An observational cohort study to determine the impact of research capacity building strategies implemented in an Australian metropolitan hospital occupational therapy department.

INTRODUCTION: Research capacity building enhances the abilities of individuals and is critical within health systems for quality patient care and promotes a culture of excellence within the occupational therapy profession. A research capacity building toolkit was proposed identifying strategies to support allied health professionals to undertake research. This study evaluated participant-reported outcomes of research capacity building toolkit implementation in an occupational therapy department. METHODS: An observational pre-post-cohort study at a tertiary hospital with volunteer occupational therapists using the standardised Research Capacity in Context Tool (RCCT) and an author-designed quality improvement (QI) survey was employed. The RCCT measures research capacity and culture at organisation, team and individual levels. Semi-structured interviews were used to elicit reflections regarding participant experience. RESULTS: All levels of the toolkit were implemented successfully. The response rate was 59% (n = 36) at baseline and 49.1% (n = 26) at follow-up. Eighty-five percent of participants held direct clinical roles. Nine clinicians participated in the interviews. There were significant improvements in the estimate mean for the organisation (6.51 [2019] compared with 8.13 [2020], p = <0.001) and the team (5.52 [2019] compared with 7.15 [2020], p = 0.001). The individual level did not significantly change with an estimate mean of 4.20 in 2019 increasing slightly to 4.84 in 2020 (p = 0.128). This was supported by the QI survey where improvements were noted in the department but not at an individual level. The qualitative findings verified the components of the toolkit including 'supporting clinicians in research', 'working together', 'valuing research for excellence' and reflected the importance of 'individual attributes'. CONCLUSION: The toolkit supported the implementation of specific strategies to enhance research capacity and culture. Improvements within the organisation and team were evident; however, these were not seen at an individual level. Further research about the contribution of individual-related factors and processes to the building of research capacity is required.

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database.

BACKGROUND: Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. METHODS: Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. RESULTS: The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). CONCLUSIONS: In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.

Introducing the Leadership in Enabling Occupation (LEO) model.

BACKGROUND: Occupational therapy is a broad profession yet access to services remains restricted and uneven across Canada. Access to the potential breadth of occupational therapy is severely restrained by complex supply, retention, and funding challenges. To improve access to occupational therapy, widespread leadership is needed by all practitioners. PURPOSE: This brief report introduces the Leadership in Enabling Occupation (LEO) Model, which displays the inter-relationship of four elements of everyday leadership as described in "Positioning Occupational Therapy for Leadership," Section IV, of Enabling Occupation II: Advancing a Vision of Health, Well-being and Justice through Occupation (Townsend & Polatajko, 2007). KEY ISSUES: All occupational therapists have the power to develop leadership capacity within and beyond designated leadership positions. IMPLICATIONS: LEO is a leadership tool to extend all occupational therapists' strategic use of scholarship, new accountability approaches, existing and new funding, and workforce planning to improve access to occupational therapy.

A Pediatric Hospital Physical Therapy and Occupational Therapy Department's Response to COVID-19: An Administrative Case Report.

OBJECTIVE: The purpose of this case report is to describe the challenges that COVID-19 presented for therapists in a pediatric hospital and the response to these challenges. METHODS: The case report setting is a physical therapy and occupational therapy department (department) of an academic pediatric medical center that provides a range of health care services for children and youth. Challenges that COVID-19 presented to the department included (1) managing safety concerns for patients, their families, and staff; (2) continuing to provide high-quality therapy services within state-mandated restrictions; (3) triaging patients; and (4) keeping clinicians employed and working productively. RESULTS: The department therapists responded to these challenges by (1) increasing communication huddles; (2) developing procedures for staffing and triaging of patients; (3) developing procedures for telehealth therapy services; and (4) designing a remote work program for all department employees. The number of patients and staff on site were reduced by initiating telehealth services, triaging patients, and developing a remote work plan. Communication huddles, department meetings, and supervision meetings were converted to virtual meetings. Staffing rates, patient-care productivity, and department project work were maintained. CONCLUSION: In response to COVID-19, the department developed new protocols and provided information about the protocols, which might be helpful for other pediatric hospitals or outpatient settings when planning for future pandemics or other issues that challenge the ability to provide usual care. Increasing the frequency of verbal and written communication on operational topics is recommended. Primary sources of information from national organizations (eg, the American Physical Therapy Association and the American Occupational Therapy Association) can assist with determining the scope of practice and code of conduct during a pandemic. IMPACT: COVID-19 posed challenges to operations and delivery of patient care. Although this case report is specific to COVID-19, principles applied and lessons learned from this experience can be applied to other emergency situations.

