Individuals with Stroke Reporting Unmet Need for Occupational Therapy Following Discharge from Hospital

ABSTRACT

The purpose of this study was to identify the characteristics and needs of individuals with stroke who report an unmet need for occupational therapy following discharge from hospital. Needs were assessed using a semi-structured interview and a survey in a sample of 209 adults hospitalized with a stroke. Participants were divided into three groups—those needing occupational therapy; those receiving occupational therapy, and those neither needing nor receiving occupational therapy. Thirteen percent (n = 28) reported an unmet need for occupational therapy and were more dependent in activities of daily living (ADL) before and after their stroke and had lower acute functional independence measure (FIM) scores than the comparison groups (p < .05). Participants with unmet needs for occupational therapy were more likely to report unmet needs related to upper extremity function, basic and instrumental ADL, leisure, assistive devices, and the resumption of social roles.     

50例全髋关节置换术后CPM疗效观察

目的：观察关节持续被动训练机（CPM）对患者全髋关节置换术后的临床疗效。方法：将103例全髋关节置换术后患者随机分为对照组53例和试验组50例。两组均给予红外线、超声波等相同的物理治疗,试验组增加CPM终端保持法训练,以第1、第7、第14、两个月为观察时间点,观察患者的疼痛度、切口愈合情况、髋关节活动度。结果：运用CPM的试验组疼痛度较对照组轻,切口愈合情况较对照组较好,患者的髋关节活动度较对照组高（P〈0.05）。结论：CPM治疗能明显加快髋关节康复速度,早期明显改善髋关节功能障碍,是一种较好的康复手段。     

Meeting the needs of elderly with bathing disability

Background/aims: Difficulties with bathing are frequent among older people and are associated with an increasing need for societal support. As loss of independence has a negative impact on health and wellbeing, it is important to study interventions that can provide the required support for people to be able to remain independent. Occupational therapy interventions can improve clients’ abilities enabling them to bathe themselves, thus reducing the need for other, more long‐term societal support from, e.g. a home help. In this study, two groups of elderly people with difficulties in bathing were compared; the clients in the intervention group were engaged in occupational therapy. Methods: A quasi‐experimental non‐equivalent control group design was used, in which participants with reported difficulties in bathing were recruited consecutively from two municipalities. The clients in the intervention group routinely received occupational therapy, whereas clients in the control group received assistance from a home help for bathing. Activities of daily living, quality of life and home‐help allocation were assessed at the baseline and after 15 weeks. Results: Clients in the intervention group received less than three home visits on average, with majority of interventions consisting of graded activity and the use of an encouraging approach. Seventy per cent of the interventions were adaptive. Activities of daily living and quality of life of both groups improved, but the differences of being allocated a home help were significant. Conclusion: Occupational therapy interventions seem beneficial in terms of supporting older people in becoming independent of home help in bathing but the results must be interpreted with caution as there were differences at baseline between the groups.     

Occupational therapy students' contribution to occasions of service during practice placements in health settings

Introduction: Currently in the Australian higher education sector, the productivity benefits of occupational therapy clinical education placements are a contested issue. This article will report results of a study that developed a methodology for documenting time use during placements and investigated the productivity changes associated with occupational therapy clinical education placements in Queensland, Australia. Supervisors’ and students’ time use during placements and how this changed for supervisors compared to pre‐ and post‐placement is also presented. Methods: Using a cohort survey design, participants were students from two Queensland universities, and their supervisors employed by Queensland Health. Time use was recorded in 30 minute blocks according to particular categories. Results: There was a significant increase in supervisors’ time spent in patient care activities (F = 94.011_{2,12.37 df}, P < 0.001) between pre‐ and during placement (P < 0.001) and decrease between during and post‐placement (P < 0.001). Supervisors’ time spent in all non‐patient care activities was also significant (F = 4.580_{2,16 df}, P = 0.027) increasing between pre‐ and during placement (P = 0.028). There was a significant decrease in supervisors’ time spent in placement activities (F = 5.133_{2,19.18 df}, P = 0.016) from during to post‐placement. Students spent more time than supervisors in patient care activities while on placement. Discussion: A novel method for reporting productivity and time‐use changes during clinical education programs for occupational therapy has been applied. Supervisors spent considerable time in assessing and managing students and their clinical education role should be seen as core business in standard occupational therapy practice. This paper will contribute to future assessments of the economic impact of student placements for allied health disciplines.     

