Mary Edwards

The physical environment as a fall risk factor in older adults: Systematic review and meta‐analysis of cross‐sectional and cohort studies

BACKGROUND/AIM Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. METHODS Eight databases (1985-2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. RESULTS Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. COHORT Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97-1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03-1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59-2.71) and institutional (OR = 1.77; 95% CI: 1.66-1.89) settings. CONCLUSIONS Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.

The effectiveness of community-based occupational therapy education and functional training programs for older adults: a critical literature review

Background. This paper examines the results of a critical literature review describing the provision of education and functional training programs by occupational therapists with older adults to maximize their occupational performance. Purpose. The critical review addressed the following question: What is the effectiveness of education and functional training programs in improving occupational performance and quality of life for older adults? Review methods are described and the outcomes of the critical review discussed. Results. The results indicate that there is evidence that programs are effective in three areas: prevention of functional decline and falls, stroke and rheumatoid arthritis. Methodological limitations exist in some studies. There are several randomized controlled studies in this area, though the description of specific occupational therapy interventions is often vague and the programs could not be easily duplicated by occupational therapists. Practice implications. Occupational therapists are provided with information through this critical review to facilitate evidence-based practice when working with older adults.

Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial

Aim The primary objective of this study was to determine whether adults with a chronic illness within a primary care setting who received a rehabilitation intervention in this setting showed greater improvement in health status and had fewer hospital admissions and emergency room visits compared with adults who do not receive the intervention. Background More than half of Canadians (16 million people) live with chronic illness. Persons with chronic illness in primary care, especially older persons who are most at risk for functional decline, are currently not receiving effective management. Methods A randomized controlled trial was used. A rehabilitation multi-component intervention was delivered by a physiotherapist (PT) and occupational therapist in a primary care setting and included collaborative goal setting for rehabilitation needs, a six-week chronic disease self-management (SM) workshop, referral to community programs and a web-based education programme. Findings Three hundred and three patients participated, n = 152 intervention group and n = 151 in the control group. There was a significant difference between the groups for planned hospital days ( F = 6.3, P = 0.00) with an adjusted difference 0.60 day per person, and increased satisfaction with rehabilitation services however no difference on health status or emergency room visits. This rehabilitation intervention which had a strong SM component prevented planned hospitalizations that resulted in a conservative estimated cost saving from reduced hospitalizations of

Role Emerging Occupational Therapy: Maximising Occupation Focused Practice

65 000. Future research needs to examine which patient groups with chronic illness show positive responses to rehabilitation and self-management.

The Occupational Therapist as a Clinical Teacher

Acknowledgements. Preface. Notes on contributors. Part I: Background to OT, and philosophy of OT and emergence/re-emergence of occupation focussed practice. 1 Emerging occupational therapy practice: Building on the foundations and seizing the opportunities (Matthew Molineux & Sue Baptiste). 2 Models of role emerging placements (Mary Edwards & Miranda Thew). Part II: Current examples of emerging practice for occupational therapists. 3 Successful role emerging placements: It is all in the preparation (Yvonne Thomas & Sylvia Rodger0. 4 The student experience of a role emerging placement (Philippa Gregory, Lydia Quelch & Elisha Watanabe). 5 Promoting well-being in a large organisation: Challenges and opportunities (Miranda Thew). 6 An occupational perspective of a disability-focused employment service (Sally Hall). 7 Promoting occupational therapy in a community health centre (Barry Trentham & Lynn Cockburn). 8 Occupational therapy: Can it make a difference in community cardiac failure? (Emma Brown & Barbara Gurney). 9 Community development (Deborah Windley). Part III: Part Three Future of the profession. 10 Using policy and government drivers to create role emerging opportunities (Lori Letts & Julie Richardson). 11 The way forward? (Sue Baptiste & Matthew Molineux). Index.

The Objective Structured Clinical Examination as a Method of Occupational Therapy Student Evaluation

When clinicians are asked to supervise students in fieldwork placements, it is often assumed that they have the skills to instruct the student in clinical methods and accurately evaluate the students clinical competence. Many therapists feel ill-equipped in this role. This paper describes the components of clinical competence and the characteristics of a good clinical teacher. Three methods of clinical teaching or evaluation (record review, case discussion and direct observation) will be discussed and their application to evaluation of student performance illustrated. Since clinical competence is multi-dimensional, no one tool will adequately evaluate the range of competencies required. Clinicians can be better prepared as clinical teachers if they possess a repertoire of approaches on which to draw for specific areas of clinical competence.

Workload measurement: A survey of computerized data collection.

An Objective Structured Clinical Examination (OSCE) was implemented in the Mohawk-McMaster Occupational Therapy Programme to assess knowledge of theoretical and practical aspects of physical assessment as applied to normal human movement. The OSCE was chosen because it was felt to have the potential to be a more objective and reliable method of evaluation than a practical examination. The OSCE is a circuit examination with a series of stations through which students rotate. Each station is designed to assess objectively one aspect of clinical competence such as knowledge or skill. This paper discusses the implementation of the OSCE, its advantages and disadvantages and will consider appropriate uses of the OSCE for evaluating the clinical skills of occupational therapy students.

