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Kalsi-Ryan S, Kapadia N, Gagnon DH, Verrier MC, Holmes J, Flett H, Farahani F, Alavinia SM, Omidvar M, Wiest MJ, Craven BC. Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S134-S146. [PMID: 34779738 PMCID: PMC8604521 DOI: 10.1080/10790268.2021.1961052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). METHOD Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. RESULTS The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. CONCLUSION The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Naaz Kapadia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain - CIUSSS du Centre-Sud-de-l’Ile-de-Montréal, Montreal, Québec, Canada
| | - Molly C. Verrier
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Holmes
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Hammell KW. Using Qualitative Research to Inform the Client-Centred Evidence-Based Practice of Occupational Therapy. Br J Occup Ther 2016. [DOI: 10.1177/030802260106400504] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Demands for increased accountability for health care expenditure, and recognition of clients' rights to interventions and methods of service delivery that are grounded in sound evidence, are compelling occupational therapists to use research findings to inform their clinical decision making. Occupational therapists also state that they embrace a client-centred orientation to practice, yet this espoused ethic seems rarely to influence decisions concerning what research is undertaken and how it is undertaken or what counts as evidence for practice. Given the widely divergent perspectives, priorities and values between health care professionals and their clients, practice based upon therapist-centred research may be neither relevant nor valid. This paper explores the philosophical underpinning of methods used to develop theory, proposing that occupational therapy's evidence-based practice must be ethically consistent with its espoused client-centred philosophy to avoid a tendency towards hypocrisy. It explores issues concerning client-centred practice and evidence-based practice and suggests that qualitative research methods may be the most appropriate tools to identify and address client priorities. While traditional quantitative research approaches render client voices silent, qualitative methods may enable occupational therapists to explore the complexities of clinical practice and of living with a disability, thereby informing a more client-centred, evidence-based practice of occupational therapy.
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Blair SEE, Robertson LJ. Hard Complexities – Soft Complexities: An Exploration of Philosophical Positions Related to Evidence in Occupational Therapy. Br J Occup Ther 2016. [DOI: 10.1177/030802260506800605] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The practice of occupational therapy rests upon the ontological assumption that there is a relationship between engagement in occupation and health. Different traditions of knowing about and investigating this relationship are evident within the literature. The professional link with biomedicine has led to an adherence to positivistic methodologies but, as the profession has begun to generate discipline-specific knowledge, inquiry approaches consistent with interpretative and critical theory have become evident. This paper explores the nature of inquiry underpinning current practice. It suggests that contemporary developments have been a reaction to a climate of uncertainty, generated by rapid political, fiscal, technological and ideological change in the delivery of health and social care in the last four decades. From these rapid changes, different views of ‘best practice’ have developed: evidence-based, reflective and reflexive practice, each with its own source of knowledge and method of inquiry. It is postulated that each of these views has implications for education, practice and research.
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Brown GT, Burns SA. The Efficacy of Neurodevelopmental Treatment in Paediatrics: A Systematic Review. Br J Occup Ther 2016. [DOI: 10.1177/030802260106400505] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurodevelopmental treatment (NDT) is widely used by clinicians when working with children diagnosed with neurological dysfunction, such as cerebral palsy, high-risk/low-birthweight infants or traumatic brain injury. The objective of this project was to determine the efficacy of NDT, used with a group of paediatric subjects diagnosed with a neurological dysfunction, through the completion of a systematic search and review of the relevant published research literature. Using a computerised literature search strategy of nine databases, expert consultation, and a hand search of 14 relevant journals and reference lists, 147 relevant citations were identified for consideration. Of the 147 articles reviewed, 17 met the inclusion criteria for further review. These studies were assessed for concealment of treatment allocation (Shulz et al 1995), quality assessment of randomised clinical trial using the Jadad scale (Jadad et al 1996) and level of evidence using the Sackett scale (Sackett 1989). A level of agreement between the two independent reviewers was calculated for each step of the systematic review process using the kappa statistic (κ). Tables containing the details and status of the 17 studies are included. Overall, the results regarding the efficacy of NDT were largely inconclusive since there were a similar number of published research studies supporting the benefit of NDT intervention (n=6) as compared with no benefit (n=9). One study did not specifically address the efficacy of NDT, while another study was unclear as to whether or not NDT was beneficial. The studies that included the use of NDT with paediatric subjects diagnosed with cerebral palsy also had inconsistent results regarding the efficacy of NDT. The studies that included the use of NDT with high-risk/low-birthweight infants did not support the usefulness of NDT with this paediatric client group. A detailed description of the systematic review process used in the completion of this paper is also included.
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Turner N, Whitty P, Lydon C, Clarke M, Browne S, Larkin C, Waddington J, O'Callaghan E. Evaluating Psychosocial Interventions in First-Episode Psychosis. Br J Occup Ther 2008. [DOI: 10.1177/030802260807100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about what influences the success of psychosocial interventions for first-episode psychosis. One possible explanation for the mixed results of clinical trials is the influence of confounders on outcome. Psychosocial functioning prior to the onset of psychosis (premorbid adjustment) is one possible confounder. In order to examine the importance of premorbid adjustment to occupational therapists providing and evaluating psychosocial interventions, this study compared the baseline characteristics and premorbid adjustment of the people with first-episode psychosis referred to psychosocial rehabilitation with those of the people not referred, and the outcomes of both groups. All people with first-episode psychosis (n = 171) were assessed at baseline, including their premorbid adjustment. The participants were followed up 4 years later. A subgroup (n = 44) had been referred to psychosocial rehabilitation. The baseline presentation, premorbid adjustment and outcomes (symptoms and functioning) at 4 years of both groups were compared. The results showed that the people referred to a psychosocial rehabilitation programme had a poorer premorbid adjustment and fewer years in education than those not referred. Unsurprisingly, those not referred had better outcomes 4 years after initial presentation. It was concluded that premorbid psychosocial functioning is influential in determining the likelihood of referral to psychosocial rehabilitation and can influence evaluations of psychosocial interventions.
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Affiliation(s)
- Niall Turner
- DETECT, Avila House, Blackrock Business Park, Blackrock, Co. Dublin
| | - Peter Whitty
- Stanley Research Unit, Cluain Mhuire Service, Newtownpark Avenue, Blackrock, Co. Dublin
| | | | - Mary Clarke
- St John of God Adult Mental Health Services, Stillorgan, Co. Dublin
| | - Stephen Browne
- Department of Psychiatry, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland
| | - Conall Larkin
- St John of God Adult Mental Health Services, Stillorgan, Co. Dublin
| | - John Waddington
- Department of Cellular and Molecular Therapeutics, Royal College of Surgeons, Dublin, Ireland
| | - Eadbhard O'Callaghan
- DETECT, Avila House, Blackrock Business Park, Blackrock, Co. Dublin
- Department of Psychiatry, University College Dublin, Dublin, Ireland
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Mortenson WB, Miller WC, Boily J, Steele B, Odell L, Crawford EM, Desharnais G. Perceptions of power mobility use and safety within residential facilities. Can J Occup Ther 2005; 72:142-52. [PMID: 15988961 PMCID: PMC4039552 DOI: 10.1177/000841740507200302] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities. PURPOSE As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use. METHOD In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members. RESULTS A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions. PRACTICE IMPLICATIONS Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.
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Affiliation(s)
- William B Mortenson
- Vancouver Coastal Health Authority, Rehabilitation Services, University of British Columbia Hospital.
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