Purposes for adults post-stroke to engage in art therapy: An integrative review
Emily MacMurdo
Day: Thursday, Time: 14:00-14:25, Session: T75
Rationale: Therapeutic art interventions have been supported through available evidence for many conditions, such as psychological illnesses and dementia. However, there has not been extensive research exploring art as a meaningful occupation with benefits for people who have had strokes. Objectives: This integrative review of the literature explores the potential benefits for adults post-stroke choosing to engage in art-therapy. Approach: Six electronic databases (CINAHL, PubMed, Academic Search Premier, ERIC, OTSeeker, and PsycInfo) were searched using search terms such as stroke and art-therapy, plus related terms. After applying inclusion and exclusion criteria, 13 articles were retained, appraised using the McMaster Critical Appraisal Tool, and thematically analyzed. Results: With moderate quality evidence, five main benefits emerged in the analysis: increasing function (improvement of upper extremity function, visual perceptual skills, cognition), method of communication (symbolic, non-verbal communication), improving emotional well-being (opportunity for emotional expression, improving quality of life and psychological/emotional well-being, mental health), enhancing social connection (shared experiences, validation, sense of belonging), and more meaningful recovery (art as a meaningful leisure occupation). Some participants reported that they felt more fulfilled and connected to themselves again after engaging in art therapy interventions. Conclusions: Art therapy is not a mainstream component of stroke rehabilitation; however, findings from this literature review indicate potential efficacy to address complex occupational needs of individuals recovering from stroke. Evidence remains relatively weak, suggesting the importance of on-going research, particularly to determine best-practice for stroke recovery and how occupational therapists can effectively implement art therapy interventions in post-stroke healthcare settings.
References:
Reynolds, F. (2012). Art therapy after stroke: Evidence and a need for further research. The Arts in Psychotherapy, 39(4), 239-244.
Kim, S., Kim, M., Lee, J., & Chun, S. (2008). Art therapy outcomes in the rehabilitation treatment of a stroke patient: a case report. Art Therapy: Journal Of The American Art Therapy Association, 25(3), 129-133
Abstract Summary:
This integrative review of the literature explores the potential benefits for people post-stroke choosing to engage in art-therapy. It holds possible benefit for improving function, emotional well-being, social connection, communication, and more meaningful recovery. With the impact on quality of life, art therapy may be an efficacious intervention for stroke populations.
Day: Thursday, Time: 14:00-14:25, Session: T75
Rationale: Therapeutic art interventions have been supported through available evidence for many conditions, such as psychological illnesses and dementia. However, there has not been extensive research exploring art as a meaningful occupation with benefits for people who have had strokes. Objectives: This integrative review of the literature explores the potential benefits for adults post-stroke choosing to engage in art-therapy. Approach: Six electronic databases (CINAHL, PubMed, Academic Search Premier, ERIC, OTSeeker, and PsycInfo) were searched using search terms such as stroke and art-therapy, plus related terms. After applying inclusion and exclusion criteria, 13 articles were retained, appraised using the McMaster Critical Appraisal Tool, and thematically analyzed. Results: With moderate quality evidence, five main benefits emerged in the analysis: increasing function (improvement of upper extremity function, visual perceptual skills, cognition), method of communication (symbolic, non-verbal communication), improving emotional well-being (opportunity for emotional expression, improving quality of life and psychological/emotional well-being, mental health), enhancing social connection (shared experiences, validation, sense of belonging), and more meaningful recovery (art as a meaningful leisure occupation). Some participants reported that they felt more fulfilled and connected to themselves again after engaging in art therapy interventions. Conclusions: Art therapy is not a mainstream component of stroke rehabilitation; however, findings from this literature review indicate potential efficacy to address complex occupational needs of individuals recovering from stroke. Evidence remains relatively weak, suggesting the importance of on-going research, particularly to determine best-practice for stroke recovery and how occupational therapists can effectively implement art therapy interventions in post-stroke healthcare settings.
References:
Reynolds, F. (2012). Art therapy after stroke: Evidence and a need for further research. The Arts in Psychotherapy, 39(4), 239-244.
Kim, S., Kim, M., Lee, J., & Chun, S. (2008). Art therapy outcomes in the rehabilitation treatment of a stroke patient: a case report. Art Therapy: Journal Of The American Art Therapy Association, 25(3), 129-133
Abstract Summary:
This integrative review of the literature explores the potential benefits for people post-stroke choosing to engage in art-therapy. It holds possible benefit for improving function, emotional well-being, social connection, communication, and more meaningful recovery. With the impact on quality of life, art therapy may be an efficacious intervention for stroke populations.
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Teaching Coping Strateges to Promote Recovery
Mary McNamara and Theresa Straathof
Day: Thursday, Time: 15:30-15:55, Session: T94
Coping strategies to Promote Occupational Engagement and Recovery: A Program Manual for Occupational Therapists and other Care Providers uses Kolb’s Adult Learning Model to teach a variety of coping strategies. It is effective because the completed learning objective is observed in the session, and efficient because the program is manualized.
Day: Thursday, Time: 15:30-15:55, Session: T94
Coping strategies to Promote Occupational Engagement and Recovery: A Program Manual for Occupational Therapists and other Care Providers uses Kolb’s Adult Learning Model to teach a variety of coping strategies. It is effective because the completed learning objective is observed in the session, and efficient because the program is manualized.
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Supporting Family Needs Through Yoga: Incorporating Coaching Techniques for Daily Routines.
Jessica Hatfield, Louise Burridge
Day: Thursday, Time: 15:30-15:55, Session: T99
Family mental health is crucial in today’s society. The increased pressures of parenting a child with a disability have led to a rise of parents report feeling stressed, tired, and rushed on quality time with their children, friends, and hobbies (Parker, Horowitz, Rohal, 2015). These stressors take a toll on the family as a unit. For families living with Autism, ADHD, and Anxiety Disorders, many parents report that the high demands associated with such diagnoses are, at times, overwhelming. An increase in prevalence of these diagnoses, validate the timeliness and need to identify evidence based interventions that improve quality of life of those living with these diagnoses and their families (Bridee, et al, 2009). To be effective, occupational therapy practitioners need to provide effective whole family interventions that address performance deficits, enable independence in daily living skills, and foster a sense of calmness and focus for all (Weaver & Darragh, 2015).
The Occupational Therapy Practice Framework (2014) addresses achieving Health and Wellbeing through engagement in occupation for full participation in life. Vision 2025 states adds the critical element of OTs role of effective problem solving for developing solutions in daily life participation. By incorporating a technique such as Yoga, we are building self regulatory behaviors, not only for the child with a condition, but the family as a unit (Martini, Cramm, Egan & Sikora, 2016)
Yoga is a holistic mind-body practice which includes: postures, breathing, and meditation. These strategies, when taught correctly, provide bonding for families and alternatives to stressors. Yoga aligns effectively with theoretical constructs of occupational therapy to improve quality of life for participation in everyday living. Emerging research supports yoga as an effective intervention to optimize the physical and mental health of children, youth, and adults (Bridee, et al, 2009’ Koenig, Buckley-Reen & Garg, 2012). This session will provide occupational therapy providers with information on how Autism, ADHD, and Anxiety impact a family’s daily occupations, ways to assess the family as a whole, guidance in clinical reasoning for using yoga with the family, and practical approaches for using yoga in ways that are effective in supporting families living with Autism, ADHD, and Anxiety holistically. Implications for interventions woven into daily activities will be incorporated.
Day: Thursday, Time: 15:30-15:55, Session: T99
Family mental health is crucial in today’s society. The increased pressures of parenting a child with a disability have led to a rise of parents report feeling stressed, tired, and rushed on quality time with their children, friends, and hobbies (Parker, Horowitz, Rohal, 2015). These stressors take a toll on the family as a unit. For families living with Autism, ADHD, and Anxiety Disorders, many parents report that the high demands associated with such diagnoses are, at times, overwhelming. An increase in prevalence of these diagnoses, validate the timeliness and need to identify evidence based interventions that improve quality of life of those living with these diagnoses and their families (Bridee, et al, 2009). To be effective, occupational therapy practitioners need to provide effective whole family interventions that address performance deficits, enable independence in daily living skills, and foster a sense of calmness and focus for all (Weaver & Darragh, 2015).
The Occupational Therapy Practice Framework (2014) addresses achieving Health and Wellbeing through engagement in occupation for full participation in life. Vision 2025 states adds the critical element of OTs role of effective problem solving for developing solutions in daily life participation. By incorporating a technique such as Yoga, we are building self regulatory behaviors, not only for the child with a condition, but the family as a unit (Martini, Cramm, Egan & Sikora, 2016)
Yoga is a holistic mind-body practice which includes: postures, breathing, and meditation. These strategies, when taught correctly, provide bonding for families and alternatives to stressors. Yoga aligns effectively with theoretical constructs of occupational therapy to improve quality of life for participation in everyday living. Emerging research supports yoga as an effective intervention to optimize the physical and mental health of children, youth, and adults (Bridee, et al, 2009’ Koenig, Buckley-Reen & Garg, 2012). This session will provide occupational therapy providers with information on how Autism, ADHD, and Anxiety impact a family’s daily occupations, ways to assess the family as a whole, guidance in clinical reasoning for using yoga with the family, and practical approaches for using yoga in ways that are effective in supporting families living with Autism, ADHD, and Anxiety holistically. Implications for interventions woven into daily activities will be incorporated.
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How does virtual reality align with occupational therapy? A scoping review
Sarah Hunt, Kayla McDonald, Jacklyn Upchan, Patrick Duong, Heidi Sveistrup, Mary Egan
Day: Saturday, Time: 11:00-11:25, Session: S77
Day: Saturday, Time: 11:00-11:25, Session: S77
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Client-informed implementation: Engaging clients to improve Ontario's addiction sector
Season Kam, Tayla Smith
Day: Saturday, Time: 10:00-10:25, Session: S48
Title: Client-informed implementation: engaging clients to improve Ontario’s addiction sector Rationale: Since 2015, the Staged Screening and Assessment (SS&A) process has been implemented to enhance quality of care in Ontario’s publicly funded addiction sector. The SS&A process, including the mandated Global Appraisal of Individual Needs (GAIN-Q3 MI ONT) assessment, represents the latest evidence on how to accurately screen and assess clients coming into service. A growing number of occupational therapists will use SS&A tools to assess, treat, and refer clients to addiction services. While service providers are involved in implementation efforts, direct client engagement in the implementation process is limited. Objectives: To a) apply a client-centred approach to quality improvement implementation efforts, and b) engage addiction service users and integrate their feedback on the SS&A process. Approach: Publicly funded addiction agencies across the province in advanced stages of implementation were selected to distribute surveys to clients about their experience with the GAIN-Q3 MI ONT assessment. Four focus groups were conducted to obtain richer, qualitative data. Results: 70 completed surveys were returned and data from the four focus groups were analyzed. Themes that emerged included the significance of the client-clinician relationship, flexibility in assessment administration, and the assessment as a “gatekeeper” to services. Conclusions: Involving clients in quality improvement efforts reflects client-centred principles and is useful in shaping large scale implementation efforts. Client feedback allows implementers and clinicians to modify quality improvement and service-delivery processes to maximize access, equity, and efficacy of services delivered. Opportunities exist for occupational therapists in the addiction sector to champion client-centred initiatives based on these results.
