ABSTRACT
INTRODUCTION: Mild traumatic brain injury (mTBI) or concussion is prevalent among trauma patients, but symptoms vary. Assessing discharge safety is not standardized. At our institution, occupational therapy (OT) performs cognitive assessments for mTBI to determine discharge readiness, potentially increasing resource utilization. We aimed to describe characteristics and outcomes in mTBI trauma patients and hypothesized that OT consultation was associated with increased length of stay (LOS). METHODS: This is a retrospective study at a level 1 trauma center over 17 mo. All patients with mTBI, without significant concomitant injuries, were included. We collected data regarding OT assessment, LOS, mechanism of injury, Glasgow coma score, injury severity score (ISS), concussion symptoms, and patient disposition. Statistical analysis was performed, and significance was determined when P < 0.05. RESULTS: Two hundred thirty three patients were included. Median LOS was 1 d and ISS 5. Ninety percent were discharged home. The most common presenting symptom was loss of consciousness (85%). No symptoms were associated with differences in LOS or discharge disposition (P > 0.05). OT consult (n = 114, 49%) was associated with longer LOS and higher ISS (P < 0.01). Representation with concussive symptoms, discharge disposition, mechanism of injury, and patient demographics were no different regardless of OT consultation (P > 0.05). CONCLUSIONS: mTBI is common and assessment for discharge safety is not standardized. OT cognitive assessment was associated with longer LOS and higher injury severity. Despite institutional culture, OT consultation was variable and not associated with improved concussion-related outcomes. Our data suggest that OT is not required for mTBI discharge readiness assessment. To improve resource utilization, more selective OT consultation should be considered. Further prospective data are needed to identify which patients would most benefit.
Subject(s)
Brain Concussion , Length of Stay , Occupational Therapy , Referral and Consultation , Humans , Retrospective Studies , Male , Female , Adult , Middle Aged , Brain Concussion/diagnosis , Brain Concussion/therapy , Brain Concussion/psychology , Brain Concussion/complications , Referral and Consultation/statistics & numerical data , Occupational Therapy/statistics & numerical data , Occupational Therapy/methods , Length of Stay/statistics & numerical data , Young Adult , Aged , Patient Discharge/statistics & numerical data , Trauma Centers/statistics & numerical dataABSTRACT
Importance: Older adults with socioeconomic disadvantage develop a greater burden of disability after critical illness than those without socioeconomic disadvantage. The delivery of in-hospital rehabilitation that can mitigate functional decline may be influenced by social determinants of health (SDOH). Whether rehabilitation delivery differs by SDOH during critical illness hospitalization is not known. Objective: To evaluate whether SDOH are associated with the delivery of skilled rehabilitation during critical illness hospitalization among older adults. Design, Setting, and Participants: This cohort study used data from the National Health and Aging Trends Study linked with Medicare claims (2011-2018). Participants included older adults hospitalized with a stay in the intensive care unit (ICU). Data were analyzed from August 2022 to September 2023. Exposures: Dual eligibility for Medicare and Medicaid, education, income, limited English proficiency (LEP), and rural residence. Main Outcome and Measures: The primary outcome was delivery of physical therapy (PT) and/or occupational therapy (OT) during ICU hospitalization, characterized as any in-hospital PT or OT and rate of in-hospital PT or OT, calculated as total number of units divided by length of stay. Results: In the sample of 1618 ICU hospitalizations (median [IQR] patient age, 81.0 [75.0-86.0] years; 842 [52.0%] female), 371 hospitalizations (22.9%) were among patients with dual Medicare and Medicaid eligibility, 523 hospitalizations (32.6%) were among patients with less than high school education, 320 hospitalizations (19.8%) were for patients with rural residence, and 56 hospitalizations (3.5%) were among patients with LEP. A total of 1076 hospitalized patients (68.5%) received any PT or OT, with a mean rate of 0.94 (95% CI, 0.86-1.02) units/d. After adjustment for age, sex, prehospitalization disability, mechanical ventilation, and organ dysfunction, factors associated with lower odds of receipt of PT or OT included dual Medicare and Medicaid eligibility (adjusted odds ratio, 0.70 [95% CI, 0.50-0.97]) and rural residence (adjusted odds ratio, 0.65 [95% CI, 0.48-0.87]). LEP was associated with a lower rate of PT or OT (adjusted rate ratio, 0.55 [95% CI, 0.32-0.94]). Conclusions and Relevance: These findings highlight the need to consider SDOH in efforts to promote rehabilitation delivery during ICU hospitalization and to investigate factors underlying inequities in this practice.
