PDAs as cognitive aids for people with multiple sclerosis

OBJECTIVE: Cognitive impairment is a common symptom for people with multiple sclerosis (MS). This study evaluated the effects of an occupational therapy training protocol using personal digital assistants (PDAs) as assistive technology for people with cognitive impairment related to MS. METHODS: Twenty participants were trained to use PDAs by an occupational therapist. Assessments of functional performance were taken at the start of an 8-week pretreatment period, at the beginning and end of training, and 8 weeks after the conclusion of training. RESULTS: Participants demonstrated the ability to learn how to use basic PDA functions and retain learning for at least 8 weeks. Functional performance increased significantly with PDA use, and this gain was maintained at 8-week follow-up. CONCLUSION: This study provides evidence of an association between an intervention providing training in the use of a PDA and improvements in the everyday function of people with cognitive impairment related to MS.     

The effectiveness of physical, psychological, and functional interventions in treating clients with multiple sclerosis: a meta-analysis.

This article provides a meta-analysis of the current best evidence for the use of occupational therapy with clients with multiple sclerosis (MS). A review of the literature identified 23 articles that examined the effectiveness of occupational therapy-related treatments on clients with MS. Meta-analytic analysis suggests that occupational therapy-related treatments were effective in treating the deficits associated with MS (r = .52), particularly for outcomes in the capacity and ability (r = .52; e.g., muscle strength, range of motion, mood) and task and activity (r = .57; e.g., dressing, bathing, ambulation) levels. A review of the research designs used to study MS suggests that more rigorous research is necessary to fully understand treatment effectiveness. Further, more research must be done to establish the effectiveness of occupational therapy treatment at the life role level.     

Rehabilitation service utilization and determinants among people with an intellectual disability: preliminary findings in Taiwan

Improving rehabilitation services for people with intellectual disabilities (ID) remains an ongoing challenge in the public health system. The purpose of this article was to investigate the types of rehabilitation services used by people with ID and determine what factors predict resource utilization in Taiwan. Samples of 957 people with ID were recruited from the Taiwan National Disability Register in a cross-sectional study in 2001. The findings indicated that 24.5% of individuals with ID had received rehabilitation services in the past 7 months. The main types of services used were speech and communication therapy (50%), psychotherapy (32.1%), occupational therapy (30.3%) and physiotherapy (25.2%). Stepwise logistic regression was carried out for the utilization of rehabilitation services (yes/no). The model revealed that the following factors: (i) Major Illness Card holder, (ii) time spent in medical care, (iii) having a family physician, (iv) having illnesses, (v) age of ID individual, and (vi) gender of the main carer, were all significantly associated with the utilization of rehabilitation services. We should reorient the healthcare system to respond adequately to the health needs of rehabilitation service users and its determinants, and further research should focus on the effectiveness and efficiency of rehabilitation for people with ID in Taiwan.     

Rehabilitation service utilization and determinants among people with an intellectual disability: Preliminary findings in Taiwan

Improving rehabilitation services for people with intellectual disabilities (ID) remains an ongoing challenge in the public health system. The purpose of this article was to investigate the types of rehabilitation services used by people with ID and determine what factors predict resource utilization in Taiwan. Samples of 957 people with ID were recruited from the Taiwan National Disability Register in a cross-sectional study in 2001. The findings indicated that 24.5% of individuals with ID had received rehabilitation services in the past 7 months. The main types of services used were speech and communication therapy (50%), psychotherapy (32.1%), occupational therapy (30.3%) and physiotherapy (25.2%). Stepwise logistic regression was carried out for the utilization of rehabilitation services (yes/no). The model revealed that the following factors: (i) Major Illness Card holder, (ii) time spent in medical care, (iii) having a family physician, (iv) having illnesses, (v) age of ID individual, and (vi) gender of the main carer, were all significantly associated with the utilization of rehabilitation services. We should reorient the healthcare system to respond adequately to the health needs of rehabilitation service users and its determinants, and further research should focus on the effectiveness and efficiency of rehabilitation for people with ID in Taiwan.     

Factors related to the intensity of occupational therapy utilization in a geriatric chronic care setting

BACKGROUND: 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. METHOD: 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. RESULTS: 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. PRACTICE IMPLICATIONS: 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.     

