Review of the evidence related to older adult community mobility and driver licensure policies.

A systematic review of literature related to the effects of drivers' license policies and community mobility programs on older adult participation was completed as a part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. The results revealed that states can achieve a goal of reducing traffic crashes, traffic violations, and traffic-related fatalities through relicensing policies requiring in-person renewal and vision testing as well as driving restrictions. Evidence suggests that failure to consider the continued community mobility needs of older adults can result in increasing fatalities among senior citizens using other modes of community mobility. This evidence-based review is informative for occupational therapy practice; however, it does not reveal the association between policy and community mobility interventions and improved engagement and participation. There is a role for occupational therapy in policy development and community mobility programming to promote engagement in occupation to support participation.     

Background and methodology of the older driver evidence-based systematic literature review.

In response to demands of health care and community-based systems, occupational therapy practitioners are eager to provide effective services that are client centered, supported by evidence, and delivered in an efficient and cost-effective manner. Findings from the scientific literature provide a source of legitimacy and authority for informing and guiding practice in all areas, including driving and community mobility with older adults. A systematic review examined studies designed to enhance the driving ability, performance, and safety of older adults. This article presents an overview of the methodology used to develop the focused questions related to the person, vehicle, infrastructure, and policy and community mobility; conduct the literature review; and establish quality control. It includes a summary of the evidence and implications of the review for clinical practice, education, and research to ultimately identify interventions effective in supporting older adult participation and engagement in occupation.     

On the road again after traumatic brain injury: driver safety and behaviour following on-road assessment and rehabilitation

Purpose: To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation. Method: A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n?=?74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n?=?32). Results: No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group. Conclusions: Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.

• Implications for Rehabilitation

• Driver assessment and on-road retraining are important aspects of rehabilitation following traumatic brain injury.

• Many drivers with moderate/severe TBI, reported modifying their driving behaviour to compensate for ongoing impairment and continued to drive safely in the longer term.

• Navigational difficulties were commonly experienced following TBI, suggesting that training in navigation may be an important aspect of driver rehabilitation.

     

Rapid growth of rehabilitation services in traditional community-based nursing homes

OBJECTIVE: To describe the changes in rehabilitation therapy services in nursing homes based in the community during a period of rapid escalation of Medicare payments to nursing homes. SETTING: All Medicaid-certified nursing homes in Ohio. SUBJECTS: The 52,705 residents newly admitted to nursing homes in 1994 and 1995. DESIGN: Retrospective trend analysis of administrative data. MAIN OUTCOME MEASURES: For newly admitted residents receiving 90 or more minutes of rehabilitation therapy per week, the trends in percentage and in the amount and type of therapy received were determined for eight quarters. RESULTS: Of all newly admitted residents, 50.5% received 90 or more minutes of therapy. When they received such therapy it averaged 412 minutes per week (SD = 259). Those residents who received rehabilitation services increased by 2.2% each quarter (p<.001), and the amount of therapy they received increased by 6.4 minutes each quarter (p<.0001). All three types of rehabilitation therapy-physical, occupational, and speech-increased (p<.015) over the study period. CONCLUSIONS: The traditional nursing home is an important site for the provision of rehabilitation therapy services. Rehabilitation specialists should be aware of these trends as they plan for the future of rehabilitation. The effectiveness of this increased provision of therapy service in terms of measurable outcomes needs to be evaluated.     

Treatment choices: rehabilitation services used by patients with multiple personality disorder.

This article identifies mental health rehabilitation services for patients with multiple personality disorder. Through the use of a literature review and a retrospective examination of 20 patients' records, the frequency of discipline-specific services is noted in occupational therapy, art therapy, movement therapy, vocational counseling, and recreational therapy. Recommendations for practice and program development include ongoing education about multiple personality disorder and continual assessment of the patient's functional level to identify subsequent treatment needs and services.     

Training in rehabilitation: basics needs and considerations.

Rehabilitation is an integral part of medicine. It includes physical therapy, occupational therapy, speech therapy. It involves nurses, social workers, clinical and educational psychologists. It also involves resettlement into the community and to work. Each patient, whether temporarily or permanently disabled, requires a comprehensive service to meet all his needs at the appropriate time. Although there are some multidisciplinary teams providing comprehensive rehabilitation services the needs are so wide and complex that many patients do not achieve optimum rehabilitation. Most doctors believe that the best rehabilitation stems from high standards of general medical care, but many patients require care and counselling extending into social and community aspects of their lives. The clinician must be trained to understand these needs and accept the responsibility for, at least, initiating appropriate rehabilitation and resettlement procedures and thus reducing clinical and social morbidity. Rehabilitation is more than the practice of special techniques. Most therapists can contribute considerably by the assessment of potential functional capability and by exploiting residual capability by alternative techniques of activity, or the use of aids and appliances. The behavioural aspects of response to illness or injury and the patterns of recovery thus determined need to be more clearly understood and the rehabilitation programme reappraised in the light of the knowledge.     

