Outcomes research: the history, debate, and implications for the field of occupational therapy

Distinguishing between Occupation, Purposeful Activity and Activity, Part 2: Why is the Distinction Important?

Part 2 of this article stresses the importance of noting the distinctions between the terms occupation, purposeful activity and activity. Both occupational therapists and occupational therapy students need to be able to articulate to others exactly what they do in their individual work settings. This includes acknowledging both shared core skills and unique core occupational therapy skills. It is important that occupational therapists employ these unique core skills in their day-to-day work to highlight their distinction from other health care professionals, who may legitimately use activity within their own interventions. Additionally, if purchasers are negotiating contracts for services from multidisciplinary teams, they need to be able to discern the differences between the input of the different health care professionals. In light of this, current political influences within health care and professional concerns are briefly explored.

Standardised Tests: An Appropriate Way to Measure the Outcome of Paediatric Occupational Therapy?

The advent of clinical governance has refocused clinicians on the need to use evidence-based practice, one aspect of which is the identification and measurement of intervention outcomes. Paediatric occupational therapists have traditionally used a variety of standardised tests in their practice and these are often cited as the means by which treatment outcomes are evaluated. However, the tests most frequently used may not be the most appropriate measures of the outcome of occupational therapy.

This paper explores some of the issues surrounding outcome measurement in the field of paediatrics and highlights aspects of outcome measurement requiring further clinical and research consideration. It is suggested that there is a need to develop a conceptual framework for outcome evaluation which is both consistent with the occupational focus of practice and uses outcome tools that are objective, useful and appropriate.

Economic Evaluation of Occupational Therapy: Where are We at?

Policy makers, health administrators, and practitioners are under pressure to justify resource allocation decisions through an analysis of need, value, and choice. Economic evaluations are increasingly being used to assess the value of health programmes and services. A search of three literature databases revealed that whereas assessments of outcomes and effectiveness are common in the rehabilitation disciplines, comparatively few studies attempt to link costs with outcomes. The purpose of this paper is to familiarize practitioners with the basic concepts and methods used to conduct economic evaluations by describing the different types of analysis, and critiquing research publications to illustrate how this approach has been used to assess the value of various domains of health service relevant to most occupational therapists. By participating in outcomes research to link the costs and consequences of services, occupational therapists will be better able to demonstrate the value of their contribution to the health of Canadians. It is hoped that this paper will stimulate evaluative efforts and enhance the practice of evidence-based decision making in resource allocations.

Factors predicting client satisfaction in occupational therapy and rehabilitation

Client satisfaction, a widely used outcome indicator of quality in health care, is inherently client centered and important in occupational therapy. We developed an instrument called the Satisfaction With Continuum of Care Revised (SCC-R) and tested a logistic regression model of satisfaction for six predictive research questions. Data collected from 769 clients from a large rehabilitation hospital using the SCC-R were paired with data that included demographics, functional status, and measures of the rehabilitation including occupational therapy. Satisfaction was stratified into two groups, satisfied and dissatisfied. The most robust and consistent predictors of satisfaction were functional status and improvements in functional status, presence of a neurological disorder, total rehabilitation hours, and admission to rehabilitation within 15 days of condition onset. The finding that improvements in functional status, especially self-care, were predictive of satisfaction is particularly relevant for occupational therapy. Implications for practice and future research are discussed.

New single-subject and Small-n design in occupational therapy: application to weight loss in obesity

Ottenbacher (1986) showed the usefulness of single-subject design (SSD) in occupational therapy. However, SSD methodology is not regarded by the wider research community as providing statistically reliable and valid evidence of effectiveness of treatment partly because of its observational nature. Although statistical estimations can also be made from least squares regression or by a trend line, a new methodology has great potential to influence research in occupational therapy. The new model enables the use of initial client data from the beginning of treatment (for single subjects or small groups) to determine a point in the linear regression at which predictions can be made for the number of treatments needed for stability or improvement. This model is invaluable for third-party payment as well as for client motivation. The purpose of this article is to present this new methodology, the semiparametric ratio estimator (SPRE), illustrated by case application to treatment of obesity.

Academic-clinician partnerships: a model for outcomes research

SUMMARY While practitioners are now asked to provide evidence that supports the services we deliver, there is little empirical evidence concerning occupational therapy interventions. Research by clinicians is limited, often due to a lack of time, institutional support and research skills. Establishing collaborative research relationships between faculty, clinicians, and graduate students has been suggested as a means of addressing these barriers. Implementation of a model teaming students with clinicians to conduct outcomes studies is described. The model will be illustrated using a case example of a collaborative research project evaluating the efficacy of a home management skills program for individuals with chronic mental illness. The benefits and challenges of the collaborative process will be described.

Clinical outcomes research from the occupational therapist's perspective

With increasing costs and scarcity of resources, occupational therapists need to embrace outcomes research to demonstrate the effectiveness of its clinical interventions. To explore clinicians' perspectives on clinical outcomes research a qualitative study was undertaken involving three in-depth group interviews with 15 occupational therapists from the South Western Sydney Area Health Service. Five broad themes permeated participants' perception: (a) defining the process, (b) factors that impact on participation in clinical outcomes research, (c) organizational influences, (d) the value of clinical outcomes research, and (e) potential partnerships with academics. Three conceptual categories are identified: knowledge and understanding about clinical outcomes research, clinicians' experience conducting or participating in clinical outcomes research and the relevance of clinical outcomes research to occupational therapy clinical practice. Similarity to findings in the international literature on occupational therapists' engagement in clinical research suggests that the findings from this small sample of Australian therapists are robust. The implications of the findings for continuing professional education programmes and clinical supervision are presented.

Occupational therapy practice patterns with older Swedish persons at home

This paper explores and describes occupational therapy practice patterns during two periods for 89 elderly persons living at home. Occupational therapists working in one social welfare district in Stockholm, Sweden documented and reported every occupational therapy intervention provided. The results revealed that the elderly persons who received occupational therapy services during an extended period had an age span of 30 years, with a mean age over 80 years. They had several medical problems and were living in different types of settings. Occupational therapists provided a wide range of interventions, most frequently categorised as treatment, especially related to leisure activities. Irrespective of level of care, the median of interventions per person increased or was the same over time, and 72% of the elderly persons remained at the same level of care. Enabling occupation for elderly disabled person living in their home involves constantly adjusting to the current situation since the clients' capacities, goals and environment change over time. Therefore, occupational therapists need to have a client-centred approach working in home health community services.