Clinical utility of the Handicap Assessment and Resource Tool: An investigation of its use with the aged people in hospital

Aims:  This article presents the findings of a qualitative study investigating the clinical utility of the Handicap Assessment and Resource Tool (HART). Clinicians' perceptions of the HART were explored in its use in acute hospital settings in a regional health service in New South Wales, Australia.
Methods and Results:  The study, which used in-depth, structured interviews with clinicians working in acute aged care, identified key themes, which point to an overall positive perception of the HART's clinical utility. The themes, identified through thematic analysis were: responses to structural features of the HART; processes of administration; perceived benefits for clients; and clinical utility in context. The article concludes with recommendations for the assessment of aged people in acute hospitals and the need for occupational therapists to continue analysing and establishing the clinical utility of the profession's assessment tools.
Conclusion:  The findings of the study support the clinical utility of the HART when used with aged people in acute care settings. Overall, though participants found it time consuming to administer, they judged the HART to be a context sensitive tool that addressed the complex needs of their patients.     

Perceptions of occupational therapists practising in rural Australia: A graduate perspective

Background:  The difficulty in recruiting and retaining health professionals into rural and remote areas of Australia is well recognised. This study explored the perceptions of occupational therapists practising in rural locations regarding the essential skills necessary for rural practice and the ability of undergraduate education to prepare them for rural practice.
Methods:  A qualitative study using a phenomenological approach was conducted using semistructured in-depth interviews. Participants included occupational therapists who were graduates of James Cook University, who were practising in rural areas in Queensland and Victoria, and academic staff.
Results:  This study demonstrates that it is important for universities to develop both a mindset in their graduates for rural practice, as well as developing broader skills in addition to core discipline-specific skills. While subjects developing core occupational therapy skills are at the centre of undergraduate education, the importance of developing a broader understanding of rural health issues and skills in public health, primary health care and health promotion was emphasised.
Conclusion:  The development of specific skills to become competent rural practitioners and to cope with the challenges of rural practice can be strengthened through initiatives at the undergraduate level. Ongoing commitment from all universities across Australia to include rural curriculum content has the potential to improve recruitment and retention of occupational therapists and other health professionals into rural Australia.     

Improving handwriting without teaching handwriting: The consultative clinical reasoning process

Background and Aim:  Children who have difficulty with handwriting are often referred for occupational therapy. This case report describes a dynamic intervention process and consultative relationship between an occupational therapist and physiotherapist, meeting the needs of an adolescent with handwriting problems.
Methods and Results:  Examples are given of the collaborative clinical reasoning process, problem-solving strategies, and ongoing adaptation of activities, materials, and equipment, leading to moderate improvement in handwriting and significant improvements in school reports and athletic competence, maintained for 6 years.
Conclusion:  Clinical decisions for selecting and modifying intervention techniques can be derived from assessment of occupational performance areas and performance components (underlying motor, sensory, and perceptual deficits interfering with the production of legible handwriting), within relevant performance contexts.     

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.     

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.     

Validity and reliability of the MEDYN questionnaire for evaluation of functioning in mental health clients receiving occupational therapy

Background:  A number of questionnaires are currently available for measuring functionality of mental health clients; however, they are complex, clumsy to use and impossible to compare to each other. There is a clear need for a simple and straightforward tool that uses quantitative measures. We formulated a questionnaire based on occupational, behavioural and cognitive theories to assess the functioning of psychiatric inpatients receiving occupational therapy.
Methods:  Thirty-one patients hospitalised in a closed and an open ward and receiving occupational therapy were monitored during 4 weeks. Clinicians completed the questionnaire for each patient on a weekly basis.
Results:  Interrater reliability was found to be generally high with correlations among the raters in the closed ward being higher than among those in the open ward. Both cognitive and general/social functioning improved over time and the improvement was associated with type of illness and duration of treatment.
Conclusions:  The MEDYN questionnaire is a valid and reliable objective tool for functional assessment of this subgroup of patients.     

