Pilot evaluation of a digital approach to occupational therapy home assessments: acceptability and efficiency compared with usual practice in a hospital.

INTRODUCTION: Pre-discharge home assessments by occupational therapists facilitate safe and timely discharge from hospital and are associated with better health outcomes. Digital technology offers the potential to reduce duplication of documentation and improve communication and sharing of home assessment findings. OBJECTIVE: This quality improvement project evaluated time-cost; clinician satisfaction and confidence; and acceptability of the use of a digital approach to home assessments. METHODS: A prospective, cross-sectional design was used to compare usual practice with the digital approach across two sub-acute wards in a large metropolitan hospital in Queensland, Australia. Time to document and conduct home assessments as well as clinician satisfaction and confidence were compared using descriptive statistics. Clinician perspectives about the home assessment approaches were collected through a survey and analyzed using content analysis. RESULTS: Home assessment and documentation time were significantly lower for the home assessments conducted using the digital approach compared with usual practice assessments. Clinician satisfaction with using digital technology was higher. CONCLUSIONS: The introduction of this simple technology reduced clinicians' time to conduct home assessments and document home assessment reports. The project was well received by occupational therapy clinicians. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A187.

Patient Experience in Adjunct Controller-Free Hand Tracking Virtual Reality Tasks for Upper-Limb Occupational Therapy Rehabilitation.

Benefits of immersive virtual reality rehabilitation (VRR) include increased motivation and improved transfer of skills to real-world tasks. The introduction of Oculus hand-tracking technology allowed for the development of VRR games that do not need virtual reality (VR) hand controllers. This is beneficial as participants with upper limb impairments/injuries may have difficulties with/be limited in using/manipulating VR hand controllers. In this project, a VRR game was developed and evaluated. The aim of this study was to determine patient experience when using VRR as an adjunct to upper-limb rehabilitation. N = 20 participants receiving upper limb rehabilitation completed a series of VRR tasks by playing the "smoothie bar" VRR game. After the completion of the VRR tasks, the participant experience was evaluated via a study-specific questionnaire. Key findings include 95% agreement that VRR tasks were fun and engaging and 75% agreed that VR tasks will be helpful to include in their rehabilitation. Hands-tracking VRR has a high potential to be used as an adjunct intervention in upper limb rehabilitation.

Student-resourced service delivery of occupational therapy rehabilitation groups: patient, clinician and student perspectives about the ingredients for success.

BACKGROUND: A number of innovative models of student practice placements are emerging due to pressures on universities to provide quality practice placements and on health services to deliver rehabilitation efficiently, safely and cost-effectively. The student-resourced service delivery (SRSD) group program is one such model in occupational therapy. There is a paucity of research evidence to guide services in planning, implementing and evaluating the SRSD model. OBJECTIVE: The study aimed to explore and identify the factors that key stakeholders perceived as contributing to the successful development and implementation of the occupational therapy student-resourced service delivery group programs. METHODS: Participants in this multi-site study were rehabilitation inpatients, clinicians, Clinical Education Liaison Managers and students completing practice placement in the student-resourced service delivery group program. Data were collected using face-to-face semi-structured interviews and focus groups. RESULTS: A total of 83 participants consented to the study. Four themes emerged from the data. Planning needs to be an iterative process that commences before and continues during the program. Support processes need to be established for students and clinicians during and across placements. The creation of an engaging, client-relevant and graded group dynamic is critical for success. Establishing a culture whereby groups are valued by the clients, therapy and multidisciplinary teams is important. CONCLUSIONS: The above-mentioned factors were perceived as contributing to successful operationalisation of a student-resourced service delivery group program, and may be helpful when developing student-resourced service delivery professional practice placements in other settings.IMPLICATIONS FOR REHABILITATIONStudent-resourced service delivery of groups are one way to achieve additional professional practice placements for students and delivery of therapy services for patients.Ongoing investment for planning and preparation, provision of continual support for students, a culture of valuing groups and students, and creating a group dynamic that engages group participants were perceived by stakeholders as key ingredients for successful implementation of the student-resourced service delivery group model.Clinicians and educators are encouraged to use the perceived success factors identified in this study as a resource for future student-resourced service delivery program development.

Experiences of and support for the transition to practice of newly graduated occupational therapists undertaking a hospital graduate Program.

