Model of Human Occupation as a framework for implementation of Motivational Interviewing in occupational rehabilitation.

BACKGROUND: A conceptual framework is needed to understand injured workers' decision-making and inform evidence-based interventions to address behavior change regarding return-to-work (RTW). The Model of Human Occupation (MOHO) can help with understanding how an injured worker's characteristics can generate behavior change while Motivational Interviewing (MI) can help facilitate behavior change. OBJECTIVE: This theoretical paper provides an overview of how MOHO and MI can be applied and integrated in occupational rehabilitation. The objectives of this paper are to: (1) evaluate MOHO as a framework for supporting occupational therapists (OTs) in occupational rehabilitation; (2) describe MI as a suitable approach for OTs in occupational rehabilitation; and (3) compare and integrate MOHO and MI. METHOD: Several important works and reviews were used to integrate MOHO and MI with occupational rehabilitation. IMPLICATIONS FOR PRACTICE: The identification of a model and approach to support OT practice in occupational rehabilitation can assist OTs to determine the most appropriate interventions and contribute to standards of best practice. CONCLUSIONS: Integrating MOHO and MI provides a comprehensive framework for understanding impairment and RTW change processes with the potential to reduce work disability and improve RTW outcomes.

Falling through the cracks. A thematic evaluation of unmet needs of adult survivors of childhood cancers.

OBJECTIVE: The population of adult survivors of childhood cancers (ASCCs) is growing, resulting in unique long-term challenges. This study explored experiences of perceived unmet ASCC survivorship needs. METHODS: We invited ASCCs to complete surveys sent through the cancer registry. Four open-ended questions allowed participants to write in comments. We analyzed responses to these open-ended questions thematically, employing a process of constant comparison. RESULTS: Our sample included 94 ASCCs who completed open-ended questions (61 female; aged 20-78 years, mean age = 34.47, SD = 11.84, mean = 23.27 years post diagnosis). Identified themes included (1) overlooked experiences of distress; (2) lack of counseling: system, patient, and family barriers; (3) difficulty negotiating future life milestones exacerbated by lack of knowledge; and (4) dissatisfaction with service provision: past and present. Prevalent issues identified by participants included lack of supportive care to address needs, distress due to missed developmental milestones as a result of cancer, lack of knowledge about late-term and long-term effects of cancer treatment, and concern over absence of organized long-term follow-up. CONCLUSIONS: Adult survivors of childhood cancers continue to experience unmet needs during their cancer diagnosis, treatment, and long into survivorship due to the treatment for cancer and ongoing side effects. Solutions could focus on addressing the needs of survivors to bridge system gaps and barriers. Specifically, there is a need to improve psychological interventions and transitions from pediatric to adult-care facilities.

Motivational Interviewing Improves Sustainable Return to Work in Injured Workers After Rehabilitation: A Cluster Randomized Controlled Trial.

OBJECTIVE: To examine whether motivational interviewing (MI) leads to more sustainable return-to-work outcomes for injured workers undergoing rehabilitation. DESIGN: Cluster randomized controlled trial. SETTING: Workers' compensation rehabilitation facility. PARTICIPANTS: Claimants (N=728) undergoing rehabilitation for musculoskeletal conditions, who were predominantly employed (529, 72.7%) men (460, 63.2%) with chronic conditions (mean duration, 234d). INTERVENTIONS: MI is a goal-oriented, client-centered counseling approach that facilitates behavioral change through identifying and resolving ambivalence. Treating clinicians at the facility were randomized into 2 groups. One group included 6 clinicians who were trained to conduct MI interventions during rehabilitation, while the control group included 6 clinicians who continued standard procedures. MAIN OUTCOME MEASURES: Outcomes included compensation outcomes over 1 year after discharge. This included reception of disability benefits and recurrence rates. Analysis was stratified by admission employment status and included chi-square test, t test, and multivariable regression. RESULTS: Participants included 728 claimants, of whom 367 (50.4%) were treated with MI. Unemployed claimants in the MI group received significantly more partial temporary disability benefits (mean, 8.2d vs 0.2d; P=.02), indicating return to modified work duties. Employed claimants in the control group had a higher recurrence rate (9.1% vs 4.5%; P=.04). The adjusted odds ratio for benefit recurrence was 2.7 (95% confidence interval, 1.1-6.5) after controlling for age, sex, and number of previous claims. CONCLUSIONS: Use of MI appears to lead to more sustainable return to work after rehabilitation and facilitates transition to modified work duties.

Word Memory Test Predicts Recovery in Claimants With Work-Related Head Injury.

OBJECTIVE: To investigate the predictive validity of the Word Memory Test (WMT), a verbal memory neuropsychological test developed as a performance validity measure to assess memory, effort, and performance consistency. DESIGN: Cohort study with 1-year follow-up. SETTING: Workers' compensation rehabilitation facility. PARTICIPANTS: Participants included workers' compensation claimants with work-related head injury (N=188; mean age, 44y; 161 men [85.6%]). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures for determining predictive validity included days to suspension of wage replacement benefits during the 1-year follow-up and work status at discharge in claimants undergoing rehabilitation. Analysis included multivariable Cox and logistic regression. RESULTS: Better WMT performance was significantly but weakly correlated with younger age (r=-.30), documented brain abnormality (r=.28), and loss of consciousness at the time of injury (r=.25). Claimants with documented brain abnormalities on diagnostic imaging scans performed better (∼9%) on the WMT than those without brain abnormalities. The WMT predicted days receiving benefits (adjusted hazard ratio, 1.13; 95% confidence interval, 1.04-1.24) and work status outcome at program discharge (adjusted odds ratio, 1.62; 95% confidence interval, 1.13-2.34). CONCLUSIONS: Our results provide evidence for the predictive validity of the WMT in workers' compensation claimants. Younger claimants and those with more severe brain injuries performed better on the WMT. It may be that financial incentives or other factors related to the compensation claim affected the performance.