Subject(s)
Hospitalization , Intensive Care Units , Medicare , Social Determinants of Health , Humans , Social Determinants of Health/statistics & numerical data , Aged , Female , Male , Intensive Care Units/statistics & numerical data , United States , Hospitalization/statistics & numerical data , Aged, 80 and over , Medicare/statistics & numerical data , Critical Illness/rehabilitation , Cohort Studies , Occupational Therapy/statistics & numerical data , Physical Therapy Modalities/statistics & numerical data , Medicaid/statistics & numerical dataABSTRACT
OBJECTIVE: To examine telerehabilitation utilization in the United States (US) during the first 2 years of the pandemic. DESIGN: We performed a retrospective analysis of outpatient insurance claims from the IBM MarketScan Commercial Claims and Encounters Database to identify the number and proportion of patients using telerehabilitation from 2020 to 2021. Telerehabilitation was identified based on the presence of specific code modifiers and place of service. SETTING: Retrospective claims analysis. PARTICIPANTS: Individuals living in the United States with employer-sponsored insurance plans using outpatient physical or occupational therapy (PT/OT) (N=2,007,524). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Number and proportion of outpatient PT/OT visits completed via telerehabilitation. RESULTS: We identified 21,026,608 PT/OT visits among 2,007,524 patients. Overall, 49,974 (2.5%) patients received ≥1 telerehabilitation visit during the specified timeframe. We observed trends in utilization over time, with utilization peaking in April 2020 when 10.9% of all PT/OT visits were conducted by telerehabilitation. We also observed geographic trends with lower rates of utilization identified in rural areas. State-by-state utilization rates ranged from 10.4% (California) to 0.3% (Wyoming). CONCLUSION: Telerehabilitation may be underutilized as a means of improving access to PT/OT, especially in rural areas of the country. Further research is needed to examine contributing factors to low observed utilization rates, such as provider and patient perceptions of telerehabilitation.
Subject(s)
COVID-19 , Telerehabilitation , Humans , United States , Retrospective Studies , Male , Female , Middle Aged , Adult , COVID-19/epidemiology , Aged , Adolescent , Young Adult , Physical Therapy Modalities/statistics & numerical data , Occupational Therapy/statistics & numerical data , Pandemics , Insurance Claim Review , Patient Acceptance of Health Care/statistics & numerical dataABSTRACT
OBJECTIVE: The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession. METHODS: This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers ("GP" or "GO"). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed. RESULTS: Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (-16.89%), days to initiate therapy (-13.43%), and episode length (-13.78%). CONCLUSION: Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes. IMPACT: Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care.
