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1.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38885526

RESUMO

IMPORTANCE: Effective communication skills (CS) are essential for occupational therapists. The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) is a standard tool for assessing the CS of medical residents. However, the interrater reliability for the nine CS domain scores ranges from poor to good. The intrarater reliability remains unclear. OBJECTIVE: To examine the inter- and intrarater reliability of the GKCSAF's nine domain scores and total score among occupational therapy interns. DESIGN: Repeated assessments with the GKCSAF. SETTING: Medical center psychiatry department. PARTICIPANTS: Twenty-five interns and 49 clients with mental illness, recruited from August 2020 to December 2021. OUTCOMES AND MEASURES: The transcripts of 50 evaluation interviews between clients and interns were used. Three independent raters assessed each transcript twice, at least 3 mo apart. RESULTS: The GKCSAF demonstrated poor interrater reliability for the nine domain scores (weighted κ = .08-.30) and the total score (intraclass correlation coefficient [ICC] = .22, 95% confidence interval [CI] [.10, .35]). The GKCSAF showed poor to intermediate intrarater reliability for the nine domain scores (weighted κ = .27-.73) and fair reliability for the total score (ICC = .69, 95% CI [.60, .77]). CONCLUSIONS AND RELEVANCE: The GKCSAF demonstrates poor interrater reliability and poor to intermediate intrarater reliability for the nine domain scores. However, it demonstrates fair intrarater reliability in assessing the overall CS performance of occupational therapy interns. Significant variations were observed when different raters assessed the same interns' CS, indicating inconsistencies in ratings. Consequently, it is advisable to conservatively interpret the CS ratings obtained with the GKCSAF. Plain-Language Summary: It is essential for occupational therapists to effectively communicate with clients. The Gap-Kalamazoo Communication Skills Assessment Form (GKCSAF) is a standard tool that is used to assess the communication skills of medical residents. The study authors used the GKCSAF with occupational therapy interns in a medical center psychiatry department to assess how effectively they interviewed clients with mental illness. This study aids occupational therapy personnel in the interpretation of GKCSAF results. The study findings also highlight the importance of developing reliable and standardized measures to assess communications skills in the field of occupational therapy.


Assuntos
Competência Clínica , Comunicação , Internato e Residência , Terapia Ocupacional , Humanos , Terapia Ocupacional/educação , Reprodutibilidade dos Testes , Masculino , Feminino , Adulto , Variações Dependentes do Observador , Relações Profissional-Paciente , Transtornos Mentais/reabilitação
2.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38889183

RESUMO

Core concepts in occupational therapy have often developed over time with contributions from multiple clinicians and scholars. This makes it difficult to determine exactly from where, or from whom, ideas originated. Without original sources, we cannot chart the historical development of ideas and honor those whose scholarship made it possible. This article documents the process undertaken to properly cite one such common concept in occupational therapy, the just-right challenge; illustrates the value of doing so; and advocates for the importance of thorough historical scholarship.


Assuntos
Terapia Ocupacional , Terapia Ocupacional/história , Humanos , História do Século XX
3.
Scand J Occup Ther ; 31(1): 2362840, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38889321

RESUMO

BACKGROUND: The concept of an occupational pattern in occupational therapy and occupational science has evolved with varying definitions, ranging from activity patterns to patterns of daily occupation. AIMS: This study aimed to explore the concept of occupational pattern, develop an updated definition of the concept, and theoretically validate the concept's definition. METHOD: Walker and Avant's concept analysis method was used, where both theoretical frameworks and peer-reviewed scientific literature were searched and synthesized to clarify and define the concept. Furthermore, seven occupational therapists theoretically validated the concept. FINDINGS: The analysis included forty-nine references from various research contexts and theoretical perspectives. The synthesis yielded a conceptualization of the concept of occupational pattern, outlining it into three overarching categories: 'content in an individual's occupational pattern', 'designing an occupational pattern', and 'balancing the occupational pattern'. IMPLICATIONS: An updated operational definition of the multifaceted concept of an occupational pattern now exists, with practical implications for enhancing the education of occupational therapy students and guiding the utilization of the concept. Moreover, it holds significance for instrument development and outcome measurement in research; especially in lifestyle intervention studies within the field of occupational therapy.