Day: Saturday, Time: 10:00-10:25, Session: S48
Title: Client-informed implementation: engaging clients to improve Ontario’s addiction sector Rationale: Since 2015, the Staged Screening and Assessment (SS&A) process has been implemented to enhance quality of care in Ontario’s publicly funded addiction sector. The SS&A process, including the mandated Global Appraisal of Individual Needs (GAIN-Q3 MI ONT) assessment, represents the latest evidence on how to accurately screen and assess clients coming into service. A growing number of occupational therapists will use SS&A tools to assess, treat, and refer clients to addiction services. While service providers are involved in implementation efforts, direct client engagement in the implementation process is limited. Objectives: To a) apply a client-centred approach to quality improvement implementation efforts, and b) engage addiction service users and integrate their feedback on the SS&A process. Approach: Publicly funded addiction agencies across the province in advanced stages of implementation were selected to distribute surveys to clients about their experience with the GAIN-Q3 MI ONT assessment. Four focus groups were conducted to obtain richer, qualitative data. Results: 70 completed surveys were returned and data from the four focus groups were analyzed. Themes that emerged included the significance of the client-clinician relationship, flexibility in assessment administration, and the assessment as a “gatekeeper” to services. Conclusions: Involving clients in quality improvement efforts reflects client-centred principles and is useful in shaping large scale implementation efforts. Client feedback allows implementers and clinicians to modify quality improvement and service-delivery processes to maximize access, equity, and efficacy of services delivered. Opportunities exist for occupational therapists in the addiction sector to champion client-centred initiatives based on these results.
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Wound care: Investigating the Interprofessional Decision Making Process
Andrew Nicholas
Day: Thursday, Time: 10:00-10:25, Session: T23
With approximately 30-50% of health care involving wounds, and costing upwards of $1.5 billion in Ontario, Canada alone, wound care management represents a serious risk to public health (Ontario Wound Care Interest Group, 2012). With hospitals often being the entry point for patients with simple and complex wounds into the healthcare system, the interprofessional team plays a significant role in ensuring evidence-based patient-centered care. Understanding the interprofessional decision making process regarding wound care is critical to ensure quality care. Objectives: To develop a robust socio-geographical transferable theory utilized by interprofessional healthcare team members when making wound care management decisions. Methods: Utilizing a Qualitative Multi-Grounded Theory approach, three focus groups were held at a Regional Health Center in Central Ontario, Canada, comprised of 13 clinicians involved in wound management. Data was analyzed utilizing an approach developed for Multi-Grounded Theory. A Critical Realist theoretical lens was applied to data analysis in developing conclusions. Results: Ten categories were identified, each with positive and negative attributes. Category interactions developed a perceived basic social process outlining how interprofessional clinicians manage wounds. Categories included: patient factors, scope of practice, equipment and supplies, internal clinician factors, knowledge and education, interprofessional team, assessment, wound care specialist consultation, care plan, documentation, and communication. Conclusions: Understanding interprofessional wound care decision making processes will assist clinical leaders and policy makers in creating a foundation for determining resource allocation, allowing clinicians to utilize evidence-based practice to improve patient and clinician satisfaction, wound healing time, decrease costs, and prevent wound recurrence.
Day: Thursday, Time: 10:00-10:25, Session: T23
With approximately 30-50% of health care involving wounds, and costing upwards of $1.5 billion in Ontario, Canada alone, wound care management represents a serious risk to public health (Ontario Wound Care Interest Group, 2012). With hospitals often being the entry point for patients with simple and complex wounds into the healthcare system, the interprofessional team plays a significant role in ensuring evidence-based patient-centered care. Understanding the interprofessional decision making process regarding wound care is critical to ensure quality care. Objectives: To develop a robust socio-geographical transferable theory utilized by interprofessional healthcare team members when making wound care management decisions. Methods: Utilizing a Qualitative Multi-Grounded Theory approach, three focus groups were held at a Regional Health Center in Central Ontario, Canada, comprised of 13 clinicians involved in wound management. Data was analyzed utilizing an approach developed for Multi-Grounded Theory. A Critical Realist theoretical lens was applied to data analysis in developing conclusions. Results: Ten categories were identified, each with positive and negative attributes. Category interactions developed a perceived basic social process outlining how interprofessional clinicians manage wounds. Categories included: patient factors, scope of practice, equipment and supplies, internal clinician factors, knowledge and education, interprofessional team, assessment, wound care specialist consultation, care plan, documentation, and communication. Conclusions: Understanding interprofessional wound care decision making processes will assist clinical leaders and policy makers in creating a foundation for determining resource allocation, allowing clinicians to utilize evidence-based practice to improve patient and clinician satisfaction, wound healing time, decrease costs, and prevent wound recurrence.
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Rest and Recover: Decreasing Patient Agitation through Environmental Modifications
Elise Goldberg
Day: Thursday, Time: 10:30-10:55, Session: T32
In an acute care Trauma unit, patients with agitated behaviours caused by traumatic brain injury (TBI) and/or delirium are commonly placed in proximity to the centralized nursing station for the purposes of high observation. A primary behavioural management strategy is use of dedicated 1:1 observers for the prevention of falls and unsafe removal of medical equipment. Evidence shows that nursing station noise, chaos, and artificial light leads to poor sleep, agitation, and increased restraint use. These negative outcomes translate into increasingly high observer costs and longer lengths of stay. Objectives: This project aimed to develop a decentralized “high observation” nursing workstation in a quiet section of the unit called Rest & Recover (R&R). The goals were to: Decrease average number of 1:1 observers by 17% and decrease average daily agitation scores by 15%, by March 2018. Methods: Data collection pre and post intervention included: Noise levels; Agitated Behaviour Scale (ABS) scores; observer costs, frequency of shared observation; and staff, patients’ and families’ satisfaction regarding the environment. Results: There was an overall 18% decrease in average patient agitation levels, with significance for daytime agitation (p<0.001). Dedicated observer use decreased by 51%, with an increased use of 1:3 and 1:2 observation ratios. This resulted in cost savings of approximately $25,920 in Jan-Feb 2018 from a single R&R room. Conclusions: A decentralized high observation nursing station facilitates the practice shift towards shared supervision, in turn facilitating decreased agitation, observer use, and costs and may help expedite timely discharges from hospital.
Day: Thursday, Time: 10:30-10:55, Session: T32
In an acute care Trauma unit, patients with agitated behaviours caused by traumatic brain injury (TBI) and/or delirium are commonly placed in proximity to the centralized nursing station for the purposes of high observation. A primary behavioural management strategy is use of dedicated 1:1 observers for the prevention of falls and unsafe removal of medical equipment. Evidence shows that nursing station noise, chaos, and artificial light leads to poor sleep, agitation, and increased restraint use. These negative outcomes translate into increasingly high observer costs and longer lengths of stay. Objectives: This project aimed to develop a decentralized “high observation” nursing workstation in a quiet section of the unit called Rest & Recover (R&R). The goals were to: Decrease average number of 1:1 observers by 17% and decrease average daily agitation scores by 15%, by March 2018. Methods: Data collection pre and post intervention included: Noise levels; Agitated Behaviour Scale (ABS) scores; observer costs, frequency of shared observation; and staff, patients’ and families’ satisfaction regarding the environment. Results: There was an overall 18% decrease in average patient agitation levels, with significance for daytime agitation (p<0.001). Dedicated observer use decreased by 51%, with an increased use of 1:3 and 1:2 observation ratios. This resulted in cost savings of approximately $25,920 in Jan-Feb 2018 from a single R&R room. Conclusions: A decentralized high observation nursing station facilitates the practice shift towards shared supervision, in turn facilitating decreased agitation, observer use, and costs and may help expedite timely discharges from hospital.
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Besoins de formation en soins palliatifs et en fin de vie
Claudia Talbot-Coulombe, Gina Bravo, Annie Carrier
Day: Saturday, Time: 09:00-09:25, Session: S17
Introduction : Dans les prochaines années, il est probable qu’un plus grand nombre d’ergothérapeutes soit sollicité à intervenir auprès de clientèles en soins palliatifs et de fin de vie (SPFV) en raison des priorités d’accès à ces services émises par le Gouvernement du Québec. Il devient ainsi essentiel de se questionner sur les ressources et les besoins de formation des ergothérapeutes. Objectifs : Identifier les besoins de formation des ergothérapeutes du Québec qui dispensent des SPFV. Méthode : Une enquête par voie électronique a été réalisée auprès de l’ensemble des ergothérapeutes du Québec œuvrant en SPFV, parallèlement à une recension des formations initiales, avancées et continues sur les SPFV actuellement offertes aux étudiants ou aux cliniciens en ergothérapie. Résultats : Plusieurs obstacles nuisent à leur pratique, dont le manque de ressources (matérielles et humaines) et la méconnaissance du rôle de l’ergothérapeute par les autres professionnels. Les ergothérapeutes (N=67) se sont dits peu satisfaits de la formation reçue sur les SPFV. Selon eux, la formation universitaire devrait aborder les interventions en ergothérapie, l’approche de soins palliatifs, les habiletés de communication et les aspects médicaux. Les programmes de formation existants couvrent les deux premiers contenus, en plus de traiter des facteurs éthiques en lien avec les SPFV; ils n’abordent pas les deux derniers contenus perçus comme un besoin par les ergothérapeutes. Conclusion : Nos résultats confirment le besoin d’enrichir la formation en SPFV destinée aux ergothérapeutes. Ils soulignent par ailleurs l’importance de former les autres professionnels au rôle de l’ergothérapeute en SPFV.
