Collaboration in the midst of chaos: perspectives of inpatient occupational and physical therapists during the COVID-19 pandemic

The COVID-19 pandemic has affected over 700 million people globally, straining healthcare systems and highlighting the need for interprofessional collaboration. The aim of this study was to describe interprofessional collaborative practice (IPCP) experiences from the perspectives of occupational therapists (OTs) and physical therapists (PTs) who were employed in a medical center both before and during the COVID-19 pandemic. This qualitative study, conducted from July 2020-November 2021, delved into the lived experiences of occupational and physical therapists in an inpatient setting during the pandemic through analysis of semi-structured interviews and journal entries. The pandemic prompted fear, uncertainty, and ethical dilemmas among therapists, affecting patient-centered care. Roles expanded, and teamwork challenges emerged in defining boundaries, while communication dynamics were transformed by virtual technologies. The pandemic affected therapists' values and ethics, and evolving roles brought expanded tasks. The crisis showcased both collaboration potential and the need to address team disparities. This study highlights the significance of values, roles, teams, and communication for occupational and physical therapists during the COVID-19 pandemic providing valuable insights into interprofessional collaboration's effect on healthcare delivery in times of crisis and beyond.

Assistive products to support daily time management of older persons with dementia in India: experiences and views of informal caregivers and occupational therapists

PURPOSE

The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs).

METHODS

The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed.

RESULTS

Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education).

CONCLUSIONS

The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Implications for rehabilitationAdoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders.Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India.It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products.Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions.

Occupational Therapy Observation Tool-Adjustment Support Details for autistic children: Investigation of content validity and clinical utility

INTRODUCTION

Standardised testing is crucial for autistic children to receive appropriate interventions, necessary services, and funding. Behaviours associated with autism can hinder children's test performance and participation. The 18-item, two-page Occupational Therapy Observation Tool-Adjustment Support Details (OTOT-ASD) is used in conjunction with standardised assessments. The OTOT-ASD enables the recording of autism-related behaviours and the reasonable assessment accommodations made to support participation in testing. The current study aims to investigate the content validity and clinical utility of the OTOT-ASD from occupational therapists' perspectives.

METHOD

A specifically designed online questionnaire was distributed Victoria-wide to occupational therapists with clinical experience with autistic children. The questionnaire was designed in line with the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN), including relevance, comprehensiveness, and comprehensibility of items evaluated for content validity. Applicability and clinical usefulness were also investigated. Quantitative data were analysed using descriptive statistics.

RESULTS

Seventy-one occupational therapists responded to the questionnaire and 46 provided a full dataset. Over 96% of the respondents considered documenting behaviours and testing accommodations as important, yet less than 45% reported having resources to record this information. Ninety-five percent of the respondents perceived the OTOT-ASD to be useful in clinical practice. Over 70% agreed that OTOT-ASD items were significantly relevant to practice and comprehensive. To improve comprehensibility, identified items were altered following feedback.

CONCLUSION

The findings suggest that the OTOT-ASD is clinically useful and content validity is sound. Further research on other psychometric properties of the OTOT-ASD and users' qualitative experiences in utilising the tool is recommended.

Characteristics of Occupational Therapy Interventions to Promote Healthy Aging: Protocol for a Scoping Review

BACKGROUND

Healthy aging is a pressing public health priority. Focusing on what people do every day may be a meaningful approach to lifestyle change, suggesting a need for occupation therapy interventions to promote healthy aging. A preliminary database search was conducted, and no current or underway systematic or scoping reviews on the topic were identified. Developing an overview of studies of occupational therapy interventions to promote healthy aging is a necessary first step to understanding the existing knowledge and increasing the impact of future interventions. This scoping review will build on previously conducted reviews.

OBJECTIVE

This scoping review will identify the following: (1) what occupational therapy interventions exist for promoting healthy aging in community-dwelling adults? and (2) what are the intervention characteristics, their evaluated outcome, and the impact observed?

METHODS

This protocol was reviewed by 2 occupational therapists as part of a patient and public involvement consultation. The review will consider all studies and publications of occupational therapy focused on promoting healthy aging in community-dwelling adults who are aged 18 years and older. Databases to be searched are AMED, CINAHL, Cochrane Library, Embase, JBI EBP database, MEDLINE, OAlster, PsycINFO, PsycArticles, ProQuest Dissertations & Theses, ProQuest nursing and allied health source, PubMed, and Science Direct. Studies published in any language will be included. Titles and abstracts will be screened against the inclusion criteria using Covidence (Veritas Health Innovation). Potentially relevant studies will be retrieved in full and assessed against the inclusion criteria. No date limiters will be used. Study selection will be completed by 2 independent reviewers. Data will be extracted using a data extraction tool, including descriptive characteristics of the participants including age, sex, and socioeconomic status. Data will be charted using the TIDieR (Template for Intervention Description and Replication) checklist in alignment with the review objectives. The scoping review will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement.

RESULTS

The research began in October 2023, and the results are expected to be published in 2024.

CONCLUSIONS

This scoping review will produce valuable information about occupation-based interventions to promote healthy aging to support the development of an occupational therapy intervention.

TRIAL REGISTRATION

Open Science Framework 5k36d; https://osf.io/5k36d/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55198.

Teacher-therapist collaboration in inclusive primary schools: A scoping review

INTRODUCTION

Inclusive school environments require collaboration between teachers and allied health professionals to promote student access and participation. Collaboration is a complex phenomenon with no universally accepted definition or measurement and with many challenges to effective practice. The purpose of this scoping review is to describe what is known about interprofessional collaboration between teachers and therapists in inclusive primary schools.

METHODS

A scoping review of health and education literature was conducted using the Joanna Briggs Institute methodology. Peer-reviewed articles reporting on empirical studies with a focus on collaboration between teachers and school-based occupational therapists or speech and language therapists in inclusive primary schools were included.

RESULTS

Results summarise how collaboration is reported in the literature. Numerical and descriptive summaries describe how collaboration is defined and measured, the challenges to collaborative practice, the structures required to support effective practice, and the outcomes of such practice.

CONCLUSION

Definitions vary between studies and disciplines but contain common elements. For effective practice, the purpose of the collaboration must be clear, and the intended outcomes of the collaboration are measured. Measurement of collaboration requires further research using tools developed from robust theoretical frameworks and validated within the educational context and with professionals of different disciplines. Consistent measurement tools would allow cross-study comparisons. Barriers to collaborative practice are well documented; thus, future research should be directed to examining effective practice, investigating how professionals circumvent obstacles.

Work-related injury or work-related pain? A qualitative investigation of work-related pain and injury management among rehabilitation professionals1

BACKGROUND

Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period.

OBJECTIVE

As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers.

METHODS

Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures.

RESULTS

Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common.

CONCLUSION

Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury.

Perceptions of Post-Stroke Fatigue among Health Care Practitioners: A Qualitative Interview Study

Background and Objectives: Post-Stroke Fatigue (PSF) is a complex, multidimensional, debilitating condition that affects almost half of all stroke survivors. This study explored the perceptions of physiatrists, physiotherapists, and occupational therapists about PSF and their experiences in managing patients with PSF in Saudi Arabia. Materials and Methods: Qualitative semi-structured interviews were conducted with participants from three different groups: eight physiotherapists (PTs), eight occupational therapists (OTs), and eight physiatrists (DRs). Using purposive sampling, participants with at least one year of experience in the field of PSF management were invited to take part. The data were analysed using inductive thematic analysis. Results: Twenty-four health care participants (eight PTs, eight OTs, eight DRs) were recruited. Five overarching themes encompassing various subthemes and sub-subthemes were generated: 'knowledge about post-stroke fatigue', 'diagnosing post-stroke fatigue', 'treatment approach', 'lack of awareness about post-stroke fatigue', and 'domains to improve'. The data indicated that participants used various strategies to manage PSF, including dietary changes, sleep hygiene, exercise, and energy conservation. Conclusions: Participants acknowledged that they lacked PSF-related management skills, despite possessing adequate knowledge about the management of stroke. Their openness to participating in activities that would improve their ability to diagnose and manage PSF was particularly striking.