Assuntos
Terapia Ocupacional , Humanos , Formação de Conceito
4.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38861552

RESUMO

IMPORTANCE: Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. OBJECTIVE: To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. SETTING: VHA inpatient psychiatric setting. PARTICIPANTS: Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). OUTCOMES AND MEASURES: Occupational therapy utilization. RESULTS: Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. CONCLUSIONS AND RELEVANCE: Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.


Assuntos
Atividades Cotidianas , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Terapia Ocupacional , United States Department of Veterans Affairs , Humanos , Estados Unidos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Veteranos , Pacientes Internados , Transtornos Mentais/reabilitação , Idoso , Serviços de Saúde Mental/estatística & dados numéricos
5.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38861551

RESUMO

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.


Assuntos
Terapia Ocupacional , Jogos e Brinquedos , Humanos , Pesquisa
6.
Scand J Occup Ther ; 31(1): 2361649, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38864428

RESUMO

BACKGROUND: Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children's play opportunities. Critical contextualised research is advocated to inform practice possibilities. AIMS/OBJECTIVES: This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice. MATERIALS AND METHODS: Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods. RESULTS: Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities - 'Finding the play' between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness. CONCLUSIONS, AND SIGNIFICANCE: Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of 'finding the play', highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.


Assuntos
Grupos Focais , Terapeutas Ocupacionais , Terapia Ocupacional , Jogos e Brinquedos , Humanos , Irlanda , Terapeutas Ocupacionais/psicologia , Instituições Acadêmicas , Criança , Masculino
7.
Scand J Occup Ther ; 31(1): 2361635, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38864443

RESUMO

BACKGROUND: Acceptance and Commitment Therapy (ACT)-based interdisciplinary pain rehabilitation programs have shown effective results. While occupational therapy within these programs has made a unique contribution to pain management because of its focus on occupation and use of group activities, little is known about occupational therapists' own experiences of it. AIM: The aim of this study was to describe the occupational therapists' experiences of working in a manual-based interdisciplinary pain management program grounded in ACT. MATERIAL AND METHODS: Six occupational therapists at a pain rehabilitation clinic were interviewed. Data were analysed using Braun and Clark's thematic analysis. RESULTS: The occupational therapists experienced that ACT and occupational therapy complement each other and that ACT facilitated comprehension of occupational therapy interventions. With ACT, the team gained a common language, which made teamwork and patient comprehension more efficient. A behavioural analysis (SORC) served as a link between occupational therapy and ACT. CONCLUSIONS: Manual-based occupational therapy activity group interventions with elements of ACT were felt to enhance the patient's understanding of their rehabilitation and supported teamwork. SIGNIFICANCE: This study provides further support for use of ACT in occupational therapy within interdisciplinary pain management programs. Occupational therapists' use of SORC is an area of development.


Assuntos
Terapia de Aceitação e Compromisso , Terapeutas Ocupacionais , Terapia Ocupacional , Manejo da Dor , Equipe de Assistência ao Paciente , Humanos , Terapeutas Ocupacionais/psicologia , Manejo da Dor/métodos , Terapia Ocupacional/métodos , Feminino , Masculino , Pesquisa Qualitativa , Atitude do Pessoal de Saúde , Adulto , Pessoa de Meia-Idade
8.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38836619

