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Scholefield BR, Menzies JC, McAnuff J, Thompson JY, Manning JC, Feltbower RG, Geary M, Lockley S, Morris KP, Moore D, Pathan N, Kirkham F, Forsyth R, Rapley T. Implementing early rehabilitation and mobilisation for children in UK paediatric intensive care units: the PERMIT feasibility study. Health Technol Assess 2023; 27:1-155. [PMID: 38063184 PMCID: PMC11017141 DOI: 10.3310/hyrw5688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background Early rehabilitation and mobilisation encompass patient-tailored interventions, delivered within intensive care, but there are few studies in children and young people within paediatric intensive care units. Objectives To explore how healthcare professionals currently practise early rehabilitation and mobilisation using qualitative and quantitative approaches; co-design the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual of early rehabilitation and mobilisation interventions, with primary and secondary patient-centred outcomes; explore feasibility and acceptability of implementing the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual within three paediatric intensive care units. Design Mixed-methods feasibility with five interlinked studies (scoping review, survey, observational study, codesign workshops, feasibility study) in three phases. Setting United Kingdom paediatric intensive care units. Participants Children and young people aged 0-16 years remaining within paediatric intensive care on day 3, their parents/guardians and healthcare professionals. Interventions In Phase 3, unit-wide implementation of manualised early rehabilitation and mobilisation. Main outcome measures Phase 1 observational study: prevalence of any early rehabilitation and mobilisation on day 3. Phase 3 feasibility study: acceptability of early rehabilitation and mobilisation intervention; adverse events; acceptability of study design; acceptability of outcome measures. Data sources Searched Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PEDro, Open grey and Cochrane CENTRAL databases. Review methods Narrative synthesis. Results In the scoping review we identified 36 full-text reports evaluating rehabilitation initiated within 7 days of paediatric intensive care unit admission, outlining non-mobility and mobility early rehabilitation and mobilisation interventions from 24 to 72 hours and delivered twice daily. With the survey, 124/191 (65%) responded from 26/29 (90%) United Kingdom paediatric intensive care units; the majority considered early rehabilitation and mobilisation a priority. The observational study followed 169 patients from 15 units; prevalence of any early rehabilitation and mobilisation on day 3 was 95.3%. We then developed a manualised early rehabilitation and mobilisation intervention informed by current evidence, experience and theory. All three sites implemented the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual successfully, recruited to target (30 patients recruited) and followed up the patients until day 30 or discharge; 21/30 parents consented to complete additional outcome measures. Limitations The findings represent the views of National Health Service staff but may not be generalisable. We were unable to conduct workshops and interviews with children, young people and parents to support the Paediatric Early Rehabilitation and Mobilisation during InTensive care manual development due to pandemic restrictions. Conclusions A randomised controlled trial is recommended to assess the effectiveness of the manualised early rehabilitation and mobilisation intervention. Future work A definitive cluster randomised trial of early rehabilitation and mobilisation in paediatric intensive care requires selection of outcome measure and health economic evaluation. Study registration The study is registered as PROSPERO CRD42019151050. The Phase 1 observational study is registered Clinicaltrials.gov NCT04110938 (Phase 1) (registered 1 October 2019) and the Phase 3 feasibility study is registered NCT04909762 (Phase 3) (registered 2 June 2021). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/21/06) and is published in full in Health Technology Assessment; Vol. 27, No. 27. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Barnaby R Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Paediatric Intensive Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Julie C Menzies
- Paediatric Intensive Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Jennifer McAnuff
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle, UK
| | - Jacqueline Y Thompson
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Children and Young People Health Research, School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Michelle Geary
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sophie Lockley
- PPIE Representative, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kevin P Morris
- Paediatric Intensive Care, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - David Moore
- Institute of Applied Health, University of Birmingham, Birmingham, UK
| | - Nazima Pathan
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Fenella Kirkham
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Forsyth
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle, UK
