Addressing clients' sexual health in occupational therapy practice.

BACKGROUND.: Sexuality is an important dimension of one's health and well-being. Studies show that occupational therapists regard clients' sexual health as a legitimate domain of practice but do not adequately address it in their clinical work. PURPOSE.: This study aims to describe occupational therapists' perspectives regarding clients' sexual health. METHOD.: This exploratory study surveyed Canadian occupational therapists using an online questionnaire that collected information on beliefs, knowledge, comfort, barriers, and facilitators with regard to addressing sexuality. Descriptive analysis was conducted on questionnaire data, and content analysis was used to organize respondents' comments. FINDINGS.: While most respondents believed that addressing sexuality was within their scope, few actually did so in practice. Participants reported comfort with sexuality but identified lack of knowledge as a barrier to addressing clients' sexual health. IMPLICATIONS.: This study provided a greater understanding of factors that require consideration for occupational therapists to effectively meet clients' sexual health needs.

Measuring the Impact of an Adolescent and Young Adult Program on Addressing Patient Care Needs.

PURPOSE: We aimed to evaluate the effectiveness of an adult-based adolescent and young adult (AYA) cancer program by assessing patient satisfaction and whether programming offers added incremental benefit beyond primary oncology providers (POP) to address their needs. METHODS: A modified validated survey was used to ask two questions: (1) rate on a 10-point Likert scale their level of satisfaction with the information provided to them by their POP and (2) did the AYA consult provide added value on top of their POP. Young people at PM were recruited over two separate time points spaced 1 year apart. Descriptive statistics was used to report demographics and survey responses. Differences in demographics between cohorts 1 and 2 were compared using Student's t-tests. RESULTS: Participants were an average of 31 years (range 15-39) of age; (Cohort 1 = 137; Cohort 2 = 130) and were dominated by diagnoses of leukemia, lymphoma, and breast cancer. More patients had a consultation with the AYA program in 2016 (Cohort 2 = 55/130, 42%) compared to 2015 (Cohort 1 = 34/137, 25%, p = 0.026). Mean satisfaction scores (±SD) with information provided by POP in AYA domains in both cohorts combined were highest among (1) cancer information (8.09 ± 2.22), (2) social supports (7.45 ± 2.52), and (3) school/work (7.42 ± 2.88). When evaluating the incremental benefit of the AYA-dedicated team, statistically significant added value was perceived in 5/10 domains, including school/work (p < 0.001), social supports (p < 0.001), physical appearance (p = 0.009), sexual health (p = 0.01), and fertility (p < 0.001). CONCLUSIONS: Participants were satisfied with the information provided by their POP and still declared incremental added benefit of the AYA program. Cancer centers should continue to advocate for AYA focused programming with ongoing evaluation.

The impact of increased weekend physiotherapy service provision in critical care: a mixed methods study.

BACKGROUND: At the hospital studied, weekend physiotherapy (WEPT) is routinely provided and in 2013 WEPT was increased from one (PRE) to three (POST) physiotherapists (PTs) to cover intensive care and ward patients. AIMS: (1) To evaluate the impact of increased WEPT on patient volumes, treatments provided and conditions treated in critical care and wards; and (2) to understand the PTs' perspectives on the new coverage model. METHODS: A mixed methods design was utilized. The quantitative component consisted of retrospective document reviews of all weekend patients treated January 1-May 5 (PRE) and May 11-December 31 (POST). The qualitative component used a questionnaire to collect staff feedback. PRE-POST comparisons were conducted using χ(2) or Mann-Whitney U tests. RESULTS: Significant (p = 0.00) increases POST were seen in number of patients treated, number of mobility treatments provided and number of post-surgical patients seen in both clinical areas. The majority of survey respondents reported feeling adequately trained, but had concerns regarding the impact of increased WEPT on work-life balance. CONCLUSION: PTs perceived enhanced service was beneficial for continuity of weekday care and improved patient function. Future studies need to focus on measuring the effect of increased weekend provision on outcomes, preventing complications and length of stay.

