Adult Physical Rehabilitation Research Articles

Improving Throughput and Length of Stay Using Nurse Consultation in the Acute Adult Physical Rehabilitation Unit.

Improving Throughput and Length of Stay Using Nurse Consultation in the Acute Adult Physical Rehabilitation Unit.

Symptoms of burnout in Whanau (Family) in an Older Adult Physical Rehabilitation Ward in New Zealand - differences between adult children's and partners' experience

Symptoms of burnout in Whanau (Family) in an Older Adult Physical Rehabilitation Ward in New Zealand - differences between adult children's and partners' experience

Use of Gamification for Adult Physical Rehabilitation in Occupational Therapy; A Novel Concept?

This commentary discusses the concept of 'gamification' as referred to implicitly or explicitly in the occupational therapy literature. Although occasionally noted to be a new frontier for occupational therapy, our analysis suggests that game mechanics and gamification elements are, in fact, a 'road long traveled' by occupational therapists and that gamification evokes the core aims and vision of occupational therapy. Gamification has been implicitly incorporated into the occupational therapy literature for years, and its benefit of enhancing therapeutic outcomes is evident in many instances. We contend that a more explicit use of the term gamification within the occupational therapy literature will lead to a framework in which both practitioners and researchers can structure and evaluate therapeutic outcomes.

What Person-Centered Rehabilitation Means in Concept and Practice: The Person-Centered Rehabilitation Model for Adult Physical Rehabilitation Derived from a Scoping Review and Thematic Synthesis

<h3>Objective(s)</h3> To frame the concept and practice of Person-Centered Rehabilitation (PCR) in adult physical rehabilitation, derived from a scoping review and thematic synthesis of the literature. <h3>Data Sources</h3> English-language empirical or conceptual papers, published from January 2007 to February 2020, were found through searches in databases (PubMed, Scopus, CINAHL), snowballing searches, and experts' consultation. <h3>Study Selection</h3> Two independent reviewers selected papers with PCR-related content, using the criteria in the published review protocol. From 6527 unique references, 147 were used in the analysis, 18% of them exclusively conceptual. <h3>Data Extraction</h3> Textual data on the PCR concepts or practices were extracted by two independent reviewers. <h3>Data Synthesis</h3> The thematic analysis and experts' consultation gave rise to the Person-Centered Rehabilitation Model (PCR Model): a cross-professional model for the concept and practice of PCR in adult physical rehabilitation settings. At the person-professional dyad, PCR was framed as: a respectful of and tailored to the person; reflexive and adaptive to the situation; compassionate and caring; focused on strengths and hopes - beyond deficits, and empowering and collaborative - toward a co-constructed rehabilitation. At the team level, a PCR approach includes significant others, is delivered in a welcoming and secure environment, and is articulated through a PCR team. At the organization level, PCR approaches are inclusive of clients and staff in service evaluation and improvement, create the context (e.g. provides training opportunities) for PCR to occur, and is organized for coordinated and tailored approaches. <h3>Conclusions</h3> PCR occurs at clinical and service organization practices, which are articulated through the PCR Model. The PCR model offers a conceptualization of PCR applicable in clinical and service settings and may assist in the implementation of PCR principles. <h3>Disclosures</h3> No conflicts of interest declared.

Indicators of Quality Rehabilitation Services for Individuals with Limited English Proficiency: A 3-Round Delphi Study

ObjectiveTo obtain expert consensus on indicators of quality rehabilitation services for individuals with limited English proficiency (LEP). DesignThree-round Delphi study. SettingDelphi survey conducted online with 30 experts. Most experts worked in adult physical rehabilitation settings and were from Illinois (n=16), and the remaining participants were from 8 other US states or Canadian provinces. ParticipantsExperts (N=30) had a minimum of 2 publications on health care services for patients with LEP and/or a minimum of 5 years clinical experience in physical rehabilitation. Of 43 experts (11 researchers, 32 clinicians) who received the round 1 survey by e-mail, 30 returned complete responses (70% response rate). Of those, 25 completed round 2 and 24 completed round 3. Of round 1 participants, most (n =21) identified their primary professional activity as clinical, whereas the others worked in research (n =5) or education (n =4). Twenty-four were women. The median age was 43 years (range, 27-67y). Disciplines included occupational therapy (n =14), physical therapy (n =13), psychology (n=1), nursing (n=1), and medicine (n=1). InterventionsNot applicable. Main Outcome MeasuresIndicators were rated on a 7-point Likert scale for importance and feasibility. Interquartile range (IQR) and 95% confidence intervals were calculated for importance and feasibility ratings. Indicators with an IQR <2 and a median importance score ≥6 were accepted as reaching consensus for importance. ResultsRound 1 responses were categorized into 15 structural, 13 process, and 18 outcome indicators. All 15 structural indicators reached consensus for importance; 8 were rated as feasible. All 13 process indicators reached consensus, of which 8 were deemed feasible. Sixteen outcome indicators reached consensus, of which 7 were deemed feasible. ConclusionsThis Delphi study identified structural, process, and outcome indicators that can inform delivery and assessment of quality rehabilitation services for individuals with LEP. Future research should operationalize and measure these quality indicators in clinical practice.