Hand therapy: Inclusive care by South African physiotherapists

Hand therapy for individuals who sustained hand injuries is included in the Health Professions Council of South Africa (HPCSA) physiotherapy scope of practice. The training that physiotherapists receive at the undergraduate level lays the foundation for them to deliver hand therapy or hand rehabilitation according to the International Classification of Functioning, Disability and Health domains in a uniquely South African health service context. Further structured formal and informal postgraduate continued education opportunities may put physiotherapists in the ideal position in a multidisciplinary team to deliver optimal hand therapy. The problem is that the physiotherapist's role in the multidisciplinary team delivering hand therapy in the past two decades has decreased, leaving room for a lack of health professional services in South Africa's private sector where physiotherapists are often the first consultation in, for example, sports teams, but more pertinently, in the public and rural areas. The International Federation of Societies for Hand Therapy (IFSHT) practice profile and physiotherapy scope of practice, curriculum and education information assist in achieving the aim of this commentary to position physiotherapists in South Africa as primary health practitioners in delivering hand therapy.

Clinical implication

The effective management of individuals with hand-related conditions and injuries is pertinent to ensure optimal hand function and quality of life. Equal continued formal education opportunities should thus be created for all multidisciplinary team professions at a postgraduate level.

Predictors of type of powered mobility aid for patients: a retrospective study in a Singapore acute hospital

PURPOSE

Rehabilitation professionals prescribe patients with suitable powered mobility aids (PMAs) based on patient characteristics, e.g., age and mobility. However, there is paucity of literature examining patient characteristics associated with PMA types in Asian contexts. This research aims to study (i) characteristics of Singapore PMA users and (ii) correlations between characteristics and two PMA types - motorised wheelchairs and powered scooters. It is hypothesised that patients' age, mobility status and medical conditions have correlations with PMA types.

METHODOLOGY

A cross-sectional, retrospective study design was used to investigate characteristics of patients (age ≥ 21 years) at Tan Tock Seng Hospital Occupational Therapy Seating Clinic between 2017 and 2019. Comparisons of proportions of motorised wheelchair users versus powered scooter users based on characteristics were analysed using Chi-square test. Subsequently, statistically significant patient characteristics were selected for a multiple logistic regression.

RESULTS

Among 352 patients, 21% and 79% were prescribed motorised wheelchairs and powered scooters, respectively. Patients aged 61-90 years were twice those aged 21-60 years. Males were double of females. Patients of (i) an older age, (ii) more ambulant, (iii) independent in transfers and (iv) in activities of daily living (ADLs), were more likely powered scooter users. Conversely, patients of (i) a younger age, (ii) less ambulant, (iii) require assistance in transfers and (iv) in ADLs were more likely motorised wheelchair users. Patients' gender and caregiver status showed no statistically significant correlations with PMA types.

CONCLUSIONS

Rehabilitation professionals could consider patients' age, mobility status, transfer status and ADL status when prescribing PMA for Asian populations.Implications for rehabilitationGuide rehabilitation professionals in making clinical decisions on the type of powered mobility aid (PMA) to prescribe based on patients' characteristics.Aid in the development of future guidelines for rehabilitation professionals in prescription of PMAs.

Implementation of digital health interventions in rehabilitation: A scoping review

OBJECTIVE

Digital health interventions have potential to enhance rehabilitation services by increasing accessibility, affordability and scalability. However, implementation of digital interventions in rehabilitation is poorly understood. This scoping review aims to map current strategies, research designs, frameworks, outcomes and determinants used to support and evaluate the implementation of digital interventions in rehabilitation.

DATA SOURCES

Comprehensive searches from inception until October 2022 of MEDLINE, CINAHL, PsycINFO, PEDro, SpeechBITE, NeuroBITE, REHABDATA, WHO International Clinical Trial Registry and the Cochrane Library.

METHODS

Two reviewers screened studies against the eligibility criteria. Implementation science taxonomies and methods, including Powell et al.'s compilation of implementation strategies, were used to guide analysis and synthesis of findings.

RESULTS

The search retrieved 13,833 papers and 23 studies were included. Only 4 studies were randomised controlled trials and 9 studies (39%) were feasibility studies. Thirty-seven discrete implementation strategies were reported across studies. Strategies related to training and educating clinicians (91%), providing interactive assistance (61%), and developing stakeholder interrelationships (43%) were most frequently reported. Few studies adequately described implementation strategies and methods for selecting strategies. Almost all studies measured implementation outcomes and determinants; most commonly, acceptability, compatibility and dose delivered of digital interventions.

CONCLUSION

The rigour of implementation methods in the field is currently poor. Digital interventions require carefully planned and tailored implementation to facilitate successful adoption into rehabilitation practice. To keep pace with rapidly advancing technology, future rehabilitation research should prioritise using implementation science methods to explore and evaluate implementation while testing effectiveness of digital interventions.

Exploring the Experiences and Perceptions of Pediatric Therapists who use Functional Electrical Stimulation in their Clinical Practice

Aim: This study aimed to 1) explore the experiences and perceptions of pediatric physical therapists (PTs) and occupational therapists (OTs) who use FES in their practice, and 2) provide recommendations for overcoming common barriers to FES implementation.Methods: Eight Canadian PTs (n = 6) and OTs (n = 2), who use FES in their pediatric practice, participated in semi-structured interviews. Open-ended questions queried the motivation, goals, perceived benefits and challenges, and facilitators and barriers of FES use. Interviews were audio recorded and transcribed verbatim. Interpretive description was used to analyze the transcripts.Results: One overarching theme emerged: FES is a useful adjunct to therapy for certain pediatric clients. Four sub-themes were identified: Participants described 1) motivation for incorporating FES into clinical practice, which led to 2) experiences with the implementation of FES in clinical practice, including strategies for overcoming implementation barriers. These experiences influenced 3) how FES is used in practice (e.g. for which populations and therapeutic goals), and informed 4) recommendations for pediatric FES practice (e.g. more educational opportunities, research, and access for families).Conclusions: Pediatric PTs and OTs who use FES in clinical practice view FES as a valuable adjunct, especially for motor training to improve functional skills.

Exploring Occupational Therapists' Professional Identity: A Q-Method Study

(1) Background: This study examines the nature of the rarely studied factors of the professional identity from an occupational therapist's perspective. (2) Methods: Q-methodology was applied to identify the different perspectives. Participants were selected through a non-probability sampling procedure in the whole Spanish territory. Different assessment tools were considered, in order to develop an ad hoc tool which had 40 statements classified into four categories. A factor analysis was performed by applying Ken-Q analysis v.1.0. (3) Results: Thirty-seven occupational therapists participated in the study. Their diverse approaches revealed different perspectives that influence the professional identity of occupational therapists: professional identity, due to referents, a grey field on professional identity, reaffirming a common professional identity, the role of education and mentors on professional identity and the outcome of ongoing training, in order to develop the abovementioned identity. (4) Conclusions: Once the different aspects of the professional identity have been understood, future educational initiatives can be designed to adapt curricula to the professional scene.