Impact of using physiotherapy self-referral in the medical-surgical neurological intensive care unit.

PURPOSE: To describe physiotherapy (PT) referral practice in a medical-surgical neurological intensive care unit (MSNICU) of a large quaternary teaching hospital before and after the implementation of PT self-referral. METHODS: Charts were reviewed for MSNICU patients who received PT pre-implementation (Pre; n=90) and post-implementation (Post; n=100) to collect data on timeliness, number of referrals, and MSNICU length of stay (LOS); t-tests were conducted to determine group differences. RESULTS: The mean age of MSNICU patients referred to PT was 60.6 (SD=18.6) years; 59.5% were male. PT treatment consisted of cardiorespiratory (39% Pre, 51.1% Post), mobility (22% Pre, 28.8% Post), and combined (39% Pre, 20% Post) interventions. Overall, the number of days between MSNICU admission and PT initiation and MSNICU LOS did not differ significantly from Pre to Post. However, for patients (n=50) receiving early (within 7 days of MSNICU admission) PT self-referral Post versus patients receiving physician referral only Pre (n=83), there was a significant decrease (p=0.01) in time to PT initiation of 1.4 days (3.2 Pre, 1.8 Post). CONCLUSIONS: PT self-referral increased both the number of patients receiving more timely access to PT and the provision of treatment of a deferred group of patients previously not referred. Future studies need to evaluate the impact of referral methods across a variety of clinical populations.

Objectif : Décrire la pratique de référence en physiothérapie (PT) dans une unité des soins intensifs médico-chirurgicaux neurologiques (USIMSN) dans un grand hôpital d'enseignement de soins quaternaires avant et après la mise en œuvre de l'autoréférence en PT (avant et après respectivement). Méthodes : On a étudié les dossiers pour déterminer les patients de l'USIMSN qui ont reçu des traitement de PT avant (n=90) et après (n=100) afin de recueillir des données sur l'opportunité, le nombre de références et la durée du séjour (DDS) à l'USIMSN; on a procédé à des tests t pour déterminer les différences entre les groupes. Résultats : L'âge moyen des patients de l'USIMSN référés en PT s'établissait à 60,6 (ET 18,6) ans, et 59,5% étaient des hommes. En PT, les intéressés ont reçu des traitements portant sur l'appareil cardiorespiratoire (39% avant, 51,1% après), sur la mobilité (22% avant, 28,8% après) et combinés (39% avant, 20% après). Dans l'ensemble, le nombre de jours écoulés entre l'admission à l'USIMSN et le début des traitements de PT, et la DDS à l'USIMSN, ne présentaient pas de différence significative entre le traitement avant et après. Dans le cas des patients (n=50) qui ont bénéficié d'une autoréférence précoce en PT (dans les 7 jours de l'admission à l'USIMSN) après par rapport aux patients référés par un médecin seulement (n=83) avant, on a constaté une diminution importante (p=0,01) du temps écoulé avant le début du traitement PT qui s'est établie à 1,4 jour (3,2 avant, 1,8 après). Conclusions : L'autoréférence en PT a augmenté à la fois le nombre de patients bénéficiant d'un accès plus opportun aux services de PT et la prestation de traitements à un groupe reporté de patients qui n'avaient pas été référés auparavant. Des études futures doivent évaluer l'incidence des méthodes de référence dans tout un éventail de groupes cliniques.

Factors related to participation in paid work after organ transplantation: perceptions of kidney transplant recipients.