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. Efficacy of Early Enhanced Occupational Therapy in an Intensive Care Unit (EFFORT-ICU): A Single-Site Feasibility Trial. Am J Occup Ther 2023; 77:7706205110. [PMID: 38015492 DOI: 10.5014/ajot.2023.050230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE This research trial contributes to the evidence for occupational therapy service delivery in intensive care settings. OBJECTIVE To explore the feasibility of a trial to evaluate the impact of early enhanced occupational therapy on mechanically ventilated patients in intensive care. DESIGN Single-site assessor-blinded randomized controlled feasibility trial. SETTING Level 5 8-bed adult medical-surgical intensive care unit (ICU) at Logan Hospital, Brisbane, Australia. PARTICIPANTS Participants were 30 mechanically ventilated patients randomly allocated to two groups. OUTCOMES AND MEASURES We compared standard care with enhanced occupational therapy with outcomes measured at discharge from the ICU, hospital discharge, and 90 days post randomization. The primary outcome measure was the FIM®. Secondary outcomes included the Modified Barthel Index (MBI); Montreal Cognitive Assessment; grip strength, measured using a dynamometer; Hospital Anxiety and Depression Scale; and the 36-Item Short-Form Health Survey (Version 2). The intervention group received daily occupational therapy, including cognitive stimulation, upper limb retraining, and activities of daily living. Data were analyzed using independent groups t tests and effect sizes. RESULTS Measures and procedures were feasible. A significant difference was found between groups on FIM Motor score at 90 days with a large effect size (p = .05, d = 0.76), and MBI scores for the intervention group approached significance (p = .051) with a large effect size (d = 0.75) at 90 days. Further moderate to large effect sizes were obtained for the intervention group for cognitive status, functional ability, and quality of life. CONCLUSIONS AND RELEVANCE This trial demonstrated that occupational therapy is feasible and beneficial in the ICU. Criteria to progress to a full-scale randomized controlled trial were met. This study contributes to embedding ongoing consistency of practice and scope of service delivery for occupational therapy in this field. What This Article Adds: Occupational therapists should be considered core team members in the critical care-ICU, with funding to support ongoing service provision and optimization of patient outcomes based on effective and feasible service delivery.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Andrea Rapolthy-Beck, MSc Neurorehabilitation, BScOccTher, BSc(Med)ExSc, is Senior Occupational Therapist, Occupational Therapy Department, Surgical Treatment and Rehabilitation Service, Herston Health Precinct, Queensland, Australia; Senior Occupational Therapist, Occupational Therapy Department, Logan Hospital, Meadowbrook, Queensland, Australia; and PhD Candidate, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia;
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy (Hons), FOTARA, is Professor and Head, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, PhD, BOccThy, GradDipCounsel, is Senior Lecturer, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kellie Sosnowski
- Kellie Sosnowski, MNursing(Hons), BNursing, GradCertHlthMgt, GradDipCriticalCare, is Nurse Unit Manager, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Simone Dullaway
- Simone Dullaway, BAppSc (Occ Ther), is Senior Occupational Therapist, Chronic Disease Team, Metro South Health and Hospital Service, Queensland, Australia
| | - Hayden White
- Hayden White, PhD, MBBCH, FCP (SA), MMED (Wits), FCICM, FRACP, is Deputy Director, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
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Twose P, Terblanche E, Jones U, Firshman P, Merriweather J, Rock C, Wallace S. Protected therapy services for critical care: A subanalysis of the UK-wide workforce survey. Aust Crit Care 2023; 36:821-827. [PMID: 36604266 DOI: 10.1016/j.aucc.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The existing United Kingdom (UK) allied health professional (AHP) workforce in critical care does not meet national standards, with widespread variation in the source of funding, service availability, and regularity of input. OBJECTIVES The aim of this subanalysis was to determine the impact of protected services on the involvement of AHPs on direct and nondirect aspects of patient care. METHODS This is a subanalysis of the previously published AHPs in critical care UK-wide workforce survey, an observational study using online surveys distributed to 245 critical care units across the UK. RESULTS/FINDINGS Services with protected funding provided more daily input within critical care. This was most apparent for occupational therapy where daily input varied from 82.1% of units with protected services compared to just 10.3% in those without (p < 0.001). For all professions, most notably occupational therapy and speech and language therapy, protected services increased the regularity in which specific interventions were completed and had impact on involvement in nonclinical aspects of care including involved in multidisciplinary team meetings, clinical governance, and research. CONCLUSIONS The absence of protected AHP services reduces compliance with national standards for therapy workforce. Based on these findings, UK and international critical care guidelines should promote protected AHP services for critical care.