RESUMO

IMPORTANCE: Children with hemiplegic cerebral palsy (HCP) require intensive task-oriented training to make meaningful gains in affected upper extremity (UE) motor function. OBJECTIVE: To evaluate the acceptability and utility of single joystick-operated ride-on toy (ROT) navigation training incorporated into a modified constraint-induced movement therapy (CIMT) camp for children with HCP. DESIGN: Single group pretest-posttest design. SETTING: Three-wk structured CIMT camp. PARTICIPANTS: Eleven children with HCP between ages 3 and 14 yr. INTERVENTION: Children received group-based CIMT for 6 hr/day, 5 days/wk, for 3 wk. As part of camp activities, children also received ROT navigation training for 20 to 30 min/day, 5 days/wk, for 3 wk. OUTCOMES AND MEASURES: We assessed children's acceptance of ROT training by monitoring adherence and evaluating child engagement (affect and attention) during training sessions. The effects of ROT training combined with other camp activities on children's affected UE motor function were also assessed with the standardized Quality of Upper Extremity Skills Test (QUEST) and training-specific measures of ROT maneuvering accuracy. RESULTS: Children demonstrated high levels of training adherence, positive affect, and task-appropriate attention across weeks. Positive engagement during ROT sessions was correlated with independent navigation. We also found medium- to large-sized improvements in QUEST scores and toy-maneuvering capabilities after the combined program. CONCLUSIONS AND RELEVANCE: Our pilot data support the use of joystick-operated ROTs as child-friendly therapy adjuncts that can be incorporated into intensive UE training programs to improve adherence and motivation in therapy programs, boost treatment dosing, and promote affected UE motor function in children with HCP. Plain-Language Summary: This pilot study offers promising evidence that supports the use of modified single joystick-operated ride-on toys (ROTs) for children with hemiplegic cerebral palsy (HCP). The study used ROTs as one of several interventions that were part of a constraint-induced movement therapy (CIMT) camp program for children with HCP. The ROTs boosted children's motivation, their engagement with and adherence to training, and their practice in using their affected upper extremity (UE) for goal-directed activities in their natural settings. ROTs are accessible, age-appropriate, and easy-to-use devices for both occupational therapy clinicians and families to encourage children to use their affected UEs by challenging their perceptual, motor-planning, problem-solving, and movement-control skills in an enjoyable and engaging way. ROTs can be used within and outside conventional rehabilitation settings.


Assuntos
Paralisia Cerebral , Hemiplegia , Terapia Ocupacional , Humanos , Paralisia Cerebral/reabilitação , Criança , Projetos Piloto , Pré-Escolar , Masculino , Feminino , Adolescente , Hemiplegia/reabilitação , Terapia Ocupacional/métodos , Jogos e Brinquedos , Extremidade Superior/fisiopatologia
9.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38836792

RESUMO

IMPORTANCE: Clinicians and researchers can leverage clinical documentation of therapy services for quality improvement and research purposes. However, documentation is often institution specific and may not adequately capture the dose of therapy delivered, thus limiting collaboration. OBJECTIVE: To implement documentation of pediatric occupational and physical therapy dose from one institution to another institution. Dose documentation includes the frequency, intensity, time, and type of interventions delivered (FITT Epic® Flowsheet) at each session. DESIGN: Prospective time-series quality improvement study. SETTING: Two large urban pediatric hospitals. PARTICIPANTS: Occupational and physical therapy staff members. INTERVENTION: Staff training and feedback loops utilizing existing groups. OUTCOMES AND MEASURES: The process measure (number of available staff trained and using the FITT Epic Flowsheet over time) and the outcome measure (percentage of FITT Epic Flowsheets used for treatment visits each month) were analyzed using a statistical process control chart. The balancing measure (percentage of notes closed before 7 p.m. on the same day as the encounter) was analyzed using mean per month across three time periods. RESULTS: Fifty-seven staff members (68%) attended formal training. On average, clinicians documented 90% of sessions using the FITT Epic Flowsheet after implementation. There was no change observed in the balancing measure. CONCLUSIONS AND RELEVANCE: Documentation of dose was spread from one institution to another. Shared documentation will facilitate future collaboration for quality improvement and research purposes. Occupational therapy practitioners and leaders should consider implementing documentation with common dose elements. Plain-Language Summary: Occupational therapy documentation is often institution specific and may not adequately capture the dose of therapy (frequency, intensity, time) or types of interventions that were delivered, thus limiting opportunities for collaboration between institutions. This article adds to the literature on administrative supports for clinical and quality improvement research by illustrating a specific example of how documentation of dose can be shared from one institution to another. The data show that clinicians at one institution started using a new style of documentation using the FITT Epic® Flowsheet and shared discrete dose elements with another institution, creating new opportunities for collaboration. Shared documentation can facilitate future collaboration for quality improvement and research purposes.


