Simulation in Occupational Therapy Curricula: A literature review.

BACKGROUND/AIM: Simulated learning experiences are increasingly being used in health-care education to enhance student engagement and provide experiences that reflect clinical practice; however, simulation has not been widely investigated in occupational therapy curricula. The aim of this paper was to: (i) describe the existing research about the use and evaluation of simulation over the last three decades in occupational therapy curricula and (ii) consider how simulation has been used to develop competence in students. METHODS: A literature review was undertaken with searches of MEDLINE, CINAHL and ERIC to locate articles that described or evaluated the use of simulation in occupational therapy curricula. RESULTS/FINDINGS: Fifty-seven papers were identified. Occupational therapy educators have used the full scope of simulation modalities, including written case studies (22), standardised patients (13), video case studies (15), computer-based and virtual reality cases (7), role-play (8) and mannequins and part-task trainers (4). Ten studies used combinations of these modalities and two papers compared modalities. Most papers described the use of simulation for foundational courses, as for preparation for fieldwork, and to address competencies necessary for newly graduating therapists. The majority of studies were descriptive, used pre-post design, or were student's perceptions of the value of simulation. CONCLUSION: Simulation-based education has been used for a wide range of purposes in occupational therapy curricula and appears to be well received. Randomised controlled trials are needed to more accurately understand the effects of simulation not just for occupational therapy students but for longer term outcomes in clinical practice.

Supervisor competencies for supporting return to work: a mixed-methods study.

PURPOSE: Line supervisors often play an important role in the return to work (RTW) process; whether they possess the competencies needed to carry out this work effectively is unknown. The aim of this research was to determine the competencies supervisors need in order to facilitate a worker's RTW following absence due to a mental health condition or a musculoskeletal disorder. METHODS: Supervisors from five Australian industries with high rates of compensable claims participated in focus groups to elicit the knowledge, skills, and personal characteristics required to support returning workers. From a multi-stage analysis of responses, RTW competencies were developed, allocated to clusters of related items, and incorporated into an online survey administered to rehabilitation professionals. RESULTS: 29 supervisors participated in 1 of 5 focus groups. Analysis of focus group data identified 84 generic competencies, eight specific to mental health conditions, and two to musculoskeletal disorders, arranged in 11 clusters. Survey respondents (n = 344) represented a variety of rehabilitation professionals and jurisdictions. Nearly all agreed that supervisors should receive training to support RTW. Over 50 % of respondents rated 90 of 94 competencies as very important or essential. The highest ratings were for competencies relating to personal attributes, knowledge of RTW processes, and empathetic support of the worker. CONCLUSIONS: Supervisors and rehabilitation professionals perceive effective support of RTW requires supervisors to have a range of knowledge, skills, and personal characteristics. Our competency model should undergo workplace testing to evaluate its validity.

Pre-placement screenings: An exploratory study of their use in a sample of New South Wales workplaces.

OBJECTIVE: To conduct an exploratory pilot study of pre-placement screening practice in Australia by examining the nature and use of pre-placement screenings in a sample of New South Wales (NSW) workplaces. PARTICIPANTS: 29 of 279 employers (10.3%) invited using three sources: a public list of self-insured NSW companies, a regional chamber of commerce group and researcher's contacts. The majority of respondents (31%) belonged to government administration and education. Half of the workplaces employed more than 200 people. METHODS: Employers completed an online survey from a link sent by email. RESULTS: Sixteen (55%) of the companies had a formal process for conducting pre-placement screenings, that were conducted by a range of professionals using a variety of methods, with costs ranging from $80 to $350 (Aus). The majority of respondents (81%) reported that the pre-placement screenings included an assessment of the person's ability to perform the specific physical demands of the job, i.e. against the specified physical demands of the position. The majority of employers who completed screenings found them useful. CONCLUSIONS: The findings, while from a small sample size, provide evidence that pre-placement screenings are being conducted in Australian workplaces by various professionals, using varying methods and are valued by employers.

Assessment of standing in Functional Capacity Evaluations: An exploration of methods used by a sample of occupational therapists.

OBJECTIVE: The primary aim of the study was to explore the current practice of occupational therapists when assessing standing performance during Functional Capacity Evaluations (FCEs). METHODS: A semi-structured interview was conducted with occupational therapists and the participants were interviewed using both open and closed questions. PARTICIPANTS: A sample of occupational therapists (n=20) from Queensland, Australia were involved in a survey. They were all experienced in conducting FCEs. RESULTS: Ninety percent of the respondents used a distracting task during the assessment of standing with standardised and non-standardised nuts and bolts assembly tasks the most commonly used. Respondents reported using a mix of biophysical, physiological and psychophysical clinical observations to assess standing. The nuts and bolts assembly activities used by the respondents were rated to be of low interest in terms of engaging the client. CONCLUSIONS: It was identified there are minimal guidelines in the literature which focuses on assessment of standing in FCEs. Questions were raised regarding the adequacy of the use of nuts and bolts activities as a suitably distracting task in FCEs and further research is required on assessing standing in functional capacity evaluation including the use of suitably distracting activities.

Professional supervision in the work rehabilitation arena in one Australian state.

