Occupational Therapy Service Provision Research Articles

Do physical agent modalities fit under an occupational therapy scope of practice?

While visiting a rehabilitation centre, I observed an occupational therapist using Functional Electrical Stimulation (FES) with a client who presented with an upper extremity hemiplegia due to a stroke. FES, a technique that uses electrical currents to activate nerves innervating upper and lower limbs that are paralysed, was being used to promote wrist extension. I was surprised to see an occupational therapist using a treatment approach that fell under the physical agent modality (PAM) category. PAMs are ‘those procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance’ (Bracciano et al., 2012: 1). Categories of PAMs include superficial thermal agents, deep thermal agents, and electrotherapeutic agents and mechanical devices. ‘PAMs use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema or inflammation’ (Bracciano et al., 2012: 1). Given that PAMs have traditionally been the professional domain of physiotherapists and other related practitioners, this raises a philosophical question: do PAMs fall under a client-centred, occupation-focused approach to occupational therapy service provision? This has generated some debate in the field previously (Stancliff, 1998; Wolf, 1995). PAMs appear to be used more in the context of the therapist applying or doing a physically based intervention to the client passively instead of the client actively engaging in an occupation. Some authors suggest that PAMs are appropriate for occupational therapy practice use when they are used as a preparatory method that can be used alongside a purposeful activity or during occupational engagement (Bracciano and Mu, 2009). A position statement about PAMs published by the American Occupational Therapy Association (AOTA, 2012) endorses this. Thinking of a person engaging in self-care, productivity, or leisure occupations in their daily living environment, applying PAMs to clients does not appear to fall under an occupational approach to practice. Our forte is promoting clients’ involvement in daily occupations that are relevant, meaningful, rehabilitative, educational, and/ or achievable. I am in no way trying to cast the use of PAMs with clients in a negative light, however, I am proposing that they may be not the most suitable intervention option within the scope of occupational therapy practice. In my view, if you think a client would benefit from the application of a PAM, then he/she should be referred to our physiotherapy colleagues. Occupational therapists who do use PAMs need to be sure they have the specialist skills to use them safely and appropriately, that it fits within the practice guidelines mandated by professional licensing boards and regulatory bodies in the jurisdictions where they practice, and that malpractice insurance policies cover therapists who utilize PAMs. I encourage further debate about this issue.

Exploring occupational justice in consumer perspectives on assistive technology

Occupational justice is an emerging paradigm in the provision of occupational therapy services. Assistive technology (AT) services, a key practice domain in occupational therapy, facilitate the participation of individuals with disabilities in all major occupations. The goal of this study was to explore personal meanings of occupational justice among consumers of AT and to propose strategies that integrate values of occupational justice in AT services. A content analysis of interviews with seven consumers of AT devices was employed. Themes relevant to the four conceptual definitions of occupational injustice, namely marginalization, alienation, deprivation, and imbalance, were identified. Four corresponding themes were inherent in the consumer experiences: ability to exercise choices through use of AT devices, using AT to achieve optimum occupational potential, empowerment through AT services, and personal relation to the AT device. Specific issues within these themes are classified and described according to the four conceptual definitions of occupational justice. The application of occupational justice is essential to promote client-centred AT services particularly in evaluation of needs, selection and acquisition of AT devices, and training and support for use of AT devices.

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Perspectives Regarding Occupational Therapy Practice with Children and Families

This article gives a brief description of Ireland's demographics and its national health service, the Health Services Executive (HSE). It highlights how economic and social changes within the country and the development of the HSE affected pediatric occupational therapy service provision. It gives an overview of the settings in which pediatric occupational therapists work, which include community health services, non-governmental agencies, acute hospitals, and schools. The role of special interest groups in developing policies and services is described. Pediatric occupational therapy practice is discussed, referencing some advantages and challenges that are faced by therapists in their striving for client-centeredness and occupation-focused services provision. The most used assessments are listed and the most dominant frames of reference discussed. It concludes by highlighting continuing professional education in pediatric occupational therapy and research activity, which is increasing in Ireland.

