Dana M. Howell

A narrative review of dexterity assessments.

NARRATIVE REVIEW: This article is a narrative review of the psychometric properties (reliability and validity) and other characteristics (cost, time to administer, and year of publication) of commercially available manual and finger dexterity assessments used for adults in the United States. Complete research articles related to dexterity assessments were gathered from online database searches and individually critiqued for scientific rigor based on reliability and validity. Articles relating to 14 dexterity assessments were reviewed. All but three tools had established reliability, seven tools had all five forms of validity established, and two had only face and content validity. The results of this review provide information to those interested in fine motor skill acquisition, impairment, or functional recovery after injury. Therapists may use this information to choose the best assessment instrument to evaluate a patients recovery of function over time. This review adds to the evidence-based, best-practice literature related to assessment and outcome measurements of patients with limited dexterity function participating in rehabilitation.

Clarifying Analysis and Interpretation in Grounded Theory: Using a Conditional Relationship Guide and Reflective Coding Matrix

Although qualitative methods, grounded theory included, cannot be reduced to formulaic procedures, research tools can clarify the process. The authors discuss two instruments supporting grounded theory analysis and interpretation using two examples from doctoral students. The conditional relationship guide contextualizes the central phenomenon and relates categories linking structure with process. The reflective coding matrix serves as a bridge to the final phase of grounded theory analysis, selective coding and interpretation, and, ultimately, to substantive theory generation.

Defining the Lived Experience of Older Adults With Voice Disorders

OBJECTIVES The purpose of this qualitative phenomenological study was to gather rich thick descriptive data regarding the lived experiences of older adults seeking treatment for a voice disorder. DESIGN Using qualitative methodologies, participants completed semi-structured interviews with trained investigators to detail their thoughts, beliefs, feelings, and experiences of living with a voice disorder. Using a process of horizontalization, themes were identified that described the experiences of older adults with voice disorders. SETTING Research was conducted at four clinical voice centers in Kentucky, Wisconsin, and Ohio. Data were analyzed in the Laryngeal and Speech Dynamics Lab at the University of Kentucky. PARTICIPANTS A total of 28 adults (aged 65-90 years) with voice disorders were recruited for this study. RESULTS AND CONCLUSIONS Aging adults demonstrated a strong urge to communicate; however, they tended to describe their voice quality in negative terms and were emotionally impacted by these associations. They admitted to withdrawing from some activity or social event because their voice did not meet their expectations or voice needs; thought their voice quality was part of normal aging; and had resigned to accept their current voice.

Practice patterns when treating patients with low back pain: a survey of physical therapists.

Abstract Low back pain (LBP), is a common musculoskeletal problem, affecting 75–85% of adults in their lifetime. Direct costs of LBP in the USA were estimated over 85 billion dollars in 2005 resulting in a significant economic burden for the healthcare system. LBP classification systems and outcome measures are available to guide physical therapy assessments and intervention. However, little is known about which, if any, physical therapists use in clinical practice. The purpose of this study was to identify the use of and barriers to LBP classification systems and outcome measures among physical therapists in one state. A mixed methods study using a cross-sectional cohort design with descriptive qualitative methods was performed. A survey collected both quantitative and qualitative data relevant to classification systems and outcome measures used by physical therapists working with patients with LBP. Physical therapists responded using classification systems designed to direct treatment predominantly. The McKenzie method was the most frequent approach to classify LBP. Barriers to use of classification systems and outcome measures were lack of knowledge, too limiting and time. Classification systems are being used for decision-making in physical therapy practice for patients with LBP. Lack of knowledge and training seems to be the main barrier to the use of classification systems in practice. The Oswestry Disability Index and Numerical Pain Scale were the most commonly used outcome measures. The main barrier to their use was lack of time. Continuing education and reading the literature were identified as important tools to teach evidence-based practice to physical therapists in practice.

Interprofessional clinical education for occupational therapy and psychology students: A social skills training program for children with autism spectrum disorders

An interprofessional clinical learning experience was developed for pre-licensure occupational therapy (OT) and psychology graduate students. Students worked in interprofessional teams to plan and implement a social skills training program for children with autism spectrum disorders (ASD). The objectives were to provide a hands-on, student-led clinical experience; facilitate interprofessional collaborative learning through leadership partnerships and teach children with ASD to engage in appropriate social skill behaviors. Concurrently, faculty performed qualitative research to explore how the students worked together to provide intervention to the children. Data were collected via interview, direct observation of student planning sessions and student interprofessional interactions, and collection of posts from an online social network site used for session planning. There were six student participants and two faculty participants. Four themes emerged: learning who I am as a professional, learning to appreciate our professional differences, learning to communicate with each other and figuring it out, for the benefit of the kids. This interprofessional clinical learning experience and research helps ensure that students are adequately prepared to represent their profession as part of a diverse interprofessional health care team.