Assuntos
Documentação , Terapia Ocupacional , Melhoria de Qualidade , Humanos , Terapia Ocupacional/métodos , Terapia Ocupacional/normas , Estudos Prospectivos , Criança , Modalidades de Fisioterapia/normas , Hospitais Pediátricos
10.
BMJ Open ; 14(6): e075727, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844396

RESUMO

INTRODUCTION: A cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation, health and well-being of children with neurodisability and their caregivers. This protocol presents the realist process evaluation which is occurring in parallel with the trial to allow testing and further refinement of OPC programme theory, as represented in its logic model. The aim of this realist evaluation is to examine what works, for whom, in the implementation of OPC with caregivers of children with neurodisability (in particular, Maori and Pasifika) in current service delivery contexts. METHODS AND ANALYSIS: Guided by OPC programme theory and realist evaluation processes, mixed-methods data collected from the MANA study OPC group will be analysed to elucidate when OPC works (outcomes), for whom, how (mechanisms) and under what circumstances (contexts). This will culminate in the synthesis of Intervention-Actor Context-Mechanism-Outcome configurations. Descriptive analyses will be reported for quantitative measures of treatment fidelity (OPC-Fidelity Measure), caregiver emotional response to OPC (Session Rating Scale) preintervention emotional state (Depression Stress and Anxiety Scale) and client outcomes (Canadian Occupational Performance Measure). Reflexive thematic analysis will be undertaken to analyse realist interviews with therapists who implemented OPC above and below fidelity thresholds and culturally focused interviews with clients of Maori or Pasifika ethnicity, informing understanding of the contexts influencing therapists' implementation of OPC with fidelity, and the mechanisms triggered within therapists or caregivers to elicit a response to the intervention. The MANA study trial outcomes will be reported separately. ETHICS AND DISSEMINATION: Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee (20/STH/93). In all participating jurisdictions local area approval was obtained, involving a process of local Maori consultation. Results will be disseminated to all participants, and more broadly to clinicians and policy-makers through conference presentations and peer-reviewed journal publications, which will inform decision-making about resourcing and supporting effective delivery of OPC to optimise outcomes for children and caregivers. TRIAL REGISTRATION NUMBER: ACTRN12621000519853.


Assuntos
Cuidadores , Humanos , Cuidadores/psicologia , Nova Zelândia , Terapia Ocupacional/métodos , Criança , Tutoria/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
BMC Med Educ ; 24(1): 664, 2024 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-38880886

