Client-centred practice from the perspective of Danish patients with hand-related disorders

Outpatients' perspectives of quality in rehabilitation - development and validation of a patient-reported experience measure (PREM)

PURPOSE

This study aimed to develop and validate a patient-reported experience measure (PREM) to examine the patients' perspectives on the quality of outpatient physiotherapy and occupational therapy rehabilitation.

MATERIALS AND METHODS

A systematic literature search in PubMed, Embase, Scopus, and Cinahl was conducted to identify relevant themes for the questionnaire. Fourteen studies were analyzed through a systematic text condensation to identify quality aspects in the rehabilitation from patients' perspectives. Further, based on the analysis, 13 items with answers on a five-point Likert scale were developed. Face validity and content validity were established during interviewing 14 municipality outpatients. Finally, to determine the construct validity and internal consistency, the questionnaire was distributed to 385 patients with various diagnoses.

RESULTS

The final questionnaire, Outpatients' Experience of quality in Rehabilitation (OPER), demonstrated good face and content validity and covered patients' experience of quality in municipal rehabilitation. Data from 307 respondents established construct validity and high internal consistency and showed, in general, a positive experience of outpatient rehabilitation.

CONCLUSIONS

The OPER demonstrates satisfactory psychometric properties based on an extensive development and validation process. By assessing outpatients' experience of the rehabilitation process, OPER offers a measurement of the quality of therapists' practice of patient-centered rehabilitation.

Are occupational therapists in hand therapy working in an occupation-centered way? A cross sectional survey

Introduction

The dominance of the biomedical approach has previously caused a limited focus on occupation within hand therapy. This study aimed to investigate the rehabilitation offered to patients with a hand-related disorder (HRD) in Denmark including to determine the extent to which occupation-focused and/or occupation-based assessments and interventions are used and to identify barriers against their use.

Methods

A cross-sectional survey with 45 questions was conducted among members of the Danish Association for Hand Therapy. Data were analysed with descriptive statistics. Categorical variables were reported with frequency and percentage, and continuous variables with average and standard deviation.

Results

One hundred and six occupational therapists working as hand therapists (n = 106) completed the survey. They reported common use of assessments measuring range of motion, pain, edema, and occupational performance. Occupational performance was assessed by non-standardized occupation-focused assessments, such as informal conversations. Exercise, pain management, and occupation-focused informal conversations were reported as the most frequently used interventions. Out of 82 respondents, 74 (91.4%) reported that they used interventions focused on body function and structures to the extent they wanted. Only 41 (50.0%) used occupation-focused or occupation-based interventions to the extent they wanted.

Discussion

Assessments and interventions reporting body function and structure were used most frequently whereas assessments and interventions reporting activity and participation were used to a lesser extent. Occupation-focused assessments and interventions were used more commonly than occupation-based. Hand therapists considered occupation-based assessments and interventions to be important in rehabilitation after HRD, despite using them with few patients. Several barriers were reported regarding the implementation of an occupation-centered approach: habit, workload, time constraints, and setting.

Adult patients' experiences after a distal radius fracture - A qualitative systematic review

BACKGROUND

Distal radius fractures are a common presentation in emergency departments. Synthesis of qualitative research of treatment, care and rehabilitation this fracture presents from the patient perspective could improve clinical practice and care. The purpose of this systematic review was to synthesize the qualitative literature on patient experiences after sustaining a distal radius fracture.

METHODS

We searched Embase, MEDLINE, CINAHL, Psycinfo and CINAHL to identify qualitative studies published from database conception to May 2023. All studies were screened, extracted, analysed and quality assessed by two blinded reviewers. A thematic synthesis approach was used to analyse the findings from included studies.

RESULTS

A total of 9 studies interviewing 160 unique patients were included. We identified 3 themes in relation to patient experiences after sustaining a distal radius fracture: 1) Concerns about dependency, 2) Fear and pain and 3) Motivators for recovery. The themes did not exist as sharply demarcated topics but were intertwined with patients reflecting that more information and knowledge could assist in managing expectations and the recovery period.

CONCLUSION

Our synthesis highlighted that adult patients with DRF experience a lack of information about the care and treatment inhibiting independence and successful management of expectations due to pain, fear and lack of motivation. Our findings can inform orthopaedic units and assist in tailoring information to patient needs.

Immersive participatory design of assistive robots to support older adults

Assistive robots have the potential to support independence, enhance safety, and lower healthcare costs for older adults, as well as alleviate the demands of their care partners. However, ensuring that these robots will effectively and reliably address end-user needs in the long term requires user-specific design factors to be considered during the robot development process. To identify these design factors, we embedded Stretch, a mobile manipulator created by Hello Robot Inc., in the home of an older adult with motor impairments and his care partner for four weeks to support them with everyday activities. An occupational therapist and a robotics engineer lived with them during this period, employing an immersive participatory design approach to co-design and customise the robot with them. We highlight the benefits of this immersive participatory design experience and provide insights into robot design that can be applied broadly to other assistive technologies.

