Occupational Therapy Input Research Articles

Improving the efficiency and person-centredness of occupational therapy input into care-plans in a forensic mental health and rehabilitation service

Care-planning is vital to the delivery of timely, person-centred, safe and effective care. Despite the understanding of the benefits of person-centred care-plan in both services, occupational therapists (OTs) within our...

The Impact of Introducing Generic Therapy Assistants to an Acute Occupational Therapy Stroke Service

Abstract Background It has been recommended that patients post-Stroke should receive 45 minutes of Occupational Therapy (OT) input on at least five days per week to evoke meaningful and significant improvements in patient-centred outcomes. However, service capacity cannot always meet recommended levels. Generic Therapy Assistants (GTAs) offer opportunities to bolster staffing and increase intensity and quality of OT input. This pilot aims to investigate the impact of the recruitment of two GTAs upon OT services in an acute Stroke unit. Methods Two GTAs were recruited to the service and underwent tailored training, followed by in-service training and supervision support. Data was collected prior to their recruitment for a four-week period (Timepoint 1) and again following their appointment (Timepoint 2). Duration of OT sessions were categorised as High (>36 minutes), Moderate (23-36 minutes) and Low Intensity (<23 Minutes). Key metrics were the number of sessions that took place, the proportion of sessions deemed low, moderate and high intensity and a functional measure of included patients using the Functional Independence Measure (FIM). Results Total sessions increased from 113 to 184 from Timepoint 1 to 2, and sessions deprioritized reduced from 116 to 71, with greater contact time per day during Timepoint 2. The proportion of sessions described as High Intensity increased from 45% to 63%. Twelve patients from each cohort had functional changes measured, with scores recorded on initial assessment and on discharge. Average increases of 3.75 points were observed during Timepoint 1, and 8 points at Timepoint 2. Conclusion The addition of two GTAs to the Stroke service in this acute hospital facilitated positive changes to the OT service capacity and delivery. Increased numbers of sessions and session duration were observed, alongside a greater proportion of sessions being of High Intensity, and greater functional improvements when compared to similar data collection prior to their recruitment.

Consumer-driven evaluation of assistive technology usage and perceived value in people with myositis in Australia.

Idiopathic inflammatory myopathies (known as 'myositis') are a group of rare sporadic inflammatory muscle disorders that significantly impact function and quality of life. There are no standardised approaches in the use of assistive technologies in myositis. This study was initiated to investigate current use and perceived value of assistive technology (AT) by people with myositis. A cross-sectional online questionnaire (Qualtrics) was designed to capture information regarding AT use and perceived value and demographic information from people with myositis across Australia. The questionnaire was distributed via the Myositis Association of Australia and specialist myositis clinics. Participants were asked to identify which AT items they owned and how frequently the item was used and to rate the 'usefulness' of those items. Information was also collected on participants' engagement with health professionals regarding assistive technologies. Consumer involvement via the Myositis Research Consumer Panel identified a knowledge gap regarding AT. The questionnaire was designed with consumer input and review. One hundred two people (102) with myositis completed the questionnaire. One hundred (100) participants owned at least one AT device, with a median of 12.5 items and a maximum of 65 items. The most used devices were associated with toileting, personal care and mobility. Participants rated AT devices relating to environmental support, sleeping, seating and body support as most useful. There was a positive correlation between disease duration and number of devices used (r2= 0.248, p= 0.012). Majority of participants (75.5%) were interested in talking to health professionals about AT; however, only 50% had done so. AT device usage is high among people with myositis, with most items deemed to be useful. Greater occupational therapy input into recommendations and potential funding options may improve knowledge and access to AT.

43 Nursing Home Residents presenting to the Emergency Department; what can multidisciplinary, integrated frailty teams offer?