Not all stroke units are the same: a comparison of physical activity patterns in Melbourne, Australia, and Trondheim, Norway.

BACKGROUND AND PURPOSE: Very early mobilization may be one of the most important factors contributing to the favorable outcome observed from a stroke unit in Trondheim, Norway. The aims of this study were to (1) describe and compare the pattern of physical activity of patients with stroke managed in a stroke unit with specified mobilization protocols (Trondheim) and those without in Melbourne, Australia; and (2) identify differences in activity according to stroke severity between the 2 sites. METHODS: Melbourne patients were recruited from 5 metropolitan stroke units. Trondheim patients were recruited from the stroke unit at University Hospital, Trondheim. All patients <14 days poststroke were eligible for the study. Patients receiving palliative care were excluded. Consenting participants were observed at 10-minute intervals from 8:00 am to 5:00 pm over a single day. At each observation, patient location, activity, and the people present were recorded. Negative binomial regression analyses were undertaken to assess differences in physical activity patterns between stroke units in the 2 cities. RESULTS: Patients in Melbourne and Trondheim had similar baseline characteristics. Melbourne patients spent 21% more time in bed and only 12.2% undertook moderate/high activity (versus 23.2% in Trondheim, P<0.001). This difference was even more pronounced among patients with greater stroke severity. The incidence rate ratio for time spent doing standing and walking activities in Melbourne was 0.44 (95% CI: 0.32 to 0.62) when compared with Trondheim. CONCLUSIONS: Higher activity levels were observed in Trondheim patients, particularly among those with more severe strokes. A greater emphasis on mobilization may make an important contribution to improved outcome. Further investigation of this is warranted.

Relevance and focal view point in occupational therapists' documentation in patient case records.

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where "Activity" and "Health" are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on "activity" and holistic health notions.

Is waiting for rehabilitation services associated with changes in function and quality of life in children with physical disabilities?

OBJECTIVES: To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life. METHODS: Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases. RESULTS: Half of the sample waited more than 9.1 months (95% confidence interval: 6.5-16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p< .05). CONCLUSION: Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.

Meeting the challenge of assessing clinical competence of occupational therapists within a program management environment.

BACKGROUND: Program management models have raised concerns among occupational therapists about professional standards related to clinical competence, performance review procedures, and quality improvement initiatives. PURPOSE: This paper describes how a chart-stimulated recall (CSR) peer-review process and interview tool was revised, implemented, and evaluated as a pilot project to assess the clinical competence of occupational therapy staff at a large urban health centre in southern Ontario. METHODS: Fourteen pairs (n=28) of occupational therapists representing various practice areas participated in this project. Half served as peer assessors and half as interviewees. Peer assessors conducted an independent chart review followed by a one-hour personal interview with a peer partner to discuss clinical management issues related to the client cases. Each interviewer rated his or her partner's clinical competence in eight areas of performance using a 7-point Likert scale. FINDINGS: Results indicated that the CSR tool could discriminate among occupational therapists in terms of overall levels of clinical competence and also identify specific areas of concern that could be targeted for professional development. Feedback from participants was positive. CONCLUSIONS: The CSR tool was found to be useful for assessing clinical competence of occupational therapists in this large health centre as a quality improvement initiative within that discipline group. Further research is needed to establish the reliability and validity of the CSR tool.

Relationships between occupational factors and health and well-being in individuals with persistent mental illness living in the community.