A model to increase rehabilitation adherence to home exercise programmes in patients with varying levels of self-efficacy

Patient adherence to rehabilitation programmes is frequently low - particularly adherence to home exercise programmes. Home exercise programmes have been identified as complementary to clinic-based physical therapy in an orthopaedic setting. Barriers to patient adherence have previously been identified within the literature. Low self-efficacy is a barrier to adherence that clinicians have the ability to have an impact on and improve. The theory of self-efficacy is defined as a persons confidence in their ability to perform a task. This theory examines the ability of a person to change through exerting control over inner processes of goal setting, self-monitoring, feedback, problem solving and self-evaluation. If clinicians are able to identify patients with low self-efficacy prior to the prescription of a home exercise programme, adjustments to individualized care can be implemented. Individualized care based on improving self-efficacy for home exercise programmes may improve patient adherence to these programmes. The purpose of this article was to use the theory of self-efficacy to direct clinicians in providing individualized programmes to patients with varying levels of self-efficacy.

Systematic Review of Interventions to Improve or Augment Handwriting Ability in Adult Clients

This systematic review examined research related to interventions that addressed handwriting deficits in adults with impaired upper limb motor coordination resulting from central and peripheral nervous system injury or illness. The clinical question was, “Based on current research, what is/are the recommended intervention(s) to improve, augment, or replace handwriting skills among adult clients with upper limb motor deficits?” A research protocol was followed, which was modified to include pediatric literature after an initial search of interventions for adults proved limited. Four studies related to adults and 10 related to pediatrics were included in the review and all were evaluated for quality using standardized procedures. The adult studies addressed the use of voice recognition software and hand dominance transfer training. Available evidence for interventions with children with handwriting deficits centered around these clinical options: Cognition Orientation to Daily Occupational Performance, task-orientated self-instruction, ergonomic modifications to a desk, school-based intervention (emphasis on visual motor skills and practice), sensory diet with therapeutic listening, therapeutic practice, and a graphomotor program. Improvement in handwriting skill emerged from seven of the 10 pediatric studies. Direct practice of handwriting tasks was common to all successful studies and missing in studies that failed to show skill improvement. It may be logical to conclude that intervention strategies should include direct practice of handwriting, whether the client is an adult or a child. Further research on handwriting intervention programs specifically for adult clients and the inclusion of direct practice as intervention is warranted.

Factors Predicting Client Satisfaction in Occupational Therapy and Rehabilitation

Client satisfaction, a widely used outcome indicator of quality in health care, is inherently client centered and important in occupational therapy. We developed an instrument called the Satisfaction With Continuum of Care Revised (SCC-R) and tested a logistic regression model of satisfaction for six predictive research questions. Data collected from 769 clients from a large rehabilitation hospital using the SCC-R were paired with data that included demographics, functional status, and measures of the rehabilitation including occupational therapy. Satisfaction was stratified into two groups, satisfied and dissatisfied. The most robust and consistent predictors of satisfaction were functional status and improvements in functional status, presence of a neurological disorder, total rehabilitation hours, and admission to rehabilitation within 15 days of condition onset. The finding that improvements in functional status, especially self-care, were predictive of satisfaction is particularly relevant for occupational therapy. Implications for practice and future research are discussed.

Prescription Medication Use and Health-Related Quality of Life in Rural Elderly

The purpose of this descriptive study was to examine health-related quality of life (HRQoL) and prescription medication use among older adults living in a rural region of America. Forty-four people aged 65 and older participated. Each participant completed the SF-36®, v2™ and a demographic form. Participants had significantly lower physical component summary (PCS) scores compared to national norms, confirming established evidence that physical function declines with age. Results indicate that medication use did not have an effect on perceived HRQoL although participants reported taking fewer prescription medications than the national average for the elderly.

International service learning and interprofessional education in Ecuador: Findings from a phenomenology study with students from four professions

Abstract Combined international service learning (ISL) and interprofessional education (IPE) experiences can move health professional student learning beyond the traditional confines of the classroom and outside uniprofessional ethos. The purpose of this transcendental phenomenological study was to describe the shared experience of health professional students participating in an ISL trip to a small community in Ecuador. The study focused on the learning and collaboration that occurred among students from multiple health professions during the trip and the cross-cultural exchange between the students and the patients in Ecuador. Participants included 15 students from 4 health professional programmes (pharmacy, medicine, physical therapy, and nursing). Data included interviews, focus groups, observation, and written documents. The essential meaning that emerged from this study was that the ISL/IPE learning opportunity created a practical opportunity for demystifying other healthcare professions in the context of a resource-limited international patient care setting, while supporting students’ personal and professional development. Four structural themes emerged to describe the student experiences. Students had to negotiate the language barrier, limited resources, and unexpected diagnoses, while simultaneously learning about the roles and scope of other professions on the team and how to communicate effectively. Student’s perseverance when facing the challenges resulted in their personal growth. The interprofessional component strengthened the students’ knowledge of interprofessional collaboration and communication through real-world application.