Milestones of my career

1. Why I chose graduate schools (rather than clinical settings): 1988~1990 (my mid 20s)
2. Why NTU (but not the others) to work for my career: 1994~  (early 30s)
3. Why stroke as research sample (but not hand injury, SCI): 1994~
4. Why research FIRST (but not teaching nor clinical practice): 1994~2018 (early 30s to early 50s)
5. Why measurement tools (but not effectiveness of OT) and applied psychometrics as research subjects: 1994~
6. Why balance/ADL as research subjects: 1994~
7. Why item response theory as core knowledge: 2003 (Professor) ~ (>30 SCI/SSCI indexed papers, May, 2019)
8. Why quality of life/utility as research subjects: 2004~ (19 papers, May, 2019) (early 40s)
9. Why computerized adaptive testing (CAT): 2008~  (16 papers, May, 2019)
10. Why cognitive assessments as research subjects: 2008~ (13 papers, May, 2019)
11. Why schizophrenia as subjects for cognitive assessments: 2010~ (13 papers, May, 2019)
12. Why social cognition as research subjects: 2015~ (early 50s)
13. Why AI as core knowledge for future research: 2018~ (middle 50s/before retirement)
14. Why child development as TOP research subjects:  2019~
15. Why professional skills/SDM as research subjects: 2018~
16. Why moving from research to teaching (including teaching-related research): 2018~
17. Back to research! Why?

Major milestones

1. Clinical settings presented numerous challenges for me, including limited re-education opportunities, low chances for promotion, low pay, heavy workloads, and minimal autonomy. These were far beyond my ability to change. Moreover, the idea of becoming a doctor, requiring years of additional study and demanding work, wasn't appealing to me. Therefore, I decided against pursuing a clinical path and entered graduate school in the US. Thanks for my parents' financial support!

2. I had several universities to be selected because very few OTs got PhD then. Although I had to be employed as teaching assistant (but not lecturer or higher position) due to my poor academic performance (no published paper), the NTU is the TRUE research university that has given me a huge lift for developing my research ability.

3. Stroke is the largest sample, which can be investigated, in the field of physical OT. In addition, because of distinct diagnosis, and a variety of issues (physical or psycho-social topics, assessments, intervention, or epidemiology) left to be studied, stroke has given me lots of research topics either in-depth or width.

4. During my participation in our 學系評鑑 in 1994, a well-known scholar stressed the importance of research. In addition, I had to be promoted and needed papers.... The other advantage is that there have been so many good physical OT teachers (e.g., Prof. Hsueh, Huang, and Mao...). Thus, I didn't have to offer the majors courses and take great responsibility on clinical teaching. They have taken tons of teaching and clinical loads from me for DECADES.

5. Assessments are fundamental and critical for clinical reasoning, goal setting, treatment planning, showing outcomes, and predicting prognosis. However, our measures currently used at clinical settings have been many miles away form achieving the above-mentioned clinical purposes. That is, there are a great number of big issues (e.g., validation of the current measures, revision of the current measures, and development of measures) left to be studied. If you are interested in this issue, please go to https://atriptouq.blogspot.com/2014/12/cat.html for further details.
Psychometrics can be defined as a study of assessment quality. Psychometric properties (e.g., reliability, validity, responsiveness) are the heart of a measure. Applied psychometrics deals with how to apply psychometrics to validate, improve, and/or develop measures.


6. ADL and balance are primary outcomes for OT. The measures used in 1990s were descriptive rather than standardized. Even the Barthel index was not commonly used at clinical settings in 90s. Thus, there were plenty of research topics for me. So far, I have written >30 papers published in well-known journals. You may go to my above-mentioned blog for details.

7. Item response theory (or called modern test theory) is an advanced test theory, which is useful for validation, simplification, and development of a measure (particularly CAT). I learned it from scratch with the lift from Prof. Wen-Chung Wang. Such knowledge help me revise some well known measures and develop some our own measures. Most of these results have been published in internationally-known journals. In addition, it also help me write several papers regarding individual-level responsiveness, which is an important issue for both clinicians and researchers to validate and select outcome measures.

8. Quality of life (QOL) or health-related QOL is a primary or secondary outcome of OT. Particularly, disease-specific QOL questionnaires had been developed and widely used for almost every disease. In addition, utility (preference of health) is commonly viewed as a generic index, which is useful for comparing effects of different interventions (even different interventions on different diagnoses) due to its generic/universal characteristics. Both QOL and utility are useful for cost-effectiveness analysis and cost-utility analysis. I'd spent several years collaborating with Prof. Jung-Der Wang on these topics. Particularly, we had developed a Taiwanese version of WHOQOL-BREF, which is the mostly used measure among the measures developed by me.

