Assessment of Motor and Process Skills (AMPS)

Evidence Reviewed as of before: 26-11-2010
Author(s): Lisa Zeltzer, MSc OT
Editor(s): Nicol Korner-Bitensky, PhD OT; Elissa Sitcoff, BA BSc
Expert Reviewer: Dianna Robertson, BSc OT, MSc OT (Thesis candidate)

Purpose

The Assessment of Motor and Process Skills (AMPS) is an observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADL). The AMPS is comprised of 16 motor and 20 process skill items.

In-Depth Review

Purpose of the measure

The Assessment of Motor and Process Skills (AMPS) is an observational assessment that allows for the simultaneous evaluation of motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADL). The AMPS is comprised of 16 motor and 20 process skill items.

Motor skills are the observable goal-directed actions people perform during ADL task performance in order to move themselves or the task objects (e.g. walk, transport objects, reach for and manipulate objects, position the body).

Process skills refer to the ability of an individual to logically sequence the actions of the ADL task performance over time (e.g. initiate and sequence actions, use appropriate tools and material, and accommodate actions when problems are encountered).

The AMPS is based on a ‘top down’ assessment approach. Using a ‘top down’ approach means that the AMPS assessment begins “with the ability of the individual to perform the daily life tasks that he or she wants and needs to perform to be able to fulfill his or her roles competently and with satisfaction” (Fisher, 2003). The ‘top down’ approach involves finding out more about a client’s occupational concerns and then observing the client performing that occupation. Through the observation process, the therapist is able to use clinical reasoning to identify the underlying functional deficit in order to intervene to compensate for the deficit, if this is possible.

The quality of the person’s occupational performance is assessed by rating the effort, efficiency, safety, and independence demonstrated in each of the motor and process skills that comprise the task performance.

Available versions

  • The AMPS was first developed by Fisher in 1990, however, the AMPS was not published by Fisher until 1995. The AMPS manual is currently on its sixth edition.
  • In 2001, it was recommended that 20 new tasks be added to the AMPS (Bray, Fisher, & Duran, 2001). These tasks were added to benefit individuals at the lower or higher ends of the AMPS motor and process skill scales.
  • To date, there are 85 AMPS tasks to select from. A list of these tasks can be found on the AMPS International webpage at: http://www.ampsintl.com/AMPS/resources/tasks.php.

Features of the measure

Items:
There are no actual items to the AMPS. After an initial interview with the caregiver or the client, the rater selects a subset of 3-5 ADL tasks from a list
of standardized tasks that are described in the AMPS manual (e.g. fetching a drink from the fridge, folding laundry, preparing a sandwich). The tasks selected must be relevant and meaningful to the client, and consist of tasks that he/she once knew how to perform. The tasks must be challenging to the client. From this subset of tasks, the client then selects 2-3 tasks to perform.

Prior to beginning task observation, the client and rater must agree on the elements of the task and the tools and materials to be used. In a clinical setting, the client can familiarize his/herself by placing the tools and materials where he/she prefers them to be stored. The client is expected to perform the designated tasks in their usual manner, but must also adhere to the guidelines specified
in the APS manual. For example, if the client selects task A-1, retrieving a beverage from refrigerator, the examiner must watch for the following specific criteria:

  • Obtain container of beverage from the refrigerator
  • Pour the beverage into cup or glass
  • Serve beverage
  • Clean up.
  • Although each of the tasks involves a standard procedure, some
    flexibility is allowed to ensure that the assessment remains
    semi-individualized.

To assist the examiner in preparing for and administering the AMPS interview, task notes are provided which outline the things to look for while task is being completed.

A list of tasks can be found at the AMPS International website: http://www.ampsintl.com/AMPS/resources/tasks.php

One can select online which tasks are to be completed by checking the box beside the task. To find a list of the steps to look for while the task is being completed, select ‘print notes’, which will automatically generate the steps into a printable worksheet. These task notes are intended to be used in combination with the AMPS task descriptions to assist the rater, and are not intended to replace
careful reading of the task descriptions in the manual.

Scoring:
The AMPS uses a 4-point Likert scale to rate the client’s performance on 16
motor and 20 process skills (see table).

Score Interpretation
4 Competent, when the patient performs the task without
evidence of increased effort, decreased efficiency, or lack of
safety.
3 If the examiner questions the effectiveness, the
performance is scored ‘questionable’.
2 Ineffective performance that disrupts or interferes with
the action
1 Marked deficient performance that impedes the action
progression and yields unacceptable outcome.