Day: Saturday, Time: 09:00-09:25, Session: S17
Introduction : Dans les prochaines années, il est probable qu’un plus grand nombre d’ergothérapeutes soit sollicité à intervenir auprès de clientèles en soins palliatifs et de fin de vie (SPFV) en raison des priorités d’accès à ces services émises par le Gouvernement du Québec. Il devient ainsi essentiel de se questionner sur les ressources et les besoins de formation des ergothérapeutes. Objectifs : Identifier les besoins de formation des ergothérapeutes du Québec qui dispensent des SPFV. Méthode : Une enquête par voie électronique a été réalisée auprès de l’ensemble des ergothérapeutes du Québec œuvrant en SPFV, parallèlement à une recension des formations initiales, avancées et continues sur les SPFV actuellement offertes aux étudiants ou aux cliniciens en ergothérapie. Résultats : Plusieurs obstacles nuisent à leur pratique, dont le manque de ressources (matérielles et humaines) et la méconnaissance du rôle de l’ergothérapeute par les autres professionnels. Les ergothérapeutes (N=67) se sont dits peu satisfaits de la formation reçue sur les SPFV. Selon eux, la formation universitaire devrait aborder les interventions en ergothérapie, l’approche de soins palliatifs, les habiletés de communication et les aspects médicaux. Les programmes de formation existants couvrent les deux premiers contenus, en plus de traiter des facteurs éthiques en lien avec les SPFV; ils n’abordent pas les deux derniers contenus perçus comme un besoin par les ergothérapeutes. Conclusion : Nos résultats confirment le besoin d’enrichir la formation en SPFV destinée aux ergothérapeutes. Ils soulignent par ailleurs l’importance de former les autres professionnels au rôle de l’ergothérapeute en SPFV.
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Preventive behaviours at work: an integrated theoretical model based on an occupational perspective
Alexandra Lecours
Day: Friday, Time: 14:30-14:55, Session: F81
Introduction. Work is an occupation valued by billions of individuals across cultures and societies. As a determinant of health, work may have several positive effects on individuals’ well-being. However, it may also have negative effects as accidents, physical illnesses or transient mental disorders may occur. Workers’ preventive behaviours appear to be a lever of interest to foster health at work, but no clear definition does exist. The use of an occupational perspective (Njelesani, Tang, Jonsson, & Polatajko, 2014) seems a promising way to understand the characteristics of preventive behaviours at work. Objective. The aim of the study was to define those behaviours workers may adopt to foster prevention in order to understand their operational characteristics. Method. To achieve this aim, secondary qualitative analysis based on data collected during three prior studies were conducted. Results. Results allowed generating the Model of preventive behaviours at work. This model defines preventive behaviours at work as six different types of engagement toward prevention. Those engagements are realized into a context, which involves several factors related to the person, the occupation and the environment. Finally, the model proposes those engagements may lead to several positive outcomes on different health indicators. The model includes all five dimensions of the occupational perspective. Conclusion. This study demonstrated how occupational sciences may help understanding the engagement of individuals in their actions and how the doing may contribute to health, in an application related to the occupation of work.
Day: Friday, Time: 14:30-14:55, Session: F81
Introduction. Work is an occupation valued by billions of individuals across cultures and societies. As a determinant of health, work may have several positive effects on individuals’ well-being. However, it may also have negative effects as accidents, physical illnesses or transient mental disorders may occur. Workers’ preventive behaviours appear to be a lever of interest to foster health at work, but no clear definition does exist. The use of an occupational perspective (Njelesani, Tang, Jonsson, & Polatajko, 2014) seems a promising way to understand the characteristics of preventive behaviours at work. Objective. The aim of the study was to define those behaviours workers may adopt to foster prevention in order to understand their operational characteristics. Method. To achieve this aim, secondary qualitative analysis based on data collected during three prior studies were conducted. Results. Results allowed generating the Model of preventive behaviours at work. This model defines preventive behaviours at work as six different types of engagement toward prevention. Those engagements are realized into a context, which involves several factors related to the person, the occupation and the environment. Finally, the model proposes those engagements may lead to several positive outcomes on different health indicators. The model includes all five dimensions of the occupational perspective. Conclusion. This study demonstrated how occupational sciences may help understanding the engagement of individuals in their actions and how the doing may contribute to health, in an application related to the occupation of work.
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Aspiration prevention in acute care: a collaborative approach to positioning
Kellen Baldock
Day: Thursday, Time: 10:00-10:25, Session: T24
After four aspiration-related deaths on a surgical oncology inpatient unit in the summer of 2017, an interprofessional group was formed to review current practice. Literature shows that a patient sitting upright during and after meals is best practice and a primary prevention measure for aspiration. During a two-week observation of weekday mealtimes, only 33% of those with diet orders were sitting in a chair at mealtimes. Objectives: The purpose of the quality improvement project will be: (1) to collaboratively develop an intervention with patients and staff that will increase the number of post-operative patients sitting in a chair at mealtimes, and (2) to pilot this intervention on the surgical oncology inpatient unit. Approach: Patient interviews, staff surveys and a facilitated focus group will inform the intervention(s) design. Education will be provided to appropriate stakeholders to inform an intervention pilot. Once implemented, unit audits of patient position at all three mealtimes will be conducted to track change. Practice Implications: The quality improvement project will aim to positively impact post-operative best practice and highlight the importance of a person-centred interdisciplinary approach to positioning in acute care. Conclusions: There is a role for occupational therapists to work collaboratively to address safe mealtime positioning in acute care.
Day: Thursday, Time: 10:00-10:25, Session: T24
After four aspiration-related deaths on a surgical oncology inpatient unit in the summer of 2017, an interprofessional group was formed to review current practice. Literature shows that a patient sitting upright during and after meals is best practice and a primary prevention measure for aspiration. During a two-week observation of weekday mealtimes, only 33% of those with diet orders were sitting in a chair at mealtimes. Objectives: The purpose of the quality improvement project will be: (1) to collaboratively develop an intervention with patients and staff that will increase the number of post-operative patients sitting in a chair at mealtimes, and (2) to pilot this intervention on the surgical oncology inpatient unit. Approach: Patient interviews, staff surveys and a facilitated focus group will inform the intervention(s) design. Education will be provided to appropriate stakeholders to inform an intervention pilot. Once implemented, unit audits of patient position at all three mealtimes will be conducted to track change. Practice Implications: The quality improvement project will aim to positively impact post-operative best practice and highlight the importance of a person-centred interdisciplinary approach to positioning in acute care. Conclusions: There is a role for occupational therapists to work collaboratively to address safe mealtime positioning in acute care.
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Driver rehabilitation after stroke: evaluating the usability of mobile technology
Michael Cammarata, Jocelyn Harris, Julie Richardson and Brenda Vrkljan
Day: Thursday, Time: 08:30-08:55, Session: T12
Introduction: To address the goal of return to driving after stroke, there remains a research evidence gap with regard to effective intervention options that can promote a person’s readiness to drive. The rapid emergence and broad adoption of technology platforms, such as the iPad™, can provide a new way for individuals to re-train this occupation. However, mobile technology has yet to be examined for driver rehabilitation after stroke. Objectives: The objective of this study is to investigate the experience of using the iPad™ alongside ‘DriveFocus®’ a commercially available mobile application (app) by individuals with stroke and their caregiver for the purpose of driver retraining. Methods: A sequential mixed-methods usability assessment involving paired participants (person with stroke and their caregiver; n=20) will analyze their interactions with the iPad™ and app. Practice Implications: Usability analysis of this technology will inform the development of clinical protocols necessary for occupational therapists (OTs) to deliver and support this novel driving intervention. In a survey conducted by this team, OTs who address driving post-stroke identified a critical need for off-road interventions that are feasible (e.g., low cost, usable by patients) yet still approximate the task of driving (i.e., ecologically valid). As well, OTs described the importance of self-administered interventions (i.e., ‘homework’) to increase time spent on driving-related activities. Mobile apps represent a promising format for addressing the identified clinical and research gaps in driver rehabilitation. Conclusions: This study will determine the usability of mobile technology as a means for OTs to deliver driver retraining after stroke.
Day: Thursday, Time: 08:30-08:55, Session: T12
Introduction: To address the goal of return to driving after stroke, there remains a research evidence gap with regard to effective intervention options that can promote a person’s readiness to drive. The rapid emergence and broad adoption of technology platforms, such as the iPad™, can provide a new way for individuals to re-train this occupation. However, mobile technology has yet to be examined for driver rehabilitation after stroke. Objectives: The objective of this study is to investigate the experience of using the iPad™ alongside ‘DriveFocus®’ a commercially available mobile application (app) by individuals with stroke and their caregiver for the purpose of driver retraining. Methods: A sequential mixed-methods usability assessment involving paired participants (person with stroke and their caregiver; n=20) will analyze their interactions with the iPad™ and app. Practice Implications: Usability analysis of this technology will inform the development of clinical protocols necessary for occupational therapists (OTs) to deliver and support this novel driving intervention. In a survey conducted by this team, OTs who address driving post-stroke identified a critical need for off-road interventions that are feasible (e.g., low cost, usable by patients) yet still approximate the task of driving (i.e., ecologically valid). As well, OTs described the importance of self-administered interventions (i.e., ‘homework’) to increase time spent on driving-related activities. Mobile apps represent a promising format for addressing the identified clinical and research gaps in driver rehabilitation. Conclusions: This study will determine the usability of mobile technology as a means for OTs to deliver driver retraining after stroke.
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The Occupational Therapy Role in Combating Human Trafficking
Carrie Mandryk, Meagan Korell, Truc Le, Reg Urbanowski
Day: Friday, Time: 13:30-13:55, Session: F62
Introduction: In 2016, approximately 17,000 people in Canada were affected by human trafficking (Dovydaitis, 2010; Global Slavery Index, 2016). This population often goes unnoticed by the health care systems, despite occupational therapists (OTs) having the underlying skills to not only identify victims of human trafficking, but to assist with the restoration of meaningful occupations. Objective: To determine the role of OTs in the care of victims and survivors of human trafficking by using the occupational justice (OJ) framework and trauma-informed care model (TIC) to guide practice. Approach: An extensive literature search was conducted on the occupational justice framework, trauma-informed care, and the role of OT in combating human trafficking. Practice implications: OTs can use the OJ framework and TIC model to inform their practice with this population in a variety of settings such as: individual counselling, group settings, providing occupation-based training, and preventative education. These strategies should also be incorporated into the MOT programs across Canada to increase awareness and competence when working with victims of human trafficking. Conclusions: It is evident that gaps in the literature exist regarding protocols for how OTs can provide care to victims of human trafficking. This may be due to issues related to self-disclosure, and the minimal education provided to OTs about the prevalence and signs of human trafficking in Canada. Despite the emerging role for OTs in assessing and treating this population, future research is needed to explicitly state the role of occupational therapy in combating human trafficking.
