Search

Introduction: Sensory impairment of the upper limb is common after stroke and negatively impacts a stroke survivor's recovery. The acute phase is a critical time for the identification of post-stroke somatosensory impairments and occupational therapists have a key role in the acute stroke setting. Sensory assessment and treatment practices of occupational therapists working in acute stroke settings are largely unknown. This study aims to describe current clinical practice and identify the barriers and enablers for the assessment of sensory impairment in patients post stroke within acute stroke units. Method: A mixed-methods approach was utilised, with an Australian national cross-sectional online survey of occupational therapists (n = 85) and state-based focus groups (n = 2). Descriptive analyses and thematic analysis were conducted. Findings: The majority of clinicians (78%) use non-standardised measures to assess for somatosensory impairment. Three qualitative themes were identified: acute setting contextual factors, individual patient characteristics and priorities, and clinician knowledge and perceived benefits. Conclusion: Occupational therapists working within acute stroke units are aware of the importance of assessing sensory impairment of the upper limb post stroke. However, the majority use non-standardised approaches and called for a standardised quick-to-administer tool kit that is readily available in acute stroke units. [ABSTRACT FROM AUTHOR]

Introduction: Driver‐trained occupational therapists are advanced practitioners who work with people to help maintain their independence and autonomy through driving. There is a lack of investigation of professional reasoning processes for why interventions are recommended by driver‐trained occupational therapists. This research project sought to explore the reasoning of driver‐trained occupational therapists when they plan, implement, and reflect on driver rehabilitation interventions. Methods: In‐depth semistructured interviews (n = 7) and one focus group (n = 5) were conducted with 12 experienced driver‐trained occupational therapists, comprising a wide range of experience, client populations, and licensing jurisdictions. Data were analysed using a modified template analysis approach. Results: Seven higher order modes that reflect professional reasoning theory and hierarchical models were evident in the work of the driver‐trained occupational therapists, with no new modes of reasoning emerging. Ethical reasoning regarding the balance of safety versus client independence was an overarching shared framework, with therapists mostly using interactive and conditional reasoning in practice. Twenty‐three second‐level themes were identified that exemplify how the reasoning modes operate in practice. Therapists described assessment activity even when solely asked about intervention, indicating the importance of assessment to intervention design. The full hierarchy of reasoning was evident during the rehabilitation phase. Conclusion: These findings elucidate the application of professional reasoning in advanced occupational therapy practices and could support driver‐trained occupational therapists in making driving rehabilitation recommendations if used in reflective practices. [ABSTRACT FROM AUTHOR]

Introduction Home assessments conducted by occupational therapists can identify hazards and prevent falls. However, they may not be conducted because of limited time or long distances between the therapist's workplace and the person's home. Developments in technologies may overcome such barriers and could improve the quality of the home assessment process. Method This scoping review synthesises the findings of studies evaluating information and communication technology use within occupational therapy home assessments. Results Fourteen studies were included and revealed the two main approaches to technology use: the development of new applications and the use of existing and readily available technologies. Facilitators and barriers to use were also identified. Facilitators included usefulness, ease of use and the potential for cost-effectiveness. Barriers to use included poor usability, unsuitability for some populations and perceived threat to the role of occupational therapy. The synthesis revealed that traditional in-home assessments conducted by therapists are more sensitive in identifying hazards. Conclusion The availability of new technologies offers potential to improve service delivery; however these technologies are underutilised in clinical practice. Technologies may offer advantages in the conduct of home assessments, especially regarding efficiency, but have not yet been shown to be superior in terms of patient outcome. [ABSTRACT FROM AUTHOR]

Background/aim Home visits, used by occupational therapists to facilitate independence and enhance safety, are effective but costly and time consuming. This research aims to establish the level of agreement in equipment prescribed by occupational therapists using: digital photographs only, and using home visits and digital photographs, respectively. Method Quasi-experimental methodological design conducted in private dwellings in the community in Adelaide with rehabilitation patients and their family members. The equipment recommended by occupational therapists for the toilet and bathroom using similar methods (both digital photographs from previous data; n = 5) was compared with equipment recommended using different methods (conventional home visits vs. digital photographs; n = 14). Results Percent agreement for equipment prescribed between groups, that is digital only and home visit/photography, respectively, were: 72.5/83.9% for toilet; 87.4/88.3% for bathroom and 83/87% for toilet and bathroom. Variability of agreement in the equipment prescribed showed that some items of equipment were incongruently prescribed, by both methods for toilet and bathroom areas. Conclusion Using digital photographs taken by family members, patient information, and an equipment list is a reliable method of making accurate equipment prescriptions in the toilet and bathroom areas. To enhance accuracy, in-depth patient information via face-to-face interview and measurements of physical environment should be included. [ABSTRACT FROM AUTHOR]

Background/aim Understanding the differences in preferences of patients and occupational therapists for the way in which rehabilitation services are provided is important. In particular, it is unknown whether new approaches to rehabilitation such as high intensity therapy and virtual reality programs are more or less acceptable than traditional approaches. Methods A discrete choice experiment was conducted to assess and compare the acceptability of these new approaches, relative to other characteristics of the rehabilitation program. The study included patients participating in a stroke or medical rehabilitation program (n = 100), occupational therapists (n = 23) and other clinicians (n = 91) working in rehabilitation settings at three hospitals in South Australia. Data were analysed using a conditional (fixed-effects) logistic regression model. Results The model coefficient attached to very high intensity therapy programs (defined as six hours per day) was negative and highly statistically significant for both patients and therapists indicating aversion for this option. In addition, other rehabilitation clinicians and patients were strongly averse to the use of virtual reality programs (as evidenced by the negative and highly statistically significant coefficient attached to this attribute for both groups) relative to occupational therapists. Conclusion The comparison of the views of patients, occupational therapists and other rehabilitation clinicians revealed some differences. All participants (patients and clinicians) showed an inclination for programs that resulted in the best recovery. However, patients expressed stronger preferences than clinicians for traditional therapy approaches. As a group, occupational therapists were most likely to accept approaches such as virtual reality suggesting changes away from traditional delivery methods will be more readily integrated into practice. [ABSTRACT FROM AUTHOR]

This study describes the self-reported driving behaviours of older South Australian drivers in a population survey (n = 3001). People over 65 years of age who drive were more likely to make adjustments to driving, reported lower confidence in driving and had less access to retraining, compared to those under 65. Of those reporting medical conditions (18.1%) people with visual impairment reported the most adjustments to driving, lowest confidence and high access to retraining. This is the first information on adjustments to driving made by South Australians as they age and suggests that interventions by occupational therapists directed at determining those most likely to stop driving, education regarding self-regulation and retraining options arc required. [ABSTRACT FROM AUTHOR]