Occupational Therapists' Beliefs and Experiences Managing Chronic Pain, Wellness, and Occupational Performance.

Chronic disease prevention, health, and wellness have become primary practice areas for occupational therapy. Occupational therapists (OTs) in pain rehabilitation are established as essential members of comprehensive and multidisciplinary pain management teams, focusing on increasing occupational performance through participation. This study's purpose was to investigate OTs' experiences managing chronic pain and to explore OTs' effectiveness in supporting clients' wellness and occupational performance through interventions. Eleven OTs (n = 11) participated with three themes emerging on chronic pain, interventions, and holistic teams. Findings suggest that OTs are successful at treating chronic pain, supporting wellness and occupational performance when their interventions are health-promoting, and clients are enabled to take an active role in their chronic pain management. This study demonstrates the critical impact OTs can have in multidisciplinary teams on clients' outcomes, such as increased occupational performance, wellness, and quality of life (QOL) through engagement in meaningful occupations.

Pediatric hand therapists' experiences with outcomes measurement: An interpretive descriptive study.

BACKGROUND: Demonstrating that pediatric hand therapy patients are achieving improved functional and health status outcomes is critical as reimbursement for therapy services shifts to value-based reimbursement. Yet, practice patterns of outcomes assessment in pediatric hand therapy are unknown. PURPOSE: Explore how pediatric hand therapists describe their experience measuring treatment outcomes and using patient reported outcome measures (PROMs). Secondarily, to elucidate what therapists perceive children and adolescents receiving hand therapy desire as treatment outcomes. STUDY DESIGN: Interpretive descriptive qualitative study METHODS: Pediatric hand therapists were recruited through an email invitation sent to members of the Pediatric Hand Study Group to participate in one-on-one interviews over a teleconference link. Interviews were transcribed verbatim and coded to derive themes. Data collection and analysis were iterative. RESULTS: Ten therapists with a median 13 years (range, 2-25 years) of experience practicing in pediatric hand therapy completed interviews. Overall, participants reported using 52 unique outcomes measures, including 20 PROMs. The following themes were elucidated: (1) Complexity and variability in pediatric hand therapy practice and outcomes assessment; (2) Barriers to PROM use; (3) Value of PROM utilization; (4) Desired characteristics of an optimal PROM for pediatric hand therapy. CONCLUSION: Practice with outcomes assessment is variable. PROM utilization in pediatric hand therapy practice may be improved with the development of a PROM that is aligned with the pediatric population's outcomes priorities.

Perceived exercise habits of individuals with Parkinson's disease living in the community.

CONTEXT: Exercise has been shown to improve gait in individuals with Parkinson's disease (PD). Stepping practice at higher intensity levels has been suggested as a beneficial treatment option to improve gait in the neurological population. Unfortunately, this mode is poorly understood and underutilized within the PD population. Information on what individuals with PD are doing for exercise would be beneficial to help tailor exercise programs to improve gait and provide exercise options in the community for intensity-based exercise. OBJECTIVE: To investigate the current exercise habits of individuals living with PD in the community aimed at improving walking and to understand the impact of perceived intensity on daily exercise practices. DESIGN SETTING PARTICIPANTS: One hundred thirty-eight individuals with PD living in the community were surveyed online regarding their current exercise habits. MAIN OUTCOME MEASURE: A total of 22 questions aimed to understand exercise selection, focus, and perceived intensity. Questions asked basic demographic, symptom presentation and management of disease related symptoms that were present while living with PD. Exercise questions focused understanding participants current function level, practice exercise habits and perceived levels of exercise intensity during daily routines. RESULTS: Of the 138 individuals surveyed for this preliminary study, eighty-seven percent of individuals with PD participated in exercise with seventy-five percent choosing walking as a mode for exercise. Sixty-five percent of the respondents noted that despite exercise, their walking speed and endurance has worsened since diagnosis. Eighty-one percent perceived exercising at moderate intensity levels, however little provocation of intensity symptoms was noted. CONCLUSION: Our preliminary study survey results suggest that individuals with PD are exercising but not at high enough intensity levels to promote improvements in gait performance. Individuals with PD may need to be pushed at higher intensity levels, beyond their voluntary limits, to induce gait performance changes. These findings can provide a foundation for future fitness interventions within this population to target improving gait.

Interference: COVID-19 and the Impact on Potential and Performance in Healthcare.

BACKGROUND: COVID-19 has had a significant effect on all aspects of life and occupational performance most recently. OBJECTIVE: This aim of this article was to discuss the concept of interference and the role that interference plays in productivity and potential across healthcare settings. METHODS: The framework design was the application of Bolea and Atwater's interference framework to probe the COVID-19 pandemic within healthcare organizations. RESULTS: Leadership that focuses on transparency, frequent metric measurement can increase potential and then managing for unintended consequences can foster optimal occupational performance for both the practitioner and client. CONCLUSION: Interference is a critical concept in understanding organizational behavior. Transparent leadership is needed to adequately support organizations to create resilience in the workplace.