Cultural awareness among Queensland undergraduate occupational therapy students

Aim:  Australia's cultural diversity generates substantial challenges and implications for students and health-care professionals. This study investigated the cultural perceptions and self-rated level of cultural competence of undergraduate occupational therapy students in Queensland, Australia.
Results:  Two hundred and ninety-three students completed the Cultural Awareness Questionnaire. The findings indicated that the majority of students have a positive attitude towards cultural differences and influences on occupational therapy services. Students also recognised the importance of cultural awareness and highlighted the need for increased incorporation of cultural information and experience throughout the undergraduate course.
Conclusion:  The implications of this study are discussed with reference to the future academic planning of culturally sensitive occupational therapy course and fieldwork experiences.     

Occupational therapists' perception of usage of information and communication technology (ICT) in Western Australia and the association of availability of ICT on recruitment and retention of therapists working in rural areas

Objective:  The purpose of this study was to investigate occupational therapists' usage of information and communication technology (ICT) in Western Australia and the association of availability of ICT on recruitment and retention of rural therapists.
Methods:  One thousand, one hundred and thirty-eight surveys were sent to all occupational therapists registered with the Western Australian Occupational Therapy Registration Board in January 2003. The survey was used to identify ICT access, support and literacy. The attitude of therapists towards using ICT as a communication tool and therapists' usage patterns of ICT in metropolitan and rural localities were analysed by using the Chi-squared test.
Results:  Email and the personal computer were used most frequently. On ICT global competency, 58% of therapists rated their competency level as good or better. Competence was rated lower for web searching (48.5%) and searching for electronic articles (29.8%). Approximately one-third of respondents were dissatisfied with the level of technical support available and only 38.4% of therapists had participated in basic computer training provided by their current employer. Rural therapists had less access to a computer in their work environments in comparison to their metropolitan peers (P  <  0.05). Nevertheless, rural therapists were using email, teleconferencing and videoconferencing more frequently than their metropolitan counterparts.
A proportion of rural therapists (45.5%) felt that ICT influenced their decision to continue working in rural areas.
Discussion and Conclusion:  Professional isolation has been cited as an inhibitor to recruit and retain health-care workers in rural areas. The higher ICT usage by rural therapists may represent the utility of ICT as a means of circumventing professional isolation that is inherent in rural and remote areas.     

Profile of paediatric occupational therapy practice in Australia

Background:  The purpose of the present study was to describe a profile of Australian paediatric occupational therapy practice in terms of theories, assessments and interventions used with the most frequently seen client groups.
Methods:  An ex post facto survey design was utilised. A purpose-designed survey was mailed to 600 occupational therapists identified by OT Australia as working in paediatrics.
Results:  The response rate was 55% ( n =  330). Respondents in the sample worked chiefly with children with developmental delays, learning disabilities, neurological impairments, and infants/toddlers. Theoretical models used by paediatric clinicians that were common to the most frequently seen client groups focused on sensory integration/multisensory approaches, occupational performance, and client-centred practice. Assessment tools most frequently used were the Test of Visual Motor Integration, Sensory Profile, Bruininks-Oseretsky Test of Motor Proficiency, Handwriting Speed Test, and Motor-Free Visual Perception Test. The most often used treatment methods across the four most frequently seen client groups were parent/caregiver education, sensory integration/stimulation techniques, and managing activities of daily living.
Conclusions:  Paediatric occupational therapists appeared to draw on a range of theoretical models. With the exception of the Sensory Profile, the assessment and treatment methods most frequently used are not congruent with the most commonly used theoretical models. It is critical that the assessment and treatment methods used are conceptually consistent with the theoretical models that guide practice. Occupational therapists need to examine the evidence and determine whether their clinical practice is grounded in the best contemporary theoretical models, assessments and interventions.     

