Occupational therapists' practice patterns for clients with cognitive impairment following acquired brain injury: development of a questionnaire

Abstract

Clients with cognitive impairment following acquired brain injury (CIABI) are a common group to receive occupational therapy services. Research has shown that occupational therapy has a positive effect on occupational performance for these clients, but the exact nature of the interventions is not clearly described and needs to be better understood and defined. The aim of this study was to develop and evaluate an empirically derived questionnaire for the purpose of surveying occupational therapists' (OTs') practice patterns in relation to CIABI. The questionnaire was developed from the results of a former qualitative study. It was evaluated for content validity by a group of six OT researchers with experience in CIABI, using the content validity index (CVI). Reliability was evaluated by a test–retest design with a group of 51 OTs. Data were analysed by non-parametric statistical methods. Initially the questionnaire consisted of 90 items dealing with OT practice and nine demographic questions. After the reliability and content validity process the OT practice items were reduced to 44. The revised questionnaire will be used to survey and explicitly describe occupational therapy practice for clients with CIABI.     

The Utilization of Spirituality in Occupational Therapy: Beliefs,Practices, and Perceived Barriers

Spirituality has become an increasingly important topic in healthcare and specifically in occupational therapy. This study utilized a survey design to examine occupational therapists' current beliefs and practices regarding spirituality, and to identify barriers to the use of spirituality in OT treatment. No statistically significant relationship was found between the use of spirituality and different practice settings or therapists' demographics However the participants' response indicated that the beliefs and practices regarding spirituality in occupational therapy may be changing Therapists reported discussing spiritual issues with clients more frequently than in previous studies. Lack of education or experience in taking a spiritual history was reported as the major barrier impeding the therapists' ability to incorporate spirituality into OT practice.     

Occupational therapy practice with clients from non-English speaking backgrounds: A survey of clinicians in south-west Sydney

Australia is a multicultural society and this has important implications for the health care worker. The aim of this study was to investigate the experiences of occupational therapists who work with clients from non-English speaking backgrounds (NESB). The ‘cross-cultural therapy questionnaire’ was developed by the author and distributed to 65 occupational therapists employed in either the South-Western Sydney Area Health Service or Western Sydney Area Health Service. Issues explored in this questionnaire included barriers to cross-cultural care, strategies employed to overcome these barriers and theoretical models used to guide practice with ethnic clients. It was found that the majority of respondents experienced a number of obstacles to cross-cultural care within occupational therapy practice. An extensive list of strategies for overcoming cross-cultural barriers was compiled. The implications of these results for the profession of occupational therapy are discussed and future research directions are suggested.     

慢性职业中毒患者心理需要问卷的编制与信效度检验

目的 编制信效度较好的慢性职业病患者心理需要测评问卷,为慢性职业中毒患者心理需要的满足程度评估和实施心理治疗及心理护理提供依据。方法 本文对100例研究对象依据马斯洛需要理论,编制慢性职业中毒患者心理需要测评问卷的45个条目,分别按年龄、性别、总体及各子维度进行测量内在一致性信度的系数,并对该问卷量表的单个条目和总量表内容效度指数值进行评估。结果 通过对100例慢性职业中毒患者的45个条目心理需要测评问卷进行信效度系数测量,结果表明,按年龄、性别、总体案例分别测定该问卷量表的总体及各子维度内在一致性信度的系数值均在0.75以上,该问卷量表的单个条目内容效度系数(I-CVI)均在0.78及以上,总量表内容效度指数(S-CVI)为0.934。结论 本文编制的慢性职业中毒患者心理需要测评问卷具有较好的信效度,可为慢性职业中毒患者心理需要及心理治疗满足程度评估提供依据。     

The Development and Validation of a Screening Instrument to Identify Hospitalized Medical Patients in Need of Early Functional Rehabilitation Assessment

The purpose of this study was to develop a scale that identifies hospitalized patients in need of physical therapy (PT) and/or occupational therapy (OT) assessments. Preliminary scale items were tested for reliability among 52 patients and remaining items were then administered to 299 patients and items that were associated with the concept of 'need for an assessment' on multivariate analyses were selected as final scale items. The concept of need was based on the clinical judgment of physical and occupational therapists. Receiver operator characteristic (ROC) curves were constructed to determine a cut-off score and the predictive ability of this score in determining length of stay and utilization of services was evaluated among 200 patients. The final scale contains two components. The PT component addresses ambulation, falls, breathing, and activities of daily living (ADL). The OT component addresses swallowing, ADL and instrumental activities of daily living (IADL). The area under the ROC curves of the PT and OT components were 0.71 and 0.72, respectively. Both components predicted length of stay and utilization (p < 0.05). In summary, this scale provides a mechanism for targeting patients for early PT and OT assessment and provides a basis for testing the effectiveness of early PT and OT interventions.     