Measurement properties of the Spanish COPM in older adult rehabilitation inpatients

AIMS

To analyse the measurement properties of the Spanish version of the COPM (Canadian Occupational Performance Measure) in older adult rehabilitation inpatients.

METHOD

A sample of 172 users from 17 inpatient care facilities for older adults (47% nursing homes) participated in a quantitative prospective study. We examined validity by correlating the COPM with the Barthel Index (BI), the Lawton Instrumental Activities of Daily Living scale (IADL), the EuroQol-five domains-three level questionnaire (EQ-5D-3L), and the Client-Centred Rehabilitation Questionnaire (CCRQ) and by examining associations with demographic variables. Reliability was evaluated through test-retest and responsiveness through differences in change scores in two types of care facilities.

RESULTS

Participants prioritised 637 occupational performance problems, mainly in the area of self-care (70.5%). The COPM scale scores were significantly correlated with BI, IADL, EQ-5D-3L (except the pain dimension), and CCRQ (except the family involvement and continuity dimensions). COPM scores did not show statistically significant differences concerning educational level. Regarding reliability, high test-retest correlations were obtained (>.80). Nursing home users showed less responsiveness to rehabilitation than other users (change score < 2 vs. > 2 points).

CONCLUSION AND SIGNIFICANCE

The Spanish COPM provides satisfactory measurement properties as a client-centred instrument in older adult rehabilitation inpatient.

Psychometric properties of the client-centred rehabilitation questionnaire-is derived from a large and varied group of rehabilitation users

PURPOSE

The purpose of this study was to inspect and establish the factor structure of the Icelandic Client-Centred Rehabilitation Questionnaire [CCRQ-is] and investigate the service experiences of a large and varied sample of rehabilitation users.

MATERIALS AND METHODS

Altogether 499 rehabilitation users completed the questionnaire. Confirmatory and exploratory factor analysis was conducted for analysis of items. Mann-Whitney's U and Kruskal-Wallis test was used to compare subscale responses based on participants' characteristics.

RESULTS

Four factors explained 53,2% of the variance: Respect and attentiveness, Interaction with significant others, Responsiveness to needs and preferences and Education and enablement. Subscales showed internal consistency from 0.72-0.91 and 0.92 for the whole instrument. The subscale Respect and attentiveness represented user centred rehabilitation the most and Interaction with significant others the least. Significant differences in relation to health conditions and age were obtained on all four subscales and differences by gender on one subscale.

CONCLUSIONS

Our results suggest the CCRQ-is is a reliable tool that can be used with rehabilitation users with a broad range of characteristics within the Icelandic context. The extent to which the intersection of age, gender and health issues influence users' perception of services needs to be further scrutinized.

Cross-cultural adaptation and validation of the Spanish version of the Client-Centred Rehabilitation Questionnaire (CCRQ)

PURPOSE

The aim of the study is to present the process of translation, adaptation and validation of the Client-Centred Rehabilitation Questionnaire (CCRQ) in the Spanish context.

METHODS

The process integrates two sequential phases. Phase 1 consists of a questionnaire translation and back-translation process conducted by a panel of experts, and a pilot study. In phase 2, CCRQ-e (Spanish version) was administered to 305 rehabilitation inpatients to collect evidence on the reliability and validity of the instrument.

RESULTS

The exploratory and confirmatory analysis confirmed seven original domains, eliminating four items from the original scale. CCRQ-e has a good internal consistency. Discriminative construct validity distinguished significant differences based on age, educational level, and severity of diagnosis. Criterion validity of the CCRQ and EQ-5D showed negative significant correlations between CCRQ-e and the general perception of health EQ-VAS, and a positive correlation between CCRQ-e and EQ pain and EQ anxiety (higher scores in CCRQ-e mean lower client-centered practice perceived).

CONCLUSIONS

The Spanish version of the CCRQ is suitable for evaluating person-centered rehabilitation from the person's perspective. It includes aspects related to the comfort, decision-making, and participation of the client, as well as questions about the provision of service and the environment.Implications for rehabilitationThe original seven domains of the CCRQ could be replicated in the sample of patients from Spanish rehabilitation services.By eliminating four items from the original scale, the validated scale, known as the CCRQ-e (Spanish version), was obtained.The CCRQ-e allows a reliable and valid evaluation of the perception of the person-centeredness of the Spanish rehabilitation services.The CCRQ-e is the first self-reported measure in Spanish of an individual's experience during the rehabilitation service.

