Practice Of Occupational Therapists Research Articles

Assessment practices of Canadian occupational therapists working with adults with mental disorders.

Little is known about assessment practices of occupational therapists working with adults with mental disorders. This study investigates the assessment practices of occupational therapists working with clients experiencing symptoms of schizophrenia or major depressive disorder. We conducted a national survey of assessment practices using case vignettes of hypothetical clients. From 343 vignettes completed by 286 respondents, 68.4% included the use of one or more standardized measures during treatment. Measures were rarely repeated. Results showed that the Canadian Occupational Performance Measure was the most frequently used, suggesting a focus on assessing global functioning, while the Assessment of Motor and Process Skills was listed as the most desired assessment tool. Implementing nonstandardized assessments was common. Despite wide variations in occupational therapists' assessment practices, the use of standardized assessments is prevalent. The low rate of repeated measures (0% to 25.9%) suggests a need to better monitor changes and treatment outcomes.

Occupational therapy hand assessment practices: Cause for concern?

INTRODUCTION: Assessment is critical for measuring improvement, or lack thereof, and demonstrating the outcome of intervention. In response to the lack of research in this area, this study aimed to determine the assessment practices of occupational therapists working with clients with hand conditions METHODS: A quantitative cross sectional survey design was used. A convenience sample of occupational therapists was recruited from five provinces. Respondents completed a questionnaire developed for the study that comprised demographic information, assessments used, frequency of use and factors influencing assessment choice. Data were analysed with Statistica version 11 RESULTS: Eighty-one respondents (n=114) completed questionnaires representing a 71% response rate. Goniometry (84.0%), manual muscle testing (76.5%) and testing for flexor tendon function (76.3%) were used most frequently. The most common reasons for not using assessments were lack of availability and unfamiliarity CONCLUSION: It is of concern that the assessment practices of participants in this study focussed primarily on the assessment of body function and structure with few therapists using activity and participation measures. This could seriously limit the evidence needed to verify the outcomes achieved through occupational therapy intervention in the treatment of hand conditions. Key words: hand assessment, occupational therapy, body structure and function, activity, participation

Abordagens corporais: recurso transformador na formação do terapeuta ocupacional

The objective of this study was to discuss the teaching-learning process of corporal approaches in the Occupational Therapy fi eld. The informations were collected during the classes, in the body approaches matter, administered in the fourth period of the graduate program in Occupational Therapy of the Universidade Estadual Paulista, through focus groups conducted at the end of all twelve-face meetings with classes of four hours each. The study was realized by forty students enrolled in the discipline. All meetings were fi lmed, which allowed the full transcript and analysis of the students reports. The speeches analysis consisted of content analysis and categories creation. The results indicated to the perception of the thematicdiscussed during the meetings enabled the student to experience and build critical thinking about what is proper the client, and through a holistic approach, about what is guiding the potency of the Occupational Therapy process. The body approaches are considered a feature powerfull transformer in the teaching-learning of occupational therapy as an investigative and formative activity in the understandings’ construction of the professional practice ofoccupational therapists in situations of uniqueness, complexity, uncertainty and confl ict in the value process.

Rural rehabilitation practice: perspectives of occupational therapists and physical therapists in British Columbia, Canada