Access to Occupational Therapy in Schools: An International Perspective

This article describes the multilayered impact that legal, institutional, and organizational structures and processes can have on occupational therapy service provision in schools. Two cities (Philadelphia and Melbourne) on different continents are compared to identify supports and barriers to the availability of occupational therapy services to students with disabilities. By contrasting system supports and constraints affecting the availability of occupational therapy in different countries, potential areas for professional advocacy are revealed. This article compares occupational therapy services in different education systems and offers insights into actions and areas that professionals might target to improve the availability to occupational therapy to students who need such services.

Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapists, occupational therapy assistants, and occupational therapy aides and in the appropriate and effective provision of occupational therapy services. It is expected that occupational therapy services are delivered in accordance with applicable state and federal regulations, relevant workplace policies, the Occupational Therapy Code of Ethics (AOTA, 2005), and continuing competency and professional development guidelines.

Occupational Therapy in the Integrated Elderly and Community Support Services for the Elderly in Hong Kong

The Integrated Elderly and Community Support Service supported by the Social Welfare Department in Hong Kong has been in operation since November 2000. This paper is a brief review on the provision of community occupational therapy services for the elderly in Hong Kong and sheds light on their development in future.

Occupational Therapy in the Integrated Elderly and Community Support Services for the Elderly in Hong Kong

The Integrated Elderly and Community Support Service supported by the Social Welfare Department in Hong Kong has been in operation since November 2000. This paper is a brief review on the provision of community occupational therapy services for the elderly in Hong Kong and sheds light on their development in future.

Occupational therapy services for adult neurological clients in Queensland and therapists’ use of telehealth to provide services

Occupational therapy is an important component of neurological rehabilitation. Clients in rural areas have fewer opportunities to receive rehabilitation than those in metropolitan areas. Telehealth is a potential method of closing these gaps in service delivery, although research into telehealth applications for neurological rehabilitation is extremely limited. To assist in the development of appropriate telehealth applications, this study aimed to identify the nature of occupational therapy services for neurological rehabilitation in areas of Queensland other than the capital city of Brisbane, the barriers to service delivery, and the current uses of various information and communication technologies among occupational therapists. A self-administered questionnaire was sent to occupational therapists working in adult neurological rehabilitation in all areas of Queensland other than the capital city of Brisbane. Contact details were obtained from OT AUSTRALIA Queensland. Responses were received from 39 eligible participants. The client's home was the most frequent setting in which participants saw clients. Home visits and modifications, equipment prescription, client/family education, and activities of daily living assessment and retraining were the most common interventions provided by participants. Frequently identified barriers to service provision included travelling distance to clients, large workloads and limited resources. Telephone, email, fax, the Internet and videoconferencing were available in most workplaces. Few participants used the Internet or videoconferencing for purposes other than continuing professional development. Home-based assessment and intervention appear to be frequent components of occupational therapy practice among therapists working in neurological rehabilitation. The use of telehealth to provide direct home-based client services is currently limited, but should be explored as a possible solution to overcome some of the identified barriers to occupational therapy service provision for clients with neurological conditions in rural and remote areas.

Redesigning Occupational Therapy Service Provision to Increase Efficiency, Effectiveness and Stakeholder Satisfaction

The Newham Children's Services Occupational Therapy Department faced a number of major challenges, including an insufficient capacity to meet the growing demand for services, insufficient funding, an inability to fill posts consistently and an extremely long waiting list. It used business process redesign (BPR) techniques to address these problems. The redesign process involved a systematic and thorough approach to problem solving and the implementation of the solutions. Within 3 years, the team had decreased significantly both the rate of formal complaints and the length of the waiting list. It had also increased staff retention and morale. The team's success demonstrates that BPR can be a useful tool in improving the efficiency and effectiveness of occupational therapy services and stakeholder satisfaction.

