The Effectiveness of Upper Extremity Orthotic Interventions on Performance Skills and Performance of Occupations for Adults after Stroke: A Scoping Review.

The objective of this study was to determine the effectiveness of upper extremity orthoses on improving performance skills and performance of occupations after stroke. Databases searched included CINAHL, PubMed, and OT Seeker. Articles were included if published between 2012 to 2022, English, peer-reviewed, level of evidence IB, IIB, or IIIB, and included upper extremity orthoses, adults after a stroke, and performance skill and performance of occupation outcome measures; six studies meet inclusion criteria. Moderate strength of evidence supports the usage of dynamic upper extremity orthoses to improve performance skills, although they do not improve performance of occupations for adults after stroke. Evidence suggests practitioners should utilize dynamic orthoses concurrently with tasks that promote performance skills such as gripping, pinching, grasping, and reaching during interventions to promote upper extremity use after stroke. Additional research is needed to further justify the use of upper extremity orthoses for performance of occupations after stroke.

Telehealth Interventions Within the Scope of Occupational Therapy Practice: A Systematic Review.

IMPORTANCE: With the increasing use of telehealth, it is imperative to synthesize the existing evidence to examine the effectiveness of telehealth interventions and inform practitioners and reimbursement entities. OBJECTIVE: To examine the effectiveness of telehealth occupational therapy interventions across the lifespan, delivered either independently or as part of an interdisciplinary team. DATA SOURCES: MEDLINE, CINAHL, SAGE, PsycInfo, Cochrane Database of Systematic Reviews, OTseeker, and OT Search and hand searches of systematic reviews, relevant journals, and known occupational therapy telehealth research. STUDY SELECTION AND DATA COLLECTION: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened and appraised articles that included an occupational therapy intervention delivered via telehealth and that were peer reviewed, written in English, published between 2009 and 2019, and Levels 1b to 3b evidence. FINDINGS: Twenty full-text articles (8 Level 1b, 9 Level 2b, and 3 Level 3b) met the inclusion criteria. Strong strength of evidence supports the use of telehealth approaches for occupational therapy interventions for people with neurological and pain conditions. Moderate strength of evidence supports the use of telehealth interventions to support education outcomes. Low strength of evidence was found for other outcomes for children with developmental disorders and additional conditions. CONCLUSIONS AND RELEVANCE: There is evidence to support that occupational therapy interventions delivered via telehealth are similarly effective as those delivered face-to-face, especially for neurological and pain conditions. What This Article Adds: The findings include an updated synthesis of telehealth occupational therapy interventions provided separately and with interdisciplinary health care teams. They expand occupational therapy's scope of practice to include interventions provided across the lifespan for rehabilitation and habilitation needs and include effectiveness by conditions.

Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions.

IMPORTANCE: Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. OBJECTIVE: In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. DATA SOURCES: We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS: We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.

Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions.

IMPORTANCE: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.

Occupational Therapy and the IMPACT Act: Part 1. A Systematic Review of Evidence for Fall Prevention and Reduction, Community Discharge and Reintegration, and Readmission Prevention Interventions.

IMPORTANCE: Interventions that prevent falls, facilitate discharge after hospitalization, and reduce hospital readmissions assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing costs. OBJECTIVE: In this systematic review, we address three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission. DATA SOURCES: We conducted a search of the literature published between 2009 and 2019. Study Selection and Data Collection: We developed operational definitions to help us identify articles that answered the search question for each outcome area. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS: We found 53 articles that address the three outcome areas. Regarding the prevention and reduction of falls, low strength of evidence is available for interventions focusing on a single fall risk and for customized interventions addressing multiple risks. Moderate strength of evidence supports structured community fall risk prevention interventions. Low strength of evidence was found for community discharge and reintegration interventions that include physical activity and educational programming. Low to moderate strength of evidence was found for readmission prevention interventions for patients with four types of condition. Conclusion and Relevance: Several intervention themes in the three outcome areas of interest are supported by few studies or by studies with a moderate risk of bias. Additional research is needed that supports the value of occupational therapy interventions in these outcome areas. What This Article Adds: Our study provides important insights into the state of the evidence related to occupational therapy interventions to address three outcome areas of the IMPACT Act.

Meeting Global Rehabilitation Needs: The Development and Evaluation of an International Visiting Rehabilitation Student Program.