The raw motor and process scores are entered into the AMPS computer-scoring program and analyzed using many-faceted Rasch analysis (Linacre, 1993). Many-faceted Rasch analysis is used to allow for the calibration of: 1. skills item difficulty, 2. task challenge, 3. individual evaluator leniency, and 4. client variation in ADL ability, on the same linear scale.

The Rasch analysis creates a unique method that enables the AMPS administrator to predict how an individual is expected to perform on any of the calibrated ADL tasks in the assessment after completion of only two or three tasks (Fisher, 1995). This analysis converts the clients’s ordinal raw scores into equal interval measures of ability (person ability measures), which are expressed in log-odds probability units (logits). The logit ability measures are placed on a linear  continuum of increasing ability for each of the ADL scales (motor and process). The AMPS person ability measures represent the person’s place on the continuum, and provides an indication of how challenging a task that person can manage effectively. The higher the ADL motor or ADL process ability, the more able is the client (Fisher, 1997).

If the AMPS is to be used for documenting treatment efficacy, quality assurance, or research, it must be computer scored.

Motor and process cutoff measures:

The position of a person’s ability measures on the ADL motor and ADL process scales can also be evaluated relative to the motor and process cutoff measures. The cutoff measures are 2.0 logits for the ADL motor scale and 1.0 logits for the ADL process scale. These cutoff measures were developed based on the performance of 2,548 subjects in the AMPS database (Fisher, 1997). Individuals with ability measures that fall below the cutoff on either the ADL motor or ADL process scale demonstrated observable motor or process deficits that were
affecting their ability to perform ADL tasks in an effective manner. They were also more likely to require assistance in performing daily life tasks.

Time:
It takes 30-40 minutes to administer the AMPS (AMPS International Website:
http://www.ampsintl.com/AMPS/resources/tasks.php).

Subscales:
The AMPS has two subscales: ADL motor skills and ADL process skills.

Equipment:
No specialized equipment is required to complete the AMPS. Only the AMPS notes, and the relevant equipment for task completion are required.

(AMPS International Website:
http://www.ampsintl.com/AMPS/resources/tasks.php).

Training:
The AMPS can be administered only by occupational therapists who have completed a 5-day training and calibration workshop. Information regarding
training sessions can be found by visiting the AMPS International website: http://www.ampsintl.com/workshops.htm

The AMPS administration manual and computer scoring software is only provided to individuals who participate in AMPS training and calibration workshops.

To become an AMPS Calibrated Rater, an occupational therapy practitioner must complete the following steps:

  • Attend a 5-day training course
  • Test 10 clients who perform 2-3 AMPS tasks
  • Independently interview and score live clients (the use of videotapes is not acceptable). Two of ten clients may be co-scored (two therapists observing a client at the same time, but independently score client performance).
  • Enter the data into the computer using the AMPS computer-scoring program
  • Email exported data to AMPS Project International within 3 months of taking the course.

Alternative forms of the AMPS

  • The School Version of the Assessment of Motor and Process
    Skills (School AMPS).

    The School AMPS is an evaluation tool for measuring student’s schoolwork task performance in typical classroom settings.

Client suitability

Can be used with:
Patients with stroke.

Should not be used with:

  • The AMPS cannot be used to diagnose underlying mind-brain-body problems (e.g. memory, apraxia, motivation, perception).
  • The AMPS cannot be administered to patients who are confined to bed or who are unwilling to participate in simple daily living tasks.
  • The AMPS is not suitable for children under the age of 3

Languages of the measure

To date, the AMPS has been administered to over 12,000 subjects from North America, Scandinavia, the United Kingdom, Australia, and New Zealand.

A number of studies have supported the validity of the AMPS as a cross-cultural measure (Fisher, Liu, Velozo & Pan 1992; Goldman & Fisher, 1997; Goto, Fisher & Mayberry, 1996; Magalhaes, Fisher, Bernspang & Linacre, 1996; Stauffer, Fisher & Duran, 2000). For example, Goto, Fisher and Mayberry (1996) tested the cross-cultural validity of the AMPS with six trained raters from diverse backgrounds, and found high cross-cultural validity and inter-rater reliability.