Pediatric Occupational Therapists and Occupational Stress: A Scoping Review

The purpose of this scoping review was to provide further insight into the stress and the stressors experienced by pediatric occupational therapists in the work environment. Using the Arksey and O'Malley framework, the search was conducted in eight databases, nine electronic journals, and eight gray literature sources to identify articles related to stress and stressors of pediatric occupational therapists. Review selection and characterization were performed by two independent reviewers. Twelve articles published from 2011 to 2020 were identified and varied in terms of purpose, population, and results although the articles all shared similar methodologies and outcome measures. Only 25% of the articles (3/12) addressed pediatric occupational therapy stress and stressors directly while the remaining addressed occupational stress, but with varying levels of attention to pediatric occupational therapists. Stress and stressors experienced by pediatric occupational therapists have been studied to a limited extent. Occupational stress is associated with increased burnout, decreased health, and decreased job satisfaction and performance. Several knowledge gaps have been identified, as well as priorities for future research into pediatric occupational therapists and occupational stress.

A realist review of the home care literature and its blind spots

RATIONALE, AIMS AND OBJECTIVES

There is a large body of literature from all over the world that describes, analyzes, or evaluates home care models and interventions. The present article aims to identify the practical lessons that can be gained from a systematic examination of that literature.

METHOD

We conducted a three-step sequential search process from which 113 documents were selected. That corpus was then narratively analysed according to a realist review approach.

RESULTS

A first level of observation is that there are multiple blind spots in the existing literature on home care. The definition and delimitation of what constitutes home care services is generally under-discussed. In the same way, the composition of the basket of care provided and its fit with the need of recipients is under-addressed. Finally, the literature relies heavily on RCTs whose practical contribution to decisions or policy is disputable. At a second level, our analysis suggests that three mechanisms (system integration, case management and relational continuity) are core characteristics of home care models' effectiveness.

CONCLUSION

We conclude by providing advice for supporting the design and implementation of stronger home care delivery systems. Our analysis suggests that doing so implies a series of sequential steps: identify what system-level goals the model should achieve and which populations it should serve; identify what type of services are likely to achieve those goals in order to establish a basket of services; and finally, identify the best ways and specific means to effectively and efficiently provide those services. Those same steps can also support ex-post evaluations of existing home care systems.

Limitations and Recommendations for Advancing the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis of the Literature

Occupational therapy workforce research can help determine whether occupational therapists exist in sufficient supply, are equitably distributed, and meet competency standards. Advancing the value of occupational therapy workforce research requires an understanding of the limitations and recommendations identified by these investigations. This scoping review and content analysis synthesizes the study limitations and recommendations reported by the occupational therapy research worldwide. Two independent reviews included 57 papers from the past 25 years. Stated limitations included: focus on cross-sectional studies with small and convenience samples; participants from single settings or regions; local markets or preferences not specified; focus on self-reported data and intentions (rather than behaviors or occurrences); challenges in aggregating or synthesizing findings from descriptive data; lack of statistical adjustment for testing multiple associations; and the lack of detailed, up-to-date, and accessible workforce data for continuous monitoring and secondary research. Stated recommendations included: strengthening routine workforce data collection; developing longitudinal studies that include interventions (e.g., recruitment or retention packages); developing context-sensitive comparisons; studying the impact on ultimate outcomes; promoting nation-wide, coordinated workforce plans and requirements; and fostering international coalitions for workforce research and developments at scale. These study limitations and recommendations reported by the literature must be considered in the design of a local and global occupational therapy workforce research agenda.

Manifestation of Generalized Anxiety Disorder and Its Association With Somatic Symptoms Among Occupational and Physical Therapists During the COVID-19 Pandemic

Purpose

The purpose of the study was to examine the level of generalized anxiety disorder among occupational and physical therapists during treatment sessions and its association with somatic symptoms during the COVID-19 pandemic.

Methods

A descriptive cross-sectional design was used in this study. Data were collected during the month of April 2021, and the study included occupational and physical therapists who practiced during COVID-19 from March 2020 to March 2021. The generalized anxiety disorder scale (GAD-7) and a modified patient health questionnaire (mPHQ-15) were used to examine self-reported anxiety and somatic symptoms among the study participants. The independent t-test was used to determine differences between groups based on GAD-7 and mPHQ-15 results. Spearman's correlation test and chi-squared test were used to find the relationships between different variables such as anxiety and somatic symptoms.

Results

The study (n = 98 participants) included 56 occupational and 42 physical therapists. An 84% response rate was achieved. GAD-7 final score was μ = 9.21 ± 5.63 with 27% reporting no anxiety, 14% mild, 38% moderate, and 21% severe. Independent t-tests on GAD-7 scores showed significant differences between therapist specializations [t₍₉₆₎ = −2.256; p = 0.026] and between therapists residing with or without their parents [t₍₉₆₎ = −2.536; p = 0.013]. The mPHQ-15 final score was μ = 9.52 ± 5.54 with 13% reporting no symptoms (n = 13), 20% mild (n = 20), 38% moderate (n = 37), and 29% severe (n = 28). GAD-7 and mPHQ-15 scores were moderately positively correlated [r₍₉₆₎ = 0.569; p <0.000]. The chi-squared test showed a significant association between GAD-7 levels of anxiety and mPHQ-15 levels of somatic symptoms [x²_{(9, N = 98)} = 70.62 p <0.000]. Therapists reported that the quality (76%) and effectiveness (20%) of their rehabilitation services were negatively impacted by the COVID-19 pandemic.

Conclusion

The majority of study participants experienced moderate to severe anxiety and associated somatic symptoms. During COVID-19, ongoing psychological counseling of healthcare professionals such as occupational and physical therapists is required to maintain positive mental health. Implications for practice are presented.

Type of Findings Generated by the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis

Occupational therapists are needed to meet the health and occupational needs of the global population, but we know little about the type of findings generated by occupational therapy workforce research conducted worldwide. We aim to synthesize these findings and their range of content to inform future investigations. A scoping review with content analysis was used. Six scientific databases, websites of official institutions, snowballing, and key informants were used for searches. Two independent reviewers took selection decisions against the eligibility criteria published a priori in the review protocol. Of the 1246 unique references detected, 57 papers were included for the last 25 years. A total of 18 papers addressed issues of attractiveness and retention, often in Australia, and 14 addressed the issues of supply, demand, and distribution, often in the US. Only these two categories generated subtopics. Many workforce issues were rarely addressed as a main topic (e.g., race/ethnic representation). Cross-national, cross-regional, or cross-professional studies generated more actionable findings. Overall, we found few discernable trends, minimal evidence of research programs, and various gaps in content coverage or in the use of contemporary research approaches. There is a need for a coordinated strengthening of the occupational therapy workforce research worldwide.

Exploring gaps in positive solitude perceptions: older adults vs. gerontology professionals

OBJECTIVES

The aim of this study was to explore old persons' experiences of positive solitude (PS) and the gaps between their experience and professional caregivers' perceptions of older adults' experiences of PS. Moreover, we attempt to understand the basic mechanism that may explain these gaps.

DESIGN

A qualitative method was used.

PARTICIPANTS

Fourty-one older adults (aged 65-103 years) and 2 groups of professionals: 16 occupational therapists with a specialization in gerontology and 41 gerontology graduate students from other occupations.

MEASUREMENT

Four open-ended questions about PS were asked. The older adults described their views on PS and experiences during solitude. The two caregiver groups, who are familiar with older adults, answered the questions twice, referring once to themselves and once to older adults in general.

RESULTS

A. Gaps exist between old peoples' and caregivers' perceptions and experience of PS. B. The caregivers believe that older adults cannot easily enjoy PS. C. Caregivers believe that there are certain preconditions for older adults' experience of PS. D. Differences in attitude toward older adults between the caregiver groups were found.