Book Review: Spirituality and Occupational Therapy, Second edition, (2011)Spirituality and Occupational Therapy, Second edition, (2011) Mary Ann McColl CAOT Publications ACE. CTTC Building 3400-1125 Colonel By DriveOttawa, ON, Canada, K1S 5R1 304 pages;

The results of a national survey which examined current computer usage and occupational therapist direct entry of Workload Measurement Data is presented. Results indicated an almost equal distribution of departments using computers versus not using computers. A variety of software packages are used for the purposes of collecting workload measurement data, but the majority of departments use customized in-house programmes. The most common method of data entry was a clerk in a central location, however, a number of departments are considering a switch to therapist direct entry. Advantages and disadvantages of both methods were described by survey respondents.

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274 Revue canadienne d’ergothérapie décembre 2012 79(5) ing in healthy older adults aged 64–81: A cohort study into the effects of age, sex, and education. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 14, 40–54. doi:10.1080/13825590969483 Verwey, W. B., Abrahamse, E. L., Ruitenberg, M. F., Jiménez, L., & de Kleine, E. (2011). Motor skill learning in the middle-aged: Limited development of motor chunks and explicit sequence knowledge. Psychological Research, 75, 406–422. doi:10.1007/ s00426-011-0320-0 Waters, D. L., Hale, L. A., Robertson, L., Hale, B. A., & Herbison, P. (2011). Evaluation of a peer-led falls prevention program for older adults. Archives of Physical Medicine and Rehabilitation, 92, 1581–1586. doi:10.1016/j.apmr.2011.05.014 Werner, P., Rosenblum, S., Bar on, G., Heinik, J., & Korczyn, A. (2005). Kinematical analysis of handwriting process in mild cognitive impairment, mild Alzheimer’s disease and healthy elderly persons. Presented at the Third Research Fair of the Faculty of Health and Social Welfare, Haifa, Israel. Wickremaratchi, M. M., & Llewelyn, J. G. (2006). Effects of ageing on touch. Postgraduate Medical Journal, 82, 301–304. doi:10.1136/ pgmj.2005.039651 Wood, K. M., Edwards, J. D., Clay, O. J., Wadley, V. G., Roenker, D. L., & Ball, K. (2005). Sensory and cognitive factors influencing functional ability in older adults. Gerontology, 51, 131–141. doi:10.1159/000082199 Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. Psychology Review, 15, 41–81. doi:10.1023/A:1021371425220 Rosenblum, S., & Werner, P. (2006). Assessing the handwriting process in healthy elderly persons using a computerized system. Aging Clinical and Experimental Research, 18, 433–439. Stelmach, G. E., Goggin, N. L., & Garcia-Colera, A. (1987). Movement specification time with age. Experimental Aging Research, 13, 39-46. doi:10.1080/03610738708259298 Tangalos, E. G., Smith, G. E., & Ivnik, R. J. (1996). The Mini-Mental State Examination in general medical practice: Clinical utility and acceptance. Mayo Clinic Proceedings, 71, 829–837. doi:10.4065/71.9.829 Thomas, P., Hazif Thomas, C., Billon, R., Peix, R., Faugeron, P., & Clément, J. P. (2009). Depression and frontal dysfunction: Risks for the elderly? Encephale, 35, 361–369. doi:10.1016/j. encep.2008.03.012 Trewartha, K. M., Penhune, V. B., & Li, K .Z. (2011). Movement kinematics of prepotent response suppression in aging during conflict adaptation. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 66B, 185–194. doi:10.1093/geronb/ gbq090 Tseng, M. H., & Chow, S. M. K. (2000). Perceptual-motor function of school-age children with slow handwriting speed. American Journal of Occupational Therapy, 54(1), 83-88. doi:10.5014/ ajot.54.1.83 Tseng, M. H., & Murray, E. A. (1994). Differences in perceptualmotor measures in children with good and poor handwriting. Occupational Therapy Journal Research, 14, 19–36. Van Hooren, S. A. H., Valentijn, A. M., Bosma, H., Ponds, R. W. H. M., Van Boxtel, M. P. J., & Jolles, J. (2007). Cognitive function-

47.00 CAOT member) ISBN: 978–1-895437-86-7

This publication provides basic information on ergonomics and injury prevention for work related musculoskeletal injuries, particularly for manual therapists. While it focuses primarily on the hands it also includes the back, neck, shoulders and emotional wellbeing. Written by an ergonomist and massage therapist with input from a physiotherapist, occupational therapist, chiropractor and nutritionist, this book provides a comprehensive approach to injury prevention. Chapters related to risk identification, injury prevention, treatment and recovery are richly illustrated with charts, photos, sidebars and tips highlighting important concepts. Worksheets for self evaluation of risk factors at work are practical and easy to follow. The text refers to an accompanying web site: www.saveyourhands.com to be used in conjunction with the text. However, the site is primarily promoting the authors’ ergonomic and injury prevention workshops. Much of the information presented is similar to the energy conservation and joint protection principles familiar to occupational therapy practice. Injury prevention chapters illustrate modifying equipment, tools, body mechanics and scheduling to reduce risk of injury. The language, while directed at “hands-on” therapists, is very clear and easy to follow so that parts of the text could be used for patient education as well. While much of the information is not new, it is presented in a complete package in this text and would be particularly useful for students, novice practitioners and therapists involved in manual therapy such as hand therapists.