Utilization and Content Validity of the Swedish Version of the Volitional Questionnaire (VQ-S)

The aim of this study was to examine the utility and content validity of the Swedish version of the Volitional Questionnaire (VQ-S). The participants in this study were thirteen occupational therapists selected because they worked with clients for whom the VQ-S is appropriate (in this case, adults with intellectual impairments) and because they had knowledge of the Model of Human Occupation. These participants completed a demographic questionnaire at the beginning of the study. Each therapist then used the VQ-S a total of six times and after each time they completed a questionnaire concerning the utility and content validity of the instrument. After having administered the instrument six times they completed a third questionnaire that assessed their perceptions of the VQ-S based on their total experience. Data from these questionnaires and the six assessment forms with the actual client ratings were analyzed using both quantitative and qualitative procedures. The findings indicate that the VQ-S has clinical relevance and potential for implementation with adults with intellectual impairments. They also support the content validity of the VQ-S.     

A survey of Israeli occupational therapists' definitions of the profession

The broad definition of occupational therapy, its holistic basis and its unifying characteristics enable occupational therapists to treat their clients as whole human beings. Yet, the holistic basis of occupational therapy and the divergence of its specialty areas seem to be polarised. This study explores Israeli occupational therapists' perceptions of their professional role and boundaries, and how it is affected by professional background; 265 Israeli occupational therapists participated in the study. A two-part questionnaire was constructed: (1) an attitudinal questionnaire including statements on issues that concern occupational therapists regarding the definition of the profession and its role; (2) nine items representing the main unifying characteristics of occupational therapy. Results indicate seven factors underlying the main issues concerning occupational therapists in Israel. From the seven factors two main sources of tension were revealed: strong sense of self-value as compared to lack of recognition by others and the advantages and the pitfalls of the holistic definition of occupational therapy. The most unifying characteristic of occupational therapy was the holistic definition, and the least important was the use of arts and crafts. In addition, occupational therapists from developmental disabilities area of specialty were distinct from others in their perceptions of the profession.     

Psychometric properties of the Worker Role Self-assessment instrument used to evaluate unemployed people in Sweden

The aim was to determine the psychometric properties of the new Worker Role Self-assessment (WRS) instrument. The content validity, utility, test–retest reliability, sensitivity to change, and predictive validity of the WRS were investigated in two subject samples, which were selected at work and pain rehabilitation clinics, respectively. One of these groups consisted of 23 clients and four occupational therapists, and the other comprised 83 clients. All clients in both samples were unemployed. The results showed that both the clients and the occupational therapists perceived the content validity and the utility of the WRS as good. The test–retest reliability showed mostly good to moderate agreement, and the internal consistency was satisfactory. One of the items showed predictive validity for work capacity, and the same item was sensitive to change. However, a ceiling effect reduced the utility and the sensitivity to change. Our findings indicate that the WRS is promising as a tool that clinicians can use to evaluate the capacity for return to work and for planning interventions, although some revisions are needed to counteract the ceiling effect.     

Ethical Dilemmas Encountered by Community-based Occupational Therapists in Home Care Settings

This study of occupational therapists practising in the field of gerontology was conducted to determine the subjects' conception of Instrumental Activities of Daily Living (IADL). and current practice in relation to assessment and treatment of their clients. A survey method was used to obtain data from 135 practising occupational therapists. The results showed that many of the subjects were unfamiliar with the term “instrumental activities of daily living.” In addition, the study showed that occupational therapists actually did spend a considerable portion of their practice time in the area of IADL, reporting that the most common tasks for intervention were meal preparation, light housework, transportation, shopping and use of the telephone. When reporting on methods and accuracy of assessment procedures, subjects agreed that “observation of performance” and standardized assessment tools were the most accurate forms of assessment. With the rapidly ageing population, and government policy for keeping people in their own homes for as long as possible. IADL is set to become a significant part of occupational therapy (OT) evaluation and intervention.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

Development and content validity of the Norwegian Self-Assessment of Modes Questionnaire (N-SAMQ)