CONCLUSIONS

Although old people occasionally prefer PS, culture and age bias may prevent caregivers from accepting older adults' need for PS. Practical implications include the need to raise awareness of age bias among caregiving staff, in particular regarding their acceptance of older adults' PS experiences. This may improve the staff's willingness to enable older adults to experience PS without interruption.

Mapping the occupational therapy workforce research worldwide: Study protocol for a scoping review

BACKGROUND

Human Resources for Health (HRH) research informs the development of evidence-based, population-centered HRH policies and practices. Occupational therapists are key human resources for meeting the health, rehabilitation, and occupational needs of the population worldwide. Yet, the global status of the occupational therapy workforce research remains unchartered.

OBJECTIVES

This study protocol depicts the methods to map out and synthesize the occupational therapy workforce research worldwide.

METHODS

Six scientific-literature databases and key international institutional websites will be systematically searched, complemented by snowballing searches and recommendations from key global, regional, or national representatives of the World Federation of Occupational Therapists. Two independent reviewers will screen titles-and-abstracts and then full-texts against the eligibility criteria, e.g., 10 categories of workforce research. Educational research, non-empirical papers, and papers (or their summaries) not available in English, Spanish or Portuguese are excluded. Data extraction (e.g., methods, geographies, aims, key findings) will be conducted by one author and fully verified by another. The extracted data will be computed as well as subject to content analysis to provide quantitative map of the literature and of the contents addressed, e.g., per inclusion category.

CONCLUSION

The results of this review can inform wide consultation processes and strategic, concerted local and global developments of the occupational therapy workforce.

The impact of COVID-19 restrictions on occupational balance: A mixed method study of the experience of Australian occupational therapists

Introduction

COVID‐19 has seen unprecedented changes to the daily occupational lives of citizens across the globe as a result social and physical restrictions. Frontline healthcare workers health and wellbeing have been impacted but what of occupational balance? The aim of this study was to investigate if there was a change in the occupational balance of occupational therapists working in a metropolitan hospital during a COVID‐19 lockdown.

Methods

All occupational therapists working in a metropolitan hospital were invited to participate in an online survey. Occupational Balance was measured using the Occupational Balance Questionnaire‐11 (OBQ11). Participants retrospectively rated their occupational balance before COVID‐19 restrictions were in place and again rated their current status during the restrictions. Participants were also asked to comment on strategies used to help them during the COVID‐19 restrictions.

Results

Forty‐two occupational therapists completed the survey. The mean total score prior to the COVID‐19 restrictions was 19.4 and during restrictions was 19.0 (Z = −0.4, p = 0.68). There was a significant decrease in having sufficient to do during the COVID‐19 restrictions (Z = −3.6, p < 0.001). Satisfaction with how time was spent in rest, recovery and sleep significantly increased during the restrictions (Z = −3.3, p = 0.001). Strategies used included engaging in valued activities, finding alternate ways of doing and showing gratitude.

Conclusion

Occupational balance of occupational therapists remained high and satisfaction in how time was spent improved during COVID‐19 restrictions. Occupational therapists implemented their own theoretical approach of adaptation to cope with the COVID‐19 restrictions.

Job Satisfaction among Occupational Therapy Practitioners: A Systematic Review of Quantitative Studies

A comprehensive description of the factors associated with job satisfaction among occupational therapy practitioners is needed to promote their work well-being. This systematic review aimed to describe occupational therapy practitioners' job satisfaction and the related intra-, inter-, and extra-personal factors. Original peer-reviewed studies published between 2010 and 2019 were retrieved from four databases with the review including fourteen studies. The review was conducted according to the Joanna Briggs Institute guideline. The data were analyzed by narrative synthesis. Occupational therapy practitioners experienced high job satisfaction. Job satisfaction was found to be associated with significantly lower rates of turnover intention and higher rates of rewards. The relationships between job satisfaction, professional identity, exhaustion, and social environment showed conflicting results.

Surveying Therapists on Seating Approaches for Patients with Muscular Dystrophy in Japan

Patients with muscular dystrophy (MD) need fitted wheelchairs. This study aimed to ascertain physiotherapists and occupational therapists’ opinions about the current wheelchair seating process for patients with MD in Japan. We identified 266 academic papers published between August 2014 and July 2019 with the keywords “muscular dystrophy” and either “physiotherapy” or “occupational therapy.” We then sent survey requests to 140 physiotherapists and occupational therapists (who were among the authors of the aforementioned papers), of whom 41 agreed to partake in this study. We found that the time required for each seating was 30–60 min for three types of MD, and the most commonly reported time to trial fitting was 1–3 months. In addition, health insurance reimbursements for seating were considered part of disease-specific rehabilitation in most cases, and most therapists were more or less satisfied with the current seating procedure. Physiotherapists had the highest degree of reflection of their views (wishes) regarding seating, followed by MDs and their families. In Japan, seating has been regarded as a medical practice since 2017. In the future, we would like to investigate the seating concept for individual therapists in detail.

Death and Dying in Long-Term Care Facilities: The Perception of Occupational Therapists

End-of-life care in long-term care facilities for older adults requires numerous skills. However, many professionals, including occupational therapists, feel unprepared to deal with death and dyingand have difficulties to attend to the real needs of the older adults and their families.This is a qualitative study anchored in phenomenologywhich had the objective to understand the perception of occupational therapists regarding death and dying inlong-term care facilities. Data were collected through focus groups and analyzed by thematic content analysis. A total of 12 occupational therapists participated in this study, and two themeswere generated: "The Experience of Death and Dying" and "The Occupational Therapist's approach in Facing Death and Dying". These results may contribute to improvingthe care provided to older adults in the process of death and dying.

Recommendations for a Pediatric Pain Education Curriculum for Physical and Occupational Therapists: Scoping Review and Survey

Specialization training for physiotherapists, occupational therapists, and sports therapists involved in pediatric pain is scarce and curricula are rarely published. The objectives of this study are twofold: firstly, to perform a scoping review to derive important contents for a pediatric pain education curriculum for specialized pain therapists. Secondly, to conduct a survey on specific contents in curricula currently used by pain experts and to obtain their evaluation regarding the importance of such contents for a specialized curriculum. The review substantiated the importance of a specific curriculum in pediatric pain education, but provided little information on adequate contents. In the survey, 45 experts in pediatric pain education confirmed that specific curricula and specialized contents for pediatric pain education are missing. Their answers give a well-defined picture of the specifics needed in the interaction with a pediatric population. The most important items they classified were e.g., the biopsychosocial framework and the impact of pediatric pain on daily life. Those expert ratings were in line with the recommendations of pediatric pain management guidelines. Further curriculum work in an interdisciplinary, international network is highly recommended.

Current practices and factors affecting evidence-based occupational therapy practice for patients with dementia in Japan

Objective/background

The rapidly increasing incidence of patients with dementia in Japan is creating an urgent demand for evidence-based occupational therapy (EBOT), which has been reported to improve clinical efficacy. This study aimed to examine the current practice of EBOT for patients with dementia in Japan and clarify factors influencing its application.

Methods

We conducted an anonymous, self-administered questionnaire survey by mail. The participants were 432 occupational therapists treating patients with dementia at 432 designated medical institutions nationwide. Descriptive statistics were calculated, and multiple regression analysis was performed to clarify the factors influencing the present application of EBOT.

Results

The response rate was 31.3%. Among the participants, 46.3% responded ‘somewhat frequently’ or more (5, 6, and 7 on a 7-grade scale) to a question on the frequency of practice of EBOT. Using multiple regression analysis with the stepwise method, we selected the model with the highest degree of fit. This model extracted three factors, namely, ability to understand scientific papers, sufficiency of means of getting information, and availability of advice, which had standardized partial regression coefficients (β) of 0.419, 0.214, and 0.158, respectively.