RESUMO

BACKGROUND: There is increasing demand for professional practice placement opportunities, supported by health professional educators, to enable future health workforce development. Early career health professionals performing the educator role is one strategy that can help meet this demand. However, there is a need to consider how best to prepare and support early career health professionals to become educators. This study aimed to explore the experiences and perspectives of early career occupational therapy clinical educators including their preparation and support needs. METHODS: Semi-structured interviews were completed with ten early career occupational therapists who had supervised their first or second student on a professional practice placement. The participants worked within an Australian tertiary hospital and health service in various clinical settings. Interviews were completed within six weeks of placement completion and lasted approximately one hour. They were recorded and transcribed verbatim and reflexive inductive thematic analysis was undertaken to identify key themes. RESULTS: Ten occupational therapists, who had been working for an average of two years and two months, consented to participate. Initially, participants expressed mixed emotions about taking on the clinical educator role. They then described their adjustment to the role responsibilities, challenges encountered, and the development of the educator-student relationship. Participants found that the experience of supervising a student enhanced their educator, clinical, and professional skills and confidence. The important support elements of tailored educator preparation, placement design, and timely access to relevant resources and experienced staff were identified. CONCLUSIONS: This study demonstrated how early career health professionals can possess desirable educator attributes, such as enthusiasm for taking on the role and cultivating collaborative learning relationships with their students. The experience of being an educator also presents a professional development opportunity for early career health professionals. Insights gained about the specific preparation and support needs of early career clinical educators warrant consideration by organisations and staff involved in the provision of student professional practice placements. Overall, this study's findings signify the importance of engaging and investing in early career health professionals to support student clinical education and to develop our current and future healthcare workforce.


Assuntos
Pesquisa Qualitativa , Humanos , Austrália , Feminino , Masculino , Adulto , Terapeutas Ocupacionais/psicologia , Centros de Atenção Terciária , Terapia Ocupacional/educação , Entrevistas como Assunto
13.
Work ; 78(2): 267-277, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38848158

RESUMO

BACKGROUND: The COVID-19 pandemic has affected physical and occupational therapist education in various ways. OBJECTIVE: This study investigated whether the pandemic changed clinical placement, thus influencing the clinical competence of physical and occupational therapists at a hospital in Japan. METHODS: Eleven therapists (seven physical and four occupational) participated in this study in April 2021. Clinical placement teaching methods were surveyed using an online questionnaire. The Objective Structured Clinical Examination (OSCE), comprising attitudinal and technical items, was used to examine clinical competence. The results were calculated as the sum of the attitudinal and technical scores, and the ratios of these scores to the full score were compared using a paired-sample Wilcoxon signed-rank test. RESULTS: During the pandemic, some schools implemented shortened practical clinical placements. The substituted classes included online-only classes and combined online and face-to-face classes. Regarding clinical competence, scores on the OSCE were mostly high. The median proportion of the total attitudinal score to the perfect score was 100% for all three items (range-of-motion test, muscle strength test, Stroke Impairment Assessment Set). The median proportion of the total technical score to the perfect score ranged from 56.7% to 76.7% for the three items. The ratio of the total attitudinal score to the full score was significantly higher than that of the total technical score to the full score (p = 0.001). CONCLUSIONS: Most clinical placements were canceled or partially administered through online learning during the pandemic. This decrease in clinical placements did not affect newly recruited physical and occupational therapists' clinical competence.


Assuntos
COVID-19 , Competência Clínica , Humanos , COVID-19/epidemiologia , Projetos Piloto , Competência Clínica/normas , Japão/epidemiologia , Masculino , Feminino , Inquéritos e Questionários , SARS-CoV-2 , Terapia Ocupacional/métodos , Pandemias , Adulto , Fisioterapeutas/educação , Educação a Distância/métodos , Terapeutas Ocupacionais
14.
Aust Occup Ther J ; 71(3): 423-442, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38720015

RESUMO

INTRODUCTION: Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals. METHODS: This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH. RESULTS: The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field. CONCLUSIONS: Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.


Assuntos
Terapia Ocupacional , Humanos , Terapia Ocupacional/organização & administração , Terapia Ocupacional/métodos , Saúde Global , Bibliometria , Qualidade de Vida , Prática Clínica Baseada em Evidências
15.
Aust Occup Ther J ; 71(3): 392-407, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38714528

RESUMO

INTRODUCTION: Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. METHODS: Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. RESULTS: The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6 minutes per person per day in the first quarter, reported allied health minutes fell to 4.6 minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3 minutes per person per day. This is just over half the Australian average of 8 minutes reported to the RCACQS in 2019. CONCLUSION: Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.