Relationship between duration of therapy services in a comprehensive rehabilitation program and mobility at discharge in patients with orthopedic problems

BACKGROUND AND PURPOSE: The purpose of this study was to examine the relationship between duration of physical therapy and occupational therapy and mobility at the time of discharge from a comprehensive rehabilitation program in a group of patients with orthopedic diagnoses. SUBJECTS: Subjects were 116 consecutive patients with orthopedic diagnoses (mean age=72.6 years, SD=12.0, range=21-99) who were admitted to a comprehensive inpatient rehabilitation program. METHODS: This retrospective cohort study utilized the Uniform Data Set, social service records, and quality assurance records to provide demographic and medical information. The Functional Independence Measure (FIM) provided information regarding mobility at admission and discharge. The duration of physical therapy and occupational therapy was measured in hours. RESULTS: Subjects received an average of 40.8 hours of therapy and showed an average change in FIM mobility subscale scores of 24.5. Multiple linear regression was used to demonstrate that duration of therapy was a predictor of FIM score at the time of discharge (partial correlation=.069) after controlling for length of stay, number of diagnoses, FIM cognitive subscale score at admission, and FIM mobility subscale score at admission. Duration of therapy accounted for 6.9% of the variance in the model. CONCLUSION AND DISCUSSION: This study indicates that the amount of physical therapy and occupational therapy that patients with orthopedic diagnoses receive during enrollment in an inpatient comprehensive rehabilitation program is related to the FIM mobility subscale score at the time of discharge. The authors suggest that increasing the hours of therapeutic intervention that a patient receives in inpatient rehabilitation could improve functional outcomes at discharge.     

Creating an occupational therapy Level II fieldwork experience in a county jail setting.

Although occupational therapy services have been rendered in prisons historically, only one occupational therapy program currently exists in a county jail: the Allegheny County Jail Project (ACJ Project). The offenders who populate county jails experience occupational deprivation. The participants of the ACJ Project have benefited from occupational therapy intervention that was initiated during incarceration and continued following their release from jail in order to help them resume productive life roles and to reduce the reoccurrence of engagement in criminal behaviors (recidivism rate). As of June 2003, the ACJ Project has successfully affected the lifestyle patterns of its participants and overall public safety by helping 63% of participants secure gainful employment and by helping 91.8% of participants maintain their freedom after prison. The purpose of this report is to describe the process and benefits of implementing fieldwork opportunities for Level II occupational therapy students in a best practice occupational therapy program in a nontraditional environment: a county jail.     

Enhancing research utilization capacity through multifaceted professional development.

Some occupational therapists report that they do not feel adequately prepared to perform the arduous tasks involved in integrating research into their practice. To explore how research utilization can be conducted by practicing clinicians, self-reported research utilization behaviors of a sample of 11 occupational therapists practicing in adult stroke rehabilitation were analyzed. The constant comparison of the interview data revealed that participants' clinical experiences, engagement in continuing education, involvement in research activities, and their mentoring of students contributed to their capacity to translate research evidence into practice. The results of the study suggest a model for enhancing research utilization capacity through professional development. Implications for practitioners, provider organizations, educators, and regulators of occupational therapy are discussed.     

Developing community occupational therapy services in Canada.

International trends in health care point to increasing development of community services. However, the majority of occupational therapists work in institutional settings. A study, between 1985 and 1987, defined and created a profile of existing community occupational therapy services across Canada, and identified the processes and strategies which led to the development of these services. One hundred and eighty nine (189) services, including home care, other salaried services, and private or consulting services were identified. A national sample of community occupational therapy program developers described processes and strategies from which the author suggests a general "ripple effect" strategy to enhance the occupational therapy contribution to the community.     

Professional strategies in work-related practice: an exploration of occupational and physical therapy roles and approaches.

Both occupational and physical therapy have historical roots in worker rehabilitation; however, the core philosophies and areas of expertise of these professions suggest there may be inherent differences in the ways each approaches therapeutic intervention. This study surveyed 600 occupational and physical therapists in the United States to determine the nature and scope of work-related practice, and the degree to which occupation-based strategies are used by either profession. The overall response rate was 54% (n = 324), and 76% of respondents (n = 246) were actively engaged in providing work-related services. Results indicate that both professions provide all services commonly associated with work-related therapy in almost equal proportions. Few significant differences were identified between the professions in terms of approaches to therapy, and findings did not reveal the use of occupation-based interventions to any greater degree by occupational therapists.     

Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services

ObjectiveTo identify nursing assessments of mobility and activity associated with lower-value rehabilitation services.DesignRetrospective cohort analysis of admissions from December 2016 to September 2019SettingMedicine, neurology, and surgery units (n=47) at a tertiary hospital.ParticipantsWe included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients).InterventionsNot applicable.Main OutcomeWe examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit.MeasuresPatient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or “6 clicks”) inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting).ResultsUsing an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults.ConclusionsNursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs.     

Large field studies of hospital based services: lessons from occupational therapy

A study with a quasi-experimental design was developed to evaluate the effectiveness of hospital-based occupational therapy services in Nova Scotia. Seven hospitals with occupational therapy services were matched with seven hospitals without occupational therapy services. Within the two hospital groups, subjects were matched on the basis of diagnosis and disability. Outcome measures included measures of functional performance in activities of daily living, and community living skills. This paper discusses some of the strengths and weaknesses of conducting large field studies of hospital based services. It is based on our experience with an occupational therapy outcome evaluation. Some of the strengths include well developed and implemented hospital admission and discharge practices, personal contact with key hospital staff, support of the hospital occupational therapy directors and the Nova Scotia Department of Health, and professional support through national guidelines on the client-centered practice of occupational therapy. Study weaknesses can be categorized into three major areas including evaluation issues, hospital issues, and professional issues. Our experience can contribute to the scientific literature on outcome studies on occupational therapy and to the conduct of large field studies of hospital based services in general.     

Role perceptions of occupational therapists providing support and education for caregivers of persons with dementia.

OBJECTIVE: This pilot study explored occupational therapists' perceptions of their roles as interventionists providing education and support for caregivers of persons with dementia. The intervention was provided in caregivers' homes as part of a larger funded study. METHOD: Interviews were conducted with four occupational therapists to elicit their reflections on practice and their views on occupational therapy services on the basis of their experiences providing support and education for caregivers in the funded study. RESULTS: Key themes consisted of the contrasts between the therapists' roles in the study and their customary practices and the professional and personal impact of their role in the study. Their recommendations for occupational therapy services emphasized the need to (a) collaborate with patients, families, and other health care staff members to solve problems; (b) acknowledge others as experts; (c) include family perspectives; and (d) fully address the needs of patients and families in their home environments. CONCLUSION: Providing support and education for caregivers in the community can be a major transition for therapists accustomed to practicing in more traditional settings. Additional research is needed to explore the ways in which specific practice contexts influence delivery of occupational therapy services.     

Reflections on...well-being and occupational rights

BACKGROUND: Although claiming that engagement in occupations influences well-being, the occupational therapy profession has largely failed to acknowledge and address the relationships between well-being, occupation, and human rights. PURPOSE: This paper supports the premise that the focus of occupational therapy should be on the right of all people to participate in meaningful occupations, and proposes allegiance to occupational rights: the right of all people to engage in meaningful occupations that contribute positively to their own well-being and the well-being of their communities. PRACTICE IMPLICATIONS: The connection between well-being and human rights would be made explicit, occupational rights would be recognized as a political issue and the profession's confinement within health-care services would end. This commitment to occupational rights would bring our practice into line with our espoused belief in the relationship between occupation and well-being, and enable us to state, unequivocally, what occupational therapy contributes to humanity.     

The effects of introducing the Klein-Bell ADL Scale in a rehabilitation service

This study investigated the impact of introducing the Klein-Bell ADL Scale into a rehabilitation medicine service. A pretest and a posttest questionnaire of rehabilitation team members and a pretest and a posttest audit of occupational therapy documentation were completed. Results of the questionnaire suggested that the ADL scale influenced rehabilitation team members' observations in the combined area of occupational therapy involvement in self-care, improvement in the identification of treatment goals and plans, and communication between team members. Results of the audit suggested that the thoroughness and quantification of occupational therapy documentation improved. The clinical implications of these findings recommend the use of the Klein-Bell ADL Scale in rehabilitation services for improving occupational therapy documentation and for enhancing rehabilitation team effectiveness.     

Clinical interpretation of "occupational therapy goal achievement for persons with postacute cerebrovascular accident in an on-campus student clinic".

Occupational therapy practitioners, educators, and researchers can gain important information from Lavelle and Tomlin's study for initiating programs that meet the needs of a population of persons who typically cannot access occupational therapy services. The study provides evidence of the effectiveness of occupational therapy for persons with postacute CVA for clinicians seeking alternative funding for community-based practice. The study also suggests that the free university clinic in which Lavelle and Tomlin's research took place was providing a valuable service to persons living near the university, creating important links between the university and the community in which it resides. Lastly, the study raises intriguing questions that provide research opportunities for occupational therapy practitioners, educators, and students that can enhance our understanding of the impact of occupational therapy services on persons long after a CVA.