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De Coninck L, Declercq A, Bouckaert L, Döpp C, Graff MJL, Aertgeerts B. Promoting meaningful activities by occupational therapy in elderly care in Belgium: the ProMOTE intervention. BMC Geriatr 2024; 24:275. [PMID: 38509458 PMCID: PMC10953191 DOI: 10.1186/s12877-024-04797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Older people want to age in place. Despite advancing functional limitations and their desire of aging in place, they are not always faithful to therapy that maintains independence and promotes safety. Occupational therapists can facilitate aging in place. Occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation. AIM To describe the content a high-adherence-to-therapy and evidence-based occupational therapy intervention to optimize functional performance and social participation of home-based physically frail older adults and wellbeing of their informal caregiver, and the research activities undertaken to design this intervention. METHODS A roadmap was created to develop the occupational therapy intervention. This roadmap is based on the Medical Research Council (MRC) framework and is supplemented with elements of the Intervention Mapping approach. The TIDieR checklist is applied to describe the intervention in detail. A systematic review and two qualitative studies substantiated the content of the intervention scientifically. RESULTS The application of the first two phases of the MRC framework resulted in the ProMOTE intervention (Promoting Meaningful activities by Occupational Therapy in Elderly). The ProMOTE intervention is a high-adherence-to-therapy occupational therapy intervention that consists of six steps and describes in detail the evidence-based components that are required to obtain an operational intervention for occupational therapy practice. CONCLUSION This study transparently reflects on the process of a high-quality occupational therapy intervention to optimize the functional performance and social participation of the home-based physically frail older adult and describes the ProMOTE intervention in detail. The ProMOTE intervention contributes to safely aging in place and to maintaining social participation. The designed intervention goes beyond a description of the 'what'. The added value lies in the interweaving of the 'why' and 'how'. By describing the 'how', our study makes the concept of 'therapeutic use-of-self' operational throughout the six steps of the occupational therapy intervention. A further rigorous study of the effect of the ProMOTE intervention on adherence, functional performance and social participation is recommended based to facilitate the implementation of this intervention on a national level in Belgium.
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Affiliation(s)
- Leen De Coninck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium.
- CEBAM Belgian Center for Evidence-based Medicine vzw, Kapucijnenvoer 7, Leuven, 3000, Belgium.
| | - Anja Declercq
- LUCAS Center for Care Research and Consultancy & CESO Center for Sociological Research, KU Leuven, Minderbroedersstraat 8, Leuven, 3000, Belgium
| | - Leen Bouckaert
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Voetweg 66, Ghent, 9000, Belgium
| | - Carola Döpp
- Scientific Institute for Quality of Health Care, Department of Rehabilitation, Radboudumc Research Institute, Radboud University Medical Center, Houtlaan 4, Nijmegen, 6525 XZ, The Netherlands
| | - Maud J L Graff
- Scientific Institute for Quality of Health Care, Department of Rehabilitation, Radboudumc Research Institute, Radboud University Medical Center, Houtlaan 4, Nijmegen, 6525 XZ, The Netherlands
| | - Bert Aertgeerts
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7, Leuven, 3000, Belgium.
- CEBAM Belgian Center for Evidence-based Medicine vzw, Kapucijnenvoer 7, Leuven, 3000, Belgium.
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Wasmuth S, Wilburn VG, Hamm JA, Chase A. Comparing narrative-informed occupational therapy in adult outpatient mental health to treatment as usual: A quasi-experimental feasibility study with preliminary treatment outcomes. OCCUPATIONAL THERAPY IN MENTAL HEALTH 2021; 37:56-71. [PMID: 34744219 DOI: 10.1080/0164212x.2020.1845276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper describes implementation of a narrative-informed occupation-based service in an outpatient community mental health setting that addressed several gaps, including 1) the need for outcome data on occupational therapy in this setting; 2) an ongoing mental health provider shortage; and 3) a need for innovative approaches to supporting mental health. We found a significant improvement from baseline to post-intervention in occupational participation, and dose of occupational therapy was significantly related to improvements in the areas of roles, habits, values, long-term goals, social environment, and readiness for change. This study suggests future, larger effectiveness studies of narrative-informed occupation-based interventions delivered by occupational therapists in outpatient community mental health are warranted.