Applications of Head-Mounted Displays for Virtual Reality in Adult Physical Rehabilitation: A Scoping Review.

Head-mounted displays for virtual reality (HMD-VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds. To explore how HMD-VR has been used in adult physical rehabilitation. A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review. This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD-VR in a physical rehabilitation context and within the scope of occupational therapy practice. HMD-VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson's disease. HMD-VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes. We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.

Correlation Between Simulation and Fieldwork Performance in Adult Physical Rehabilitation

Correlation Between Simulation and Fieldwork Performance in Adult Physical Rehabilitation

An Exploratory Survey of Physical Rehabilitation Occupational Therapy Practice Patterns

A computer-assisted survey was developed and administered to 66 occupational therapists working in adult physical rehabilitation to explore how and to what extent occupational therapists evaluate and treat medication management impairments. Approximately 90% of the sample evaluate and treat medication management, but only about 25% addressed medication management on a consistent basis. This suggests that current medication management service provision levels may be insufficient to meet clients’ needs. Research is warranted to understand and improve occupational therapists’ abilities to address medication management in practice.

Social circus program (Cirque du Soleil) promoting social participation of young people living with physical disabilities in transition to adulthood: a qualitative pilot study

ABSTRACTPurpose: To explore the perceived impact of a social circus program on the participation level of young adults’ living with physical disabilities from their own and their parents’ perspective.Method: Exploratory phenomenological qualitative design. A social circus program was offered for nine months. Perceived participation level was documented through pre and post semi-structured interviews. A pretested interview guide was used. Interviews were transcribed and coded by two independent researchers.Results: The average age of the participants (n = 9) was 20.0 ± 1.4 years with 2/9 being female. Participation was perceived as being improved after the intervention from both perspectives (participants and parents) mainly for communication, mobility, relationships, community life and responsibilities. The intervention was perceived as strengthening self-perception and self-efficacy, which in turn enhanced participation level and decreased parents’ bounding.Conclusion: The results show promises for social circus as a new approach in adult physical rehabilitation for this population in transition.

The Occupational Therapy Practice Checklist for Adult Physical Rehabilitation

Although the practice of occupational therapy is described in textbooks, research, and professional standards, a tool for outcomes research is needed. The Occupational Therapy Practice Checklist (OTPC), based on the Model of Occupational Performance (Pedretti, 1996), includes domains of adjunctive, enabling, purposeful, and occupational performance. Practices are also identified by phase of therapy (early, middle, late). The OTPC was piloted with 40 adults in an outpatient physical rehabilitation center. The Kuder Richardson 20 coefficient of internal consistency was .91. Practices on the OTPC discriminated between clients with and without neurological disorders. The OTPC has potential for yielding knowledge about occupational therapy practice. Results of the pilot show that occupational therapy practice was not linear, as theorized, but rather a complex integration of techniques.

Outcome measurement in Australian rehabilitation environments

To determine the frequency and pattern of methods of outcome assessment used in Australian physical rehabilitation environments. Postal survey. A questionnaire on service type, staffing, numbers of adults treated and outcome measures used for 7 conditions related to injury and road trauma as well as stroke and neuromuscular disorders was sent to 973 services providing adult physical rehabilitation treatment. Questionnaires were completed by 440 service providers for a response rate of 45%, similar to that reported in a recent European survey reported in this journal. A small number of measures were reported as in use by most respondents, while a large number of measures were used by a few respondents. Measures of physical changes were used more frequently than those of generic well-being or quality of life. Ease of use and reporting to other professionals were cited as the most important reasons in selection of outcome measures. This Australian-wide survey detected considerable heterogeneity in outcome measurement procedures used in rehabilitation environments. While the goal of measurement may vary between providers and differ between conditions, the results highlight opportunities for harmonization, bench-marking and measurement of health-related quality of life.