Subject(s)
Occupational Therapy , Patient Acceptance of Health Care , Physical Therapy Modalities , Rotator Cuff Injuries , Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Occupational Therapy/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Physical Therapy Modalities/statistics & numerical data , Retrospective Studies , Rotator Cuff Injuries/surgery , Rotator Cuff Injuries/rehabilitation , United StatesABSTRACT
BACKGROUND: Most stroke survivors have ongoing deficits and report unmet needs. Despite evidence that rehabilitation improves stroke survivors' function, access to occupational and physical therapy is limited. Describing access to care for disadvantaged communities for different levels of stroke severity will provide proportions used to create Markov economic models to demonstrate the value of rehabilitation. OBJECTIVES: The objective of this study was to explore differences in the frequency of rehabilitation evaluations via outpatient therapy and home health for Medicare Part B ischemic stroke survivors in rural and socially disadvantaged locations. METHODS: We completed a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services using STROBE guidelines for observational studies. We extracted rehabilitation Current Procedural Terminology (CPT) codes for those who received occupational or physical therapy to examine differences in therapy evaluations for rural and socially disadvantaged populations. RESULTS: Of the 9,076 stroke survivors in this cohort, 44.2% did not receive any home health or outpatient therapy. Of these, 64.7% had a moderate or severe stroke, indicating an unmet need for therapy. Only 2.0% of stroke survivors received outpatient occupational therapy within the first year Rural and socially disadvantaged communities accessed rehabilitation evaluations at lower rates than general stroke survivors. CONCLUSIONS: These findings describe the poor access to home health and outpatient rehabilitation for stroke survivors, particularly in traditionally underserved populations. These results will influence future economic evaluations of interventions aimed at improving access to care.
Subject(s)
Health Services Accessibility , Rural Population , Stroke Rehabilitation , Vulnerable Populations , Humans , Stroke Rehabilitation/economics , Stroke Rehabilitation/statistics & numerical data , Male , Female , Health Services Accessibility/statistics & numerical data , Retrospective Studies , Aged , Rural Population/statistics & numerical data , United States , Aged, 80 and over , Occupational Therapy/statistics & numerical data , Medicare/statistics & numerical data , Stroke , Survivors , Middle Aged , Cohort Studies , Ischemic Stroke/rehabilitation , Physical Therapy Modalities/statistics & numerical data , Physical Therapy Modalities/economicsABSTRACT
OBJECTIVE: The aim of this study was to understand the frequency of patients receiving rehabilitation services at various periods after stroke and the possible medical barriers to receiving rehabilitation. DESIGN: A retrospective cohort study was conducted using a nationally representative sample in Taiwan. A total of 14,600 stroke patients between 2005 and 2011 were included. Utilization of physical therapy or occupational therapy at different periods after stroke onset was the outcome variable. Individual and geographic characteristics were investigated to determine their effect on patients' probability of receiving rehabilitation. RESULTS: More severe stroke or more comorbid diseases increased the odds of receiving physical therapy and occupational therapy; older age was associated with decreased odds. Notably, sex and stroke type influenced the odds of rehabilitation only in the early period. Copayment exemption lowered the odds of rehabilitation in the first 6 mos but increased the odds in later periods. Rural and suburban patients had significantly lower odds of receiving physical therapy and occupational therapy, as did patients living in areas with fewer rehabilitation therapists. CONCLUSIONS: Besides personal factors, geographic factors such as urban-rural gaps and number of therapists were significantly associated with the utilization of post-stroke rehabilitation care. Furthermore, the influence of certain factors, such as sex, stroke type, and copayment exemption type, changed over time.
Subject(s)
National Health Programs/statistics & numerical data , Occupational Therapy/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Physical Therapy Modalities/statistics & numerical data , Stroke Rehabilitation/statistics & numerical data , Aged , Female , Humans , Male , Occupational Therapy/economics , Physical Therapy Modalities/economics , Retrospective Studies , Risk Factors , Rural Population/statistics & numerical data , Stroke/economics , Stroke Rehabilitation/economics , Taiwan , Treatment Outcome , Urban Population/statistics & numerical dataABSTRACT
BACKGROUND: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. OBJECTIVE: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. METHODS: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status. RESULTS: Patients with more severe CI received least total therapy hours (TTH) (MMSE <â17, 13.67±6.58 versus MMSE 17-26, 16.12±7.19 and MMSE >â26, 17.79±8.88 h, pâ=â0.014) and were less often included in occupational therapy (MMSE <â17, 48.9%versus MMSE 17-26, 65.5%and MMSE >â26, 71.4%, pâ=â0.019) and group-based physiotherapy (MMSE <â17, 73.3%versus MMSE 17-26, 88.5%and MMSE >â26, 81.2%, pâ=â0.027). Regression models showed that CI negatively impacted TTH (ß=â0.24, pâ=â0.003) and rehabilitation outcome (ß=â0.41, pâ=â0.008). In the mediation model, TTH accounted for 23.18%(pâ<â0.001) of the relationship between CI and rehabilitation outcome. CONCLUSION: Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.
