Occupational Therapy Level II Fieldwork Impact on Clinicians: A Preliminary Time Study.

The aim of this preliminary study was to quantify the amount of time clinicians spend at work with and without a student and identify predictors of time spent at work with a student. A quasi-experimental design evaluated 22 occupational therapists that supervised a student. The occupational therapists completed a time log for 3 months without a student and 3 months while supervising a student. A statistically significant difference in overall time spent at work while supervising a student compared to when not supervising a student was found. Clinicians spent an average additional 25 minutes at work per day when supervising a student. Clinician years of experience and time spent without a student were found to be predictive of the time spent at work with a student. The additional time spent at work when supervising a level II fieldwork student should be considered along with all of the documented benefits of supervising a student by potential fieldwork educators.

National Survey of Fieldwork Educators: Implications for Occupational Therapy Education.

OBJECTIVE: The purpose of this study was to gain information on the current status of fieldwork training facilities to understand facilitators of and barriers to fieldwork education, including fieldwork educators' perceptions of benefits, challenges, and valued supports. METHOD: A descriptive, nonexperimental exploratory design was used. A pilot survey was conducted, and a revised online survey, consisting of 49 items, was distributed nationwide in Fall 2013. RESULTS: Opportunity to update practice was the most commonly perceived benefit associated with fieldwork, and workload or time was the greatest perceived challenge. Readiness and high-quality preparation of students by academic programs were the most valued supports. Participants also identified preferred time frames and supervisory models of fieldwork education. CONCLUSION: Interpretation of these data provides valuable information for the profession, notably academic programs, regarding needs and resources to foster collaborative relationships with fieldwork facilities to meet the growing need for fieldwork education.

Supervision of Occupational Therapy Level II Fieldwork Students: Impact on and Predictors of Clinician Productivity.

This study aimed to determine whether a difference in productivity exists between clinicians supervising and not supervising a Level II occupational therapy student and whether factors including clinician years of experience, practice setting, and clinician productivity without a student could predict clinician productivity while supervising a student. We used paired-sample t tests to examine clinician productivity with and without a student in 109 clinician-student encounters and regression analysis to determine factors predictive of clinician productivity with a student. Results indicated no difference in clinician productivity with or without a student. Clinician years of experience, practice area, and productivity without a student were significant predictors of clinician productivity while supervising a student. Study results contradict the belief that supervising Level II fieldwork students lowers clinicians' productivity. Findings suggest that practice area and productivity without a student are important factors influencing the productivity of clinicians supervising a fieldwork student.

Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.

BACKGROUND/OBJECTIVE: Describe associations of occupational therapy (OT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and 1-year post-injury. METHODS: Occupational therapists at six inpatient rehabilitation centers documented detailed information about treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary for a 75% subset; models were validated with the remaining 25%. Functional outcomes for injury subgroups (motor complete low tetraplegia and motor complete paraplegia) also were examined. RESULTS: OT treatment variables explain a small amount of variation in Functional Independence Measure (FIM) outcomes for the full sample and significantly more in two functionally homogeneous subgroups. For patients with motor complete paraplegia, more time spent in clothing management and hygiene related to toileting was a strong predictor of higher scores on the lower body items of the self-care component of the discharge motor FIM. Among patients with motor complete low tetraplegia, higher scores for the FIM lower body self-care items were associated with more time spent on lower body dressing, manual wheelchair mobility training, and bathing training. Active patient participation during OT treatment sessions also was predictive of FIM and other outcomes. CONCLUSION: OT treatments add to explained variance (in addition to patient characteristics) for multiple outcomes. The impact of OT treatment on functional outcomes is more evident when examining more homogeneous patient groupings and outcomes specific to the groupings. Note: This is the third of nine articles in the SCIRehab series.

The SCIRehab project: treatment time spent in SCI rehabilitation. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation.

BACKGROUND: Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously. OBJECTIVE: To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities. METHODS: Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables. RESULTS: SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of 'therapeutic activities' that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM) score, neurologic injury group, and the medical severity of illness score. CONCLUSION: OT treatment patterns for patients with traumatic SCI show much variation in activity selection and time spent on activities, within and among neurologic level of injury groups. Some of the variation can be explained by patient and injury characteristics. Almost all patients with SCI participated in strengthening/ endurance and ROM/stretching exercises during OT treatment and these two activities are where the most time was spent when therapy provided in individual and group settings was combined. ADL work consumed the most time in individual therapy sessions.

SCIRehab Project series: the occupational therapy taxonomy.

BACKGROUND/OBJECTIVE: Lack of a classification system for occupational therapy (OT) rehabilitation interventions for traumatic spinal cord injury (SCI) rehabilitation in the United States makes conducting outcomes research difficult. This article describes an OT SCI rehabilitation taxonomy (system to categorize and classify treatments). METHODS: OT clinicians and researchers from 6 SCI rehabilitation centers developed a taxonomy to describe details of each OT session. This effort is part of the SCIRehab study, which uses the practice-based evidence, observational research methodology to examine current treatment processes without changing existing practice. RESULTS: The OT taxonomy consists of 26 OT activities (eg, training on activities of daily living, communication, home management skills, wheelchair mobility, bed mobility, transfers, balance, strengthening, stretching, equipment evaluation, and community reintegration). Time spent on each activity is documented along with therapeutic interventions used to facilitate the activity. Treatment descriptions are enhanced further with identification of assistance needs, patient direction of care, and family involvement, which help to describe and guide OT activity selection. The OT taxonomy documentation process includes all OT rehabilitation interventions for patients with SCI while maintaining efficiency in data collection. CONCLUSION: The electronic documentation system is being used at 6 centers for all OT sessions with 1,500 patients with acute traumatic SCI. It is the largest known attempt to document details of the comprehensive OT rehabilitation process for patients with SCI in the United States.