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

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

Effects of An Occupational Therapy Memory Strategy Education Group Intervention on Irish Older Adults’ Self-Management of Everyday Memory Difficulties

An occupational therapy memory strategy education group (MSEG) was developed to assist clients with varying levels of memory impairment to adopt strategies to manage memory impairment in their daily lives. Participants were healthy older adults presenting with subjective memory complaints (SMC, n?=?14), mild cognitive impairment (MCI, n?=?33), or early stages of dementia (n?=?13). Clients and their caregivers attended a one-hour session each week for six weeks. Outcome measures were taken at baseline, two weeks post completion of the group, and at a 3-month follow-up for 47 participants. Statistically significant improvements post-program were scored on the Rivermead Behavioural Memory Test (p?=?0.001) and a dementia quality of life measure (p?=?0.02), with increased use of external memory aids (p?<?0.001) and significant improvements in participants’ self-ratings of performance (p?<?0.001) and satisfaction with their performance (p?<?0.001) using the Canadian Occupational Performance Measure. Findings suggest positive outcomes that were maintained at 3-month follow-up and thus, support the role of occupational therapy in delivering occupation-focused memory strategy programs.     

Adaptation and Ability in Daily Occupations in People with Poliomyelitis Sequelae

The aims of these studies were to explore the adaptive process from an occupational perspective by revealing strategies used to manage daily occupations, to examine factors influencing the development of strategies, to investigate ability and perceived difficulty in ADL, use of assistive devices and to investigate the prevalence of distress in aspects of perceived health. Methods. Both qualitative and quantitative analyses were used. The adaptive process was explored by tape-recorded interviews, observations in the subjects' own homes and analysis according to grounded theory. Structured interviews regarding demographic data, use of assistive devices and housing adaptations were also included. Assessments used in the studies were: the NRH postpolio limb classification for the progress and degree of polio; the staircase of ADL (an extension of Katz' index) supplemented with self-ratings of perceived difficulty; walking speed for 30 m indoors and the Nottingham Health Profile (NHP). Subjects. In the qualitative analysis, 22 persons were selected according to theoretical sampling from a longitudinal study of volunteers with poliomyelitis sequelae. In the quantitative analysis, 133 participants with polio were obtained from a consecutive clinical group. Results. Six broad groups of strategies were used to keep some kind of balance among goals, abilities and environmental demands in daily occupations. One group of strategies was emotion-focused, while five groups were problem-focused: utilising physical capability, promoting concrete problem-solving, altering the pattern of occupations, influencing relations and facilitating future activities. The examination of factors influencing the development and choice of everyday life strategies resulted in identification of the concept conception of occupational self, which comprised the participant's body image, sense of competence, values and goals in interaction with the environment. Coming to a new approach towards the shift in one's capabilities revealed two integrated processes: one dealing with the process of realisation and reorganisation, the other six patterns of behaviour in daily occupations. The participants had a high degree of independence in personal ADL, whereas more than 50% were dependent in cleaning, shopping and transportation. However, a great number of independent persons reported difficulties in some activities. Most distress was found in the dimensions of physical mobility, pain and energy according to NHP and most health-related problems were reported in housework, employment and leisure. Fifty-nine percent of the participants were in gainful employment. Conclusions. The results showed that the persons with poliomyelitis sequelae tried to maintain their independence despite perceived difficulties in ADL and might be reluctant to use assistive devices. Signs of overload indicate that balance among goals, abilities and environmental demands might be difficult to achieve. Flexibility in the use of strategies facilitated participation in daily occupations. Requirements for this adaptive pattern seemed to be time to realise and modify behaviour; energy and ability to solve problems; access to information and support and being ready to compensate with assistive devices. The results suggest that late effects of polio interfere with many areas of daily activities and that there is a need for multidisciplinary support.     

The Impact of Regression to the Mean on Economic Evaluation in Quasi‐Experimental Pre–Post Studies: The Example of Total Knee Replacement Using Data from the Osteoarthritis Initiative

Many treatments are evaluated using quasi‐experimental pre–post studies susceptible to regression to the mean (RTM). Ignoring RTM could bias the economic evaluation. We investigated this issue using the contemporary example of total knee replacement (TKR), a common treatment for end‐stage osteoarthritis of the knee. Data (n = 4796) were obtained from the Osteoarthritis Initiative database, a longitudinal observational study of osteoarthritis. TKR patients (n = 184) were matched to non‐TKR patients, using propensity score matching on the predicted hazard of TKR and exact matching on osteoarthritis severity and health‐related quality of life (HrQoL). The economic evaluation using the matched control group was compared to the standard method of using the pre‐surgery score as the control. Matched controls were identified for 56% of the primary TKRs. The matched control HrQoL trajectory showed evidence of RTM accounting for a third of the estimated QALY gains from surgery using the pre‐surgery HrQoL as the control. Incorporating RTM into the economic evaluation significantly reduced the estimated cost effectiveness of TKR and increased the uncertainty. A generalized ICER bias correction factor was derived to account for RTM in cost‐effectiveness analysis. RTM should be considered in economic evaluations based on quasi‐experimental pre–post studies. Copyright © 2017 John Wiley & Sons, Ltd.     