Intraprofessional Fieldwork Education: Occupational Therapy and Occupational Therapist Assistant Students Learning Together

In the past 10 years, the use of support personnel in Canada has generated significant interest from occupational therapists, professional associations, regulatory bodies, employers, educational institutions, and government agencies. The purpose of this study was to explore the impact of a combined collaborative fieldwork placement and weekly tutorial as a teaching strategy for intraprofessional education. Seven pairs of student occupational therapists and occupational therapist assistants were assigned to fieldwork placements. Tutorials were scheduled during the placements to discuss intraprofessional issues and provision of occupational therapy services in the clinical setting. Journaling and focus groups were used to collect data from students, tutors, and preceptors. Three key themes emerged from the data: (1) developing the relationship, (2) understanding roles, and (3) recognizing environmental influences on learning. Intraprofessional learning experiences prior to graduation can help prepare occupational therapy and occupational therapist assistant students for future collaborative practice.

Factors Related to the Intensity of Occupational Therapy Utilization in a Geriatric Chronic Care Setting

There is very little known about the intensity of occupational therapy service provision in relation to client characteristics of a geriatric chronic care population. A model was utilized to study demographic and clinical factors associated with the intensity of occupational therapy utilization. A retrospective correlational design was carried out using secondary analysis of occupational therapy workload data merged with selected variables from the Minimum Data Set (MDS) at Baycrest Centre for Geriatric Care, Toronto, Ontario and included a sample of 168 clients receiving occupational therapy. The outcome measure used was the total number of minutes of occupational therapy service provided. Having a pressure relieving device for the chair and being active more than one third of waking hours were significantly associated with the intensity of occupational therapy utilization. The clients received a greater amount of time in indirect therapy compared with the amount of time which they received in direct care. The method used to examine occupational therapy service utilization developed in this research facilitates the understanding of occupational therapy resource use based on client characteristics.

Mental Health Vocational Rehabilitation: An Overview of Occupational Therapy Service Provision in Northern Ireland

The job clinic model was established in Northern Ireland in 1992. It was initiated by mental health occupational therapists and represented an interagency model of vocational rehabilitation (McCrum et al 1997). Occupational therapy vocational practice has evolved significantly since then, with a regional variation in service delivery, which necessitated review. There was a recognition that practice needed to be examined to develop services in a unified professional way. This paper gives an overview of occupational therapy mental health vocational service provision in Northern Ireland. The authors sought information from 13 regional trusts, which demonstrated that vocational work is a very active part of occupational therapy provision but that there are also opportunities to develop services based on current evidence. This paper makes recommendations and highlights the action required to take forward occupational therapy vocational rehabilitation in Northern Ireland.

The Dilemma of Psychosocial Occupational Therapy in Public Schools

This article presents the textual analysis of the responses of 373 occupational therapists working in school systems across the United States of America who responded to the question “List any obstacles to providing occupational therapy services to school aged students with severe emotional disturbance” on a recent survey. The purpose of the analysis is to describe some of the barriers and solutions to the provision of occupational therapy services to school aged students with emotional disturbance. The 754 responses received were categorized into themes. The themes which emerged from the occupational therapists' responses were: (1) role confusion; (2) limited knowledge base; (3) identification and provision of occupational therapy services; (4) administrative factors; (5) lack of efficient teaming; (6) classroom factors; (7) the behaviors of the student with emotional disturbance; and (8) parental factors. The respondents' suggestions for improving the provision of occupational therapy services to this population are discussed.

Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2004)

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapy personnel and in the appropriate and effective provision of occupational therapy services. All personnel are expected to meet applicable state and federal regulations, adhere to relevant workplace policies and the Occupational Therapy Code of Ethics (AOTA, 2000), and participate in ongoing professional development activities to maintain continuing competency.

Clinical Application of the Canadian Model of Occupational Performance in a Forensic Rehabilitation Hostel

In order to improve the quality and effectiveness of occupational therapy service provision, therapists should be using models of practice. This paper describes the Canadian Model of Occupational Performance and critically evaluates its application within a forensic rehabilitation hostel. It provides examples from practice and discusses the strengths and limitations of the model.

