Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study.

OBJECTIVE: Measuring health outcomes plays an important role in patient-centred healthcare. When aggregated across patients, outcomes can provide data for quality improvement (QI). However, most physical therapists are not familiar with QI methods based on patient outcomes. This mixed-methods study aimed to develop and evaluate a QI programme in outpatient physical therapy care based on routinely collected health outcomes of patients with low-back pain and neck pain. METHODS: The QI programme was conducted by three teams of 5-6 physical therapists from outpatient settings. Plan-do-study-act cycles were used based on team-selected goals. Monthly feedback reports of process and outcomes of care, including pre-post treatment changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI), guided the QI efforts. Primary outcomes were pre-QI and post-QI changes in knowledge and attitudes towards outcome measures through a survey, and administered and self-reported compliance with using the ODI and NDI. Semistructured interviews and a focus group were conducted to evaluate the perceived value of the programme. RESULTS: Post-QI, the survey showed improvements in two items related to the role of patients and implementation of outcome measures. Registered pre-QI and post-QI completion rates were high at intake (ODI:91% pre, 88% post; NDI:75% pre, 84% post), while completion rates at discharge improved post-QI (ODI:14% pre, 66% post; NDI: 32% pre, 50% post). Perceived benefits of the QI programme included clinician and institutional accountability to processes and strategies aimed at continuous improvement in patient care. An important facilitator for programme participation was autonomy in project selection and development, while a main barrier was the time required to set up the QI project. CONCLUSION: A QI programme based on the feedback of routinely collected health outcomes of patients with low back pain and neck pain was feasible and well accepted by three pilot teams of physical therapists.

Nurturing the Seeds of Participation: Unveiling the Foundational Path for Understanding Aging in Place Barriers and Facilitators From the Perspective of Older Adults Using Mixed Methods and Translational Science.

Participation in society is a cornerstone for quality of life, active aging, and aging in place. While the majority of older adults prefer aging in place, health and financial challenges can hinder this vision. Conducted in suburban South Jersey, this study utilized mixed methods, including surveys and interviews with older adult participants. Surveys indicated that satisfaction with participation in the community is influenced by functional ability, healthcare service availability, and information access. Interviewees identified suggestions to overcome barriers (e.g., improve access to community and address ageism). Combined results provide a theory of change which suggests older adults' empowerment in community participation hinges on home living support, participation options aligning with ability and interest, and accessible information on community events. This person-centered planning approach emphasizes the importance of older adult and stakeholder participation in foundational community planning, offering translational foundational tools for evidence-based strategies to engage them in future community action plans (CAPs).

Exploring Knowledge Translation Concepts in U.S. Occupational Therapy Research: A Content Analysis.

IMPORTANCE: As a new Accreditation Council for Occupational Therapy Education® standard, knowledge translation (KT) is an important concept to occupational therapy. A better understanding of KT in occupational therapy research could inform its relevance to occupational therapy education, research, and practice. OBJECTIVE: To answer the question "To what extent does published U.S.-based occupational therapy research that is explicitly underpinned by a KT theory, model, or framework reflect processes and concepts outlined in the knowledge-to-action (KTA) framework?" DESIGN: A systematic search was conducted to purposively sample U.S.-based occupational therapy research. A content analysis of 11 articles explored concepts of the KTA framework. OUTCOMES AND MEASURES: KTA was used as a conceptual foundation. RESULTS: Multiple sources of data mapped onto concepts in the knowledge creation cycle and each of the first five concepts of the knowledge action cycle. We found that three concepts from the knowledge action cycle-monitor knowledge use, evaluate outcomes, and sustain knowledge use-were not well represented in the sample. CONCLUSIONS AND RELEVANCE: Future research on the monitoring, evaluation, and sustained use of occupational therapy interventions is needed. The adoption of new interventions is important, and the knowledge of how they are sustained in practice will facilitate the clinical integration of future interventions. What This Article Adds: Occupational therapy research that uses KT lacks an emphasis on monitoring and sustaining evidence-informed interventions. Future research on the integration of such interventions into clinical practice is needed so that best practices in occupational therapy can be promoted.

Evaluating the Implementation of Fall Risk Management Practices within Home-delivered Meal Organizations.

Falls remain a major public health issue, particularly for frail older adults, such as those who receive home-delivered meals (HDMs). Social workers who assess the needs of HDM clients and routinely monitor their care are uniquely positioned to address fall prevention; however, the degree to which HDM social workers currently manage fall risk is unknown. To close this knowledge gap, we conducted a retrospective chart review and evaluated HDM social workers' current practices relative to identifying clients at risk for falling and the client characteristics associated with social workers' perceptions of fall risk. A total of 230 client charts were included in our analysis. Thirty-eight percent of HDM clients were determined to be at risk of falling. Advanced age, activity limitations, and specific health conditions (e.g., diabetes mellitus) were associated with social workers' fall risk concerns. However, over 80% of our sample presented with well-established fall risk factors (e.g., mobility impairment) suggesting that HDM social workers might be under-identifying fall-risks. Though HDM social workers are well positioned to play a critical role in fall risk management, systematic efforts are needed to optimize social workers' capacity for effectively identifying HDM clients at risk for falling.