Assuntos
Pessoal Técnico de Saúde , Reforma dos Serviços de Saúde , Humanos , Austrália , Terapia Ocupacional/organização & administração , Política de Saúde , Idoso , Serviços de Saúde para Idosos , Instituição de Longa Permanência para Idosos/organização & administração , Instituição de Longa Permanência para Idosos/normas
16.
Aust Occup Ther J ; 71(3): 379-391, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38720120

RESUMO

BACKGROUND: Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government's "Closing the Gap" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice. METHODS: Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy. RESULTS: Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of "working with" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation. CONCLUSION: A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.


Assuntos
Serviços de Saúde do Indígena , Havaiano Nativo ou Outro Ilhéu do Pacífico , Terapia Ocupacional , Humanos , Terapia Ocupacional/organização & administração , Serviços de Saúde do Indígena/organização & administração , Política de Saúde , Austrália do Sul , Liderança , Vitória , Competência Cultural , Encaminhamento e Consulta/organização & administração , Colonialismo
17.
JAMA Netw Open ; 7(5): e2410713, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38728030

RESUMO

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.


Assuntos
Hospitalização , Unidades de Terapia Intensiva , Medicare , Determinantes Sociais da Saúde , Humanos , Determinantes Sociais da Saúde/estatística & dados numéricos , Idoso , Feminino , Masculino , Unidades de Terapia Intensiva/estatística & dados numéricos , Estados Unidos , Hospitalização/estatística & dados numéricos , Idoso de 80 Anos ou mais , Medicare/estatística & dados numéricos , Estado Terminal/reabilitação , Estudos de Coortes , Terapia Ocupacional/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Medicaid/estatística & dados numéricos
18.
Turk J Med Sci ; 54(1): 157-164, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38812628

RESUMO

Background/aim: The treatment for multiple sclerosis (MS) does not cure the disease, but it is intended to reduce the intensity, duration, and frequency of symptoms. Rehabilitation therapy (RT), including an individualized physical therapy program (PTP) and adapted occupational therapy (OT), has benefits in terms of aerobic capacity, muscle strength, coordination, and ability to perform activities of daily living (ADL). The primary objective of this study was to examine the efficacy of RT comprising PTP, OT, and drug treatment (DT) versus DT alone in patients with MS. Another objective was to highlight the importance of continuing the PT and OT at home, in the long term, practically for their entire life. Materials and methods: Between 2020 and 2022, a follow-up observational study was conducted that included 77 patients diagnosed with MS, independent in terms of ability to perform ADL, divided into two groups: group A (39 patients who complied with the RT) and group B (38 patients who did not comply). At the beginning and end of the study, the following parameters were assessed: timed walk for 25 feet [Timed 25-Foot Walk test (T25FW test)], dexterity of the upper limbs [9-Hole Peg Test (9HPT)], and cognitive function [Paced Auditory Serial Addition Test (PASAT)]. Results: Significant improvement in the experimental group was observed regarding the mobility and the performance of leg function (T25FW, p < 0.05) and finger dexterity (9HPT, p < 0.05) for the dominant hand. Conclusion: The current study proves the importance of combining DT with RT in MS therapy with clear benefits in regaining muscle strength in the lower limbs, thus improving coordination and balance while walking and improving dexterity in the dominant hand.