Providing rehabilitation services to address the health needs of rural residents requires overcoming the challenges of geography, limited referral options and a shortage of occupational therapists (OTs) and physical therapists (PTs). However, little is known about how rehabilitation professionals in rural areas enact their practice to meet and overcome these challenges. To address this gap and contribute to enhancing health for rural residents, this study was designed to explore rural rehabilitation practice from the perspectives of OTs and PTs in rural British Columbia (BC). A purposive sample of OTs and PTs in rural communities (population <15 000) in northern BC was recruited for this qualitative study. Potential participants received an invitation mailed to workplaces and were selected to ensure a variety of work experiences, roles and practice settings. In semi-structured interviews, participants were asked to describe the skills and knowledge they perceived as unique to rural practice and strategies they used to overcome challenges. Guided by interpretive description, transcripts were analysed inductively using broad-level coding, and findings were collapsed into interpretive categories. Interpretations and implications for education, practice and policy were reviewed with participants to ensure relevance to rural practice. From interviews with 6 OTs and 13 PTs, serving a total of 15 rural communities, rehabilitation practice and participants' definition of health were understood to be substantially shaped by rurality or the contextual features of geography, determinants of health and access to services. Participants considered general practice 'a specialty' requiring advanced skills in assessment. They described 'stretching their role' and 'participating in, and partnerships with, community' as ways to overcome resource shortages. Reflective practice, networking and collaboration were deemed essential to maintaining competence. Rural clinical placements, mentoring and improving access to continuing professional development were regarded as central to the recruitment and retention required to sustain optimal levels of service to residents. The research findings illustrate the unique influence that the rural context has on the practice of OTs and PTs in BC. They underscore the importance of facilitating learning about rural health within professional training programs and of providing accessible professional development resources to address health human resource shortages and meet the rehabilitation needs of rural residents.

Readiness for work injury management and prevention: important attributes for early graduate occupational therapists and physiotherapists.

Early graduate occupational therapists (OTs) and physiotherapists (PTs) are routinely employed in work injury management and prevention in Australia. However, our understanding is limited about employer requirements for early graduates entering the field, and how commencing practitioners manage transition to practice. In addition, employers have expressed concerns anecdotally about the preparedness of early graduates for work injury management and prevention. However, evidence is limited about early gradutate preparedness for the field. The study aimed to develop a detailed qualitative account of the perceptions of employers and early graduates on the attributes required of early graduates in work injury management and prevention, and processes for effective transition to practice in this field. A purposive sample of 12 employers and 12 early graduates in work injury management and prevention participated in semi-structured interviews. Questions to employers focused on recruitment, supervision and readiness for practice. Questions to early graduates focused on challenges in transition and effective learning methods. Transcripts were analysed by Leximancer™ and supported by manual coding and synthesis. Four themes with findings were, 1) 'Job and workplace requirements'; skills required by employers and support needed for early graduates, 2) 'Learning for work injury management and prevention'; options for early graduate development and learning methods early graduates found effective, 3) 'Employer expectations of early graduates in transition to work injury management and prevention', responses to transition; and 4) 'Early graduate perceptions on transition to work injury management and prevention'; early graduates responses to transition. Findings for employers and early graduates were similar to those expected in other areas of practice for OTs and PTs. Work injury management and prevention skills were not expected of early graduates by employers. Employers and early graduates shared similar views that clinical education in work injury management and prevention was useful to early graduates entering this field. Physiotherapy employers considered PT early graduates not yet ready for work injury management and prevention.

Driving with Dementia: Evaluation, Referral, and Resources

ABSTRACTDriving is a highly valued instrumental activity of daily living, especially for the older adults who consider it part of their definition of independence and mobility. This paper discusses the issues associated with driving and older adults, including the difficulty of identifying when it is time to give up the keys. With a review of the latest research and need for specialized services for those with diminished capacity, the paper highlights how general practice occupational therapists must work in conjunction with driver rehabilitations specialists to meet the need of this growing population. A framework for referral and judgment is described and resources offered to practitioners to use.

The provision of weight management advice: An investigation into occupational therapy practice

Obesity affects more than half the Australian population and has become epidemic throughout the world. Little is known regarding occupational therapy interventions with clients who are overweight or obese. This study aimed to identify occupational therapy practice in relation to the provision of weight management. This was part of a larger study investigating health professional practice. A cross-sectional study design using a self-administered, purpose-designed survey was employed to identify the current practices of occupational therapists working in a regional area of New South Wales, Australia. Participants were recruited via email or mail as publically available. Fifty-one occupational therapists anonymously completed the survey. Results revealed that 53% (n=26) of respondents did not consider weight management to be within their scope of practice or their workplace role description. The most common intervention was the provision of physical activity advice (65.2%; n=30). Dietary advice was provided by 20.8% (n=10), while 77% (n=32) referred onto dietitian services. During entry-level occupational therapy education, only 7.8% (n=4) had received weight management advice education. Completion of postgraduate professional development training in this area was reported by 14% (n=7) of respondents. This study provides insight into the current practices of Australian occupational therapists in relation to the provision of weight management advice. This research displays a need to acknowledge both a generic and a discipline-specific role for the provision of healthy lifestyle interventions. This may be achieved through better access to education during entry-level programmes and in the workplace.

