Workers' compensation insurance agents' satisfaction with occupational therapy activities of daily living assessments

Background and Aim:  Little is known about insurance agents' (insurers) satisfaction with the services provided by occupational therapists when they assess injured workers' activities of daily living (ADL). Demonstration of accountability and provision of high-quality services are important to the occupational therapy profession. The aim of this study was to evaluate insurers' overall satisfaction with occupational therapy ADL assessments for injured workers, including communication, timeliness of reports, equipment provision, knowledge of insurers' requirements and the workers' compensation process, and provision of a professional opinion. Relationships between insurers' overall satisfaction with ADL assessments, degree of experience in their job, formal qualifications and roles within their organisation were also investigated.
Method:  A telephone survey was developed and administered to a sample of 40 claims officers and injury management advisors from 10 Victorian Work Cover Authority authorised agents.
Results:  Insurers were generally satisfied with occupational therapy ADL assessments. They were less satisfied with occupational therapists' knowledge of workers' compensation system requirements and how occupational therapists made decisions when recommending household services.
Conclusion:  To improve services to the insurance industry, occupational therapists need to better understand relevant legislative frameworks.     

Predischarge occupational therapy home assessment visits: towards an evidence base

Background/aim:  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.
Methods:  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.
Results:  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.
Conclusion:  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.     

Cultural differences: The experience of establishing an occupational therapy service in a developing community

Aim:  This paper documents the subjective experience of a Western trained occupational therapist as she establishes a service in a community that is developing its health-care services. The community is located in the Dominican Republic.
Method and Results:  Ethnographic interviewing was used to document the tasks and events that occurred during this 6 month project. Challenges arose related to the region's developing health, education and community services, training the local workers and the reaction of the recipients of occupational therapy service. The contrast in beliefs, values and cultural customs between the therapist and the local people contributed to the challenge.
Conclusion:  This study indicates that exporting Western occupational therapy services without any changes causes significant conflict for the professional and the clients. Furthermore, this study demonstrates the importance of understanding cultural differences between the therapist and client, as well as the need for occupational therapy services in communities that seek to improve the health and abilities of the local people requiring rehabilitation services.     

Queensland extended care services for people with severe mental illness and the role of occupational therapy

Background:  People with serious mental illness in Queensland who require extended rehabilitation may be treated in extended inpatient mental health services. Two of these extended inpatient services, hospital and community-based 'Extended Treatment and Rehabilitation Units (ETRUs) and Community Care Units (CCUs)', are described, including the aims, objectives, philosophy and service delivery.
Methods:  A quality project involving occupational therapists working in these settings, as well as a consumer and carer, provides different perspectives concerning these relatively new health services in Queensland.
Results:  Two main occupational therapy roles were identified: case management and occupational therapy-specific roles (including assessment and intervention). The consumer and carer perspective is also presented.
Conclusion:  These services provide a positive option for people with high levels of functional disability as a result of mental illness and also for their carers. They provide environments with many exciting opportunities and challenges for occupational therapists working in mental health.     

Occupational performance modification and personal change among clients receiving rehabilitation services for rheumatoid arthritis

Background:  A client's personal process of change is recognised as an important element in the rehabilitation process that may affect the acceptance and outcome of recommended occupational therapy self-management interventions. Recent research has examined the transformative process of changing underlying values, beliefs, feelings and knowledge, collectively known as meaning perspectives, in clients receiving rehabilitation for various chronic conditions.
Aim/methods:  This article presents the findings of a Grounded Theory Qualitative retrospective study of 10 adults diagnosed with rheumatoid arthritis receiving occupational therapy to modify their daily living environment and activities to maximise the quality of life and occupational performance. They were interviewed twice in a semidirected manner.
Results:  Two personal change processes were identified for two different courses of the illness: progressive adaptation during a course of gradual steady development of symptoms without remission, and complex adaptation that led to transformation during a course of acute development of symptoms with periods of remission.
Conclusion:  Implications for more effective and efficient occupational therapy interventions are suggested.     

