The use of adaptive equipment following total knee replacement

Introduction

This study evaluates the need for adaptive equipment following total knee replacement. There are no recent studies to guide occupational therapists in the optimum time adaptive equipment is required following total knee replacement.

Method

A non-experimental, concurrent mixed methods approach was used. The study population was patients attending for total knee replacement at a large general hospital. Outcome measures were the Oxford Knee Score, the United Kingdom Functional Independence Measure and a weekly diary.

Results

A total of 19 patients were included in the study. Following assessment, 53% ( n = 10) required adaptive equipment following total knee replacement. No significant difference was found in pre-operative pain or function scores, gender or surgical pathway when comparing those who did and did not need adaptive equipment post-operatively. Patients who required adaptive equipment post-operatively had significantly worse pain ( p = 0.030) and function ( p = 0.040) at 6 weeks post-operatively and had significantly longer inpatient stay ( p = 0.041).

Conclusion

Although there are resource implications, patients requiring adaptive equipment following total knee replacement should be assessed by occupational therapy staff 6 weeks post-operatively to ensure optimal functional outcomes following surgery.

The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

Introduction:

Older people are the main users of adult social care services in Great Britain. Evidence suggests that occupational therapists employed by local authorities are providing interventions that promote and maintain older people's independence, and decrease dependency on other services. However, such evidence is disparate in nature and lacks synthesis.

Method:

This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services.

Findings:

Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received.

Conclusion:

Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services.

An Evaluation of the Use of Self-Assessment for the Provision of Community Equipment and Adaptations in English Local Authorities

Introduction:

The Government plans to transform adult social care in England. Future services will place more emphasis on prevention and enablement, and promoting personalisation and choice. Self-assessment is one possible facilitator of this agenda. However, little is known about its utility in social care. This evaluation examined how eight local authorities employed self-assessment in the provision of community equipment and adaptations, and explored the implications for service delivery.

Method:

A multiple case study was employed, using a mixed methods approach. This drew on internal documents, management interviews, and service user and administrative records.

Findings:

Self-assessment was primarily used to facilitate service access. Although the authorities differed in the way in which they operationalised self-assessment, professional staff were almost always involved. The differences between people receiving self and traditional assessments were modest, but the people undertaking self-assessments in preventative services formed a particularly healthy subgroup. There was little consensus about the items suitable for provision through self-assessment.

Conclusion:

The concept of self-assessment was variously interpreted and not all its possible uses were explored. Nevertheless, the evaluation suggested that self-assessment can facilitate access to community equipment and adaptations and has the potential to extend the population traditionally served by social care services, thereby addressing the preventative agenda.

‘I Feel So Much Safer’: Unravelling Community Equipment Outcomes

Health and wellbeing outcomes are the new currency of health and social care commissioning. To explore the extent to which community equipment had an impact on the health and wellbeing outcomes of choice and control, quality of life and personal dignity, a postal survey was carried out among a sample of adults who had been prescribed community equipment by social or primary care services to meet mobility, domestic, personal care or sensory needs. A response rate of 52% (251) was achieved.

Seventy-eight per cent of respondents reported that they were using all the equipment prescribed. Bathing equipment tended to be either very successful or not used at all. Of those who had used all or some of the equipment prescribed, 91% reported feeling safer and over 80% said that it made a positive difference to their independence, quality of life or ability to do things when they wanted. The provision of equipment had less of an impact on reducing the need for assistance at home, particularly from paid carers.

The practice implications highlighted by the findings focus on the need to review the opportunities available for maximising effective use of bathing equipment.

Equipment Provision by Local Authority Occupational Therapy Teams Using the Fair Access to Care Services Eligibility Framework: A Vignette and Interview Study

Purpose:

In April 2003, the first national eligibility framework for adult services, Fair Access to Care Services (FACS), was implemented by local authorities in England. The intention was to ensure equity in the provision of adaptive equipment. This study examined how the criteria were being used by local authority occupational therapy teams and if equity was being achieved.

Procedure:

Five vignettes or hypothetical case histories were used to capture the experiences of a purposefully selected group of 12 employees from three local authority occupational therapy teams in the Midlands. Semi-structured interviews were then conducted to explore the themes raised by responses to the vignettes. Interviews were recorded and transcribed. Thematic analysis was independently conducted by two of the authors.

Findings:

There are inconsistencies in the access to services and the use of eligibility criteria, particularly at the point of entry to the service and for those people who are classified as having ‘low’ level needs. However, there is consistency within professional practice and evidence that staff prioritise client need.

Conclusion:

The implementation of FACS has been inconsistent and has not resulted in equity of provision. Some occupational therapy staff appear to prioritise the needs of clients above organisational policies.