PURPOSE: This study identified relationships between occupational factors and health and well-being among individuals with persistent mental illness. METHODS: There were 103 subjects assessed in regards to time spent in different occupations, activity level, satisfaction with daily occupations, and experienced occupational value. The health-related variables were self-rated health, quality of life, self-esteem, sense of coherence, self-mastery, psychosocial functioning, and psychiatric symptoms. RESULTS: Subjective perceptions of occupational performance were consistently related to both self-rated and interviewer-rated aspects of health and functioning. While variables pertaining to actual doing showed weak or no associations with self-rated health-related variables, they exhibited moderate relationships to interviewer-rated health and functioning. IMPLICATIONS: The health-promoting ingredients in occupations were determined by the way occupations were perceived, rather than the doing per se. The findings indicate that perceived meaning and satisfaction ought to be prioritized when setting goals in occupational therapy practice, and, besides, that existing occupational therapy theory needs to be updated.

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: a comparison between four European rehabilitation centres.

PURPOSE: The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries. METHOD: Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units. RESULTS: The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units. CONCLUSIONS: Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.

Process of care for battle casualties at Walter Reed Army Medical Center: Part IV. Occupational therapy service.

Occupational therapy addresses deficits in activities of daily living, upper-extremity motor performance deficits secondary to injury or disease, and occupational or role performance deficits attributable to mental and behavioral health conditions. We describe the inpatient and outpatient services provided, the problems and solutions encountered, and the lessons learned.

A review of 41 upper extremity war injuries and the protective gear worn during Operation Enduring Freedom and Operation Iraqi Freedom.

Forty-one patients with upper extremity war injuries sustained during combat operations Operation Enduring Freedom and Operation Iraqi Freedom were reviewed to report on protective gear availability and usage at the time of injury. Participants treated at the Madigan Army Medical Center occupational therapy clinic from August 2004 until February 2005 completed a questionnaire regarding injuries sustained during deployment. Overall, 6 injuries were to upper extremity regions that were covered with issued protective gear; 21 injuries were to areas not covered with issued protective gear (i.e., participant was not wearing issued gear), and 22 injuries were to regions that were not covered because no protective gear was issued for that body area. Although this study is limited, future research would provide valuable insights about the efficacy of current body armor and the need for additional or modified gear.

Os trabalhadores do contexto hospitalar em tempos de pandemia: singularidades, travessias e potencialidades / Hospital workers in times of pandemic: singularities, journeys and potential / Los trabajadores del contexto hospitalario en tiempos de pandemia: singularidades, travesías y potencialidades

Este relato de experiência teve como objetivo apresentar algumas singularidades, travessias e potencialidades advindas da construção e do desenvolvimento do Programa de Terapia Ocupacional, Saúde e Trabalho (ProTost) em um hospital universitário durante os meses iniciais da pandemia. Esse programa foi orientado pelos princípios da Ergonomia da Atividade e da Psicodinâmica do Trabalho e pautou-se na necessidade de construção de ações participativas. Foram realizados grupos de reflexão sobre o trabalho envolvendo 15 setores do hospital e 140 trabalhadores. Os grupos proporcionaram aos trabalhadores espaços de escuta coletiva sobre o trabalho e ampliaram a visibilidade dos esforços empreendidos e os processos de reconhecimento horizontal e vertical. Além disso, contribuíram para o estudo de situações de trabalho, as discussões sobre transformações nos processos de trabalho e a construção de estratégias para enfrentamento dos desafios vivenciados no hospital que foram agravados pelo advento da pandemia. (AU)

The aim of this experience report is to present singularities, journeys and potential arising from the development and implementation of the Occupational Therapy, Health and Work Program (ProTOST) in a university hospital during the first months of the pandemic. The program was guided by the principles of activity ergonomics and psychodynamics of work and based on the need to build participatory actions. Work reflection groups were created involving 15 hospital sectors and 140 workers. The groups provided staff with spaces for collective listening about work and increased the visibility of efforts and horizontal and vertical recognition processes. In addition, they contributed to the study of work situations, discussions about the transformation of work processes and building strategies to address the challenges faced by the hospital aggravated by the pandemic. (AU)