Day: Friday, Time: 13:30-13:55, Session: F62
Introduction: In 2016, approximately 17,000 people in Canada were affected by human trafficking (Dovydaitis, 2010; Global Slavery Index, 2016). This population often goes unnoticed by the health care systems, despite occupational therapists (OTs) having the underlying skills to not only identify victims of human trafficking, but to assist with the restoration of meaningful occupations. Objective: To determine the role of OTs in the care of victims and survivors of human trafficking by using the occupational justice (OJ) framework and trauma-informed care model (TIC) to guide practice. Approach: An extensive literature search was conducted on the occupational justice framework, trauma-informed care, and the role of OT in combating human trafficking. Practice implications: OTs can use the OJ framework and TIC model to inform their practice with this population in a variety of settings such as: individual counselling, group settings, providing occupation-based training, and preventative education. These strategies should also be incorporated into the MOT programs across Canada to increase awareness and competence when working with victims of human trafficking. Conclusions: It is evident that gaps in the literature exist regarding protocols for how OTs can provide care to victims of human trafficking. This may be due to issues related to self-disclosure, and the minimal education provided to OTs about the prevalence and signs of human trafficking in Canada. Despite the emerging role for OTs in assessing and treating this population, future research is needed to explicitly state the role of occupational therapy in combating human trafficking.
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Waitlist Management using a RTI approach
Patricia O'Krafka, Jillian Quigley
Day: Saturday, Time: 11:30-11:55, Session: S93
Title: Waitlist management using a Response to Intervention (RTI) approach
Introduction: RTI has grown in popularity across education and health systems since the early 2000’s. Implementation in education involves identifying children at the greatest risk of failure and providing multi-tiered intervention. Children move through the tiers based on their needs and intervention success. Translation of this model to occupational therapy supports ensured a match between need and service provision. Objectives: To describe the development of a response to intervention (RTI) approach to manage an extensive wait list for Occupational Therapy (OT) assessment and treatment for over 50 children referred through community-based referrals. Method: The RTI approach focused on quality improvement measures and was implemented using a phased methodology to provide treatment services to community-based OT referrals using allied health students completing their clinical practicums. The model of service provision offered was based on the needs of the child, and children were offered progressively specialized services as required. Results: Group-based offerings expanded treatment capacity. By providing structured group programming, the overall number of client visits increased, and a greater number of individuals were seen. The increase in the number of clients supported by the students eliminated the OT waitlist and clients were booked at the time the referral was received. Additionally, clients attending targeted group intervention received a greater number of sessions, while using fewer staffing resources. Conclusions: Offering tiered service provision based on client need can facilitate increased caseload capacity, improved access to service, and increased consistency of service provided.
Abstract Summary: Occupational therapy students employing a ‘response to Intervention’ approach in a peer supported learning environment were successful at eliminating a service waitlist, increasing service capacity, ensuring consistency and improving quality of service. Changing practice to target actual need can have improved outcomes for clients, clinicians, students, and operations.
References:
Fuchs, D., & Fuchs, L. (2006). Introduction to response to intervention: What, why, and how valid is it? Reading Research Quarterly, 41 (1): 93–99.
Day: Saturday, Time: 11:30-11:55, Session: S93
Title: Waitlist management using a Response to Intervention (RTI) approach
Introduction: RTI has grown in popularity across education and health systems since the early 2000’s. Implementation in education involves identifying children at the greatest risk of failure and providing multi-tiered intervention. Children move through the tiers based on their needs and intervention success. Translation of this model to occupational therapy supports ensured a match between need and service provision. Objectives: To describe the development of a response to intervention (RTI) approach to manage an extensive wait list for Occupational Therapy (OT) assessment and treatment for over 50 children referred through community-based referrals. Method: The RTI approach focused on quality improvement measures and was implemented using a phased methodology to provide treatment services to community-based OT referrals using allied health students completing their clinical practicums. The model of service provision offered was based on the needs of the child, and children were offered progressively specialized services as required. Results: Group-based offerings expanded treatment capacity. By providing structured group programming, the overall number of client visits increased, and a greater number of individuals were seen. The increase in the number of clients supported by the students eliminated the OT waitlist and clients were booked at the time the referral was received. Additionally, clients attending targeted group intervention received a greater number of sessions, while using fewer staffing resources. Conclusions: Offering tiered service provision based on client need can facilitate increased caseload capacity, improved access to service, and increased consistency of service provided.
Abstract Summary: Occupational therapy students employing a ‘response to Intervention’ approach in a peer supported learning environment were successful at eliminating a service waitlist, increasing service capacity, ensuring consistency and improving quality of service. Changing practice to target actual need can have improved outcomes for clients, clinicians, students, and operations.
References:
Fuchs, D., & Fuchs, L. (2006). Introduction to response to intervention: What, why, and how valid is it? Reading Research Quarterly, 41 (1): 93–99.
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Perceived Value of a Knowledge Translation Intervention Designed to Facilitate Burn Survivors’ Work Reintegration
Melissa Lamble, Vanessa Seto, Zi Ye, Charlotte Couture, Ana de Oliveira, Valerie Calva, Marie-Andrée Couture, Chantal Poulin, Léo LaSalle, Bernadette Nedelec
Day: Thursday, Time: 08:30-08:55, Session: T8
Background: Returning to work can be a substantial challenge for burn survivors. In other conditions, open communication has been identified as a facilitator for return to work (RTW).
To promote communication in the workplace, a knowledge translation (KT) intervention in the form of an educational video was developed for adult burn survivors. Objectives: To evaluate
the impact of the KT intervention on the RTW process of burn survivors. Methods: This study was a cross-sectional, mixed methods study in which burn survivors included in the KT
intervention were recruited and compared to a control group (CG). The CG included burn survivors who had not seen the video and were selectively invited to participate so that the two
groups’ mean age, gender and percent total body surface area burned were similar. Semistructured interviews were conducted to gather information about their RTW process and
outcomes. Results: Overall, both groups were satisfied with their RTW process. Participants from the CG identified more barriers related to support received at work and psychological
symptoms. Many participants from the KT group indicated that the video gave them tools to explain and provide others with a better understanding of their lived experience. Conclusions: It
is possible that the video facilitated more open communication by empowering burn survivors to explain their situation on their own, thus reducing the prevalence of social and psychological barriers among the KT group. The video should continue to be used, although modifications should be made to further elaborate on RTW facilitators.
Day: Thursday, Time: 08:30-08:55, Session: T8
Background: Returning to work can be a substantial challenge for burn survivors. In other conditions, open communication has been identified as a facilitator for return to work (RTW).
To promote communication in the workplace, a knowledge translation (KT) intervention in the form of an educational video was developed for adult burn survivors. Objectives: To evaluate
the impact of the KT intervention on the RTW process of burn survivors. Methods: This study was a cross-sectional, mixed methods study in which burn survivors included in the KT
intervention were recruited and compared to a control group (CG). The CG included burn survivors who had not seen the video and were selectively invited to participate so that the two
groups’ mean age, gender and percent total body surface area burned were similar. Semistructured interviews were conducted to gather information about their RTW process and
outcomes. Results: Overall, both groups were satisfied with their RTW process. Participants from the CG identified more barriers related to support received at work and psychological
symptoms. Many participants from the KT group indicated that the video gave them tools to explain and provide others with a better understanding of their lived experience. Conclusions: It
is possible that the video facilitated more open communication by empowering burn survivors to explain their situation on their own, thus reducing the prevalence of social and psychological barriers among the KT group. The video should continue to be used, although modifications should be made to further elaborate on RTW facilitators.
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Une formation pour prévenir et gérer le syndrome d’épuisement professionnel
Caroline Borris, Dominique Cardinal, Bernard Pinet
Day: Saturday, Time: 11:30-11:55, Session: S92
Introduction : Le syndrome d’épuisement professionnel (SdEP) atteint un niveau épidémique parmi les professionnels de la santé. Il est crucial d’agir afin de réduire les conséquences néfastes du SdEP sur les plans personnel, professionnel et socioéconomique. Plusieurs stratégies, incluant le développement de la résilience, permettraient de diminuer le risque d’être atteint du SdEP. Le INSÉRER LE NOM X a conçu un atelier en ce sens afin de mieux outiller les professionnels de la santé. Objectifs : Mesurer la satisfaction des participants à l’égard de l’atelier et évaluer s’ils sont mieux outillés pour prévenir et gérer le SdEP. Méthode : 201 participants ont suivi l’atelier en ligne et 72 en salle, de 2015 à 2017. Des données touchant le niveau de satisfaction, l’acquisition des connaissances perçue et les stratégies mises en place quatre mois après la formation ont été recueillies. Résultats : Les participants affichent un niveau de satisfaction très élevé concernant le contenu, la satisfaction globale et l’acquisition des connaissances. De plus, 100 % des répondants peuvent mieux reconnaitre le SdEP. Plusieurs répondants ont mis en place diverses stratégies de prévention pour eux ou leurs collègues. Conclusion : L’atelier semble répondre aux besoins de formation des professionnels de la santé. Il a permis aux participants d’intégrer des stratégies simples qui correspondent à celles retrouvées dans les écrits. Ce changement est un premier pas vers la promotion et la protection du bien-être des professionnels de la santé.
Day: Saturday, Time: 11:30-11:55, Session: S92
Introduction : Le syndrome d’épuisement professionnel (SdEP) atteint un niveau épidémique parmi les professionnels de la santé. Il est crucial d’agir afin de réduire les conséquences néfastes du SdEP sur les plans personnel, professionnel et socioéconomique. Plusieurs stratégies, incluant le développement de la résilience, permettraient de diminuer le risque d’être atteint du SdEP. Le INSÉRER LE NOM X a conçu un atelier en ce sens afin de mieux outiller les professionnels de la santé. Objectifs : Mesurer la satisfaction des participants à l’égard de l’atelier et évaluer s’ils sont mieux outillés pour prévenir et gérer le SdEP. Méthode : 201 participants ont suivi l’atelier en ligne et 72 en salle, de 2015 à 2017. Des données touchant le niveau de satisfaction, l’acquisition des connaissances perçue et les stratégies mises en place quatre mois après la formation ont été recueillies. Résultats : Les participants affichent un niveau de satisfaction très élevé concernant le contenu, la satisfaction globale et l’acquisition des connaissances. De plus, 100 % des répondants peuvent mieux reconnaitre le SdEP. Plusieurs répondants ont mis en place diverses stratégies de prévention pour eux ou leurs collègues. Conclusion : L’atelier semble répondre aux besoins de formation des professionnels de la santé. Il a permis aux participants d’intégrer des stratégies simples qui correspondent à celles retrouvées dans les écrits. Ce changement est un premier pas vers la promotion et la protection du bien-être des professionnels de la santé.