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Affiliation(s)
- Paul Twose
- School of Healthcare Sciences, Cardiff University, UK; Physiotherapy Department, Cardiff and Vale UHB, UK.
| | - Ella Terblanche
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London SE1 8WA, UK.
| | - Una Jones
- School of Healthcare Sciences, Cardiff University, UK.
| | | | | | - Claire Rock
- Mid and South Essex NHS Foundation Trust, UK.
| | - Sarah Wallace
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.
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Dall'Ora C, Rubbo B, Saville C, Turner L, Ball J, Ball C, Griffiths P. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:30. [PMID: 37081525 PMCID: PMC10116759 DOI: 10.1186/s12960-023-00817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death. METHODS Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality. RESULTS We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect. CONCLUSIONS Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.
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Affiliation(s)
- Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.
| | - Bruna Rubbo
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Cheska Ball
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
- Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
- NIHR Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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VanPuymbrouck L, Friedman C. Early Career Occupational Therapists' Experiences during the COVID-19 Pandemic. Occup Ther Health Care 2023:1-20. [PMID: 36794316 DOI: 10.1080/07380577.2023.2175291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023]
Abstract
Occupational therapists entering the clinical workforce during the COVID-19 pandemic experienced levels of uncertainty and stress. This study's aim was to explore the clinical experiences and concerns of early-career occupational therapists entering the workforce during the COVID-19 pandemic (n = 27). We administered an open-ended online survey and analyzed the data using inductive thematic analysis. Resulting themes included: safety, exposure, and transmission; implementation and enforcement of safety protocols; quality of care; and impact of the pandemic on overall health highlighting the issues that need to be addressed to be more prepared for future practice in an evolving environment.
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Affiliation(s)
| | - Carli Friedman
- CQL | The Council on Quality and Leadership, Towson, MD, USA
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Rapolthy-Beck A, Fleming J, Turpin M. Occupational therapy service provision in adult intensive care units in Australia: A survey of workload practices, interventions and barriers. Aust Occup Ther J 2022; 69:316-330. [PMID: 35224739 PMCID: PMC9306833 DOI: 10.1111/1440-1630.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Occupational therapy practice within intensive care units (ICUs) is limited with respect to published research evidence and guidelines regarding scope of practice. An understanding of the current level of service provision, feasibility of services in ICUs and training and development needs of occupational therapists is required to enable consistent best practice and promote the occupational therapy profile. This study aimed to explore occupational therapy practice within ICUs in Australia including the barriers and enablers to practice perceived by occupational therapists. METHODS In this cross-sectional study, a national customised online survey was completed by registered occupational therapists who provide services in intensive care settings in Australia. Recruitment was from July to September 2019 through Occupational Therapy Australia and other professional networks and interest groups. RESULTS The survey was completed by 43 respondents. The majority were experienced therapists from Queensland with greater than 10-years post-qualification and working in a tertiary hospital setting. The most common length of time spent working in the ICU was 0-2 h per week. Formal and informal self-care measures, cognitive screens and physical outcome measures were commonly used. Bed-based grooming retraining, pressure care management, functional upper limb retraining and passive ranging were the most frequent interventions provided on a daily basis. Perceived barriers to occupational therapy service provision in ICU included lack of funding for staffing, competing workload demands, lack of occupational therapy role delineation and scope of practice and lack of published evidence and training. CONCLUSION Occupational therapy services in intensive care settings in Australia are limited. Published practice guidelines, further research, applications for service funding and ongoing education of the ICU multidisciplinary team regarding the scope of occupational therapy practice are recommended to promote the development of occupational therapy services in ICU.