Validation of the AMPS has been established for use in Sweden, (Bernspang & Fisher, 1995), Taiwan (Fisher, Liu, Velozo, & Pan, 1992), and in Spain (http://www.terapia-ocupacional.com/Cursos/Curso_AMPS_Escala_Valoracion_Habilidades_Motoras_Procesamiento_Terapia_Ocupacional.htm).

Limited parts of the AMPS manual(s) and software are available in Japanese, Swedish, Dutch, French, Norwegian, Slovenian, Finnish, and Danish. AMPS International is currently working on new translations in Spanish, Italian, and German.

Summary

What does the tool measure? Motor and process skills and their effect on the ability of an individual to perform complex or instrumental and personal activities of daily living (ADL).
What types of clients can the tool be used for? The AMPS can be used with, but is not limited to patients with stroke.
Is this a screening or assessment tool? Assessment
Time to administer The AMPS takes 30-40 minutes to administer.
Versions The School Version of the Assessment of Motor and Process Skills (School AMPS)
Other Languages Limited parts of the manual(s) and software are available in Japanese, Swedish, Dutch, French, Norwegian, Slovenian, Finnish, and Danish. AMPS International is currently working on new translations in Spanish, Italian, and German.
Measurement Properties
Reliability
  • No studies have examined the internal consistency of the AMPS.
  • Out of 2 studies examining the test-rest reliability of the AMPS, both reported excellent test-retest.
  • No studies have examined the inter-rater reliability of the AMPS.
  • Only 1 study has examined the intra-rater reliability of the AMPS and reported excellent intra-rater.
    Validity

    Criterion:

    Predictive:

    The AMPS score has been found to be predictive of the need for supervision/assistance to live in the community, and home safety for individuals with psychiatric conditions associated with cognitive impairments.

    Concurrent:

    Excellent correlations with the Scale of Independent Behavior, the Functional Independence Measure, and the Cambridge Cognitive Examination (CAMCOG) have been reported.

    Construct:

    Known groups:

    AMPS can differentiate between individuals with Multiple Sclerosis and healthy controls; patients with stroke and healthy controls; older adults without disability and people with Alzheimer’s disease who need minimal assistance; people with Alzheimer’s disease who require moderate assistance; individuals with and without psychiatric disorders.

    Floor/Ceiling Effects No studies have examined the floor or ceiling effects of the AMPS.
    Does the tool detect change in patients? One study examined the responsiveness of the AMPS in a 3-arm drug trial and reported significant differences for instrumental ADL process skills among the 3 conditions, suggesting that the AMPS may be a sensitive measure for detecting change under various study conditions in drug trials.
    Acceptability The AMPS cannot be used to diagnose underlying mind-brain-body problems (e.g. memory, apraxia, motivation, perception). The AMPS cannot be administered to patients who are confined to bed or who are unwilling to participate in simple daily living tasks, or for children under the age of 3.
    Feasibility The AMPS takes 30-40 minutes to administer, and does not require any specialized equipment. The rater selects a subset of 3-5 ADL tasks (from which the client selects 2-3 to perform) from a list of standardized tasks that are described in the AMPS manual. The AMPS is simple to score and uses a 4-point Likert scale. The scores are then analyzed using an AMPS computer-scoring program. The AMPS can be administered only by occupational therapists who have completed a 5-day training and calibration workshop.
    How to obtain the tool? The AMPS manual and software can be purchased online at http://www.ampsintl.com/

    Psychometric Properties

    Overview

    We conducted a literature search to identify all relevant publications on the psychometric properties of the AMPS.

    Reliability

    Intra-rater

    Fisher, Liu, Velozo and Pan (1992) reported that in a sample of Taiwanese participants without disability, the AMPS had excellent intra-rater reliability (r = 0.93).

    Test-retest

    Doble, Fisk, Lewis and Rockwood (1999) examined the test-retest reliability of the AMPS in a sample of 55 elderly adults and reported excellent test-retest coefficients for both the motor and process subscores (r = 0.88 and r = 0.86, respectively).

    Fisher (1995) reported that with a sample of older adults (mean age of 80), the test-retest reliability was excellent for both the AMPS motor scale (r = 0.91) and for the AMPS process scale (r = 0.90).

    Validity

    Criterion

    Predictive:
    Fisher (1997) reported that 84% of people with ADL motor ability measures below 2.0 logits and 93% of those with ADL process ability measures below 1.0 logits, required supervision or assistance to live in the community. The fact that a higher proportion of people with low ADL process ability measures than with low ADL motor ability measures required some assistance demonstrates that the ADL process scale is a better indicator of need for assistance to live in the community than is the ADL motor scale.