Professional practice of occupational therapists with regard to therapy for children with developmental disorders (2)

Professional practice of occupational therapists with regard to therapy for children with developmental disorders (2)

Preparing Occupational Therapy and Physiotherapy Students for Work-Related Practice: A Clinical Education Initiative at One Australian University

Purpose: Despite increasing numbers of novice occupational therapists (OTs) and physiotherapists (PTs) entering work-related practice since the early 2000s, clinical learning opportunities are often limited due to legal and insurance issues. In response, clinical educators at The University of Queensland, Australia, developed an industry consultancy service to provide clinical learning for students in this field. Students delivered injury prevention services with supervision from experienced educators. This paper describes the program and an evaluation of student learning. Method: Twenty-six students (10 OTs and 16 PTs) participated voluntarily in an evaluation of the program during 2008 and 2009. Surveys pre and post-placement included open and closed questions that sought students’ knowledge of work-related practice and perceptions of practitioner roles. Knowledge was assessed with 20 questions on work-related practice. Differences in knowledge before and after the placement were analysed with non-parametric statistics. Open ended responses were subject to manual thematic analysis. Results: Students demonstrated a good understanding of the roles and tasks undertaken by practitioners in this field pre-placement. Their knowledge of work-related practice significantly increased following the placement (p&lt; 0.05). Half of the students reported that their expectations for the placement had been met. Open ended responses provided students’ perceptions of the program, both positive and negative. Conclusions: This clinical learning experience in work-related practice for OT and PT students provided a novel practical experience. Students demonstrated a good understanding of professional roles in the field and post-placement increased their understanding of work-related practice. The model provided a valuable method that ensures OT and PT students experienced work-related practice prior to graduation.

Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia

This qualitative study formed part of a large-scale, multi-phase study into the delivery of therapy services to people with a disability, living in one rural area of New South Wales, Australia. The study's purpose was to identify the impact of Information and Communication Technology on the workforce practices of occupational therapists' working in a rural area of New South Wales. Individual semi-structured telephone interviews were conducted with 13 occupational therapists working in disability, health and private practice in a rural area of New South Wales. Participants were asked about access to, skills and limitations of using Information and Communication Technology. A modified grounded theory approach, based on thematic analysis and constant comparison, was used to analyse the interview transcripts. This study found widespread use of technology by rurally based occupational therapists working in the disability sector in New South Wales. However, Information and Communication Technology was primarily used for client contact, professional development and professional networking rather than therapy provision. The study identified individual, workplace and community barriers to greater uptake of Information and Communication Technology by this group. The individual barriers included: age cohort, knowledge and personal preferences. The workplace barriers included: support and training and availability of resources. The community barriers included: infrastructure and perceptions of clients' acceptance. The potential exists for Information and Communication Technology to supplement face-to-face therapy provision, enhance access to professional development and reduce professional isolation thereby addressing the rural challenges of large distances, travel times and geographic isolation. To overcome these challenges, individual, workplace and community Information and Communication Technology barriers should be addressed concurrently.

Occupational Therapy Practice as it Relates to Drivers with Dementia

ABSTRACTBackground: Occupational therapy has taken a leading role in the screening, assessment, and retraining of potentially unsafe older drivers. This investigation examined the attitudes, knowledge, and practices of occupational therapists (OTs) concerning drivers with dementia. Methods: A questionnaire that obtained perspectives about and experiences with drivers with dementia was mailed to licensed OTs from North Carolina and South Carolina. Results: The sample was comprised of 180 OTs. Therapists who had a strong perceived role regarding driver rehabilitation and intervention, believed that it was an important topic to address, and were knowledgeable about driving-related issues were more likely to address the issue with clients and their family. Conclusions: The growing concern about the safety of older drivers with dementia supports the importance of OTs addressing the driving needs of their clients. We recommend increasing the number of trained OT driving specialists as well as emphasizing dementia-related continuing education training for OT generalists.