Subject(s)
Cognitive Dysfunction/complications , Geriatrics , Recovery of Function , Rehabilitation/psychology , Severity of Illness Index , Aged, 80 and over , Cohort Studies , Hospitals , Humans , Mental Status and Dementia Tests/statistics & numerical data , Occupational Therapy/statistics & numerical data , Outcome Assessment, Health Care , Physical Therapy Modalities/statistics & numerical dataABSTRACT
OBJECTIVE: he objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe Coronavirus Disease 19 (COVID-19) infection. METHODS: This was an observational study of 30 patients (ages 26-80 years) within a large, metropolitan, academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care, and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long-duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. RESULTS: The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4-22 days). Patients averaged 165 min/d (ranging from 140-205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty-eight of the 30 patients (93%) were discharged to the community. One patient required readmission from an inpatient rehabilitation facility to an acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. CONCLUSION: In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long-duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long-duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. IMPACT: Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.
Subject(s)
COVID-19/rehabilitation , Physical Therapy Modalities/statistics & numerical data , Rehabilitation Centers/organization & administration , Skilled Nursing Facilities/statistics & numerical data , Adult , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Inpatients/statistics & numerical data , Male , Middle Aged , Occupational Therapy/statistics & numerical data , Quality of LifeABSTRACT
BACKGROUND: The authors sought to determine whether differences exist in (1) the number of postoperative occupational therapy visits and (2) narcotic use in two carpometacarpal arthroplasty groups. METHODS: A retrospective study comparing patients undergoing abductor pollicis longus (APL) suspensionplasty (154 patients) or flexor carpi radialis ligament reconstruction and tendon interposition (FCR LRTI) techniques (40 patients) between January 1, 2012, and August 1, 2018, was performed. Data included demographics, procedure performed, complications, number of postoperative occupational therapy visits, and postoperative morphine equivalent dosage used. Statistical testing used the chi-square test for proportions and the Wilcoxon-Mann-Whitney test for nonnormal data. The significance level was 0.05. RESULTS: The APL suspensionplasty and FCR LRTI groups had similar ages (58.1 ± 7.8 years versus 58.1 ± 7.7 years), sex ratios (73 percent female versus 75 percent female), and preoperative narcotic user proportions (1 percent versus 3 percent). Complication rates following the procedures were similar (21 percent and 18 percent, respectively). The number of postoperative occupational therapy visits following APL suspensionplasty (median, 0; interquartile range, 0 to 4) and FCR LRTI (median, 0; interquartile range, 0 to 4) were not significantly different (p = 0.961). There was less use of narcotics following APL suspensionplasty (median, 375 morphine equivalent dosage; interquartile range, 241.9 to 525 morphine equivalent dosage) compared with FCR LRTI (median, 462.5 morphine equivalent dosage; interquartile range, 375 to 768.8 morphine equivalent dosage), and this difference was significant (p = 0.0007). CONCLUSIONS: The APL suspensionplasty technique had less narcotic use and similar complication rates and occupational therapy visits compared to FCR LRTI. Prospective studies comparing postoperative pain control and function with these two carpometacarpal arthroplasty techniques may be beneficial. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Subject(s)