    McNulty and Fisher (2001) examined whether the AMPS could predict home safety for individuals with psychiatric conditions associated with cognitive impairments. Moderate positive relationships were found between ADL motor and ADL process ability and home safety in both the clinic and the home. Home ADL process ability was the best predictor of home safety for participants who were categorized as less safe in the study.
    Concurrent:
    Bruininks, Woodcock, Weatherman, and Hill (1985) correlated the AMPS with the Scale of Independent Behavior (Neistadt, 1993) and reported excellent correlations (ranging from r = 0.62 to r = 0.85).

    Robinson and Fisher (1996) examined the Functional Independence Measure (Keith, Granger, Hamilton & Sherwin, 1987) (r = 0.62) as well as with the Cambridge Cognitive Examination (CAMCOG), a cognitive component of the Cambridge Mental Disorders of the Elderly Examination (an interview measure of dementia) (Roth et al., 1986) (r = 0.65).

    Construct

    Known groups:
    Doble, Fisk, Fisher, Ritvo and Murray (1994) examined the instrumental ADL performance of 22 community-dwelling patients with mild to moderate Multiple Sclerosis in comparison to participants without disability who were matched for age and gender. Functional competence of the patients with Multiple Sclerosis, as measured by the AMPS, was poorer than that of the control group suggesting that the AMPS can differentiate between individuals with Multiple Sclerosis and healthy controls.

    Bernspang and Fisher (1995) administered the AMPS to 71 individuals with right cerebral vascular accident, 76 persons with left cerebral vascular accident, and 83 community-living healthy individuals. Both stroke groups had significantly lower IADL performance than the control participants, suggesting that the AMPS can distinguish between patients with stroke and healthy controls.

    Hartman, Fisher, and Duran (1999) administered the AMPS to 329 older adults without disability and 167 people with Alzheimer’s disease who need minimal assistance, and 292 with Alzheimer’s disease who require moderate assistance. In this study, the AMPS was able to distinguish between the three groups.

    Pan and Fisher (1994) examined the hypothesis that mean AMPS scores would differ between individuals with psychiatric disorders and individuals without. Sixty participants, 30 without and 30 with psychiatric disorders, were studied. The hypothesis was supported for both the AMPS motor and process scales, suggesting that the AMPS can distinguish between individuals with and without psychiatric disorders.

    Responsiveness

    One pharmacological pilot study of individuals with Alzheimer’s disease examined the responsiveness of the AMPS using repeated measures ANOVA (Oakley & Sunderland, 1997). Significant differences were found for instrumental ADL process skills, but not for motor skills, among three drug conditions. The results of this study suggest that the AMPS may be a sensitive measure for detecting change under various study conditions in drug trials.