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A framework to describe risks associated with dementia-related wandering
Noelannah Neubauer, Dr. Lili Liu
Day: Saturday, Time: 10:30-10:55, Session: S58
Introduction: Three in five Canadians with dementia will wander and become lost raising concern as to how it can be managed effectively. Hundreds of interventions, such as GPS devices have been developed to manage this issue, however no guideline exists to allow for the successful adoption of these strategies. Objectives: To develop a practice framework that will help stakeholders choose strategies to manage challenging behaviours associated with dementia-related wandering. Methods: Semi-structured individual phone interviews containing 12 questions were conducted with family and formal caregivers, persons with mild dementia, occupational therapists, police, social workers, and staff from community organizations concerned about dementia-related wandering. The purpose of the interviews was to determine what factors influenced successful adoption of wander-management strategies and to identify if any differences across stakeholders exist. Responses from these interviews were used to develop a practice framework for adoption of wander-management strategies. Results: Thirty-five participants from four Canadian provinces were recruited. Responses from the interviews highlighted 3 contextual factors that influence the successful adoption of wander-management strategies: (1) Risk associated with wandering; (2) Culture; (3) Geography. Perceived risk was conveyed as the most influential factor of strategy adoption across all stakeholder groups. The relationships of these three factors were further reflected in the framework. Conclusion: This is the first study to identify and describe factors that influence strategy adoption for dementia-related wandering. This framework can be used by caregivers, health and community service providers to enhance the safety and well-being of older adults at risk of getting lost.
Day: Saturday, Time: 10:30-10:55, Session: S58
Introduction: Three in five Canadians with dementia will wander and become lost raising concern as to how it can be managed effectively. Hundreds of interventions, such as GPS devices have been developed to manage this issue, however no guideline exists to allow for the successful adoption of these strategies. Objectives: To develop a practice framework that will help stakeholders choose strategies to manage challenging behaviours associated with dementia-related wandering. Methods: Semi-structured individual phone interviews containing 12 questions were conducted with family and formal caregivers, persons with mild dementia, occupational therapists, police, social workers, and staff from community organizations concerned about dementia-related wandering. The purpose of the interviews was to determine what factors influenced successful adoption of wander-management strategies and to identify if any differences across stakeholders exist. Responses from these interviews were used to develop a practice framework for adoption of wander-management strategies. Results: Thirty-five participants from four Canadian provinces were recruited. Responses from the interviews highlighted 3 contextual factors that influence the successful adoption of wander-management strategies: (1) Risk associated with wandering; (2) Culture; (3) Geography. Perceived risk was conveyed as the most influential factor of strategy adoption across all stakeholder groups. The relationships of these three factors were further reflected in the framework. Conclusion: This is the first study to identify and describe factors that influence strategy adoption for dementia-related wandering. This framework can be used by caregivers, health and community service providers to enhance the safety and well-being of older adults at risk of getting lost.
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How does Virtual Reality Align with Occupational Therapy?: A Scoping Review
Sarah Hunt, Kayla McDonald, Jacklyn Upchan, Mary Egan, Heidi Sveistrup & Patrick Duong
Day: Saturday, Time: 11:00-11:25, Session: S77
Introduction. Stroke rehabilitation guidelines encourage occupational therapists to utilize virtual reality (VR). There are many potential uses of VR and it is not yet clear how these uses align with occupational therapy goals and processes. Objectives. The purpose of this project was to determine which occupational therapy uses of VR are currently described in the research literature, and how these uses align with occupational therapy goals and processes. Methods. A scoping review was carried out. A systematic search strategy was used to identify peer-reviewed papers that described VR in occupational therapy in descriptive or research papers. Articles in English or French were included if there was an occupational therapist author or the publication was in an occupational therapy journal, or the terms occupational therapy, stroke and virtual reality were found in the title, abstract or keywords. Uses of VR were organized under Golledge’s classification of occupation: diversional activity, activity, purposeful activity and occupation. Results. Bibliographic searches resulted in 396 articles, of which 36 met the inclusion criteria. Current occupational therapy uses of VR are primarily in the context of activity in stroke rehabilitation. Of the articles retained, 27 (75%) described VR as activity and 9 (25%) described VR as purposeful activity. There were no descriptions of diversional activity or occupation. Conclusions. This paper provides an important starting point for considering whether VR in occupational therapy can be developed in ways more consistent with occupation-focused practice.
Day: Saturday, Time: 11:00-11:25, Session: S77
Introduction. Stroke rehabilitation guidelines encourage occupational therapists to utilize virtual reality (VR). There are many potential uses of VR and it is not yet clear how these uses align with occupational therapy goals and processes. Objectives. The purpose of this project was to determine which occupational therapy uses of VR are currently described in the research literature, and how these uses align with occupational therapy goals and processes. Methods. A scoping review was carried out. A systematic search strategy was used to identify peer-reviewed papers that described VR in occupational therapy in descriptive or research papers. Articles in English or French were included if there was an occupational therapist author or the publication was in an occupational therapy journal, or the terms occupational therapy, stroke and virtual reality were found in the title, abstract or keywords. Uses of VR were organized under Golledge’s classification of occupation: diversional activity, activity, purposeful activity and occupation. Results. Bibliographic searches resulted in 396 articles, of which 36 met the inclusion criteria. Current occupational therapy uses of VR are primarily in the context of activity in stroke rehabilitation. Of the articles retained, 27 (75%) described VR as activity and 9 (25%) described VR as purposeful activity. There were no descriptions of diversional activity or occupation. Conclusions. This paper provides an important starting point for considering whether VR in occupational therapy can be developed in ways more consistent with occupation-focused practice.
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The Effect of Productivity-Based Wages on Employment Participation – A Scoping Review
Lysaght, R., Bobbette, N. & Ciampa, A.
Day: Saturday, Time: 11:30-11:55, Session: S28
Introduction: Persons with intellectual disabilities (ID) face a number of challenges to labour market entry. The legal requirement for employers to compensate workers at fair market wages, regardless of their ability to perform at competitive levels, has been cited as a barrier to hiring of workers with ID. Productivity-based wage systems (PBWS) are a possible alternative. Objectives: This scoping review sought to answer the questions: 1) What theoretical and practical arguments have been advanced for and against PBWS? 2) What is the impact of PBWS on employment participation? Methods: The review followed the procedures outlined by Arksey & O’Malley (2005). The initial search identified 63 papers published since 2012 that addressed the central concept of PBWS and ID. Further review relative to selection criteria reduced the pool to 34 papers. The three authors independently conducted thematic analysis of the papers, and used a consensus-building process to identify final themes. Results: PBWS exist in only Australia, Israel, and the U.S., and their implementation is a source of great controversy. Positions against PBWS include the opportunity for exploitation of vulnerable workers, and the inequity of basing the wages of workers with IDD on productivity when such standards are rarely applied to other workers. Arguments in favour of PBMS cite opportunity for increased inclusive productivity options and the potential for greater wage fairness. Conclusions: There exists little empirical evidence concerning the impact of PBWS on the employment of persons with ID. Ongoing research is needed to inform debate on this contentious issue.
Day: Saturday, Time: 11:30-11:55, Session: S28
Introduction: Persons with intellectual disabilities (ID) face a number of challenges to labour market entry. The legal requirement for employers to compensate workers at fair market wages, regardless of their ability to perform at competitive levels, has been cited as a barrier to hiring of workers with ID. Productivity-based wage systems (PBWS) are a possible alternative. Objectives: This scoping review sought to answer the questions: 1) What theoretical and practical arguments have been advanced for and against PBWS? 2) What is the impact of PBWS on employment participation? Methods: The review followed the procedures outlined by Arksey & O’Malley (2005). The initial search identified 63 papers published since 2012 that addressed the central concept of PBWS and ID. Further review relative to selection criteria reduced the pool to 34 papers. The three authors independently conducted thematic analysis of the papers, and used a consensus-building process to identify final themes. Results: PBWS exist in only Australia, Israel, and the U.S., and their implementation is a source of great controversy. Positions against PBWS include the opportunity for exploitation of vulnerable workers, and the inequity of basing the wages of workers with IDD on productivity when such standards are rarely applied to other workers. Arguments in favour of PBMS cite opportunity for increased inclusive productivity options and the potential for greater wage fairness. Conclusions: There exists little empirical evidence concerning the impact of PBWS on the employment of persons with ID. Ongoing research is needed to inform debate on this contentious issue.
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On-line learning module development to support dysphagia assessment competency
Sandy Leznoff, Kevin Waldorf, Judi Dueck
Day: Friday, Time: 13:00-13:25, Session: F49
Rationale: The McGill Ingestive Skills Assessment (MISA) is a validated tool designed to assist occupational therapists (OTs) in the assessment of feeding, eating and swallowing. Practice is needed to learn to use the tool and to establish competency for those new to this area of practice. Typically the mentorship is done face-to-face which places high demands on the educator’s time. Objectives: Through the on-line module, novice practitioners are taught how to use MISA and practice with a simulated client. Learners do this at a time they choose. Educator’s time is made available for further mentorship needs. Approach: This work was done based on a study using vignettes to score the MISA (Hansen, et al. 2016). An on-line learning module was designed to support OTs to learn the set-up, administration and scoring of the MISA using a video of the simulated client eating a meal. Learners score each item on the assessment and are given feedback based on the observations from clinical experts. Data is collected to ensure the module is completed by OTs. Mentorship is then provided to use the MISA to assess actual clients, analyze results and devise appropriate intervention plans. Practice Implications: This on-line module is a self-learning tool for OTs new to feeding, eating and swallowing assessment. It encourages use of the MISA, a validated assessment tool. It allows OTs timely access to this learning content. Results inform further mentorship conversations with educators. Conclusions: This module serves as a beneficial piece of a larger competency development strategy.
