Showing papers in "Occupational Therapy in Health Care in 2015"
TL;DR: Compared occupation-focused models are compared and recommendations on how to choose and combine these models in practice are provided to provide a systematic approach for integrating occupation- focused models with frames of reference to guide assessment and intervention.
Abstract: As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.
54 citations
TL;DR: How digital storytelling can be applied in occupational therapy clinical practice, education, and research is proposed and the ethical and methodological challenges in relation to using the method are discussed.
Abstract: Digital storytelling is a method of using storytelling, group work, and modern technology to facilitate the creation of 2-3 minute multi-media video clips to convey personal or community stories. Digital storytelling is being used within the health care field; however, there has been limited documentation of its application within occupational therapy. This paper introduces digital storytelling and proposes how it can be applied in occupational therapy clinical practice, education, and research. The ethical and methodological challenges in relation to using the method are also discussed.
43 citations
TL;DR: E-mentoring positively impacted the professional development of participants during and after the online OTD program, and how multi-modal e-MENToring supports the accessibility needs of participants was investigated.
Abstract: This retrospective study employed a descriptive, quantitative design to investigate the nature, perception, and impact of the e-mentoring experiences of 29 graduates of an online post-professional Doctor of Occupational Therapy (OTD) program. Study results highlight positive features of electronic mentoring (e-mentoring); how multi-modal e-mentoring supports the accessibility needs of participants; and students' preferences to engage in real-time e-mentoring communication by web camera or telephone, supplemented with e-mail. E-mentoring positively impacted the professional development of participants during and after the online OTD program. As online education continues to grow, a better understanding of e-mentoring will assist in providing exemplary education to meet the needs of adult learners.
30 citations
TL;DR: The challenges of developing and delivering two interprofessional education courses in an online format are discussed, specifically the innovation that addresses logistics, time factors, and social presence for the IPE courses across two institutions.
Abstract: Interdisciplinary courses among students in occupational therapy, physical therapy, and speech-language pathology are important for addressing teamwork, communication, and understanding of professional roles, especially in pre-service training for early intervention and school-based practice where collaboration is essential. Although interprofessional education (IPE) as a part of higher education in the health sciences has been strongly encouraged, IPE courses are difficult to schedule and implement. This article discusses the challenges of developing and delivering two IPE courses in an online format, specifically the innovation that addresses logistics, time factors, and social presence for the IPE courses across two institutions.
24 citations
TL;DR: This article builds on the available research to address barriers to model use, applying theoretical foundations of collaborative supervision to practical considerations for academic fieldwork coordinators and fieldwork educators as they prepare for participation in group supervision of occupational therapy and occupational therapy assistant students on level II fieldwork.
Abstract: Historically, occupational therapists have used a traditional one-to-one approach to supervision on fieldwork. Due to the impact of managed care on health-care delivery systems, a dramatic increase in the number of students needing fieldwork placement, and the advantages of group learning, the collaborative supervision model has evolved as a strong alternative to an apprenticeship supervision approach. This article builds on the available research to address barriers to model use, applying theoretical foundations of collaborative supervision to practical considerations for academic fieldwork coordinators and fieldwork educators as they prepare for participation in group supervision of occupational therapy and occupational therapy assistant students on level II fieldwork.
23 citations
TL;DR: A pilot study is described in which qualitative data is gathered from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships.
Abstract: Today, more than ever, occupational therapists are engaged in close partnerships with community organizations and community settings such as service agencies, refugee and immigrant enclaves, and faith-based organizations, to name a few, for the purpose of engaging in scholarship of practice. However, we know little about the views of community partners regarding the development and sustainability of university–community partnerships. The purpose of this article is twofold: First, we will describe a pilot study in which we gathered qualitative data from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships. Second, based on this pilot study and extensive experience of the authors, we propose a revised version of a partnerships model available in the literature. We illustrate the model through examples of the authors’ collective experiences developing and susta...
17 citations
TL;DR: The role of occupational therapy in primary care is described and how the Scholarship of Practice model can guide the development of occupation-based and evidence-based best practice in primary Care is described.
Abstract: Interest in the emerging role for occupational therapy in the primary care practice setting has increased due to implementation of the Patient Protection and Affordable Care Act (ACA), which intends to expand health care coverage to uninsured Americans while improving coordination of care, health outcomes, and cost savings. Expanding occupational therapy to encompass promotion of wellness and prevention in a primary care context provides an opportunity for occupational therapy. The purpose of this article is to describe the role of occupational therapy in primary care and how the Scholarship of Practice model can guide the development of occupation-based and evidence-based best practice in primary care.
