Occupational Therapy Home Assessment Research Articles

Pilot evaluation of a digital approach to occupational therapy home assessments: acceptability and efficiency compared with usual practice in a hospital.

Pre-discharge home assessments by occupational therapists facilitate safe and timely discharge from hospital and are associated with better health outcomes. Digital technology offers the potential to reduce duplication of documentation and improve communication and sharing of home assessment findings. This quality improvement project evaluated time-cost; clinician satisfaction and confidence; and acceptability of the use of a digital approach to home assessments. A prospective, cross-sectional design was used to compare usual practice with the digital approach across two sub-acute wards in a large metropolitan hospital in Queensland, Australia. Time to document and conduct home assessments as well as clinician satisfaction and confidence were compared using descriptive statistics. Clinician perspectives about the home assessment approaches were collected through a survey and analyzed using content analysis. Home assessment and documentation time were significantly lower for the home assessments conducted using the digital approach compared with usual practice assessments. Clinician satisfaction with using digital technology was higher. The introduction of this simple technology reduced clinicians' time to conduct home assessments and document home assessment reports. The project was well received by occupational therapy clinicians. http://links.lww.com/IJEBH/A187.

A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study.

Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial. This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment. A cohort of adults aged ≥60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen κ and Gwet AC1 were used to assess validity. A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77% agreement, Gwet AC1=0.56), toilets (56% agreement, κ=0.10), bathrooms (64% agreement, κ=0.46), and backyards (55% agreement, κ=0.24). Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment.

The smart-home study: A feasibility study to pilot the use of smartphone technology to identify environmental falls risk factors in the home.

While occupational therapy home assessments are effective to identify environmental falls risk factors, patients may not receive these services due to workforce distribution and geographical distances. Technology may offer a new way for occupational therapists to conduct home assessments to identify environmental fall risks. To (i) explore the feasability of identifying environmental risk factors using smartphone technology, (ii) develop and pilot a suite of procedures for taking smartphone images and (iii) examine the inter-rater reliability and content validity between occupational therapists when assessing smartphone images using a standardised assessment tool. Following ethical approval a procedure was developed and participants recruited to submit smartphone images of their bedroom, bathroom and toilet. Two independent occupational therapists then assessed these images using a home safety checklist. Findings were analysed using inferential and descriptive statistics. Of 100 volunteers screened, 20 individuals participated. A guideline for instructing patients to take home images was developed and tested. Participants averaged 9.00minutes (SD 4.401) to complete the task, whilst occupational therapists took approximately 8minutes to review the images. The inter-rater reliability between the two therapists was 0.740 (95% CI: 0.452-0.888). The study found that use of smartphones was to a large extent feasible and conclude that the use of smartphone technologies is a potential complimentary service to traditional home visits. The effective prescription of equipment in this trial was identified as a challenge. The impact on costs and potential falls incidents remains uncertain and more research is warranted in representative populations.

Fall prevention in old people through occupational therapy home assessment, consultation and modification: aprocess outline

Falls occur frequently in old people and are associated with relevant short-term and long-term trauma sequelae. Particularly in the light of demographic change, preventive measures such as falls prevention are increasingly gaining in importance. Occupational therapy home assessments enable the evaluation of external and behavioral risk factors for falls in the context of environmental prevention. Environmental prevention is an effective measure in preventing morbidity and mortality related to falls in old people and the increase in healthcare costs associated with falls. Occupational therapy home assessments effectively reduce fall risk and fall rate among older people at risk of falling and can be implemented in the context of existing regulatory frameworks. The aim of this overview is to illustrate the optimal process of home assessment and adaptation for patients at risk of falling by general practitioners, orthopedic surgeons and occupational therapists.

Barriers and facilitating factors influencing implementation of occupational therapy home assessment recommendations: A mixed methods systematic review.