PURPOSE: Following kidney transplantation, recipients often have difficulty returning to meaningful occupations, including paid employment. The purpose of the current study was to describe the sociodemographic profile of kidney transplant recipients at a major Canadian Transplant Centre and to identify factors perceived to affect participation in paid work post-transplant. METHODS: Of the 530 kidney recipients who had received a kidney transplant at our facility between 2003 and 2008, 144 recipients were randomly selected, and mailed a questionnaire. RESULTS: There were 60 returned questionnaires (41.7 % response rate). The average age of responders was 49.4 years and the majority were male (68.3 %). While the rate of employment decreased significantly (p = 0.00) from 68.3 % pre- to 38.3 % post-transplant, retirement rates increased significantly (p = 0.00) from 8.3 % pre- to 18.3 % post-transplant. The responders, who were not working post-transplant, more likely lived alone (p = 0.05), had a lower level of education (p = 0.02), and had lower perceived emotional (p = 0.00) and physical (p = 0.00) health status compared to those who returned to work post-transplant. Gender, donor type, age, and post-transplant complications did not differ (p > 0.05) between the working and not working groups. Both person- and work-related factors impacted on return to paid work post-transplant. Most responders (working and not working) reported feeling emotionally and physically ready to work after their transplant. Work-related enablers included positive employer attitude towards medical history and employer agreement that recipients could take time off for medical appointments. Of those returning to work, the nature of their jobs changed from heavy physical demands to sedentary work. There was a 20.0 % increase in reliance on government disability insurance post-transplant. Responders recommended the development of a rehabilitation program focused on working and consulting with transplant recipients' employers to further enable successful reintegration into the workplace after transplantation. CONCLUSIONS: The ability to return to paid work after kidney transplant is a complex phenomenon, likely impacted by a combination of person- and work-related factors, which contributed to how individuals perceived their abilities to attain or return to paid work. It is important that in facilitating renal transplant recipients to resume valued life occupations such as paid work, the dynamic interactions between personals values, perception of one's abilities, skills, job requirements and employer characteristics be considered.

Physiotherapists' perceptions of and experiences with the discharge planning process in acute-care general internal medicine units in ontario.

PURPOSE: To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. METHODS: A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. RESULTS: Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. CONCLUSIONS: Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning.

Objectif : Étudier la préparation du départ des patients dans les unités de médecine interne générale des hôpitaux de soins actifs de l'Ontario du point de vue des physiothérapeutes. Méthodes : Une étude transversale portant sur l'utilisation d'un questionnaire en ligne a été envoyée aux participants en novembre 2011. Les caractéristiques démographiques des répondants et le classement des facteurs ont été analysés par statistique descriptive et l'on a procédé à des tests-t pour déterminer les différences entre groupes (compte tenu des caractéristiques démographiques). On a codé les réponses aux questions ouvertes de façon à dégager des thèmes. Résultats : La mobilité était considérée comme le principal facteur de la détermination de la préparation au départ. Les autres facteurs ont inclus la disponibilité des moyens de soutien social et des ressources communautaires. La communication entre les professions a été jugée importante, mais les processus étaient souvent informels. Les politiques sur le départ, la disponibilité au moment opportun d'autres options sur le plan du départ et les pressions exercées en faveur du départ hâtif ont une incidence sur la planification du départ. Les répondants ont aussi signalé un manque de formation en planification des départs et des anecdotes portant sur les dilemmes éthiques vécus par les répondants ont appuyé ces thèmes. Conclusions : Les physiothérapeutes tiennent compte de nombreux facteurs en plus de la fonction physique du patient au cours du processus de planification du départ. Il faudrait envisager d'améliorer la communication et la répartition des ressources au sein de l'équipe pour faire face aux réalités de la planification des départs.

Practice patterns of canadian physiotherapists mobilizing patients with external ventricular drains.