Day: Friday, Time: 13:00-13:25, Session: F49
Rationale: The McGill Ingestive Skills Assessment (MISA) is a validated tool designed to assist occupational therapists (OTs) in the assessment of feeding, eating and swallowing. Practice is needed to learn to use the tool and to establish competency for those new to this area of practice. Typically the mentorship is done face-to-face which places high demands on the educator’s time. Objectives: Through the on-line module, novice practitioners are taught how to use MISA and practice with a simulated client. Learners do this at a time they choose. Educator’s time is made available for further mentorship needs. Approach: This work was done based on a study using vignettes to score the MISA (Hansen, et al. 2016). An on-line learning module was designed to support OTs to learn the set-up, administration and scoring of the MISA using a video of the simulated client eating a meal. Learners score each item on the assessment and are given feedback based on the observations from clinical experts. Data is collected to ensure the module is completed by OTs. Mentorship is then provided to use the MISA to assess actual clients, analyze results and devise appropriate intervention plans. Practice Implications: This on-line module is a self-learning tool for OTs new to feeding, eating and swallowing assessment. It encourages use of the MISA, a validated assessment tool. It allows OTs timely access to this learning content. Results inform further mentorship conversations with educators. Conclusions: This module serves as a beneficial piece of a larger competency development strategy.
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Évaluation cognitive chez la personne hospitalisée en soins aigus
Leanna Haidar, Alexane Lacombe, Jacinthe Savard, Geneviève Lemay, Danijela Subara, Charline Boudreau
Day: Thursday, Time: 14:30-14:55, Session: T84
Introduction : Les ergothérapeutes travaillant en soins aigus reçoivent régulièrement des références afin de procéder à un dépistage cognitif avec le Montreal Cognitive Assessment (MoCA). Ces demandes peuvent être inappropriées lorsque les patients présentent des facteurs affectant leur cognition d’une façon temporaire ou lors d’une atteinte cognitive permanente déjà documentée telle qu’une démence. Objectif : Valider le contenu d’un algorithme permettant aux professionnels de la santé de déterminer l’outil et le moment approprié pour procéder à une évaluation cognitive afin de gérer un patient qui présente un changement cognitif en soins aigus. Méthodes : La validation du contenu de l’algorithme suit une approche qualitative exploratoire en deux étapes, soit une revue de la littérature rapide et une consultation d’ergothérapeutes et de médecins grâce à des groupes de discussion ainsi que des entrevues individuelles. Une analyse de contenu a permis de faire ressortir les éléments importants à considérer dans la démarche de dépistage. Résultats : Ce processus a permis d’apporter des modifications pour produire un l’algorithme et un guide d’accompagnement reflétant le contexte de pratique en soins aigus et les données probantes. Ces documents seront présentés lors de la conférence. Une deuxième étape du projet est prévue pour documenter la validité prédictive de l’algorithme, c’est-à-dire sa capacité à distinguer les personnes chez qui un dépistage en soins aigus apporte un résultat similaire ou différent de celui obtenu en externe 3 mois plus tard. Conclusion : La présente étude a pu établir l’utilité perçue d’un tel outil, ainsi que le contenu approprié.
Day: Thursday, Time: 14:30-14:55, Session: T84
Introduction : Les ergothérapeutes travaillant en soins aigus reçoivent régulièrement des références afin de procéder à un dépistage cognitif avec le Montreal Cognitive Assessment (MoCA). Ces demandes peuvent être inappropriées lorsque les patients présentent des facteurs affectant leur cognition d’une façon temporaire ou lors d’une atteinte cognitive permanente déjà documentée telle qu’une démence. Objectif : Valider le contenu d’un algorithme permettant aux professionnels de la santé de déterminer l’outil et le moment approprié pour procéder à une évaluation cognitive afin de gérer un patient qui présente un changement cognitif en soins aigus. Méthodes : La validation du contenu de l’algorithme suit une approche qualitative exploratoire en deux étapes, soit une revue de la littérature rapide et une consultation d’ergothérapeutes et de médecins grâce à des groupes de discussion ainsi que des entrevues individuelles. Une analyse de contenu a permis de faire ressortir les éléments importants à considérer dans la démarche de dépistage. Résultats : Ce processus a permis d’apporter des modifications pour produire un l’algorithme et un guide d’accompagnement reflétant le contexte de pratique en soins aigus et les données probantes. Ces documents seront présentés lors de la conférence. Une deuxième étape du projet est prévue pour documenter la validité prédictive de l’algorithme, c’est-à-dire sa capacité à distinguer les personnes chez qui un dépistage en soins aigus apporte un résultat similaire ou différent de celui obtenu en externe 3 mois plus tard. Conclusion : La présente étude a pu établir l’utilité perçue d’un tel outil, ainsi que le contenu approprié.
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Use of Title by Retired Occupational Therapists
Cindy Huang, Selina Huang, Shannon Reid, Rosemary Lysaght
Day: Thursday, Time: 13:00-13:25, Session: T55
Rationale: Professional identity can diminish in retirement due to the loss of well-established roles and professional relationships (Silver & Williams, 2016). Furthermore, professional regulation rules may restrict one from self-identifying as part of a long-held profession. Standards for occupational therapy (OT) regulation and use of title are variable across North America (Hall et al., 2016). Understanding the range of approaches to regulating retirement, and the views of occupational therapists relative to continued use of title, may help inform policy directions in this regard.
Objective: The purpose of this study was to identify current title-use provisions for healthcare professionals in Canada, and to understand the views of occupational therapists on this issue.
Method: An environmental scan of title-use provisions in Canada was conducted within the fields of OT, PT, SLP, audiology, nursing, and medicine. Subsequently, a 24-question instrument was developed to poll currently practicing and retired occupational therapists concerning professional regulation, use of title, and retirement. A purposive network sampling method was used, with the questionnaire being distributed through the mailing lists of OT education programs across Canada and the CAOT website. Descriptive statistics and thematic analyses were used to summarize results.
Results: Over 70% of respondents indicated interest in retaining the OT title post retirement. Respondents reported a number of regulatory barriers to maintaining a title, and a range of motivations for keeping or relinquishing their title.
Conclusion: Use of title after retirement is of interest to many Canadian occupational therapists and requires continued discussion in the field.
Day: Thursday, Time: 13:00-13:25, Session: T55
Rationale: Professional identity can diminish in retirement due to the loss of well-established roles and professional relationships (Silver & Williams, 2016). Furthermore, professional regulation rules may restrict one from self-identifying as part of a long-held profession. Standards for occupational therapy (OT) regulation and use of title are variable across North America (Hall et al., 2016). Understanding the range of approaches to regulating retirement, and the views of occupational therapists relative to continued use of title, may help inform policy directions in this regard.
Objective: The purpose of this study was to identify current title-use provisions for healthcare professionals in Canada, and to understand the views of occupational therapists on this issue.
Method: An environmental scan of title-use provisions in Canada was conducted within the fields of OT, PT, SLP, audiology, nursing, and medicine. Subsequently, a 24-question instrument was developed to poll currently practicing and retired occupational therapists concerning professional regulation, use of title, and retirement. A purposive network sampling method was used, with the questionnaire being distributed through the mailing lists of OT education programs across Canada and the CAOT website. Descriptive statistics and thematic analyses were used to summarize results.
Results: Over 70% of respondents indicated interest in retaining the OT title post retirement. Respondents reported a number of regulatory barriers to maintaining a title, and a range of motivations for keeping or relinquishing their title.
Conclusion: Use of title after retirement is of interest to many Canadian occupational therapists and requires continued discussion in the field.
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Répertoire d'interventions efficaces auprès des personnes atteintes de démence
Julie Lahaie, Martine Brousseau
Day: Friday, Time: 13:00-13:25, Session: F50
Introduction : Les démences affectent 7,1% des Canadiens (Agence de la santé publique du Canada, 2017) et sont accompagnées dans une proportion de 40 à 60% de symptômes comportementaux et psychologiques (SCPD) (MSSS, 2014). Ceux-ci, tels que l’errance, l’agressivité et l’agitation entraînent de nombreuses conséquences pour la personne, son entourage ainsi que pour le personnel soignant. Travers et coll. (2016), dans une revue systématique, font une synthèse de l’efficacité des interventions basées sur les occupations signifiantes aidant à diminuer les SCPD. Depuis, de nombreuses études viennent compléter le répertoire d’interventions efficaces. Objectifs : Exposer le répertoire des différentes interventions de l’ergothérapeute dans la gestion des SCPD en fonction de leur efficacité. Méthodologie : Une recension des écrits a été effectuée dans les bases de données suivantes : Cinahl, Medline, PsycInfo, Scopus, Cochrane Library et a conduit à l’appréciation critique de 37 articles scientifiques. Résultats : Les interventions telles que les activités structurées et adaptées, la modification de l’environnement, les interventions sensorielles, les activités physiques, les contacts sociaux et les interventions comportementales montrent de bons niveaux d’évidence pour confirmer l’efficacité à réduire la fréquence des problématiques de comportement. Conclusion : La connaissance des interventions efficaces pour gérer les symptômes est un incontournable afin que les ergothérapeutes adoptent de bonnes pratiques auprès des personnes âgées. Des pistes de recherche seront suggérées.
Day: Friday, Time: 13:00-13:25, Session: F50
Introduction : Les démences affectent 7,1% des Canadiens (Agence de la santé publique du Canada, 2017) et sont accompagnées dans une proportion de 40 à 60% de symptômes comportementaux et psychologiques (SCPD) (MSSS, 2014). Ceux-ci, tels que l’errance, l’agressivité et l’agitation entraînent de nombreuses conséquences pour la personne, son entourage ainsi que pour le personnel soignant. Travers et coll. (2016), dans une revue systématique, font une synthèse de l’efficacité des interventions basées sur les occupations signifiantes aidant à diminuer les SCPD. Depuis, de nombreuses études viennent compléter le répertoire d’interventions efficaces. Objectifs : Exposer le répertoire des différentes interventions de l’ergothérapeute dans la gestion des SCPD en fonction de leur efficacité. Méthodologie : Une recension des écrits a été effectuée dans les bases de données suivantes : Cinahl, Medline, PsycInfo, Scopus, Cochrane Library et a conduit à l’appréciation critique de 37 articles scientifiques. Résultats : Les interventions telles que les activités structurées et adaptées, la modification de l’environnement, les interventions sensorielles, les activités physiques, les contacts sociaux et les interventions comportementales montrent de bons niveaux d’évidence pour confirmer l’efficacité à réduire la fréquence des problématiques de comportement. Conclusion : La connaissance des interventions efficaces pour gérer les symptômes est un incontournable afin que les ergothérapeutes adoptent de bonnes pratiques auprès des personnes âgées. Des pistes de recherche seront suggérées.