OBJECTIVE: This study examined the methods and frequency of professional supervision in Queensland's work rehabilitation sector. Professional supervision is regarded as an important aspect of professional development and hence, critical to the improvement of services delivered by practitioners. However, there is little documented on the extent of supervision of practitioners in this setting and even less on the impact and effectiveness of supervision. PARTICIPANTS: Eighty-two (82) work rehabilitation professionals participated in the study. METHODS: The majority of participants (76) responded to a web-based survey that had been sent to them by a web-link, and 6 completed a paper based survey version of the survey, which evaluated the extent, practice methods, and barriers to the delivery and receipt of supervision. A follow-up focus group was held with key opinion holders to examine possible barriers to supervision in the industry. RESULTS: 59% of the participants had not received any form of supervision in the past two years. Those who received or delivered supervision reported it to be a valuable practice. The follow-up focus group identified barriers to supervision as being pressures of commercial targets, lack of exposure to work rehabilitation in university curricula, high staff turn-over, relative inexperience of case managers and purchasers dictating product outcomes. CONCLUSIONS: The development of industry standards for supervision practice is recommended to overcome the barriers to supervision.

Test-retest reliability of the GAPP functional capacity evaluation in healthy adults.

BACKGROUND: Functional capacity evaluations are commonly used in work rehabilitation practice to assess a person's capacity to perform work-related activities. PURPOSE: This study examined the test-retest reliability of participants' performance and administrator ratings using the Gibson Approach to Functional Capacity Evaluation (GAPP FCE). METHODS: Forty-eight healthy adults were evaluated twice on 12 recommended core items of the GAPP FCE and rated for overall performance. FINDINGS: The ICCs and 95% CIs for the Physical Level of Work and Alternative Physical Level of Work Ratings were 0.93 (0.87-0.96) and 0.86 (0.72-0.93) respectively. The ICCs for the core item-level ratings ranged from 0.15 to 0.94, and the ICCs for the actual loads handled in the manual handling items ranged from 0.88 to 0.95. IMPLICATIONS: The stability of an overall physical level of work rating shows potential for use in functional capacity evaluation practice and research. Further research is needed to investigate other measurement properties of the GAPP FCE using populations with injury or disability.

Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain.

OBJECTIVES: To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients. METHODS: Four studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evaluations by at least 1 other trained therapists or the first investigator or both. An expert review using 5 expert occupational therapists was also conducted. RESULTS: Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE. DISCUSSION: The evidence thus far available supports the GAPP FCE as an approach that provides a sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.

Item validity of the physical demands from the Dictionary of Occupational Titles for functional capacity evaluation of clients with chronic back pain.

This study assessed the item validity of 15 of the physical demands from the Dictionary of Occupational Titles (DOT), as evaluated in a new approach to functional capacity evaluation (FCE) for clients with chronic back pain, the Gibson Approach to FCE (GAPP FCE). Fifty-two occupational therapists were sent the specifications of the items in the GAPP FCE procedures and were asked to rate the items in terms of item-objective congruence, relevance and difficulty. A response rate of 59.2% was obtained. The majority of the therapists agreed that most of the items were congruent with the objectives based on the definition of the physical demands from the DOT. The items evaluating Balancing and Pushing and Pulling had the lowest item-objective congruence. The evaluation of Balancing and the Lifting, Carrying and Pushing and Pulling of loads greater than light-medium weight (10-16 kg) were not considered significantly relevant. Concerns were raised about the difficulty and safety of the evaluation of Lifting, Carrying and Pushing and Pulling with clients with chronic back pain, particularly if the therapist evaluates the manual handling of medium to heavy loads. These results may have implications for other FCEs, particularly those which are based on the DOT, or when assessing clients with chronic back pain.

Safety issues in functional capacity evaluation: findings from a trial of a new approach for evaluating clients with chronic back pain.

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the person's performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.

A survey of occupational therapy in Australian work practice.

While the prevention and management of work-related injuries are major areas of practice for Australian occupational therapists, there has been little research on occupational therapy's contribution in these areas. This study examined the characteristics of current Australian occupational therapy practice in the work arena. A postal questionnaire was sent to 355 occupational therapists employed in work practice from six of the eight state or territory Occupational Therapy Associations. The questionnaire enquired about demographic details, service provision in the prevention, assessment and rehabilitation areas and further education needs in these areas. The responses of 125 (35%) therapists were analysed and show the services commonly offered in prevention, assessment and rehabilitation. The most commonly offered services included job analyses, workplace assessment and suitable duties programs. The results also indicate high levels of service provision in the workplace. In presenting the findings of the survey, current trends in international and Australian occupational therapy work practice are discussed along with suggestions for directions in future education, practice and research.

Expert review of an approach to functional capacity evaluation.

Functional capacity evaluation (FCE) is a widely used tool in work rehabilitation, despite the limited examination of the soundness of its measurement properties. This paper outlines the development of a new approach to FCE, the GAPP FCE, and reports on the findings of an expert review of aspects of its content validity and technical adequacy and how it meets established test criteria. Five expert occupational therapists reviewed the materials of the GAPP FCE then completed a questionnaire related to the content validity, technical adequacy and safety, reliability, validity, practicality and utility of the GAPP FCE. The experts gave support to most aspects of these criteria. The main issue identified by the review was related to interpretation and extrapolation of the FCE results for return to work. This and other issues are discussed in relation to recent developments in FCE and plans for future development of the GAPP FCE.