Conclusions

The three factors extracted using the multiple regression analysis indicate that in order to encourage EBOT for patients with dementia, occupational therapists need to acquire reading comprehension skills, so that they can assess the quality of scientific papers. Furthermore, it is important to create environments where they have access to publications and can discuss research with superiors and colleagues.

Implementation of video modeling in the occupational therapy intervention process for children and adolescents with special needs: A scoping review

This scoping review explores the implementation of video modeling (VM) by occupational therapists during the intervention process for children and adolescents with special needs. Four primary electronic databases were used to conduct the scoping review: PubMed, Scopus, CINAHL, and Proquest (Nursing and Allied Health). Research methodologies by Arksey and O'Malley were used as a framework to perform the review process. From the review, two themes emerged: (1) implementing VM by occupational therapists during the intervention process can successfully improve a client's desired skills; (2) VM can be applied through several types of technologies. The findings support occupational therapists' use of VM during interventions to positively enhance and promote desired skills among children and adolescents with special needs. Also, it can be incorporated into technological devices to suit a client's specific needs.

Job demands and job control among occupational therapists in public sector in Finland

BACKGROUND

Although health care professionals' increased job demands and strain have generated much public debate in recent years, the way in which occupational therapists' job strain has developed remains unknown.

OBJECTIVE

To examine how Finnish occupational therapists working in municipalities experienced job demands and control in 2014-2018 compared with physiotherapists and registered nurses.

MATERIAL AND METHODS

Occupational therapists (OT, n = 107), physiotherapists (PT, n = 331) and registered nurses (RN, n = 1389) responded to repeated surveys in the Finnish Public Sector Study in 2014-2018. We used the Job Content Questionnaire and analyzed the data using repeated measures analysis of variance and multiple linear regression with generalized estimating equations to identify the trends and differences.

RESULTS

More OTs had lower job demands and higher job control than PTs and RNs in each year of study. These differences were statistically significant. Most OTs had low job strain. The changes in job control and job demands of participants in different years were not statistically significant.

CONCLUSIONS

The OTs consistently experienced low job strain as compared to the PTs and RNs. Developing good practices in OT's work may be beneficial for improving employee health and well-being and high-quality client care.

"Tutor and student dyadic interactions in relation to Interprofessional education and clinical care: A constructivist grounded theory study"

AIM

The aim of this study was to explore and understand the interprofessional collaboration preparation processes implemented by clinical tutors and students, in various professions, involved in interprofessional education experiences.

DESIGN

A constructivist grounded theory approach. The study was carried out between 2015-#2017.

METHOD

Semi-structured interviews were conducted with a total of ten undergraduate students and the seven clinical tutors who supervised them from three undergraduate courses in a university of applied sciences and arts in Switzerland. Students were sampled during their clinical placement. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software.

RESULTS

A substantive theory "Practicing contextual models of interprofessional care" was generated. It explains how the whole process takes place, the tutor-student interactions, and how together they gradually build models of interprofessional care, linked to their clinical context and to the patients/families who are part of it.

CONCLUSION

The process describes a journey to comprehensively explain the roles played by the two main actors (student and tutor) who build a relationship of interaction.

IMPACT

This theory provides an understanding of the complex process set up by students and how they are prepared for collaboration with other professionals. Its importance is mainly expressed in the educational field because it reveals a different vision from the one present so far and enables a thorough reflection from the pedagogical point of view. Teachers will be able to observe and approach the students' training curricula from a different point of view by evaluating any changes to favour it and rethink the organizational and training models of current programs.

Musculoskeletal Complaints in Occupational Therapists Compared to the General Population: A Cross-Sectional Study in Germany

Occupational therapists (OTs) are exposed to physical factors at work, which can lead to an increased risk of musculoskeletal disorders. Most studies examining musculoskeletal complaints in OT report that the neck, shoulders, and lower back are most often afflicted. The aim of the present study was to examine the impact of work as an OT (focusing on specific work tasks) on specific musculoskeletal complaints compared to the general working population. A cross-sectional study involving a self-administered standardized questionnaire was conducted from January until October 2015 in Germany. In OT and the comparison group, the highest 12-month prevalence of musculoskeletal disorders were observed for the lower back, the neck, and the shoulders. In contrast, elevated prevalence ratios (PR) were found for OT in the thumbs (PR = 2.7; 95% CI = 1.9-3.8), the wrists (PR = 1.4; 95% CI = 1.1-1.8), and the elbows (PR = 1.5; 95% CI = 1.0-2.2). OTs were particularly exposed to high exertion hand activity and several stressful postures at work. In conclusion, OTs seem to be at risk of developing work-related musculoskeletal complaints in the thumbs, wrists, and elbows. Preventive measures should help to reduce the exposures caused by highly repetitive and forceful hand activities.

Institutional context: What elements shape how community occupational therapists think about their clients' care?

Clinical reasoning (CR) is the cognitive process that therapists use to plan, direct, perform and reflect on client care. Linked to intervention efficiency and quality, CR is a core competency that occurs within an institutional context (legal, regulatory, administrative and organisational elements). Because this context can shape how community therapists think about their clients' care, its involvement in their CR could have a major impact on the interventions delivered. However, little is known about this involvement. Our study thus aimed to describe the elements of the institutional context involved in community therapists' CR. From March 2012 to June 2014, we conducted an institutional ethnography (IE) inquiry in three Health and Social Services Centres in Québec (Canada). We observed participants and conducted semi-structured interviews with 10 occupational therapists. We also interviewed 12 secondary key informants (colleagues and managers) and collected administrative documents (n = 50). We analysed data using the IE process. Of the 13 elements of the institutional context identified, we found that four are almost constantly involved in participants' CR. These four elements, that is, institutional procedures, organisation's basket of services, occupational therapists' mandate and wait times for their services, restrictively shape CR. Specifically, occupational therapists restrict their representation of the client's situation and exploration of potential solutions to what is possible within the bounds of these four elements. In light of such restrictions on the way they think about their clients' care, therapists should pay close attention to the elements of their own institutional context and how they are involved in their CR. Because of its potentially important impact on the future of professions (e.g. further restrictions on professionals' role, reduced contribution to population health and well-being), this involvement of the institutional context in CR concerns all professionals, be they clinicians, educators, researchers or regulatory college officers.

Burnout Syndrome in Occupational Therapists in Spain: Prevalence and Risk Factors

The objective of this study was to assess the potential levels of burnout syndrome in occupational therapists in Spain, as well as the risk factors involved in its prevalence. The data were obtained through an online survey. The tool utilised for this purpose was the Maslach Burnout Inventory General Survey (MBI-GS) that takes into consideration the following dimensions: emotional fatigue, depersonalisation and reduction of personal satisfaction. A sociodemographic questionnaire was also utilised. The sample of the study included 758 occupational therapists, 90.8% of whom were women and 9.2% of whom were men. For identifying the variables associated to the presence of burnout, the prevalence was compared through the chi-squared test, and the odds ratios by age were calculated through the binary logistic regression model. We found that 69.4% of the occupational therapists presented burnout syndrome and especially emotional fatigue (63.5%). Likewise, relevant and significant differences in the prevalence of burnout syndrome were observed depending on the age, marital status, number of children, work field and type of workday. We can conclude that burnout syndrome poses a clear risk for the health of occupational therapists that could have direct consequences on the work environment, affecting the way the interventions are performed with patients. This study could help to raise awareness on this reality and the factors implied. We suggest the implementation of measures (individual, labour and political) both for the prevention of burnout in occupational therapists as well as for reducing the levels of those who suffer from it.