Low implementation rates of occupational therapy home assessment recommendations have previously been reported. The objective was to identify and describe the barriers and facilitating factors that influence implementation of home assessment recommendations. A mixed methods systematic review consisting of studies involving adults living in the community who received an occupational therapy home assessment was conducted. Seven databases were last searched in August 2021. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools (SUMARI) dependent on study design. Data synthesis followed the convergent integrated approach. Findings were mapped to the theoretical Capability Opportunity Motivation Behaviour (COM-B) model of health behaviour change. From 5,540 citations, 22 articles met the criteria for the systematic review. Implementation of occupational therapy home assessment recommendations ranged between 55% and 90%. Six synthesised findings were identified. Capability barriers included a patient's cognitive and physical ability. Motivation barriers included a perceived lack of need and stigma; patient reported decreased involvement and lack of choice. Opportunity barriers included limited family or carer involvement, carer stress, level of service provision available, including funding, therapy dosage and timing and environmental restrictions. Overall facilitators included patient-centred care, including choice and understanding need, individualised tailored recommendations, involvement of families and carers, provision of written record and strategies to support implementation. Results were limited by methodological weaknesses in identified studies and heterogeneity in the definition and measurement of implementation impacting on comparison. Specific intervention components were often poorly described. The theoretical model elucidates priority factors to address for promoting implementation of home assessment recommendations. Future high-quality research clearly defining intervention components is required to support short- and long-term implementation of recommendations in the home environment. Behaviour change techniques could be utilised to support home assessment practices in future research.

Barriers and facilitators influencing adherence to occupational therapy home assessment recommendations: a mixed methods systematic review protocol.

To identify and describe the barriers and facilitators that influence adherence to recommendations provided as part of an occupational therapy home assessment. Home assessments, including environmental interventions, are commonly used by occupational therapists. Home assessment recommendations aim to support a patient's independence in their occupational roles and improve safety in the home. Research evaluating home assessments and adherence to recommended strategies is limited. However, low adherence has been associated with poorer outcomes including falls, deconditioning, and decreased function. This research aims to synthesize factors that influence adherence to home assessment recommendations. This review will consider all qualitative and quantitative studies that report on adherence to recommendations provided during occupational therapy home assessments. Studies will include adults (>18) and/or their caregivers, who live in the community and receive an occupational therapy home assessment. A mixed methods systematic review will be undertaken. Eight databases will be searched for studies published in English reporting on adherence following home assessments completed by occupational therapists published after January 2000. Study quality will be assessed using standardized JBI critical appraisal tools dependent on study design. Data extraction will be performed using a standardized tool, followed by data transformation. Data synthesis will follow the convergent integrated approach. All findings will be tabulated to explore factors that influence adherence. PROSPERO CRD42020159233.

Remote Home Visit: Exploring the feasibility, acceptability and potential benefits of using digital technology to undertake occupational therapy home assessments

Introduction Home assessments are integral to the occupational therapy role, providing opportunities to personalise and integrate care. However, they are resource intensive and declining in number. A 3-month service development within one United Kingdom National Health Service acute hospital setting explored the concept of using digital technology to undertake remote home assessments. Methods Four work streams explored the concept’s feasibility and acceptability: real-world testing; user consultations; narrative case study collection; traditional visit resource use exploration. Project participants were occupational therapists and patient and public representatives recruited via snowball sampling or critical case sampling. Qualitative data were thematically analysed identifying key themes. Analysis of quantitative data provided descriptive statistics. Findings The remote home visit concept was feasible within four specific contexts. Qualitative themes suggest acceptability depends on visitor safety, visitor training, visitor induction and standardisation of practice. Consultees perceived the approach to have potential for resource savings, personalisation and integration of care. Barriers to acceptance included data security, data governance, technology failure and threat to occupational therapists’ role and skills. Conclusion Applying digital technology to occupational therapy home assessment appears feasible and acceptable within a specific context. Further research is recommended to develop the technology, and test and investigate perceived benefits within wider contexts and stakeholder groups.

Information and communication technology use within occupational therapy home assessments: A scoping review

Introduction Home assessments conducted by occupational therapists can identify hazards and prevent falls. However, they may not be conducted because of limited time or long distances between the therapist’s workplace and the person’s home. Developments in technologies may overcome such barriers and could improve the quality of the home assessment process. Method This scoping review synthesises the findings of studies evaluating information and communication technology use within occupational therapy home assessments. Results Fourteen studies were included and revealed the two main approaches to technology use: the development of new applications and the use of existing and readily available technologies. Facilitators and barriers to use were also identified. Facilitators included usefulness, ease of use and the potential for cost-effectiveness. Barriers to use included poor usability, unsuitability for some populations and perceived threat to the role of occupational therapy. The synthesis revealed that traditional in-home assessments conducted by therapists are more sensitive in identifying hazards. Conclusion The availability of new technologies offers potential to improve service delivery; however these technologies are underutilised in clinical practice. Technologies may offer advantages in the conduct of home assessments, especially regarding efficiency, but have not yet been shown to be superior in terms of patient outcome.

