The AMPS and the A-ONE

The A-ONE consists of two parts: an A-ONE ADL scale and an A-ONE Neurobehavioral (NB) scale. The occupational therapist scores 22 test items based on the level of assistance needed to do ADL tasks as well as underlying neurobehavioral impairments impacting that performance.

The AMPS is comprised of 16 ADL motor skill items and 20 ADL process skill items that the occupational therapist scores across two ADL tasks (72 items in total). As a result, the AMPS is a highly sensitive measure of ADL performance. The AMPS is not designed to be used to evaluate for the presence of underlying neuromuscular, biomechanical, cognitive, or psychosocial impairments (e.g., strength, range of motion, memory), nor is it designed to be used to evaluate underlying capacities (e.g., ability to grip, ability to remember, ability to plan a course of action). Unlike impairments and underlying capacities, the ADL motor and ADL process skills of the AMPS are goal-directed actions enacted in the context of occupational performance, and are analogous to the goal-directed actions defined under the Activities and Participation domains of the International Classification of Functioning Disability and Health (World Health Organization [WHO], 2001).

Similarity between the AMPS and the A-ONE

The AMPS and the A-ONE overlap, in that the AMPS and the A-ONE ADL scale both can be used to evaluate ADL ability.

Differences between the AMPS and the A-ONE

The AMPS and the A-ONE ADL scales differ in several ways:

The AMPS is a standardized performance analysis in that AMPS provides the occupational therapist with detailed information about the client's ability to perform ADL tasks. In contrast, the A-ONE ADL scale focuses on global PADL ability, and thus, can be used to determine if a client has an overall problem with occupational performance, specifically PADL.
The ADL tasks standardized for use with the AMPS include PADL, IADL, and some leisure activities. The A-ONE is limited to PADLs, but addresses more PADLs than does the AMPS.
Scoring of the 22 A-ONE ADL items is based on the level of assistance needed during ADL task performance. AMPS skill items are scored based on independence, safety, efficiency, and ease (lack of physical effort) of the ADL motor and ADL process skill items that reflect the smallest observable units of ADL task performance.
Scoring of the AMPS is fully standardized on over 110,000 persons internationally. Research has shown it to be a sensitive measure of change in ADL ability. While standardization data for the A-ONE is more limited, it also has been shown to be valid and reliable. An exciting development of the A-ONE ADL scale is its conversion, via Rasch analysis methods, to a linear outcome measure. Likely, that scale will be more sensitive than either FIM or Barthel, but it will lack the sensitivity of the AMPS.
The A-ONE is intended to be used only with clients with neurobehavioral disorders (e.g., stroke, brain injury, dementia). Research to extend its application to children is in process. The AMPS is intended to be used with persons 3 to over 100 years of age, from all diagnostic groups.
The A-ONE NB scale can be used to identify, among clients with neurobehavioral disorders, the extent to which underlying neurobehavioral impairments or symptoms affect PADL performance. Unlike common tests of cognition, perception, or other neruobehaviors, the A-ONE enables the OT to evaluate for such deficits in a relatively naturalistic context (vs. using noncontextual pencil/paper, block, or other forms of assessment). The AMPS cannot be used to test underlying neurobehavioral impairments.

When would I use the AMPS versus the A-ONE?

The AMPS and the A-ONE have the potential to compliment each other in practice. If one thinks in terms of the top-down evaluation and reasoning process described in the Occupational Therapy Intervention Process Model (OTIPM), the occupational therapist begins the evaluation process with a comprehensive occupational therapy interview. If desired, the A-ONE ADL scale can then be used to verify global deficits in PADL task performance if there is need to confirm the client’s (patient and carers) self-report.

At the next phase, the occupational therapist administers the AMPS as a standardized ADL performance analysis, provided the client reported problems with ADLs. That is, the AMPS is used to assess the quality of the client's ADL motor and ADL process skills, the smallest, observable, and goal-directed units of ADL performance. This more detailed information provides the basis for establishing the client’s baseline level of AMPS performance.

After the AMPS is administered, the occupational therapist proceeds to reflecting on observed task performances to determine how environmental factors, underlying impairments, or societal factors have impacted the observed task performance. The A-One Neurobehavioral Scale can be used at this point in the evaluation process to evaluate directly the impact that neurobehavioral impairments have on the client's observed ADL task performance.

In summary, if you're working with clients who have neurological disorders and problems with PADLs, you should consider using both the AMPS and the A-ONE. The A-ONE ADL scale can be used early in the OT process to determine if the person has a problem with PADLs, as evidenced by need for assistance. This evaluation could be followed by an AMPS evaluation of PADL and/or IADL, as well as to implement a performance analysis. The AMPS performance analysis will further clarify whether or not the person indeed has a problem in PADL, but also, the performance analysis adds the important step of clarifying which clusters of ADL motor and ADL process skills are most effective and which are most ineffective.

Then, after implementing the AMPS performance analysis, the OT can use the results of the A-ONE Neurobehavioral scale to help determine why some ADL skill clusters were ineffective. In this way, the OT can intertwine the results of the AMPS and the A-ONE to (a) provide evidence of the client's need for OT services, and (b) gather information needed to plan intervention. Finally, both the AMPS and the A-ONE can be used as outcome measures, but the AMPS is likely a more sensitive measure of change than is the A-ONE.

For more information on the A-ONE, contact:
Guðrún Árnadóttir
E-mail: a-one@islandia.is