Contemporary occupational therapy philosophy and practice in hospital settings

BACKGROUND

Occupational therapists have sought to reconnect with the foundations of the profession for many years, and a key focus has been the place of occupation in practice. Existing literature suggests that therapists working in acute settings experience difficulties practicing in ways that centralise occupation.

AIM/OBJECTIVE

This scoping review aimed to explore the existing literature on contemporary occupational therapy philosophy and practice in acute hospital settings.

METHODS

A five step scoping review process was implemented. Four electronic databases were searched using a combination of search terms. Searching reference lists of papers was also completed. Results were summarised using numeric and thematic analysis.

RESULTS

Twenty four publications were included. Four themes were identified; attitudes towards occupation-based practice, benefits of occupation-based approaches, challenges implementing occupation-based practice, and strategies to overcome challenges.

CONCLUSION AND SIGNIFICANCE

Findings highlighted therapists value occupation as an important aspect of practice, however they experience many environmental and personal challenges in acute settings. Strategies to overcome these challenges related to individual's changing their practice to be more occupation-focussed and changes within the practice context including adapting environments, documentation and intervention protocols to focus on occupation. These strategies may support therapists to align practice with their professional values.

Collaboration in work ability assessment for sick-listed persons in primary healthcare

BACKGROUND

General practitioners (GPs) have expressed difficulties in issuing sickness certificates and problems may arise if this work is not performed in an adequate manner. There is scant knowledge about how collaboration with other professions could be organized to enhance this work.

OBJECTIVE

Evaluate the feasibility of occupational therapists (OTs) performing supplementary assessments for persons on sick leave.

METHODS

Four healthcare centres (HCs) tested a working approach intervention where sick-listed patients were offered a complementary occupational therapy assessment. The OT assessments were intended to provide useful information for GP issued extended sickness certificates. Data on sick leave, sickness certificates and patient questionnaires were collected at different HCs. Interviews were conducted with GPs and OTs and the Consolidated Framework for Implementation Research was used to analyse the intervention's implementation.

RESULTS

No major differences in the sickness certificate quality was found. Available data on sick leave increased for all HCs during the project. Not all GPs used the OT assessments, which indicates that the implementation of the intervention was insufficient.

CONCLUSION

Testing a new working approach in primary healthcare requires an implementation strategy. To improve sickness certification quality, this work needs to be prioritized as an important healthcare task.

A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study

INTRODUCTION

Rehabilitation post-stroke is critical for maximizing patient outcomes. This study assessed the feasibility of implementing and evaluating a continuing professional development (CPD) intervention aimed at increasing the uptake of stroke best practice guidelines among physiotherapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) in six university-affiliated stroke rehabilitation centers in Quebec, Canada.

METHOD

Twelve stroke best practice recommendations with reflective tools were sent weekly by e-mail. Participants' eligibility criteria included: a) profession; b) practicing more than 1 year in a stroke rehabilitation program; c) fluency in French or English; and d) basic computer literacy. Feasibility (operationalized via participation, satisfaction and relevance), cognitive impact, perceived application in practice and expected patient outcomes were measured over 24 weeks using three questionnaires and analyzed using descriptive statistics.

RESULTS

The sample totaled 62 of 133 eligible (47%) clinicians. Satisfaction, relevance and cognitive impact of delivered information varied across disciplines and recommendations. Agreement with the recommendations was high across disciplines. On average, three-interdisciplinary recommendations (related to post-stoke depression, post-stoke fatigue and patients' and caregivers' learning needs) were rated as the most relevant for at least one patient. The majority of clinicians would use the recommendations for a specific patient and expected health benefits by applying those recommendations.

CONCLUSION

This study demonstrated the feasibility of assessing the impact of a CPD intervention in stroke rehabilitation uptake and informed the design of a research program aimed at increasing the use of stroke evidence-based rehabilitation interventions.

[Prestige of selected medical professions in the opinion of representatives of these professions]

BACKGROUND

The aim of this article is to present the prestige of selected medical professions in the opinion of people practicing these professions.

MATERIAL AND METHODS

The study was conducted by means of the survey technique. The research tool was an original questionnaire prepared by the authors of the study, which was carried out on a sample of 346 professionally active physicians, nurses, physiotherapists, psychotherapists, and occupational therapists. Those people were employed in public institutions (hospitals, outpatient clinics, rehabilitation centers) located in Kraków and Katowice. The selection of the sample was deliberate.

RESULTS

The profession of a physician received the highest score of prestige, while the lowest one was achieved by the profession of an occupational therapist. As factors influencing the prestige of a given profession, physicians and physiotherapists most often indicated social respect for the profession, while nurses, psychotherapists, and occupational therapists emphasized the importance of education. The level of prestige of medical professions, as compared with other professions, decreased with seniority.

CONCLUSIONS

The profession of a physician occupies the leading position in the hierarchy of the self-assessed prestige of medical professions. Physicians notice a general tendency to assess the prestige of their profession in a broader context - the position of this profession is weakening in favor of other public utility jobs, despite the fact that physicians still occupy an important place in the rankings of prestige including all professions. A negative self-assessment of the prestige of the occupation performed over the period of ten years prevail only in the case of physicians and nurses. Med Pr. 2019;70(5):587-95.

Factors related to hospital utilisation for people living with schizophrenia: Examining Allen's Cognitive Level Scores, recommended supports and routinely collected variables

INTRODUCTION

Australian occupational therapists working on mental health inpatient wards are often requested to assess a person's function and, based on that assessment, recommend the best support environments for that person post-discharge. The Allen Cognitive Level Screen (ACLS) is a tool used by some therapists to screen cognitive functioning as a basis with which to make support recommendations. There is limited examination of the outcomes for people post-discharge if the ACLS score-based support recommendations are followed.

METHOD

A retrospective cohort design involved quantitative analysis of archival data for 150 adult (18-65 years old) consumers with a primary diagnosis of schizophrenia and an ACLS completed pre-discharge. Data up to 12 months post-discharge from hospital were studied. Outcomes examined included re-presentations or readmission to hospital, length of time in community prior to re-presentation and length of stay in hospital if readmitted.

RESULTS

Being younger, male, receiving formal supports, having a drug and alcohol disorder comorbidity, living in public housing and having a lower cognitive level as measured by the ACLS were significant univariate factors associated with higher hospital utilisation for one or more of the outcome variables. Multivariate analyses revealed fewer significant relationships, with being younger and receiving formal supports significantly associated with greater likelihood of return to hospital.

CONCLUSION

This research contributes to evidence of the complexity of living with schizophrenia in the community and supporting people to stay out of hospital. More research regarding how the ACLS score-aligned support recommendations are carried out and the impact on hospital utilisation is needed in order to enhance occupational therapists confidence in their use and prescription.

Patient participation in municipal elderly care from the perspective of nurses and occupational therapists

AIM

The aim of this study was to describe how nurses and occupational therapists in municipal care of older people define and implement patient participation in their daily work.

DESIGN

This study had a cross-sectional design. Data were collected using an online questionnaire.

METHODS

The questionnaire had both closed and open-ended questions. One-hundred and fourteen nurses and occupational therapists responded. Data were analysed with descriptive statistics and thematic analysis.

RESULTS

Two main themes were identified as follows: "The professionals' perspective at the centre - Patient participation to enhance compliance" and "The patients' perspective at the centre - Patient participation as an ongoing process." The themes covered a continuum. On one extreme, patient participation was equated with making the patient comply with what the professionals wanted to do. On the other extreme, all power was transferred to the patient. The first theme was restricted to the decision-making process. The second theme covered the entire care or, rehabilitation, process.