17 citations
TL;DR: A community-engaged SOP model is described, the evidence justifying the need for such a model, and strategies to effectively create community-Engaged practitioners, educators and career scientists within occupational therapy are described.
Abstract: Trends in policy, practice, and research point to the need for a community-engaged Scholarship of Practice (SOP) model that can be used to inform the development of occupational therapy practitioners, educators, and researchers. This article describes a community-engaged SOP model, the evidence justifying the need for such a model, and strategies to effectively create community-engaged practitioners, educators and career scientists within occupational therapy. We highlight several examples of community-based participatory research to further inform this model, and in turn, translate this knowledge back to communities for action and systems change that can affect the lives of people with disabilities and the communities in which they seek to live and participate long term.
17 citations
TL;DR: Professional reasoning used by occupational therapists in home modifications as they develop from novice to expert was explored in this grounded theory study.
Abstract: Professional reasoning used by occupational therapists in home modifications as they develop from novice to expert was explored in this grounded theory study. Eight occupational therapists participated in multiple interviews and member checks about home modifications training and practice. Formal academic and experiential learning provided the foundation for reasoning systems and habits of practice. As therapists gained expertise, they were able to shift their primary focus from systematic reasoning steps to focus on the comprehensive, client-centered, and contextual picture. Creative educational strategies support confidence in engaging in home modifications practice.
16 citations
TL;DR: A nation-wide survey was conducted of occupational therapy and occupational therapy assistant academic fieldwork coordinators to describe demographic characteristics and tasks of the role.
Abstract: A nation-wide survey was conducted of occupational therapy and occupational therapy assistant academic fieldwork coordinators (AFWCs) to describe demographic characteristics and tasks of the role. From the data, 10 clusters of role tasks of the AFWC are described. AFWCs view the position as a final career goal although the majority of respondents reported 5 years or less experience. Administrative assistant support and hours dedicated to fieldwork tasks are higher at the professional level than for occupational therapy assistant AFWCs. AFWCs reported difficulty accomplishing tasks in a 40-h work week and limited time for research and scholarship. Recommendations are provided for recruitment and retention through development of a systematic training program and establishment of a national fieldwork education research agenda.
15 citations
TL;DR: The published evidence available about the occupational therapy entry-level clinical doctorate is summarized and the perceived or frequently cited pros and cons of moving to theclinical doctorate as the singular entry point to occupational therapy practice are considered.
Abstract: Internationally, occupational therapy education has gone through several paradigm shifts during the last few decades, moving from certificate to diploma to bachelors to masters and now in some instances to clinical doctorate as the entry-level professional credential to practice. In the United States there is a recommendation under consideration by the American Occupational Therapy Association (AOTA) that by 2025, all occupational therapy university programs will move to the clinical doctorate level. It should be noted, however, that the AOTA Board can only make recommendations and it is the Accreditation Council for Occupational Therapy Education (ACOTE) who has regulatory authority to approve such a change. What are the potential implications for the profession, our clients, and funders of occupational therapy services? What are the primary drivers for the move towards the clinical doctorate being the educational entry point? Is the next step in the evolution of occupational therapy education globally a shift to the entry-level clinical doctorate? This article reviews current literature and discusses issues about the occupational therapy entry-level clinical doctorate. The published evidence available about the occupational therapy entry-level clinical doctorate is summarized and the perceived or frequently cited pros and cons of moving to the clinical doctorate as the singular entry point to occupational therapy practice are considered. The potential impacts of the introduction of the clinical doctorate as the entry-to-practice qualification across the United States on the occupational therapy community internationally will be briefly discussed. If the United States moves toward the entry-level clinical doctorate as the only educational starting point for the profession, will other jurisdictions follow suit? Further discourse and investigation of this issue both inside and outside of the United States is needed so that informed decisions can be made.
TL;DR: This study supports the use of an AEP as an intervention for pregnant women on prescribed bed rest and Statistical tests were used to assess evidence of differences in length of gestation as well as blood pressure and amniotic fluid index (AFI) at discharge.
Abstract: This pilot study examined the effectiveness of an Aquatic Exercise Program (AEP) provided by an occupational therapist for pregnant women on hospitalized bed rest. Researchers conducted a retrospective analysis of medical records of hospitalized pregnant women comparing those who attended an AEP (n = 19) to a control group who received no AEP (n = 12). Statistical tests were used to assess evidence of differences in length of gestation as well as blood pressure and amniotic fluid index (AFI) at discharge. Women who received an AEP had increased AFI and length of gestation compared to the control group. This study supports the use of an AEP as an intervention for pregnant women on prescribed bed rest. Further research is recommended to validate these findings with a larger sample.
