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Critical Care and Occupational Therapy Practice Across the Lifespan. Am J Occup Ther 2023; 77:7713410220. [PMID: 38166053 DOI: 10.5014/ajot.2023.77s3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
This AOTA Position Statement defines the distinct role and value of occupational therapy practitioners in critical care settings across the lifespan. Occupational therapy practitioners are essential interprofessional team members who address the needs of critically ill individuals by implementing evidence-based critical care guidelines that aim to improve the quality of survivorship.
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Foussell I, Negley M, Thompson A, Turner A, Wygal A, Devries A, Hilton C, Pritchard KT. Characteristics of Early Interventions for Pain and Function Following Lower Extremity Joint Replacement: Systematic Review. Occup Ther Health Care 2023; 37:627-647. [PMID: 35654087 PMCID: PMC9715835 DOI: 10.1080/07380577.2022.2066239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
Occupational therapy is beneficial among adults with chronic pain; however, occupational therapy interventions addressing earlier phases of pain have not been clearly explicated. This systematic review characterized acute and subacute interventions billable by occupational therapy after hip or knee replacement to improve pain and function. Seven articles met inclusion criteria. Six articles had a low risk of bias. Three intervention types were found: task-oriented exercise, water-based, and modalities. Only task-oriented interventions improved both pain and function one-year after surgery. There are long-term benefits to early task-oriented exercise. Further research is needed to contextualize occupational therapy's role in early pain interventions.
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Affiliation(s)
- Isabella Foussell
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Marisa Negley
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Abigail Thompson
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Turner
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Amanda Wygal
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Alison Devries
- Moody Medical Library, University of Texas Medical Branch,
Galveston, TX, USA
| | - Claudia Hilton
- Department of Occupational Therapy, School of Health
Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Kevin T. Pritchard
- Department of Nutrition, Metabolism, and Rehabilitation
Sciences, School of Health Professions, University of Texas Medical Branch,
Galveston, TX, USA
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Casey K, Sim E, Lavezza A, Iannuzzi K, Friedman LA, Hoyer EH, Young DL. Identifying Cognitive Impairment in the Acute Care Hospital Setting: Finding an Appropriate Screening Tool. Am J Occup Ther 2023; 77:24036. [PMID: 36764005 DOI: 10.5014/ajot.2023.050028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
IMPORTANCE Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment. OBJECTIVE To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care. DESIGN Prospective mixed methods. SETTING Acute care hospital. PARTICIPANTS Fifty adults. OUTCOMES AND MEASURES We examined the interrater reliability, administration time, and usability of the Brief Cognitive Assessment Tool Short Form (BCAT-SF), the Activity Measure for Post-Acute Care "6-Clicks" Applied Cognitive Inpatient Short Form (AM-PAC ACISF), and the Montreal Cognitive Assessment (MoCA). We compared the construct validity, sensitivity, and specificity of the BCAT-SF and AM-PAC ACISF with those of the MoCA. RESULTS Interrater reliability was good to excellent; ICCs were .98 for the MoCA, .97 for the BCAT-SF, and .86 for the AM-PAC ACISF. The BCAT-SF and the AM-PAC ACISF both had 100% sensitivity, and specificity was 74% for the BCAT-SF and 98% for the AM-PAC ACISF. The optimal cutoff score for cognitive impairment on the AM-PAC ACISF was <22. Administration time of the AM-PAC ACISF (1.0 min) was significantly less than that of the BCAT-SF (5.0 min) and the MoCA (13.3 min; p < .001). CONCLUSIONS AND RELEVANCE Each screen demonstrated acceptable reliability and construct validity. The AM-PAC ACISF had the optimum mix of performance and feasibility for the fast-paced acute care setting. What This Article Adds: Early identification of cognitive impairment using the AM-PAC ACISF can allow for timely occupational therapy intervention in acute care settings.