    References

    • Bernspang, B., Fisher, A. (1995). Differences between persons with right or left cerebral vascular accident on the Assessment of Motor and Process. Archives of Physical Medicine and Rehabilitation, 76, 1144-1151.
    • Bray, K., Fisher, A. G., Duran, L.(2001).The validity of adding new tasks to the Assessment of Motor and Process Skills. American Journal of Occupational Therapy 55,, 409-415.
    • Bruininks, R. H., Woodcock, R. W., Weatherman, R. F., Hill, B. K. (1985). Development and Standardization of the Scales of Independent Behavior. Allen, TX: DLM Resources.
    • Cooke, K, Z., Fisher, A. G., Mayberry, W., Oakley, E. (2000). Differences in activities of daily living process skills of persons with and without Alzheimer’s disease. Occupational Therapy Journal of Research, 20, 87-104.
    • Dickerson, A. E., Fisher, A. G. (2000). Age differences in functional performance. American Journal of Occupational Therapy, 47, 686-692.
    • Doble, S. E., Fisk, J. D., Fisher, A., Ritvo, P. Murray, T. (1994). Functional competence of community-dwelling persons with multiple sclerosis using the Assessment of Motor and Process Skills. Archives of Physical Medicine and Rehabilitation, 75, 843-851.
    • Doble, S. E., Fisk, J. D., Lewis, N., Rockwood, K. (1999). Test-retest reliability of the Assessment of Motor and Process Skills. Occupational Therapy Journal of Research, 19, 203-215.
    • Doble, S. E., Fisher, A. G., Fisk, J. D., MacPherson, K. M. (1992). Validation of the Assessment of Motor and Process Skills (AMPS) with Elderly Adults with Dementia. Final Report to the Alzheimer’s Association. Halifax, Nova Scotia: Dalhousie University.
    • Duran, L., Fisher, A. (1996). Male and female performance on the Assessment of Motor and Process Skills. Archives of Physical Medicine and Rehabilitation, 77, 1019-1024.
    • Fisher, A. G. (1990). Assessment of Motor and Process Skills. Research edition, R. Unpublished test manual. Chicago, IL: University of Illinois at Chicago.
    • Fisher, A. (1995). The Assessment of Motor and Process Skills (AMPS). Fort Collins, CO: Three Star Press.
    • Fisher, A. G. (1997). Assessment of Motor and Process skills, 2nd edn. Fort Collins, CO: Three Star Press.
    • Fisher, A. G., Liu, Y., Velozo, C., Pan, A. W. (1992). Cross-cultural assessment of process skills. American Journal of Occupational Therapy, 46, 876-885.
    • Fisher, A. G. (2003). AMPS: Assessment of Motor and Process Skills. Volume 1: Development, Standardisation, and Administration Manual. 5th edn. Colorado: Three Star Press Inc.
    • Goldman, S., Fisher, A. G. (1997). Cross-cultural validation of the Assessment of Motor and Process Skills (AMPS). British Journal of Occupational Therapy, 46, 77-85.
    • Goto, S., Fisher, A. G., Mayberry, W. L. (1996). Assessment of Motor and Process Skills applied cross-culturally to the Japanese. American Journal of Occupational Therapy, 50, 798-806.
    • Hartman, M. L., Fisher, A. G., Duran, L. (1999). Assessments of functional ability of people with Alzheimer’s disease. Scandinavian Journal of Occupational Therapy, 6, 111-118.
    • Keith, R., Granger, C., Hamilton, B., Sherwin, F. (1987). The Functional Independence Measure: A new tool for rehabilitation. In: N. Eisenberg & R. Grzesiak (Eds.), Advances in Clinical Rehabilitation. New York: Springer.
    • Linacre, J. M. (1993). Many-Facet Rasch Measurement, 2nd edn. Chicago: MESA.
    • Linden, A., Boschian, K., Eker, C., Schalen, W., Nordstrom, C.-H. (2005). Assessment of motor and process skills reflects brain-injured patients ability to resume independent living better than neuropsychological tests. Acta Neurol Scand, 111, 48-53.
    • Magalhaes, L., Fisher, A., Bernspang, B., Linacre, J. (1996). Cross-cultural assessment of functional ability. The Occupational Therapy Journal of Research, 16(1), 45-63.
    • McNulty, M. C., Fisher, A. G. (2001). Validity of using the Assessment of Motor and Process Skills to estimate overall home safety in persons with psychiatric conditions. Am J Occup Ther, 55(6), 649-655.
    • Neistadt, M. E. (1993). A meal preparation treatment protocol for adults with brain injury. Am J Occup Ther, 48, 431-438.
    • Oakley, F., Sunderland, T. (1997). Assessment of Motor and Process Skills as a measure of IADL functioning in pharmacologic studies of people with Alzheimer’s disease: A pilot study. International Psychogeriatrics, 9, 197-206.
    • Pan, A. W., Fisher, A. G. (1994). The Assessment of Motor and Process Skills of persons with psychiatric disorders. American Journal of Occupational Therapy, 48, 775-780.
    • Robinson, S., Fisher, A. G. (1996). A study to examine the relationship of the Assessment of Motor and Process Skills (AMPS) to other tests of cognition and function. British Journal of Occupational Therapy, 59, 260-63.
    • Roth, M., Mountjoy, C., Huppert, F., Hendrie, H., Verna, S., Godard, R. (1986). CAMDEX. The Cambridge Examination for Mental Disorders of the Elderly. Cambridge, UK: Cambridge University Press.
    • Stauffer, L. M., Fisher, A. G., Duran, L. (2000). ADL Performance of black Americans and white Americans on the Assessment of Motor and Process Skills. American Journal of Occupational Therapy, 54, 607-613.

    See The Measure

    How to obtain the AMPS

    The AMPS manual and software can be purchased online at http://www.ampsintl.com/

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