早期介入作业疗法对脑卒中患者康复疗效的影响

目的 :探讨早期介入作业疗法(OT)对脑卒中患者康复疗效的影响。方法 :对30例脑卒中患者予以运动疗法(PT)治疗的同时进行系统的OT治疗 ,并与只进行PT治疗组进行对照。结果 :OT组的运动功能、ADL能力评分均高于PT组 ,在同一运动功能状态下作业疗法组的ADL能力高于运动疗法组 ,特别在运动功能积分(Fugl-Meyer肢体运动功能评价法)低于60分时 ,两组的ADL能力差异显著(P<0.001)。结论 :OT对提高脑卒中患者的ADL能力及肢体运动功能有重要意义。     

职业治疗对住院慢性精神分裂症患者康复效果的影响

目的：探讨职业治疗对长期住院慢性精神分裂症患者社会功能与康复效果的影响。方法将80例长期住院的慢性精神分裂症患者随机分为两组,两组均接受常规药物治疗及常规康复训练,在此基础上职业治疗组转入康复科接受职业治疗,观察6个月。采用阳性与阴性症状量表、住院精神病人社会功能评定量表、Morningside康复状态量表评定临床效果。结果治疗后职业治疗组阳性与阴性症状量表阴性症状分、Morningside康复状态量表总分显著低于对照组（P＜0．05或0．01）,住院精神病人社会功能评定量表评分显著高于对照组（P＜0．01）。结论职业治疗融合传统农艺治疗能有效改善慢性精神分裂症患者的阴性症状,提高社会功能及康复效果。     

Active learning of geriatric rehabilitation: deliberations of an undergraduate occupational therapy programme

Occupational therapists working in geriatric rehabilitation must possess skills of self-directed learning and critical thinking, but conventional teaching-learning strategies are limited in acquiring the said skills. This action research aimed at developing in students an ability for active learning and problem solving. An inquiry-based learning (IBL) methodology was introduced to two geriatric-related subjects of an undergraduate occupational therapy (OT) programme. Students worked on four real-life problems in tutorials and participated in service learning. Lectures were carefully structured to consolidate theoretical knowledge generated from the problems. This study was evaluated qualitatively through interviews of both students and clinical educators, and reflective journals. Students found the problems and service learning stimulating enough to encourage active learning and develop basic study skills. Likewise, clinical educators noted students to be more competent when working with geriatric clients than former students who learned through a conventional curriculum. However, the IBL methodology was stressful in areas related to consistency of teaching-learning strategies across curriculum, workload and time constraints. Curriculum review, development of resource files and provision of systematic support are some of the recommendations to the challenges encountered. To conclude, the IBL approach provides appropriate learning environments that foster in students a self-directed learning attitude in the study of geriatric rehabilitation.     

精细作业疗法对断指再植手功能恢复的影响

目的观察精细作业治疗对断指再植手功能恢复的影响。方法将100例患者按随机数字表分为观察组和对照组各50例,对照组断指再植术后采用常规康复治疗,观察组在常规康复治疗基础上行精细作业治疗。采用手指总主动活动度评价法、普渡手精细运动评定法、明尼苏达手灵巧度评定法评价两组患者手功能恢复情况。结果康复治疗3月后,观察组患者手指总主动活动度、小关节精细运动及手灵巧度均优于对照组,两组间比较均有统计学意义(P均0.01)。结论精细作业治疗有助于提高断指再植术后手指的精细运动功能,促进手功能的恢复。     

Occupational therapy for complex inpatients with stroke: identification of occupational needs in post-acute rehabilitation setting

Purpose: Inpatients admitted to rehabilitation express needs not linked to disease causing hospitalization.

This observational cross-sectional study identifies features and occupational needs of complex inpatients during rehabilitation, focusing on function and ability, regardless of diagnosis.

Method: This study included sixteen adult inpatients with stroke, deemed complex according to Rehabilitation Complexity Scale-Extended, at admission to Rehabilitation ward (from July 2014 to February 2015). Patients with primary psychiatric disorders, language barriers, cognitive or severe communication deficits were excluded. Upon admission, a multidisciplinary team collected data on general health, independence in daily activities (Modified Barthel Index), fatigue (Fatigue Severity Scale), resistance to sitting and ability to perform instrumental activities (Instrumental Activities of Daily Living). The occupational therapist identified occupational needs according to Canadian Occupational Performance Measure.

Results: Inpatients enrolled in this study were dependent in basic ADL, limited in instrumental ADL and easily fatigable. Their occupational needs related to self-care (75%) and, to a lesser extent, productivity (15%) and leisure (10%). According to inpatients, rehabilitation process should firstly address self-care needs, followed by productivity and leisure problems.

Conclusions: Despite small sample size, this study described patterns of occupational needs in complex inpatients with stroke. These results will be implemented in client-centered rehabilitation programs to be tested in a phase-two trial. [NCT02173197]

• Implications for Rehabilitation

• Priority occupational needs of complex inpatients with stroke during rehabilitation are focused on self-care area.