PURPOSE: To describe current mobilization practices of Canadian physiotherapists when treating patients with external ventricular drains (EVDs). METHODS: A quantitative, descriptive, cross-sectional study design using an online questionnaire via SurveyMonkey. An email invitation and questionnaire link was distributed in March 2010 to physiotherapists currently working with this patient population in Neurosurgical Centres across Canada. RESULTS: Respondents were 25 physiotherapists (21 full-time, 2 part-time, and 2 who did not disclose work status) working in 5 different provinces who treated ≥1 patient/month with an EVD (n=9). Slightly more than half of respondents had ≤10 years' clinical physiotherapy experience (n=14); the remainder had >10 years' experience (n=11). The majority of respondents indicated that they felt comfortable mobilizing patients with EVDs (n =19) and that it was safe to do so (n=20). Clinical experience (n=23) and safety concerns (n=25) were most commonly cited as guiding practice. More experienced physiotherapists were more likely to use out-of-bed mobilization practices. Regardless of experience, the majority of physiotherapists (20/25) ranked intracranial pressure (ICP) as the most important factor and saturation of oxygen (Spo2) as the least important factor to consider before mobilization. CONCLUSIONS: Canadian physiotherapists are mobilizing patients with EVDs, and the intensity level of their mobilization practices appears to be related to their experience level. Data from the current study may be used in developing future best-practice guidelines for the mobilization of patients with EVDs.

Objectif : Décrire les méthodes actuelles de mobilisation pratiquées par les physiothérapeutes canadiens qui traitent des patients avec des drains ventriculaires externes (DVE). Méthodes   : Étude transversale descriptive quantitative basée sur un questionnaire en ligne administré via SurveyMonkey. Une invitation électronique comportant un lien vers le questionnaire a été distribuée en mars 2010 aux physiothérapeutes qui travaillent actuellement avec cette population dans les centres de neurochirurgie du Canada. Résultats : Les répondants étaient 25 physiothérapeutes travaillant (21 à temps plein, 2 à temps partiel, 2 qui n'ont pas révélé leur statut) dans cinq provinces différentes qui ont traité ≥1 patient/mois au moyen de DVE (n=9). Un peu plus de la moitié des répondants comptaient ≤10 ans d'expérience de la physiothérapie clinique (n=14); les autres en comptaient >10 (n=11). La majorité des répondants ont indiqué se sentir à l'aise de mobiliser cette population (n=19) et qu'il était sécuritaire de le faire (n=20). L'expérience clinique (n=23) et les préoccupations en matière de sécurité (n=25) ont été les facteurs mentionnés le plus souvent comme guide de pratique. La plupart des physiothérapeutes chevronnés étaient plus susceptibles d'utiliser des méthodes de mobilisation hors du lit. Sans égard à l'expérience, la majorité des physiothérapeutes (20/25) a classé la pression intracrânienne (PIC) comme facteur le plus important et la saturation en oxygène (Spo2) comme facteur le moins important dont il faut tenir compte avant la mobilisation. Conclusions : Les physiothérapeutes canadiens mobilisent les patients en utilisant le DVE et l'intensité de leurs méthodes de mobilisation semble liée à leur expérience. Les données tirées de l'étude en cours pourront servir à établir de futurs guides de pratique clinique sur la mobilité des patients au moyen de DVE.

Work-related injuries in Canadian occupational therapy practice.

BACKGROUND: No studies investigate work-related injuries experienced by Canadian occupational therapists. PURPOSE: To identify the nature and prevalence of work-related injuries, impact of practice context, cultural and structural factors that influence response to these injuries, and strategies used to manage return-to-work after injury. METHODS: Members of the Canadian Association of Occupational Therapists were sent an electronic survey in June 2009. FINDINGS: Over half of the 600 respondents reported at least one injury episode. Patient-handling and equipment-related incidents accounted for the largest proportion of injuries. Almost one-third of respondents reported being threatened at work or experiencing workplace violence. IMPLICATIONS: Injured occupational therapists tended to minimize the extent and impact of their injuries by underreporting incidents and continuing to work after injury. These behaviours may contribute to a failure to recognize the reality of work-related injuries in occupational therapy practice and thereby limit the development of profession-specific, risk-minimization strategies.

Exercise program to enhance physical performance and quality of life of older hemodialysis patients: a feasibility study.

