OCCUPATIONAL THERAPY IN HEALTH CARE最新文献

The aim of this study was to explore and describe how occupational therapists build therapeutic relationships while providing skilled mental health care within acute medical settings. This pilot study used a grounded theory design to capture the expertise of seven occupational therapists who have built therapeutic relationships with recipients of mental healthcare within acute medical environments. A constructivist grounded theory approach was used to analyze the transcribed interview data. A dynamic process emerged in a model of four main conceptual categories: intersections between the personal and the professional, communication guides the therapeutic approach, seeking and establishing new therapeutic connections, and cultivating therapeutic connections over time. Findings were interpreted according to the intentional relationship model and organized into a logical and reproducible collection of skilled approaches that occupational therapy practitioners and students can reference for clinical practice.

Medication management is a complex task, in which unintentional errors can have serious adverse effects. Occupational therapy practitioners can play a preventive role in this process but currently are limited in their involvement. Therefore, this qualitative study sought to better understand occupational therapy practitioners' current practices in medication management and thereby determine specific ways to increase the occupational therapy practitioner role. Twenty participants were interviewed, and verbatim transcripts were analyzed using the six-step process by Kiger and Varpio (2020). Three major themes emerged: (1) educational needs of occupational therapists, (2) educational needs of the client/caregiver, and (3) practitioner desire for standardization. Some practitioners are adept in their engagement in medication management, but there is a need for more didactic training and increased continuing education on medication management to promote the important role of occupational therapy in medication management.

This systematic review aimed to evaluate the effectiveness of occupational therapy interventions in individuals with muscular dystrophy, focusing on functional outcomes and quality of life. The study included randomized controlled trials (RCTs) involving individuals with muscular dystrophy, regardless of age or gender. Various therapeutic interventions were assessed, along with a range of outcome measures. The quality of the included studies was evaluated using the Cochrane Risk of Bias tool, and the PEDro Scale was applied to assess methodological rigor. Six RCTs published between 2011 and 2020 were analyzed. The primary focus of these studies was on interventions targeting functional deficits in individuals with muscular dystrophy. The Cochrane RoB 2 tool indicated that four studies had a moderate risk of bias, while two had a low risk. The PEDro Scale also revealed varying methodological quality. The interventions centered on adapting daily activities and using compensatory strategies, involving caregivers to promote patient independence and improve quality of life. Thus, the analysis highlights the potential benefits of occupational therapy for individuals with muscular dystrophy to improve functional abilities. However, more high-quality research is needed to solidify these findings and improve the evidence base.

Comprehensive driving evaluations for older adults with cognitive impairment are time-consuming, expensive, and involve risk. To minimize these challenges, we evaluated a three-tiered driving evaluation process incorporating cognitive tests (Step 1), a driving simulator test (Step 2), and a road test (Step 3). Participants in this study were referred to a driving assessment center for concerns about cognitive fitness-to-drive. Each participant completed all three evaluation steps. Their fitness-to-drive was determined independently by an occupational therapist and an experienced driving evaluator with a driver instructor background. Our main objective was to examine the agreement between the occupational therapist's determination of fitness-to-drive after each step and the driving evaluator's determination of fitness-to-drive after the road test. As a secondary objective, the occupational therapist's confidence in their determinations was also examined. Results showed agreement for 38.8% of participants after Step 1, 46.5% after Step 2, and 92.3% after Step 3. The mean occupational therapist's confidence rating in their determination (scale of 0 to 100; higher is better) was 36.15 after Step 1, 49.54 after Step 2, and 90.54 after Step 3. All drivers deemed to have passed the evaluation had been identified as such after the driving simulator test. These results suggest that the best agreement between the occupational therapist and the driving evaluator was reached after the final step. However, the results also indicate that for some participants, a road test may not be required following a driving simulator test. Eliminating the road test in some instances may create efficiencies and reduce cost and risk while maintaining accurate determinations of fitness-to-drive.

Since self-efficacy or belief in one's personal capabilities is an important predictor of rehabilitation outcomes, this study aimed to investigate the effect of motivational interviewing (MI) on the self-efficacy of stroke patients. Stroke patients (n = 34) participated in a single-blinded randomized control trial study. Both the intervention (n = 17) and control (n = 17) groups received the usual occupational therapy treatment with the intervention group also receiving a weekly session of MI for four weeks. Using a pretest and posttest design, the posttest was measured eight weeks after the last session of MI. General self-efficacy score, quality of life scores, and upper limb recovery scores did not significantly improve with time in either group. However, functional independence scores, and lower limb recovery scores (p = 0.001, and p = 0.003, respectively) were significantly improved in the intervention group compared to the control group. While MI did not effectively enhance self--efficacy in stroke patients, occupational therapists could potentially enhance rehabilitation outcomes by incorporating MI in patient recovery.

This article presents a case report of a three and half year-old boy with functional constipation and sensory hyperreactivity. The Integrated Sensory Toileting® approach was used to guide clinical reasoning and identify the sensory underlying factors that were impacting the child's ability to acquire age-appropriate toileting habits and gastrointestinal health. The six months of treatment in occupational therapy and gastroenterology, as well as six months of follow-up are described. Improvements in sensory reactivity are documented using the Sensory Processing Measure-2 and the Toileting Habit Profile Questionnaire-Revised and corroborate with improvements in the child's ability to participate in toileting routines and improved gastrointestinal health.

Dementia affects the individual's functional ability including sexual activity. Limited understanding is available to support sexual health practices. This meta-synthesis review aimed to identify the gaps in the study of sexuality in dementia using the Model of Human Occupation (MOHO). Electronic searches utilizing six databases for existing articles involving persons living with dementia, care partners, and healthcare workers. The result showed that available studies primarily explored sexuality from the viewpoint of spouses of persons living with dementia. The volition domain of MOHO was the most explored provides a deeper understanding of volition on intrinsic perspective on sexuality in people with dementia. The environment domain was the least explored, highlighting healthcare professionals' need for social support and training. The topic of sexuality remains sensitive, limiting the availability of evidence-based interventions in this area.

The study aim was to identify the most problematic self--reported activities of daily living (ADLs). In a retrospective study, 1935 problematic ADLs were reported by 538 clients with 95% experiencing two or more problematic ADLs. Problematic ADLs were assessed by occupational therapists using the Canadian Occupational Performance Measure with walking (67%), household activities (41%), and climbing the stairs (41%) identified as the most prevalent problematic ADLs. Significant but weak associations were found between clinical determinants (e.g. physical, psychosocial) and problematic ADLs. The wide variety of problematic ADLs and the absence of a strong association with clinical determinants emphasizes the need for using individualized interview-based performance measures in clients with asthma.

The purpose of this qualitative constructivist grounded theory study was to develop a model to explain potential mechanisms of change in the nature-based pediatric occupational therapy process, based on analysis of the perspectives of occupational therapy practitioners currently engaging in nature-based practice with children. Using 27 photos and interview data from 22 participants the Ecology of Change in Outdoor Therapy (ECO-Therapy) Model was developed. The model suggests mechanisms of change in nature-based pediatric occupational therapy may involve six iterative phases: Longing for Freedom, Embarking on Adventure, Dancing with Nature, Claiming Self-Agency, Braving Real-Life Challenges, and Growing Adaptive Capacity. The practitioner and child experiencing these phases throughout the nature-based occupational therapy process may lead to improved participation and performance in the child's daily life.

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.