An exploratory study on the role of occupational therapists in home-based rehabilitation team in South Korea

Introduction: Cooperation among rehabilitation team members is essential in the home-based rehabilitation setting. Q-methodology that can quantitatively analyze the subjectivity of members of the rehabilitation team was used to explore the role of occupational therapists (OTs) in home-based rehabilitation. Methods: The Q-methodology process was implemented in five steps: Step 1 - Representative statements about the role of OTs were collected through in-depth interviews, open questionnaires, and literature reviews (Q-sample); Step 2 - A total of 34 rehabilitation team members (physical therapists, OTs, social workers, nutritionists) were recruited (P-sample); Step 3 - The statements were classified according to their subjective perspective (Q-sort); Step 4 - Factor analysis was performed based on the correlation among the responses from the participants (Q-factor analysis); Step 5 - The awareness factor for roles was interpreted (Interpretation of awareness factors). Results: The roles of OTs perceived by members of the home-based rehabilitation team were formed into five factors (A) Adaptation within home environments; (B) Professional development; (C) Reliable service execution; (D) Client needs resolution; and (E) Focus on activity participation. In all factors, perspectives on the role of OTs in helping clients participate in their roles and activities at home were included. These factors included issues and directions addressed in prior literature on the development of occupational therapy. Conclusions: In home-based rehabilitation, OTs must play a professional role in ensuring clients live fully at home, and cooperate with team members for an effective rehabilitation approach.     

Rehabilitation of home care workers: supportive factors and obstacles prior to disability pension due to musculoskeletal disorders

The aim of this study was to retrospectively explore the prevalence of rehabilitation actions, supportive factors, and obstacles for rehabilitation among home care workers with musculoskeletal disorders, especially focusing on aspects related to occupational rehabilitation. All home care workers in Sweden whose disability pension was approved in 1997 and 1998 because of a musculoskeletal disorder, were selected (n = 373). Data, covering aspects of the rehabilitation process and conditions in working life 5 and 15 years prior to their disability pension, were collected from a questionnaire. The majority considered that the disorder leading to a disability pension was caused by their work, but only one-third of them had their occupational disorder formally approved. Only one-third of the study group received occupational rehabilitation. However, an approved occupational disorder was related to higher prevalence of occupational rehabilitation. In the age group 60–65, few home care workers received rehabilitation. The majority perceived good support from their supervisor and working team, but no support with regard to lowering physical demands. Modification and reduction of physical demands might improve both sustained work ability in home care work and the outcome of the rehabilitation.     

Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members

Background/Aim:  The occupational therapy profession is in need of self-examination in view of the extent to which culturally constructed meanings of occupation guide its work within an increasingly diverse practice environment.
Methods:  Semistructured interviews were completed with 14 individuals who defined themselves as minority group members in order to gain an understanding of their experience of the occupational therapy process.
Results:  Five themes emerged: the importance of social location, the need for safety and acceptance, avoiding omissions, understanding differences in occupation, and the face of discrimination.
Conclusions:  Cultural and sexual identities influence occupational choices and interface with the social location of the therapist to influence the therapeutic process. Despite holistic and client-centred values, the comprehensive nature of occupational therapy is not experienced by clients of minority groups. Practice models are needed that provide directives for the establishment of alliances with minority clients and that highlight the significance of exploring occupational choices, experiences of oppression and the impact of the therapists' culture on the therapeutic process.     

The influence of social support on the rehabilitation of women with spinal cord injury: experiences recounted by occupational therapists

Abstract

Objective: Women with a spinal cord injury (SCI) often require support from others to perform their everyday activities. The aim was to describe OTs' experiences of how social support from the network influences or could influence the rehabilitation of women with SCIs. Methods: Four occupational therapists, specialized in rehabilitation of persons with SCIs, narrated 11 separate stories relating to women with an SCI. Five themes were identified: “Assisting the women to identify new ways to perform activities”, “Giving support to the women by re-establishing relationships on their behalf”, “Enabling the women to find solutions to problems that have an impact on everyday activities”, “Enabling the women to learn what it is like to live with an SCI from first-hand accounts”, and “Assisting the women to set goals in anticipation of life outside the clinic”. Results and conclusions: The results indicate that professionals within rehabilitation need to be aware of and actively create and strengthen natural social networks during the complex and demanding rehabilitation process. Furthermore, they ought to use their capacity as professionals to ensure that support is provided and to reduce negative interactions within the injured person's network, given that social support, social integration, and negative interactions have the potential to influence health and well-being.     

