of such procedures can limit their value.
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Psychological Testing
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An assessment of outcomes of the treatment of the diseases and injuries to the hand should include both objective parameters, i.e. range of motion or grip strength, and subjective parameters i.e. intensity of complaints or dexterity of the hand in various tasks of daily activity. Questionnaires were developed to evaluate subjective parameters in objective and systematic manner. They indeed allow us to better apprehend what is important from our patients' perspective. Questionnaire (called also form or test) is a list of queries concerning the issue being a subject of the assessment. The queries are designed in the way allowing answers to imply an important and possible objective information on the problem of interest. The objective of this article was to attract notice on the problems associated with the use of questionnaires in a research, with particular attention on hand surgery. Authors referred to the parameters which characterise these instruments: responsiveness, validity and reliability. Brief descriptions of most commonly used forms were provided, including DASH, Levine, PEM, Michigan and CISS. Shortcomings and pitfalls associated with the use of questionnaires and possible sources of bias were emphasised, e.g. difficulties in precise assignation of scores, answering some particular questions and accuracy of the completion of the form. Attention was paid on the choice of the questionnaire to be well-matched for an aim of a given research project both in substantial and formal manner. An opinion was supported that modem research projects measuring outcomes in hand surgery must include questionnaires as an obligatory component of a complex assessment.
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Do psychological assessments require more time than third parties and managed care are willing to reimburse? A survey of clinical psychologists and neuropsychologists was conducted to evaluate the current uses of psychological assessment instruments. Respondents reported their use of tests for 8 different areas of assessment, the average time spent in performing various assessment services and other assessment practices. Results suggested that a majority of neuropsychologists devote a substantial portion of their time to assessment, but only 12% of clinical psychologists reported spending more than 10 hr in assessment-related practice each week. The authors describe the typical time required to administer, score, and interpret various tests and assessments; factors that affect the time required to conduct assessments; and provide a current ranking of the most frequently used assessments in clinical and neuropsychology. How long does it take to conduct comprehensive psychological assessments? Does the time required for assessment activities depend on the nature of the assessment and the presenting problems? What assessments are most commonly used and do they differ by the nature and function of the assessment? What are the implications of these issues for psychologists conducting assessment services in today's managed care environment? What strategies may psychologists invoke to overcome the multiple obstacles imposed by managed care and demonstrate the efficacy and extensiveness of comprehensive assessment practices? We examined these and other related questions through a survey of a sample of clinical and neuropsychologists who conducted assessment
Professional psychology
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Summary: Current existing or proposed standards and guidelines in the field of psychological assessment are confined to psychological tests and psychological testing. But tests constitute only one category of psychological assessment procedures, and testing is only one of many available strategies or classes of actions in the course of the assessment process. Tests and testing are closely linked to a certain approach to psychological assessment, i. e., the psychometric one. This is one reason why it is relatively easy to formulate and establish standards or guidelines in the case of psychological tests and testing. The much more comprehensive assessment process is an indispensable part of any approach to psychological assessment, even of those that do not use psychometric tests. This makes the formulation of guidelines for the assessment process an ambitious and very difficult enterprise. But it can be done, at least at the level of recommendations that could help the assessor to cope with the complexities and demands of assessment processes in various contexts of psychological assessment. The European Association of Psychological Assessment (EAPA) decided to sponsor the development of Guidelines for the Assessment Process (GAP), setting up a Task Force for this specific purpose. The GAP introduced in this paper are intended as a first proposal to initiate a broad discussion about how to improve the practice of psychological assessment and the education and training of psychological assessors.
Psychological Testing
Psychological evaluation
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