Interventions, Effects, and Outcomes in Occupational Therapy

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1 Interventions, Effects, and Outcomes in Occupational Therapy ADULTS AND OLDER ADULTS Instructor s Manual Learning Activities Mary Law, PhD, FCAOT Professor and Associate Dean Rehabilitation Science McMaster University Hamilton, Ontario, Canada Mary Ann McColl, PhD, MTS Associate Director, Centre for Health Services and Policy Research Professor, Community Health and Epidemiology/Rehabilitation Therapy Queen s University Kingston, Ontario, Canada

2 Copyright 2010 by SLACK Incorporated All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for brief quotations embodied in critical articles and reviews. The procedures and practices described in this book should be implemented in a manner consistent with the professional standards set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of the information presented and to correctly relate generally accepted practices. The authors, editor, and publisher cannot accept responsibility for errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied warranty of this book or information imparted by it. Care has been taken to ensure that drug selection and dosages are in accordance with currently accepted/recommended practice. Due to continuing research, changes in government policy and regulations, and various effects of drug reactions and interactions, it is recommended that the reader carefully review all materials and literature provided for each drug, especially those that are new or not frequently used. Any review or mention of specific companies or products is not intended as an endorsement by the author or publisher. SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide important feedback on the content that we publish. We welcome feedback on this work. Published by: SLACK Incorporated 6900 Grove Road Thorofare, NJ USA Telephone: Fax: Contact SLACK Incorporated for more information about other books in this field or about the availability of our books from distributors outside the United States.

3 Instructor s Manual Table 1 Example Occupational Performance Issues A 30-year-old woman with a complete C7 spinal cord injury and a single-leg above-knee amputation who wishes to independently transfer from her wheelchair to her bed. A 55-year-old woman with depression who wants to fulfill her job duties as a sales clerk in a department store. A 75-year-old man is having difficulty completing his grocery shopping. A 32-year-old woman with fibromyalgia has significant difficulty cleaning her apartment. A 64-year-old man with multiple sclerosis is having difficulty feeding himself independently without losing food to the table. An 18-year-old high school student has significant challenges completing his exams because of anxiety attacks. A 22-year-old person with schizophrenia has been unable to sustain social relationships. A clerical support worker is having significant challenges managing the basic tasks of her job description, including answering the telephone, typing letters to clients, and filing. Introduction The Learning Activities in this manual consider the content (i.e., outcomes measures, interventions, and effects) from all outcomes within each chapter. The activity sections are divided into five parts: Using the book Tools to measure outcomes Implementing intervention Understanding the effects Application to future research Within the Instructor s Manual, the examples of evidence that are discussed from the book mainly refer to the interventions provided solely by occupational therapists. Nevertheless, examples of evidence involving multi-disciplinary interventions with occupational therapy can easily be applied to these activities, if the instructor chooses to do that. The following learning activities can be used within a large group class or individually as an evaluation assignment. To select an outcome to aim for, students should be encouraged to first define what outcome(s) they wish to address as that selection will lead them to use a specific chapter from the book. For example, if a client s main issue relates to risk for falls (or ongoing issue with falls), then outcomes with fall-related characteristics, such as fear of falling, falls prevention, and number of falls and injuries, could be evaluated. These outcomes can be found in Chapter 7 with specific sources for each one as follows: Fear of falling (Gitlin et al., 2006) Falls prevention (Haines et al., 2004) Number of falls and injuries (Weatherall, 2004) From identifying these sources in the outcome measure table by author, students can refer to the intervention and effects table for further data to respond to the activities in this section. Learning Objectives for Students Learn how to optimally use the contents of this book to support occupational therapy practice. Learn about the evidence supporting occupational therapy practice related to specific outcomes (i.e., interventions used, outcomes measured, and expected effects). Learn about the utility of outcome measures in clinical practice. Learn about interventions that are most frequently implemented and studied for specific outcomes and applying them to practice. Learn about interpreting the results of occupational therapy effects for treatment planning and communication with colleagues, consumers, and decision makers. Learn about the current scope of the research regarding occupational therapy interventions and how to build on the evidence for future studies. Activity Sections Using the Book Activity #1 Review the examples of occupational performance issues in Table 1 and define an outcome that could be desired by the client in the selected scenario. Using Table 2, indicate what chapters are pertinent to these outcomes. List the specific measures that could be used to evaluate these outcomes. Refer to the interventions discussed in the chapter that are associated with these outcomes. Examine the results of the evidence and discuss the expected effect of the intervention on the outcome.

