The Occupation-Based Intervention of Bathing: Cases in Home Health Care

Abstract

Although bathing skills can be an indicator of long term placement, documentation of occupational therapists doing bathing as an occupation-based intervention is limited. Five clients were referred to a hospital-based home health agency with various diagnoses and at different levels of functioning. Each client was assessed at admission and discharge using the Outcomes and Assessment Information Set and the occupational therapists used the Activities of daily living (ADL) of bathing as the intervention based on client centered expressed needs. Findings reveal a statistically significant change in individuals pre- and post-assessment of bathing (Z?=?–2.032, p?=?.042) supporting occupation-based interventions, specifically bathing, should be further researched as a means of significantly improving the functional status of clients.     

Beyond good practice: Issues in working with people with intellectual disability and high support needs

Many more people with an intellectual disability now live in the community as a result of de-institutionalization. Occupational therapy is one service that assists people with intellectual disabilities to participate as fully as possible in their local communities. Despite the potential benefits of occupational therapy, there is little written about the types of interventions used and the effectiveness of their outcomes with people with intellectual disabilities. The present interview study about current occupational therapy practice with people with intellectual disabilities and high support needs was conducted with experienced Australian clinicians. Positive outcomes for clients with high support needs were achieved in two ways: (i) by what therapists do; and (ii) by the features of the therapy relationship. In addition, interventions that indirectly empowered clients and changed others' perceptions were seen to have the most positive effect. The findings are discussed with regard to current occupational therapy literature and implications for occupational practice and education are presented.     

Community occupational therapists' clinical reasoning: identifying tacit knowledge

Background: Occupational therapy interventions in the community, a fast expanding practice setting, are central to an important social priority, the ability to live at home. These interventions generally involve only a small number of home visits, which aim at maximising the safety and autonomy of community‐dwelling clients. Knowing how community occupational therapists determine their interventions, i.e. their clinical reasoning, can improve intervention efficacy. However, occupational therapists are often uninformed about and neglect the importance of clinical reasoning, which could underoptimise their interventions. Aim: To synthesise current knowledge about community occupational therapists’ clinical reasoning. Method: A scoping study of the literature on community occupational therapists’ clinical reasoning was undertaken. Results: Fifteen textbooks and 25 articles, including six focussing on community occupational therapists’ clinical reasoning, were reviewed. Community occupational therapists’ clinical reasoning is influenced by internal and external factors. Internal factors include past experiences, expertise and perceived complexity of a problem. One of the external factors, practice context (e.g. organisational or cultural imperatives, physical location of intervention), particularly shapes community occupational therapists’ clinical reasoning, which is interactive, complex and multidimensional. However, the exact influence of many factors (personal context, organisational and legal aspects of health care, lack of resources and increased number of referrals) remains unclear. Conclusion: Further studies are needed to understand better the influence of internal and external factors. The extent to which these factors mould the way community occupational therapists think and act could have a direct influence on the services they provide to their clients.     

The Contribution of Occupational Therapy to Alcohol and Drug Rehabilitation: A Descriptive Review

Occupational therapists work as members of multidisciplinary teams in the assessment and treatment of people experiencing alcohol and drug related difficulties. In the context of “team” treatment, the role of the occupational therapist often appears unclear. Although there is a paucity of available literature regarding occupational therapy roles and functions in this field, the importance of activity based interventions to promote the development of living skills and for facilitating lifestyle changes is well documented. Occupational therapists employed at Pleasant View Centre, Victoria, aim to assist people with addiction problems in reducing or abstaining from drug use within a psychosocial framework. They assist clients in both the detoxification and rehabilitation phases of treatment and provide appropriate follow-up and support. Occupational therapists contribute both their group and individual counselling skills and, in addition, provide a unique focus on maximsising self-efficacy and competence to perform life skills. They provide activity based programmes which enhance existing skills and the acquisition of new skills. The complex nature of addiction requires a diverse range of orientations and skills to which the occupational therapist contributes a philosophy and practice of learning skills for living through “doing” and activity.     