Conducting a needs assessment to justify the provision of occupational therapy services in a rheumatology outpatient clinic

Investigating the best method of service delivery, or the ‘need’ for a particular service is gaining increasing support as demands intensify across the health‐care system, often with reduced financial resources. Following a restructuring within the Occupational Therapy department at the Austin and Repatriation Medical Centre, a limited amount of time (0.2 EFT Grade II) became available to provide additional services within the hospital. Occupational therapy services to patients of the rheumatology outpatient clinics had ceased since funding cuts approximately 7 years before, yet there had been numerous requests for service. As part of quality assurance activities, a needs assessment was conducted, interviewing clients attending these outpatient clinics. The Health Assessment Questionnaire, a Visual Analogue Scale for Pain, and a non‐standardised questionnaire were used to assess the need for occupational therapy by this patient group. Thirty‐five people were interviewed over a period of 2 weeks. The results supported increased occupational therapy involvement with this client population within the rheumatology outpatient clinic specifically in the areas of improving functional performance, pain management and hand therapy. The study also highlighted a need for promotion of the occupational therapy role both with clients and the medical staff.

An Exploratory Investigation of Undergraduate Students' Perceptions of Cultural Awareness

As the British population becomes increasingly diverse, cultural differences pose challenges for health and social care workers. The aim of this exploratory study was to investigate occupational therapy students' perceptions of cultural issues and their perceived level of cultural awareness. A self-administered questionnaire was designed to target the occupational therapy students from a university occupational therapy degree course in the North East of England. Fifty-one of the 65 questionnaires were completed. Two questionnaires were returned as address unknown and, therefore, were excluded from the study. The overall response rate was 81%. The results showed that the students seemed to have a positive attitude towards cultural influences on occupational therapy services. However, a lack of knowledge and skills about different cultures was expressed. The need for more information and education on these issues was emphasised. The findings confirmed that there was a significant negative correlation between the stage of education and training and the amount of exposure to cultural issues in occupational therapy theory. This study offers some insights, which would be beneficial in the development of a culturally sensitive education curriculum and the provision of quality occupational therapy services for people from different cultural commitments.

An Evaluation of the Design and Implementation of a National Vocational Qualification in an Occupational Therapy Service

This article is a study of the implementation of the Self and Environmental Management Skills National Vocational Qualification (NVQ) in an occupational therapy service. The history and reasons for developing NVQs are first described. Semi-structured interviews were used to obtain comments from the four candidates about their perceptions of the assessment process. The discussion incorporates these views, which are of both positive and negative experiences. Recommendations are made in order to improve future NVQ programmes. The article concludes that, in this situation, despite some difficulties, the NVQ has generally improved occupational therapy service provision.

Mandatory HIV testing and occupational therapists.

As the prevalence of human immunodeficiency virus (HIV) increases, so does the prevalence of HIV-positive health care workers. This study explored what effect this will have on occupational therapy service provision. Attitudes and policies of 118 occupational therapy administrators were examined in relation to mandatory testing for HIV, attitudes on treating HIV-positive patients, working with HIV-positive staff members and students, and use of Centers for Disease Control's guidelines on universal precautions. A stratified sample of 200 occupational therapy administrators, drawn proportionally from all occupational therapy fieldwork centers, was sent questionnaires. The respondents (N = 118) were asked questions reflecting policy and attitude regarding HIV-positive staff members, students, and patients and mandatory testing. Descriptive statistics and chi-square analyses were computed to examine variances related to policy, ethics, and attitudes. Few occupational therapy departments have policies regarding HIV-positive health care workers or students. Those policies in place involve disability discrimination acts and using universal precautions. More than one third of the respondents support mandatory testing of all health care workers and notifying patients if their occupational therapist is HIV-positive. A large minority of respondents would either refuse to hire or train an HIV-positive therapist or student, or would restrict patient care responsibilities. Although most occupational therapy administrators adhere to CDC guidelines and anti-discrimination policies, some concern and fear was expressed regarding HIV transmission through occupational therapy practice. This may result in administrative decisions regarding work and training responsibilities that are unnecessarily restrictive, such as limiting all patient care responsibilities.