Catherine Donnelly

Individualized Outcome Measures: A Review of the Literature

The client-centred nature of occupational therapy acknowledges the individual as the central element of treatment. This philosophy, however, challenges the therapist to choose an outcome measure that is capable of reflecting this individualized perspective. Recent papers published in the rehabilitation literature have reported on the increased responsiveness of such measures over traditional self-report questionnaires. Although the need for a comprehensive review of individualized outcome measures has been identified in the literature, none exists to date. The purpose of this paper is to review six individualized outcome measures that have been identified in the rehabilitation and psychology literature. The measures include: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, McMaster (MAC) Toronto Arthritis, Goal Attainment Scaling, Target Complaints and the Patient Specific Functional Scale. The reliability, validity, responsiveness and clinical utility of each outcome measure was examined and critiqued. Each tool, to a varying degree, met the description of a standardized, client-centred outcome measure.

Models for Integrating Rehabilitation and Primary Care: A Scoping Study

OBJECTIVE To describe the scope and breadth of knowledge currently available regarding the integration of rehabilitation and primary care services. DATA SOURCES Peer-reviewed journals were searched using CINAHL, MEDLINE, and EBM Reviews for the years 1995 through 2007. This process identified 172 items. STUDY SELECTION To be considered for the subsequent review, the article had to describe a service delivery program that offered primary care and rehabilitation, or services specifically designed for people with chronic conditions/disabilities. Further, it had to be available in English or French. No methodological limitations were applied to screen for levels of evidence. DATA EXTRACTION Based on these criteria, 38 articles remained that pertained to both primary care and rehabilitation. These were reviewed, sorted, and categorized to discover commonalities and differences among the approaches used to integrating rehabilitation into primary care. DATA SYNTHESIS In consultation with the team of investigators, it was determined that there were 6 different models for providing primary health care and rehabilitation services in an integrated approach: clinic, outreach, self-management, community-based rehabilitation, shared care, and case management. In addition, a number of themes were identified across models that may act as either supports or impediments to the integration of rehabilitation services into primary care settings: team approach, interprofessional trust, leadership, communication, compensation, accountability, referrals, and population-based approach. CONCLUSIONS Rehabilitation providers interested in working in the primary care sector may be assisted in conceptualizing the benefits that they bring to the setting by considering these models and issues.

The integration of occupational therapy into primary care: a multiple case study design

BackgroundFor over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration.MethodsA multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires.ResultsEach Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers.ConclusionWith an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group. An understanding of professional roles, trust and communication are foundations for interprofessional collaborative practice.

Factors predicting applicant outcomes in occupational therapy education.

Background. Student selection for health science programs is a complex process designed to identify individuals who are most likely to succeed academically and professionally. There is limited evidence supporting specific admission criteria beyond the pre-admission GPA, and no strong evidence substantiating the need for specific academic prerequisites. Purpose. This study examined the predictive value of selected pre-admissions criteria relative to student outcomes in a master of occupational therapy program. Methods. The study involved analysis of data for 129 students admitted to a new master in occupational therapy program. Findings. Results show strong support for the pre-admission academic average as a selection criterion and limited support for referee ratings. No evidence was found linking pre-admission coursework to subsequent performance in courses of similar content. Implications. Results provide evidence upon which to ground admissions decisions, and point to the need for further examination of the value of extensive pre-admission course requirements.

Digital Storytelling: An Innovative Tool for Practice, Education, and Research

ABSTRACT Digital storytelling is a method of using storytelling, group work, and modern technology to facilitate the creation of 2–3 minute multi-media video clips to convey personal or community stories. Digital storytelling is being used within the health care field; however, there has been limited documentation of its application within occupational therapy. This paper introduces digital storytelling and proposes how it can be applied in occupational therapy clinical practice, education, and research. The ethical and methodological challenges in relation to using the method are also discussed.

The emerging role of occupational therapy in primary care.