Children and young people’s occupations, health and well being: a research manifesto for developing the evidence base

Evidence based practice is key to occupational therapists making a difference in professional practice for the people they work with. The challenge is that delivery of evidence based services requires evidence. This paper focuses on the need to develop more evidence to support the practice of occupational therapists working with children and young people. This research needs to reflect the re-focus on occupation in both what occupational therapists do, and what they measure, rather than traditional approaches which are solely directed at impairments and component skills. A research manifesto is presented for developing the evidence base to understand the relationship between children and young people’s occupations and their health. The key issues it addresses are the need to map, plan and coordinate research systematically in order to develop high quality research that will influence practice. This manifesto provides a platform for action for occupational therapists researching children and young people’s occupations to work together strategically.

The impact of action learning on analysis of occupation

Technology and millennials have created a shift in the world and how it operates. This impact has been experienced in the field of occupational therapy education. As a result of this paradigm shift, an analysis of effective teaching methodologies was carried out to assess the most effective way to engage the millennials in an analysis of occupation process, which is a critical foundation for effective critical thinking and clinical practice for occupational therapists. An action learning assignment was utilized to bridge this gap. The action learning assignment immersed the students in a safe learning environment that recreated many types of domains that needed to be analyzed. As a result, the students experienced first-hand the outcomes of effective and ineffective analysis and problem-solving during their action learning project. Therefore, the students were able to reflect and critically think through alternatives and hear about other students' projects. Overall, the action learning project yielded positive learning and engaging outcomes.

Using a time-geographical diary method in order to facilitate reflections on changes in patterns of daily occupations

Objective and methods: Time-use methodologies have been proposed to be established research techniques when exploring aspects of daily occupations. In this study, two graphs illustrating the time arrangement of occupations as they appear in a continuous sequence were used in order to encourage individuals to reflect on their everyday life. The aim was to investigate the usefulness of a time-geographical diary method (using illustrative graphs) in combination with stimulated-recall interviews, to facilitate reflections on how patterns of daily occupations change over time and the causes that lie behind these changes. The study had a qualitative design. The participants were two working, married mothers, i.e. individuals considered to have highly complex patterns of daily occupations. The data analysis was performed by using thematic content analysis. Results: The results showed that the stimulated-recall interviews, based on the graphs, facilitated new insights that came to light concerning the scope of the participants' daily life. The method enabled the participants to reflect on their patterns of daily occupations and become aware of changes relevant to explain the causes for engaging in occupations the way they did. Conclusions: The method thus seems useful in research and practice for occupational therapists working with individuals with a need to change lifestyle.

Effect of a DVD Intervention on Therapists’ Mental Health Practices With Older Adults

We tested the effectiveness of an educational intervention in DVD format aimed at strengthening the mental health practices of occupational therapists working with older adults. The DVD intervention was tested in a pretest-posttest design. Occupational therapists (n = 30) completed a brief knowledge and attitude questionnaire; a chart review (n = 383) of therapists' (n = 20) patients at 3 mo before and 3 mo after DVD training was also conducted. Questionnaire data showed that the percentage of therapists with correct answers increased 20%-30% for 5 of the 11 knowledge items. Chart review data showed therapists spoke more often with their older patients about mood, depression, and cognitive impairment; screened more often for depression and cognitive impairment; and reported findings more often to the treatment team after training. Educational interventions can significantly improve therapists' mental health practice with older adults.

