Chinese Version of Skills Test for Occupational Therapy Students Passes Key Reliability Checks

Occupational therapy students in China may soon be graded with a new yardstick. A research team led by Zhizhuo Wang and Cheng Lin of Fujian Medical University reports in BMC Medical Education that a Spanish-language assessment tool known as the CPTO has been carefully translated into Chinese and validated for use with Chinese students. The work, published as an open-access research article, addresses a long-standing gap in Chinese rehabilitation education, where educators have lacked a rigorously tested instrument for measuring the professional skills that students acquire during training.

The instrument in question, formally titled the Assessment of Professional Skills of Occupational Therapy Students, was originally developed in Spanish-speaking contexts to evaluate the clinical competencies of students in the field. Occupational therapy, a profession focused on helping people regain the ability to perform everyday activities, has been expanding rapidly in China, and the World Federation of Occupational Therapists has set international expectations for what entry-level practitioners should be able to do. Existing Chinese-language options, however, have been limited. Tools such as clinical competency evaluation instruments, clinical internship evaluation tools, the revised Student Practice Evaluation Form, and competency-based fieldwork evaluations for occupational therapists exist in various forms, but none of them included a validated Chinese version of the CPTO. That gap meant Chinese educators had no way to benchmark their students against an internationally recognized measure of professional skill.

Translating a psychological or educational test is far more involved than running text through a dictionary. Words must carry not only the same literal meaning but the same connotations, and the underlying constructs measured by each item must survive the journey across cultures. To manage this, the team followed a structured four-step translation procedure, a standard approach in cross-cultural instrument adaptation that typically involves forward translation by independent translators, reconciliation of the versions, back-translation by linguists blind to the original, and review by a committee of experts to resolve discrepancies. This systematic process is designed to establish semantic, idiomatic, experiential, and conceptual equivalence between the source and target versions, ensuring that a Chinese-speaking student responding to an item is effectively answering the same question as a Spanish-speaking counterpart.

With a draft Chinese version in hand, the researchers turned to a modified Delphi process, a consensus-building method in which a panel of experts reviews items over repeated rounds while the organizers collect ratings and feedback. Nine experts participated in two rounds of consultation, five of whom, or 55.56 percent of the panel, were women. Their professional experience was substantial, averaging 21 years of practice in their respective fields. The panel judged each item for importance and for clarity, and the statistical signals from the second round were encouraging. The mean Spearman’s rho value, a measure of ranking agreement among experts, reached 0.88 with a standard deviation of 0.21, and the improvement between rounds was statistically significant, with a Z statistic of -2.33 and a p value below 0.05. The semi-interquartile range, which captures how tightly expert ratings clustered, averaged just 0.05 in the second round, indicating that consensus had converged to a narrow band. Every item passed the importance threshold set for retention.

Content validity was then quantified using the content validity index, a metric widely used in instrument development. At the item level, the I-CVI values for all items fell between 0.8 and 1.0, meaning that at least four out of every five experts considered each item relevant and essential. At the scale level, the average S-CVI reached 0.98 in the second Delphi round, an exceptionally high figure that comfortably exceeds the commonly cited benchmarks of 0.80 for the item level and 0.90 for the scale level. In plain terms, the expert panel regarded the translated items as a faithful and complete representation of the professional skills the instrument is meant to measure.

The next stage involved putting the instrument in front of actual students. All 103 students invited from two universities agreed to participate, a 100 percent response rate that strengthens the representativeness of the pilot data. The researchers analyzed the responses using SPSS version 26.0 and R version 4.3.1, applying both classical and modern psychometric techniques. A central question in validation is whether the structure of the instrument, meaning the pattern of relationships among its items and sections, matches the theoretical model of professional competence it is supposed to reflect. Confirmatory factor analysis, a technique that tests how well observed data fit a predefined factor structure, demonstrated a good fit to the data, with standardized factor loadings ranging from 0.55 to 0.98. These loadings indicate how strongly each item relates to its intended underlying skill domain, and values in this range suggest that the items hang together coherently.

Reliability, the second pillar of psychometric quality, was assessed from several angles. Inter-rater agreement, which reflects whether different evaluators assign consistent scores to the same performance, produced an intraclass correlation coefficient of 0.787 for the total scale, with section-level values ranging from 0.817 to 0.961. Test-retest reliability, which examines whether scores remain stable when the instrument is administered on separate occasions under similar conditions, was even stronger, with a total-scale ICC of 0.896 and section-level values between 0.759 and 0.955. Internal consistency, measured by Cronbach’s alpha, reached 0.950 for the total scale, a figure indicating that the items collectively measure a unified construct with very high precision. Correlations between the total score and the scores of the individual sections, labeled the s-section, c-section, and p-section, were 0.43, 0.77, and 0.84 respectively, all statistically significant at p below 0.001. This pattern suggests that each section contributes meaningfully to the overall score while also capturing distinct information of its own.

The distribution of student performance offered a further sanity check on the instrument’s usefulness. When the 103 participants were classified into the CPTO’s four performance bands, roughly a quarter fell into each category: 24.27 percent scored in the low range of 0 to 150, 25.24 percent in the medium range of 151 to 154, 25.25 percent in the high range of 155 to 183, and 25.24 percent in the excellent category of 184 or above. For an assessment tool intended to differentiate among learners, this near-uniform spread is a favorable property, because a test that piles most examinees into a single band cannot distinguish strong performers from weak ones. The even dispersion across the Chinese student sample suggests the translated instrument can meaningfully stratify professional skill levels in this population.

The authors conclude that the Chinese version of the CPTO demonstrates good reliability and validity for assessing the professional skills and clinical competencies of occupational therapy students. The study received ethical approval from the Fujian Medical University Biomedical Research Ethics Review Committee under number 2024 Fuyi Ethics Review No. 172, was conducted in accordance with the Declaration of Helsinki, and was funded by undergraduate educational teaching research projects from Fujian Medical University and Fujian Province, with the funders playing no role in the study’s design or conduct. The work, accepted on 2 October 2026 and published on 19 October 2026 under a Creative Commons Attribution 4.0 license, arrives at a moment when rehabilitation professions across Asia are professionalizing quickly and education programs are under pressure to demonstrate measurable outcomes. A validated Chinese-language measure of professional competence gives Chinese occupational therapy programs a tool that aligns with international standards, supports fair and consistent evaluation during clinical placements, and opens the door to cross-national comparisons of student readiness. For a profession whose entire purpose is helping people reclaim independence in daily life, ensuring that its newest practitioners are competently assessed is not an academic nicety but a matter of patient safety and workforce quality.

Subject of Research: Translation and psychometric validation of the Chinese version of an occupational therapy student professional skills assessment instrument

Article Title: Translation, reliability and validity of the assessment of professional skills of occupational therapy students (Chinese version)

Article References: Wang, Z., Han, P., Liu, X., Guo, W., Zhong, H., Mo, Y., Liu, Z., & Lin, C. (2026). Translation, reliability and validity of the assessment of professional skills of occupational therapy students (Chinese version). BMC Medical Education. https://doi.org/10.1186/s12909-026-10552-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10552-9

Keywords: occupational therapy, psychometrics, translation, reliability, validity, Delphi method, content validity index, confirmatory factor analysis, medical education, China, clinical competency, assessment instrument