Occupational Therapy in the ICU: A Scoping Review of 221 Documents.

OBJECTIVES: Occupational therapists have specialized expertise to enable people to perform meaningful "occupations" that support health, well-being, and participation in life roles. Given the physical, cognitive, and psychologic disability experienced by ICU survivors, occupational therapists could play an important role in their recovery. We conducted a scoping review to determine the state of knowledge of interventions delivered by occupational therapists in adult ICU patients. DATA SOURCES: Eight electronic databases from inception to 05/2018. STUDY SELECTION: We included reports of adult patients receiving direct patient care from an occupational therapist in the ICU, all study designs, and quantitative and qualitative traditions. DATA EXTRACTION: Independently in duplicate, interprofessional team members screened titles, abstracts, and full texts and extracted report and intervention characteristics. From original research articles, we also extracted study design, number of patients, and primary outcomes. We resolved disagreements by consensus. DATA SYNTHESIS: Of 50,700 citations, 221 reports met inclusion criteria, 74 (79%) published after 2010, and 125 (56%) appeared in critical care journals. The three most commonly reported types of interventions were mobility (81%), physical rehabilitation (61%), and activities of daily living (31%). We identified 46 unique original research studies of occupational therapy interventions; the most common study research design was before-after studies (33%). CONCLUSIONS: The role of occupational therapists in ICU rehabilitation is not currently well established. Current interventions in the ICU are dominated by physical rehabilitation with a growing role in communication and delirium prevention and care. Given the diverse needs of ICU patients and the scope of occupational therapy, there could be an opportunities for occupational therapists to expand their role and spearhead original research investigating an enriched breadth of ICU interventions.

Supporting (re) entry to professional practice: the SEPP project.

BACKGROUND: During the past decade, there has been an increasing awareness of the challenges affecting internationally educated professionals seeking registration in Canada. PURPOSE: To describe a project designed to support entry or re-entry to active practice for occupational therapists and physiotherapists who were internationally educated or seeking a return to practice after a prolonged absence. METHODS: The major objectives of the project were to develop and evaluate a mentoring network model to support therapists entering or re-entering professional practice in Ontario. Online and other resources were used to enhance professional knowledge and build mentored networks. Supervised placement opportunities were also sought for many participants to meet their learning and integration needs. RESULTS: The project achieved its major objectives and highlighted the challenges faced by individuals seeking to (re)enter professional practice in Ontario. IMPLICATIONS: Project outcomes have wide applications across many health professions.

Factors that influence engagement in collaborative practice: how 8 health professionals became advocates.

OBJECTIVE: To generate hypotheses regarding factors that might influence engagement in collaborative practice. DESIGN: Qualitative study using in-depth interviews. SETTING: Participants interviewed each other in dyads. The pairing was based upon geographical location and proximity to each other. PARTICIPANTS: Eight professionals from the disciplines of medicine, nursing, occupational therapy, physical therapy, and massage therapy. METHOD: Semistructured interviews, lasting 30 to 45 minutes each, were recorded and transcribed verbatim. The transcripts were read by all research team members using independent content analysis for common words, phrases, statements, or units of text for key themes. At a subsequent face-to-face meeting, the team used an iterative process of comparing and contrasting key themes until consensus was reached. The transcripts were then analyzed further for subthemes using NVivo software. MAIN FINDINGS: Initial findings suggest that some common characteristics grounded in family history, school experiences, social interactions, and professional training might influence collaborative practice choices. The narrative form of the interview broke down interpersonal and interprofessional barriers, creating a new level of trust and respect that could improve professional collaboration. CONCLUSION: This study suggests that life experiences from childhood into later adulthood can and do influence professional choices.

Use of functional capacity evaluations in workplaces and the compensation system: a report on workers' and report users' perceptions.

Until recently, little was documented about how functional capacity evaluations (FCEs) are used by employers and workers' compensation organizations. Such information was one focus of a comprehensive research study on FCEs carried out in southern Ontario, Canada, which involved representatives from the full range of groups involved in FCEs: referral sources, assessors, return-to-work specialists, third party payers and injured workers [1]. This paper shares findings from a cohort of injured workers undergoing FCEs, and explored how their FCE results were perceived and utilized by those receiving the reports. Based on study findings, we provide recommendations as to how FCEs should be requested, undertaken, reported and particularly applied to reduce work disability among injured workers.

Functional assessment of injured workers: a profile of assessor practices.

BACKGROUND: Considerable controversy and limited information surrounds the use of performance-based functional assessments for determining an injured worker's ability to function at work. PURPOSE: Amidst a variety of protocols, philosophies and tools, the key aspects of different assessment approaches are described and compared across a range of assessment provider organizations. METHOD: Qualitative and quantitative strategies were used to generate an in-depth understanding of the different assessment practices among 23 Southern Ontario assessment providers. RESULTS: Assessment approaches share common elements and variations that can be described along the continua of five dimensions: nature of assessor-evaluee interactions, fixed or flexible protocol delivery, efforts to contextualize, perceptions and use of evidence, and provider organizational environment. These approach dimensions are offered as a focus for appraising practices. PRACTICE IMPLICATIONS: Assessors need to reflect upon to what extent they are using a whole person, client-centred approach directed by clinical reasoning amidst a market driven industry.