Date Presented 04/21/2023
This process improvement project aimed to determine how OT may potentially benefit an acute care orthopedic hospital that currently provides only PT services. Functional screening tools were used to obtain scores to determine deficits in activities of daily living.
Primary Author and Speaker: Jared Schnell
Additional Authors and Speakers: Stacy Wentz
PURPOSE: Determining the value of implementing OT in an acute orthopedic setting for post joint replacements where only PT is given. Three screening tools were utilized to determine functional scores after PT eval and d/c to identify areas that the patients could benefit from OT services.
DESIGN: Process Improvement study using current screening tool to identify patients who would qualify for OT. Three screening tools were used to obtain data on ADL deficits, fear of falling, and home readiness.
METHOD: Data was collected over a 6 week period at 2 separate orthopedic hospitals. PT provided the Modified Barthel Index (MBI),Falls Efficacy Scale (FES) and Home Readiness Scale (HRS) at eval and at d/c to qualifying patients.
RESULTS: 71 patients were assessed at one site over a 6-Week period with 7 of 71 patients qualifying. MBI: A score showing severe dependency on eval. An Average of moderate dependency on d/c. FES Score: An average of 63.8 on eval. An Average of 56.3 on d/c. HRS Score: An Average of 3 on d/c. At other site: 12 of 64 patients qualified. MBI Score: An average of showing moderate dependency on eval. An Average showing moderate dependency on d/c. HRS: An Average of 11 on d/c.
CONCLUSION: Utilization of only PT services, the scores on MBI, FES, and HRS indicated moderate dependency on the MBI; moderate fear of falling on the FES; and scoring on the HRS ranged from 3-11 showing poor to adequate readiness for return home. The results indicate patients that qualified would benefit from OT to address the functional deficits in the areas of ADL, IADL, and functional household mobility. This study can help to advocate for the benefit of OT to address these functional deficits in the acute orthopedic patient population. Future studies are planned for when OT is implemented at these 2 hospitals. The MBI, FES, and HRS will be provided at time of OT evaluation and OT discharge to assess effectiveness of OT.
References
Hack, S., & Wentz, S. (2021). Development of a Unique Screening Tool for Acute Care Occupational Therapy Services in Patients Following Total Joint Replacement Surgery. Archives of Physical Medicine and Rehabilitation, 102(10), e89. https://doi.org/10.1016/j.apmr.2021.07.738
Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol. 1990 Nov;45(6):P239-43. https://doi.org/10.1093/geronj/45.6.p239
Collin, C., et al. The Barthel ADL Index: a reliability study. International disability studies 10.2 (1988): 61-63.