Collaboration to increase capacity for healthcare professionals requires careful planning, open communication, implementation, formative and summative evaluation, and sustainability. International collaboration to meet the rehabilitation needs of China requires a supportive structure of faculty and staff implementing the program. The purpose of this article is to explore the development of a collaborative international rehabilitation education program and illustrate outcomes as they relate to professional development, cultural competency, and healthcare team skills. A retrospective analysis of program assessment data was completed including pre and posttest survey results and focused interviews. Results indicate that program participants had a significant positive change in values and beliefs towards cultural diversity and increased awareness of interdisciplinary team skills which contributed to overall professional development as future rehabilitation practitioners. The description and assessment of the program also serves as a framework for the development of future collaborative international rehabilitation education programs. Future research could explore institutional growth and faculty development of collaborating educational institutions.

Development of a hybrid distance occupational therapy program in Alaska.

There are shortages of health professionals in rural states. Correspondingly, health professions education programs often do not exist in these areas. Students from rural areas seeking health professions degrees frequently move out of state or to urban areas for education. To address the shortage of occupational therapists in Alaska, Creighton University, a private, Jesuit university partnered with the University of Alaska Anchorage, a public institution, to deliver a hybrid occupational therapy program to students residing near or in Anchorage, Alaska. Characteristics for a successful interorganizational partnership include effective communication, a common goal, mutual needs, and trust. This academic program was designed by applying these characteristics and using agreed-upon benchmarks for web-based programs as described by Phipps and Merisotis. The collaborative program demonstrates a model, which could be used between two disparate institutions to meet the challenges and needs of rural and underserved areas for access to health education programs.

Physical therapists' perspectives on practice errors in geriatric, neurologic, or orthopedic clinical settings.

While practice errors have been studied extensively in medicine and pharmacy, little research exists in physical therapy. The purpose of this study was to explore the phenomenon of physical therapy practice errors in geriatric, adult neurologic, and orthopedic clinical settings. Thirty physical therapists with three or more years of practice experience participated in the study, representing four geographically distinct regions of the United States. Four focus groups were conducted via guided discussion questions in four different states. Collected data were transcribed and analyzed by using constant comparative method. Data analysis yielded five major themes including: 1) taxonomy of error, 2) aversive outcomes, 3) individual and systematic causes, 4) post hoc actions, and 5) prevention of future errors. Because human errors are inevitable in physical therapy practice, understanding of causes and prevention strategies is necessary to minimize harm to patients. In addition, physical therapists must recognize their role and responsibility in creating a culture of error analysis and error prevention.

Impact of an interprofessional community-based educational experience on students' perceptions of other health professions and older adults.

Caring for older adults has become increasingly complex due to multiple health and societal factors. The purpose of this study was to evaluate the impact of an interprofessional community-based educational project on students' attitudes toward other health care professions and older adults. A pretest and posttest quasi-experimental research design was implemented with 64 participating students from four health care professions (nursing, occupational therapy, physical therapy, and pharmacy). These students completed the Interdisciplinary Education Perception Scale (IEPS) and Survey of Attitudes on Aging Scale (SAAS) before and following an educational experience with older adults. Qualitative data were collected through student reflection journals and focus groups with participating students. The results of the study showed that interprofessional community-based learning had a significant impact on some students' attitudes toward older adults. The difference between pretest and posttest reached a statistically significant level on the SAAS in occupational therapy (p = 0.013) and physical therapy students (p = 0.044). No significant differences, however, were found between the pretest and posttest in pharmacy (p = 0.097) or nursing students (p = 0.144). Similarly, the experience also had a positive impact on some students' perceptions of other health care professions as measured by the IEPS. A significant difference was found between the pretest and posttest in occupational therapy (p = 0.000) and physical therapy students (p = 0.028). This study indicates that interprofessional community-based learning can be an effective method for some students to increase their understanding and respect toward other health professionals and older adults.

Preventing practice errors and improving patient safety: an examination of case studies reflecting common errors in occupational therapy practice.

Like other health care professionals, occupational therapists make errors in clinical practice. Only recently have we systematically studied errors in occupational therapy practice. In this report, key findings from two grant projects in occupational therapy practice errors are further examined. Specifically, this report includes an in-depth analysis of five examples of occupational therapy practice errors in physical rehabilitation and geriatric settings. These examples from the five most commonly reported causes of errors found in a national survey study on occupational therapy errors are misjudgment, lack of preparation, lack of experience, lack of knowledge, and insufficient communication. For each of the five examples, hypothesized causes of errors and their implications for professional education training and current occupational therapy practice are explored. It is hoped that this report helps to better inform practice and educational approaches to contribute to the prevention and reduction of occupational therapy and other health care practice errors.

