The Assessment of Work Performance, or AWP, was originally developed in Sweden and has now been translated into ten languages, with Finnish being the most recent addition. Unlike interview-based instruments, the AWP relies on direct observation. An occupational therapist watches a client carry out a real or simulated work task and rates fourteen distinct observable skills on a four-point scale, from incompetent to competent performance. These skills fall into three domains: motor skills such as mobility, coordination, and strength; process skills such as time management, planning, and adaptation; and communication and interaction skills such as social contact and information exchange. Crucially, the instrument is not tied to any particular diagnosis. Because it measures the interaction between person and environment, it can be applied to clients with mental health conditions, musculoskeletal problems, or any other work-related challenge, in genuine workplaces or constructed assessment settings.

In the new study, a team led by Jennie Nyman of Metropolia University of Applied Sciences, together with colleagues at Linköping University in Sweden, put the Finnish translation, the AWP-FI, through a demanding statistical technique known as Rasch analysis. Seventeen occupational therapists across Finland, all trained in a one-day session and two follow-up meetings, collected ninety-four assessments as part of their routine clinical work. The clients ranged from 18 to 60 years of age, and a majority of those with reported diagnoses had mental or behavioural disorders. Most assessments were conducted through direct observation, and the overwhelming majority, 84 percent, took place in simulated settings, with tasks such as book binding, household chores, and arranging and indexing magazines standing in for real jobs.

Rasch analysis is a form of modern psychometrics that converts ordinal rating-scale data into interval-level measurements. The method estimates two quantities simultaneously: the ability of each person and the difficulty of each item, placing both on a common scale. If the data behave as the model expects, the instrument can be said to measure a single coherent underlying trait, in this case work performance, in a way that is fair and comparable across individuals. The researchers structured their evaluation around three questions drawn from established psychometric guidance: whether the scale’s difficulty range matched the abilities of the sample, whether a reliable measurement scale had been constructed, and whether the individuals in the sample were being measured reliably and meaningfully.

The headline result was encouraging. The AWP-FI showed an overall fit to the Rasch model, with a non-significant chi-square test indicating that observed responses aligned well with model expectations. Individual items performed within acceptable statistical limits, and, importantly, no item behaved differently for different groups. Tests for differential item functioning, which detect whether an item is biased, for example by being harder for women than for men at the same underlying ability level, came back clean across gender, across direct versus participatory observation, and across simulated versus genuine work tasks. This stability suggests the Finnish instrument can be used confidently with men and women alike, in real workplaces or assessment laboratories, and whether the therapist watches from the side or joins the work activity as a participant.

The analysis was not without complications. Five of the fourteen items showed disordered thresholds, meaning that adjacent response categories were not being used in a consistent, ordered way. In practice, the middle rating of the four-point scale was rarely the most probable response for those items, likely because the observed clients clustered at similar performance levels and the full range of the scale was seldom used. The researchers collapsed the affected categories and reran the analysis, a standard corrective procedure, but they caution that any permanent change to the rating scale should wait for confirmation in larger and more varied samples.

Two deeper issues also emerged. First, targeting was suboptimal: the mean person location of 1.6 sat well above the item mean of zero, and the item difficulty range, spanning roughly from minus 1.3 to 0.9 on the logit scale, was narrow. In plain terms, the clients assessed were generally more capable than the hardest items could measure, leaving the scale without items at the demanding end of the work-performance continuum. The authors attribute this largely to the tasks chosen: most assessments used simulated, non-work-specific activities with relatively low demands. Their clinical recommendation is that assessors think carefully about task selection, since the nature and demands of the chosen task directly shape what the assessment can reveal. Adding harder items could widen the measure, but the authors urge caution, because new items must remain faithful to the instrument’s theoretical foundation in the Model of Human Occupation, and expanding item counts carries its own psychometric risks.

