Kerry Adam

Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: A systematic review

BACKGROUND/AIM Occupational therapists and physiotherapists have established roles in work-related practice. However, there is limited information about the attributes required by these professions for competent practice in this field. The aim of this systematic review was to evaluate the research literature to determine the knowledge, skills and professional behaviours required by occupational therapists and physiotherapists, including new graduates, in work-related practice. METHODS A systematic search was conducted of standard databases using keywords and phrases. All types of studies and reports were included from empirical research to descriptive reports. Included literature was appraised by standard critical appraisal tools by two reviewers. Words, phrases or themes related to the attributes required for work practice were manually extracted and a meta-synthesis conducted. RESULTS Seven observational studies, six professional practice guidelines, one book chapter, one journal editorial and seven opinion pieces met the inclusion criteria. Observational studies and descriptive reports were low on the evidence hierarchy. Meta-synthesis determined that key attributes required by occupational therapists and physiotherapists in work-related practice were knowledge of injury prevention and management, skills in communication, and professional behaviours of self-reflection and evaluation. CONCLUSION Findings from this systematic review provided credible evidence about attributes required by occupational therapists and physiotherapists but not including new graduates, in work-related practice. However, due to low evidence levels findings will need to be applied with caution. More rigorous research is needed to evaluate occupational therapy and physiotherapy workplace interventions to guide practice and to assist occupational therapists and physiotherapists promote the effectiveness of their services.

Knowledge, skills and professional behaviours needed for occupational therapists and physiotherapists new to work-related practice

OBJECTIVES The paper seeks to identify the key knowledge domains, skills and professional behaviours required to prepare occupational therapists and physiotherapists for employment in work related practice. PARTICIPANTS Twelve experienced work related practitioners in one Australian state participated in face to face semi-structured interviews. PARTICIPANTS represented the majority of perspectives in the field and in addition to professional qualifications, a number of participants were employers or contractors of therapists. METHODS The paper reviews existing evidence about knowledge, skills and professional behaviours in the field. The results of a study examining requisite knowledge, skills and professional behaviours for occupational therapists and physiotherapists follow. Interviews were analysed using the Leximancer™ text analysis program developed at The University of Queensland. RESULTS A high level of congruence was evident in key areas of knowledge, skills and professional behaviours between all interviewees and the literature. Findings included the need for very good communication skills by both professions and the need for a sound grounding in specific disciplinary skills. Results identified that occupational therapists take a broad view of function and task analysis and that physiotherapists have good skills in anatomy, musculoskeletal assessment and movement analysis. CONCLUSIONS These results are considered in relation to planning the clinical education of OT and PT students in preparation for work related practice.

Role of research in occupational therapy clinical practice: applying action learning and action research in pursuit of evidence-based practice.

BACKGROUND  In South Africa, as in many other countries, the development of research capacity in students and their early professional career is regarded as of major importance. Within the context of clinical education for occupational therapy students at the University of the Free State, a lecturer and her students embarked on a collaborative journey while fulfilling the requirements of their undergraduate curriculum. The outcome is a model promoting evidence-based practice (EBP) during service development on a dementia care ward. METHODS The practical use of action learning, action research (ALAR) approach in the clinical context, was used to encourage student engagement in successive small-scale research projects while simulating EBP. The projects ranged from the development of therapeutic multi-sensory environments to compiling activity profiles for identified residents. At the same time, students had the opportunity to experience the value of a scientific approach to practice development, which stimulated their awareness of the importance of research. RESULTS Reflection by the researcher contributed towards more effective ways for compiling project assignments and a formalised approach for assessing projects. Students described personal and professional gains because of participation in projects against the life-changing experience of rendering a service to elderly persons suffering from dementia. The formalised approach guiding thoughts and actions finally assisted in developing a practical process model that could support EBP. CONCLUSIONS The ALAR model contributed towards a scholarship of practice where the students, clinical educator and residents of a dementia unit all experienced the value of research.