Abstract Background Comprehensive Geriatric Assessment (CGA) in the Emergency Department (ED) may provide opportunities to improve care of Nursing Home Residents (NHR). The aim was to develop an abbreviated CGA (aCGA) for NHRs presenting to the ED and identify their multidisciplinary care needs. Methods The existing Frailty at the Front Door (FFD) CGA was simplified. Over a three-month period, consecutive patients over the age of 75 years in an age friendly hospital accredited emergency department, were selected by address from iPMS and underwent an aCGA. Age, gender, Clinical Frailty Score (CFS), 4AT, excessive polypharmacy, high risk medications usage, 4QT swallow screen, MST nutrition screen, need for physiotherapy and/or occupational therapy input, use of intravenous (IV) antibiotic therapy and the number of those experiencing their last 1,000 days was entered prospectively onto an Excel database. Data was analysed using descriptive statistics. Results 104 NHR presented to the ED, 59 of which (57%) underwent an ‘a-CGA’. Co-ordinated care was then delivered through the FFD. The mean (SD) age was 85 years (+/−6.5). Male to female ratio was 2:1. The mean CFS was 6.6(+/−0.5) 0.39% (n = 23) were at risk of delirium (4AT ≥ 2), 80% (n = 47) had excessive poly-pharmacy or were prescribed high risk medications, 63% (n = 37) presented with dysphagia, 50% (n = 30) were at risk for malnutrition (MST ≥ 2), 39% (n = 23) required trans-disciplinary assessment of function/mobility, 52% (n = 31) required IV antibiotics and 20% (n = 12) were experiencing their last 1,000 days. Conclusion The aCGA effectively identified frailty syndromes, triggering early input from the ED based interdisciplinary team. A significant number of NHRs were in their last 1,000 days. Administering IV antibiotics in nursing homes with on-site access to the wider multi-disciplinary team would address the needs of many NHRs who currently have no option other than admission to hospital. For those in their last 1,000 days particularly, this would represent a more person-centred approach.

15 Hospital at home—a potential alternative option to acute hospital admission for older adults

Abstract Background Novel ways to respond to the acute care needs of older adults are needed. Hospital at Home (H@H) could be a viable alternative to emergency hospitalisation. We developed inclusion and exclusion criteria for selected medical conditions that could theoretically be treated in a hospital at home setting if supported by a geriatric medicine multidisciplinary team with a consultant, Advanced Nurse Practitioner (ANP), Physiotherapist (PT) and Cccupational Therapist (OT). Methods We completed a retrospective cohort study of unselected medical admissions over a two week period in a level four hospital. We developed illness specific criteria for stable patients that if met could allow a patient to be treated in a hospital at home environment. These conditions included community acquired pneumonia, congestive cardiac failure, COPD exacerbation and urinary tract infection. Results There were 307 medical admissions over the study period, with 144 over the age of 75 (47%). Mean age 83.2. 59 patients met our inclusion criteria for a potential H@H service (41%). All patients were clinically stable based on admission vital signs. The mean length of stay was shorter for patients eligible for H@H than patients who did not meet the criteria (9 days vs 14 days, p 0.01), and patients meeting the H@H criteria were more likely to be discharged home directly. They were less likely to have needed occupational therapy (32% vs 52%, p = 0.02) or medical social worker input (22% vs 42%). There was no difference in frailty category or readmission rates by whether or not a patient met the H@H criteria. Conclusion Over 40% of unselected medical take patients were of a low acuity that could have theoretically met our inclusion criteria for a supported hospital at home model. Strategies are needed to support expansion of this model of care.

894 What Proportion of Acute Admissions for Urinary Tract Infection Under Urology Require Surgical Intervention Within 6 Months?

Abstract Introduction All male patients with urinary tract infections (UTI) at this large district general hospital are admitted under the care of the urology department. This audit aims to establish how many male patients over the age of 70 with a diagnosis of UTI required surgical intervention in the 6 months following admission. Method We performed a retrospective audit of all patients over 70 admitted with a UTI over a five-month period. Patients with recent instrumentation or other pathologies, including visible haematuria or ureteric stones confirmed on imaging in the accident and emergency department were excluded. Results Of the 30 patients included, five (16.7%) required invasive intervention. Three (10%) acutely, (two ureteric stents, one nephrostomy), two (6%) as an outpatient on an elective basis (flexible ureteroscopy and prostate artery embolisation). Conclusions Over 80% of patients included in this audit did not require surgical intervention within six months. Whilst UTI is a significant finding in younger men suggestive of structural or systemic abnormality, UTIs in incontinent, catheterised, or older men does not carry the same risks and rarely requires intervention. Elderly care wards were established to ensure older patients receive support to improve health functioning and prevent acute deterioration in physical and mental health during admission. Given that less than 20% of men required intervention, this cohort of patients would be better admitted to wards geared towards elderly care who are better able to manage their co-morbidities and have the resources for early physiotherapy and occupational therapy input.

