Effects of Integrated Therapy: A Pilot Study

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million.1 Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths.2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs).4,5 Notwithstanding the substantial progress in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke,6 the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care1; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery. Because there remains a …

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapists, occupational therapy assistants, and occupational therapy aides and in the appropriate and effective provision of occupational therapy services. It is expected that occupational therapy services are delivered in accordance with applicable state and federal regulations, relevant workplace policies, the Occupational Therapy Code of Ethics (AOTA, 2005), and continuing competency and professional development guidelines.

As I wrote the Editorial for the last issue of the journal, I could never have imagined the different world in which we now live as a result of COVID-19. The importance of information that is consistent and evidence-based has never been more essential for occupational therapists and the people who access our services. Occupational Therapy Australia have supported the profession with lobbying and advocacy activities, regular communications, and resources such as guidelines that outline the practical and ethical considerations for delivering clinical care using telehealth (Occupational Therapy Australia, 2020). The sudden move to online technologies has been experienced by many within the profession and this editorial will discuss online learning within occupational therapy education. In the COVID-19 response, university educators were required to move all teaching and assessment activities online at relatively short notice. As a result, all classes, simulations, practicums, vivas, and assessment, etc. were adapted for the online environment and launched. From an educator perspective, the hours of planning and preparation, and the newly developed skills have been exceptional. From a student perspective, there has been adaptation and the opportunity to develop new skills, possibly including the provision of occupational therapy services via telehealth. As an example, imagine an online classroom with five breakout rooms—within each breakout room there is an actor who is a simulated patient. Each simulated patient will meet with a different student every 20 min in an occupational therapy session, and 100 students will have this experience across the day. In the background, staff are marshalling the students, coordinating the entry into and out of the virtual breakout rooms, and providing feedback and support to the students and actors. This type of activity is exhausting for staff and anxiety producing for students when conducted face-to-face in rooms along an actual corridor—and this is magnified when conducted virtually. All educators, students, support staff, and actors are to be congratulated for what you have navigated and achieved. This is not the first time that learning has been delivered online within occupational therapy curricula. Blended learning is the preferred approach of education providers, promoting the integration of online and traditional face-to-face learning experiences within a program. However, this is the first time that all learning has been delivered online and, from an organisational perspective, each university will undoubtedly seek to understand the student experience and explore what can be retained as online learning into the future. There is a need for caution here: these changes have been made in a short timeframe, under extreme circumstances, and it is important that any future decisions consider the impact on the learning environment and the learning outcomes. More importantly, it is essential that we consider the ongoing issue of equity. COVID-19 and the switch to online learning has created inequities within the student body. Students are disadvantaged when they do not have access to a computer or internet at home. This has been particularly noticeable during the COVID-19 online learning environment when all alternate options for computer and internet access were unavailable, such as in public libraries or university campuses. From a curriculum perspective, it is essential to review how online learning aligns with the pedagogy of the program, and the experience and well-being of the students. Students in the current online environment have spoken of challenges with self-regulation skills such as time management and motivation, and that they feel isolated and distant from the learning. This experience aligns with previous findings that student challenges in the online environment of blending learning include: self-regulation; technological literacy and competency; student isolation; technological sufficiency; and technological complexity (Rasheed, Kamsin, & Abdullah, 2020). There is a need to keep the focus on the students, their experiences, and their learning. Smith and Hill (2018) highlight that blended learning is only effective when the purpose of the online content is clear with explicit links made to the face-to-face classes. The learning environment is complex and further research is required to determine when and how online learning can support occupational therapy curricula to achieve their learning and graduate outcomes. In conclusion, occupational therapy education has momentarily gone online. The educators and occupational therapy students have demonstrated that we can adapt courses and programs to an online format, and both groups will have undoubtedly gained transferrable skills within this online environment. However, despite demonstrating that it is possible, it is important to remember that this change has been undertaken during a crisis situation, and we must move carefully forwards adopting an evidence-based approach. Blended learning should remain the preferred approach and research is required to establish what online components can remain to support the development of occupational therapy knowledge, skills, and competencies.