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Beyond Silence: Advancing Workplace Mental Health in Healthcare
Sandra Moll, Sheila Addanki, Luciana Macedo
Day: Saturday, Time: 09:30-09:55, Session: S31
Introduction: Mental health problems are experienced by many healthcare workers, but they are often surrounded by a web of stigma and silence. Customized, evidence-based approaches are needed to overcome the unique barriers to psychological health and safety in the context of healthcare work. The need is particularly acute in small, under-resourced healthcare organizations.
Objective: To evaluate an innovative approach to workplace mental health training for healthcare workers in small, community-based organizations.
Method: The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) evaluation framework (Glasgow et al., 1999), was adopted to track both process and outcomes of the two-day training. Eight training programs, co-led by peer educators, included approximately 100 attendees from small, under-resourced healthcare organizations across Ontario. Pre, post, three and six-month follow-up questionnaires included standardized tools to track mental health literacy, stigmatized beliefs, and help-outreach behavior. In addition, process data included participant characteristics, attendance rates, and fidelity evaluations.
Results: Multilevel regression models will highlight changes over time on primary outcomes (behavior change) and secondary outcomes (mental health literacy and stigmatized beliefs). In addition, mixed effects models will track predictors of the program outcomes. Qualitative process data will illustrate key issues shaping program implementation and impact.
Conclusion: In the rapidly growing field of workplace mental health, there is a need for high quality, evidence-based programs to meet the needs of vulnerable healthcare workers. Findings from this study will inform recommendations for therapists engaged in workplace mental health promotion, particularly in healthcare settings.
Day: Saturday, Time: 09:30-09:55, Session: S31
Introduction: Mental health problems are experienced by many healthcare workers, but they are often surrounded by a web of stigma and silence. Customized, evidence-based approaches are needed to overcome the unique barriers to psychological health and safety in the context of healthcare work. The need is particularly acute in small, under-resourced healthcare organizations.
Objective: To evaluate an innovative approach to workplace mental health training for healthcare workers in small, community-based organizations.
Method: The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) evaluation framework (Glasgow et al., 1999), was adopted to track both process and outcomes of the two-day training. Eight training programs, co-led by peer educators, included approximately 100 attendees from small, under-resourced healthcare organizations across Ontario. Pre, post, three and six-month follow-up questionnaires included standardized tools to track mental health literacy, stigmatized beliefs, and help-outreach behavior. In addition, process data included participant characteristics, attendance rates, and fidelity evaluations.
Results: Multilevel regression models will highlight changes over time on primary outcomes (behavior change) and secondary outcomes (mental health literacy and stigmatized beliefs). In addition, mixed effects models will track predictors of the program outcomes. Qualitative process data will illustrate key issues shaping program implementation and impact.
Conclusion: In the rapidly growing field of workplace mental health, there is a need for high quality, evidence-based programs to meet the needs of vulnerable healthcare workers. Findings from this study will inform recommendations for therapists engaged in workplace mental health promotion, particularly in healthcare settings.
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A scoping review of transfer safety outcomes using active-assist devices
Eisa Galle, Javier Diaz, Orson Lui, Lucas Proulx, Kent Tang, Tara Packham
Day: Thursday, Time: 14:30-14:55, Session: T81
Introduction. Safe patient handling practices reduce injury risk for health care workers (HCW) and patients, but may conflict with goals of rehabilitation and person-centred care by minimizing a) active participation in transfers and b) autonomy and dignity while using mechanical lifts. Active-assist transfer devices (AATDs) have potential to address both safety and support needs for appropriate clients. Objectives. To review and synthesize the scope and nature of evidence to support the use of AATD for improving transfer safety for patients and caregivers in hospital and community settings. Methods. Scoping review of peer-reviewed and grey literature, using systematic search strategies and multiple reviewers for identifying papers and extracting data. Results. Twenty nine peer-reviewed publications, and 12 other documents (policy, technical) were included in the review. Half focused on HCW safety in the hospital setting: only seven addressed patient safety in the community. Generally, literature was of low quality, with no controlled trials to support the benefit of this equipment, and often from a nursing perspective. However, positive outcomes reported included safety, satisfaction, and equipment utilization. Conclusions. There is a need for rigorous research on use of AATDs in the community comparing rehabilitation outcomes across other forms of transfer equipment. Other important targets include injury risk for family caregivers, and potential to support early discharge. At present, utilization of AATDs within the rehabilitation field will continue to rely on best judgement of the care team. Implementation of AATDs should be considered a compelling target for practice-based research and quality improvements.
Day: Thursday, Time: 14:30-14:55, Session: T81
Introduction. Safe patient handling practices reduce injury risk for health care workers (HCW) and patients, but may conflict with goals of rehabilitation and person-centred care by minimizing a) active participation in transfers and b) autonomy and dignity while using mechanical lifts. Active-assist transfer devices (AATDs) have potential to address both safety and support needs for appropriate clients. Objectives. To review and synthesize the scope and nature of evidence to support the use of AATD for improving transfer safety for patients and caregivers in hospital and community settings. Methods. Scoping review of peer-reviewed and grey literature, using systematic search strategies and multiple reviewers for identifying papers and extracting data. Results. Twenty nine peer-reviewed publications, and 12 other documents (policy, technical) were included in the review. Half focused on HCW safety in the hospital setting: only seven addressed patient safety in the community. Generally, literature was of low quality, with no controlled trials to support the benefit of this equipment, and often from a nursing perspective. However, positive outcomes reported included safety, satisfaction, and equipment utilization. Conclusions. There is a need for rigorous research on use of AATDs in the community comparing rehabilitation outcomes across other forms of transfer equipment. Other important targets include injury risk for family caregivers, and potential to support early discharge. At present, utilization of AATDs within the rehabilitation field will continue to rely on best judgement of the care team. Implementation of AATDs should be considered a compelling target for practice-based research and quality improvements.
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Making it work - documenting conjoint occupational and physiotherapy assessments
Andrea Dyrkacz and Megan Hudson
Day: Thursday, Time: 14:30-14:55, Session: T83
Introduction: In acute care, occupational therapists (OTs) and physiotherapists (PTs) are often called upon to do an assessment to ‘clear’ a patient for discharge. These quick assessments may be done by an individual clinician, or by OT and PT conjointly, and the documentation required may take more time than the episode of care itself due to the need to comply with various legislative, regulatory and organizational standards. Objectives: To demonstrate the efficacy of a short conjoint OT/PT documentation tool for single episodes of care. Approach: 1) To outline the process required to create a form to capture short interventions in the acute care setting by OT or PT individually or conjointly; 2) To review steps taken to ensure legislative, regulatory and organizational standards are met; and 3) To present the care contexts most appropriate for use of this form. Results: The conjoint OT/PT assessment tool was created, pilot-tested, revised in real-time, and organizationally approved in 6-months. Some clinicians (both OT and PT) expressed concern about role-blurring and confusion if a conjoint form was approved, requiring more discussion and time to ensure achieving general consensus prior to seeking organizational approvals. Review after 3-years of use indicates most OTs/PTs have adopted the assessment form for use in single episodes of care, with significantly decreased documentation times. Conclusion: Development of a conjoint OT/PT assessment form for single episodes of care has been widely adopted in a multi-sited health care organization, and has proven to reduce documentation times significantly while still meeting legislatory, regulatory and organizational standards.
Day: Thursday, Time: 14:30-14:55, Session: T83
Introduction: In acute care, occupational therapists (OTs) and physiotherapists (PTs) are often called upon to do an assessment to ‘clear’ a patient for discharge. These quick assessments may be done by an individual clinician, or by OT and PT conjointly, and the documentation required may take more time than the episode of care itself due to the need to comply with various legislative, regulatory and organizational standards. Objectives: To demonstrate the efficacy of a short conjoint OT/PT documentation tool for single episodes of care. Approach: 1) To outline the process required to create a form to capture short interventions in the acute care setting by OT or PT individually or conjointly; 2) To review steps taken to ensure legislative, regulatory and organizational standards are met; and 3) To present the care contexts most appropriate for use of this form. Results: The conjoint OT/PT assessment tool was created, pilot-tested, revised in real-time, and organizationally approved in 6-months. Some clinicians (both OT and PT) expressed concern about role-blurring and confusion if a conjoint form was approved, requiring more discussion and time to ensure achieving general consensus prior to seeking organizational approvals. Review after 3-years of use indicates most OTs/PTs have adopted the assessment form for use in single episodes of care, with significantly decreased documentation times. Conclusion: Development of a conjoint OT/PT assessment form for single episodes of care has been widely adopted in a multi-sited health care organization, and has proven to reduce documentation times significantly while still meeting legislatory, regulatory and organizational standards.
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A shared pathway = reducing inpatient admissions through allied health collaboration
Veronika Lukacs, Andrea Dyrkacz, Sahila Subendran, Elizabeth Weidmark, Nadia Iannetta, Betty Lulseged
Day: Thursday, Time: 13:00-13:25, Session: T51
Introduction: Embedding Allied Health (AH) teams in the Emergency Department (ED) is a trend, with occupational and physiotherapists and social workers supporting care. In one ED, the AH team led practice change in the management of patients with non-surgical pelvic fractures. As most admissions of these patients are attributed to fracture pain, functional disability and difficultly managing in the community, the AH team initiated creation of a pathway to address these issues. The pathway’s goal was a shared conceptual framework to promote consistent practice in ‘flowing’ these patients to the most appropriate level(s) of care, and to mitigate the risk of contracting hospital-acquired conditions, such as delirium or infection. Objectives: To outline the process of creating a pathway for patients presenting to the ED with non-surgical pelvic fractures. Approach: The pathway was developed using the practice-based experience of the AH team in reducing unnecessary inpatient admissions. Content-matter experts from the ED and inpatient orthopedic team refined the pathway. Results: A review indicated 84.6% of patients with non-surgical pelvic fractures were put on the pathway. Supported by AH ED team recommendations, only 15.4% required acute care admission, 60.0% with disposition plan in place. 53.8% received expedited admission for to a rehabilitation or respite centre from ED, with the final 15.4% discharged home with supports. Additionally, ED length of stay was reduced by 49.4%. Conclusion: These improvements may be attributable to the shared pathway, as well as the support of the ED AH interdisciplinary team, with each discipline providing expert assessment, treatment and discharge planning skills.