Cost‐effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials

A systematic review of the cost‐effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial‐based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1–5) that were randomized controlled trials with high‐quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost‐effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost‐effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client‐centred approach) suggested potentially cost‐effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future studies on the cost‐effectiveness of occupational therapy in older people are strongly warranted. Copyright © 2015 John Wiley & Sons, Ltd.     

Client outcomes after student community fieldwork in Russia

This short report outlines how occupational therapy education was introduced in Russia in 1996 through a partnership between Canadian and Russian academic organizations and consumer groups. Role‐emerging placements were selected as a strategy to provide clinical experience in a healthcare system where there were no established occupational therapists. Students' ability to help clients to improve their occupational performance was evaluated through a record audit when the second cohort of students had completed their training. Thirty‐one files of clients aged 6 to 80 were reviewed. Clients' ratings of performance and satisfaction scores on the Canadian Occupational Performance Measure before and after occupational therapy intervention were examined. Analysis using the Wilcoxon signed rank test showed highly significant differences (p=0.001), indicating that students were able to help clients to improve their occupational performance. This is also interpreted as an indication of the success of the education programme. Copyright © 2000 Whurr Publishers Ltd.     

Integrating proven falls prevention interventions into government programs

Objective : To identify Department of Health programs with high potential to integrate evidence‐based interventions to prevent falls among older people. Methods : Broad consultation within the Department followed by structured decision making. This work was informed by an analysis of Victorian hospital separations data and a Cochrane Systematic Review to identify relevant target groups and interventions. Ranking of the integration potential of interventions for a broad range of Department program areas was achieved through a facilitated workshop. A short list of program areas was then developed and scored, using pre‐defined criteria, for their match with the interventions. Results : The ranked order of interventions, from most to least suitable for integration, were: multifactorial risk assessment and intervention; multi‐component group exercise; medication review; occupational therapy‐based home safety; home‐based exercise; and first eye cataract surgery. Four of six program areas had a strong match (a score of ≥75% of the maximum score) with one or more of three interventions. Two program areas (Primary Care Partnerships, and Home and Community Care) had strong matches with three interventions (group‐ and home‐based exercise; occupational therapy‐based home safety) and were selected as priority areas. The Hospital Admissions Risk Program had strong and good matches respectively with home‐based exercise and medication review, and was also selected. Conclusions : Our systematic methods identified Department programs with strong potential for integration of proven falls prevention interventions. Implications : Matching departmental programs and evidence‐based interventions for integration may lead to more efficient resource allocation for falls prevention in Victoria.     

Participatory citizenship: Critical perspectives on client-centred occupational therapy

Abstract

Background/aims: This article aims to discuss client-centred practice, the current dominant approach within occupational therapy, in relation to participatory citizenship. Occupational therapists work within structures and policies that set boundaries on their engagement with clients, while working with complex, multidimensional social realities. Methods: The authors present a critical discussion shaped by their research, including a survey, discussions at workshops at international conferences, and critical engagement with the literature on occupational therapy, occupation, and citizenship. Conclusion: A focus on citizenship suggests reframing professional development based on the participation in public life of people as citizens of their society. While occupational therapists often refer to clients in the context of communities, groups, families, and wider society, the term client-centred practice typically represents a particular view of the individual and may sometimes be too limited in application for a more systemic and societal approach. Significance: The authors question the individual focus which has, until recently, been typical of client-centred occupational therapy. Placing citizenship at the core of intervention is a transformative process that assumes all people are citizens and conceives of health as a collective issue, influencing the way we educate, do research, and practise.     

Meaning of Daily Activities and Subjective Quality of Life in People with Severe Mental Illness

The occupational therapy services for adults with severe and persistent mental illness are concerned with their quality of life. A correlational study explored the relationship between the meaning of daily activities and the subjective quality of life of this group of people. In this study, the meaning of activities was defined by three elements, related to the Human Occupation Model: perceived competence, value and pleasure, measured by the Occupational Questionnaire. The Wisconsin Quality of Life-Client Questionnaire provided a global score for the subjective quality of life. A total of 45 people with severe and persistent mental illness, living in downtown Montréal, participated in a semi-structured interview. The results suggest that perceived competence in daily tasks and rest, and pleasure in work and rest activities are positively correlated with subjective quality of life. The influence of occupation and its meaning on quality of life, an occupational therapy assumption, is supported by these results. It also supports occupational therapists' interventions with these clients when aiming to help develop their sense of competence and their enjoyment in the performance of activities.     