Nutritional management of cystic fibrosis in Australia and New Zealand

Aim:  To document current practice in the nutritional management of cystic fibrosis in Australia and New Zealand and to examine changes in practice since 1996.
Methods:  Thirty-four cystic fibrosis services in Australia and New Zealand responded to a survey that examined current nutritional management practices and dietetic staffing levels. The questionnaire was based on a previous survey conducted in 1996.
Results:  Cystic fibrosis dietetic staffing levels were low. No service met the staffing level recommended by the UK Cystic Fibrosis Trust. Minor practice variations existed in nutrition assessment and monitoring: nutrition support and vitamin supplementation. Changes in the management of pancreatic enzyme replacement therapy and cystic fibrosis-related diabetes were reported since 1996.
Conclusion:  This survey highlights that improvements in consistency of nutrition management have been achieved since 1996 and reflect adherence to available clinical guidelines for pancreatic enzyme replacement therapy. While there are many areas of agreement in nutrition care for people with cystic fibrosis around Australia and New Zealand, there are still practice differences, implying that Australian- and New Zealand-specific clinical guidelines are warranted. The implementation of the Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis will be important in standardising and improving cystic fibrosis care.     

The meaning of leisure for well-elderly Italians in an Australian community: implications for occupational therapy

Aim:  This paper documents a study that aimed to discover the meaning of leisure experiences for an ageing Italian community in a large regional centre in Victoria, Australia.
Methods:  This qualitative investigation used a phenomenological study design, and data were collected through semistructured interviews with 10 well-elderly Australian Italians.
Results:  Participants engaged in numerous leisure occupations that were meaningful to them and directly impacted on positive subjective experiences and health outcomes.
Conclusion:  This paper adds to an understanding of how leisure impacts on the health of well-elderly Australians and how occupational therapists can use leisure effectively in interventions for successful ageing.     

Using the Assessment of Motor and Process Skills to measure functional change in adults with severe traumatic brain injury: A pilot study

Aim:  To measure functional change in 10 adults following severe traumatic brain injury using the Assessment of Motor and Process Skills (AMPS).
Methods:  This clinical pilot study used a standardised occupational therapy tool, the AMPS, to measure motor and process scores during activities of daily living, for over 3 weeks of inpatient rehabilitation.
Results:  Wilcoxon signed ranks tests indicate significant improvement in motor and process scores from initial assessment to repeat evaluation ( z = – 2.70 , p  =  0.01 ; z = – 2.81 , P =  0.01 , respectively).
Conclusions:  The AMPS measured statistically and clinically significant change in motor and process abilities over 3 weeks of neurosurgical rehabilitation. Findings suggest that the AMPS is a sensitive measure of functional change for the study sample and timeframe.     

Language, identity and representation: occupation and occupational therapy in acute settings

Aim:   This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia.
Methods and findings:   Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation.
Conclusions:   The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.     

Understanding where we come from: Occupational therapy with urban Indigenous Australians

Background:  This article outlines issues of service provision for Indigenous families in Brisbane, Australia. It presents guidelines for the development of a socially and culturally appropriate occupational therapy service for urban Indigenous children.
Methods:  A mixed methodology was used in two independent components of the research. Part 1 comprised a survey of paediatric occupational therapists in Brisbane. Part 2 consisted of focus groups and interviews with recipients of a newly established occupational therapy service for Indigenous children.
Results:  Survey findings indicated that very few Indigenous families access mainstream occupational therapy services. Issues and strategies for developing culturally appropriate practice emerged around five main themes. These were the need to develop effective relationships, develop particular personal qualities, understand the background of both the client and the therapist, both gain and give knowledge, and address logistical issues of service delivery.
Conclusions:  Service providers need to understand the social and cultural context of both their Indigenous clients and themselves. Recommendations for future education and practice are provided.     

The Collaborative Model of Fieldwork Education: Implementation of the model in a regional hospital rehabilitation setting

Aim:   This paper describes the implementation of a Collaborative Model of Fieldwork Education in a regional hospital occupational therapy department.
Methods:  The literature on models of fieldwork education for occupational therapy students is reviewed, and an approach to the implementation of the collaborative model with three students to one clinical educator is described after piloting of this model's recommendations, arising from the pilot placement, are proposed.
Conclusions:  The implementation of a Collaborative Model of Fieldwork Education requires careful planning, close links with the university fieldwork team and a willingness on the behalf of occupational therapist clinical educators to explore alternative approaches to the provision of fieldwork education.     