• Productivity and leisure problems also arise in early post-acute phase.

• Client-centered rehabilitation programs should firstly address self-care needs and, later on, they should also focus on the recovery of family and social roles.

     

Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners

Aim: The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners’ perspectives on the practices that constitute high quality hip fracture rehabilitation.

Methods: Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners’ perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach.

Results: Seven themes emerged: objectives of care; first 72?h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration.

Conclusions: Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners’ perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes.

• Implications for Rehabilitation

• This study highlights occupational and physiotherapy therapy practitioners’ perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation.

• While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers.

• Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.

     

患者对作业疗法需求的调查

目的了解患者对作业疗法的各种需求,探讨最佳的作业疗法实施方案。方法以恢复身体机能、获得心理稳定、回归职业等几个代表性的作业疗法为主要内容,对69名患者进行问卷调查,探寻患者对这些作业疗法需求的程度。结果90%以上的患者对“恢复身体机能”、“在家庭中发挥自己的作用”、“减少帮助量”、“获得心理稳定”及“能进行一些趣味活动”5项的回答为需求;对出院后的打算,32%的患者回答“在家中无须帮助而独立生活”,各有25%的患者回答“恢复原职/寻找职业”、“继续住院治疗”、23%的患者回答“到其他设施中生活”。结论患者虽然对恢复身体机能的需求程度非常高,但有必要促使患者从其他侧面来理解作业疗法的作用。     

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists’ practice of stroke rehabilitation. Method The frame of reference is Fairclough’s critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012–2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient’s independence than to enabling the regaining of meaningful activities and participation.

• Implications for Rehabilitation

• Individualized rehabilitation must be organized with flexibility as it is a complex process

• Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality

• A broader range of stake holders, including patient organizations, are in demand within health policy making

• The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient

     

Access and perceived need for physical and occupational therapy in chronic arthritis

Purpose.?Physical and occupational therapy are beneficial for persons with chronic arthritis; however, access is problematic. The goal was to examine issues related to access to these services for patients with chronic arthritis.

Methods.?We used two data sources: 1) questionnaires sent to a random sample of 600 family physicians and to all 85 rheumatologists in the province of Quebec; and 2) interviews of 211 patients with physician-confirmed chronic arthritis recruited from 34 primary care settings in Quebec.

Results.?Only 11.5% of family physicians and 31.7% of rheumatologists referred patients with rheumatoid arthritis (RA) to rehabilitation, whereas 60.4% of family doctors referred patients with osteoarthritis. Only 26.1% of patients felt that they required rehabilitation and this was associated with lower self-efficacy (OR: 0.84, 95% CI: 0.72, 0.99) and higher educational level (OR: 2.10, 95% CI: 1.01, 4.36).

Conclusion.?Family physicians are less likely to refer patients with RA to therapy. Only about a quarter of patients with chronic arthritis treated in primary care perceived the need for these services. Efforts to improve arthritis care should address education of physicians and patients regarding the benefits of rehabilitation and there should be efforts to increase therapy resources in order to enhance access.     

Parents' perspectives on occupational therapy and physical therapy goals for children with cerebral palsy

Contemporary rehabilitation literature emphasises functional goals for children with disabilities and use of a collaborative goal-setting process grounded in principles of family centred service delivery.

Purpose.?To explore parents' experiences with goals and goal setting.

Method.?We conducted a qualitative study with 11 focus groups and two individual interviews with 39 parents of children with cerebral palsy living in western Canada. We used an inductive, thematic analysis to identify prominent themes.

Results.?The analysis revealed five themes representing goals that were meaningful to parents and provided insight into parents' experiences with goal-setting processes in occupational and physical therapy: (1) movement as the means to functional success; (2) physical health and fitness are important therapy goals; (3) the importance of leading happy, fulfilling lives and being accepted by others; (4) ‘We can't do it all’: balancing therapy with the demands of everyday life; and (5) shifting roles and responsibilities in goal setting.

Conclusions.?The variability noted both in parents' desired role in goal setting and in goals important to parents highlights the importance of establishing trusting relationships with families so that family goals, values, individual circumstances, and desired level of participation in goal setting can be openly discussed.     

The meaning and form of occupational therapy as experienced by women with psychoses. A phenomenological study

The meaning and form of occupational therapy as experienced by women with psychoses: a phenomenological study The aim of this study was to illuminate the experiences of occupational therapy interventions in individuals with psychoses. Repeated tape-recorded narrative interviews were conducted with six women participating in occupational therapy immediately after an intervention. The subsequent analyses followed a phenomenological approach. Key constituents integrated in two structures, are the main findings. The meaning of occupational therapy as expressed in the key constituents relief, self-knowledge, belief in the future, capability, resistance and satisfaction formed one structure. The form of occupational therapy as expressed in the key constituents time, environment, guidance, voluntariness and collaboration represented the other structure. These findings confirm and give empirical support to beliefs and assumptions expressed in occupational therapy literature. The results form a conceptual base for developing an evaluative assessment instrument for individuals with psychoses participating in occupational therapy.     