Occupational therapy practice errors in physical rehabilitation and geriatrics settings: a national survey study.

OBJECTIVES: The purpose of this survey study was to investigate occupational therapy practice errors in physical rehabilitation and geriatric practice settings. METHOD: Two hundred and forty-five (245) out of 994 surveyed occupational therapists who have practiced or currently practice in physical rehabilitation or geriatrics settings responded to a self-developed questionnaire. Descriptive statistical analysis was used to describe practice errors as to the types, causes, impact on, and responses of occupational therapists and work sites. Inferential statistical analysis was used to explore the relationships among different variables of interest including: the effect of the number of years of practice experience on the perceived impact of making errors on practice; the relationship between disclosure or nondisclosure of errors; and the types of coping strategies used by occupational therapists and work site administrators' responses to errors. RESULTS: The vast majority of practice errors occurred during the intervention phase of the occupational therapy process. Misjudgment, lack of preparation, and lack of experience were reported as the top three causes of practice errors. Various coping strategies-such as compensating for the errors by voluntarily devoting additional time for care of the patient, making and following a corrective plan, concentrating on the next step, or not letting errors interfere with daily work-were used by the occupational therapists when errors occurred. The types of coping strategies and work site responses appeared to be associated with the disclosure or nondisclosure of errors. CONCLUSION: Errors occur in occupational therapy practice. Making errors has considerable impact on occupational therapists as well as their future practice. However, disclosure of errors can often lead to positive outcomes.

From pedestal to possibility: learning scholarly writing using a unique course assignment.

Can the experience of interviewing published authors and reflection help developing health care professionals learn about scholarly writing? Students were asked to interview published authors by phone and in person, asking a set of six interview questions designed to give insight into the authors' writing process. Students' reflective assignments based on such interviews were then analyzed. Students identified particular rituals and routines that certain authors used to promote their writing ability, as well as the struggles authors face and their strategies to overcome these problems. After the course assignment, students viewed published authors more realistically as individuals who learned to write in a scholarly manner through experience and skill development. This course assignment is an innovative pedagogical approach to help students understand the process of writing in a scholarly manner and to encourage the professional dissemination of information via scholarly publications.

Occupational therapists' responses to practice errors in physical rehabilitation settings.

OBJECTIVE: Errors occur in all health care professions. Practice errors, however, have not been systematically examined in occupational therapy. The purpose of this study was to examine occupational therapists' responses to practice errors in physical rehabilitation settings. METHOD: A qualitative focus group research method was used in this study and a total of 35 occupational therapists from four different states who had practice experience in physical rehabilitation settings participated in four focus groups. Focus group discussions were transcribed verbatim and analyzed by two investigators of the study. Qualitative software program, NUD*IST Vivo was used to aid the data analysis process. RESULTS: Five major themes were generated from the data regarding practice errors, which included (1) Concept of practice error: It is against our standards; (2) Perceived causes of practice error: Not just an individual matter; (3) Emotional responses: I felt horrible; (4) Impact on practice: Doing things differently; and (5) Management of practice error: Being honest and taking initiative. Occupational therapists perceived practice error from a broad perspective and identified physical and psychosocial issues as practice error. CONCLUSION: Most practice errors described by participants appeared to be preventable. Despite the tremendous emotional distress in reaction to making an error, participants valued the learning in the experience and made constructive practice changes. Findings of the study have implications for current educational training programs and practice such as the development of clinical reasoning related to patient safety and assertiveness training for hierarchical situations.

Posttraumatic stress disorder and traumatic hand injuries: a neuro-occupational view.

Using the clinical phenomenon of posttraumatic stress disorder related to traumatic hand injuries, this article conceptually explores the theoretical construct of neuro-occupation on the basis of these conditions. Neuro-occupation is an evolving concept that combines knowledge and understanding of occupation with knowledge and understanding of how the human brain functions in environmental context; thus, the concept is important to the core of occupational therapy practice. The first section of the article introduces the concept of neuro-occupation; the second provides an overview of posttraumatic stress disorder and traumatic hand injury. To help therapists better understand behavior seen in clinical settings, the third section presents key neuro-occupational processes pertaining to posttraumatic stress disorder, using clinical application examples. Finally, a query about the value of neuro-occupation as a developing theoretical construct is put forth.