Second, the analysis flagged local dependency among items and indications of multidimensionality. Twenty-four of ninety-one residual correlations exceeded the statistical cut-off, and these correlations clustered neatly within the three AWP domains, suggesting that items within a domain share information beyond what the single underlying trait of work performance can explain. When the researchers compared person estimates derived from different domains, between 11 and 17 percent of respondents fell outside the range expected for a truly unidimensional scale, well above the 5 percent benchmark. Notably, this finding diverges from an earlier evaluation of the Swedish original, which found no multidimensionality. The authors suggest the clinical impact may be minimal, since the domain structure reflects the deliberate theoretical architecture of the Model of Human Occupation, but they recommend that future studies with larger samples apply multidimensional or testlet-based Rasch approaches to confirm the pattern.

On the reliability front, the news was solid. The person-separation index reached 0.83, comfortably above the 0.8 benchmark, indicating the scale can distinguish roughly three clinically meaningful groups of clients. Only four participants, about 4 percent, showed erratic response patterns outside acceptable fit limits, meaning nearly everyone was measured in a statistically coherent way. Taken together, the results provide an initial validation of the AWP-FI and support its use as a valid and reliable observational tool for assessing work performance in Finland, where the Finnish Institute for Health and Welfare has explicitly called for more reliable and valid vocational assessment practices. Used alongside the interview-based Worker Role Interview, whose Finnish version passed a similar evaluation in 2023, the AWP-FI can contribute to the kind of holistic, multi-source assessment that sickness insurance and vocational rehabilitation systems increasingly demand.

The study’s limitations are candidly acknowledged. The sample of ninety-four assessments is modest, the DIF analysis suffered from very unequal group sizes, with simulated tasks dominating at 84 percent, which raises the risk that genuine item bias could have gone undetected, and the narrow spread of client performance likely constrained several of the analyses. The authors therefore frame this as a first step rather than a final verdict, recommending further testing with larger and more diverse samples to resolve the local dependency and targeting issues. For clinicians, the practical message is immediate and actionable: the AWP-FI works, but its usefulness depends on choosing work tasks demanding enough to reveal the full range of a client’s capability, and on remembering that the fourteen observed skills are organised into three theoretically distinct domains that should inform, not obscure, the interpretation of results.

Subject of Research: Psychometric validation of the Finnish version of the Assessment of Work Performance using Rasch analysis

Article Title: Psychometric evaluation of the Finnish version of the Assessment of Work Performance (AWP-FI)

Article References: Nyman, J., Sandqvist, J., Pihlava, J., Ekbladh, E., & Yngve, M. (2025). Psychometric evaluation of the Finnish version of the Assessment of Work Performance (AWP-FI). Scandinavian Journal of Occupational Therapy, 32(1), Article 2555182. https://doi.org/10.1080/11038128.2025.2555182

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2555182

Keywords: psychometrics, Rasch analysis, occupational therapy, work ability, vocational rehabilitation, AWP-FI, construct validity, differential item functioning, Model of Human Occupation, Finland, assessment tools, work performance

Occupational science, the field that studies how everyday activities shape human health and identity, has long been anchored in Western, autonomy-centered paradigms. Its foundational models emphasize volition, personal choice, and self-expression as the engines of occupational identity. But Budman and Bourke-Taylor point out that these assumptions may simply not hold in traditional, faith-based communities, where motherhood is not a lifestyle decision but a divinely ordained vocation. In such settings, maternal roles are socially prescribed, religiously defined, and structurally reinforced, meaning that the very concept of ‘choice’ operates differently than mainstream theory predicts.

To build their framework, the researchers used a reflective thematic synthesis of two previously conducted qualitative studies with ultra-Orthodox Jewish mothers—one using semi-structured in-depth interviews and the other using focus groups. Rather than re-coding raw transcripts, the team revisited original thematic matrices, analytic memos, and interpretive reflections to extract patterns with theoretical relevance. They then triangulated these empirical findings with three theoretical lenses: role theory, which explains how societies define and enforce roles like ‘good mother’; occupational identity theory, which describes how people come to know themselves through what they do; and occupational justice, which examines how structural barriers limit access to meaningful activity.