Occupational Therapists on The Front Line

Introduction. There is a growing focus on the need for an increased number of allied health professionals to reduce the pressure on acute hospitals through admission avoidance. There is little in the way of guidelines on how services should be delivered and a lack of evidence base demonstrating effectiveness. Methods. An audit has been carried out by the occupational therapy team in the Emergency Department to capture the total number of referrals to the occupational therapy service in the Emergency Department at Royal Berkshire Hospital and to capture discharge decisions made following occupational therapy input. Results. The occupational therapy team in the Emergency Department focuses particularly on admission avoidance using a home first approach to prevent patients from being admitted to acute wards. The results showed that the service was beneficial regarding both the number of referrals and the utilisation of various discharge destinations from the Emergency Department. Conclusion. The report has identified several areas for further research by the same team and implications for the wider literature base. The hope is that this report would highlight the role of occupational therapists working in the emergency department at Royal Berkshire Hospital and encourage the completion of further research in this area of practice.

Innovation and invention: the role of virtual occupational therapy in the management of motor neurone disease

Background: Motor neurone disease (MND) is a progressive neurological condition with no known cure. Supportive management and symptom control by a multidisciplinary team forms the mainstay of treatment. Caring for patients with MND throughout the COVID-19 required service providers to think of ways to adapt the service in order to meet the acute and constantly changing needs of their service users within pandemic guidelines. Aims: This paper explores innovative changes within the occupational therapy service provision during the pandemic and how it supports the multidisciplinary team (MDT) working. It also evaluates the merits and disadvantages of using virtual technology in specific areas of occupational therapy intervention. Methods: A set of prioritisation criteria was developed to understand the rationale for virtual versus face-to-face input. A reflective process has been used to identify and evaluate innovative service provision in occupational therapy in the management of motor neurone disease. Findings: Virtual consultations were an effective way of providing certain aspects of occupational therapy input. Virtual consultations were found to be less effective during moving and handling assessments, complex environmental adaptations assessment and when managing complex cognitive presentations. During the pandemic there was a rise in referrals for cognitive behavioural management, a specialist area of expertise for occupational therapy in this clinical area. A holistic approach was paramount in meeting the evolving needs of patients across functional domains. Occupational therapy complemented the caring and supportive role of nurses and other members of the MDT in the management of MND. Conclusions: Occupational therapy input can support an MDT by providing valuable assessment of functional decline, specialist equipment, supporting cognitive-behavioural performance, restoring life roles and minimising the challenges imposed by the environment. Using virtual technology discernibly can be an invaluable approach to occupational therapy practice within an MDT setting for managing a progressive neurological condition, such as MND, during a pandemic.

215 WHAT IMPACT CAN ‘EMERGENCY DEPARTMENT IN THE HOME’ (EDITH) HAVE ON THE OLDER ADULT POPULATION PRESENTING WITH FALLS?

Abstract Background EDITH is a frailty response service providing medical and occupational therapy input to older adults living within the catchment area of a level 4 acute hospital. EDITH aims to reduce avoidable Emergency Department (ED) attendances and utilise alternative care pathways. Falls are common among older people and are often associated with poorer outcomes. Traditionally, older patients who have had a fall and contact emergency services for assistance are transferred to the ED and this can be associated with elevated risks. Additionally, older patients who have had a fall and are discharged on scene by the emergency services are at greater risk of recurring falls in the absence of immediate onward referral to community falls prevention services (Nowak and Hubbard 2009). Methods Paper count method data collection was completed. Inclusion criteria included referrals from the National Ambulance Service within the last 6 months. Results 75 patients met the inclusion criteria; 34 males, 41 females with an average age of 82. 11 patients were conveyed to hospital, giving a conveyance rate of 14.6%, the average conveyance rate for the EDITH service is 7.2%. 3 patients were conveyed to ED, while 8 patients were conveyed to the Medical Assessment Unit (MAU) in the local level 3 hospital. This resulted in 72% of patients that required hospital conveyance being streamed to the MAU; traditionally 100% of these patients would have presented to ED. Overall, 85.4% of patients seen remained at home. Conclusion EDITH are providing targeted medical and occupational therapy assessment(s) for older adults in their homes with successful outcomes. Implementation of alternative care pathways, reduction in avoidable ED attendances and prolonged independence in the home for this patient profile are some of the favourable findings. Reference 1. Nowak A, Hubbard RE. (2009) Falls and frailty: lessons from complex systems. Journal of the Royal Society of Medicine. 102(3):98–102.

