以人類職能模式為基礎的評估工具之心理計量特質：系統性回顧

Abstract

背景： 職能治療實務仰賴理論、實證與臨床推理的整合，以支持以個案為中心的介入規劃。「人類職能模式」（Model of Human Occupation, MOHO）為職能治療中最廣泛應用的理論架構之一，其將職能概念化為四個相互關聯的構念：意志（volition）、習慣（habituation）、表現能力（performance capacity）與環境（environment）。過去四十年來，許多基於MOHO發展的評估工具相繼問世；然而，其心理計量特性之實證證據多分散於個別工具的研究中，尚未有系統性的整合與比較。 目的： 本系統性回顧旨在整合並嚴謹評價基於MOHO發展之評估工具的心理計量證據，並透過衡量成熟度（measurement maturity）框架加以脈絡化，以支持實證導向的評估工具選擇。 方法： 本研究依循PRISMA 2020（系統性回顧與統合分析之首選報告項目）指引進行系統性文獻回顧。透過多個資料庫檢索評估MOHO相關評估工具心理計量特性的研究。方法學品質以COSMIN偏誤風險檢核表（Risk of Bias checklist）進行評價，並跨工具、構念與測量特性整合證據。此外，納入之評估工具亦對照至「國際功能、失能與健康分類」（ICF）與「職能治療實務架構第四版」（OTPF-4），以提升跨專業應用之相關性。 結果： 最終納入17項以人類職能模式（MOHO）為基礎之評估工具進行綜合分析。心理計量證據在MOHO各構念間分布不均，其中以表現能力與綜合性評估工具具備最強且一致的支持證據，特別是在結構效度與信度方面。然而，在反應性（responsiveness）、測量誤差（measurement error）與跨文化測量不變性（cross-cultural measurement invariance）方面的證據仍然有限。基於COSMIN（以共識為基礎的健康測量工具選擇標準）所累積之證據，本研究提出一套「衡量導向的成熟度框架」（measurement-informed maturity framework），將評估工具區分為「新興」、「發展中」與「成熟」三個層級，其中職能自我評估（Occupational Self Assessment, OSA）、人類職能模式篩檢工具（MOHOST）、溝通與互動技巧評估（ACIS）及動作與歷程技巧評估（AMPS）被歸類為成熟工具，顯示其具備較完整且一致之心理計量支持。 結論： 本研究提供跨MOHO評估工具之心理計量證據的整合性綜述，並提出以成熟度為導向的解釋性框架，以支持臨床推理、教學與研究應用。透過將MOHO評估工具與國際認可之架構（ICF與OTPF-4）對齊，本研究提升了MOHO測量工具在職能治療實務中的透明度、可解釋性與全球適用性。

Background: Occupational therapy practice relies on the integration of theory, evidence, and clinical reasoning to support client-centered intervention planning. The Model of Human Occupation (MOHO) is one of the most widely applied theoretical frameworks in occupational therapy and conceptualizes occupation through four interrelated constructs: volition, habituation, performance capacity, and environment. Over the past four decades, numerous MOHO-based assessment tools have been developed; however, psychometric evidence has accumulated in a fragmented manner across individual instruments. Objective: This systematic review aimed to synthesize and critically appraise the psychometric evidence of assessment tools developed under the Model of Human Occupation, and to contextualize their measurement maturity to support evidence-informed assessment selection. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic reviews and Meta- Analyses). Studies evaluating psychometric properties of MOHO-based assessment tools were identified across multiple databases. Methodological quality was appraised using the COSMIN Risk of Bias checklist, and evidence was synthesized across tools, constructs, and measurement properties. Included instruments were further mapped onto the International Classification of Functioning, Disability and Health (ICF) and the Occupational Therapy Practice Framework, Fourth Edition (OTPF-4), to enhance interdisciplinary relevance. Results: Seventeen MOHO-based assessment tools were included in the final synthesis. Psychometric evidence was unevenly distributed across MOHO constructs, with the strongest and most consistent support observed for performance capacity and comprehensive assessments, particularly with respect to structural validity and reliability. Evidence for responsiveness, measurement error, and cross-cultural measurement invariance remained limited. Based on accumulated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) evidence, a measurement-informed maturity framework was proposed to classify tools into emerging, developing, and mature levels of psychometric support. The Occupational Self Assessment (OSA), Model of Human Occupation Screening Tool (MOHOST), Assessment of Communication and Interaction Skills (ACIS), and Assessment of Motor and Process Skills (AMPS) were identified as mature instruments, reflecting robust and consistently replicated psychometric evidence across multiple contexts. Conclusions: This review provides an integrated synthesis of psychometric evidence across MOHO-based assessment tools and introduces a maturity-oriented interpretive framework to support clinical reasoning, education, and research. By aligning MOHO assessments with internationally recognized frameworks, this study enhances the transparency, interpretability, and global applicability of MOHO-based measurement in occupational therapy practice.