Este relato de experiencia tuvo el objetivo de presentar algunas singularidades, travesías y potencialidades provenientes de la construcción y desarrollo del Programa de Terapia Ocupacional, Salud y Trabajo (ProTOST) en un hospital universitario durante los meses iniciales de la pandemia. Ese programa fue orientado por los principios de la Ergonomía de la Actividad y de la Psicodinámica del Trabajo y tuvo como pauta la necesidad de construcción de acciones participativas. Se realizaron grupos de reflexión sobre el trabajo que envolvieron 15 sectores del hospital y a 140 trabajadores. Los grupos proporcionaron a los trabajadores espacios de escucha colectiva sobre el trabajo y ampliaron la visibilidad de los esfuerzos emprendidos y los procesos de reconocimiento horizontal y vertical. Además, contribuyeron con el estudio de situaciones de trabajo, discusiones sobre transformaciones en los procesos de trabajo y la construcción de estrategias para enfrentamiento de los desafíos vividos en el hospital que se vieron agravados por la llegada de la pandemia. (AU)

Lineamientos del Colegio Colombiano de Terapia Ocupacional para la atención hospitalaria aguda y subaguda de pacientes con COVID-19 / Guidelines of the Colombian College of Occupational Therapy for acute and subacute hospital care of patients with COVID-19 / Diretrizes do Colégio Colombiano de Terapia Ocupacional para atendimento hospitalar de pacientes com COVID-19 na fase aguda e subaguda

El amplio espectro clínico de la enfermedad COVID-19 tiene importantes implicaciones funcionales para el cuidado hospitalario agudo y subagudo en unidades de cuidado inten-sivo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colom-biano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales que participan en la rehabilitación tem-prana de pacientes con COVID-19 en Colombia. Se realizó una revisión de literatura sobre la clasificación y las manifestaciones clínicas de la enfermedad, la efectividad de la reha-bilitación temprana adulta, pediátrica y neonatal, y el rol y la experiencia de profesionales en Terapia Ocupacional en el uso de guías de salud existentes. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. Terapia Ocupacio-nal, como parte del equipo de rehabilitación temprana, juega un papel fundamental en la restauración y el mantenimiento de la independencia funcional; la adaptación del ambiente y el acondicionamiento holístico gradual de las funciones respiratorias, cardiovasculares, sensoriomotoras y cognitivas durante las actividades básicas cotidianas, y la prevención del deterioro físico, mental, espiritual y social de la persona hospitalizada y su familia. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupa-cional hospitalaria.(AU)

The broad clinical spectrum of COVID-19 disease has critical functional implications for acute and subacute hospital care in intensive care units. Faced with the health emergency triggered by this disease, the Colombian College of Occupational Therapy convened a group of professional experts in the area to provide guidelines for occupational therapists involved in the early rehabilitation of patients with COVID-19 in Colombia. A literature review was conducted on the classification and clinical manifestations of the disease, the effectiveness of early adult, pediatric and neonatal rehabilitation, and the occupational therapist's role and experience in the use of existing health guidelines. A consensus of experts determined the applicability of the guidelines to the Colombian context. Occu-pational Therapy, as part of the early rehabilitation team, plays a fundamental role in res-toring and maintaining functional independence, the adaptation of the environment and the gradual holistic conditioning of respiratory, cardiovascular, sensorimotor and cognitive functions during basic daily activities, and the prevention of physical, mental, spiritual and social deterioration of the hospitalized person and their family. These guidelines cons-titute a relevant technical and educational resource for hospital Occupational Therapy.(AU)

O amplo espectro clínico da doença COVID-19 tem implicações funcionais relevantes para os cuidados hospitalares agudos e subagudos em unidades de terapia intensiva. Diante da emergência sanitária desencadeada por esta doença, o Colégio Colombiano de Tera-pia Ocupacional reuniu um grupo de profissionais, especializados na área, para fornecer orientações aos terapeutas ocupacionais, envolvidos na reabilitação precoce de pacientes com COVID-19, na Colômbia. Foi realizada uma revisão da literatura sobre a classificação e as manifestações clínicas da doença, a eficácia da reabilitação adulta precoce, pediá-trica e neonatal, bem como o papel e experiência do terapeuta ocupacional no uso das diretrizes de saúde existentes. Um consenso de especialistas determinou a aplicabilidade das diretrizes ao contexto colombiano. A Terapia Ocupacional, como parte da equipe de reabilitação precoce, desempenha um papel fundamental na restauração e manutenção da independência funcional; a adaptação do meio ambiente e o condicionamento holístico gradual das funções respiratórias, cardiovasculares, sensório-motoras e cognitivas, durante as atividades diárias básicas; e a prevenção da deterioração física, mental, espiritual e so-cial da pessoa hospitalizada e sua família. Essas orientações constituem um recurso técnico e educacional relevante para a Terapia Ocupacional hospitalar.(AU)

Occupational therapy program development for medical-psychiatry units: a cognitive model.