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Occupational Therapy Department, Surgical Treatment and Rehabilitation Service, Herston Health Precinct, Herston, Australia.,Logan Hospital, Meadowbrook, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Malcolm M, Nordon-Craft A, Sharp J, Moss M, Hoffman A, Morrow M, Freeman K, Graham J. Occupational Therapist Treatment of Patients in the Neurological Critical Care Unit: Utilization and Patient Characteristics. Am J Occup Ther 2021; 75:12677. [PMID: 34780634 DOI: 10.5014/ajot.2021.041087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy use in the neurological critical care unit (NCCU) may relate to patient factors, but data about these relationships remain unpublished. OBJECTIVE To examine how patient factors predict NCCU occupational therapy use and intervention types. DESIGN Retrospective cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 2015. SETTING NCCU in a large, urban academic hospital. PARTICIPANTS Adults (age ≥18 yr; N = 1,134) admitted to the NCCU. MEASURES Using length of stay (LOS), number of comorbidities, Glasgow Coma Scale (GCS) score, gender, age, and racial-ethnic minority status as independent variables, separate regression models identified predictors for each dependent variable: receipt of NCCU occupational therapy, occupational therapy onset (days after admission), and receipt of self-care or home management (ADL-Home); functional activities or cognitive training (Func-Cog); and therapeutic exercise (Ther-Ex). RESULTS Four hundred twenty patients (37.0%) received occupational therapy in the NCCU. Receipt of occupational therapy was positively associated with LOS, number of comorbidities, GCS score, and age. Earlier occupational therapy onset was associated with higher GCS score and shorter LOS. Receipt of ADL-Home or Func-Cog interventions was significantly predicted by number of occupational therapy sessions, but patients with longer LOS were less likely to receive ADL-Home interventions. Receipt of Ther-Ex interventions became less likely as GCS score increased. CONCLUSIONS AND RELEVANCE Patients are more likely to receive occupational therapy services if they are older and have a longer NCCU LOS, more comorbidities, and a higher level of consciousness. What This Article Adds: A patient's level of consciousness is clearly associated with occupational therapy utilization and hospital outcomes, but it should not be the only factor considered when prioritizing patients for NCCU occupational therapy services. Compared with patients who were more awake and alert, patients with a lower level of consciousness had a later onset of occupational therapy, which suggests an opportunity for NCCU occupational therapists to collaborate with physicians in the modification of sedation protocols to enable early rehabilitation.
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Affiliation(s)
- Matt Malcolm
- Matt Malcolm, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Colorado State University, Fort Collins, and Associate Professor, Colorado School of Public Health, Aurora;
| | - Amy Nordon-Craft
- Amy Nordon-Craft, PT, DSc, is Associate Professor, Physical Therapy Program, University of Colorado Denver Anschutz Medical Campus, Aurora
| | - Julia Sharp
- Julia Sharp, PhD, is Associate Professor, Department of Statistics, Colorado State University, Fort Collins
| | - Marc Moss
- Marc Moss, MD, is Professor, Pulmonary and Critical Care Division, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, is Inpatient Rehabilitation Supervisor, University of Colorado Hospital, Aurora
| | - Meghan Morrow
- Meghan Morrow, BS, OTR/L, is Occupational Therapist, University of Colorado Hospital, Aurora
| | - Katherine Freeman
- Katherine Freeman, MSOT, OTR/L, is Occupational Therapist, University of Colorado Hospital, Aurora
| | - James Graham
- James Graham, DC, PhD, FACRM, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
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George S, Barrett M, De Ionno J, Fletcher L, Choo WS, Rivas-Dominguez S, Romanic N, Lizarondo L, Stern C. Experiences and effectiveness of occupational therapy interventions delivered in the acute setting: a mixed methods systematic review protocol. JBI Evid Synth 2021; 19:2457-2463. [PMID: 34100827 DOI: 10.11124/jbies-20-00407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to synthesize and integrate the best available evidence on the experiences and effectiveness of occupational therapy interventions delivered in the acute setting. INTRODUCTION Occupational therapy is a client-centered health profession promoting health and well-being through occupation. In acute hospital settings, occupational therapy interventions are provided to patients to maximize function, prevent readmission, and promote safe discharge. Recent studies have demonstrated that occupational therapy has modified its practice in acute settings to include advocacy, team facilitation, and rapid clinical reasoning. This review will investigate not only the effectiveness of occupational therapy interventions, but also the experiences of patients, caregivers, and clinicians in the acute setting. INCLUSION CRITERIA This review will consider qualitative, quantitative, and mixed methods studies on the experiences and effectiveness of occupational therapy interventions delivered in acute settings. For the qualitative component, the experiences of patients and caregivers receiving any occupational therapy intervention, and clinicians directly or indirectly involved in delivering occupational therapy interventions, will be investigated. For the quantitative component, occupational therapy interventions will be compared with non-occupational therapy interventions, no intervention, wait-list, or other inactive or active (usual care) control interventions. Patient outcomes will include impairment, activities of daily living, psychological outcomes, and quality of life, while health system outcomes will include health care utilization and patient flow. METHODS The databases to be searched include CINAHL, Cochrane Controlled Trials Register, MEDLINE (Ovid), OT Seeker, PsycINFO (Ovid), and Scopus. Study selection, critical appraisal, data extraction, and data synthesis and integration will utilize the JBI segregated approach to mixed methods systematic reviews. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020206363.