4 Instructor s Manual Table 2 Chapter Specific Client Outcome Outcome Measure Intervention Approach Expected Effect Participation Self-Care Productivity Leisure Environment Physical Socio-Cultural Psycho-Emotional Cognitive-Neurological

5 Instructor s Manual Activity #2 From Chapters 3 through 11, select an example of an outcome that applies to a clinical situation that you have experienced or discussed in class. Think about and discuss what outcome measure and intervention are most appropriate for this situation. Based on the effects from the evidence tables, hypothesize what you might expect as a long-term outcome. (Consider all information to formulate your clinical judgment evidence, client attributes, disease process, practice setting, and resources.) Activity #3 Choose a chapter and outcome area of interest. Summarize all of the evidence relevant to this outcome. What are the strengths and weaknesses of this evidence? Discuss how you might use this information to influence your practice (i.e., either to use it, consider aspects of it, or not use it at all). Tools to Measure Outcomes Activity #4 Select an outcome applicable to a hypothetical client (or client whom you have encountered during your studies or on your caseload). Select the appropriate chapter in the book that applies to that outcome. Referring to the outcome measures within this chapter, identify the main supports and/or barriers that might impact the use of this measure in routine practice. Think about establishing a plan to use the supports and address any challenges. Use the questions below to help you summarize the utility of the outcome measure. Decide whether you would consider using the measure, learn more about it before using it, or not use it at all. Questions to assist with evaluating applicability of the selected outcome measure: What is specifically being evaluated by the outcome measure? What is the purpose of the outcome measure? Does the measure evaluate the outcomes you are targeting? What valuable clinical information is expected from the outcome measure (i.e., what do the scores tell you about short- or long-term outcomes)? How is the measure used (e.g., single or multiple time points)? Who is being evaluated? In what context are they evaluated? Who is providing responses (e.g., client, caregiver)? Is the measure easy to implement? What kind of training is required? Have the psychometric properties of the measure been tested for your client population? Are they adequate? Do the results influence how you plan your intervention? How? Intervention Implementation Activity #5 Create a case scenario or consider a client in your clinical area for whom there is a specific outcome within his or her goals for occupational therapy. Describe the client. Be sure to specify diagnosis and other relevant characteristics such as age, gender, and social supports. Define the occupational therapy setting and scope of service for this client. Refer to the outcome that best matches the client s occupational therapy goal and describe the outcome measure(s) used to evaluate it and the intervention approach used within the book chapter. Discuss the applicability of the intervention to your client, outcome, and occupational therapy practice. Based on the results from the effects table in the specific chapter you are studying, hypothesize the possible results that can be expected at the end of the intervention for this particular client. If the intervention is not directly applicable or easy to implement in practice, are there any alternative interventions that could be considered? If there is not enough evidence to support an alternate intervention, how would you measure the outcome of that intervention? Activity #6 For the intervention described in Activity #5, consider the mechanism by which the intervention will have an impact on the client s outcomes. For example, the mechanism of constraint-induced movement therapy (CIMT) facilitates the improved function of an affected limb when forced to be used (while the unaffected limb is constrained) based on the principles of cortical-motor re-organization. How does this process help you in the selection of outcome measures to evaluate the effect(s) of your occupational therapy intervention? Activity #7 For the intervention described in Activity #5, discuss the resources necessary to implement this intervention into practice (e.g., equipment, training, etc.).

6 Instructor s Manual Table 3 Outcome of Interest: Chapter: Rigor of the Research Strengths Weaknesses Future Research Study Design Outcome Measures Intervention Used Understanding the Effects Activity #8 How could the evidence from the results in the effects table help you shape your goals at the outset of therapy? Set a goal for an intervention plan based on an outcome selected from one of the chapters. Activity #9 Review the results from the effects table for an outcome of interest. From the results, summarize the expectations of all the effects for the outcome evaluated in the short- and/or long-term (i.e., if follow-up occurred after 1 year). In addition to considering the results, strengths, and limitations of the research, comment on how your client s attributes (e.g., diagnosis, age, social support) could potentially influence your expectation of intervention. Activity #10 In clinical practice, there may be several individuals involved in clinical decisions with whom an occupational therapist is likely to communicate in addition to the client; for example, caregivers who live or work to take care of the client, agencies providing funding for the client s health care (e.g., insurance), and other professionals within the health care setting (i.e., team members or management) who have an interest in the client or the treatment they are receiving. Using your information from Activity #9, consider how you might communicate these expectations to the client, other team members, your manager, advocacy groups, or funders. Keep in mind the purpose of your communication, the type of language used to share the information, and how much information is necessary. If these aspects are not considered, what could be the possible implications of ineffective communication? Application to Future Research Activity #11 Choose a chapter and a specific outcome area of interest (e.g., community mobility for participation from Chapter 3). Summarize all of the evidence relevant to this topic in Table 3. What are the strengths and weaknesses of this evidence? Discuss future directions for research in this area (e.g., study design, new outcome measure, different interventions evaluated). Activity #12 Within any chapter, what aspects of occupational therapy practice (outcome measures or interventions) are not evident in the literature and should be studied in future research? Design a study to examine this area of clinical practice.

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