Analgesics, Opioid/therapeutic use , Arthroplasty/adverse effects , Carpometacarpal Joints/surgery , Osteoarthritis/surgery , Pain, Postoperative/therapy , Aged , Arthroplasty/methods , Arthroplasty/rehabilitation , Female , Humans , Male , Middle Aged , Occupational Therapy/statistics & numerical data , Pain, Postoperative/etiology , Range of Motion, Articular , Retrospective Studies , Tendon Transfer/adverse effects , Tendon Transfer/methods , Treatment OutcomeABSTRACT
Objective: The purpose of this study is to investigate the effect of Leap Motion Based Exergame Therapy (LMBET) on upper limb gross grip strength (GGS), pinch forces, hand functions, gross motor function, and cognitive functions in patients with cerebral palsy (CP). Materials and Methods: Twenty patients with CP (11 hemiplegia and 9 diplegia) were included in the study. Structured Neurodevelopmental Therapy-based hand rehabilitation (SNDTBHR) (first treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks), and then LMBET (second treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks). GGS was evaluated by "dynamometer," pinch strengths were evaluated by "pinch meter," hand skills were evaluated by "Manual Ability Classification System (MACS)" and "Jebsen-Taylor Hand Function Test (JHFT)," the gross motor level was evaluated by "Gross Motor Function Classification System (GMFCS)," and cognitive functions were evaluated by "Wisconsin Card Sorting Test (WCST)." Results: Significant difference was found between LMBET and SNDTBHR on GGF, pinch forces, JHFT, and WCST in favor of LMBET (P < 0.017). There was no significant difference between both MACS and GMFCS measurements (P > 0.05). Conclusion: Positive effects of both SNDTBHR and LMBET have been found. However, measurements after LMBET are statistically more significant. Future research should take into account higher patient allocation. Including additional leap motion training to conventional physiotherapy is feasible and might be promising to train cognitive function in children with CP.
Subject(s)
Cerebral Palsy/rehabilitation , Cognition , Video Games/standards , Adolescent , Child , Disability Evaluation , Female , Humans , Male , Occupational Therapy/methods , Occupational Therapy/standards , Occupational Therapy/statistics & numerical data , Upper Extremity/physiology , Upper Extremity/physiopathology , Video Games/psychology , Video Games/statistics & numerical dataABSTRACT
OBJECTIVE: To examine the association between the number of physical and occupational therapist visits received in the acute care hospital and the risk of hospital readmission or death. DESIGN: Retrospective cohort study of electronic health records and administrative claims data collected for 2.25 years (January 1, 2016-March 30, 2018). SETTING: Twelve acute care hospitals in a large health care system in western Pennsylvania. PARTICIPANTS: Adults (N=8279) discharged with a primary stroke diagnosis. INTERVENTIONS: The exposure was number of physical and occupational therapist visits during the acute care stay. MAIN OUTCOME MEASURES: Generalized linear mixed models were estimated to examine the relationship between therapy use and 30- and 7-day hospital readmission or death (outcome), controlling for patient demographic and clinical characteristics. RESULTS: The 30- and 7-day readmission or death rates were 16.0% and 5.7%, respectively. The number of therapist visits was inversely related to the risk of 30-day readmission or death. Relative to no therapist visits, the odds of readmission or death were 0.70 (95% confidence interval [CI], 0.54-0.90) for individuals who received 1-2 visits, 0.59 (95% CI, 0.43-0.81) for 3-5 visits, and 0.57 (95% CI, 0.39-0.81) for >5 visits. A similar pattern was seen for the 7-day outcome, with slightly larger effect sizes. Effects were also greater in individuals with more mobility limitations on admission and for those discharged to a postacute care facility vs home. CONCLUSIONS: There was an inverse relationship between the number of therapist visits and risk for readmission or death for patients with stroke discharged from an acute care hospital. Effects differed by time to the event (30d vs 7d), discharge location, and mobility limitations on admission.