Injury prevention in the meat industry: Limited evidence of effectiveness for ergonomic programs in reducing the severity of musculoskeletal injuries

Objective of the review: To investigate the effectiveness of occupational health interventions in the meat processing industry on work and health-related outcomes. Design: Systematic review. Search strategies: Key terms were ‘meat processing industry’ including interventions and outcomes (e.g. ‘health promotion’, ‘work ability’, ‘sickness absence’, ‘health status’). A search of databases was conducted including: PubMed, Embase and the Cochrane Library, unpublished studies and grey literature for articles published between 1990 and January 8, 2013. Selection criteria: Studies were included when reporting on intervention outcomes related to work or health, for employees in the meat processing industry defined as – starting at slaughterhouses and finishing with transport to retailers. Only studies performed in upper-middle and high-income countries (World Bank, 2012), and only randomised controlled trials (RCTs) and non-randomised interventions studies were included. Methods of the review: Abstract selection was performed by two reviewers independently and a third reviewer if no consensus reached. The risk of bias was independently assessed by three reviewers, using the checklist for RCTs in the Cochrane Handbook for Systematic Reviews of Interventions and a checklist for observational studies. One reviewer extracted the final dataset. Evidence quality was graded on the basis of study design, risk of bias, inconsistency, indirectness, imprecision, publication bias, effect size, dose–response gradient and confounding. The results of data extraction were synthesised descriptively according to intervention type. Results: Search terms identified 1200 titles; 38 articles were selected for full-text evaluation following exclusion. There was high agreement (K = 0.86) between the two reviewers. After full-text screening, 13 articles reporting on 11 studies remained for data extraction, risk of bias assessment and evidence grading. The 13 articles included two RCT’s and nine non-randomised intervention studies. Studies covered three topics: ergonomics programs, skin protection and Q fever vaccination. There was limited evidence for additional rest breaks in the reduction of discomfort or added productivity over the day. There was moderate evidence for educational activities for reducing eczema prevalence. There was high quality evidence for the effectiveness of Q fever vaccinations. Authors’ conclusions: Authors concluded that there was limited evidence for the effectiveness of workplace health and safety programs in reducing the severity of musculoskeletal injuries, reducing days lost from injury or reducing costs and claims for several musculoskeletal disorders. However, there was moderate evidence for skin protection interventions and strong evidence for Q fever vaccination. Contact details of original author: b.j.van.holland@ umcg.nl

Leading physiotherapists promote occupational health as a rewarding practice area

Interestingly, the paper notes that physiotherapists were enlisted as ‘masseuses’ in World War 1 to treat work injuries. The paper continues that in World War 2 physiotherapists were involved in rehabilitation of injured servicemen, and in the 1960s, physiotherapists began working on site in industry with a focus on injury prevention. The description of the process towards recognition of advanced practice and speciality recognition is clear and informative. A range of issues that were addressed along the way were identified and included standards development, subjects relevant to occupational health physiotherapists (OHPs), assessment processes, and whether the educational or experiential pathway was effective and appropriate. This section is a great strength of the paper and would interest other professions like occupational therapy yet to embark on this complex process. The inclusion of a glossary of terms relevant to this practice area will be useful to therapists considering following the ‘Pathways to OHP Title’ described in the paper. A strong commitment to education and professional development is described by the authors in relation to the way the physiotherapy profession has supported the development of practice in this area. The authors were clearly enthusiastic and passionate about the opportunities for physiotherapists in occupational health practice, and wish ‘to spread the word’.

Prevention of occupational skin cancer

Skin cancers in the context of occupation were first identified in the eighteenth century. There is a significant body of evidence available to identify work-related causation of occupational skin cancers. A detailed sequential occupational history and possible exposures is essential. Levels of evidence are provided for causative agents including chemicals, solar and artificial UVR. The high incidence and prevalence of skin cancer from solar UVR among outdoor workers is well recognized (particularly in Australia) and prevention programs are being delivered and evaluated by governments and industry. Recently documented risk factors for occupational skin cancer are identified. Effective prevention programs will include employer policy, worker education, and environmental controls (PPE).