9. CAT means fast and reliable assessments, which are fascinating for all. However, the knowledge and data needed for CAT are a lot. Thus, developing a CAT takes time, effort, as well as luck! However, almost all my CATs haven't been used by clinicians. Something wrong about the utility of CAT. to be added later...

10. Cognitive assessments are critical for goal setting and treatment planning. However, the current cognitive measures have limited or poor psychometric evidence, which cannot support its utility for clinical practice. For example, the psychometric properties of the LOTCA are not satisfactory. Using the LOTCA might be just a waste of time. In addition, it often takes lengthy time to administer cognitive assessments. For research purposes, researchers have to use psychometrically sound cognitive measures to specify or screen patients' cognitive impairments in order to target/match corresponding cognitive intervention protocols. However, most of the current cognitive measures cannot satisfy such needs. Another critical issue is "cultural dependence." Specifically, the items and content of cognitive assessments are highly affected by culture and language. So, the cognitive measures developed in the other countries may not be used here. Thus, we have to develop our own cognitive measures to achieve our research and clinical purposes.

11. Patients with schizophrenia have various cognitive impairments. In addition, they, large size of sample, can be easily reached/assessed in some major hospitals. Thus, they are very suitable sample for examining psychometric properties of cognitive measures.

12. Social cognition has been shown as a critical mediator between cognitive functions and social functions. Impairment of social cognition can be seen in patients with schizophrenia or ASD. Thus, assessing social cognition is important for clinical management or research of patients with schizophrenia or ASD.

13. AI might solve some problems of CATs. Although CAT can achieve fast and precise assessments, development of CATs takes time and luck. There are still lot of of domains without CATs. For using CATs, clinicians have to learn how to administer, which takes time. In addition, they have to install the CATs' programs into their institutions' system. On the other hand, AI can AUTOMATICALLY and SIMULTANEOUSLY assess patients' several physical, psychological, social, and even cognitive domains (e.g., motor, balance, mobility, emotion, attention, executive function, language, social interaction, communication, empathy) via video analysis WITHOUT clinicians' efforts. The results of AI assessments are digitized so that the afterward analysis, application, and output are very useful for clinicians, researchers, and patients!! The progress of AI is very speedy so that we just need to catch up the contemporary advancements and that we don't need to pay efforts to advance the AI technologies.

14. Current assessments of children's developmental domains can be inefficient. Both children and their parents are generally receptive to video recording. Video recordings can capture a child's development across several domains, such as motor skills, language, cognition, emotion, and social function. These recordings can then be analyzed by AI using data from children with normal and abnormal development. Parents would likely be interested in video recording and receiving results from AI analysis over time. AI has the potential to revolutionize child development assessment by helping us assess progress, analyze data, predict future development or outcomes, and generate reports for parents, clinicians, and researchers. Additionally, the techniques, results, and knowledge gained from this approach could be translated to assessments of age-related decline in the elderly population.

Source: https://encrypted-tbn0.gstatic.com/images?q=tbn%3AANd9GcS4gu9bxwh1qVmhUWzhpJxEMAiiDRmafmksEXgZgxgHRtvWgfKn&usqp=CAU

15. Professional skills and shared-decision making (SDM) are both crucial for delivering high-quality and effective occupational therapy (OT). However, effective methods for improving professional skills and client-centered communication remain largely unexplored. If video recording is implemented in clinical settings, patient-therapist communications can be captured as well. Artificial intelligence (AI) could then be used to analyze the recordings and identify both strengths and weaknesses in professional skills. The information gleaned from these analyses would be invaluable in pinpointing areas for improvement and ultimately enhancing professional skills.

16. With < 10 years until retirement, my research potential naturally becomes more limited. As a result, I find myself spending more time on teaching my graduate students and research assistants. I believe my teaching can strengthen their abilities and prepare them for their future careers. The experience I gained from researching topics like OSCE and professional skills assessment will definitely be helpful in my teaching.

Note: It might be interesting for you to find why my priority shifts from "research first" to "teaching first."  Also, my research sample shifts from stroke, to schizophrenia, and then to  children. Actually, children have been my research sample and I've written several papers in the filed of children.

17. Back to research! I tried teaching and sharing my knowledge/experience with undergraduate students for several years, but ultimately, it wasn't the right fit for me. So, I'm devoting my time to research again, and I absolutely love it! I can't imagine doing anything else for the rest of my career!