Subject(s)
Occupational Therapy/statistics & numerical data , Patient Readmission/statistics & numerical data , Physical Therapy Modalities/statistics & numerical data , Stroke Rehabilitation/mortality , Stroke Rehabilitation/methods , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Patients receiving hospice care have a host of occupational challenges, though few are being seen in occupational therapy for treatment. Occupational therapy can help those receiving hospice care live with dignity before death. Data retrieved from the National Home and Hospice Care Survey were analyzed using independent t-tests, Wilcoxon rank-sum tests, Chi-square tests and logistic regressions. Only 10.6% of the participants received occupational therapy. Patients who received occupational therapy were significantly older and had shorter lengths of hospice care service compared to their counterparts. Over 85% of the patients needed assistance with at least one task of activity of daily living (ADL). Findings suggested a need to increase occupational therapy workforce in hospice care and advocate the value of occupational therapy services in hospice settings.
Subject(s)
Activities of Daily Living , Hospice Care , Occupational Therapy/statistics & numerical data , Quality of Life , Adult , Aged , Aged, 80 and over , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Palliative CareABSTRACT
BACKGROUND: To determine whether preexisting dementia is associated with poorer quality of care and outcomes after stroke in the acute hospital phase. METHOD: This was a retrospective analysis of pooled data from the Australian Stroke Foundation national audit conducted in 2015 and 2017. Dementia status was obtained from the medical records. Processes of care to assess quality included: stroke unit care, time-dependent therapy, nursing/allied health assessments, and preparation for discharge. Outcomes included in-hospital complications, independence on discharge, and destination. Logistic regression was used to examine associations between dementia status and processes of care. Multilevel random effects logistic regression, with level defined as hospital, was used to examine associations between dementia status and outcomes. RESULTS: There were 683/7,070 (9.7%) audited patients with dementia included. Patients with dementia were less likely to be treated in stroke units (58.3% vs 70.6%), receive thrombolysis if an ischemic stroke (5.8% vs 11.1%), have access within 48 hours to physiotherapy (56.4% vs 69.7%) or occupational therapy (46.8% vs 55.6%), see a dietitian if problems with nutrition (64.4% vs 75.9%), or have mood assessed (2.6% vs 12.3%). Patients with dementia were more likely to receive no rehabilitation (adjusted odds ratio 1.88, 95% confidence interval 1.25, 2.83) and be discharged to residential care (adjusted odds ratio 2.36, 95% confidence interval 1.50, 3.72). CONCLUSION: People with dementia received poorer quality of care and had worse outcomes after stroke. Our findings raise questions regarding equity and the need for better understanding of why the quality of care differs after stroke for people with dementia.
Subject(s)
Dementia/epidemiology , Medical Audit , Quality of Health Care , Stroke/therapy , Aged , Aged, 80 and over , Australia/epidemiology , Female , Health Services Accessibility/statistics & numerical data , Humans , Male , Nutrition Assessment , Occupational Therapy/statistics & numerical data , Residential Facilities/statistics & numerical data , Retrospective Studies , Stroke/epidemiology , Stroke Rehabilitation/statistics & numerical data , Thrombolytic Therapy/statistics & numerical dataABSTRACT
BACKGROUND: The Canadian Occupational Performance Measure (COPM) is intended to help clients identify and evaluate their occupational performance issues. As it enhances client-centred practice (CCP), more frequent use of the COPM might fulfill the political agenda of patient involvement in Denmark. However, in a study translating the COPM into Danish, challenges were found highlighting the need to study its clinical utility. AIM: To examine the clinical utility of the Danish version of the COPM (COPM-DK) and help determine whether to recommend a more routinely use. METHODS: Data gathered during qualitative interviews with 16 occupational therapists (OTs) from various settings were subjected to a qualitative content analysis. RESULTS: The COPM-DK appeared to have clinical utility, especially regarding the meaning and relevance of the information obtained, and seemed to facilitate an occupational lens and CCP. The OTs' difficulties and concerns when using the COPM and their personal and environmental commitment to the COPM seemed associated with how they performed the COPM. Thus, training was recommended to facilitate a valid and reliable use. CONCLUSION: Given the benefits and the perceived utility of the COPM-DK, a more routinely use, to place OTs and CCP in the center of Danish healthcare system, is recommended.Key MessagesThe utility of the Danish version of the Canadian Occupational Performance Measure is supported, according to Danish occupational therapists in various rehabilitation settings and hospitals.Using the Canadian Occupational Performance Measure seems to enhance a client-centred practice with collaborative goals and helps to establish partnership, being of value to the interdisciplinary team, too.The utility and acceptability of the Canadian Occupational Performance Measure seemed to be linked to the occupational therapists' experience and understanding of the Canadian Occupational Performance Measure's content and form, thus an introduction course is recommended to avoid a use that affects the assessment's validity and reliability.