In need of review: Developing Sensory Provision in Northern Ireland’s Mainstream Primary classrooms

The impact of Sensory Processing Difficulties across a range of Special Educational Needs is well researched. More recently, the impact on children’s mental health and well‐being, linked with anxiety, depression and self‐injurious behaviours, have redirected international research to consider the holistic benefits of sensory provision, for those with special educational provision and the wider classroom population. A SMART SURVEY was designed to collate empirical evidence regarding current sensory awareness and provision in mainstream primary schools throughout Northern Ireland, in a time efficient manner. Out of 809 schools, 164 (20.27%) fully completed the online survey. Findings indicate that Special Educational Needs Coordinator confidence in developing practice, supporting staff and children was limited and impaired by insufficient and inconsistent training opportunities. While healthcare research recommends provision by trained professionals, Occupational Therapy input was limited (n = 34; 24.8%), resulting in practice that could be detrimental rather than beneficial to children’s progress. Respondents identified a need for sensory training for teachers (n = 124; 93.94%) to ensure that the impact of Sensory Processing Difficulties on the holistic development of all children is understood. Pupil voice was undervalued (n = 5; 3.6%). Active involvement of children in the process of evaluation and intervention is recommended to enhance pupil autonomy and well‐being.

Global assessment of pollicization outcomes: an analysis in 27 patients

Outcomes measurements after pollicization remains difficult due to the lack of a standardized assessment protocol. This study reports our experience of a global assessment of pollicized thumbs that includes a specific questionnaire for subjective evaluation, a detailed clinical assessment focused on functional outcomes incorporating function and usage of the pollicized thumb. Twenty-seven patients completed the questionnaire, and nine hands were clinically evaluated by a multidisciplinary team composed of hand surgeons and occupational therapists. Subjective evaluations revealed that 24 patients would recommend pollicization. Clinical evaluations revealed that only four out of nine patients properly integrated their pollicized thumb during bimanual activities; however, occupational therapy input allowed the children to compensate for the lack of strength and other difficulties. We propose the use of this global assessment package to analyse function and usage at various capacities, which can be useful for the surgeon, child and parents.Level of evidence: IV.

416 A NARRATIVE SYSTEMATIC REVIEW OF POSTOPERATIVE REHABILITATION FOLLOWING SURGERY FOR ESOPHAGEAL CANCER

Abstract Esophagectomy is a complex procedure with associated high levels of morbidity. Rehabilitation programmes are being developed and increasingly utilised in the perioperative period and comprise a variety of physical, nutritional and psychological interventions. Such strategies may help reduce the incidence of postoperative complications, mitigate sarcopenia, prevent progressive frailty and restore quality of life. This systematic review aimed to identify and analyse studies reporting outcomes of post-esophagectomy rehabilitative interventions. Methods Major reference databases (PubMed, Medline, EMBASE, Cochrane Library and Google scholar) were interrogated and a systematic search with a pre-defined search strategy was performed up until January 2020. All eligible articles were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using the MINORS (Methodological Index for Non-Randomized Studies) criteria for cohort studies and the Cochrane risk of bias tool for randomised studies. Results Three studies (n = 1 pilot study; n = 1 feasibility study and n = 1 randomised controlled trial) including some 108 patients were included in this narrative review, of whom 64 patients had undergone esophagectomy. Rehabilitative strategies utilised included a combination of physical activities such as walking and low- to moderate-intensity exercises, dietary counselling, psychological support and occupational therapy input. There was wide variation in the outcomes assessed between studies. Postoperative physical activity with exercises consistently demonstrated maximum positive impact upon cardiopulmonary fitness. The median MINORS score for included studies was 9 (8-10) and the risk of bias in the included randomised trial was low. Conclusion There is a paucity of data currently to help determine the impact that rehabilitation may have on clinical outcomes and quality of life following esophagectomy. While improved physical function has been demonstrated, there is a need to determine which interventions patients deem most important and acceptable to help them return to as close to baseline as possible. Additionally, there is a need to further understand the impact rehabilitation may have upon long-term outcomes.