Assessing the Quality of Mobile Apps Used by Occupational Therapists: Evaluation Using the User Version of the Mobile Application Rating Scale

Background

The continuous development of mobile apps has led to many health care professionals using them in clinical settings; however, little research is available to guide occupational therapists (OTs) in choosing quality apps for use in their respective clinical settings.

Objective

The purpose of this study was to use the user version of the Mobile Application Rating Scale (uMARS) to evaluate the quality of the most frequently noted mobile health (mHealth) apps used by OTs and to demonstrate the utility of the uMARS to assess the quality of mHealth apps.

Methods

A previous study surveying OTs’ use of apps in therapy compiled a list of apps frequently noted. A total of 25 of these apps were evaluated individually by 2 trained researchers using the uMARS, a simple, multidimensional analysis tool that can be reliably used to evaluate the quality of mHealth apps.

Results

The top 10 apps had a total quality score of 4.3, or higher, out of 5 based on the mean scores of engagement, functionality, and aesthetics. Apps scored highest in functionality and lowest in engagement. Apps noted most frequently were not always high-quality apps; apps noted least frequently were not always low-quality apps.

Conclusions

Determining the effectiveness of using apps in clinical settings must be built upon a foundation of the implementation of high-quality apps. Mobile apps should not be incorporated into clinical settings solely based on frequency of use. The uMARS should be considered as a useful tool for OTs, and other professionals, to determine app quality.

Understanding independent wheelchair transfers. Perspectives from stakeholders

Purpose: Transferring to and from the wheelchair is among the most important routine tasks for many wheelchair users. Transfers are also greatly affected by many personal and external factors. The purpose of this study is to investigate personal experiences, needs and concerns of wheelchair users in relation to wheelchair transfers performed in their everyday lives.Methods: A series of focus groups and interviews were carried out with 11 wheelchair users and 4 occupational therapists. Data were analysed using a hybrid deductive and inductive approach of thematic analysis.Results: The seven themes identified emphasize the importance and complexity of wheelchair transfers. Transfers were described as gateways to independence that grant access to life opportunities, and community participation. Nonetheless, transferring skills are difficult to acquire and the concept of correct technique, although really important, is often poorly defined. Wheelchair transfers can be further complicated by the characteristics of the individual, the presence of upper limb pain, fear of falling or the characteristics of the environment. Despite the importance of transfer training to improve safety and reduce the risk of overload injuries, only a few people receive dedicated advice from health professionals. Currently available assistive technologies were perceived as only partially successful in providing support to wheelchair users during the execution of transfers, especially when environmental constraints make the transfer more challenging.Conclusion: Due to their multifactorial nature, creating effective solutions to improve any aspect of wheelchair transfers will require a collaborative effort from users, clinicians, designers and other professionals.Implications for rehabilitationThe ability to transfer independently is extremely important for many wheelchair users and can affect not only their personal and social lives, but also the way they perceive themselves and are perceived by others.The use of a correct transferring technique plays an important role in reducing the effort required to complete a transfer and decreases the risk factors for both falls and upper limb injury development. Unfortunately, few wheelchair users have access to in-person training to develop transferring skills. The remaining people rely on a combination of peer observation, personal research and simple trial and error to figure out the movement strategies that better suit their needs.Currently available assistive technologies are perceived by wheelchair users as only partially successful in providing support during the execution of transfers. Transfer boards and other devices are often described as only useful for basic transfers and for individuals with reduced, but still sufficient, upper limb function.

Work Ability Index (WAI) values in a sample of the working population in Poland

INTRODUCTION

Ability to work is most often defined as a relationship between a person's resources and requirements specific to a particular type of work. It is the result of interaction between job requirements in terms of physical and mental strain, capabilities and skills of the employee, as well as his/her health condition and own evaluation of functioning in a given organizational and social situation.

OBJECTIVE

The primary objective of the study was to evaluate the current value of the Work Ability Index (WAI) in a sample of employees in Poland.

MATERIAL AND METHODS

The study sample was selected purposefully from 422,000 employees covered by the largest occupational health provider in Poland. The standard WAI questionnaire provided by CAWI (Computer-Assisted Web Interview) methodology was voluntary and completed anonymously by 688 employees within 12 months (0.16% response rate). The results were statistically analyzed using the Pearson's chi-squared test and correlation coefficient, independent-sample T test and one-way analysis of variance (p<0.05).

RESULTS

It was found that the average value of WAI was 37.5 ± 7.7, and 37% of the participants represented low to moderate ability to work. The results showed no significant correlation between the WAI value and its 7 compounds and demographic variables. Nonetheless, a dependency between WAI level and industrial branch was observed.

CONCLUSIONS

Subjects with moderate and low WAI (1/3 of the study population) had particular indications to implement prophylactic actions, especially for the health care employees and civil servants, whose ability to work may be subject to accelerated deterioration.

Using an Electronic Tablet to Assess Patients' Home Environment by Videoconferencing Prior to Hospital Discharge: Protocol for a Mixed-Methods Feasibility and Comparative Study

Background

Occupational therapists working in hospitals are usually involved in discharge planning to assess patients’ safety and autonomy upon returning home. However, their assessment is usually done at the hospital due to organizational and financial constraints. The lack of visual data about the patients’ home may thus reduce the appropriateness and applicability of the support recommended upon discharge. Although various technological tools such as mobile devices (mobile health) are promising methods for home-based distance assessment, their application in hospital settings may raise several feasibility issues. To our knowledge, their usefulness and added value compared to standard procedure have not been addressed yet in previous studies. Moreover, several feasibility issues need to be explored.

Objective

This paper aims to (1) document the clinical feasibility of using an electronic tablet to assess the patient's home environment by mobile videoconferencing and (2) explore the added value of using mobile videoconferencing, compared to the standard procedure.

Methods

A feasibility and comparative study using a mixed-methods (convergent) design is currently undergoing. Six occupational therapists will assess the home environment of their patients in the hospital setting: they will first perform a semistructured interview (a) and then use mobile videoconferencing (b) to compare “a versus a+b.” Interviews with occupational therapists and patients and their caregivers will further explore the advantages and disadvantages of mobile videoconferencing. Two valid tools are used (the Canadian Measure of Occupational Performance and the telehealth responsivity questionnaire). Direct and indirect time is also collected.

Results

The project was funded in the spring of 2016 and authorized by the ethics committee in February 2017. Enrollment started in April 2017. Five triads (n=4 occupational therapists, n=5 clients, n=5 caregivers) have been recruited until now. The experiment is expected to be completed by April 2019 and analysis of the results by June 2019.

Conclusions

Mobile videoconferencing may be a familiar and easy solution for visualizing environmental barriers in the home by caregivers and clinicians, thus providing a promising and inexpensive option to promote a safe return home upon hospital discharge, but clinical feasibility and obstacles to the use of mobile videoconferencing must be understood.

International Registered Report Identifier (IRRID)

DERR1-10.2196/11674

New graduate occupational therapists' narratives of ethical tensions encountered in practice

BACKGROUND/AIM

Professionals in health and social care have high workloads and are working with diverse populations in hierarchical and complicated service delivery systems. There is increasing pressure on new graduates because they are expected to be immediately work ready and may not receive adequate support or supervision. It is well known that there can be issues with satisfaction and retention rates of new graduates due to the challenges they experience. Ethical tensions are an unavoidable part of occupational therapy practice and may contribute to unique challenges for new graduates who may not yet have the personal resources to make sense of these independently. New graduate occupational therapy perceptions of ethical tensions have not yet been explored and this study sought to fill this gap. Exploring the ethical tensions experienced by new graduates can inform appropriate policies, procedures, preparedness and standards.

