Clients vs. Therapists

Clients vs. therapists. Gerardi S, Eckberg S. … 1995, 8:4 p.399

A common opinion in medical rehabilitation is that patients feel more disabled than their therapists perceive them to be. Successful therapy requires the therapist to act as though the patient can almost "do it" - that success is almost within reach. Patients, however, in their need for help and sympathy, often act as though they are in a worse state than they appear to be.

Support, clarity and hope are provided by the Occupational Rehabilitation Database (ORDB) collected in a 1994 study funded by the American Occupational Therapy Foundation. 230 clients from 28 rehabilitation sites across the USA rated themselves at rehabilitation admission and discharge. They were also rated by their therapists. The plot compares the item calibrations.

Clients vs. Therapists views

There were 8 physical movement items on the protocol. Clients rated themselves lower than their therapists did. Clients saw themselves as less effective than their therapists did. Overall, clients reported the items to be .75 logits more challenging than did their therapists. Thus clients were functioning .75 logits less capably in their own minds than in the reports of their therapists. This supports and quantifies the anecdotal evidence.

The plot also reaches beyond the common wisdom. The plot shows a trend. The less incapacitated the client, the smaller the discrepancy between client and therapist views. As clients heal, they see themselves performing better. Then the items becoming suitable for them (the harder items: carrying, lifting..) are reported ever closer to the way their therapists see them. Extrapolating onwards, we reach a point, corresponding to normal functioning, at which clients and therapists agree. To confirm this extrapolation, more demanding items could be devised and administered to suitably capable clients.

The hope lives in the trend-line. Now we can transform measures based on patient self-ratings and therapist-based measures onto the same scale of reference. This simplifies the clinical task of assessment, and opens the door to tracking patient progress, even over the telephone.

Clients vs. therapists. Gerardi S, Eckberg S. … Rasch Measurement Transactions, 1995, 8:4 p.399

Rasch Publications
Rasch Measurement Transactions (free, online) Rasch Measurement research papers (free, online) Probabilistic Models for Some Intelligence and Attainment Tests, Georg Rasch Applying the Rasch Model 3rd. Ed., Bond & Fox Best Test Design, Wright & Stone
Rating Scale Analysis, Wright & Masters Introduction to Rasch Measurement, E. Smith & R. Smith Introduction to Many-Facet Rasch Measurement, Thomas Eckes Invariant Measurement: Using Rasch Models in the Social, Behavioral, and Health Sciences, George Engelhard, Jr. Statistical Analyses for Language Testers, Rita Green
Rasch Models: Foundations, Recent Developments, and Applications, Fischer & Molenaar Journal of Applied Measurement Rasch models for measurement, David Andrich Constructing Measures, Mark Wilson Rasch Analysis in the Human Sciences, Boone, Stave, Yale
in Spanish: Análisis de Rasch para todos, Agustín Tristán Mediciones, Posicionamientos y Diagnósticos Competitivos, Juan Ramón Oreja Rodríguez

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