Shaping knowledge regarding occupation: examining the cultural underpinnings of the evolving concept of occupational identity

Background/aim:   Within occupational therapy and occupational science, knowledge regarding occupation-based concepts is in the process of being developed, disseminated and acted upon internationally. It is critical to reflect on the forces shaping the ways in which this knowledge is being constructed.
Method:   In this paper, the ways in which cultural assumptions and values have influenced the evolving concept of occupational identity are examined through applying Kluckhohn and Strodtbeck's framework of cultural variations in values to two contemporary conceptualisations of occupational identity.
Results:   The analysis demonstrates the ways in which values most consistent with Western culture are embedded within and dominate these contemporary conceptualisations of occupational identity, emphasising a future orientation, achievement-based doing, individual choice, and mastery of individuals over nature.
Conclusions:   This paper points to conceptual boundaries within which occupational identity is currently being shaped and points to alternative possibilities in the hope of prompting dialogue and research that looks at this concept in more diverse ways. Heightened sensitivity to the influence of culture on the shaping of occupation-focussed knowledge will serve to strengthen and enrich the growth of the evolving body of knowledge pertaining to occupation, and foster culturally sensitive research and practice.     

Are we applying interventions with research evidence when targeting secondary complications of the stroke-affected upper limb

Background/aim:  This study aimed to survey occupational therapy practice with reference to the current evidence for management of secondary complications of the stroke-affected upper limb.
Methods:  A questionnaire was developed to identify the clinical practice of occupational therapists in managing the client's stroke-affected upper limb. Participants were recruited via an email to the national occupational therapy neurology listserve. Occupational therapists working in stroke rehabilitation were invited to complete the questionnaire online or to print off and return.
Results:  Fifty-five occupational therapists completed the questionnaire. Results revealed that treatment techniques with little to no evidence were used frequently, including pillow cushion supports (98%), positional stretch (94%) and slings (61%). Alternatively, treatment techniques with significant supporting evidence were used at a lower frequency, such as electrical stimulation (39%).
Conclusions:  The results of the questionnaire highlight an inconsistent application of evidence within clinical practice and the consistent application of treatment techniques with poor supporting evidence. This result does not represent poor clinical practice. Rather, it highlights the need for the research literature to articulate the clinical reasoning underpinning clinicians' selection of treatment techniques and to determine the effectiveness of frequently used, but poorly supported treatment techniques.     

Discharge decision-making with older people: The influence of the institutional environment

Background/Aim:  Occupational therapists often participate in decision-making about postdischarge accommodations. This paper presents the findings of a study that identified and explored institutional factors influencing discharge accommodation decision-making with older people, from the perspective of occupational therapists.
Methods:  Qualitative, semistructured, face-to-face interviews were conducted with 10 occupational therapists. Interviews were recorded, transcribed, coded and analysed for the presence and emergence of themes.
Results:  Decision-making processes were influenced by the institutional environment. The medical model and pressure for fast decisions seemed to impede client-centred processes in acute settings.
Conclusions:  When possible, decision-making about long-term care needs to occur in community or longer-stay rehabilitation settings that allow time for negotiated client-centred processes.     

Occupational therapists' perception of their practice: A phenomenological study

Background:  International literature seems consistent in reporting that occupational therapists value their methods. However, little empirical evidence has been generated supporting the basic system of belief for occupational therapy. Few studies have explored the nature of the occupational therapists' experiences and thoughts about their use of occupation as means and ends, and which strategies they use to implement their tools in their current practice. Accordingly, the aim of this study was to explore how occupational therapists understood and presented their practice and interventions.
Methods:  A sample of six occupational therapists graduated in different decades, from diverse client populations and health-care settings was selected to participate in a semistructured interview.
Results:  Three main themes were developed: 'To make the client's potentials visible', 'reaching a position one values' and 'looking with other eyes'. Whatever their specialities, the participants were unanimous in the way they described their role. Their common focus was 'activities of daily living'. However, they had problems describing their therapeutic tools, and were not able to clearly articulate the 'common sense aspects' of their own methods. The participants were engaged in constructing their professional identities, and stressed the need to construct professional boundaries relevant to their particular work.
Conclusion:  The occupational therapists perceived their practice and interventions as distinctly different from other team members, thus, they provided a 'counterpoint'. The participants used various ways of marketing their perspectives. While the novices tended to go along with the team, the experienced therapists tended to assert their own special contribution.     

Workers compensation and occupational health and safety in the Australian agricultural industry

Objectives:  The objective of this paper is to review the available workers compensation and occupational health and safety data and the legal framework in relation to the agricultural industry to explore whether any factors highlight the need to pay special attention to the particular circumstances of those engaged in the industry.
Design:  This paper explores some of the special features of the agricultural industry, looking first at agricultural worker fatalities and injuries as a matter of ongoing concern for all participants in this industry, government, as well as occupational health and workers compensation authorities. The paper analyses how occupational health and workers compensation laws may have special application to this industry. Finally, the paper considers some workers compensation provisions that have particular application to the agricultural industry.
Conclusions:  Our survey of the available data and literature leads to the conclusion that the dangerous nature of agricultural work and the special legal and economic framework in which that work is undertaken identify the agricultural industry as presenting Australian Governments and specialist authorities with particular challenges in relation to improving workplace safety and reducing workplace injury.     