Hand therapy role in return to work for patients with hand and upper limb conditions

STUDY DESIGN

Electronic Web-based survey INTRODUCTION: Evidence supports the use of health-focused interventions combined with service coordination and work modification components to reduce the individual, community, and societal burden associated with acute and chronic musculoskeletal conditions. The levels of engagement, skill, and confidence of Australian hand therapists in assisting their patients to return to work (RTW) are currently unknown.

PURPOSE OF THE STUDY

To identify current practices, skill, and the need for additional training in management of the RTW process from a sample of Australian hand therapists.

METHODS

An electronic survey was sent to current members of the Australian Hand Therapy Association. Data collected included training and/or professional experience, caseload and/or workplace, scope of and barriers to vocational practice, and satisfaction with own contribution to the RTW process for patients.

RESULTS

A total of 99 individual responses (12.4% of total membership) were included, with most indicating a limited role in the RTW process. Only 52.7% said they regularly monitored and adjusted their patients' RTW program. Most plans were informed by formal tests of underlying body structure and function components rather than the patient's ability to perform of a specific work role or task. Median satisfaction with the quality of RTW service they provided was 6 of 10, with 42% scoring ≤ 5 of 10, indicating considerable scope for improvement.

CONCLUSIONS

Practice patterns are described for planning and monitoring RTW, and these did not always align with the evidence-base. Further exploration of clinician barriers to implementing RTW interventions is warranted, as is upskilling for those indicating a lack of confidence in this field.

Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature

OBJECTIVE

To develop a cross-professional model framing the concept and practice of person-centered rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature.

DATA SOURCES

Key databases (PubMed, Scopus, Cumulative Index to Nursing and Allied Health), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual articles published from January 2007-February 2020.

STUDY SELECTION

Two independent reviewers selected adult-based articles addressing at least 1 of the 6 categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual articles.

DATA EXTRACTION

Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews.

DATA SYNTHESIS

A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by 5 external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across 3 levels: (1) the person-professional dyad; (2) the microsystem level (typically an interprofessional team, involving significant others); and (3) a macrosystem level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR.

CONCLUSIONS

The PCR Model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.

A psychometric comparison of patient-reported outcome measures used in pediatric hand therapy

STUDY DESIGN

Retrospective case series.

INTRODUCTION

Patient-reported outcome measures are important for research and also for informing clinical practice. The Pediatric Outcomes Data Collection Instrument (PODCI) and the Canadian Occupational Performance Measure (COPM) are commonly used in pediatric hand therapy. Both are validated in research, but no data exist regarding their relative merits for clinical practice.

PURPOSE OF THE STUDY

This study compares the psychometric properties of the PODCI and COPM in children receiving hand therapy to examine their relative utility in clinical practice.

METHODS

We assessed the psychometric properties of the PODCI and COPM in 75 children receiving hand therapy. Treatment outcomes were assessed simultaneously with the PODCI (Upper Extremity Function and Pain and Comfort scales), COPM (Performance and Satisfaction scales) at baseline and posttreatment time points. Interim scores were included for a subset of patients. Each scale was assessed for responsiveness, ceiling effect, and concurrent and discriminate validity.

RESULTS

All scales, except PODCI/Pain from interim to completion, were able to detect changes over the course of therapy. However, both COPM scales demonstrated greater responsiveness and less severe ceiling effects than both PODCI scales at all time points. All scales had weak concurrent validity and limited discriminate validity.

CONCLUSIONS

The COPM is more responsive to changes during treatment and less hindered by a ceiling effect than the PODCI. Weak concurrent validity between the PODCI and COPM suggests that they measure different things in this population.

An occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale-A randomized controlled trial

STUDY DESIGN

A nonblinded randomized controlled trial.

INTRODUCTION

Occupation-based interventions are superior to physical exercise-based interventions in patients with activity limitations. However, only a few studies have examined the effect in patients with hand-related disorders. Patients recover heterogeneously, which could be due to personal factors, such as sense of coherence (SOC).

PURPOSE OF THE STUDY

To investigate the effectiveness of an occupation-based intervention for patients with hand-related disorders and whether SOC can give an indication of the expected effects.

METHODS

A total of 504 patients were stratified into three SOC groups and then randomized to either an occupation-based intervention, including physical exercises (OBI) or a physical exercise-based occupation-focused intervention. The primary outcome, functioning, was measured using the Disability of the Arm, Shoulder and Hand questionnaire. Primary endpoint was at three months. Patients were followed up for a year.

RESULTS

No significant difference was found in primary outcome analysis. Nevertheless, patients receiving OBI had a statistically significant and greater change in satisfaction with their occupational performance at one, two, and three months follow-up. Patients with a weak SOC had worse functioning and lower health-related quality of life than those in the other groups, at all times.

