Occupational therapy assessments used in acute physical care settings

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy

INTRODUCTION

Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice.

METHODS

Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis.

FINDINGS

Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'.

CONCLUSION

Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.

Exploring occupation-based practice among occupational therapists in hospitals and rehabilitation institutions

BACKGROUND

While occupational therapists value occupation-based practice, they appear to spend less time on this approach and more time on impairment-based practices. Several barriers are reported for the occupation-based approach.

AIM

To explore different aspects of occupation-based practice among occupational therapists working in hospitals and rehabilitation institutions, and to examine associations between sociodemographic factors, barriers, and occupation-based practice.

MATERIALS AND METHODS

A cross-sectional survey was conducted. Participants were occupational therapists working in hospitals and rehabilitation institutions in Norway. The data were analysed with descriptive statistics and logistic regression.

RESULTS

The therapists (n = 124) valued occupation-based practice and reported using it frequently and to a large extent. Relatively small proportions of their practice (26% assessments and 38% interventions) were classified as occupation-based. Lack of time, space and equipment were reported as large barriers. Lack of time and lack of equipment were associated with low self-reported level of occupation-based practice.

CONCLUSIONS

The participants valued occupation-based practice, while the reported assessment and intervention methods were mainly not occupation-based. Several barriers were reported, and some were associated with less use of occupation-based practice.

SIGNIFICANCE

The results can be used to raise awareness of occupational therapists' use of occupation-based practice and barriers to this approach.

Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives

BACKGROUND

Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers.

METHODS

A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed.

RESULTS

Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors).

CONCLUSIONS

These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.

Reliability of the Emotional Experiences in Activities of Daily Living Scale

There is a need to quantify daily emotional affect and demonstrate the range of emotions associated with occupational performance. We describe the development and psychometric testing of the Emotional Experiences in Activities of Daily Living Scale (EEADLs). A total of 343 individuals reported the frequency of positive and negative emotions in the context of activities of daily living. Factor analysis of emotional ratings and occupational areas was undertaken. Internal consistency was evaluated for each of the factors and the relationship between emotional ratings and task complexity was established. Internal consistency of emotional subscales was good (Cronbach's α = .81-.82). Emotional ratings of daily activities varied by task complexity with more complex tasks rated as higher in both positive and negative valence. The findings of this study support the internal consistency of the EEADLs scale and suggest that assessment of emotional valence can occur within daily occupations.

Mobile Videoconferencing for Occupational Therapists' Assessments of Patients' Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study

Background

Occupational therapists who work in hospitals need to assess patients’ home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients’ home environments could be an innovative solution to allow better and more appropriate recommendations.

Objective

The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients’ home environments.

Methods

Occupational therapists assessed home environments using, first, the standard procedure (interview), and then, videoconferencing (with the help of a family caregiver located in patients’ homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient’s occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews.

Results

Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not.

Conclusions

The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning.

International Registered Report Identifier (IRRID)

RR2-10.2196/11674

Novice Occupational Therapy Practitioners’ Use of Occupation in Practice: A Scoping Review

An occupation-centered perspective is a foundational component defining occupational therapy practice. A scoping review was conducted of research studies from 2002 - 2020 describing novice occupational therapy practitioners and occupation. Ten articles met the inclusion criteria. Novices acknowledged that using occupation was a source of professional tension, describing a mismatch between their education and workplace expectations. The cognitive load of occupation-centered practice influenced novices' avoidance of occupation. Few articles address novices' experiences using occupation in their practice. Existing research primarily addresses barriers limiting novices' use of occupation such as lack of supervision and confidence.

Learning, translating, and applying the perceive, recall, plan, perform system of task analysis assessment to practice: Occupational therapists’ experiences

Introduction

This study explored occupational therapists’ experiences of embedding the Perceive, Recall, Plan, Perform System of Task Analysis (PRPP) assessment in practice and gained understandings of the clinical utility.

Methods

Qualitative interpretive description research using data from semi-structured interviews with 11 New Zealand registered occupational therapists and a focus group with two Māori occupational therapists. Thematic data analysis was used to develop themes.

Results

Five themes emerged: Resonating with practice as it should be, Translating to practice, Communicating assessment findings using an occupational performance focus on cognition, Validating the practice fit and Cultural application. Participants described the PRPP assessment as a flexible tool, which was applied in different ways in varied practice settings, with clients performing a range of culturally specific occupations. Embedding the assessment in practice was an involved process that challenged many participants’ existing assessment procedures and included managing team expectations to perform cognitive-based assessments.

Conclusions

The PRPP assessment added value to occupational therapists’ practice. Effective implementation of the assessment required a secure occupation-focused perspective and client-centred culturally responsive communication skills. Commitment was needed to both adopt a new assessment process and to communicate occupation-based assessment results. Participants connected as social learners to address practice challenges post-training.