Attitudes of entry level occupational therapy doctoral students towards inclusion for students with disabilities

Background/Aims:  The increasing popularity of inclusive education for students with disabilities and the attitudes towards it inevitably affect school-based occupational therapy practice. This survey study investigated the attitudes of entry-level occupational therapy doctoral (EOTD) students towards inclusive education and the effect of professional education on their perception.
Methods:  A total of 62 EOTD students responded to a self-developed questionnaire, Attitudes and Inclusive Education Survey , yielding a response rate of 91.2%.
Results:  Results of the study revealed that entry level occupational therapy doctoral students have positive attitudes towards inclusive education and believe that the inclusion movement has an inevitable impact on school-based occupational therapy practice. Professional education in occupational therapy might positively affect students' attitudes.
Conclusion:  Given the close association between one's attitude and behaviour, the findings of the study are particularly encouraging. Future research needs to further examine school-based occupational therapy practice in inclusive environments.     

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

Objective:  The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice.
Design:  Self-report questionnaires and semistructured in-depth telephone interviews.
Participants:  Graduates ( n =  15) from the first cohort of occupational therapists from James Cook University, Queensland.
Main outcome measure:  The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice.
Results:  Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice.
Conclusions:  Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements.     

The meanings of craft to an occupational therapist

Aim:   Craft was the first therapeutic occupation of occupational therapy. Since the early days of the profession, the value of craft in practice is a topic that has been discussed with fluctuating interest. Recent discussions by occupational therapists have reinforced that although craft is relevant to occupational therapy, there are uncertainties about its place in contemporary practice. Presently, scholars have identified that occupation is both the center of human experience and the core of our profession. Therefore, this study aimed to begin to clarify the meaning of craft to practice today by gaining a deep understanding of the meanings that one occupational therapist attributes to craft.
Methods:   Using narrative inquiry, data were gathered through a conversation held between the research participant and myself. A reflexive journal was also kept to support this data gathering process. Narrative analysis enabled intimate engagement with the data and the emergence of themes and sub-themes.
Results:   The findings, in the form of an interpretive story, suggest first, that craft-making has therapeutic value; second, that reasoning about the therapeutic use of craft is similar to reasoning about other therapeutic activities; and third, that personal experience with craft-making can influence the selection of craft as therapeutic media.
Conclusions:   From this study, further research into the impact personal and professional experiences can have on choice of therapeutic media and an analysis of the sociopolitical context of the meanings that occupational therapists attribute to craft-making is suggested.     

Job satisfaction in occupational therapy: a qualitative investigation in urban Australia

Background:  Job satisfaction has been shown to affect levels of staff retention and work productivity, but few studies have been conducted with occupational therapists in an Australian setting.
Methods:  Using a hermeneutical phenomenological approach, the findings from a study examining the factors that contribute to job satisfaction in occupational therapists working in Australia, are reported.
Results:  Job satisfaction in occupational therapy was derived from the sense of achievement felt when providing effective clinical care. Job dissatisfaction stemmed from the poor profile and status of the profession.
Conclusions:  Based on the study findings, there is an imperative that the profession of occupational therapy continue to use research findings to support clinicians in providing effective health care, and improve the community understanding of occupational therapy.     

Retirement: What will you do? A narrative inquiry of occupation‐based planning for retirement: Implications for practice

Aim:  To examine, using a retrospective narrative study, the factors influencing four older people's decision to plan for the activities they would undertake once retired, the planning process undertaken and their subsequent experience of retirement.
Method:  Semi-structured interviews were conducted to examine the factors influencing older people's decision to commence pre-retirement planning, the planning process undertaken and their experience of retirement. In keeping with narrative inquiry, paradigmatic-type narrative analysis led to the development of categories and subsequent themes to reveal the participants' experiences of these issues.
Results:  Three themes: environmental influences, the planning process and retirement experiences: the outcome of planning, were derived from the participants' narratives. Overall, retirement activities that were continued or initiated led to a positive experience even when these planned activities were temporarily interrupted or altered. Planning for future years in retirement and older age also continued.
Conclusion:  Occupational therapists have a unique understanding of the centrality of occupation to health and wellbeing. Thus occupational therapists are well-positioned to assist people identify, plan and engage in meaningful occupations outside work in retirement.