Differences and similarities in therapeutic mode use between occupational therapists and occupational therapy students in Norway

Background: The Intentional Relationship Model (IRM) is a new model of the therapeutic relationship in occupational therapy practice. Two previous studies have focused on therapist communication style, or ‘mode’ use, but to date no group comparisons have been reported.

Aim: To explore differences between occupational therapists and occupational therapy students with regard to their therapeutic mode use.

Methods: The study had a cross-sectional design, and convenience samples consisting of occupational therapists (n?=?109) and of second-year occupational therapy students (n?=?96) were recruited. The Self-Assessment of Modes Questionnaire was the main data collection tool. Group differences were analysed with independent t-tests.

Results: The occupational therapists responded more within the collaborative and empathizing modes than the students did. The students responded more within the advocating and instructing modes than the occupational therapists did.

Conclusion and significance: There may be systematic differences between occupational therapists and students concerning their therapeutic mode use. Some modes, such as the collaborating and empathizing modes, may be viewed as requiring more experience, whereas other modes, such as the advocating mode may be related to more recent rehabilitation ideologies. These factors may contribute to explaining several of the group differences observed.     

A client‐centred,occupation‐based occupational therapy programme for adults with psychiatric diagnoses

The purpose of this study was to assess the effectiveness of a client‐centred, occupation‐based occupational therapy programme for individuals with psychiatric diagnoses. The study took place in a college campus. A pre‐test/post‐test design was used. There were 38 participants which included college students and community members who desired to attend college, work and/or address life skill goals. The Canadian Occupational Performance Measure (COPM) was used as a pre‐ and post‐test measure. Goals were based on problems identified in the COPM, reflected academic, vocational, life skill, and leisure goals, and were systematically addressed weekly through activities developed by the participant and a graduate occupational therapy student who acted as a mentor. The Participant Overall Satisfaction Scale was completed by each participant. A case study was used to describe the programme in more depth. The results support that the client‐centred, occupation‐based occupational therapy programme increased client scores on satisfaction and performance of occupational performance problems identified on the COPM. Further research is recommended to explore how client‐centred occupational therapy programmes can be effective in improving academic, vocational and life skill goals. Copyright © 2010 John Wiley & Sons, Ltd.     

Nutritional monitoring of patients post‐bariatric surgery: implications for smartphone applications

Background

Optimal results from bariatric surgery are contingent on patient commitment to dietary and lifestyle changes and follow‐up care. The present study aimed to investigate the attitudes and use of mobile health (mHealth) smartphone applications (apps) as a potential tool for maintaining connectivity between dietitians and patients post‐bariatric surgery.

Methods

A cross‐sectional online survey was developed and distributed to a purposeful sample of bariatric dietitians and bariatric patients in Australia. The survey questions explored technology penetration (smartphone and app use), communication preferences, nutrition monitoring methods, professional relationship expectations and reasons for loss to follow‐up.

Results

Survey completion rate was 85% (n = 50/59) for dietitians and 80% (n = 39/49) for patients. Smartphone ownership was 98% and 95% for dietitians and patients, respectively. Common reasons given for losing patients to follow‐up suggest that a traditional in‐clinic practice setting could be a barrier for some. Most dietitians (n = 48; 91%) prefer to see patients face‐to‐face in their clinic, whereas patient preferences extended to e‐mail and mobile messaging. Sixty‐eight percent of bariatric patients were receptive to two‐way communication with dietitians via an app between clinic visits. Both cohorts recognised the potential for emerging technologies to be used in practice, although there was no single routinely recommended mHealth app.

Conclusions

The present study provides the first insight into the use of mobile devices and apps by post‐bariatric patients and the dietitians who support them. A mixture of traditional methods and smartphone technology is desirable to both dietitians and patients. The utility and effectiveness of such technologies should be confirmed in future intervention studies.     