Survey of current pre-discharge home visiting practices of occupational therapists

Discharge planning frequently involves occupational therapy pre-discharge home visiting as one component of intervention. Pre-discharge home visits aim to maximise a person's functional performance within the context of their home and community environment, bridging the transition between hospital and home. The aim of this study was to describe the pre-discharge home visiting practices of occupational therapy departments. This descriptive study used a postal survey which was sent to occupational therapists in 215 public and privately funded hospitals in New South Wales, Australia. The survey enquired about the number of pre-discharge home visits completed per month, who went on visits and time spent on visits. Descriptive statistics were used in analyses. Surveys were returned by occupational therapists from 53 departments, representing a response rate of 25%. Respondents estimated that they conducted approximately 13 pre-discharge home visits per month (range: 1-60). Visits were estimated to take an average of 1 hour and 20 minutes (excluding travel time). Approximately one-quarter of respondents felt that there was pressure to reduce the number of pre-discharge home visits conducted. Using their local hospital records, nine hospital departments estimated that the number of home visits completed per month had reduced by 50% compared with the number of home visits five years previously. Findings suggest a wide variation in current pre-discharge home visiting practice. There is a need for well-designed clinical trials that investigate the effectiveness of these costly and time-consuming visits on functional performance.

Assessment of standing in Functional Capacity Evaluations: An exploration of methods used by a sample of occupational therapists

The primary aim of the study was to explore the current practice of occupational therapists when assessing standing performance during Functional Capacity Evaluations (FCEs). A semi-structured interview was conducted with occupational therapists and the participants were interviewed using both open and closed questions. A sample of occupational therapists (n=20) from Queensland, Australia were involved in a survey. They were all experienced in conducting FCEs. Ninety percent of the respondents used a distracting task during the assessment of standing with standardised and non-standardised nuts and bolts assembly tasks the most commonly used. Respondents reported using a mix of biophysical, physiological and psychophysical clinical observations to assess standing. The nuts and bolts assembly activities used by the respondents were rated to be of low interest in terms of engaging the client. It was identified there are minimal guidelines in the literature which focuses on assessment of standing in FCEs. Questions were raised regarding the adequacy of the use of nuts and bolts activities as a suitably distracting task in FCEs and further research is required on assessing standing in functional capacity evaluation including the use of suitably distracting activities.

Evaluating Driving as a Valued Instrumental Activity of Daily Living

The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-the-wheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers.

Translation of a Dementia Caregiver Intervention for Delivery in Homecare as a Reimbursable Medicare Service: Outcomes and Lessons Learned

families of dementia patients receiving skilled homecare do not receive supportive services. We evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into homecare practices of occupational therapists (OTs) and reimbursed through Medicare Part B. a 2-year translational project with a homecare practice was conducted. Five translational activities included refining ESP, site preparation, therapist training, establishing referral mechanisms, and evaluating outcomes using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM). of 30 OTs approached for participation, 23 (77%) agreed, 22 (96%) completed training, and 21 (95.5%) used ESP and intended to continue use. Of 69 eligible caregivers, 41 (59%) agreed to participate averaging 4.7 sessions. Of 20 returned caregiver surveys, enhancements were reported in all targeted areas of knowledge and skills. Fidelity monitoring revealed inconsistency in therapists use of problem solving, yet caregiver enactment of ESP strategies was high. ESP sessions integrated within patient-directed therapy were reimbursed by Medicare Part B. RE-AIM indicators suggest moderate translational success. As ESP was reimbursed through Medicare B, its delivery may be sustainable and meet the needs of family caregivers of dementia patients receiving therapies at home.

Development of Hand Rehabilitation in Mainland China

Hand rehabilitation has been a major area of practice for occupational therapists in Hong Kong when the profession first emerged in the early 1970s. It was a time when the economy of Hong Kong relied heavily on small industries and assembly work mainly for export to western countries. Due to lack of awareness of occupational health and safety, most of the workers were injured at work while operating on machines without protective guard. Occupational therapists were trained to handle a huge volume of workers with hand trauma with the goal of helping them maximize hand function so that they could return to the work force. Similar situation occurs in Mainland China nowadays, particularly in the Southern part of the Mainland where industries and factories are densely built to support the industrialization. This paper attempts to review the development of hand rehabilitation postsurgery and to discuss the current assets and challenges in meeting the needs of patients with hand injuries in Mainland China.