Subject(s)
Activities of Daily Living/psychology , Occupational Therapists/standards , Occupational Therapy/statistics & numerical data , Occupational Therapy/standards , Outcome Assessment, Health Care/statistics & numerical data , Outcome Assessment, Health Care/standards , Surveys and Questionnaires/standards , Adult , Canada , Denmark , Female , Humans , Male , Middle Aged , Occupational Therapists/statistics & numerical data , Reproducibility of Results , TranslationsABSTRACT
Background: Theoretical ways of knowing in occupational therapy include paradigms, conceptual practice models and related knowledge. Despite the diversity of models available to guide practice, there are few examples of analyses which compare and contrast their respective core concepts.Aims: The aims of this paper are to describe how the dimensions of occupation described in the Pan Occupational Paradigm pervade conceptual practice models, and are embedded within case reports of occupational therapy.Materials and Methods: A framework analysis was undertaken, using the dimensions of occupation - doing, being, becoming and belonging - as core concepts. The alignment of concepts from four widely utilised occupational therapy conceptual practice models with these dimensions were investigated and described. Four case reports developed in reference to these specific conceptual practice models were also analysed, and their expression of the core concepts and dimensions discussed.Results: The dimensions of occupation were embedded in all reviewed conceptual practice models and case reports. The dimensions are explained in discrete, relational and embedded forms, with each conceptual practice model adopting a specific terminology and structure to describe them.Conclusions and Significance: The presence of all four dimensions of occupation, regardless of form, terminology or structural arrangement, is proposed as a hallmark of an occupational therapy conceptual practice model.
Subject(s)
Occupational Therapy/organization & administration , Occupational Therapy/psychology , Occupational Therapy/statistics & numerical data , Occupations/statistics & numerical data , Self Concept , Adult , Female , Humans , Male , Middle Aged , Models, TheoreticalABSTRACT
BACKGROUND: Research suggested combining modern test theory with classical test theory to achieve comprehensive evaluation of an assessment tool. However, the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire has not yet been examined by the modern test theory. AIMS/OBJECTIVE: This study aims to examine psychometric properties of the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire by using Rasch analysis. MATERIAL AND METHODS: One hundred and eleven occupational therapy students from two universities in Norway completed the questionnaire across four time points. Rasch analysis was used to examine the appropriateness of the rating scales, unidimensionality, person response validity, item/person separation, and the Wright map. RESULTS: The ten-point rating scale did not fully maximise the measurement potentials. Unidimensionality was confirmed except for two items. Person response validity needs further investigation. Excellent person/item separation and Wright map were found. CONCLUSION: This study supports the psychometric properties of the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire in assessing self-efficacy in therapeutic encounters. Further research is needed to address the misfit items and the rating scale issue. SIGNIFICANCE: Rasch analysis showed that the Norwegian Self-Efficacy for Therapeutic Use of Self questionnaire is promising to be used as a reliable and valid tool.