Sport as a Leisure Occupation in Occupational Therapy Literature: A Scoping Review.

The focus of occupational therapy is often on personal care, life skills, and daily living. Sport, as a type of leisure activity, can also provide benefits to health and well-being. Occupational therapy practitioners should therefore promote the role of sport in the lives of clients. To investigate the extent, range, and nature of peer-reviewed occupational therapy literature investigating sport as a leisure occupation. The following databases were searched: Embase, MEDLINE, OTseeker, PsycINFO, PubMed, and SPORTDiscus. We identified published studies investigating competitive sport in occupational therapy research or practice. Included studies investigated adult participants (age ≥18 yr) participating in sport, had a clear occupational therapy input, and were written in the English language. Six studies met the inclusion criteria. Only 2 of the 6 studies identified through the search strategy were conducted after 2004, diagnosis and outcome measures varied widely, and sport as a leisure occupation was found to have positive individual outcomes. Opportunities exist to investigate sport as a leisure occupation and its involvement in occupational therapy practice. Future research may contribute to positive outcomes and experiences for clients who receive occupational therapy. This scoping review describes literature about sport as an occupation and highlights the opportunities for practitioners and researchers to incorporate sport as a leisure occupation.

P74 Group counselling: a holistic care model

Abstract Background Disease modifying anti rheumatic drugs (DMARDs) play a vital role in controlling autoimmune disease. They are complex medications requiring nurse counselling to initiate. Staff vacancies and increasing referrals led to 12-week waiting times from decision to treat in our Trust. We wanted to improve the efficiency of the medication counselling process, but at the same time use it as an opportunity to educate our patients on their disease, management and self-care. Methods We designed and delivered a successful group clinic to improve patient experience, reduce waiting times and improve efficiency. As well as covering the necessary DMARD information, the clinic includes patient education on general, physical and mental well-being, dietary advice as well as physiotherapy and occupational therapy input. The clinic format consists of a presentation/discussion, peer support and individual consultation, providing truly holistic care. Results Waiting times: reduction from 84 days to 7-14 days from decision to treat for our two main DMARDS and 56 days to 14 days for our anti TNF therapies. Clinical outcome/patient safety: Earlier initiation of DMARDs has been shown to reduce morbidity. Financial: Additional £444 income per clinic (compared with previous clinic process) at a tariff of £111 per patient. Group clinics currently run weekly. Patient feedback: 50 patient feedback forms have been collected and reviewed. Of these 50 patients 97.8% of questions asked were marked as agree or strongly agree to a positive experience. Shared learning: The clinic format was presented at a regional meeting and at our Trusts Quality Improvement Day. There is interest in adopting a similar approach in other departments in the Trust and in other rheumatology departments in the region. Conclusion Our group consultation model provides a holistic model to care that has been very popular with our patients. We have subjectively had an increase uptake in physiotherapy services and patients seem to be persevering and tolerating their medications better. Our group consultations have been running successfully for a year, and we have expanded the sessions to cover more drugs including our anti TNF therapies. It is yet early days to comment on the long-term impact our clinic has on patients, but with our clinic providing patient education and empowering patients through self management we are hopeful that we will be improving the long-term outcome of our patients. Disclosures K. Nadesalingam None. C. Short None.