Predicting the use of occupational therapy services among people with multiple sclerosis in Atlantic Canada

This secondary analysis examined the factors that predicted the use of occupational therapy services since diagnosis and over the past year among people with multiple sclerosis in Atlantic Canada. Data were gathered through a mail-out survey of members of the Multiple Sclerosis Society of Canada (Atlantic Division) in the winter of 1997/98. The Behavioral Model of Health Services Utilization (Andersen & Newman, 1973) was used to guide the analysis. Seeing greater numbers of health professionals, having a hospitalization in the past year, and having more functional limitations all increased the likelihood of seeing an occupational therapist, both since diagnosis and over the past year. These findings suggest that the organization and structure of the service system play a large role in the likelihood that a person with multiple sclerosis will see an occupational therapist in Atlantic Canada.     

Issues in bidding for contracts for occupational therapy services.

There is an increasing number of occupational therapists in Canada who are involved in bidding for contracts to deliver occupational therapy services. Occupational therapists working in an institutional or community-based setting may not have had the responsibility of developing a proposal or a marketing plan for bidding purposes. However, the responsibility of developing a bid to compete for a service delivery contract often rests on occupational therapists who are sole practitioners in a private practice setting. The purpose of this paper is to highlight issues in the literature such as service delivery plans, marketing strategies and costing of services that can assist the occupational therapist in the development of a contractual bid. A specific clinical example, school therapy services, has been used to illustrate how these strategies can be applied to practice. Success in contractual bids appears to be primarily influenced by cost of the service, the expertise of the service provider, ability to provide coordinated care, ease of access for clients, and inclusion of methods to measure client outcome.     

A service evaluation of a specialist community palliative care occupational therapy service

Abstract

Background

Occupational therapy aims to maximize patients' independence and is thus particularly relevant in palliative care where a loss of function is both common and distressing for patients. However, there is evidence that health professionals have a limited understanding of its role and remit, with the consequence that timely referrals are not made.

Method

A service evaluation was undertaken to establish colleagues' understanding of the palliative care occupational therapy service and its perceived benefit to patients in one local primary care area. A mixed methods approach was used, combining an online survey and focus groups. One hundred people were invited to complete the questionnaire, with a 58% response rate. Twenty-five people subsequently participated in two focus groups.

Results

Participants believed that the service achieved its aims. The main reasons for referral to the occupational therapy service were for the provision of equipment, or advice about equipment to support independent community living. Facilitating patients' preferred place of care was ranked next in importance. Participants did not feel that they were sufficiently aware of the full range of occupational therapy services available, and suggested that the provision of education and information would be effective in raising awareness of the remit of the specialist occupational therapy service.

Conclusion

From the professional service users' perspective, the specialist community palliative care occupational therapy service makes a valuable contribution to maintaining patients' independence, comfort, and quality of life, and is associated with supporting patients' preferred place of care. Areas highlighted for development include clear communication pathways, and education and information strategies regarding the role of the palliative care occupational therapist.     

Services That Nursing Facilities Should Provide to Residents with MS: A Survey of Health Professionals

This study identified care-related services, programs, and equipment that nursing facilities should provide to residents with multiple sclerosis (MS). Two sets of surveys were used to collect the perspectives and opinions of 140 health professionals representing a variety of disciplines. Frequency tabulations of all responses were done by computer for 10 care-related categories to identify the most frequently mentioned services or programs in each category. Stratified frequency tabulations also were done in the medical, rehabilitation, nursing, as well as psychological and social service categories of care that nursing facilities should provide to residents with MS. The health professionals identified mental health-related services as the most important care that nursing facilities should provide to residents with MS, followed by physical therapy, recreational therapy, occupational therapy, and neurological care.     

Clinical reasoning process for service provision in the public school.

This paper outlines the clinical reasoning process used to guide decisions on the provision of occupational therapy services in the Wake County Public School System in North Carolina. The process is based on a theoretical framework derived from occupational therapy theory and public law. Benefits of using the clinical reasoning process include (a) increased consistency of decision making among therapists; (b) increased appropriateness of decisions regarding whether a student needs educationally based occupational therapy services, what type of occupational therapy service would meet the student's need, and how often this service should be provided; and (c) improved ability of therapists to articulate to all those involved with a student the reasoning behind decisions to provide educationally based occupational therapy services. The schematic diagrams that depict this process provide a useful tool for therapists with varied work experiences entering school-based practice.     

Knowledge and use of community services among family caregivers of Alzheimer's disease patients

The number of people with dementia residing within the community is steadily increasing. Community services can alleviate the burdens experienced by families, but are used infrequently by families of dementia patients. Caregivers (N = 93) of dementia patients were surveyed regarding their knowledge and use of community services. The most frequently used services were family support groups and home health aides. Overall, service use was low despite high levels of perceived availability of services. Older and less educated caregivers had higher levels of uncertainty about service availability. Depressed caregivers were less likely to know about service availability. Implications for practice and research are presented.     