Effects of a 3‐month supplementation with a novel soluble highly viscous polysaccharide on anthropometry and blood lipids in nondieting overweight or obese adults

Background: High viscosity fibre is known to exert many beneficial effects on appetite and metabolism. It could potentially help in weight management, in dieting or nondieting individuals. The present study investigated the effects of the daily intake of a novel high viscosity polysaccharide (HVP) over 3 months in nondieting obese or overweight men and women. Methods: The study comprised a double‐blind, randomised controlled clinical trial. Participants ingested 5–15 g per day of either HVP (n = 29, experimental group) or inulin (n = 30, control group) for 15 weeks. Changes in anthropometry (weight, waist and hip circumferences), blood lipids and glucose tolerance were studied from the beginning to the end of administration. Compliance and tolerance were examined. Results: Differences appeared between HVP and inulin supplementation in female participants only. Mean (SD) decreases in body weight [1.6 (3.2) kg; approximately 2% of initial weight] and hip circumference [2.8 (3.6 ) cm] occurred in women of the HVP group but not in controls (Time × Group interactions, P ≤ 0.002). Total, high‐density lipoprotein and low‐density lipoprotein‐cholesterol were lower at the end of supplementation in the women of the HVP group compared to controls (P ≤ 0.021). No effect appeared in waist circumference and triacylglycerol. No difference was noted in the number or severity of the adverse effects reported in both groups. Adverse effects were mild and agreed with commonly reported reactions to intake of dietary fibre. Conclusions: Beneficial although modest effects appeared after several weeks of daily HVP intake in nondieting obese or overweight women. The effects of HVP should be investigated in the context of a weight loss programme.     

Efficacy of Occupational Therapy Task‐oriented Approach in Upper Extremity Post‐stroke Rehabilitation

There is a need for more effective rehabilitation methods for individuals post‐stroke. Occupational Therapy Task‐Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more‐affected Upper Extremity (UE) of persons post‐stroke. A randomized single‐blinded cross‐over trial recruited 20 participants post‐stroke (mean chronicity = 62 months) who demonstrated at least 10° active more‐affected shoulder flexion and abduction and elbow flexion‐extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no‐intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post‐stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.     

Post‐stroke fatigue: qualitative study of three focus groups

Fatigue affects many persons after cerebrovascular accident, particularly those with mild stroke. A qualitative methodology using focus groups with 19 community‐living post‐stroke survivors was utilized to explore the occupational impact of fatigue as communicated by the participants. Although self‐report of a small sample of the United States' post‐stroke population will have limitations in generalizability, this study identifies specific health‐related quality of life issues that can occur with post‐stroke fatigue. The participants felt unprepared for the fatigue phenomenon and struggled to adapt, with fatigue having a debilitating influence upon daily occupational performance and roles, including social participation, return to work, driving, reading and sleeping. The participants indicated that exercise (such as walking and water aerobics) and use of assistive technology were helpful strategies in reducing fatigue. The occupational performance and role impact identified by participants in this study can inform the design of effective occupational therapy interventions and further quantitative study of persons with post‐stroke fatigue. Copyright © 2009 John Wiley & Sons, Ltd.     

改良强制诱导运动疗法和手-臂双侧强化训练对痉挛型偏瘫儿童上肢功能疗效对比研究

目的 分析改良强制诱导运动疗法(mCIMT)和手-臂双侧强化训练(HABIT)对痉挛型偏瘫儿童上肢功能的疗效,以了解两种疗法特点。方法 选取2018年2—10月在佳木斯大学附属第三医院收治的痉挛型偏瘫儿童30例,并随机分为mCIMT组、HABIT组和对照组各10例,分别接受mCIMT、HABIT和常规OT治疗8周。治疗前后,采用Carroll双上肢功能评定量表(UEFT)、儿童功能独立评定(WeeFIM)、Peabody运动发育量表-精细运动量表(PDMS-FM)、运动效能测试-患手使用程度(MAL-AOU)进行评价。结果 干预后,3组儿童UEFT、WeeFIM、PDMS-FM、MAL-AOL评分与治疗前比较均有显著性提高(P＜0.05或<0.01),其中组间比较,mCIMT和HABIT组儿童4项评定得分均高于对照组(F=6.75,7.01,23.91,21.17,P＜0.01);与mCIMT组对比,HABIT组儿童WeeFIM和MAL-AOU得分明显高于mCIMT组(P＜0.01)。结论 mCIMT和HABIT可改善痉挛型偏瘫儿童的患侧上肢精细功能及使用量、双上肢协调能力,提高功能独立性,其中HABIT在患侧使用量和功能独立性方面疗效优于mCIMT。     

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.