Background: The Intentional Relationship Model (IRM) introduced six therapeutic modes as ways of relating to clients. By increasing occupational therapists’ awareness of modes, and by increasing their skills in using them, therapists may improve their interactions with clients. The Self-Assessment of Modes Questionnaire may assist in increasing awareness of modes. Aim: To describe the process of developing a Norwegian version of the Self-Assessment of Modes Questionnaire (N-SAMQ) and to evaluate its content validity. Materials and methods: A 10-step translation and adaptation procedure was followed. Occupational therapists working in diverse practice areas completed the preliminary N-SAMQ version. Individual cognitive interviews were performed with these therapists in order to examine the comprehensibility and cultural appropriateness of the N-SAMQ. Results: Initially, one item was omitted. Following the pilot study (n?=?7), two of the remaining items were modified with a view to increasing their cultural relevance. Otherwise, modifications were made mostly in terms of words and phrasing. Conclusion: The N-SAMQ appears to have good face and content validity. Significance: With the N-SAMQ, Norwegian occupational therapists can assess their preferred therapeutic modes.     

The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives. Additionally the authors sought to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated that the most common level of participation for the clients was interdependent, meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist. However, more than 20% of the clients were described as being dependent. Almost 90% of the occupational therapists rated client participation in therapy to be very important and nearly 70% claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.     

The Partnering Model: Occupational Therapy Assistant and Occupational Therapy Students Working Together

SUMMARY

Establishing a partnering relationship between the occupational therapy assistant (OTA) and the occupational therapist (OT) is imperative in order to create an optimal working environment and deliver effective client care. A developmental model that provides students with opportunities to practice such a relationship has been used by an OTA and OT program in southwestern Ohio. This developmental Partnering Model gives students an opportunity to interact, work as teams, and collaborate during their educational experience. Each aspect of the model provides students with experiential learning opportunities. Educators will serve their OTA and OT students well in providing opportunities for them to develop and practice the skills they will need to create an optimal working environment and deliver effective client care as occupational therapy practitioners.     

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.     

Volitional questionnaire: Psychometric evaluation of the finnish translation

Abstract

Background: Supporting clients’ motivation to engage in occupations is essential to occupational therapy practice. The Volitional Questionnaire Finnish version (VQ-FI) can be used to evaluate volitional behaviors of clients with limited ability to communicate.

Objective: The many-facet Rasch model was used to evaluate the reliability and validity of the VQ-FI using the FACETS and WINSTEPS software.

Methods and materials: Forty-two therapists received an in-person training on the VQ-FI and completed 226 independent ratings of clients. The VQ-FI was evaluated in its rating scale functioning, unidimensionality, person validity, rater severity, item targeting, and item/person separation.

Results: The four-point rating scale demonstrated adequate functioning; the ‘passive’ rating category was rarely adopted. The VQ-FI showed unidimensionality, with all 14 items fitting the Rasch model. No evidence for ceiling or floor effects, and the assessment demonstrated appropriate item and person separation. The VQ-FI reliably separated participants to three levels of ability.

Conclusions: The study provides preliminary evidence for the reliability and validity of the VQ-FI.

Significance: The VQ-FI is an observational measure that can be used to evaluate clients’ volitional behaviors. The VQ-FI offers practitioners and researchers a valid approach to evaluate volition that is theoretically grounded in the Model of Human Occupation.     

Utilization of the iPad application: Aid for Decision-making in Occupation Choice

The purpose of the study was to develop and evaluate an iPad (Apple) application, Aid for Decision-making in Occupation Choice (ADOC), so as to promote shared decision-making in an occupation-based goal setting. This application involves the client choosing from 94 illustrations describing daily activities related to the category of "activities and participation". One hundred occupational therapy clients evaluated the ADOC for goal setting; the clients and 37 occupational therapists underwent a survey to determine their perceptions of decision-making in the goal setting. More than 90% of the clients felt that they could give their opinions using the ADOC regarding goal setting. The majority of the occupational therapists (>90%) felt that ADOC would be useful in their clinical practice for setting client goals. The results indicated that ADOC is a useful and acceptable tool for both clients and occupational therapists in shared decision-making in occupation-based goal setting.     

Reliability of a physical activity questionnaire in middle-aged men

Although some items from a questionnaire used to assess occupational and leisure activity in a cohort of male factory workers have reasonable validity, their reliability is unknown. In this study the reliability of this questionnaire was assessed in 54 middle-aged male factory employees by test-retest administration over a 4-6 week period. Kappa statistics for test-retest agreement for individual items on the questionnaire ranged between 0.24 and 0.66. Those items that demonstrated reasonable reliability and validity will subsequently be related to a range of disease endpoints in a prospective cohort study.     

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.