Occupational Therapy Community Practice and Home Assessments: Use of the Home Safety Self-Assessment Tool (HSSAT) to Support Aging in Place

ABSTRACTMore than 70 million Americans are expected to be 65 years or older by 2030, with 8.7 million 85 or older. Occupational therapists can provide client and population-centered interventions to promote home safety, functional abilities, and quality of life to support older adults’ desires for independence and to age in place. This includes the use of assistive technology, home modifications, and rehabilitation principles, to design real life solutions to support the needs of older adults. Using case study methodology this paper focuses on the development and pilot-testing of the Home Safety Self-Assessment Tool (HSSAT), a new home assessment, designed for use by older individuals to promote home safety and aging in place. The results suggest the tool may assist older adults in identifying environmental factors that are related to falls and facilitate their ability to age in place.

Measurement Properties of the Occupational Therapy Discharge Needs Screen

Pre-discharge home assessments are integral to discharge planning; however, there is no screening tool identifying clients with complex needs. To determine the inter- and intrarater reliability and predictive and concurrent validity of the Occupational Therapy Discharge Needs Screen (OTDNS), a screening tool that identifies clients with more complex discharge needs. The OTDNS Functional Independence Measure (FIM) and Functional Autonomy Measurement System (SMAF) were administered to 89 participants. Intrarater reliability was ICC = 0.93 (95% CI 0.90 - 0.96) (n = 89). Interrater reliability was ICC = 0.53 (95% CI 0.27- 0.70) (n = 89) with the initial OTDNS instructions, and ICC = 0.91 (95% CI 0.62 - 0.96) (n = 10) with revised OTDNS instructions. The OTDNS had an inverse relationship with the FIM (r = -0.51; p < 0.001) and a positive relationship with the SMAF (r = 0.64; p < 0.001). A score of > 7/28 had a sensitivity = 75% and specificity = 40% when predicting occupational therapy home assessment post-discharge. The OTDNS has potential to contribute to continuity and efficiency of the discharge-planning process.

Do occupational therapy pre-discharge home visits affect the longer term outcomes of the discharge process?

Background: Pre-discharge occupational therapy home assessments are routinely performed with older adults in Europe, Australia, and North America. Their primary aim is to facilitate a timely and safe discharge. There has been remarkably little research on the impact of pre-discharge occupational therapy home visits upon the subsequent discharge outcomes. Aim: The purpose of this study was to determine whether pre-discharge home visits from an acute care National Health Service hospital enable an older person to remain at home, whether pre-discharge home visit prevents re-admission to hospital and whether occupational therapy recommendations made on the pre-discharge visit were still complied with two years after discharge. Method: Medical notes of 7 older adults were retrospectively analysed in May 2007 two years after their pre-discharge home visits carried out in 2005. A non-standardised pre-designed data collection tool was used in the medical note analysis. Results: The findings from this exploratory study suggest that occupational therapy pre-discharge home visits may have a positive effect in enabling frail older adults to remain living at home, that re-admissions following home visits in the current sample were for medical rather than functional reasons and that not all the recommendations made by occupational therapists were complied with. Conclusion: It is suggested that further research needs to be done to determine whether occupational therapists in acute care services have a wider role in the management of more frail older adults with long term and deteriorating conditions. There needs to be an acknowledgement that the compensatory approach used within pre-discharge home visits may be of benefit to many older clients.