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Affiliation(s)
- Sally Wasmuth
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
| | - Victoria G Wilburn
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
| | - Jay A Hamm
- Sandra Eskenazi Mental Health Center, Eskenazi Health, Indianapolis, IN 46202, United States College of Pharmacy, Purdue University, West Lafayette, IN 47907
| | - Anthony Chase
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
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Prusynski RA, Frogner BK, Skillman SM, Dahal A, Mroz TM. Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities. J Appl Gerontol 2021; 41:352-362. [PMID: 34291695 DOI: 10.1177/07334648211033417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.
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Harkko J, Sumanen H, Pietiläinen O, Piha K, Mänty M, Lallukka T, Rahkonen O, Kouvonen A. Socioeconomic Differences in Occupational Health Service Utilization and Sickness Absence Due to Mental Disorders: A Register-Based Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2064. [PMID: 32244960 PMCID: PMC7143750 DOI: 10.3390/ijerph17062064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18-34 years (N = 6545) and 35-54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18-34 year old employees; and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35-54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; (H.S.); (A.K.)
| | - Hilla Sumanen
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; (H.S.); (A.K.)
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (O.P.); (K.P.); (M.M.); (T.L.); (O.R.)
- South Eastern Finland University of Applied Sciences, 48220 Kotka, Finland
| | - Olli Pietiläinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (O.P.); (K.P.); (M.M.); (T.L.); (O.R.)
| | - Kustaa Piha
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (O.P.); (K.P.); (M.M.); (T.L.); (O.R.)
| | - Minna Mänty
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (O.P.); (K.P.); (M.M.); (T.L.); (O.R.)
- City of Vantaa, Department of strategy and research, 01030 Vantaa, Finland
| | - Tea Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (O.P.); (K.P.); (M.M.); (T.L.); (O.R.)
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (O.P.); (K.P.); (M.M.); (T.L.); (O.R.)
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; (H.S.); (A.K.)
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
- Administrative Data Research Centre–Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
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Sumanen H, Harkko J, Piha K, Pietilainen O, Rahkonen O, Kouvonen A. Association between socioeconomic position and occupational health service utilisation trajectories among young municipal employees in Finland. BMJ Open 2019; 9:e028742. [PMID: 31780585 PMCID: PMC6887011 DOI: 10.1136/bmjopen-2018-028742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s). METHODS The present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20-34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender. RESULTS A large proportion of the young employees do not use OHS. Trajectory groups of 'No visits' (50%), 'Low/increasing' (18%), 'Low/decreasing' (22%) and 'High/recurrent' (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for 'High/recurrent' OHS utilisation for both genders. CONCLUSIONS Preventive measures should be targeted particularly to the trajectory groups of 'Low/increasing' and 'High/recurrent' in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.
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Affiliation(s)
- Hilla Sumanen
- Health Care and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Public Health, University of Helsinki, Helsinki, Finland
- Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jaakko Harkko
- Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kustaa Piha
- Public Health, University of Helsinki, Helsinki, Finland
| | | | - Ossi Rahkonen
- Public Health, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
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Baxter MF, Newman R, Longpré SM, Polo KM. Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition. Am J Occup Ther 2017; 71:7103090010P1-7103090010P7. [PMID: 28422624 DOI: 10.5014/ajot.2017.713001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.
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Affiliation(s)
- Mary Frances Baxter
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Robin Newman
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Sheila M Longpré
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Katie M Polo
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
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Leland NE, Fogelberg DJ, Halle AD, Mroz TM. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform. Am J Occup Ther 2017; 71:7101090010p1-7101090010p6. [PMID: 28027031 PMCID: PMC5182013 DOI: 10.5014/ajot.2017.711001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system.
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Affiliation(s)
- Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy and Davis School of Gerontology, University of Southern California, Los Angeles;
| | - Donald J Fogelberg
- Donald J. Fogelberg, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Ashley D Halle
- Ashley D. Halle, OTD, OTR/L, is Assistant Professor and Coordinator of Primary Care Residency and Services, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Tracy M Mroz
- Tracy M. Mroz, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
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