The impact of surviving bowel cancer on occupation: A scoping review

Introduction The number of people surviving bowel cancer is increasing globally, with many of those affected living with long-term psychological and physical sequelae that potentially disrupt occupations. Method A scoping review – guided by Arksey and O’Malley’s methodological framework – was conducted to provide an overview of what is known about the impact of having had bowel cancer on occupations, and to reveal the potential role of occupational therapy. A systematic search of four databases and a grey literature repository generated 244 results. Applying inclusion and exclusion criteria, 33 items addressing bowel cancer and occupations were selected and thematically analysed. Results Researchers have identified six domains of occupation that are impacted by bowel cancer (social activity, physical activity, sexual activity, employment and role functioning, physical functioning, and self-care) but survivors report a distinct lack of health professional support after completion of medical treatment and being left to devise self-management strategies to accommodate the long-term effects of their cancer. Conclusion The sequelae of bowel cancer can have a significant impact on occupational participation. There is scope for increasing and improving occupational therapy input to assist people with cancer-related loss of function to re-engage in valued occupations and improve wellbeing.

331 Implementation of Community Based Comprehensive Geriatric Assessment and Intervention in a Rural Irish Setting

Abstract Background The Integrated Care Team for Older People (ICTOP) in Sligo formed in 2018 to provide home based rehabilitation for acutely frail older adults to enable them to continue to live independently. It serves a predominantly rural catchment area with 14.5% aged >65 years versus the national average of 11%.1 An in-home person-centred multi-disciplinary approach is utilized based on the principles of comprehensive geriatric assessment (CGA). This observational study aims to describe the typical user of this service, interventions and outcomes to date. Methods An Excel database was compiled and analysed from CGA of consecutive referrals from June to December 2018. Results Of the 70 referrals studied, 69% resided in rural Sligo, two thirds were female and there was a mean age of 82.3 (range 68-95). The median Rockwood Clinical Frailty Scale level was 6 and the median Timed Up and Go was 28seconds. Hospital in-patients accounted for 58% of referrals with functional deterioration (74%), mobility decline (72%) and cognitive decline (28%) the most frequent referral reasons. Gait imbalance was the most prevalent co-morbidity (77%). There was an average of 4.5 home visits per person. Over 80% of referrals received combined physiotherapy and occupational therapy input, with Clinical Nurse Specialist (CNS) in Dementia involvement in 40%, speech and language therapy in 26% and social work in 15%. CGA identified additional clinical and social needs in 100%, and the team made 217 onward referrals to available community health and social supports. ICTOP referral decreased length of stay by 2.6days and only one patient required long term care. Conclusion The use of a multidisciplinary team providing domiciliary assessments decreased hospital stay, facilitated maintenance of independent living and addressed both identified and un-identified needs in a frail older person’s population. Further evaluation over time is needed to indicate impact on readmission rate.

Quality of Care in Hip Fracture Patients: The Relationship Between Adherence to National Standards and Improved Outcomes.

Optimizing the perioperative care of patients with a hip fracture is a key health-care priority. We aimed to determine whether adherence to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP) was associated with improved patient outcomes. In this retrospective cohort study of prospectively collected data from the Scottish National Hip Fracture Audit, we assessed adherence to the SSCHFP in 21 Scottish hospitals over a 9-month period in 2014 and examined the effect of the guidelines on 30 and 120-day mortality, length of hospital stay, and discharge destination. A total of 1,162 patients who were ≥50 years old and admitted with a hip fracture were included. There was a significant association between low adherence to the SSCHFP and increased mortality at 30 and 120 days (odds ratio [OR], 3.58 [95% confidence interval (CI), 1.75 to 7.32; p < 0.001] and 2.01 [95% CI, 1.28 to 3.12; p = 0.003], respectively). Low adherence was associated with a reduced likelihood of a short length of stay (OR, 0.58; 95% CI, 0.42 to 0.78; p < 0.0001), but increased odds of discharge to a high-care setting (OR, 1.63; 95% CI, 1.12 to 2.36; p = 0.01). Early physiotherapy input and occupational therapy input were associated with a reduced likelihood of discharge to a high-care setting (OR, 0.64 [95% CI, 0.44 to 0.98; p = 0.04] and 0.34 [95% CI, 0.23 to 0.48; p <0.001], respectively). Adherence to the SSCHFP is associated with better patient outcomes. These findings confirm the clinical utility of the SSCHFP and support their use as a benchmarking tool to improve quality of care for hip fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Feasibility and efficacy of a multi-factorial intervention to prevent falls in older adults with cognitive impairment living in residential care (ProF-Cog). A feasibility and pilot cluster randomised controlled trial