Commentary

International Journal of Therapy and RehabilitationVol. 19, No. 6 CommentariesCommentaryKylie JohnstonKylie JohnstonSearch for more papers by this authorKylie JohnstonPublished Online:29 Sep 2013https://doi.org/10.12968/ijtr.2012.19.6.342AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R et al. (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet 371(9614): 725–35 Crossref, Google ScholarClemson L, Mackenzie L, Ballinger C, Close JCT, Cumming RG (2008) Environmental interventions to prevent falls in community dwelling older people: a meta-analysis of randomised controlled trials. J Aging Health 20 (8): 954–71 Crossref, Google ScholarGrimmer K, Moss J (2001) The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective. Int J Qual Health Care 13(2): 109–16 Crossref, Google ScholarJohnston K, Barras S, Grimmer-Somers K (2010) Relationship between pre-discharge occupational therapy home assessment and prevalence of post-discharge falls. J Eval Clin Pract 16(6): 1333–9 Crossref, Google ScholarTinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18): 1279–84 Crossref, Google Scholar FiguresReferencesRelatedDetails 1 June 2012Volume 19Issue 6ISSN (online): 1759-779X Metrics History Published online 29 September 2013 Published in print 1 June 2012 Information© MA Healthcare LimitedPDF download

Consensus on ‘core/essential’ and ‘ideal world’ criteria of a pre‐discharge occupational therapy home assessment

There are no standard criteria for an occupational therapy (OT) home assessment for patients about to be discharged from an acute rehabilitation facility. This has implications for benchmarking, quality improvement and research. The aim of this paper is to establish 'core/essential' and 'ideal world' elements of OT home assessments for patients about to be discharged from acute rehabilitation settings. A piloted open-ended questionnaire initiated a Delphi study involving knowledgeable OTs working in Australian public and private acute rehabilitation settings. 'Core/essential' and 'ideal world' elements of OT home assessments were confirmed when 70% agreement was reached. Of 242 facilities in two Australian states, 110 were invited to participate, and 81 OTs from 84 facilities did so. Four Delphi rounds were required to reach consensus on 30 'core/essential' and 25 'ideal world' elements. Standard use of 'core/essential' pre-discharge home assessment elements should improve standards of care and the quality of discharge planning. OTs should consider including 'ideal world' criteria in pre-discharge assessments to optimize recently ill patients' community independence.

Relationship between pre‐discharge occupational therapy home assessment and prevalence of post‐discharge falls

Pre-discharge occupational therapy home assessments are common practice, and considered important for falls prevention in older people. This prospective, observational cohort study describes the association between pre-discharge home assessment and falls in the first month post-discharge from a rehabilitation hospital. 342 inpatients were recruited and followed up 1 month post-discharge. Patients were classified into diagnostic groups (cardiac, orthopaedic trauma, spinal, peripheral joint surgery, neurological and deconditioned). Age, gender, falls risk [Falls Risk Assessment Scoring System (FRASS)], functional independence scores (FIM™) and receipt (or not) of a home assessment were recorded. Patients completed a diary to document post-discharge falls. Logistic regression analysis tested the effect on falling of receiving a home assessment, age, gender, diagnostic group, FRASS and FIM™. Considering all subjects, not receiving a home assessment increased the risk of falling 1 month post-discharge [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-4.7, P=0.003]. Neurological and orthopaedic trauma patients had significantly elevated risks of falling [OR (95% CI), respectively, 12.5 (4.7-33.2), 3.4 (1.4-8.4)] relative to the orthopaedic joint group. For all diagnostic groups except neurological, falls risk was mitigated by a home assessment. In non-neurological patients, adjusting for the effect of diagnostic group, FRASS and FIM™ scores indicated a significant association between not receiving a home assessment and falling (OR 4.2, 95% CI 2.1-8.2, P<0.001). Pre-discharge occupational therapy home assessments are sound post-discharge falls-prevention strategies in non-neurological patients. The decision to conduct a home assessment should consider diagnosis, falls risk and functional independence.