Background: Literature indicates that access to rehabilitation services in South Africa is limited. Recent policy documents by the National Department of Health related to disability and rehabilitation propose the integration of occupational therapy services in primary healthcare (PHC). However, the implementation strategies concerning integration are not clear as there is inadequate evidence locally on the occupational therapy service provision in PHC even though there is growing evidence internationally.Purpose: This study sought to determine the services provided by occupational therapists in PHC and to explore the perceptions of the occupational therapists on the integration of occupational therapy services within the PHC reengineering streams of the National Insurance (NHI).Method: A two-phase explanatory sequential mixed method strategy was utilised in this study. A quantitative survey was sent to members of the occupational therapy professional association and an organisation of professionals providing rehabilitation services in rural communities. Qualitative data were then collected using semi-structured interviews with five therapists who completed the survey.Findings: Findings from this study showed there is increasing alignment of occupational therapy services in PHC with the community-based rehabilitation (CBR), the Social Model, the International Classification of Functioning, Disability and Health (ICF) and the Medical Model using client self-management and case-management intervention approaches. The majority of occupational therapists are currently based in district hospitals (42%), community health centres (16%), community organisations (8%), and clinics (8%).Those working in the community indicated they work in a multidisciplinary team (MDT). They also use PHC service delivery models to manage people with disabilities (PWDs). Occupational therapists in PHC have a strong perception of their relevance in the PHC reengineering streams, despite the numerous barriers and few facilitators to the integration of occupational therapy services in the PHC reengineering streams of the NHI.Conclusion: The perception of the study participants is that occupational therapy service integration in the PHC reengineeringstreams will lead to improved healthcare. However, they are also of the opinion that integration will not happen without advocacy from occupational therapists or occupational therapy being adequately supported in PHC. Key words: Occupational therapy, primary health care re-engineering, integration, National Health Insurance, universal health coverage.

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapy personnel and in the appropriate and effective provision of occupational therapy services. All personnel are expected to meet applicable state and federal regulations, adhere to relevant workplace policies and the Occupational Therapy Code of Ethics (AOTA, 2000), and participate in ongoing professional development activities to maintain continuing competency.

