Date Presented 04/04/19
Secondary effects of burn injury, such as scarring and contractures, impair occupational performance. Home programs (HP), which may include exercises, splint or garment wear, and functional activities, are used by OT practitioners to extend care postdischarge. This study utilized a descriptive survey to gather information from OT practitioners across the US. This poster will describe OT practice patterns for this population.
Primary Author and Speaker: Ann Cook
Additional Authors and Speakers: Elena Donoso-Brown, Margaret Hyland
PURPOSE: Following a burn injury, secondary effects such as scarring and contractures impair occupational performance (Cheng & Rogers, 1989). Home programs (HP), which may include exercises, splint/garment wear, and functional activities, are tools occupational therapy practitioners (OTP) use to extend care post-discharge (Oosterwijk, Mouton, Schouten, Disseldorp, van der Schans, & Nieuwenhuis, 2017). Although current literature expresses the significance activity has on increasing functional outcomes, there is a gap in the literature about how OTP are creating and implementing HP, what therapeutic components are included in HP, and the rate of patient adherence to HP. This study analyzed how certified occupational therapists and occupational therapy assistants who work with individual’s post-burn design and implement HP.
DESIGN: This study used a cross-sectional descriptive design, through the use of a clinician-reported online survey. The potential participant pool included 72 licensed OTP from American Burn Association (ABA) verified burn centers across the United States, whose managers agreed to distribute the survey. Participants were requested to have designed at least two HP for clients with burn injuries within the last two months. A total of 39 responses were gathered across a 4-month period.
METHOD: The final survey had 25 items including multiple choice, multiple select, and open-ended questions. Question topic areas encompassed demographic information of the practitioners, frequency of HP prescription, HP components, and the prevalence of adherence to HP. The survey was based on a previous survey and piloted with two clinicians who had experience with individuals post-burn, but who would not be eligible for participation based on inclusion criteria. Primary contacts were e-mailed three times across a four week period. Descriptive statistics including means and standard deviations were calculated for quantitative questions. Data from open-ended questions were analyzed using content analysis, placing responses in similar categories.
RESULTS: The response rate was 54% (n=39) of the potential pool. Twenty-two respondents (56%) provided acute care and about thirteen (33%) had over 20 years of experience, nine (23%) had 10-20 years of experience, and fifteen (38%) had less than 10 years of experience. Preliminary data indicated 32 respondents (82%) always or almost always created HP. HP creation software was the most used application of technology. Twenty respondents (51%) indicated that they always or almost always used specific software to create HP. Twenty-seven respondents (69%) listed range of motion exercises as commonly prescribed while only ten respondents (26%) reported functional activity as commonly prescribed. Thirty-five respondents (90%) reported pain and motivation to be barriers to HP adherence. Further in-depth analysis will be presented on the poster.
CONCLUSION: This description of OTPs’ self-report on implementing HP for individuals post-burns provides an initial description of practice patterns. As in other populations, HP prescription is a common practice that occurs with most clients. There is an emphasis on rote exercises over functional activities. In contrast to other populations, pain and motivation were considered the greatest barriers to adherence. Impact statement: This study provides a description of current practice patterns and will support future research into methods to make HP more effective for individuals post-burn in the home setting. Areas for further research include the implementation of technology and additional strategies to increase motivation in HP adherence for this population.
References
Cheng, S. & Rogers, C. (1989). Changes in occupational role performance after a severe burn: A retrospective study. The American Journal of Occupational Therapy, 43(1), 17-24.
Oosterwijk, A., Mouton, L., Schouten, H., Disseldorp, L. van der Schans, C., & Niuwenhuis, M. (2017). Prevalence of scar contractures after burn: A systematic review. Burns, 43, 41-49.