BackgroundFalls are common in people with dementia living in residential care. The ProF-Cog intervention was developed to address fall risk factors specific to this population. The aim of this study was to evaluate the safety, acceptability, and feasibility of the intervention and provide an estimate of its efficacy.MethodsThis was a cluster randomised controlled pilot study undertaken in care homes in London, UK. All permanent residents living in participating homes who were not terminally ill were invited to participate. The intervention included an assessment of falls risk factors followed by a tailored intervention which could include dementia care mapping, comprehensive geriatric assessment, occupational therapy input and twice-weekly exercise for 6 months as required to target identified risk factors. The control group received usual care without a falls risk assessment.Standing balance was the primary outcome. This and other outcome measures were collected at baseline and after 6 months. Falls were recorded for this period using incident reports. Changes were analysed using multi-level modelling. Adherence to the interventions, adverse events and trial feasibility were recorded.ResultsNine care homes enrolled in the study with a total 191 participants (51% of those eligible); five homes allocated to the intervention with 103 participants, and four homes to the usual care control group with 88 participants. The intervention was safe with only one reported fall whilst undertaking exercise. Adherence to agreed recommendations on activity and the environment was modest (21 and 45% respectively) and to exercise was poor (41%). Balance scores (score range 0–49) analysed on 100 participants decreased by a mean of 3.9 in the control and 5.1 in the intervention groups, a non-significant difference (p = 0.9). In other measures, both groups declined equally and there was no difference in falls rates (IRR = 1.59 95%, CI 0.67–3.76).ConclusionThe intervention was safe but not clinically effective. Poor adherence suggests it was not an acceptable or feasible intervention.Trial registrationISRCTN00695885. Registered 26th March 2013.

Occupational Therapy in HomEcare Re-ablement Services (OTHERS): results of a feasibility randomised controlled trial

ObjectivesThe objective of this study was to test the feasibility of conducting a randomised controlled trial (RCT) of an intervention targeted at activities of daily living (ADL), delivered by an...

What is the role of occupational therapy in an Enhanced Recovery after Surgery (ERAS) protocol?

Objectives: ERAS has prompted changes to practice across the surgical, anaesthetic and nursing professions that have minimised the surgical stress response and reduced length of hospital stay. The next goal for ERAS teams is to return patients to normal function as quickly as possible following discharge. Occupational therapists support patients to recover and overcome any barriers that prevent them from doing activities (occupations) that matter to them. This study examines the current role of occupational therapy (OT) in ERAS. Methods: A broad literature search was conducted on 26th January 2016 as described in Table 1.Table 1(MM “Occupational Therapy”) OR (MM “Activities of Daily Living“) OR (MM “Self-Help Devices“) OR occupational therap* OR activities of daily living OR self care OR assistive devices OR assistive technologyAND“enhanc* recover*” OR “fast track” OR “ERAS” OR “rapid surgery” OR “accelerated surgery” OR “rapid recovery” OR “accelerated recovery“Peer-reviewed, English language abstracts, published after 2000, were searched in the ScienceDirect, MEDLINE, CINAHL, and Cochrane databases. Open table in a new tab Results: 68 peer reviewed abstracts, in English, from 2000, were identified. This reduced to 17 once the abstracts had been filtered for duplicates and relevancy, and reduced to 4 once the full papers had been studied. The 4 remaining papers comprised a cohort study with some OT input described, but no OT specific outcome (Dawson-Bowling et al, 2014); and 3 comparative cohort studies (Husted et al, 2011; Pape et al, 2013; Petersen et al, 2008), 2 describing some OT input but no OT specific outcome, and 1 with an OT outcome, but little description of input. Conclusion: There is very little research describing the explicit role of OT in ERAS even though OTs work routinely within surgical MDTs. The skills of an OT would appear to be very useful in helping to accelerate return to full function post discharge. Further work is needed to evaluate whether OT input can help accelerate return to normal activities of daily living.