Parental Adherence to Home Activities in Early Intervention for Young Children With Delayed Motor Development.

OBJECTIVE: The purpose of this study was to investigate the relationship between characteristics of home activities and coaching practices with the adherence of parents of children with motor delays to home activities provided by physical therapists and occupational therapists in early intervention. METHODS: An online survey study was developed and distributed to physical therapists and occupational therapists across the United States. A survey flier was posted online in parent support groups, physical and occupational therapy groups, newsletters, and organizations supporting parents of children with disabilities. RESULTS: A total of 720 respondents participated in the survey, and 446 participants from 49 states met the inclusion criteria and were included in the analysis. Parents indicated that physical therapists and occupational therapists applied the 5 coaching practices (joint planning, observation, practice, reflection, and feedback). However, parents (63%) reported more time was needed on coaching. Parents stated that therapists' modeling the activities was the most helpful teaching technique that enhanced their adherence to home activities. Coaching practices, appropriateness of the home activities to daily routines and home environment, provision of home activities enjoyed by the child, and parent self-efficacy were all significantly associated with adherence to home activities. CONCLUSIONS: Parents' adherence to home activities is affected not only by the type of coaching used by the therapists but also by the characteristics of the home activities provided for young children with delayed motor development. IMPACT: The results of this study provide additional evidence supporting individualization of home activities to promote parents' continuous provision of learning opportunities to promote their children's development. There was also support of the therapists' use of the 5 coaching practices in early intervention to support the parent's application of home activities when the therapists are not present. LAY SUMMARY: This study explored the use of home activities from the parents' perspective and provided valuable recommendations to therapists to improve parents' adherence to the recommended home activities in early intervention.

The Environmental Impact on Occupational Therapy Interventions.

The purpose of this study was to investigate how the environment influenced the intervention choices occupational therapists made for patients recovering from a stroke in an inpatient rehabilitation hospital. Three occupational therapists were observed providing intervention for six patients over a 16-month period. Treatment spaces included a therapy gym, gym with kitchen combination, and a home-like space. Furniture was added to the therapy gym to be more home-like midway through the study. Observations included therapist selection of treatment location and interventions, and observational data of the environment and interactions among therapists and patients. This study found that inpatient rehabilitation environments did influence interventions. The occupational therapists provided therapy in the standard therapy gym environment most often, whether it was enhanced to be more home-like or not, and predominately used preparatory methods.

Becoming occupation-based: a case study.

This descriptive case study illustrates the experiences of a 55-year-old male with a chronic disability resulting from a stroke, living in the community and a clinician's trial using occupation-based interventions predominately in a rehabilitation setting. The participant engaged in occupation-based interventions three times a week for 5 weeks guided by the Canadian Occupational Performance Measure (COPM). Data were collected through semi-structured interviews during the intervention sessions and journal entries made by the therapist. Results suggested occupation-based interventions facilitated a transformation for both the client and the therapist by enhancing the participant's occupational performance and the ability to resume previous roles. The therapist's belief in the power and value of occupation-based practice was reinforced and validated, particularly in the rehabilitation of an individual with chronic stroke.

Behavioral, neurophysiological, and descriptive changes after occupation-based intervention.

OBJECTIVE: We evaluated the effects of occupation-based intervention on poststroke upper-extremity (UE) motor recovery, neuroplastic change, and occupational performance in 1 research participant. METHOD: A 55-yr-old man with chronic stroke and moderately impaired UE motor function participated in 15 sessions of occupation-based intervention in a hospital setting designed to simulate a home environment. We tested behavioral motor function (Fugl-Meyer Assessment, Stroke Impact Scale, Canadian Occupational Performance Measure) and neuroplasticity (transcranial magnetic stimulation [TMS]) at baseline and at completion of intervention. We collected descriptive data on occupational participation throughout the study. RESULTS: All behavioral outcomes indicated clinically relevant improvement. TMS revealed bihemispheric corticomotor reorganization. Descriptive data revealed enhanced occupational performance. CONCLUSION: Occupation-based intervention delivered in a hospital-based, homelike environment can lead to poststroke neuroplastic change, increased functional use of the affected UE, and improved occupational performance.

Toward a physical environmental continuum for occupational intervention in a rehabilitation hospital.

ABSTRACT A study was conducted to explore occupational therapists' perceptions of rehabilitation environments and the influence of these perceptions on practice and occupational interventions. Traditionally, inpatient occupational therapists have a choice of intervention environments, ranging from a gym-like to a more home-like setting. Choosing to provide interventions in these different environments can have an impact on occupational performance. In this qualitative exploration, 21 occupational therapists participated in focus groups designed to explore their perceptions of practice environments. Analysis of the transcribed data revealed that therapists felt rehabilitation environments should offer choices and be flexible, that environments influenced intervention strategies, and that the practice environment had an impact on professional identity. On the basis of this data, a conceptual matrix of the intersection of environmental setting and occupation-based interventions is presented to highlight the importance of these two aspects of therapy. Future research in this understudied area is needed to transform this matrix into a clinically useful model.