Background. Few studies have examined the role of occupational therapy working in a primary care setting. Purpose. The objective of the study was to describe the emerging role of occupational therapy in Family Health Teams, a model of interprofessional primary care. Method. A multiple case study design was used to provide in-depth description of the occupational therapy role. Data collection included interviews, document analyses, and questionnaires. Each case was first analyzed individually, followed by cross-case analyses to determine common themes. Findings. The role of occupational therapy in Family Health Teams epitomizes that of a generalist, whose overarching focus is on function. Occupational therapists are working across the life span with a wide range of client populations. Older adults and individuals with complex chronic conditions are two prominent areas of occupational therapy focus. Implications. Understanding the impact of health conditions on daily function and enabling participation in activities are unique and important contributions of occupational therapy. Description. Peu d’études se sont penchées sur le rôle de l’ergothérapeute travaillant dans un milieu de soins primaires. But. L’objectif de l’étude était de décrire le nouveau rôle de l’ergothérapie au sein des équipes de santé familiale, un modèle de soins primaires interprofessionnels. Méthodologie. Un devis d’étude de cas multiple a été utilisé pour donner une description approfondie du rôle de l’ergothérapie. La cueillette de données comprenait des entrevues, des analyses de documents et des questionnaires. Chaque cas a d’abord été analysé de manière individuelle, puis à partir d’analyses globales de cas, en vue de déterminer des thèmes communs. Résultats. Le rôle de l’ergothérapie dans les équipes de santé familiale est la parfaite illustration de celui d’un généraliste qui met l’accent sur les capacités fonctionnelles. Les ergothérapeutes travaillent avec un large éventail de clientèles, à toutes les étapes de leur vie. Les personnes âgées et les personnes ayant des problèmes complexes et chroniques sont deux domaines sur lesquels l’ergothérapie met l’accent. Conséquences. L’ergothérapie contribue de manière unique et déterminante à la compréhension de l’impact des problèmes de santé sur le fonctionnement quotidien et à l’habilitation de la participation à des activités.

Best practices in the rehabilitation of acute musculoskeletal disorders in workers with injuries: an integrative review and analysis of evolving trends.

OBJECTIVE Strategies for the restoration of function and job performance in workers with musculoskeletal disorders have changed considerably since industrial rehabilitation became a distinct specialization in the 1980s. A rich body of research concerning approaches to medical and rehabilitative management of these disorders exists, resulting in a large number of hybrid approaches worldwide. METHODS This integrative review examined the evidence base for best practices in the rehabilitation of acute musculoskeletal workplace injuries, and also mapped the evolution of approaches over the past thirty years. Contextual factors that may have contributed to change were assessed through analysis of changing practice trends and review of descriptive literature over time. RESULTS A clear movement away from simplistic, unidimensional approaches towards comprehensive workplace interventions is evident. Economic concerns and growing government and insurance regulation of workplace safety and injury management were the likely drivers of change. While the contributions of various elements of disability management in the workplace were examined, many features of onsite interventions remain to be examined. CONCLUSIONS A strong body of research has produced notable advances in management of acute musculoskeletal workplace injury. Research concerning the delivery of workplace-based interventions, the role of workplace environment factors and a range of worker outcomes will further advance knowledge in this field.

Occupational therapy in primary care: Results from a national survey

Background. To support integration of occupational therapy in primary care and research in this area, it is critical to document examples of occupational therapy in primary care. Purpose. This study describes occupational therapy roles and models of practice used in primary care. Method. An electronic survey was sent to occupational therapists across Canada. Participants were identified using purposive and snowball sampling strategies. Descriptive statistics were used to analyze the data. Findings. Respondents (n = 52) were almost exclusively working on interprofessional teams. Intervention was provided most frequently to individual clients, and services were provided both within the home/community and in the clinic. Occupational therapists offered a range of health promotion and prevention services, predominantly to adults and older adults. A number of supports and barriers to the integration of occupational therapy were identified. Implications. A growing number of occupational therapists are working in primary care providing a broad range of services across the life span.

Using program evaluation to support knowledge translation in an interprofessional primary care team: a case study

BackgroundEvaluation is a fundamental component in building quality primary care and is ideally situated to support individual, team and organizational learning by offering an accessible form of participatory inquiry. The evaluation literature has begun to recognize the unique features of KT evaluations and has described attributes to consider when evaluating KT activities. While both disciplines have focused on the evaluation of KT activities neither has explored the role of evaluation in KT. The purpose of the paper is to examine how participation in program evaluation can support KT in a primary care setting.MethodsA mixed methods case study design was used, where evaluation was conceptualized as a change process and intervention. A Memory Clinic at an interprofessional primary care clinic was the setting in which the study was conducted. An evaluation framework, Pathways of Influence provided the theoretical foundation to understand how program evaluation can facilitate the translation of knowledge at the level of the individual, inter-personal (Memory Clinic team) and the organization. Data collection included questionnaires, interviews, evaluation log and document analysis. Questionnaires and interviews were administered both before and after the evaluation: Pattern matching was used to analyze the data based on predetermined propositions.ResultsIndividuals gained program knowledge that resulted in changes to both individual and program practices. One of the key themes was the importance clinicians placed on local, program based knowledge. The evaluation had less influence on the broader health organization.ConclusionsProgram evaluation facilitated individual, team and organizational learning. The use of evaluation to support KT is ideally suited to a primary care setting by offering relevant and applicable knowledge to primary care team members while being sensitive to local context.

Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial

BackgroundBack pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to:1)Determine feasibility of patient recruitment, assessment procedures, and retention.2)Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP)3)Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes.MethodsThis pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites.DiscussionIf this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas.Trial registrationClinicalTrials.gov, NCT03320148. Submitted for registration on 17 September 2017.