Subject(s)
Occupational Therapists/education , Occupational Therapists/psychology , Occupational Therapy/psychology , Occupational Therapy/statistics & numerical data , Self Efficacy , Self-Assessment , Students/psychology , Adult , Humans , Male , Norway , Psychometrics/methods , Psychometrics/statistics & numerical data , Reproducibility of Results , Students/statistics & numerical data , Surveys and Questionnaires/standards , Young AdultABSTRACT
BACKGROUND: There is a need for research to identify the impact of mild stroke on occupational engagement. The Occupational Gaps Questionnaire (OGQ) measures the difference between a person's actual and preferred occupational engagement. AIMS/OBJECTIVES: This study aimed to test the feasibility of the English version of the OGQ, and describe occupational gaps of people with mild stroke. MATERIAL AND METHODS: A mixed methods, cross-sectional study involving 10 people with mild stroke at 1 and/or 9 months after stroke. Quantitative data were summarised descriptively and thematic analysis explored qualitative responses. RESULTS: Participants reported a mean of 6.7 (SD 5.1) gaps at 1-month and 3.00 (SD 2.1) gaps at 9-months. Outdoor activities, work, sports, and light home and heavy-duty maintenance were identified as gaps at both time-points. Two themes emerged from the qualitative analysis: Drivers of occupation and Occupations can be challenged or enabled. An additional finding in terms of feasibility was drawn from qualitative data: Feasibility of Conducting the OGQ with people with mild stroke. CONCLUSIONS AND SIGNIFICANCE: The English version of the OGQ was found to be a feasible instrument for identifying occupational gaps following mild stroke and may be suitable to support research and clinical practice with this population.
Subject(s)
Activities of Daily Living , Occupational Therapy/methods , Patient Participation/methods , Patient Participation/statistics & numerical data , Stroke Rehabilitation/methods , Surveys and Questionnaires/standards , Work Engagement , Adult , Aged , Aged, 80 and over , Australia , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Occupational Therapy/statistics & numerical data , Principal Component Analysis , Stroke Rehabilitation/statistics & numerical dataABSTRACT
BACKGROUND: Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. OBJECTIVES: To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. METHOD: Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. RESULTS: Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2). CONCLUSIONS: Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development. SIGNIFICANCE: Implications for research and practice are discussed.
Subject(s)
Community Integration/psychology , Community Integration/statistics & numerical data , Housing/statistics & numerical data , Ill-Housed Persons/psychology , Ill-Housed Persons/statistics & numerical data , Occupational Therapy/methods , Occupational Therapy/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , United StatesABSTRACT
Background: The concept of client-centred practice is an essential element of occupational therapy (OT), but there is a lack of a clear and shared definition of the concept in Scandinavia (Norway, Sweden and Denmark). This may complicate the articulation, discussion, development and implementation of client-centredness in OT practices.Aim: The purpose of this study was to investigate and discuss current understandings of client-centred practice in Scandinavian contexts.Material and method: The study was based on a social constructivist research approach in which Fairclough's critical discourse analysis was applied. The analysis was based on six documents published in Scandinavian OT journals and four documents published in Scandinavian Journal of OT.Results: In Scandinavian contexts, the concept of client-centred practice was articulated in three overall discourses: a client, collaborative and practice discourse. The practice discourse was the most prominent and the source of the other discourses.Conclusions and significance: Occupational therapists (OTs) in the Scandinavian countries have conceptual understandings of client-centred practice that potentially provide the basis for knowledge sharing and collaboration between OT communities. However, the study also found that client-centred practice may not yet be firmly established in all OT practices in Scandinavia.
Subject(s)
Occupational Therapy/organization & administration , Occupational Therapy/statistics & numerical data , Patient-Centered Care/organization & administration , Patient-Centered Care/statistics & numerical data , Research Report , Adult , Aged , Aged, 80 and over , Denmark , Female , Humans , Male , Middle Aged , Norway , SwedenABSTRACT
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.