Achieving patient-centred goals in oncology: A retrospective analysis of a domestic activities of daily living group

Introduction

This retrospective study aimed to investigate the effectiveness of a domestic activities of daily living group on the occupational performance and satisfaction of adult inpatients with cancer.

Method

A retrospective analysis was completed with an initial cohort of patients who participated in the group during their acute inpatient oncology admission. As part of their routine care, patients completed the Canadian Occupational Performance Measure before and after their participation in the group. The occupational performance and satisfaction scores of 31 adults (mean age 71.61 years, 19 females) were reported descriptively and within-group changes analysed using one-sample t-test analyses and bootstrapping.

Results

Most (71%) of the 31 patients were discharged home following their inpatient stay. Canadian Occupational Performance Measure mean (SD) change scores were 3.44 (3.90) for performance and 2.04 (2.16) for satisfaction following participation in one domestic activities of daily living intervention group session. Statistically significant improvements in patients’ Canadian Occupational Performance Measure performance and satisfaction scores were demonstrated in the one-sample t-test ( p < .002) and bootstrapping sampling ( p < .002).

Conclusion

Acute oncology inpatients who attended a domestic activities of daily living intervention group reported a positive change in Canadian Occupational Performance Measure occupational performance and satisfaction. This study highlights the potential benefit of a group-based domestic activities of daily living intervention in an acute oncology setting.

Occupational therapy and allied health use for older people in acute care: A description of services, time, and readmission in an Australian setting

Introduction

Acute care readmissions of older people are an ongoing concern in many countries. Occupational therapists are well positioned to play a significant role in contributing to improved outcomes and fewer readmissions following discharge from acute hospitals, yet there is a lack of empirical evidence to support this claim.

Methods

This study used a retrospective clinical audit of secondary hospital data to investigate and describe the time spent on occupational therapy, and the range of occupational therapy and other allied health services provided to older people admitted to acute care, in one Australian health care service.

Results

Occupational therapists conducted numerous assessments and interventions to support patients and to prepare them for safe discharge home. Occupational therapy was significantly associated with length of stay. Readmission was not related directly or significantly to time spent in occupational therapy or any other factor included in this study. However, of the people who received occupational therapy, there was a higher percentage readmitted when they had more services already in place on admission and when they lived alone.

Conclusions

This study provides preliminary evidence regarding the contact time and range of occupational therapy assessments and interventions provided to older people in the acute hospital setting.

Perceptions of acute hospital occupational therapy services: developing a new model of care for occupational therapy on acute medical wards

Background/Aims

This study was conducted at a regional tertiary referral facility in Australia. It was part of a project to implement a new model of care for occupational therapy services on medical wards. Before the new model was implemented, focus groups were conducted to explore the perceived role of the occupational therapist on the acute medical ward, identify potential barriers to changing the service and garner support for the change in service.

Methods

Three focus groups were held. The groups consisted of nursing, physiotherapy and speech pathology staff who worked on acute medical wards. Participants were asked for their perception of the role of occupational therapy on the acute medical ward. Audio-recordings of the groups were transcribed and analysed.

Results

Qualitative content analysis highlighted the following themes: assessment of patient function; ‘safe discharge’; more than assessment; equipment and home modifications; collaboration and communication; delegating tasks to assistants; and specialist intervention strategies.

Conclusions

Multidisciplinary team members' overriding perception is that occupational therapists in acute care settings provide assessment of patient function for the specific purpose of safe discharge. Some participants recalled that occupational therapists had a greater role in ensuring patients returned to their chosen function through rehabilitation and home visits, suggesting support for a change to our proposed post-acute model of care. Concerns highlighted by focus group members regarding increased workload for multidisciplinary team members and loss of communication need to be addressed to ensure the change in service is successful.

The conflicted practice: Municipal occupational therapists' experiences with assessment of clients with cognitive impairments

BACKGROUND

The practice of Norwegian occupational therapists (OTs) in municipal practice is a little explored area and with the Coordination Reform Act from 2012, Norwegian OTs in municipal practice have received responsibilities concerning clients with cognitive impairments. The aim of this study was to explore municipal OTs experiences with assessment of clients with cognitive impairments.

METHOD

Fourteen individual interviews with OTs who worked with clients with cognitive impairments, were conducted. An inductive thematic analysis, using text condensation and coding, was performed.

RESULTS

The results revealed three themes; power of occupation, advantages and disadvantages of assessments used and the need for competencies within municipal services. The participants emphasized using observation in the assessment process and reflected on pros and cons of the standardized assessment tools they used. They expressed a need for competence development, although it was difficult to prioritize to do so.

CONCLUSION

This study illustrated a conflicted practice related to choices OTs make in their practices. They valued the importance of working occupation based, however, they chose to use impairment based standardized assessments. They expressed a need to engage in professional development, but due to heavy workloads, the limited power they experienced and lack of knowledge, this was difficult.

