Abstract
This single-group pre/double posttest study sought to enhance the use of occupation-centered practice by providing occupation-based kits and professional development. Five OTs were assessed using the Occupation-Centered Intervention Assessment during three phases of the study. A comparison revealed therapists became significantly less occupation-centered as the study progressed. A predominant factor was increasing acuity among the clients, which interfered with participation in therapy sessions.
Primary Author and Speaker: Wendy Stav
Contributing Authors: Rachel Albright, Kelsey Bontrager, Mary Hollenkamp, Emily Janson, Carli Marano, Rebecca Mendoza, Michelle Raskin, Jennifer Solloway, Gabrielle Torre
Occupation and health have long been recognized as having a reciprocal and beneficial relationship. When occupation is used therapeutically as a means or an ends in practice (Gray, 1998), it gives meaning to clients as they achieve their occupation-centered goals (Fisher, 2014). Despite the strong beliefs and foundations in the health-promoting benefits of occupation, practice has shifted to a more medical-model approach due to a variety of factors including limited equipment, high productivity demands, time constraints, shortage of space, supplies provided in facilities, and reduced environmental adaptability in the clinical setting (Daud, Judd, Yau, & Barnett, 2016). Colaianni & Provident (2010) also acknowledge lack of education and professional development about occupation-centered intervention have contributed to the shift in practice.
This single group pre/double post-test study sought to enhance the use of occupation-centered practice in an in-patient rehabilitation facility through the provision of occupation-based practice kits and professional development specific to appropriate use of the kits, grading the activities up and down, and documentation of the intervention. A local rehabilitation hospital with whom the researchers have an established community partnership agreed to collaborate on this study to assist with their Quality Programs initiative. All therapists in the orthopedic gym were invited to participate with support from administration and five of the seven practitioners agreed and signed consent forms. Each therapeutic interaction was assessed during a full day of interventions using the Occupation-Centered Intervention Assessment (OCIA, Jewell & Pickens, 2017) at the start of the study, two weeks after delivery and use of occupation-based kits, and again two weeks after presentation of a professional development workshop on occupation-centered practice. The OCIA possesses strong inter-rater reliability for self-administration (α = .683 - .769) and researcher administered (W = .93 - .98) allowing the team of ten researchers to reliably assess the five participating occupational therapists across every client intervention for three full days of therapy.
A total of 368 interventions were observed and assessed by the researchers along the three OCIA constructs of personal relevance, contextual relevance, and occupational relevance during the three phases of data collection. A comparison of each construct across the three data collection times was completed using a Kruskal-Wallis H for ordinal data and revealed a statistically significant decrease in personal relevance (X 2 = 19.132; p <.001), a significant decrease in the contextual relevance (X 2 = 6.726; p = .035), and no change in the occupational relevance (X 2 = 3.499; p = .174). An ANOVA of the OCIA total scores revealed a significant decrease from the start of the study to the end of the study (F = 4.690; p = .009). These results suggest the study participants became significantly less occupation-centered as the study progressed.
Despite attempting to increase the use of occupation-centered practice, it decreased over the course of the study. As reported in the literature, there are several factors hindering the use of occupation in practice. One prevalent issue during this study was increasing acuity among the clients with advanced medical complexities which interfered with participation in therapy sessions. In addition, the exercise culture in the therapy gym shared with physical therapy was well established. While evolving trends in healthcare are inevitable, managers should be aware there are service delivery implications of administrative decisions such as admissions, which may reduce the value and perception of occupational therapy services.
Daud, A. Z. C., Judd, J. A., Yau, M. K., & Barnett, F. (2016). Issue in applying occupation-based intervention in clinical practice: A delphi study. Procedia-Social and Behavioral Sciences, 222, 272-282. doi: 10.1016/j.sbspro.2016.05.158
Fisher, A. G. (2013). Occupation-centred, occupation-based, occupation-focused: Same, same, or different? Scandinavian Journal of Occupational Therapy, 20(3), 162-173. doi: 10.3109/11038128.2012.754492
Gray, J. M. (1998). Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy, 52, 354-364. doi:10.5014/ajot.52.5.354
Jewell, V., & Pickens, N. (2017). Psychometric evaluation of the occupation-centered intervention assessment. OTJR: Occupation, Participation, & Health, 37(2), 82-88. doi:10.1177/1539449216688619