Patient Consumerism and Its Influence on the Future of Occupational Therapy.

The cost of care is shifting to the individual in the form of high-deductible health plans and health savings accounts. The public demands and expects innovation in health care and health delivery and is using quality and cost data to make purchasing decisions. Public expectations for convenience are demonstrated in the use of walk-in clinics, telemedicine, and other technologies. As a result of the responsibility for paying and managing one's own health, consumerism involves a curated approach to selecting health services. This Health Policy Perspectives column examines how consumerism influences health care policy, in particular occupational therapy service delivery. Issues that consumerism creates include (1) a lack of publicly shared cost and quality data about occupational therapy; (2) confusion in measurement of client-centered care, patient satisfaction, and patient experience; (3) inadequate incorporation of patient shared decision-making throughout the occupational therapy process; and (4) payment model restrictions in service delivery. Occupational therapy practitioners must help consumers learn, through patient shared decision-making, that occupational therapy is evidence based and produces desired outcomes, thereby both improving the quality and lowering the cost of health care. Occupational therapy practitioners must advocate for lower cost and convenient service options in the community through an array of technologies. Practice scholarship of the clinical doctorate in occupational therapy must focus on conducting consumer research related to patient experience; enhancing service delivery through quality improvement; and innovating practice for new sites and methods of service delivery, including the use of technology.

Rehabilitation Nurses' Knowledge, Attitudes, and Behaviors for Preventing Urinary Tract Infections From Intermittent Catheterization.

PURPOSE: The aim of this study was to develop and examine the reliability of a survey to assess knowledge, attitudes, and behaviors (KAB) of rehabilitation nurses for preventing urinary tract infections in persons requiring intermittent catheterization. DESIGN: Cross-sectional survey with principal component analysis. METHODS: Survey development and administration based on national guidelines. FINDINGS: Principal component analysis produced three reliable components of KAB explaining 54.5% of response variance. Results indicate that nurses report adequate knowledge and training. Although the facility had an evidence-based online catheterization procedure, staff reported that the procedure was not helpful nor useable. Twenty-eight percent incorrectly identified the root cause of urinary tract infection, and 45% reported that other nurses always washed their hands. Barriers to using standard intermittent catheterization technique were staff, time, and patient variables. CONCLUSION: The modified survey is a reliable measure of KAB. CLINICAL RELEVANCE: The survey assists with identifying knowledge gaps, customizing education, and changing practice.

Interprofessional evidence-based clinical scholar program: learning to work together.

St. Catherine University and North Memorial Medical Center conducted an Interprofessional Clinical Scholar Program (ICSP) involving five teams of staff, students, and faculty. The aim of the case study was to determine how the interprofessional teams implemented evidence-based projects. We triangulated data from interviews, field notes, and surveys to produce themes: learning to value interprofessional teams, working as a team, and being evidence-based practitioners. We found significant differences pre- and post-ICSP on the Attitudes Toward Interprofessional Teamwork and Education scale, t(14) = -5.48, p < .005, and the Terminology subscale of the Evidence-Based Practice Profile, t(15) = -4.04, p = .001. We found no change in scores on the Evidence-Based Practice Belief Scale, t(14) = -1.49, p = .156. The study supported predicted patterns of benefits from ICSP. Not all participants benefited because of variability in attendance.

The innovation imperative.

An improved healthcare system will require significant departures from current practices. Leadership capacity will provide the abilities to innovate and creative thinking needed to be effective in championing the value of occupational therapy in the future.

An evidence-based and occupational perspective of interventions for persons with substance-use disorders.

An interdisciplinary evidence-based review of interventions among persons with substance-use disorders was completed in 2001 as part of American Occupational Therapy Association's (AOTA's) Evidence-Based Literature Review Project (Lieberman & Scheer, 2002). Four effective interventions for adults and adolescents with substance use were identified, including brief interventions, cognitive behavioral therapy, motivational strategies, and 12-step programs. The research studies reviewed reported outcomes primarily related to reduction in alcohol and drug use. Occupational therapy interventions grounded in current evidence-based literature are suggested. Interventions are modified to include an occupational perspective leading to outcomes consistent with the Occupational Therapy Practice Framework (American Occupational Therapy Association [AOTA], 2002). Study findings propose research questions to encourage further investigation of the effectiveness of these best practice interventions.