Orientaciones conceptuales, evaluativas y prácticas desde la terapia ocupacional para la participación de niños con enfermedades crónicas: revisión de la literatura

Introducción. Las enfermedades crónicas generan alto impacto psicológico, económico y social, restringen la participación y son un factor de riesgo para procesos incapacitantes que se pueden experimentar a largo plazo. En población pediátrica, se reconoce que el terapeuta ocupacional debe intervenir de forma integral para favorecer la participación del niño y mejorar su calidad de vida.Objetivo. Aportar orientaciones conceptuales, evaluativas y prácticas relacionadas con la intervención de niños con enfermedad crónica en sus actividades cotidianas.Materiales y métodos. Revisión de literatura especializada según categorías analíticas: referentes conceptuales, herramientas evaluativas y orientaciones prácticas para el abordaje del niño con enfermedad crónica incapacitante.Resultados. Los referentes conceptuales mencionan la importancia de un enfoque centrado en el niño y la familia, así como de su empoderamiento en el proceso de manejo de la condición de salud crónica. Las herramientas evaluativas muestran suficiente disponibilidad de instrumentos formales aplicables a esta población y dan cuenta de variadas estrategias y recomendaciones prácticas, aplicables a niños en distintas áreas ocupacionales y escenarios donde se desarrolla su cotidianidad.Conclusiones. Se evidenció la necesidad de integralidad en la intervención profesional, de trascender del escenario clínico al familiar y social (manejo individual de los casos) y de acudir a enfoques centrados en el usuario y su familia. También se identificaron temas que resultan de relevancia para ser incorporados en el actuar cotidiano de los terapeutas ocupacionales y sobre los cuales deben ahondar estudios posteriores: bioética y cuidado paliativo de menores con enfermedad crónica.

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

BACKGROUND

With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments.

METHOD

An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR = 36%) Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%).

CONCLUSION

The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.

Determining client cognitive status following mild traumatic brain injury

BACKGROUND

People with mild traumatic brain injury (mTBI) commonly experience cognitive impairments. Occupational therapists working in acute general hospitals in Australia routinely access client Glasgow Coma Scale (GCS) scores, and assess cognitive status using standardized tools and by observing basic activity of daily living (ADL) performance. However, limited evidence exists to identify the best assessment(s) to determine client cognitive status.

AIM/OBJECTIVES

To determine whether cognitive status assessed by GCS score and the Cognistat are predictive of basic ADL performance among clients with mTBI in an acute general hospital and make inferences concerning the clinical utility of these assessment tools.

MATERIAL AND METHODS

Retrospective analysis of medical record data on demographics, Cognistat, GCS, and modified Barthel Index (MBI) using descriptive statistics, chi-square tests and linear regression.

RESULTS

Data analysis of 166 participants demonstrated that no associations exist between GCS and Cognistat scores, or Cognistat scores and MBI dependency level. The presence of co-morbid multi-trauma injuries and length of stay were the only variables that significantly predicted MBI dependency level.

CONCLUSION AND SIGNIFICANCE

While the MBI scores are of value in identifying clients with difficulty in basic ADLs, Cognistat and GCS scores are of limited use in differentiating client levels of cognitive impairment and the authors caution against the routine administration of the Cognistat following mTBI. Further research is required to identify more suitable assessments for use with a mTBI population.

The Cognistat (neurobehavioural cognitive status exam): Administering the full test in stroke patients for optimal results

BACKGROUND

One of the most commonly administered tools occupational therapists use for stroke patients is the Cognistat, which was designed as a brief screening tool of cognitive functioning. Evaluations in samples of patients have identified a high false-negative rate if the Cognistat is administered using the 'screen metric' approach. Assessing the Cognistat based on its intended design can ensure consistency and accuracy among occupational therapists for this commonly administered tool. Thus, this study examined the accuracy of administering the entire Cognistat in comparison to the screen-metric approach and the factor analytic structure within stroke patients.

METHODS

The full Cognistat was administered to stroke patients receiving inpatient rehabilitation.

RESULTS

Seventy-five patients who experienced a recent stroke met inclusion criteria. An inconsistency between the screen and metric items was found for five of 10 subscales. Additionally, a principal component analysis (PCA) found the Cognistat to be a two factor structure with six of the subscales loading on Factor 1, while the remaining subscales loaded on Factor 2.

CONCLUSIONS

Our findings confirm that occupational therapists should administer the full Cognistat to stroke patients rather than the original screen-metric approach. A two-factor structure was also supported in our results, suggesting that occupational therapists' scoring practices should reflect this finding and use the differentiated score out of 10 rather than a global sum. However, additional research is necessary to consider the clinical and theoretical significance of the Cognistats' subscale clustering.

Quantifying function: status critical

Occupational therapy practitioners are more appropriately trained for restoring health through meaningful, purposeful activity than practitioners in any other discipline.