Biomedical Engineering Reference
In-Depth Information
dimension should be carefully considered in the ATA process. However, the attention
must be twofold. On the one hand, ignoring the subjective dimension can lead to inac-
curate assessments and inappropriate assignments, whereas on the other, as argued by
Sen, one must bear in mind that “the internal view of health deserves attention, but
relying on it in assessing health care or in evaluating medical strategy can be extremely
misleading” (2002, p. 861).
With regard to 2, the choice of a set of measurement tools specifically for the purposes
of the ATA process facilitates the multidisciplinary team-building process by means
of the characterization of each professional required during the assessment (and
measurement) process. In the ATA process the two points are strictly linked. We agree
with Kayes and McPherson's statement that “a critical evaluation of one 'objective' mea-
sure highlights a number of potential limitations suggesting that the apparent will-
ingness to adopt 'objective' measures with little questioning may be misguided” (2010
p. 1011). In fact, objective measures “are not necessarily invariant across populations”
and often produce outcomes that “lack clinical relevance” (Kayes and McPherson 2010,
p. 1013); moreover, the administration method can also be affected by the subjectivity
of the practitioner.
All things considered, it seems that more than “simplistic dichotomy” among objec-
tive versus subjective measures can be useful in determining whether or not a mea-
surement tool is “fit for purpose.” In the ATA process, the ultimate aim of ensuring the
well-being of the user/client is achieved through the use of many different instruments
(clinical measures, functional analysis, and psycho-socio-environmental evaluations).
These tools are both subjective and objective, but, in any case, a professional who can
interpret the results is always required. For these reasons, many different profession-
als are involved in the ATA process for each type of user/client and for each step of the
process.
In the body function and structure evaluation step—medical diagnosis analysis—the
team consists of a physician, a psychologist, a cognitive therapist, and an optometrist, audi-
ologist, pediatric specialist, and geriatrician when the user/client's age or impairment calls
for them. In the activity evaluation step, a psychotechnologist, OT, architect, and engineer
are primarily needed. Finally, the support and follow-up phases allow us to evaluate the
performance of the user/client (participation step) by means of a multidisciplinary contri-
bution from a cognitive therapist, special educator, OT, psychologist, consumer support
person, speech language pathologist (if needed), and physiotherapist.
2.1.1.3 What Is Measured Versus Who Measures: Balancing
the Power of the Assessment
Apart from all of this, the whole process is “user-driven”: Subjective measures are not only
considered in the activity or participation evaluation steps but also in medical diagnosis
analysis, although making a diagnosis is traditionally characterized by the prevalence and
precedence of the objective measurement. Nevertheless, we agree with Mezzich (2002),
who cited Lain Entralgo (1982): “Diagnosis is more than identifying a disorder (nosological
diagnosis) or distinguishing one disorder from another (differential diagnosis); diagnosis
is really understanding what is going on in the mind and body of the person who
presents for care” (quoted in Mezzich 2002, p. 162). In other words, we make a claim for a
comprehensive diagnosis that “aims to combine the best of objective scientific categorical
diagnosis with the unique features, including the strengths and resources as well as dif-
ficulties, of individual patients” (Fulford and Stanghellini 2008, p. 10).