The result is a framework with five interrelated domains: Spiritual Meaning and Obligation, Communal Structures and Expectations, Family Dynamics and Resources, Health and Well-being Outcomes, and Negotiation and Adaptation. The first three act as foundational forces, embedding mothering in shared values, moral obligations, and systemic conditions. The final two capture how mothers respond over time—reprioritizing daily occupations, seeking guidance from religious authorities, or reframing struggles through a spiritual lens. Together, the domains model the interplay between structure and agency, showing identity as something continuously negotiated rather than fixed.

The ultra-Orthodox Jewish community in Israel provides a striking case study. Composed of Hasidic, Lithuanian, and Sephardic groups united by adherence to halacha, or Jewish law, the community structures daily life around spiritual practice. Because Torah study is prioritized—especially for men—women typically assume central responsibility for caregiving, household management, and often financial provision. Large families are common, and mothers are viewed not merely as caregivers but as transmitters of tradition and protectors of communal boundaries. Motherhood, in this context, is a sacred vocation shaped by teachings about self-sacrifice, modesty, and the sanctity of childrearing.

These conditions generate what the authors call deep occupational meaning alongside intense pressure. Communal structures—religious leadership, gendered education systems, and dense social networks—reinforce norms through what the researchers describe as social surveillance and communal cohesion. Maternal roles become publicly accountable as well as privately meaningful. For some mothers, this offers clarity, belonging, and identity affirmation; for others, it produces internal conflict when personal needs or aspirations diverge from communal expectations. Health and well-being, the framework suggests, are shaped not only by external demands but by internalized beliefs about what it means to be a ‘good’ mother, with well-being often measured by perceived success in meeting religious and familial expectations rather than personal fulfillment alone.

To illustrate the framework’s dynamics, the authors constructed two fictionalized composite vignettes based on common patterns in their data. The first portrays a 34-year-old mother of seven whose internal values and external environment are aligned: she keeps a kosher kitchen, orchestrates Sabbath preparations and holiday celebrations, and describes her home as a sacred space, finding coherence and satisfaction in roles her community affirms. The second portrays a 28-year-old mother of four who has begun part-time seminary studies and feels caught between communal expectations of prioritizing family and her desire for intellectual engagement and financial independence. Her story shows identity under tension—guilt over missed family meals, disrupted routines, and private questions about whether her aspirations are compatible with her faith.

The framework is also positioned as a critique and extension of two established occupational therapy models. The Model of Human Occupation, or MOHO, explains identity through volition, habituation, and performance capacity, but is grounded in individual agency—an emphasis that fits awkwardly where occupational roles are inherited and morally reinforced. The new framework situates volition within spiritual obedience and communal norms, suggesting that motivation is filtered through divine duty rather than emerging solely from personal preference. The Kawa Model, which uses the metaphor of a river shaped by rocks, banks, and driftwood to capture cultural context, offers narrative richness but does not explicitly theorize identity development. The proposed framework builds on both by showing how identity is actively constructed through alignment—or misalignment—between internal values and external expectations.

The authors are candid about the framework’s limitations. It is based on secondary analysis of previously published qualitative findings and reflects the researchers’ interpretations; it requires validation through participant feedback and application in other sociocultural settings. They also acknowledge an inherent tension: the foundational theories they build on originate from the very Western, autonomy-centered paradigms the framework critiques, and they describe engaging with these theories critically and reflexively. Future research, they argue, should explore how maternal occupational identity develops across the lifespan and in different religious traditions, with comparative studies clarifying which elements are context-specific and which have broader relevance.

Even so, the implications reach well beyond one community. For occupational therapists, the framework underscores cultural humility: clinicians working with mothers from traditional or minority communities must attend to the meanings, values, and expectations shaping maternal roles, or risk misinterpreting occupational needs and applying inappropriate service models. For occupational science, the work joins a growing critical movement calling for pluralistic, justice-oriented theory that accommodates collective meaning-making, spirituality, and diversity. The researchers suggest the framework may transfer to other collectivist or faith-oriented populations, including Indigenous, Muslim, and Christian communities where maternal identity is similarly shaped by collective values and gendered expectations. If validated, it could mark a meaningful step toward theories of occupation that recognize not just what people choose to do, but what they believe they are obligated to become.

