Bottom-up or top-down evaluation: is one better than the other?

September/October 2004, Volume 58, Number 5 The Occupational Therapy Practice Framework: Domain and Process (Framework; American Occupational Therapy Association [AOTA], 2002) specifies that all occupational therapy evaluation must begin with an occupational therapy profile and an analysis of occupational performance (AOTA, 2002). This document requires that a top-down approach to evaluation be used wherein the therapist always begins by examining the client’s occupational performance, grounded in a client-centered approach. In this paper, we question the soundness of the AOTA official position that occupational therapy evaluation should always be based on a top-down approach. After surveying the evolution of each approach and examining their relative strengths and ability to document effectiveness, we suggest that clients’ needs may be better served by a therapist determining which evaluation approach would be most appropriate to the situation through the use of a screening tool.