TL;DR: Consumer-directed services are a type of support system designed to increase the quality of life and self-determination of clients, such as adults with developmental disabilities and occupational therapists can play an important role in facilitating people's involvement in CDS supports.
Abstract: Consumer-directed services (CDS) are a type of support system designed to increase the quality of life and self-determination of clients, such as adults with developmental disabilities. Occupational therapists can play an important role in facilitating people's involvement in CDS supports. This paper describes CDS, evidence that supports their use, and ways that occupational therapists use their training in person-centered practice to enhance CDS supports and self-determination. A case study is used to illustrate the application.
TL;DR: It is demonstrated that while CBCR may be a promising intervention for improving global cognition in individuals with ABI, additional intervention might be needed for generalization to occur to a novel daily task.
Abstract: Computer-based cognitive retraining (CBCR) intervention has gained great popularity in recent years. This study aimed to investigate the occurrence of skill generalization to daily living task for individuals with acquired brain injury (ABI) after completion of eight modules of a commercially available CBCR program, the Parrot Software. The study investigated changes in individuals' global cognition as measured by the Montreal Cognitive Assessment, and changes in individuals' performance during a medication-box sorting task, a novel instrumental activity of daily living. The medication-box sorting task resembled real life medication management with daily prescribed and over-the-counter medications. Twelve individuals with ABI from a community-based program completed the study. Results indicated that CBCR intervention brought about improvement in global cognition, but the improvement did not appear in any particular cognitive domain. Additionally, the gains in global cognition failed to enhance performance in the medication-box sorting task. This exploratory study demonstrated that while CBCR may be a promising intervention for improving global cognition in individuals with ABI, additional intervention might be needed for generalization to occur to a novel daily task. Future studies should look for the ultimate therapeutic outcome from CBCR interventions or include interventions that could bridge the gap between CBCR intervention and performance improvement in daily living occupations.
TL;DR: It was found that the MS group demonstrated significantly decreased dexterity when compared to age and gender matched controls, and there was no significant difference in gross grasp strength by diagnostic group.
Abstract: This study examined the gross grasp strength and fine motor dexterity of adolescents, who are diagnosed with multiple sclerosis (MS). A total sample size of 72 participants between the ages of 13 to 17 was studied. Thirty six with a diagnosis of pediatric relapse remitting MS and 36 matched control participants were selected from various local youth groups. Data on hand strength and dexterity was collected using a dynamometer, nine hole peg board and Purdue pegboard on both groups. Utilizing ANCOVA to describe the differences across the two groups by diagnosis, controlling for age and gender, it was found that the MS group demonstrated significantly decreased dexterity when compared to age and gender matched controls. There was no significant difference in gross grasp strength by diagnostic group. This preliminary study showed that children with a diagnosis of pediatric MS may have differences in fine motor dexterity, but not gross grasp strength from their peers who do not have the diagnosis. Fur...
TL;DR: Several contextual factors were found to be associated with social participation of immigrant children, such as health insurance coverage, household education, household connectedness with the neighborhood, and access to computers and the Internet.
Abstract: The population of immigrant children in the United States has increased dramatically. Little is known about how immigrant children, especially those with disabilities, fare on outcomes relevant to occupational therapy such as participation in home, school, and community activities. Using secondary data from the Making Connections survey, we compared social participation outcomes and predictors for children with/without disabilities from underserved immigrant and nonimmigrant households in a sample of 2,295 children aged 3 to 17 years. We found that social participation rates differed significantly for children based on their disability and immigrant status and were lowest for immigrant children with disabilities. Several contextual factors were found to be associated with social participation of immigrant children, such as health insurance coverage, household education, household connectedness with the neighborhood, and access to computers and the Internet. Implications of these findings for occupational therapy practice and research are discussed.
TL;DR: Multiple-Mini Interviews were used to assess professional attributes of candidates seeking admission to an occupational therapy professional entry-level master's program and were perceived to be fair, enjoyable, and capable of capturing professional attributes.
