Assessment of Awareness of Occupational Performance (AAOP)

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An innovative client-centrered approach in evaluating limitations in awareness in relation to occupational performance.

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The Assessment of Awareness of Occupational Performance (AAOP) (formerly the Assessment of Awareness of Ability) is a unique and innovative standardized, client-centred evaluation based on a semi-structured interview, developed at Karolinska Institutet, Stockholm, Sweden. The instrument has been evaluated regarding evidence of validity and reliability, as well as test-retest reliability and sensitivity to change. The instrument has also been revised based on research in order to improve the tool in its clinical use with persons with different types of activity limitations. The AAOP is used to evaluate the discrepancy between a person’s observed activity limitations and the self-experienced and described activity limitations after the performance of specific ADL task.

A well-known clinical problem in rehabilitation is that clients with limitations in their everyday functioning are not always fully aware of these limitations, which may result in increased personal or societal risk situations (e.g., a client who persists continuing driving a car after a severe right hemispheric stroke). These limitations can also result in restrictions in the persons participation in community life and society. The habilitation and rehabilitation services often offer interventions aiming to improve the ability to perform ADL tasks and increase the opportunities to participate in the community. In order for a person to become an active participant in the intervention planning to improve the ability to perform ADL tasks, an awareness of the limitations has been viewed as crucial to motivate the person. Persons with a limited awareness of their limitations in the ADL performance may therefore be less motivated to change their performance. It may therefore be important to evaluate the awareness of disability among persons with ADL limitations in order to target the interventions to appropriate areas and goals.

A limited awareness of problems in occupational performance is also a well-known clinical problem in persons with different types of diagnoses (e.g., stroke, traumatic brain injury, dementia, schizophrenia, mental retardation). Awareness of disability has, however, mostly been described from a specific neurological disorder and/or with a focus on awareness of specific impairments (e.g., neglect). There is a lack in knowledge about if and how specific disorders impact onto the awareness of limitations in everyday life contexts, and the consequences of a limited awareness of the performance in everyday life tasks. The overall aim of this research program is to develop clinical tools and strategies to be used with clients with limitations in activities of daily living (ADL) functioning associated with limitations in awareness of occupational performance, in order to enhance or maintain abilities and opportunities for active participation in relevant and meaningful situation/roles.

In order to implement occupational therapy in a client-centred context, it is crucial to gather information about the client’s own experiences of his/her performance. The AAOP offers a structured way of gathering information about a client’s experiences of occupational performance. At the same time, it allows for a comparison of views; client versus OT, in order to continue to plan interventions in a client-centred approach.

Main purpose

The main purpose is to generate knowledge of how the phenomenon awareness of occupational performance can be evaluated and measured by a method that demonstrate validity, reliability, and sensitivity across a variety of diagnostic groups.

Project coordinator/Main researcher

Anders Kottorp, PhD, OT reg, associate professor.


Several research projects are currently in progress internationally validating the AAOP for specific purposes and specific diagnostic groups. Models in modern test statistics (Rasch family of models) are used for developing the AAOP.

Financial support

The research project has been supported by

  • Forskningsrådet för Arbetsliv och Social Forskning (FAS)
  • Centrum för Vårdvetenskap (CfV), Karolinska Institutet
  • Stiftelsen Sävstaholm
  • Förbundet Sveriges Arbetsterapeuters Stipendiefond


Kottorp A, Peterson Lie I, Heuchemer B & Gumpert C (2013). Evaluation of Activitites of Daily Living (ADL) ability and awareness among clients in a forensic psychiatry evaluation unit in Sweden. British Journal of Occupational Therapy, 76, 23-30.

Kottorp A, Ekstam L & Petersson Lie I (2013). Differences in awareness between persons with left and right hemispheric stroke. Scandinavian Journal of Occupational Therapy, 20,37-44.

Kottorp A & Petersson I (2011). Psychometric evaluation of an assessment of awareness using two different Rasch models. Scandinavian Journal of Occupational Therapy, 18, 219–230.

Asaba E, Bontje P, Petersson I & Kottorp A (2011).The Assessment of Awareness of Ability (A3) in a Japanese context: A Rasch model application. Scandinavian Journal of Occupational Therapy, 19, 370-376.

Öhman A, Nygård L & Kottorp A (2011). The relationship between occupational performance and awareness of disability in older adults with cognitive impairment or dementia. Scandinavian Journal of Occupational Therapy, 18, 133-142.

Anderson R, Doble S, Merritt B & Kottorp A (2010). Assessment of Awareness of Disability (AAD) Measures among persons with Acquired Brain Injury (ABI). Canadian Journal of Occupational Therapy, 77, 22-29.

Patomella A-H, Kottorp A & Tham K. (2008). Awareness of driving disability in people with driving difficulties after stroke. Scandinavian Journal of Occupational Therapy, 15, 184-192.

Ekstam L, Uppgard B-M, Kottorp A. & Tham K. (2007). Awareness of disability and ADL ability in long-term follow-up after stroke. American Journal of Occupational Therapy, 61, 503-511.

Hällgren, M & Kottorp A (2005). Effects of occupational therapy program in activities of daily living and awareness of disability in persons with intellectual disabilities. Australian Occupational Therapy Journal 52, 350-359.

Kottorp A, Bernspång B, & Fisher AG (2003). Client-centred occupational therapy for persons with mental retardation: Implementation of an intervention programme in activities of daily living. Scandinavian Journal of Occupational Therapy 10, 51-60.


Ongoing activities with the Assessment of Awareness of Occupational Performance (AAOP)

Additional research studies using the AAOP as an outcome measure are currently in progress. The AAOP is currently implemented clinically with clients with neurological, psychiatric, developmental, and orthopedic disorders. The AAOP manual has been translated into English, Japanese, and Korean and the first international course was given in Okayama, Japan, in the fall of 2006.

A planned integration of the AAOP in the AMPS software package is currently in the planning process.

If you are interested in knowing more about the Assessment of Awareness of Occupational Performance, or want to take a course learning how to administer and score the AAOP

please contact Anders Kottorp by e-mail for further information.

Occupational Therapy