The planning process in occupational therapy: perceptions of adult rehabilitation patients.

The purpose of this study was to learn about (a) adult physical rehabilitation patients' perceptions of their involvement in the treatment planning process (goal setting, treatment planning, outcome evaluation), (b) their valuation of occupational therapy, and (c) how they would describe their interpersonal relationships with their occupational therapists. Fifteen subjects who had received occupational therapy were interviewed. The transcripts were independently and jointly reviewed by the authors to answer five research questions. Most of the subjects indicated that they had been involved in occupational therapy goal setting; treatment planning; and outcome evaluation, albeit this indication was weak. They also valued the occupational therapy services they received. Eight described positive interpersonal interactions with their therapists, and seven provided no information. Patients receiving occupational therapy services are involved in goal setting, treatment planning, and outcome evaluations; however, their involvement varies and can be difficult for them to identify and describe. Because of increasing societal emphasis on patient rights and participation (e.g., consumerism, health professions standards, health care accreditation criteria, health care legislation) and the likelihood that health care funding will be used for services linked to patient goals, occupational therapy practitioners could become more overt and systematic in involving patients in the planning process. Increasing patient involvement in planning may result in more individualized treatment and more effective use of health care dollars.

Treatment activity preferences of occupational therapists in adult physical dysfunction settings.

Research has suggested that using an adaptive approach to provide direct training in occupational behaviors is more effective than using a remedial approach to retrain component skills. This survey was done to see whether occupational therapy practice in physical dysfunction reflects that research. Surveys from a convenience sample of 269 (70.2% response rate) occupational therapy directors in adult physical rehabilitation facilities throughout the United States were analyzed to determine the relative rankings of remedial and adaptive activities by therapists in those settings. For all facilities combined, the four most frequently used types of activities, in order of frequency, were self-care, upper extremity exercise, functional mobility, and neuromuscular training. Facilities using multiple formal methods to assess client priorities used functional activities more frequently than other facilities. Occupational therapists in adult physical dysfunction settings are not routinely providing client training in the full spectrum of occupational behaviors.

Methods of assessing clients' priorities: a survey of adult physical dysfunction settings.

Recent clinical reasoning literature has identified a collaborative model of treatment--one that responds to clients' perceptions of their illness and disability experiences--as central to occupational therapy practice. Assessing clients' priorities on admission is essential to that model. Surveys from of a convenience sample of 269 occupational therapy directors in adult physical rehabilitation facilities throughout the United States (70.2% response rate) were analyzed to see whether occupational therapists in those settings are assessing clients' priorities on admission, and if so, how. The majority of occupational therapists are using informal interview to determine clients' priorities on admission. Client goals obtained from these interviews are vague and do not specify meaningful occupations; this finding suggests that therapists are setting treatment goals without specific input from clients about their valued activities. Occupational therapists have not yet successfully translated their values about client-therapist collaboration into a formal set of procedures for practice.

Involvement of adult rehabilitation patients in setting occupational therapy goals.

This preliminary study was designed to determine whether occupational therapists involve patients and their families in a goal-setting process and, if so, to identify the methods used. Thirty registered occupational therapists practicing in adult physical rehabilitation settings were audiotaped during an initial evaluation. Researchers reviewed corresponding documentation and interviewed each subject. Twenty-three patient and family involvement criteria were generated from standards developed by accreditation commissions and health care professions. Data revealed that although subjects did involve patients and families in a goal-setting process, a number of criteria were not attempted, thus much potential for involvement was unrealized. Subjects with scores above and below one standard deviation from the mean were identified to determine which patient participation criteria had the highest discrepancies. Discrepancies included (a) verbal preparation of the patient and family for initial and ongoing treatment, purposes and procedures of evaluation and treatment, and potential outcomes of treatment, (b) attempts to elicit the patient's concerns, and (c) collaboration with the patient to establish treatment goals. Factors that might have influenced subjects' use of a patient participation approach included the application of a specific theory or technique, time constraints, patient's age, and assumptions about the patient's cognitive status.