Adaptation of the older worker to occupational challenges.

The occupational adaptation practice model guided the search for and the analysis of the literature on the older worker. The purpose of this literature review was to: identify the occupational challenges that older workers experience, determine ways in which the occupational therapist can promote the occupational adaptation of older workers, and articulate the research and policy changes implied in the model related to health and improved productivity. The analysis of the worker's personal characteristics, work tasks, and environments highlighted the types of occupational challenges that may overwhelm the older worker's adaptive capacity. Straining adaptive capacity of the older worker leads to degradation in levels of mastery. The occupational therapist and others could assist the older worker to achieve relative mastery in response to occupational challenges through ergonomic solutions, training, assistive devices, management policy, and health promotion. Combined efforts of the employer, of the occupational therapist, and of the older work to capitalize on the older worker's years of experience, existing skills, and knowledge facilitates higher job satisfaction, better performance, and an increased sense of well-being in the older worker.

Test-retest reliability of the commercial volumeter.

OBJECTIVE: The purpose of this study was to improve the standardization of the current protocol for measuring hand volume with the commercial volumeter. METHOD: A repeated-measures design was used to determine test-retest reliability of the new protocol of measuring hand volume with the commercial volumeter. The new protocol used a height-adjustable table and external trunk support of the participant in order to maintain consistency of web-space pressure between the first and second measurement. A 1 ml micropipette was used to obtain a more accurate volume reading. An intraclass correlation (2,1), repeated measures ANOVA, and standard error of measurement were used to determine the results of this study. RESULTS: This study confirmed the test-retest reliability of the commercial volumeter and decreased the standard error of measurement to 3~ml as opposed to the current standard of 10 ml. CONCLUSION: Clinically, this study is significant in that occupational and physical therapists can detect more subtle change in hand volume.

The effects of a typing task on the hand volume of the older worker.

UNLABELLED: Few studies have examined the relationship between changes in hand volume and typing. Volumetric evaluation documents the presence of an inflammatory response to activity. METHOD: To study this relationship, researchers used a convenience sample of 31 participants who were aged 45 and older and worked full time where they typed at least one hour per day. Volumetric measurements were taken before a 15-minute typing activity, immediately after and 10 minutes after typing. Before typing, ergonomic adjustments were made to computer workstations, when necessary. Participants typed using an advanced speed test of the Mavis Beacon Teaches Typing program, which calculated adjusted words per minute. RESULTS: The data showed no significant (F = 0.321, p > 0.05) change in hand volume resulting from the typing activity. CONCLUSION: The amount of exercise provided in this study, a fifteen minute typing activity, did not result in changed hand volume.

Relationship among grip strength, functional outcomes, and work performance following hand trauma.

This study examined the relationship among the recovery grip strength, functional outcomes, and work performance following occupational therapy intervention for hand trauma. This study had a sample size of 15 participants whose recovery grip strength was measured using a Jamar dynamometer, whose satisfaction with outcomes was measured by the Michigan Hand Outcomes Questionnaire (MHQ), and whose compliance with the home therapy program was measured by a visual analog scale (VAS). A Pearson r correlation demonstrated a significant relationship between recovery grip strength and two MHQ subset scores: overall hand function (r = 0.59, p = 0.019) and activities of daily living (ADL) performance (r = 0.61, p = 0.016). The participants' self-rating of compliance did not predict or influence either recovery grip strength or MHQ scores. A moderate positive correlation approaching significance (r = 0.51, p = 0.052) was found between grip strength and overall MHQ scores. The researchers concluded that a recovery grip strength measure should be used along with functional measures to appropriately assess overall hand function following hand trauma.