Abstract: Multiple-Mini Interviews (MMIs) were used to assess professional attributes of candidates seeking admission to an occupational therapy professional entry-level master's program. Candidates and interviewers were invited to complete a questionnaire comprised of quantitative and open-ended questions following the MMIs. The MMIs were perceived to be fair, enjoyable, and capable of capturing professional attributes. Descriptive analysis of candidates' data revealed perceptions regarding logistics, interview station content, process, and interviewers. Interviewers commented on the positive and challenging aspects of the scenarios and the MMI process. Admissions committees need to consider several logistical, content, and process issues when designing and implementing MMIs as a selection tool.
TL;DR: An interprofessional (IP) learning unit was developed that was embedded in neurorehabilitation tracks of each respective program and showed positive effects on student learning and attitudes toward interprofessionalism.
Abstract: Occupational and physical therapy professionals are natural partners in neurorehabilitation especially in the acute stages of recovery. To enhance student-learning experiences from both disciplines, we have developed an interprofessional (IP) learning unit that was embedded in neurorehabilitation tracks of each respective program. The primary goal of this project was to examine interprofessional attitudes and perception toward interprofessional learning and practice. A total of 117 occupational therapy (53) and physical therapy (64) students completed an IP case-based learning module with the goal of developing an IP care plan typically seen in neurorehabilitation. Using a sequential explanatory mixed methods design, we collected data pre- and postintervention using the Readiness for Interprofessional Learning Survey (RIPLS). We also utilized a postintervention questionnaire and focus groups intended to solicit information regarding IP competencies. At pretest, students had high ratings on the RIPLS that led to minimal changes at posttest (p = .157). However, common threads from the questionnaire and focus groups showed positive effects on student learning and attitudes toward interprofessionalism. Students reported positive experiences with the IP module. An IP case-based educational module has the potential to facilitate professional development and readiness for future IP practice. Students from different disciplines appreciate the value of IP education (IPE) in reinforcing their professional identity and understanding the professional contributions of others. Our findings are consistent with literature on best practices for IPE.
TL;DR: It is concluded that emphasis on instruction of students in the use of occupational therapy practice models could be a viable method of improving practice through consistent use of theoretical guidelines in clinical reasoning.
Abstract: We investigated the effectiveness of instructing students in occupational therapy practice models to facilitate their competence in applying theory in clinical practice. Course evaluation data were gathered and analyzed retrospectively. We found that perceived understanding of theory and its application improved significantly after instruction. The students' perceived competence in theory use predicted their level of confidence in their assessment and intervention skills. We concluded that emphasis on instruction of students in the use of occupational therapy practice models could be a viable method of improving practice through consistent use of theoretical guidelines in clinical reasoning.
TL;DR: Findings suggest that community-based occupational therapy has potential to address important issues such as habits, roles, and volition in the HIV/AIDS population.
Abstract: Three case studies illustrate the complexities and opportunities in providing community-based occupational therapy services to persons with HIV. An infectious disease physician recommended three clients for therapy sessions in both the home and community. The Model of Human Occupation (MOHO) in conjunction with the Conceptual Framework for Therapeutic Occupation (CFTO) was used to guide the therapeutic process. Assessments measured challenges to clients and client progress in the following areas: leisure, mobility, organization, problem solving, community involvement, transitioning to independent living, fatigue, childcare/play, and home management. This paper describes the three cases with findings suggesting that community-based occupational therapy has potential to address important issues such as habits, roles, and volition in the HIV/AIDS population.
TL;DR: This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum.
Abstract: While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a “maybe” group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive pic...
TL;DR: Goals set by therapists to integrate EBP into their practice following the course were analysed and grouped into categories which included getting ready to use evidence based practice, examining current and best practices, and promoting a culture of evidence basedpractice in the workplace.
Abstract: Confidence levels of 136 Irish occupational therapists were measured before and after an evidence based practice training course. Ranked scores on the evidence based practice confidence scale showed statistically significant improvement in all areas between pre and post course. Goals set by therapists to integrate EBP into their practice following the course were analysed and grouped into categories which included: 1) getting ready to use evidence based practice, 2) examining current and best practices, and 3) promoting a culture of evidence based practice in the workplace. Course feedback using Likert scales identified satisfaction with course content and delivery method.
TL;DR: The premise of this book is to describe the clinical reasoning process to facilitate a successful transition for young adults with disabilities from an occupational therapy perspective.
Abstract: As the first edition of this edited book, the authors offer a fresh occupational therapy perspective in an area of practice where we do not have an established and consistent presence. The transiti...
TL;DR: This article presents the format and use of Process-Oriented Guided-Inquiry Learning (POGIL) as a recommended teaching strategy for occupational therapy classes based upon evidence of effectiveness of this strategy for enhancing critical thinking, content retention, and teamwork.