METHODS

A qualitative study using narrative enquiry was undertaken in which stories were gathered from eight new graduate occupational therapists who had been working for 6-24 months. Semi-structured in-depth interviews were used to gather data. Transcripts were analysed following narrative analysis guidelines. Member checking, reflexivity and keeping an audit trail of methodological and analytical decisions were employed to strengthen the rigour of the study.

RESULTS

Analysis revealed six predominant themes: working in a business model, respecting client choice, dealing with aggression and death, mandatory reporting is hard to do, differing team values, and feeling devalued and unsupported.

CONCLUSION

The findings highlight the importance of understanding the ethical tensions faced by new graduates and of exploring ways to assist new graduates to respond constructively to ethical dilemmas, distress and uncertainties. To address the risk of attrition, graduates need systems in place for accessing support to increase preparedness to respond to ethical tensions when they do arise.

Spirituality in Occupational Therapy Practice According to New Graduates

Occupational therapy practitioners consider spirituality to be significant in affecting the process and outcome of occupational therapy; however, many therapists voice confusion and concern about its application within their practice. This study aimed to describe the personal definition of spirituality of young occupational therapy practitioners and their perspectives on its application to their practice. Thirty-five young occupational therapists, engaged in a postprofessional master's degree, were interviewed using a self-prepared questionnaire, which included open and close-ended questions. The data was analysed using qualitative and quantitative methods. Most participants defined spirituality as a driving force, which shapes many aspects of life. More than half of the participants considered spirituality as crucial in forming therapeutic relationships. The findings suggest that inclusion of spirituality within occupational therapy education warrants further research.

Meaningful engagement and person-centered residential dementia care: A critical interpretive synthesis

BACKGROUND

People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood.

AIM

A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia.

METHODS

A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers.

RESULTS

Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future.

CONCLUSIONS

Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history.

SIGNIFICANCE

Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.

Wheelchair service provision education and training in low and lower middle income countries: a scoping review

PURPOSE

Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities.

METHOD

A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes.

RESULTS

Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC.

CONCLUSIONS

Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated. Implications for rehabilitation Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue. Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision. Key wheelchair personnel need to establish their central role in this arena. The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.

Future Rehabilitation Professionals' Intentions to Use Self-Management Support: Helping Students to Help Patients

Purpose: We evaluated whether education in self-management support (SMS) increases future clinicians' intentions to use a new way of delivering rehabilitation services. Methods: A convenience sample of 10 students took a 5-week theoretical course, followed by 6 weeks spent assessing patients, establishing treatment plans, and monitoring their performance by telephone. Focus groups were held before and after the educational modules, with deductive mapping of themes to the Theory of Planned Behaviour and inductive analysis of additional themes. Results: Five themes and 22 subcategories emerged from the deductive-inductive focus group content analysis. After participating in the educational modules, students reported gaining knowledge about SMS and highlighted the lack of similar preparation during their academic courses. Nonetheless, they were hesitant to adopt SMS. Conclusion: Future clinicians gained knowledge and skills after being exposed to SMS courses, but their intention to adopt SMS in their future daily practice remained low. We also noted a lack of formal training in SMS in the academic setting. The findings from this study support incorporating SMS training into the curriculum, but to increase students' intention to use SMS as part of patient care, training may need to be in more depth than it was in the modules we used.

Development and face validity of a cerebral visual impairment motor questionnaire for children with cerebral palsy

AIM

The objectives of this study were (i) to develop two cerebral visual impairment motor questionnaires (CVI-MQ's) for children with cerebral palsy (CP): one for children with Gross Motor Function Classification System (GMFCS) levels I, II and III and one for children with GMFCS levels IV and V; (ii) to describe their face validity and usability; and (iii) to determine their sensitivity and specificity.

BACKGROUNDS

The initial versions of the two CVI-MQ's were developed based on literature. Subsequently, the Delphi method was used in two groups of experts, one familiar with CVI and one not familiar with CVI, in order to gain consensus about face validity and usability. The sensitivity and specificity of the CVI-MQ's were subsequently assessed in 82 children with CP with (n = 39) and without CVI (n = 43). With the receiver operating curve the cut-off scores were determined to detect possible presence or absence of CVI in children with CP.

RESULTS

Both questionnaires showed very good face validity (percentage agreement above 96%) and good usability (percentage agreement 95%) for practical use. The CVI-MQ version for GMFCS levels I, II and III had a sensitivity of 1.00 and specificity of 0.96, with a cut-off score of 12 points or higher, and the version for GMFCS levels IV and V had a sensitivity of 0.97 and a specificity of 0.98, with a cut-off score of eight points or higher.

CONCLUSION

The CVI-MQ is able to identify at-risk children with CP for the probability of having CVI.

Physiotherapists working in clinics have increased risk for new-onset spine disorders: a 12-year population-based study

Health care professionals are known to have a high risk for work-related musculoskeletal disorders. However, the information on the risk of new-onset spine-related musculoskeletal disorders (SRMDs) in health care professionals is insufficient. This study aimed to investigate new-onset spine disorder associations among physical, occupational, and pharmacy health care professionals working in different workplaces.Taiwan's National Health Insurance Research Database for registered medical personnel claims from 2000 to 2011 was analyzed. An age- and sex-matched longitudinal cohort study of 7448 subjects (1682 physiotherapists, 1682 occupational therapists [OTs], and 3724 pharmacists) with or without new-onset spine disorders was conducted. The hazard ratios for the development of new-onset spine disorders were estimated among these 3 groups.The overall percentage of new-onset SRMD for physiotherapists is 32.12. The median time from obtaining a registered license to developing SRMD is 1.94 years. The log-rank test showed that physiotherapists have the least possibility of having a SRMD-free rate (P < 0.0001). The Cox model showed that physiotherapists have a higher risk of new-onset SRMD (hazard ratio: 1.65, 95% confidence interval: 1.48-1.84, P < 0.0001) compared with OTs and pharmacists. Physiotherapists working in clinics have a 2.40-fold increased risk of developing SRMD (95% confidence interval: 1.97-2.92, P < 0.0001) relative to OTs and pharmacists.This may be the first study regarding new-onset SRMD in physiotherapists based on a powerful nationwide population-based database. We conclude that working in clinics is a potential risk for new-onset SRMD in physiotherapists. Therefore, we suggest that physiotherapists should pay more attention to this issue to prevent the development of spine disorders.

A Comparison of the Quality of Life of Arab Mothers of Children with and without Chronic Disabilities

AIM

To compare the quality of life (QoL) of Arab mothers in Kuwait who had children with chronic disabilities and those whose children had no disabilities and provide recommendations for how occupational therapists can assist in enhancing the mothers' QOL.

METHODS

The case group included 71 mothers of children with chronic disabilities and a control group of 86 mothers of children without disabilities. Mothers' QoL was assessed using the Arabic WHOQOL-BREF questionnaire and the support systems of mothers of children with disabilities using a support questionnaire.

RESULTS

The QoL of mothers of children with disabilities was significantly lower than that of mothers of healthy children (p < .001) in all four domains of WHOQOL-BREF (physical health, psychological wellbeing, social relationships, and environment). Mothers of children with disabilities reported that they received most support from their nuclear family. There was a lack of formal support systems in place in Kuwait.

CONCLUSION

Mothers of children with disabilities perceive their QoL as poor and they have limited support systems. Occupational therapists are encouraged to serve as a resource for families, sharing information including available services and community resources, and supporting mothers as competent caregivers.