Subject of Research: A conceptual framework for maternal occupational identity in faith-based minority communities

Article Title: Rituals, roles, and realities: A conceptual framework for maternal occupational identity in faith-based minority contexts

Article References: Rituals, roles, and realities: A conceptual framework for maternal occupational identity in faith-based minority contexts. (n.d.). https://doi.org/10.1080/11038128.2025.2558742

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2558742

Keywords: maternal occupational identity, occupational science, ultra-Orthodox Jewish mothers, faith-based communities, role theory, occupational justice, Model of Human Occupation, Kawa Model, occupational therapy, cultural responsiveness, motherhood, qualitative research

The study, led by Jessica Vollertsen of Linköping University together with Mathilda Björk, Anna-Karin Norlin, and Elin Ekbladh, recruited 48 working-age individuals in Sweden who had experienced a stroke within the previous five years and who reported fatigue. All had been gainfully employed at the time of their stroke. The participants, 37 of whom were women, were interviewed using the Swedish version of the Worker Role Interview, a semi-structured assessment grounded in the Model of Human Occupation that rates sixteen psychosocial and environmental factors on a four-point scale indicating whether each item interferes with or supports return to work. A questionnaire adding demographic data, the Mental Fatigue Scale, and the Hospital Anxiety and Depression Scale completed the picture. Data were analysed with a qualitative abductive content analysis complemented by descriptive statistics, and the study was approved by the Swedish Ethical Review Authority.

The technical profile of the sample underscores why post-stroke fatigue deserves attention as an obstacle to employment. On the Mental Fatigue Scale, 89 percent of participants reported mental fatigue, most at moderate to severe levels, even though the majority did not show clinically significant depression or anxiety. At interview, 96 percent were employed, but only 15 percent were working full-time; 58 percent worked reduced part-time schedules of 25 to 75 percent, and 23 percent remained on full-time sick leave. The Worker Role Interview ratings revealed a telling pattern: the items most often rated as supportive of returning to work were enjoying work, appraising work expectations, and commitment to work, while perceptions of the work environment, expectations of job success, and pursuing interests were most often rated as interfering. In other words, motivation was rarely the problem. Capacity and context were.

The qualitative analysis produced two overarching categories. The first, re-evaluating work ability while experiencing fatigue, captures how participants confronted an altered, fluctuating capacity that often manifested through memory difficulties, impaired concentration and multitasking, and heightened stress sensitivity. This altered capacity maps onto disruptions in what occupational scientists call personal causation, the appraisal of one’s abilities and the confidence to use them effectively. Participants described learning to recognise early warning signs of fatigue, because ignoring them could trigger headaches, migraines, or exhaustion lasting from a single day to a full week. Crucially, because the impairment was largely invisible, participants struggled not to express their needs but to have them understood and regarded as legitimate by supervisors, co-workers, and external contacts such as customers. Concrete needs, like sensitivity to noise or light, were easier for employers to accommodate than task-related needs, which were frequently dismissed.

The social architecture of the workplace emerged as decisive. Supervisors who actively sought to understand the nature of fatigue were described as crucial, yet frequent leadership changes repeatedly forced participants to re-explain their condition, eroding continuity and trust. One participant recounted how a supportive supervisor had arranged adapted work tasks, only for the next supervisor to remove that possibility. Close working relationships with colleagues were especially valuable because familiar co-workers could notice subtle signs of fatigue and informally adjust workloads. Gradual return-to-work programs and work training helped participants understand their changed abilities, but several experienced an abrupt withdrawal of vocational rehabilitation support the moment they reached full-time hours. Some also reported external pressure from employers or the Social Insurance Agency to increase working hours prematurely, leading to relapses and renewed sick leave, an experience one participant described as being forced to crash three or four times to prove the limitations were real.