Abstract: After a brief review of the major group cooperative learning strategies, this article presents the format and use of Process-Oriented Guided-Inquiry Learning (POGIL) as a recommended teaching strategy for occupational therapy classes. This recommendation is based upon evidence of effectiveness of this strategy for enhancing critical thinking, content retention, and teamwork. Strategies for learning the process and suggestions for its use are based upon literature evidence and the authors’ experiences with this strategy over 4 years in a class on evidence-based practice.
TL;DR: National and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach and research that focuses on how therapists adopt and use evidence in practice are discussed.
Abstract: A scholarship of practice approach sets the stage for collaborative partnerships across academic and clinical practice settings that result in positive gains for all stakeholders. These gains include an enhanced ability to generate and apply relevant evidence in practice, disseminate knowledge and innovation, and ensure best practice is relevant to and effective for, people receiving services and their caregivers. This paper discusses national and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach. The exemplars described here are framed within the Model of Human Occupation, which addresses the importance of volition, habits, roles, environment, and performance capacities in facilitating engagement in occupation for people with dementia. Research that focuses on how therapists adopt and use evidence in practice, as well as the opportunities and challenges for supporting therapists and their use of theory and evidence are discussed.
TL;DR: Overall, ratings scores showed an increase in participants’ self-efficacy and knowledge and skill at post-course and one-month follow-up, and participants continued to implement sensory strategies to decrease challenging behaviors due to increased self- efficacy in using sensory strategies and the lack of support in implementing behavior techniques outside their session time.
Abstract: A three hour continuing education course combining occupational therapy practice and behavior analysis strategies related to children with autism spectrum disorders was developed and delivered to 24 occupational therapy practitioners. Participants completed evaluations pre-course, post-course, and one month follow up on their self-efficacy, knowledge, and skills in managing challenging behaviors of children with autism spectrum disorders. Overall, ratings scores showed an increase in participants' self-efficacy and knowledge and skill at post-course and one-month follow-up. Despite this increase, participants continued to implement sensory strategies to decrease challenging behaviors due to increased self-efficacy in using sensory strategies and the lack of support in implementing behavior techniques outside their session time.
TL;DR: The argument is made that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice.
Abstract: Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.
TL;DR: It is demonstrated that the experimental group improved their self-concept scores when compared to the control group in the areas of peer acceptance and cognitive competence, which would offer tentative evidence that an after-school program directed by occupational therapists that is designed to improve self- Concept may be successful.
Abstract: The goal of this pilot study was to ascertain the effectiveness of an occupation-based after-school program for improving self-concept in children, ages five through eight. Fifty-four randomly selected children ages five through eight from two schools (one being the control group) with similar socioeconomic status along the Ohio River were involved in this research study. The Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PCSA; Harter & Pike, 1984) was administered to all participants (N = 54), four subtests were analyzed: cognitive competence, social competence with peers, physical competence in sports, and maternal acceptance. The experimental group (n = 25) attended occupation-based groups two times a week after school. The control group (n = 29) did not participate in an after-school program. Data from pre-test and post-test were analyzed using a t-test. Findings demonstrated that the experimental group improved their self-concept scores when compared to the control group in the areas of peer acceptance and cognitive competence. This would offer tentative evidence that an after-school program directed by occupational therapists that is designed to improve self-concept may be successful.
TL;DR: The programmatic formative evaluation results demonstrated that all students felt moderately prepared to use cognitive-behavioral strategies in their future practices, preferring behavioral strategies over cognitive strategies for changing client thinking.
Abstract: The integration of psychosocial strategies into pediatric and physical disabilities coursework presents an issue of importance to advancing the outcomes for both occupational therapy education and practice. After curriculum mapping and modification to course content, a retrospective student survey and review of educational outcomes were undertaken in one curriculum. The programmatic formative evaluation results demonstrated that all students felt moderately prepared to use cognitive-behavioral strategies in their future practices, preferring behavioral strategies over cognitive strategies for changing client thinking. Implications for the importance of integration of psychosocial content across curricula and for future study of effective teaching methods within classroom learning activities and fieldwork are included.
TL;DR: The challenge, and a challenge to the profession of occupational therapy, is to create scholars of practice, who can generate new research and evidence about practice, as well as practice scholars who can then change actual practice to meet changing needs and priorities of community members.
Abstract: The last two decades have been marked by a new vision of how researchers and practitioners work together in order to better address the health and social issues that societies are confronting today...