A framework for systematically improving occupational therapy expert opinions on work capacity

Determining the Need for Client 24-Hour Supervision: A Cross-Sectional Survey of Occupational Therapists

This study explored how private practice occupational therapists determined whether their clients' need 24-hour supervision, including assessments used, modes of clinical reasoning and therapists' confidence in their determinations. Survey data from 90 participants were analyzed using descriptive statistics. Participants reported using 166 different assessments to inform decisions about 24-hour supervision and most frequently engaged in pragmatic and conditional reasoning. On average, therapists perceived that they were confident or very confident in their determinations. There is variability in how therapists assess and reason through when 24-hour supervision may be required. Research to develop practice guidelines in this area is needed.

Occupational therapy medicolegal assessment of domestic assistance requirements: Focus group perspectives

BACKGROUND/AIM

Estimating domestic assistance requirements within the medicolegal field is a role for occupational therapists. It is a complex multidimensional process of clinical reasoning with no published research outlining how an occupational therapist translates assessment data into the number of hours of domestic assistance required. This study describes the current occupational therapy practice of estimating domestic assistance hours within the medicolegal context.

METHOD

Three focus groups, totalling 14 occupational therapists providing medicolegal reports in New South Wales, were conducted. Sydney University provided ethics approval. Focus group data were thematically analysed.

RESULTS

Four themes were identified: Tasks included as housework. Assessment process - interview of pre-injury and recovery status; functional performance on specific tasks and a tour of the home. Influential factors - include legal system restrictions, medical management, cultural and society values, family expectations, location and impact of diagnosis. Strategies to determine care - triangulation of observed data with medical reports and clinical experience. Knowledge of community and own performance times within the framework of occupational therapy philosophy DISCUSSION: No single method of translating assessment data to hours of care was identified. Therapists use of their own housework performance raises ethical issues. Use of claimant only statements raises issues of inaccurate data on which to base decisions. Therapists should refer to occupational therapy process of clinical reasoning to explain their recommendations even though the reasoning does not give a definite number of care hours.

CONCLUSION

Therapists need to understand the factors influencing their clinical reasoning when integrating all available information into an estimating of domestic assistance hours. Further study analysing the content of medicolegal report may provide information as to how therapists document their clinical reasoning for court.

Occupational therapists as expert witnesses on work capacity

AIM

The aim of this study was to explore the particular challenges for occupational therapists during their cross-examination as an expert witness on work capacity.

METHODS

Grounded theory methodology was used to collect and analyse data. Interviews were conducted with 31 participants with direct experience of occupational therapy work capacity assessments. Of these, 19 were occupational therapists, six were medical specialists and six were lawyers.

RESULTS

All participant groups perceived that maintaining one's credibility in the witness box was of paramount importance. The occupational therapists identified 11 strategies that barristers may use to challenge their credibility as an expert witness.

CONCLUSIONS

The three professional groups proposed practices that maintain occupational therapists' credibility as expert witnesses on the work capacity of personal injury claimants.