Occupational therapy practitioners' comfort level and preparedness in working with individuals who are gay, lesbian, or bisexual

Occupational therapists and other allied health professionals face diversity with their clients, including sexual orientation. The purpose of this study was to determine the preparedness and comfort level of occupational therapy practitioners in working with gay, lesbian, and bisexual clients. A 23-item survey was mailed to 1,051 practitioners in a midwestern state. Eighty-eight were undeliverable and 373 usable surveys were returned, yielding a 39% response rate. Most respondents felt prepared and comfortable to work with clients who are gay, lesbian, or bisexual, and 48% agreed that sexuality influences occupational choices. Twenty-nine percent agreed that sexual orientation influences occupational therapy treatment. Less than 20% of the respondents, however, received education and used inclusive language in their documentation, and only 14% reported having resources and support services for clients who are gay, lesbian, or bisexual. Effective education and policy-making strategies are necessary to ensure an accepting therapeutic environment and respect for the role of sexual orientation in the intervention process.     

Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review

With the ageing of the world's population comes significant implications for nearly all sectors of society, including health and aged care spending. Health and aged care systems need to respond to the increasing need for services for older people. Occupational therapy is concerned with maintaining a person's functional independence and well‐being from preventative and treatment perspectives. The aim of this systematic review was to identify the costs and outcomes of occupational therapy for people with cognitive and/or functional decline. The searches for this review were conducted on 23 September 2016 and updated on 20 April 2017. Full economic evaluation studies, partial economic evaluations, randomised trials reporting estimates of resource use or costs associated with intervention(s) and comparator(s) and studies with pre‐ and post‐intervention cost comparators were included. Thirteen studies met the inclusion criteria. The type and duration of occupational therapy intervention in the included studies varied, ranging from one‐off assessments through to systematic multicomponent programmes. Results suggested that structured occupational therapy interventions which comprised of multiple consultations and engaged caregivers delivered better functional and economic outcomes.     

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.     

Health and functioning among elderly recipients of home help in Norway

We used data on respondents 60 years of age and above (n= 2111,54% women) from a nationwide Norwegian health survey. In all, 186 (8.8%) of the respondents received home help. The data demonstrate that home help tends to be provided as a supplement to formal care, i.e. home nursing, as well as to informal support from relatives, neighbours and friends. High age, being of female gender and living alone were strongly associated with the provision of home help in bivariate analyses. A negative relationship existed between income and receiving home help, but this association only existed for subjects under 70 years of age. The home help clients, more frequently than those without home help, reported having functional problems, suffering from chronic illnesses, and consulting a doctor due to disease. They also reported poorer self-perceived health, more frequent symptoms of depression or anxiety, and more frequent loneliness. Multivariate analyses identified age, impaired ability to do housework, living alone, difficulties in using public transportation, poor perceived health and suffering from chronic illnesses or impairments as explanatory variables for being a recipient of home help. The results demonstrate that the home help clients represent a particularly frail group of elderly people.     

The potential role of occupational therapy in acute care with clients with HIV/AIDS

As medical interventions aimed at prolonging the lives of people with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are implemented, HIV/AIDS is evolving into a chronic disease with associated disability. People with HIV/AIDS can experience numerous occupational performance problems and occupational therapists need to examine and develop their role in helping to meet the needs of this population. Acute-care occupational therapists work with clients with HIV/AIDS who experience multiple admissions and who present with varying levels of occupational function. This paper outlines the potential role of occupational therapy in acute care with clients with HIV/AIDS using the Model of Occupational Performance (Canadian Association of Occupational Therapists, 1991) as a conceptual framework. The results of a retrospective chart review that investigated the role of two occupational therapists working with clients with HIV/AIDS in an acute-care setting are presented and compared with the potential role. Practice and research recommendations to address the discrepancies between the potential and present role are presented. Copyright © 1998 Whurr Publishers Ltd.