Functional Testing: A Key Component of OT Assessments
In my medicolegal occupational therapy practice, I use functional testing for every assessment I complete. Whether I’m evaluating attendant care needs, catastrophic impairment, or future cost of care (FCC), functional testing has become an integral part of my assessment process. Functional testing allows us to collect real-world evidence of how a client actually performs daily activities, beyond what can be gathered from interviews, self-reports, or medical records.
Here are some key reasons to support the use of functional testing:
Objective measurement of ability
Functional testing gives OTs direct observations of how a client manages specific tasks (e.g., dressing, cooking, housekeeping, mobility). This allows therapists to see the gap between what the client says they can do and what they actually do.
Identifies barriers and facilitators
Testing highlights physical, cognitive, sensory, and emotional challenges that may not be obvious in a clinical interview. It also reveals strategies or strengths the client uses to compensate.
Individualized treatment planning
By analyzing task performance, OTs can design interventions that are specific to the client’s functional needs, instead of relying solely on generic rehab goals.
Real-world relevance
Functional tests simulate everyday activities, making the assessment outcomes meaningful for the client’s independence, participation, and quality of life.
Tracking progress and outcomes
Repeating functional tests over time allows therapists to measure improvement, decline, or plateau, supporting clinical decision-making.
Interdisciplinary communication & documentation
Objective, standardized test results provide clear data that can be shared with other professionals, insurers, or legal counsel.
Client motivation and engagement
Clients often find functional tests more relevant and motivating than abstract measures, since they directly relate to their daily life.
Putting functional testing into practice doesn’t have to be complicated. After you’ve discovered what some of the client’s meaningful occupations are, select a few that you can observe during your in-home assessment. Ask them to style their hair, change their bed linens or clean their floors. The list is endless.
Meal planning / preparation is one that I select often, as long as it is relevant to the client’s pre-injury history and rehabilitation goals. Depending on how much time you have, you can ask the client to prepare a simple meal like tea and toast or something a little more complex like planning a main course, getting all of the ingredients together and cooking the dish to completion.
Participation in cooking tasks allows us to directly observe many of the physical, cognitive and emotional strengths and/or limitations that are at play after an injury. Can the client tolerate prolonged standing and reach necessary items? Can they sequence sub-tasks appropriately and remember to turn off appliances? Do they get overwhelmed or need to stop before finishing? Direct observation of functional activity allows us to get rich, real-world data that we can then use to bolster our overall analysis. Do our observations align with the client’s self-reports and collateral information from caregivers? Are findings congruent with opinions stated in the medical file? Functional testing is only one piece of the assessment puzzle, but an important one at that. By including observations of real-world performance, we can ensure that assessments are client-centered, evidence-based, ecologically valid, and occupation-focused.
Have questions or comments about the inclusion of functional testing in occupational therapy assessment? Email me at: rosa@newtonOT.com