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Affiliation(s)
- Kelly Casey
- Kelly Casey, OTD, OTR/L, BCPR, ATP, CPAM, is Acute Care Therapy Services Team Leader, Johns Hopkins Hospital, Baltimore, MD;
| | - Erin Sim
- Erin Sim, OTD, OTR/L, PMP, is Acute Care Team Coordinator, Johns Hopkins Hospital, Baltimore, MD
| | - Annette Lavezza
- Annette Lavezza, OTR/L, is Director, Inpatient Therapy Services, Johns Hopkins Hospital, Baltimore, MD; Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristen Iannuzzi
- Kristen Iannuzzi, OTD, OTR/L, BCPR, CPAM, is Occupational Therapist and Occupational Therapy Acute Care Fellow, Johns Hopkins Hospital, Baltimore, MD
| | - Lisa Aronson Friedman
- Lisa Aronson Friedman, ScM, is Senior Biostatistician, Division of Pulmonary and Critical Care Medicine, and Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erik H Hoyer
- Erik H. Hoyer, MD, is Assistant Professor and Vice Chair for Quality and Safety, Department of Physical Medicine and Rehabilitation, and Member, Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Daniel L Young
- Daniel L. Young, PT, DPT, PhD, is Associate Professor, Department of Physical Therapy, University of Nevada; Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD; and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
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Malcolm MP, Kinney AR, Graham JE. Predicting Community Discharge for Occupational Therapy Recipients in the Neurological Critical Care Unit. Am J Occup Ther 2022; 76:23111. [PMID: 34935915 DOI: 10.5014/ajot.2022.045450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy in the neurological critical care unit (NCCU) may enable safe community discharge by restoring functional ability. However, the influence of patient characteristics and NCCU occupational therapy on discharge disposition is largely unknown. OBJECTIVE To examine how patient factors and receipt of occupational therapy predict discharge disposition for NCCU patients. DESIGN Retrospective cross-sectional cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 30, 2015. SETTING NCCU in a large urban academic hospital. PARTICIPANTS Adults age 18 yr or older (N = 1,134) admitted to the NCCU. Outcomes and Measures: Using logistic regression with discharge disposition as the dependent variable, we entered sex, age, length of stay (LOS), baseline Glasgow Coma Scale score, Elixhauser Comorbidity Index, and receipt of occupational therapy services as predictor variables. RESULTS Of NCCU patients, 39% received occupational therapy. Younger age, shorter LOS, lower comorbidity burden, and not receiving occupational therapy services increased the likelihood of discharge to the community. Men who received occupational therapy were less likely to be discharged to the community than men who did not receive occupational therapy. As age increased, differences in the probability of community discharge decreased between recipients and nonrecipients of occupational therapy services. CONCLUSIONS AND RELEVANCE Our results suggest that patients receiving occupational therapy services in the NCCU may have a lower likelihood of community discharge. However, these findings may result from therapist's consideration of the safest discharge location to ensure the greatest balance between independence and support. What This Article Adds: This study's findings suggest that receipt of occupational therapy in the NCCU is associated with higher likelihood for noncommunity discharge (i.e., to inpatient rehabilitation, skilled nursing, or long-term care). However, activity limitations and comorbidity burden may be greater for recipients of occupational therapy, and these NCCU patients are presumably less prepared for community discharge.
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Affiliation(s)
- Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Colorado State University, Fort Collins, and Associate Professor, Colorado School of Public Health, Aurora;
| | - Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, U.S. Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
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Bukhari RA, Kinney AR, Edelstein J, Malcolm MP. Change in Activity Performance Mediates the Relationship between Occupational Therapy Utilization and Discharge Disposition among Adults with Traumatic Brain Injuries. Occup Ther Health Care 2021; 36:459-475. [PMID: 34955087 DOI: 10.1080/07380577.2021.2018752] [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: 10/19/2022]
Abstract
A retrospective cross-sectional study was conducted on 435 adults with TBI who received occupational therapy services in an acute care trauma center hospital. Outcome measures were (1) occupational therapy utilization based on billed minutes of occupational therapy evaluation and treatment (low vs. high); (2) Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" to assess activities of daily living level of assistance; and (3) Discharge disposition (community vs. institution). Community discharge included home and supported living facilities. Institutional discharge involved long term care, rehabilitation facility, short term hospital, and skilled nursing facility. Results indicated that change in ADL performance, between admission and discharge, partially mediated the relationship between occupational therapy utilization and community discharge (OR= 0.80, p = .003). High occupational therapy utilization (vs. low) was associated with greater change in ADL performance (β = 0.39, p < .001). Greater change in ADL performance was associated with lower odds of community discharge (OR= 0.96, p <.001). Independent of change in ADL performance, higher occupational therapy utilization was associated with significantly lower odds for community discharge (OR = 0.57, p = 0.023). In conclusion, patients who received more occupational therapy were less likely to be community discharged, as mediated by change in ADL performance. This result can provide direction for future research exploring acute care occupational therapy utilization and discharge disposition.
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Affiliation(s)
- Rayyan A Bukhari
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA.,Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Adam R Kinney
- Education, and Clinical Center, Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Aurora, CO, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica Edelstein
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Matt P Malcolm
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA.,Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
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Pritchard KT, Hong I, Goodwin JS, Westra JR, Kuo YF, Ottenbacher KJ. Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement. J Am Med Dir Assoc 2021; 22:1735-1743.e3. [PMID: 33041232 PMCID: PMC8026771 DOI: 10.1016/j.jamda.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/07/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Understand the association between social determinants of health and community discharge after elective total joint arthroplasty. DESIGN Retrospective cohort design using Optum de-identified electronic health record dataset. SETTING AND PARTICIPANTS A total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018. METHODS Logistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics. RESULTS Mean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.85; knee: OR 0.73, 95% CI 0.69-0.77], current smoking (hip: OR 0.82, 95% CI 0.77-0.88; knee: OR 0.90, 95% CI 0.85-0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50-0.60; knee: OR 0.57, 95% CI 0.53-0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively. CONCLUSIONS AND IMPLICATIONS Social determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.