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Affiliation(s)
- Stacey George
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia.,Occupational Therapy, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Matt Barrett
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jessica De Ionno
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Laura Fletcher
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Wen Shin Choo
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sergio Rivas-Dominguez
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nikolina Romanic
- Occupational Therapy Department, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia
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Robinson MR, Koverman B, Becker C, Ciancio KE, Fisher G, Saake S. Lessons Learned From the COVID-19 Pandemic: Occupational Therapy on the Front Line. Am J Occup Ther 2021; 75:7502090010p1-7502090010p7. [PMID: 33657341 DOI: 10.5014/ajot.2021.047654] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The pandemic caused by coronavirus disease 2019 (COVID-19) highlighted the insufficient public health policies and lack of a national pandemic response strategy. Rehabilitation departments faced barriers to providing care in the traditional manner and needed to consider protection of patients and staff, staffing and personal protective equipment shortages, and uncertainty about best practices to address a novel health condition. This article highlights the strategies implemented by acute care occupational therapy leaders to support their staff; facilitate efficient care provision; and pivot with constantly changing policies, procedures, and research during the COVID-19 crisis. Occupational therapy's distinct value in caring for this population and role in responding to the pandemic are shared to provide a guidepost for future health care crises.
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Affiliation(s)
- Marla R Robinson
- Marla R. Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA, is Assistant Director, Inpatient Therapy Services, University of Chicago Medical Center, Chicago, IL;
| | - Brenda Koverman
- Brenda Koverman, MBA, MS, OTR/L, is Director of Rehabilitation Services, Rush University Medical Center, Chicago, IL
| | - Carson Becker
- Carson Becker, MS, OTR/L, CBIS, is Education Coordinator, Rehabilitation Services, Northwestern Memorial Hospital, Chicago, IL
| | - Kate E Ciancio
- Kate E. Ciancio, MS, OTR/L, is Coordinator of Inpatient Occupational Therapy, University of Illinois Hospital and Health Sciences System, Chicago, IL
| | - Gail Fisher
- Gail Fisher, PhD, OTR/L, FAOTA, is Clinical Professor, Department of Occupational Therapy, University of Illinois at Chicago
| | - Serena Saake
- Serena Saake, MS, OTR/L, is Occupational Therapist, San Diego Occupational Therapy, San Diego, CA
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. A comparison of standard occupational therapy versus early enhanced occupation-based therapy in a medical/surgical intensive care unit: study protocol for a single site feasibility trial (EFFORT-ICU). Pilot Feasibility Stud 2021; 7:51. [PMID: 33602337 PMCID: PMC7889705 DOI: 10.1186/s40814-021-00795-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Admissions to intensive care units (ICUs) are increasing due to an ageing population, and rising incidence of cardiac and respiratory disease. With advances in medical care, more patients are surviving an initial stay in critical care; however, they can experience ongoing health and cognitive limitations that may influence return to baseline function up to a year post-admission. Recent research has focused on the introduction of early rehabilitation within the ICU to reduce long-term physical and cognitive complications. The aim of this study is to explore the feasibility and impact of providing early enhanced occupation-based therapy, including cognitive stimulation and activities of daily living, to patients in intensive care. METHODS This study involves a single site randomised-controlled feasibility trial comparing standard occupational therapy care to an early enhanced occupation-based therapy. Thirty mechanically ventilated ICU patients will be recruited and randomly allocated to the intervention or control group. The primary outcome measure is the Functional Independence Measure (FIM), and secondary measures include the Modified Barthel Index (MBI), Montreal Cognitive Assessment (MoCA), grip strength, Hospital Anxiety and Depression Scale (HADS) and Short-Form 36 Health survey (SF-36). Measures will be collected by a blind assessor at discharge from intensive care, hospital discharge and a 90-day follow-up. Daily outcome measures including the Glasgow Coma Scale (GCS), Richmond Agitation and Sedation Scale (RASS) and Confusion Assessment Measure for intensive care units (CAM-ICU) will be taken prior to treatment. Participants in the intervention group will receive daily a maximum of up to 60-min sessions with an occupational therapist involving cognitive and functional activities such as self-care and grooming. At the follow-up, intervention group participants will be interviewed to gain user perspectives of the intervention. Feasibility data including recruitment and retention rates will be summarised descriptively. Parametric tests will compare outcomes between groups. Interview data will be thematically analysed. DISCUSSION This trial will provide information about the feasibility of investigating how occupational therapy interventions in ICU influence longer term outcomes. It seeks to inform the design of a phase III multicentre trial of occupational therapy in critical care general medical intensive care units. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618000374268 ; prospectively registered on 13 March 2018/ https://www.anzctr.org.au Trial funding: Metro South Health Research Support Scheme Postgraduate Scholarship.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Logan Hospital, Brisbane, Queensland, Australia.
