Examining Patient Outcomes at a Faculty-Led Clinic for Uninsured and Underserved Clients

IMPORTANCE

Routine measurements used in clinical settings can foster evidence-based interventions and show the treatment effectiveness.

OBJECTIVE

To examine the efficacy of occupational therapy services for health outcomes, as determined by modified self-care and mobility items of the Continuity Assessment Record and Evaluation Tool, also known as Section GG.

DESIGN

Retrospective and longitudinal. Data were obtained from medical records at four time points over 1 yr.

SETTING

The study took place at a pro bono, faculty-led clinic.

PARTICIPANTS

Ninety-one client charts were reviewed; 64 (70%) clients met the inclusion criteria and were enrolled.

INTERVENTIONS

Interventions were provided by registered occupational therapists and entry-level occupational therapy students under supervision.

OUTCOMES AND MEASURES

Self-care and mobility function were measured using modified GG0130 and GG0170 items from the Centers for Medicare & Medicaid Services Quality Reporting Program; three additional functional items were added. The 36-Item Short Form Health Survey, Version 2® (SF-36v2) was used to evaluate clients' quality of life at intake.

RESULTS

Self-care and mobility composites significantly improved throughout the 1-yr intervention period. The additional functional composite significantly improved during the first 6 mo. Clients' scores on the physical function subdomain of the SF-36v2 were significantly related to their self-care, mobility, and additional functional items.

CONCLUSIONS AND RELEVANCE

Faculty-led clinics can improve the occupational performance of clients in need of occupational therapy services, particularly in the areas of self-care and mobility, which have previously been identified as top priorities for clients. What This Article Adds: This study addressed health disparities in unique and effective ways. By using objective measures of functional mobility and self-care, the study provides robust evidence of the faculty-led clinic's impact in providing underserved and uninsured communities with effective client-centered occupational therapy services.

Occupational performance and satisfaction of individuals with mental disorders in Jordan: A cross-sectional study

Introduction: Individuals with mental disorders face challenges while performing occupations. Existing evidence is limited to Western countries and certain daily life occupations that do not explore all factors related to occupational performance. This study aimed to explore occupational performance and satisfaction in individuals with mental disorders, explore the challenging occupations, investigate the relationship between demographic characteristics to occupational performance and satisfaction, and investigate the factors affecting the occupational performance of individuals with mental disorders. Methods: This was a descriptive correlational cross-sectional study that used the convenience sampling method. It included 95 individuals with mental disorders that had a mean age of (34.46 ± 12.22) years, and were from different mental health care facilities. Additionally, this study used the Canadian Occupational Performance Measure instrument. Results: Individuals with mental disorders had a low mean occupational performance and satisfaction scores (5.8 ± 1.7), (5.2 ± 2.0), respectively. Instrumental Activities of Daily Living were the most reported challenging occupations. There was a relationship between work status and both occupational performance and satisfaction (r = 0.243, p = 0.018), (r = 0.239, p = 0.020), respectively. Also, there was a relationship between the diagnosis and occupational performance (r =0.219, p = 0.033), and work status predicted occupational performance (α ≤ 0.05). Work status is a predictor of occupational performance in individuals with mental disorders.

Self-Perceived ADL/IADL Function is Influenced by Residual Neurological Impairment, Aphasia, and Anxiety

BACKGROUND.

Self-perceptions of performance of activities of daily living (ADL) and instrumental activities of daily living (IADL) are reduced following stroke. Research investigating contributing factors is lacking.

PURPOSE.

We examined the extent to which aphasia status, neurological impairment and poststroke depression, and anxiety contribute to self-perceived ADL/IADL function.

METHOD.

Seventy-six community-dwelling individuals at least 6 months poststroke, 44 with and 32 without aphasia, participated in the cross-sectional study. The Stroke Impact Scale (SIS) ADL/IADL domain was the primary outcome measure with aphasia status, residual neurological impairment, depressive symptoms, and anxiety as predictor variables.

FINDINGS

Aphasia status, residual neurological impairment, and anxiety were independent predictors of self-perceived ADL/IADL function, together accounting for more than half the variance. Depression was not associated with ADL/IADL.

IMPLICATIONS.

Clinician awareness of the influence of anxiety on self-perceived ADL/IADL function, particularly for people with aphasia, may lead to future interventions that improve self-perceived ADL/IADL function.

Sensory Modulation and Participation in Daily Occupations in Stroke Survivors

Background. Stroke may alter sensory modulation and restrict participation in daily occupations. Although studies highlight the relationship between altered sensory modulation and reduced participation, this relationship in stroke survivors has not been studied enough. Purpose. To examine the prevalence of altered sensory modulation among stroke survivors; to compare sensory modulation and participation between stroke survivors and healthy controls; to estimate the relationship between sensory modulation and participation among stroke survivors. Method. Thirty stroke survivors and 30 healthy controls, aged 18-70, completed the MoCA, the Adolescent-Adult Sensory Profile and the Activity Card Sort. Findings. Altered sensory modulation was more prevalent among stroke survivors. Their participation was significantly restricted as compared to healthy controls. Lower tendency to seek sensory input predicted lower participation in social activities. Implications. Occupational therapists should screen for altered sensory modulation in stroke survivors and understand their impacts on participation, in order to improve intervention outcomes.

Examining components of community psychosocial stroke interventions using concept mapping

BACKGROUND

Stroke impacts psychosocial well-being and engagement in occupation. Psychosocial interventions reduce depression and anxiety but may not impact occupation. Knowledge of key processes and components of community psychosocial stroke interventions can inform future intervention development.

AIM/OBJECTIVE(S)

To determine the essential elements common to three psychosocial interventions for stroke survivors.

MATERIAL(S) AND METHOD(S)

Concept maps were created for three community psychosocial stroke interventions based on published literature and communication with researchers who tested the intervention with stroke survivors. The concept maps were then compared to identify common elements. Ongoing communication with researchers ensured accurate representation of each respective intervention.

RESULTS

Similarities in intervention processes and components included support for autonomy; individualized information exchange; coping, life skill development and adaptation support; competence development; and the incorporation of goals. Differences included intervention delivery (individual versus group), and the avenues in which psychosocial needs are addressed (occupation versus dialogue).

CONCLUSIONS

Concept mapping identified similarities among the three interventions that can be best understood using self-determination theory. Clinicians may utilize findings revealed in the process to inform evidence-based psychosocial stroke interventions.

SIGNIFICANCE

Knowledge of key 'active ingredients' for psychosocial community stroke interventions, can be used to guide clinical reasoning and inform development of interventions.