Belonging to a community-based football team: An ethnographic study

Purpose:  This study considered the benefits derived from participation in a community-based Australian Rules Football league in Melbourne, Australia. The RecLink league deliberately tackles the social and occupational disadvantages associated with mental illness, addictions, unemployment and homelessness.
Methods:  An ethnographic methodology was used to study one team from the RecLink football league throughout an entire season. Fieldnotes were written following participant observation at training, games and events, and five in-depth interviews were conducted and transcribed. A constant comparative approach to data analysis was adopted.
Results:  Three major themes were identified: a spirit of inclusion, team-building and meaning of team involvement . The first describes how members were accepted, welcomed and given the opportunity for team involvement, with the expectation that they 'had a go', and 'tried their best'. The second illustrates how the team collectively fostered a culture of friendship, cooperation and support. The third examines the significance of being part of the team, incorporating personal contributions and gains, and meanings attributed to team involvement.
Conclusions:  These findings demonstrated how football can be used as non-clinical, community-based occupational therapy: enabling participation in a personally meaningful and culturally valued occupation. Occupational therapists are challenged to explore further how such community-based sports programs may complement existing clinical and welfare-based approaches to social disadvantage.     

Fine motor difficulties: The need for advocating for the role of occupational therapy in schools

Background:  Fine motor difficulties can impact on the academic, social and emotional development of a student.
Aim:  The aims of this paper are to: (i) investigate the need for support to students experiencing fine motor difficulties from the perspective of their classroom teachers, and (ii) report on the level of knowledge teachers have in regard to the role of occupational therapists in supporting students with fine motor difficulties.
Methods:  Fifteen teachers from a stratified random sample of public schools within two regions of Victoria, Australia, were interviewed in this qualitative, grounded theory investigation.
Results:  Results showed that the current level of support for students with fine motor difficulties is inadequate.
Conclusion:  Occupational therapists in Victoria need to advocate their role in developing the fine motor skills of students at both an organisational and an individual level in order to increase the access of students with fine motor difficulties to occupational therapy services.     

How and why do occupational therapists use the OTseeker evidence database?

Background:  OTseeker is a free online bibliographic database containing systematic reviews and methodological ratings of randomised controlled trials relevant to occupational therapy. The database aims to help therapists efficiently identify high quality pre-appraised research.
Aim:  This study explored the search practices of therapists who regularly used OTseeker, what they did with the information retrieved and their perceptions of the database.
Sample:  A purposive sample of 11 occupational therapists was recruited in 2004. All had visited OTseeker at least five times in the previous 12 months.
Study design:  Qualitative.
Methods:  A semistructured interview was conducted with each participant. Grounded theory methods were used for analysis.
Findings:  Five distinct categories were identified: reasons for visiting OTseeker, learning about OTseeker, search times and locations, using information from OTseeker, and improving OTseeker. Therapists used the database to teach or model evidence-based practice, answer clinical questions and keep up-to-date. Suggestions for improvement focussed on search functionality, access to abstracts and the location of the PEDro rating scale. Only two participants synthesised information from OTseeker into a summary, and/or used it to inform client reports.
Conclusion:  This study suggests that OTseeker is helping to increase research utilisation by occupational therapists. Further research is needed to help therapists apply research evidence to change practice and policy.     

Understanding children's motivation from a self-determination theoretical perspective: Implications for practice

Background:  This paper investigates three human psychological needs — autonomy, competence and relatedness — within the context of self-determination theory (SDT). Meeting these needs in therapeutic environments is congruent with principles of client-centred practice.
Aims:  A key objective is to describe how SDT can increase understanding of children's motivation and their willingness to engage in occupations. An additional objective is to investigate commonalities between SDT and specific client-centred approaches such as cognitive orientation to daily occupational performance (CO-OP).
Method and Results:  Literature about SDT is reviewed and a model of motivation based on self-determination and flow theory is presented. Clinical examples are used to highlight theoretical principles.
Conclusions:  It is proposed that understanding theories of motivation, such as SDT and flow, can further occupational therapists' understanding of the psychological processes involved in client-centred practice, particularly when working with children. This information has the potential to enhance clinical knowledge about activity choices to promote children's participation.