CONCLUSIONS

OBI as delivered in this study was not superior to physical exercise-based occupation-focused intervention in this patient group. However, in taking a client-centered approach, we recommend that OBI be based on individual needs, given that patients had a statistically greater change in score regarding satisfaction with their occupational performance. It is evident that patients with a weaker SOC have a lower level of functioning. This knowledge should inform clinical practice.

Client-centred practice in Scandinavian contexts: A critical discourse analysis

Background: The concept of client-centred practice is an essential element of occupational therapy (OT), but there is a lack of a clear and shared definition of the concept in Scandinavia (Norway, Sweden and Denmark). This may complicate the articulation, discussion, development and implementation of client-centredness in OT practices.Aim: The purpose of this study was to investigate and discuss current understandings of client-centred practice in Scandinavian contexts.Material and method: The study was based on a social constructivist research approach in which Fairclough's critical discourse analysis was applied. The analysis was based on six documents published in Scandinavian OT journals and four documents published in Scandinavian Journal of OT.Results: In Scandinavian contexts, the concept of client-centred practice was articulated in three overall discourses: a client, collaborative and practice discourse. The practice discourse was the most prominent and the source of the other discourses.Conclusions and significance: Occupational therapists (OTs) in the Scandinavian countries have conceptual understandings of client-centred practice that potentially provide the basis for knowledge sharing and collaboration between OT communities. However, the study also found that client-centred practice may not yet be firmly established in all OT practices in Scandinavia.

Looking into the Content of the Canadian Occupational Performance Measure (COPM): A Danish Cross-Sectional Study

PURPOSE

To examine the content validity of the Danish version of the Canadian Occupational Performance Measure (COPM-DK).

MATERIALS AND METHODS

This cross-sectional study was performed in a hospital and a community rehabilitation centre. The content validity of the COPM was assessed by relating the clients' prioritized occupational performance issues (OPIs) to the conceptual model of the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the levels of the Taxonomic Code of Occupational Performance (TCOP). Six occupational therapy lecturers participated in classifying the OPIs using the TCOP.

RESULTS

A total of 112 clients from a regional and community-based rehabilitation participated. The 56% regional participants came from a hospital's hand and knee surgery department. The remaining 44% participants came from a community-based rehabilitation centre with in- and outpatient departments. There were 44% males, with a mean age of 65.2 years. They prioritized 495 OPIs, of which 40% concerned self-care, 32% productivity, and 28% leisure. The prioritized OPIs were divided into a total of 224 different OPIs. There were significant differences in which areas were prioritized in the various population groups. Of the OPIs, 64.3% could be classified into the TCOP levels of occupation and activity, i.e., 1/3 of the OPIs were related to tasks and actions, and thus beyond the scope of the COPM. The interrater agreement of the OPI classification was only fair (kappa 0.3).

CONCLUSION

The content validity of the COPM seems to depend on how and with which clients it is administered. Caution must be taken to secure OPIs on the higher levels of the TCOP, while maintaining the clients' right to nominate OPI preferences. Therefore, an introductory course and on-going support are recommendable. Bearing this in mind, the COPM seems useful to identify individual clients' prioritized OPIs in a Danish context.

The Validity of the Danish Version of the Canadian Occupational Performance Measure

PURPOSE

To establish the construct validity of the Danish version of the Canadian Occupational Performance Measure (COPM).

METHODS

A cross-sectional study was performed in two settings, a regional hospital and a rehabilitation centre in a community. Including adult clients with a variety of diagnoses, we assessed construct validity by correlating the COPM to the Occupational Self-Assessment (OSA), the five-item World Health Organization Well-Being Index (WHO-5), and the EuroQol-five domain-five level questionnaire (EQ-5D-5L). Further examination of the comparability of the OSA and the COPM was performed in two ways. First, an interrater agreement of the theoretical correlation of the 21 OSA items and the three areas of the COPM was conducted. Secondly, we examined the compliance between the prioritized occupational performance issues (OPIs) and items of the OSA prioritized for change.

RESULTS

The study included a total sample of 112 participants with more than half of the participants (56%) recruited from the hospital. 109 participants had measurements for both COPM and OSA (44% males) with a mean age of 64.7 years (range 16-96 years). All correlations, between the COPM and the OSA, the WHO-5, and the EQ-5D-5L, were low or negligible (r < 0.50). Manual examination confirmed a difference in the constructs of the OSA and the COPM. This was demonstrated by a negligible interrater agreement between the items of the OSA and the areas of the COPM, and differences in the prioritized OPIs and OSA items, even if there were some resemblances, were found.

CONCLUSIONS

This study suggests that the construct of the COPM provides data different to those obtained with the standardized measurements included for comparison. The present study supports the assumption that the COPM can detect unique OPIs that clients want to do, need to do, must do, or are not satisfied with the way they do.