Living in a glasshouse: exploring occupational alienation

BACKGROUND: Community mental health care has shifted focus from resettlement to empowerment, reflecting a wider agenda for social inclusion. PURPOSE: This study evaluated mental health day services from the perspectives of thirty-nine clients. METHOD: Data analysis of the four focus groups explored the implications for occupational therapy. The data collected were subjected to constant comparative analysis and theoretical sampling. RESULTS: Participants described how mental health day services structured their day and enabled access to support networks. However, many perceived aspects of the services as fostering their dependence and threatening sessions they valued. This dependency led to them feeling alienated and wishing to seek greater influence over decisions about their current and future life. The concept of occupational alienation was used to further interpret their situation. PRACTICE IMPLICATIONS: Occupational therapy could overcome occupational alienation experienced by mental health day service clients, through the development of services within and beyond day services which promote a sense of belonging and offers meaningful occupation.     

Occupational Therapy Telehealth Applications for the Dementia-Caregiver Dyad: A Scoping Review

Abstract

Aims: The aim of this review was to examine how occupational therapy practitioners use telehealth to provide services to clients with dementia and their caregivers. Methods: This study utilized Arksey and O’Malley’s five-step process for a scoping review. Results: The review yielded 14 articles. Only one study directly included an occupational therapist as the primary service provider; the other 13 studies focused on services within the scope of occupational therapy practice. Conclusions: The review provided evidence of the effectiveness of telehealth methods to deliver occupational therapy services to clients with dementia and their caregivers. Telehealth delivered occupational therapy services have the potential to decrease caregiver burden, depression, stress, anxiety, and hours of care provided; increase caregivers’ ability to manage dementia-related behaviors; and increase caregivers’ perceived self-efficacy for caregiving skills and exercise, health, self-care skills, adherence to exercise, utilization of respite care, and social support.     

Home and community occupational therapy for children and youth: a before and after study

BACKGROUND: There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. PURPOSE: To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. METHODS: Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. RESULTS: A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. PRACTICE IMPLICATIONS: Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.     

Outcomes in hand rehabilitation using occupational therapy services.

OBJECTIVE: The purpose of this study was to measure functional outcomes after outpatient occupational therapy for clients who had upper-extremity injury and surgery or both. METHODS: A sample of 33 clients referred to occupational therapy outpatient intervention was recruited from five clinics in Ohio. The Canadian Occupational Performance Measure (COPM) was used to guide the occupational therapy sessions and to measure outcomes. The Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Short Form 36 (SF-36) were also administered to the clients pre and post 6 to 8 weeks of hand rehabilitation services. Two to three months after discharge, the clients responded by the telephone to the Community Integration Questionnaire. RESULTS: The clients received a mean of 13 hours of outpatient occupational therapy services and received no other rehabilitation service. Functional performance gains following 6 to 8 weeks of services were significant (COPM; t(32) = -11.5, p < .001; t(32) = -11.31, p < .001; DASH; t(32) = 9.22, p < .001; t(32) = -9.02, p < .001). Effect sizes on the COPM and DASH ranged between 1.43 and 2.52. Progress in the clients' goals was moderately correlated to progress in functional measures. CONCLUSION: Clients with upper-extremity injury or surgery made strong, positive gains in functional measures following client-centered occupational therapy services. The COPM was the most sensitive to client change, followed by the DASH, and then the SF-36.     

Characteristics of people living with HIV who use community-based services in Ontario, Canada: implications for service providers.

Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.     

Occupational therapy benchmarks within orthopedic (hip) critical pathways.

OBJECTIVE: This study examined patient performance benchmarks for occupational therapy within orthopedic (hip) critical pathways. METHOD: Eight orthopedic (hip) critical pathways gathered from occupational therapy practitioners working in hospital and rehabilitation settings were examined to determine commonalities and differences of occupational therapy benchmarks, disciplines involved, and identified allowable variances. A comparison and contrast matrix was developed to provide a visual means of reviewing the data. RESULTS: Nursing, physical therapy, and occupational therapy were disciplines consistently involved in the pathways. Activities of daily living related to self-care were the most consistently used occupational therapy benchmark within the sample pathways, and functional transfers were the second most-used benchmark. The remaining occupational therapy benchmarks varied, and little commonality was found in their use. Frequency of use also varied among the eight pathways. Five of eight pathways specifically coded variances, with the remaining three providing space for explanation of the variance. CONCLUSION: Although these eight orthopedic (hip) critical pathways included occupational therapy benchmarks, further development and definition of the role of occupational therapy within subsequent orthopedic (hip) critical pathways is needed.