Official documents and professional policies are approved by the AOTA Representative Assembly and undergo scheduled review and approval by the Representative Assembly Coordinating Committee (RACC). These documents are used by the Association and its membership to guide education, practice, advocacy, and policy on behalf of the profession. The documents are a valuable resource for occupational therapy practitioners and provide a solid grounding in the profession for students, consumers, and external stakeholders.Items in bold are new for 2022 and are available in this supplement to the American Journal of Occupational Therapy. Official documents are periodically reviewed, and documents may be superseded by newer versions or rescinded. A complete list of the most current documents is available at https://www.aota.org/practice/practice-essentials/aota-official-documents.Guidance documents provide comprehensive perspective and guidance on topics that shape advancement of the profession and its future direction. ▪ Guidelines for Documentation of Occupational Therapy (2018)▪ Guidelines for Occupational Therapy Services in Early Intervention and Schools (2017)▪ Guidelines for Reentry Into the Field of Occupational Therapy (2020)▪ Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2020)▪ Occupational Therapy Practice Framework: Domain and Process, 4th Edition (2020)▪ The Practice of Occupational Therapy in Feeding, Eating, and Swallowing (2017)▪ A Descriptive Review of Occupational Therapy Education (2016)▪ Scholarship in Occupational Therapy (2022)Position statements present an official stance on the provision of services, practice of occupational therapy, or role of occupational therapy. They are developed in response to a professional issue, concern, or need. ▪ COE Academic Terminal Degree (2022)▪ Assistive Technology and Occupational Performance (2016)▪ Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services (2022)▪ Cognition, Cognitive Rehabilitation, and Occupational Performance (2019)▪ Continuing Professional Development in Occupational Therapy (2016)▪ Driving and Community Mobility (2016)▪ Fieldwork Level II and Occupational Therapy Students (2018)▪ Importance of Collaborative Occupational Therapist-Occupational Therapy Assistant Intraprofessional Education in Occupational Therapy Curricula (2017)▪ Importance of Interprofessional Education for Occupational Therapy (2022)▪ Importance of Primary Care Education in Occupational Therapy Curricula (2017)▪ Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments (2022)▪ Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice (2017)▪ Occupational Therapy and Complementary Health Approaches and Integrative Health (2016)▪ Occupational Therapy Doctoral Capstone: Purpose and Value (2022)▪ Occupational Therapy Fieldwork Education: Value and Purpose (2022)▪ Occupational Therapy for Children and Youth Using Sensory Integration Theory and Methods in School-Based Practice (2015)▪ Occupational Therapy in the Promotion of Health and Well-Being (2019)▪ Occupational Therapy Scope of Practice (2021)▪ Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence (2017)▪ Occupational Therapy Services in Facilitating Work Participation and Performance (2017)▪ Occupational Therapy Services in the Promotion of Mental Health and Well-Being (2016)▪ Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion (2020)▪ Occupational Therapy’s Perspective on the Use of Environments and Contexts to Facilitate Health, Well-Being, and Participation in Occupations (2015)▪ Occupational Therapy’s Role in Case Management (2018)▪ Occupational Therapy’s Role in Medication Management (2017)▪ Occupational Therapy’s Role in the Neonatal Intensive Care Unit (2018)▪ Occupational Therapy’s Role With Chronic Conditions (2022)▪ Philosophical Base of Occupational Therapy (2017)▪ Philosophy of Occupational Therapy Education (2018)▪ Role of Occupational Therapy in End-of-Life Care (2016)▪ Role of Occupational Therapy in Pain Management (2021)▪ Physical Agents and Mechanical Modalities (2018)▪ Role of Occupational Therapy in Primary Care (2020)▪ Role of Occupational Therapy in Wound Management (2018)▪ Telehealth in Occupational Therapy (2018)▪ Value of Occupational Therapy Assistant Education to the Profession (2019)▪ Vestibular Impairment, Vestibular Rehabilitation, and Occupational Performance (2017)Professional standards describe and define minimal standards for practice, continued competence, and other professional behaviors. ▪ AOTA 2020 Code of Ethics▪ Standards for Continuing Competence (2021)▪ Standards of Practice for Occupational Therapy (2021)Societal statements are written in the form of public announcements and identify a societal issue of concern; state how the issue affects the participation of individuals, families, groups, or communities in society; and may offer action to be taken by individuals, families, groups, or communities. ▪ AOTA’s Societal Statement Denouncing Conversion “Therapy” (2022)▪ AOTA’s Societal Statement on Disaster Response and Risk Reduction (2017)▪ AOTA’s Societal Statement on Community Violence (2022)▪ AOTA’s Societal Statement on Gun Violence (2022)▪ AOTA’s Societal Statement on Health Disparities (2013)▪ AOTA’s Societal Statement on Health Literacy (2016)▪ AOTA’s Societal Statement on Livable Communities (2016)▪ AOTA’s Societal Statement on Stress, Trauma, and Posttraumatic Stress Disorder (2017)▪ AOTA’s Societal Statement on Youth Violence (2016)▪ Specialized Knowledge and Skills of Occupational Therapy Educators of the Future (2009)

Telehealth Opportunities in the Digital Age

Development of a Unique Screening Tool for Acute Care Occupational Therapy Services in Patients Following Total Joint Replacement Surgery

Investigating Preseason Symptoms of Depression and Concussion in Adolescent Athletes

We have identified severely disabled arthritics who live in the community through social service records. All had either rheumatoid arthritis (RA) or osteoarthritis (OA). The diagnosis influenced referral to hospital, those with RA being referred while only half of those with OA had been referred. Referral was important for both surgical and environmental intervention. Provision of social services and community occupational therapy services was greater if the patients had been seen in hospital departments irrespective of the diagnosis. Recipients of joint surgery had all gained temporary benefit although progression of arthritis or other disabling disease compromised this after several years. There was a substantial minority of people with severe OA living in the community who had not been considered for joint replacement and did not have optimal provision of aids, appliances and environmental adaptation.