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia.
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Bittencourt EDS, Moreira PS, Paixão GMD, Cardoso MM. A atuação do terapeuta ocupacional em Unidade de Terapia Intensiva: uma revisão sistemática. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2021. [DOI: 10.1590/2526-8910.ctoar2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução A participação do terapeuta ocupacional (TO) em Unidades de Terapia Intensiva (UTI) ainda é discreta no Brasil, talvez, por isso, haja pouca discussão das intervenções e inserção do profissional nessa área. Objetivo Sintetizar as atuações do TO para restabelecimento da função em pacientes adultos internados na UTI mais frequentemente descritas na literatura especializada. Método Revisão Sistemática baseada na recomendação PRISMA. A busca dos estudos foi realizada nas plataformas Cochrane, PubMed, OTSeek e PEDro, utilizando os termos de busca “Occupational Therapy”, no título ou resumo, (AND) “Intensive Care Unit” (OR) “Critical Illness” (OR) “Critical Care”, em outras partes do texto. Foram incluídos textos em língua inglesa e publicados nos últimos 20 anos. Excluiu-se textos que abordavam UTI pediátrica/neonatal, doenças psiquiátricas e artigos de revisão. Dois pesquisadores independentes selecionaram os artigos e a concordância foi submetida à análise Kappa. O nível de evidência e a qualidade metodológica dos estudos incluídos foram avaliados pela Escala PEDro e pela Ferramenta de Colaboração Cochrane, respectivamente. Resultados As principais intervenções foram relativas ao treino de Atividades de Vida Diária (AVDs) e tarefas relacionadas às Atividades Instrumentais de Vida Diária (AIVDs). Essas atribuições privativas da profissão ocorreram isoladamente ou com fisioterapeutas. As sessões, excluídos os critérios de contraindicação, aconteceram precocemente (24-48h). Conclusão Os achados evidenciam intervenções de mobilização precoce, seguidas por práticas de treino de AVDs/ AIVDs. Ademais, é notado que a atuação do terapeuta ocupacional na UTI está em elaboração. Estudos sobre outros efeitos da internação prolongada na UTI devem ser conduzidos. Registro PROSPERO: CRD42020214615.
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Wang J, Ren D, Liu Y, Wang Y, Zhang B, Xiao Q. Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud 2020; 110:103708. [PMID: 32736250 DOI: 10.1016/j.ijnurstu.2020.103708] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early mobilization is considered a safe and effective therapeutic strategy for accelerating the rehabilitation of patients admitted to the intensive care unit, with a proven benefit for critically ill patients. OBJECTIVES To evaluate the effects of early mobilization on the prognosis of critically ill patients through a meta-analysis of data pooled from studies meeting the inclusion criteria. DESIGN Systematic review and meta-analysis. DATA SOURCE Electronic databases including PubMed, EMBASE, the Cochrane Library, CINAHL, ProQuest, Web of Science, ProQuest Dissertations and Theses, Chinese BioMedical Literature Service System, WANFANG database, CNKI database, and Clinical Trial Register Platform were systematically searched from inception up to December 31, 2019. REVIEW METHODS Study eligibility was independently evaluated by two researchers. The title and abstract of the studies were first screened, and full-text articles of the remaining studies were screened for verification. Methodologic quality and risk of bias of the included studies were evaluated, and data were extracted from eligible studies. The meta-analysis was conducted using Review Manager v5.3 software. Key outcomes are presented as pooled risk ratio, weighted mean difference, and the corresponding 95% confidential interval . RESULTS A total of 39 articles were included in the meta-analysis. The results showed that early mobilization improved ventilator-associated pneumonia patients' Medical Research Council score; reduced the incidence of intensive care unit-acquired weakness and intensive care unit-related complications such as ventilator-associated pneumonia, deep vein thrombosis, and pressure sores; and shortened the duration of mechanical ventilation, length of intensive care unit stay and hospital stay. However, there were no statistically significant differences in handgrip strength, delirium rate, intensive care unit mortality, hospital mortality, and physical function- and mental health-related quality of life at 2-3 months and 6 months post-hospital discharge. CONCLUSIONS Early mobilization was effective in enhancing the recovery of critically ill patients, but more large-scale, multicenter randomized controlled trials are required to further confirm these findings.