OBJECTIVE: Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients. DESIGN: A prospective longitudinal 12-week pilot study. SETTING: A university hospital HD unit and patients' homes. PARTICIPANTS: A convenience sample of nine older (>55 years) patients undergoing HD. INTERVENTIONS: An individualized exercise program performed on HD days (3/week) and at home (2-3/week), including aerobic, flexibility, strength exercises and patient education. MAIN OUTCOME MEASURES: Feasibility measure: patient participation. Exercise performance: Duke Activity Status Index (DASI); 2-min walk test (2MWT); Timed-up-and-go (TUG). Quality of life: The Illness Intrusiveness Ratings Scale (IIRS); The Kidney Disease Quality of Life Questionnaire (KDQOL). RESULTS: The mean (SD) age of the patients was 68.1 (7.1). Participation in the in-hospital supervised exercise program was high, with patients exercising during 89% of HD sessions, but was lower for the unsupervised home-based component (56% exercised ≥ 2 times/week). Patients showed a gradual increase in the amount of exercise performed over 12 weeks. The 2MWT, TUG, IIRS and the KDQOL physical composite score demonstrated moderate responsiveness, while the DASI score exhibited only limited responsiveness. CONCLUSIONS: This exercise program and the outcome measures were feasible for older HD patients: in-hospital participation was high, and physical performance and QOL measures exhibited moderate levels of responsiveness. Future, larger studies are needed to demonstrate whether intra-dialysis exercise, with or without home exercise, can lead to improved outcomes in this population.

Factors influencing exercise participation by older adults requiring chronic hemodialysis: a qualitative study.

Despite the recognized health and psychosocial benefits of exercise for older adults with end-stage renal disease (ESRD), exercise participation remains poor. Previous research has attributed low levels of exercise to patient-related factors such as lack of motivation and fear of adverse consequences. This qualitative study involving focus group discussions with hemodialysis patients, nephrology nurses, and family care providers explored specific motivators and barriers to exercise participation in older adults requiring hemodialysis. Nurse participants were chosen for the health care provider focus groups because their prolonged and sustained contact with hemodialysis patients during the dialysis treatment sessions positions them well to encourage and promote exercise. Motivators to exercise included patient aspirations to exercise and their experiences of improvements from exercising, as well as the formal incorporation of exercise into the overall dialysis treatment plan. Barriers to exercise included nurses' lack of encouragement to exercise, transportation issues, and the use of exercise equipment that precludes participation by patients who recline during dialysis and inhibits exercise encouragement by nurses due to concerns of equipment-related injury. These findings support the need for a broader recognition of the systemic factors that may impede exercise participation by older adults requiring hemodialysis. A shift is required in the culture of ESRD treatment programs towards a wellness perspective that includes expectations of exercise encouragement by the health care team and participation by patients.

The use of topical 4% lidocaine in spheno-palatine ganglion blocks for the treatment of chronic muscle pain syndromes: a randomized, controlled trial.

To assess the efficacy of 4% topical lidocaine in spheno-palatine blocks, a randomized controlled trial was carried out on patients with chronic muscle pain syndromes. Sixty-one patients (42 with fibromyalgia (FM) and 19 with myofascial pain syndrome (MPS)) completed the trial. Outcome measures included pain intensity, a daily pain diary, headache frequency, sensitivity to pressure using a dolorimeter, anxiety, depression, and sleep quality. Patients were randomized to receive either 4% lidocaine or sterile water (placebo) 6 times over a 3-week period. Both subjects and investigators were blind to treatment allocation. The results showed that 4% lidocaine had no superiority over placebo in any of the outcome measures. Twenty-one subjects (35%) showed a decrease in pain which was greater than 30% of their baseline value. Of these 21 subjects, 10 received lidocaine and 11 received placebo. These data suggest that, in this population, 4% lidocaine is no better than placebo in the treatment of chronic muscle pain.