Outside the workplace, the study documented how everyday life shaped work ability in a continuous feedback loop. Fatigue left no buffer for unexpected events, so a child missing the school bus or misplaced keys could drain enough mental energy to derail an entire workday. Participants engineered elaborate routines, planning clothing the night before, using calendars and reminders, and keeping their homes meticulously organised, because, as one put it, a cluttered mind requires order and tidiness around it. All participants emphasised scheduling rest and recovery into their days, whether through sleeping, lying in a dark room, pausing during walks with a carried yoga mat, or retreating discreetly to restrooms at work. Remote work arrangements, accelerated by the COVID-19 pandemic, were welcomed because eliminating commutes and using home rest areas conserved scarce energy. Yet the researchers highlight a central paradox: structure and routine are the very strategies needed to manage fatigue, but fatigue itself makes those routines difficult to establish and maintain.

The second category, redefining identity in the context of everyday life, is arguably the study’s most striking contribution. Many participants had built careers around helping others and defined themselves through high performance, making it emotionally wrenching to reconcile current limitations with previous expectations. Family members, witnessing the toll of fatigue firsthand, often questioned whether participants should work full-time at all, fearing another stroke. Energy limits strained parental roles, with one mother describing how work overload left her without the energy to cook proper meals for her children, and reshaped spousal dynamics, sometimes producing closeness through emotional support and sometimes provoking worry about how long a partner would tolerate the changes. Deliberate occupational choices, such as moving closer to work or downsizing housing, conferred a sense of control, whereas giving up cherished social and physical activities was experienced as loss and grief. One participant captured the arc from mourning to acceptance with the phrase: this is the new me, Eva 2.0.

From a clinical standpoint, the authors argue that sustainable return to work cannot be achieved through rehabilitation that treats work in isolation. Because challenges at work and at home proved to be integral to the same adaptive process rather than parallel problems, they call for person-centred rehabilitation that integrates work and everyday life, supports the reconstruction of occupational identity, and enables engagement in meaningful activities despite fatigue. The findings align with the Action Plan for Stroke in Europe 2018 to 2030 and Sweden’s integrated care reform, both of which emphasise person-centred, preventive, and long-term support. The researchers also caution that previous studies have focused overwhelmingly on the binary outcome of whether people return to work, while the sustainability of that return over time has been comparatively neglected, leaving clinicians without evidence-based guidance for the long tail of recovery.

The study has limitations worth noting. Recruitment relied solely on Facebook groups for stroke survivors, which may have excluded marginalised populations and limits generalisability, and interviews were conducted by telephone without audio recordings, restricting verbatim analysis, a constraint the authors offset by conducting 48 interviews to ensure sufficient information power. The COVID-19 pandemic also overlapped with early data collection, although recruitment continued post-pandemic. Still, the scale and depth of the qualitative dataset make this one of the richest accounts to date of how fatigue reshapes working life after stroke. The message for employers is concrete: flexible task and schedule adjustments, consistent supervisory relationships, systematic information about post-stroke fatigue, and continued individualised follow-up beyond the return to full-time hours are not accommodations of convenience but prerequisites for keeping skilled people in the workforce. For clinicians, the message is equally clear: supporting someone back to work after stroke means treating the return not as an event to be achieved, but as an ongoing negotiation between a changed self and a demanding everyday life, one in which identity, not just capacity, must be given time to heal.

Subject of Research: How post-stroke fatigue affects sustainable return to work among working-age stroke survivors

Article Title: Return to work with fatigue after stroke: A complex occupational adaptation process

Article References: Vollertsen, J., Björk, M., Norlin, A.-K., & Ekbladh, E. (2025). Return to work with fatigue after stroke: A complex occupational adaptation process. Scandinavian Journal of Occupational Therapy, 32(1), 1-13. https://doi.org/10.1080/11038128.2026.2613621

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2613621

Keywords: post-stroke fatigue, return to work, stroke rehabilitation, occupational therapy, occupational identity, Worker Role Interview, Model of Human Occupation, vocational rehabilitation, mental fatigue, workplace accommodation, everyday life, person-centred care