Chronic pain and occupation: an exploration of the lived experience.

OBJECTIVE: There is limited research on the relationship between chronic pain and occupation. This phenomenological research study explored the lived occupational experiences of people who have chronic pain. METHOD: Via demographic questionnaires, semistructured interviews, and field notes, data were collected on 13 participants with various types of pain. RESULTS: Thematic analysis yielded one main theme: "Chronic Pain Is Life Changing." The following subthemes also emerged: "Chronic Pain Triggers Emotional Distress"; "Chronic Pain Reveals the Strength of Relationships"; "Chronic Pain and Occupation Are Reciprocally Related Forces"; and "Chronic Pain Elicits Innovative Adaptive Responses." Study participants reported experiencing myriad troubling emotions; however, they resourcefully modified their routines and tasks and found enhanced meaning in favored occupations. CONCLUSIONS: This study illuminates the importance of therapeutic listening, the innovativeness of people who have chronic pain, and the possible therapeutic potential of occupation.

A pilot study of the delivery of occupational therapy in long term care settings under the medicare prospective payment system.

OBJECTIVE: The purpose of this pilot study was to examine occupational therapists' perceptions of practice in skilled nursing facilities since the implementation of the Medicare Prospective Payment System (PPS). METHOD: A survey was sent to 250 randomly selected occupational therapists who had worked or were currently working in skilled nursing facilities for a minimum of two years. RESULTS: A majority of therapists reported an increase in caseload size since the implementation of the new prospective payment system. Most also noted increasing expectations to maintain patients on their caseloads for longer periods of time. Many reported that their facilities were decreasing the number of level II fieldwork students they were accepting. An even greater number reported that their facilities were decreasing the amounts of their continuing education budgets. A significant number also reported that they felt the quality of life for their residents had decreased since the implementation of prospective payment. CONCLUSION: This pilot survey may indicate some problematic trends in occupational therapists' perceptions of practice in skilled nursing facilities. There may be a relationship between these trends and the implementation of prospective payment in these settings. Further studies are recommended to more deeply assess occupational therapists' practice perceptions, as well as the quality of life of patients in skilled nursing facilities. Research is also needed to determine if occupational therapists' perceptions of practice in skilled nursing facilities changes or stabilizes under the prospective payment system.