INTRODUCTION: Newly graduated occupational therapists face well-documented difficulties as they embark on professional practice. Occupational therapy departments need to ensure that new graduates conduct their roles appropriately while developing experience and building clinical and professional skills. This study aimed to explore the experiences of new graduates at a major Australian metropolitan hospital occupational therapy department, the support provided to them and their perceptions of this support. METHODS: The research design was Interpretive Description. Semi-structured interviews of approximately 60 min were undertaken with seven occupational therapists, their team leader and the Departmental Head. The two research questions were as follows: What were the graduates' experiences of their first year in practice? What support was provided to graduates and what were their perceptions of this? RESULTS: New graduates perceived the transition to practice as overwhelming, particularly regarding their caseload responsibility. During the first few months, work tasks took them longer and they felt stressed and anxious. They received a range of support and education, both inter-professional and discipline specific. Their occupational therapy team leader and clinical senior provided tailored support, guidance and reassurance. Guided questioning facilitated development of new graduates' clinical reasoning and professional skills. Reflection helped them to identify and address learning goals relating to occupational therapy professional competencies. New graduates valued having a consistent caseload and a supportive workplace was highly valued. CONCLUSION: New graduates initially feel overwhelmed by being responsible for their decisions. However, they can benefit from tailored supervision and guided questioning to help develop clinical reasoning and professional skills, formal and informal support from experienced occupational therapists and their inter-professional teams and time to increase skill with their caseload. Engagement in a professional community of practice is important.

A cohort investigation of patient-reported function and satisfaction after the implementation of advanced practice occupational therapy-led care for patients with chronic hand conditions at eight Australian public hospitals.

STUDY DESIGN: Prospective cohort. INTRODUCTION: Patients referred to medical specialist outpatient clinics in Australian public hospitals often wait longer than the recommended timeframe for their first appointment. This study examines the use of advanced hand therapy practitioners to facilitate access to care for long-waitlisted patients with chronic hand conditions. PURPOSE OF STUDY: To examine patient-reported function and satisfaction outcomes with advanced practice hand therapy. METHODS: Data was collected from eight public hospital outpatient departments in Queensland, Australia. Patients with chronic hand conditions were screened from waitlists at each site and invited to participate in the hand therapy program while waiting to see a medical practitioner. RESULTS: A total of 1947 patients were screened from the waitlists, and 1116 patients completed advanced practice therapy. Patients completing hand therapy were older (P ≤ .001) and more likely to have more than one diagnosis (P ≤ .001). They reported a significant improvement in function using the Michigan Hand Questionnaire (P ≤ .001) and demonstrated increased grip strength (left injuries P = .016, right injuries P = .001). Ninety-three percent were satisfied or highly satisfied with hand therapy care. Some variation in Michigan Hand Questionnaire scores was observed across different diagnoses, with those with carpal tunnel syndrome and trigger finger reporting the best outcomes. CONCLUSIONS: Advanced practice hand therapy for long-waitlisted patients with chronic hand conditions was associated with improvements in patient function and satisfaction. Further research is warranted to study the specific response of different diagnostic groups to intervention using this model of care.

Evaluation of occupational therapy-led advanced practice hand therapy clinics for patients on surgical outpatient waiting lists at eight Australian public hospitals.

STUDY DESIGN: This is a prospective cohort study. INTRODUCTION: Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes. PURPOSE OF THE STUDY: The aim of this study was to evaluate an advanced practice hand therapy model of care for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals. METHODS: Nonurgent and semiurgent patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patients' perception of change as measured by Global Rating of Change (GROC). The GROC score was also compared across diagnoses. The relationship between the waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and analysis of variance were used for statistical analyses. RESULTS: A total of 37.2% of patients who commenced hand therapy were removed or discharged from the surgical outpatient waiting lists. Of the subset of patients who completed hand therapy (n = 1116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe, and patient satisfaction was above 90%. The mean GROC score was +2.09 (±3.58) but varied across diagnoses with trigger finger or trigger thumb showing the greatest improvement (+4.21 ± 2.92, P < .01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (P < .001). CONCLUSIONS: The advanced practice hand therapy model of care was safe and effective in reducing hospital surgical outpatient waiting lists. Patients reported high satisfaction.