Reported use of technology in stroke rehabilitation by physical and occupational therapists

Purpose: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs.

Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.

Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.

Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.

• Implications for Rehabilitation

• The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.

• Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.

• Physical and occupational therapists do not widely use technology in stroke rehabilitation.

• Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

     

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: a comparison between four European rehabilitation centres

Purpose. The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries.

Method. Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units.

Results. The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units.

Conclusions. Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.     

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: A comparison between four European rehabilitation centres

Purpose. The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries.

Method. Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units.

Results. The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units.

Conclusions. Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.     

The role of the ICF in physical therapy and vocational rehabilitation: contributing to developments in occupational health

Abstract

Background: Vocational rehabilitation is implemented to ensure and sustain return to work. Different healthcare professionals are involved in the process of vocational rehabilitation and physical therapists are in the forefront of providing vocational rehabilitation services. A comprehensive conceptual framework is required, so appropriate and adequate vocational rehabilitation can be provided by physical therapists. The international classification of functioning, disability, and health (ICF) by the World Health Organization can provide such a framework.

Objective: This paper will discuss recent developments in the field where the ICF has been used in vocational rehabilitation, how such usage will benefit physical therapy practice, and priority areas that need to be addressed in the near future.

Discussion: The ICF has been used in multiple ways in vocational rehabilitation in which physical therapists can play a major role. To better understand and measure work disability, the ICF can be used as a basis for a conceptual definition of vocational rehabilitation and as a tool to develop or select functioning domains and measurement instruments relevant to vocational rehabilitation.

Conclusion: The ICF is a viable option for physical therapists to understand and facilitate the process of vocational rehabilitation towards better return to work outcomes. Physical therapists, as one of the primary health professionals engaged in vocational rehabilitation, will benefit from using a reference framework like the ICF in their clinical practice and research.     

The Kawa model: The power of culturally responsive occupational therapy

The Kawa (Japanese for river) model, developed by Japanese and Canadian rehabilitation professionals, presents an important and novel alternative to contemporary ‘Western’ models of rehabilitation. Rather than focussing primarily on the individual client, the Kawa model focusses on ‘contexts’ that shape and influence the realities and challenges of peoples' day-to-day lives. The first substantial model of rehabilitation practice developed outside of the West illuminates the transactional quality of human-environment dynamics and the importance of inter-relations of self and others through the metaphor of a river's flow. The model's reflection of Eastern thought and views of nature presents a useful point of comparison to familiar rational and mechanical explanations of occupation and well-being. In this article, the rationale for an alternative model in rehabilitation is presented, followed by an explanation of the structure and concepts of the Kawa model. Implications for culturally responsive practice as well as the model's significance to the advancement of culturally safe rehabilitation worldwide are discussed.     

早期作业治疗对全面性发育迟缓患儿认知发育的影响

目的:探讨早期作业疗法对全面性发育迟缓患儿智力发育的影响。方法:将62例全面性发育迟缓患儿分为观察组38例和对照组24例,对照组患儿接受运动训练、慢性小脑电刺激、水疗等康复训练治疗,观察组在此基础上进行早期作业治疗。2组治疗前和治疗12周后分别进行Gesell智力测试评估检查(GDS)和Peabody运动发育量表(PDMS)测试。结果:治疗12周后,2组GDS及PDMS各项评分均较治疗前明显提高(P0.05),且观察组更高于对照组(P0.05)。在不同年龄段,治疗前后观察组患儿的GDS各项评分差值有统计学差异(P0.05),1岁以内的患儿治疗前后发育商差值最大。结论:早期作业训练治疗可有效的提高全面性发育迟缓患儿的智力各能区的发育水平,越早干预效果越好,值得临床推广。     

小组模式作业治疗对伴有情绪障碍脑卒中患者的康复疗效观察

目的 研究小组作业治疗对伴有情绪障碍脑卒中患者的康复疗效。方法 选择72例脑卒中患者,采用随机数字表随机分为小组作业治疗组(研究组)和常规作业治疗组(对照组),于治疗前、治疗4周后分别采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评测焦虑及抑郁情况;采用蒙特利尔认知评估量表(MoCA)评测认知情况;采用简化Fugl-Meyer量表(FMA)评定运动功能;采用改良Barthel指数量表(MBI)评定日常生活活动能力。结果 治疗4周后,两组患者HAMA、HAMD、MoCA、FMA、MBI评分较治疗前明显改善(P <0.05),且研究组HAMA (10.80±2.39)分、HAMD (15.34±3.96)分、MoCA (24.61±4.72)分、FMA(74.16±8.12)分、MBI (75.6±12.11)分均显著优于对照组HAMA (14.79±3.42)分、HAMD (20.77±3.85)分、MoCA(20.83±4.90)分、FMA(62.34±7.91)分、MBI(64.14±10.71)分,组间差异均具有统计学意义(P <0.05)。结论 小组作...