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Affiliation(s)
- Kevin T Pritchard
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju-si, South Korea.
| | - James S Goodwin
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan R Westra
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
Despite technological advancements in health care documentation and the proliferation of electronic health records, health information and health data remain disparate. Patients and health care teams benefit from access to comprehensive patient records to make informed health care decisions. Significant governmental policy and investments have been made to promote interoperability of systems that connect health information with the ultimate intent of developing a longitudinal patient record. In this article, we discuss how health data, interoperability, and related systems are influenced by federal policy. The intent is to expand occupational therapy practitioners' understanding of the promise of interoperability and the role the occupational therapy profession can play in advancing the infrastructure needed to optimize health care delivery.
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Affiliation(s)
- Joy Doll
- Joy Doll, OTD, OTR/L, FNAP, is Vice President, Community and Academic Programs, CyncHealth, Omaha, NE
| | - Julie Malloy
- Julie Malloy, MOT, OTR/L, PMP, CPHQ, is Director of Quality, Practice Improvement, American Occupational Therapy Association, North Bethesda, MD;
| | - Jaime Bland
- Jaime Bland, DNP, MBA, RN, is President and Chief Executive Officer, CyncHealth, Nebraska Health Information Initiative, Omaha
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Margetis JL, Wilcox J, Thompson C, Mannion N. Occupational Therapy: Essential to Critical Care Rehabilitation. Am J Occup Ther 2021; 75:7502170010p1-7502170010p5. [PMID: 33657342 DOI: 10.5014/ajot.2021.048827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic reshaped the health care landscape, leading to the reassignment of essential health care workers to critical areas and widespread furloughs of providers deemed nonessential, including occupational therapy practitioners. Although multidisciplinary critical care teams often include occupational therapy practitioners, efforts to define, measure, and disseminate occupational therapy's unique contributions to critical care outcomes have been overlooked. This editorial provides recommendations to improve the occupational therapy profession's readiness to meet society's current and future pandemic needs. We propose a three-pronged strategy to strengthen occupational therapy clinical practice, education, and advocacy to illuminate the distinct value of occupational therapy in critical care.
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Affiliation(s)
- John L Margetis
- John Margetis, OTD, OTR/L, is Associate Professor of Clinical Occupational Therapy, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles
| | - Jamie Wilcox
- Jamie Wilcox, OTD, OTR/L, is Assistant Professor of Clinical Occupational Therapy, Chan Division of Occupational Science & Occupational Therapy, University of Southern California, Los Angeles;
| | - Chelsea Thompson
- Chelsea Thompson, MOT, OTR/L, BCPR, is Occupational Therapist, University of Chicago Medical Center, Chicago, IL
| | - Nicole Mannion
- Nicole Mannion, MA, OTR/L, is Occupational Therapist, Kindred Rehabilitation
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Roberts P, Robinson M, Furniss J, Metzler C. Occupational Therapy's Value in Provision of Quality Care to Prevent Readmissions. Am J Occup Ther 2020; 74:7403090010p1-7403090010p9. [PMID: 32365306 DOI: 10.5014/ajot.2020.743002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health care systems are prioritizing the quality of outcomes over the quantity of services provided, and health care payers and other stakeholders are focusing on preventing hospital readmissions. This priority supports the effort to reduce the cost of health care by avoiding the most expensive care type and improving the quality of health care by promoting sustained return to the community and remaining in the community. Occupational therapy practitioners have expertise that is critically important in this effort. Occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmissions if they are not addressed. By addressing activities of daily living, instrumental activities of daily living, functional cognition, psychosocial needs, vision, fear of falling, and safety, occupational therapy practitioners can be a valuable addition to the effort to keep people out of the hospital and participating in their lives. This article reviews the literature supporting the role of occupational therapy in each of these key areas.
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Affiliation(s)
- Pamela Roberts
- Pamela Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, FNAP, FACRM, is Executive Director and Professor, Department of Physical Medicine and Rehabilitation and Executive Director to the Chief Medical Officer, Cedars-Sinai Medical Center, Los Angeles;
| | - Marla Robinson
- Marla Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA, is Assistant Director, Inpatient Therapy Services, University of Chicago Medicine, Chicago
| | - Jeremy Furniss
- Jeremy Furniss, OTD, OTR/L, BCG, is Vice President, Knowledge and Data Science, Division of Finance and Administration, American Occupational Therapy Association, North Bethesda, MD
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