Occupational therapy programs form an essential component of the overall treatment program on medical psychiatry units for patients with depression, physical debilitation, and cognitive dysfunction. This article outlines theoretical and practical aspects of developing an occupational therapy program for medical-psychiatric inpatients. Emphasis is placed on accurate assessment of cognitive and physical functioning to facilitate stratification of patients into appropriate therapeutic activities that are commensurate with their level of functioning. The theoretical basis and orientation of occupational therapy is also discussed vis-à-vis its relevance to the treatment of patients with concurrent medical and psychiatric illness.

The effect of clinical education programs on hospital production.

Because of rising hospital costs and the reluctance of third-party payers to reimburse for clinical training, major questions have been raised about the costs and benefits of these programs. The effect of student programs on production has, nonetheless, been largely neglected, in part because of the difficulty of measuring the effectiveness of these programs. To address this deficiency, multiple regression analysis was used to determine the impact of physical therapy, occupational therapy, and radiologic technology students on production in a large hospital in a metropolitan area. The impact of students on departmental output in all three areas was found to be positive.

Patients' views of industrial therapy.

Patients are rarely consulted about the major planning decisions which affect them more than anyone else. The present study, completed in 1984, sought the views of patients in the Industrial Therapy Department of a large psychiatric hospital due for closure in the next decade. Areas covered included what patients felt about the department, attitudes to staff, pay rates and working conditions, and preferences in future care. Results showed a positive attitude to Industrial Therapy tempered by some suggestions for improvement. A preference by a majority of patients for living in the community was backed by a realistic interpretation of the problems involved.

Occupational therapy: a study of supply and demand in Georgia.

In 1986 the University of Georgia's Institute of Higher Education conducted a statewide needs assessment of the supply of and demand for health care professionals in over 25 health care fields. Of the 638 hospitals, nursing homes, home health agencies, and freestanding ambulatory surgical centers surveyed, 321 replied (50%). Respondents reported that occupational therapy positions have one of the highest vacancy rates and pose severe recruitment difficulties. The occupational therapy vacancies in Georgia hospitals were 16.1% and averaged 15% in all surveyed facilities. In the hospital setting, the length of time needed to hire an occupational therapist ranged from 0 to 280 days with 3 months as average. Nevertheless, the respondents projected a 41% increase in employment of occupational therapists by 1995. Occupational therapy employment opportunities in Georgia far exceed the supply, and this imbalance will continue until the turn of the century. Although much publicity has been focused on the severe nursing shortage nationwide, in Georgia and apparently in other states, the shortage of occupational therapists is also severe. A concerted effort is required to turn this situation around.

Establishing and administrating a private practice in a hospital setting.

This paper presents specific guidelines for establishing a private practice in an institution. Guidelines are discussed for structuring the practice, establishing the fee schedule, the billing procedures, proposals and contracts, general organization and administration, together with the expansion and termination of the practice for a client/institution.

Micro-costing analysis: a measure of accountability.

A description of a micro-costing analysis conducted by the Psychiatric Occupational Therapy Department at Rush-Presbyterian St. Luke's Medical Center is reported. Analysis enabled a department manager to establish cost estimates for the services provided by the department. Included are data reflective of both costs and overhead. The analysis generates information concerning the relative amount of labor used, projected annual volumes, costs for direct and indirect labor, overtime, direct and indirect supplies, allocated cost, and cost for each identified evaluation and/or treatment. Access to cost information enables the department manager to realistically establish charges and to assess efficient use of personnel and supplies. The micro-costing analysis provides a vehicle to communicate departmental needs to the hospital administration based upon documented use of resources, and justified by a thorough cost breakdown.