Land-Based Versus Pool-Based Exercise for People Awaiting Joint Replacement Surgery of the Hip or Knee: Results of a Randomized Controlled Trial

Gill SD, McBurney H, Schulz DL. Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Objective To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee. Design Randomized, single-blind, before-after trial. Setting Physiotherapy gymnasium and hydrotherapy pool. Participants Patients awaiting elective hip or knee joint replacement surgery. Interventions Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment. Main Outcome Measures Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale. Results Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes. Conclusions While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

The Relationship between Staff Compliance with Implementing Discharge Planning Guidelines, and Stroke Patients’ Experiences Post-Discharge

Purpose: To investigate staff compliance with discharge planning clinical guideline recommendations in an acute stroke unit, and its relationship with post-discharge experiences of stroke patients and their carers. Subjects: Fifty acute stroke patients were systematically recruited for a retrospective patient record audit of staff compliance with clinical guideline recommendations related to discharge planning. Methods: Semi-structured interviews were conducted over six months post-discharge on patients’ actual community support needs and experiences. Audit and patient experience data were integrated to seek evidence of 1) characteristics of patients receiving guideline-compliant care, 2) relationships between staff compliance with discharge planning recommendations and patient’s post-discharge experiences, and 3) whether patient’s post-discharge experiences of shortfalls in support related to hospital discharge planning. Results: Not all patients received guideline-based care. There was a trend that patients with more complex strokes received guideline-compliant care than other patients. Compliance with providing an occupational therapy (OT) home assessment was significantly related to discharge directly home from hospital. There was a shortfall with 40% of patients between community supports predicted by hospital staff and actual post-discharge support requirements. Community support requirements increased over time for 32% of patients, whose six-month post-discharge needs were actually greater than their needs at six weeks. Conclusions: Staff compliance with discharge planning recommendations was variable and did not always relate to improved post-discharge patient experiences. The post-discharge experiences of many stroke patients could not have been predicted whilst they were in hospital. Discharge planning and support systems thus need to be flexible and responsive to short and long-term needs.

Predischarge occupational therapy home assessment visits: Towards an evidence base

Predischarge home assessment visits are a commonly accepted, but little researched, aspect of occupational therapy practice. The aim of this research was to systematically investigate current predischarge occupational therapy home assessment visit practices in a rehabilitation ward of a regional Australian hospital. A retrospective chart audit was conducted over a 7-month time period and included 227 patients discharged from the inpatient rehabilitation ward at the study hospital. Fifty-five per cent of patients in the study sample received home assessment visits. At least one recommendation for change was made as a result of the visit for 99% of those patients receiving visits. A total of 139 visits were completed and resulted in 1179 recommendations for change. The median number of recommendations made for the home assessment visits was 10 (range 0-33). The most common types of recommendations, timing of visits, persons present during the visit and documentation of visits were also investigated. Although occupational therapy home assessment visits are routinely completed, there is limited research available to provide evidence-based guidelines relating to predischarge occupational therapy home assessment visit practices. Recommendations for future practice and areas for further research into occupational therapy home assessment visits are discussed.

Occupational Therapy Home Assessments: More than Just a Visit? An Audit of Occupational Therapy Practice in Oncology and Palliative Care

Occupational therapists at a specialist cancer centre found home assessments to be the most time-consuming intervention. To evaluate the breakdown of time and total time use for this intervention, 15 occupational therapists working in the area of oncology and palliative care participated in an audit. A total of 107 home assessments was audited. The results indicated that the total time for an average home assessment in the audit ranged between 3.31 hours and 5.59 hours. They also highlighted that the time spent in preparation and follow-up was similar to the time spent in travel and the visit itself.

Occupational Therapists' Perceptions of Predischarge Home Assessments with Older Adults in Acute Care

Predischarge occupational therapy home assessments are routinely performed with older adults in Europe, Australia and North America. Their primary aim is to facilitate a timely and safe discharge from hospital. However, there is a lack of published research on this topic, especially studies exploring occupational therapists' perceptions of home assessments. The paper aims to redress this by describing occupational therapists' perceptions of predischarge occupational therapy home assessments with older adults in acute care. All occupational therapists who undertook home assessments in an acute care hospital with older adults during the duration of the study period were invited to complete a reflective diary. In total, 15 reflective diaries were completed by six therapists. The data were analysed using thematic content analysis. The findings suggest that home assessments were carried out because of mobility or environmental concerns. Satisfaction and dissatisfaction with the outcome of the home assessment were related to the incidents that occurred during the assessment. Some of the occupational therapists' anxieties were related to the older adults' level of functioning or ill health, and the older adults' own concerns did have an impact upon the therapists' expectations of the home assessment process.

Chart audit of predischarge occupational therapy home assessment visits

Chart audit of predischarge occupational therapy home assessment visits