Assuntos
Atividades Cotidianas , Esclerose Múltipla , Humanos , Feminino , Masculino , Esclerose Múltipla/terapia , Esclerose Múltipla/reabilitação , Esclerose Múltipla/fisiopatologia , Adulto , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Terapia Ocupacional/métodos , Seguimentos , Resultado do Tratamento
19.
Schizophr Res ; 269: 18-27, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38718691

RESUMO

This study aimed to evaluate the feasibility and efficacy of individualized occupational therapy (IOT) plus group occupational therapy (GOT) as standard care for cognition compared to GOT alone, and to determine which IOT component has the greatest effect on cognitive outcome in patients with schizophrenia. This study was conducted at 14 clinical sites across Japan and enrolled recently hospitalized patients with schizophrenia. The IOT consisted of motivational interview, self-monitoring, individualized visits, craft activities, individualized psychoeducation, and discharge planning. Among the 68 patients who were randomized to the GOT + IOT group (n = 34) and GOT alone group (n = 34), 67 completed the trial (GOT + IOT group, n = 34; GOT alone group, n = 33). There were significant improvements in change from baseline to post-treatment between the groups in verbal memory, working memory, verbal fluency, attention, executive function domains, and the composite score of the Brief Assessment of Cognition in Schizophrenia (BACS). The BACS composite score was significantly associated with the number of craft activity sessions. The addition of IOT to GOT has a favorable feasibility profile and efficacy for cognition in schizophrenia. Craft activity is the most effective IOT component in improving cognition.


Assuntos
Terapia Ocupacional , Esquizofrenia , Humanos , Esquizofrenia/reabilitação , Esquizofrenia/terapia , Esquizofrenia/complicações , Esquizofrenia/fisiopatologia , Masculino , Feminino , Terapia Ocupacional/métodos , Adulto , Pessoa de Meia-Idade , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/reabilitação , Disfunção Cognitiva/terapia , Disfunção Cognitiva/fisiopatologia , Estudos de Viabilidade , Psicoterapia de Grupo , Avaliação de Resultados em Cuidados de Saúde , Psicologia do Esquizofrênico
20.
OTJR (Thorofare N J) ; 44(3): 511-520, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38736294

RESUMO

Employment intervention is essential for supporting people with Parkinson's disease (PwPD), who leave the workforce on average 5 years earlier than those without Parkinson's disease (PD). We developed a framework for occupational therapists (OTs) to address employment for PwPD. Our qualitative analysis employed data source triangulation of environmental scan of resources and publications, electronic medical records data, and focus groups with clinicians and PwPD. The framework underwent expert panel review by OTs and researchers who are knowledgeable of current evidence-based practices for PD. The framework is based on the Person-Environment-Occupation-Performance (PEOP) Model and PEOP Occupational Therapy Process and comprised of four parts: PEOP features of PD relevant to employment, performance changes experienced by PwPD, a process to evaluate and address employment, and intervention ideas. This framework serves as an impetus to explore evidence-based, scalable, proactive intervention approaches to address employment in PwPD.


Creating a framework to help occupational therapists support people with Parkinson's Disease to maintain employmentThis study aims to support people with Parkinson's disease (PwPD) in maintaining employment by developing a framework for occupational therapists (OTs). PwPD often leave their jobs 5 years earlier than others because they lack early employment support. OTs are well suited to address this need due to their expertise in task analysis, client-centered interventions, and enabling participation in meaningful activities.The researchers created a framework through an iterative process. They analyzed various sources, including occupational therapy resources and medical records, and reviewed data from focus groups with clinicians and PwPD. The framework aligns with the Person-Environment-Occupation-Performance (PEOP) Model and PEOP Occupational Therapy Process and consists of four main parts:Understanding how Parkinson's disease affects individuals, their work environment, and job-related aspects.Identifying the changes in employment performance experienced by PwPD.Outlining a process for OTs to evaluate and intervene in employment-related issues.Providing various intervention ideas categorized by therapeutic domain.The study also acknowledges the challenges clinicians face when addressing employment needs in PwPD. In conclusion, this framework serves as a foundation for clinicians and researchers to explore evidence-based, proactive intervention strategies for assisting PwPD in maintaining their employment.


Assuntos
Terapia Ocupacional , Doença de Parkinson , Humanos , Doença de Parkinson/reabilitação , Terapia Ocupacional/métodos , Emprego , Grupos Focais , Pesquisa Qualitativa
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