Date Presented 03/26/20
OTs are uniquely qualified to address mental-health needs and functional implications. A pilot wellness program co-led by integrative health and therapists utilized breath management, visualization, mindfulness, and cognitive behavioral methods to promote healthy coping mechanisms. It was developed as an adjunct therapy and a nonpharmacological modality to enhance quality of life and promote a safe transition to community for adult patients on an acute rehabilitation unit.
Primary Author and Speaker: Amanda Romano
Additional Authors and Speakers: Charlene Wong, Jeanina Miller
Contributing Authors: Miriam Ringel, Marci Resnicoff, Kara Nizolek
PURPOSE: Current research validates the need for supportive strategies for stress reduction during inpatient rehabilitation facility (IRF) admissions. Support during transition home is crucial for reintegration to community. The purpose of this study was multifactorial: to promote patient satisfaction; stress reduction; quality of life; and a safe transition to the community. Occupational Therapists are uniquely positioned to address mental health concerns functionally and holistically. In collaboration with integrative health, a pilot program was developed to improve patient wellness. Techniques included breath management, mindfulness, visualization, and cognitive behavioral strategies. These non-pharmacological methods were integrated with standard therapy to facilitate coping post-IRF stay. Given the limited time available for addressing mental health during inpatient rehabilitation, this pilot study offers a novel, interdisciplinary solution.
DESIGN: This pilot follows a quasi-experimental study design. Participants were recruited from the IRF unit at NYU Langone-Brooklyn. Participation was voluntary, indiscriminate of age, gender, creed, and medical history. Potential members were identified by the interdisciplinary medical team as patients or caregivers who could benefit from alternative coping and wellness practices. Throughout the trial, 44 adult patients and 20 caregivers were invited to participate. Members participated in one of two one-hour classes entitled “Breathing Techniques” and “Self Care Tools for Your Healing Journey”. Patients who demonstrated motor, cognitive, communication deficits or pain levels that limited their ability to participate in a seated activity for 60 minute intervals were deemed inappropriate and therefore, excluded from the program.
METHOD: Qualitative patient questionnaires were administered via phone to determine participants’ perception of the group’s value on an interval scale of 0-10 or select from multiple choices. Questions included: “Would you recommend the wellness hour to future patients/caregivers?”, “What I learned during the wellness hour helped me relax/reduce stress at home”, “What did you find least/ most helpful about the wellness hour?”.
RESULT: After a 14 week trial, 64 individuals participated in total. 20 attendees completed the post-evaluation call, 85% of which agreed that class tools helped to reduce stress at home. Patients reported that relaxation exercises were most frequently used to mediate stress and coping. 95% of attendees would recommend the class for others.
CONCLUSION: The results of this qualitative pilot support the significance of wellness programs for IRF facilities. Specifically, patients reported significant stress reduction after transition home. This study highlights the benefits of utilizing mindfulness, breathing techniques, and modifying thought patterns to manage stress after an IRF stay. Preliminary results yielded are promising and further investigation are currently ongoing. As the program matures, its benefits can be expanded to additional IRFs. Furthermore, the incorporation of this group into an IRF program supports the Occupational Therapist’s role as a holistic practitioner in a physical disability setting. In these settings, mental health is challenging to address, often overlooked, and relegated secondary to physical needs. Utilizing holistic groups such as this in a setting focused on physical disabilities allows occupational therapists a platform to directly provide mental health services. Research supports that addressing mental health also helps to improve physical functioning and should therefore, be incorporated in IRF settings.
References
Wang, M., Liao, W., & Chen, X. (2019). Effects of a short-term mindfulness-based intervention on comfort of stroke survivors undergoing inpatient rehabilitation. Rehabilitation Nursing, 44(2),78-86. doi: 10.1097/rnj.0000000000000098
White, C.L., Brady, T.L., Saucedo, L.L., Motz, D. Sharp, J. & Birnbaum, L.A. (2014). Towards a better understanding of readmissions after stroke: partnering with stroke survivors and caregivers. Journal of Clinical Nursing, 24, 1091-1100. doi:10.1111/jocn.12739