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Affiliation(s)
- Jiani Wang
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, PA 15261, United States.
| | - Yue Liu
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Yanling Wang
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Bohan Zhang
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing 100069, China.
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Abstract
OBJECTIVES Occupational therapists have specialized expertise to enable people to perform meaningful "occupations" that support health, well-being, and participation in life roles. Given the physical, cognitive, and psychologic disability experienced by ICU survivors, occupational therapists could play an important role in their recovery. We conducted a scoping review to determine the state of knowledge of interventions delivered by occupational therapists in adult ICU patients. DATA SOURCES Eight electronic databases from inception to 05/2018. STUDY SELECTION We included reports of adult patients receiving direct patient care from an occupational therapist in the ICU, all study designs, and quantitative and qualitative traditions. DATA EXTRACTION Independently in duplicate, interprofessional team members screened titles, abstracts, and full texts and extracted report and intervention characteristics. From original research articles, we also extracted study design, number of patients, and primary outcomes. We resolved disagreements by consensus. DATA SYNTHESIS Of 50,700 citations, 221 reports met inclusion criteria, 74 (79%) published after 2010, and 125 (56%) appeared in critical care journals. The three most commonly reported types of interventions were mobility (81%), physical rehabilitation (61%), and activities of daily living (31%). We identified 46 unique original research studies of occupational therapy interventions; the most common study research design was before-after studies (33%). CONCLUSIONS The role of occupational therapists in ICU rehabilitation is not currently well established. Current interventions in the ICU are dominated by physical rehabilitation with a growing role in communication and delirium prevention and care. Given the diverse needs of ICU patients and the scope of occupational therapy, there could be an opportunities for occupational therapists to expand their role and spearhead original research investigating an enriched breadth of ICU interventions.
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Abstract
Abstract
The American Occupational Therapy Association (AOTA) asserts that occupational therapists and occupational therapy assistants, through the use of occupations and activities, facilitate clients’ cognitive functioning to enhance occupational performance, self-efficacy, participation, and perceived quality of life. Cognitive processes are integral to effective performance across the broad range of daily occupations such as work, educational pursuits, home management, and play and leisure. Cognition plays an integral role in human development and in the ability to learn, retain, and use new information to enable occupational performance across the lifespan.
This statement defines the role of occupational therapy in evaluating and addressing cognitive functioning to help clients maintain and improve occupational performance. The intended primary audience is practitioners1 within the profession of occupational therapy. The statement also may be used to inform recipients of occupational therapy services, practitioners in other disciplines, and the wider community regarding occupational therapy theory and methods and to articulate the expertise of occupational therapy practitioners in addressing cognition and challenges in adapting to cognitive dysfunction.
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Algeo N, Aitken LM. The evolving role of occupational therapists in adult critical care in England. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2019. [DOI: 10.1108/ijot-04-2019-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilisation. The purpose of this study is to investigate current and future roles and practices of critical care occupational therapists in the UK.
Design/methodology/approach
Occupational therapists with clinical experience in adult critical care were invited to participate in a mixed-methods design using a locally developed online questionnaire and semi-structured interviews, concurrently. Descriptive statistics were generated through SPSS. Qualitative data were analysed using the framework approach.
Findings
Twelve occupational therapists participated in the survey element, with five continuing to interview. Occupational therapists described a multifaceted role in critical care where the majority reported practice in upper limb function, seating/positioning, cognition, psychosocial sequelae and discharge planning. Role and internal characteristics impacted on service delivery. It is envisaged that earlier intervention in a greater percentage of patients, a greater evidence-base, raising awareness and adequate staffing will be features for future development.
Originality/value
This study provides new insight into the current role and practices of adult critical care occupational therapists in England and generates insights into their role in addressing physical and non-physical morbidity for this patient cohort. Findings are preliminary in nature; however, future research is warranted to evaluate the effectiveness of interventions.
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