ObjectiveThe objective was to compare home care episode, standardised assessment, and service patterns in Ontario’s publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference.Study design and settingWe plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient’s most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models.ResultsThe March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind.ConclusionThe first wave of the COVID-19 pandemic was associated with substantial changes in Ontario’s publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.

Occupational therapy is an important component of neurological rehabilitation. Clients in rural areas have fewer opportunities to receive rehabilitation than those in metropolitan areas. Telehealth is a potential method of closing these gaps in service delivery, although research into telehealth applications for neurological rehabilitation is extremely limited. To assist in the development of appropriate telehealth applications, this study aimed to identify the nature of occupational therapy services for neurological rehabilitation in areas of Queensland other than the capital city of Brisbane, the barriers to service delivery, and the current uses of various information and communication technologies among occupational therapists. A self-administered questionnaire was sent to occupational therapists working in adult neurological rehabilitation in all areas of Queensland other than the capital city of Brisbane. Contact details were obtained from OT AUSTRALIA Queensland. Responses were received from 39 eligible participants. The client's home was the most frequent setting in which participants saw clients. Home visits and modifications, equipment prescription, client/family education, and activities of daily living assessment and retraining were the most common interventions provided by participants. Frequently identified barriers to service provision included travelling distance to clients, large workloads and limited resources. Telephone, email, fax, the Internet and videoconferencing were available in most workplaces. Few participants used the Internet or videoconferencing for purposes other than continuing professional development. Home-based assessment and intervention appear to be frequent components of occupational therapy practice among therapists working in neurological rehabilitation. The use of telehealth to provide direct home-based client services is currently limited, but should be explored as a possible solution to overcome some of the identified barriers to occupational therapy service provision for clients with neurological conditions in rural and remote areas.

Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p > 0.0014) and indirect (p = 0.001) occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p = 0.001). Patients admitted to the metropolitan hospital received more face-to-face (p > 0.000) and indirect (p > 0.000) physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p > 0.000). Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient's first therapy session.

Purpose: The purpose of this study was to examine barriers to accessing physical therapy (PT) services in Ontario primary health care with respect to funding sources and wait times. Methods: A stratified random sample of 1100 registered Ontario PTs and 3000 Ontario family physicians were surveyed by mail in 2004. Relationships were examined between PT wait times, funding source, geographical region and caseload composition. Results: Physicians identified the cost of private rehabilitation and long wait times as the most common barriers to referring patients to rehabilitation. Wait times for PT were longer in publicly funded settings than in privately funded practice settings (p, 0.001) and in the North (p, 0.001) and East (p 5 0.010) regions of Ontario compared with the most urban region of Ontario. Patients with chronic musculoskeletal conditions, cardiopulmonary conditions and general debility were at least three times more likely to receive PT services at publicly funded than privately funded practice settings. Furthermore, patients with acute musculoskeletal conditions were less likely to receive PT services in publicly funded practice settings (odds ratio 5 0.11, 95% confidence interval 5 0.05-0.23). Conclusions: Current Ontario health-care structures may affect access to PT services for vulnerable populations such as those with chronic conditions, those lacking private health insurance and those living in less urban regions of Ontario.

Some emergency departments (EDs) in the UK, North America and Australia have provided occupational therapy (OT) services for over 10 years; however, little is known about practice patterns as previous literature has focussed on single programmes or the generic contribution of allied health multidisciplinary teams to ED throughput and safe discharge. To describe practice patterns of OT services in Australian EDs. Of 129 Australian public hospital EDs, 41 were identified to have offered OT services in the past 5 years (32%). Using snowball sampling an investigator designed survey was sent to 51 occupational therapists who were identified to have worked in these EDs in the past 5 years. 30 subjects (58% response rate) from 21 sites participated. Mean age 30.4, 29 females, one male and an average of 9-year clinical experience. OT service was usually provided within multidisciplinary or interdisciplinary teams by full-time employed staff and patients were overwhelmingly Australian Triage Scale level 4 or 5 and were over 65 years. Few standardized assessment or outcome measures were used. The OT role was consistently focussed on functional assessment and provision of interventions such as equipment prescription, patient education and referral to community and support services to ensure safe discharge or inform inpatient admission decisions.