Day: Thursday, Time: 13:00-13:25, Session: T51
Introduction: Embedding Allied Health (AH) teams in the Emergency Department (ED) is a trend, with occupational and physiotherapists and social workers supporting care. In one ED, the AH team led practice change in the management of patients with non-surgical pelvic fractures. As most admissions of these patients are attributed to fracture pain, functional disability and difficultly managing in the community, the AH team initiated creation of a pathway to address these issues. The pathway’s goal was a shared conceptual framework to promote consistent practice in ‘flowing’ these patients to the most appropriate level(s) of care, and to mitigate the risk of contracting hospital-acquired conditions, such as delirium or infection. Objectives: To outline the process of creating a pathway for patients presenting to the ED with non-surgical pelvic fractures. Approach: The pathway was developed using the practice-based experience of the AH team in reducing unnecessary inpatient admissions. Content-matter experts from the ED and inpatient orthopedic team refined the pathway. Results: A review indicated 84.6% of patients with non-surgical pelvic fractures were put on the pathway. Supported by AH ED team recommendations, only 15.4% required acute care admission, 60.0% with disposition plan in place. 53.8% received expedited admission for to a rehabilitation or respite centre from ED, with the final 15.4% discharged home with supports. Additionally, ED length of stay was reduced by 49.4%. Conclusion: These improvements may be attributable to the shared pathway, as well as the support of the ED AH interdisciplinary team, with each discipline providing expert assessment, treatment and discharge planning skills.
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Debrief: Optimizing Careful Conversations after Violence Events in Acute Care
Estella Tse
Day: Thursday, Time: 13:30-13:55, Session: T65
Introduction: Healthcare is the largest sector impacted by workplace violence with 56% of lost time injuries occurring among frontline staff due to the close nature of their work in caring for patients. After numerous violence events on an acute trauma ward with implications on patient and family safety, staff wellbeing and team functioning, a quality improvement project was initiated to optimize the debrief process. Objectives: The goals of a positive debrief include performance and reflective elements. Participants will understand how this is achieved through a formalized checklist that was created from wide stakeholder engagement and then implemented by frontline staff. Approach: Quality improvement activities identified barriers and supportive activities for debriefing after code white violence events. This resulted in a debrief tool which includes input from families and wider team members refined through an evaluative series of improvement cycles. Follow up education sessions and frontline champions supported the implementation of debriefs to improve safety for patients, families and staff. Practice Implications: Intentional debrief after violence and other significant events can help to identifying safety plans for ongoing patient engagement; comprehensive and timely communication for staff handover and increased identification of worker self care skills leading to higher performing teams. Conclusions: Careful debrief embedded through a systematic quality improvement process can prevent workplace violence in the healthcare setting, improving patient and worker safety as well as improve quality of work life.
Day: Thursday, Time: 13:30-13:55, Session: T65
Introduction: Healthcare is the largest sector impacted by workplace violence with 56% of lost time injuries occurring among frontline staff due to the close nature of their work in caring for patients. After numerous violence events on an acute trauma ward with implications on patient and family safety, staff wellbeing and team functioning, a quality improvement project was initiated to optimize the debrief process. Objectives: The goals of a positive debrief include performance and reflective elements. Participants will understand how this is achieved through a formalized checklist that was created from wide stakeholder engagement and then implemented by frontline staff. Approach: Quality improvement activities identified barriers and supportive activities for debriefing after code white violence events. This resulted in a debrief tool which includes input from families and wider team members refined through an evaluative series of improvement cycles. Follow up education sessions and frontline champions supported the implementation of debriefs to improve safety for patients, families and staff. Practice Implications: Intentional debrief after violence and other significant events can help to identifying safety plans for ongoing patient engagement; comprehensive and timely communication for staff handover and increased identification of worker self care skills leading to higher performing teams. Conclusions: Careful debrief embedded through a systematic quality improvement process can prevent workplace violence in the healthcare setting, improving patient and worker safety as well as improve quality of work life.
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Function as defined by young adults with mental health disorders: A qualitative study
Rozmin Irani, Arianna Coles, Rebecca Zivanovic, Adelena Leon, Skye Barbic
Day: Friday, Time: 14:30-14:55, Session: F86
Background
One in four Canadian young adults, 25 and under, experience a mental health disorder each year. Improved “function” is a common outcome targeted by mental health practitioners. However, no known studies exist that define or measure function from the perspective of young adults with mental health disorders.
Methods
We recruited young adults with mental health disorders, aged 19-25, from an integrated youth health centre to participate in 90-minute focus groups. Two focus groups were conducted using a semi-structured script, audio recorded and transcribed. Transcripts were analyzed using an inductive thematic analysis with NVIVO 11.
Results
Nineteen youth participated with a median age of 24 years (range 19-25 years). Seven (37%) identified as female, twelve (63%) as male, and one (5%) as genderqueer. Twelve (63%) of participants were unemployed and not in school. Participants’ self-reported mental health diagnoses included mood disorders (79%), anxiety disorders (74%), post-traumatic stress disorder (PTSD) (32%), other disorders (32%) and psychotic disorders (16%).
69% of participants reported using alcohol, 53% reported using cannabis and 31% reported using substances. Major themes around defining and conceptualizing function emerged, including intrinsic and extrinsic factors. Major themes within intrinsic factors included holistic health and self-awareness. Major themes within extrinsic factors included personal resources and professional supports.
Conclusions
Our results provide a novel conceptualization of function as described by young adults with mental health and substance use diagnoses. This definition aligns with the World Health Organization’s definition of function, as per the International Classification of Functioning (ICF), with critical emphasis on activity and participation as core needs to function. We also identified motivation, self-awareness and structure as key components of function, which supplements the ICF.
Day: Friday, Time: 14:30-14:55, Session: F86
Background
One in four Canadian young adults, 25 and under, experience a mental health disorder each year. Improved “function” is a common outcome targeted by mental health practitioners. However, no known studies exist that define or measure function from the perspective of young adults with mental health disorders.
Methods
We recruited young adults with mental health disorders, aged 19-25, from an integrated youth health centre to participate in 90-minute focus groups. Two focus groups were conducted using a semi-structured script, audio recorded and transcribed. Transcripts were analyzed using an inductive thematic analysis with NVIVO 11.
Results
Nineteen youth participated with a median age of 24 years (range 19-25 years). Seven (37%) identified as female, twelve (63%) as male, and one (5%) as genderqueer. Twelve (63%) of participants were unemployed and not in school. Participants’ self-reported mental health diagnoses included mood disorders (79%), anxiety disorders (74%), post-traumatic stress disorder (PTSD) (32%), other disorders (32%) and psychotic disorders (16%).
69% of participants reported using alcohol, 53% reported using cannabis and 31% reported using substances. Major themes around defining and conceptualizing function emerged, including intrinsic and extrinsic factors. Major themes within intrinsic factors included holistic health and self-awareness. Major themes within extrinsic factors included personal resources and professional supports.
Conclusions
Our results provide a novel conceptualization of function as described by young adults with mental health and substance use diagnoses. This definition aligns with the World Health Organization’s definition of function, as per the International Classification of Functioning (ICF), with critical emphasis on activity and participation as core needs to function. We also identified motivation, self-awareness and structure as key components of function, which supplements the ICF.
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Driving with Parkinson's Disease: Exploring lived experience
Jeffrey Holmes, Liliana Alvarez, Andrew Johnson, Amy Robinson
Day: Thursday, Time: 11:00-11:25, Session: T22
Introduction: A growing body of literature has explored the impact of Parkinson’s disease (PD) on fitness to drive, including the utility of clinical tests for screening, and the specific driving errors that are predictive of failing an on-road assessment. Such evidence can lead to the development of evidence-based interventions, yet little is known about the lived experiences of persons with PD as they navigate driving related concerns. The latter is critical, if interventions are to address the priorities and concerns of this population. Objectives: To examine the lived experience of driving with PD and its implications for occupation. Methods: We conducted a secondary data analysis of primary data exploring the experience of living with PD. In the primary study 19 participants with PD used photographs to illustrate their experience of living with PD, and participated in interviews and focus groups wherein their photos were used to elicit discussion. Summative content analysis was used to identify the prominence of driving as an emerging topic, and the themes related to participants’ experience of driving. Results: Participants identified driving as an occupation that holds significant importance both as a primary occupation, and as a means for enabling other occupations. Five themes emerged through inductive iterative analysis: (1) the meaning and significance of driving; (2) driving cessation; (3) modified driving behaviors, (4) factors affecting driving; and (5) accessibility. Conclusions: Findings from this study lay the foundation for developing client-centered and evidence-informed driving interventions and driving retirement programs for individuals with PD.
Day: Thursday, Time: 11:00-11:25, Session: T22
Introduction: A growing body of literature has explored the impact of Parkinson’s disease (PD) on fitness to drive, including the utility of clinical tests for screening, and the specific driving errors that are predictive of failing an on-road assessment. Such evidence can lead to the development of evidence-based interventions, yet little is known about the lived experiences of persons with PD as they navigate driving related concerns. The latter is critical, if interventions are to address the priorities and concerns of this population. Objectives: To examine the lived experience of driving with PD and its implications for occupation. Methods: We conducted a secondary data analysis of primary data exploring the experience of living with PD. In the primary study 19 participants with PD used photographs to illustrate their experience of living with PD, and participated in interviews and focus groups wherein their photos were used to elicit discussion. Summative content analysis was used to identify the prominence of driving as an emerging topic, and the themes related to participants’ experience of driving. Results: Participants identified driving as an occupation that holds significant importance both as a primary occupation, and as a means for enabling other occupations. Five themes emerged through inductive iterative analysis: (1) the meaning and significance of driving; (2) driving cessation; (3) modified driving behaviors, (4) factors affecting driving; and (5) accessibility. Conclusions: Findings from this study lay the foundation for developing client-centered and evidence-informed driving interventions and driving retirement programs for individuals with PD.
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Knowledge Translation: A Client-Centered Smoking Cessation Tool
Parisa Ghanouni, Samir Gupta, Stephanie Segovia, Laura Nimmon
Day: Friday, Time: 09:00-09:25, Session: f21
Day: Friday, Time: 09:00-09:25, Session: f21
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Supporting Clinical Expertise: The Experience of Joining a Well Established Community of Practice
Ipshitha Anand, Michelle Mohan, Fatima Quraishi, Nicola Tahair, Elizabeth Linkewich
Day: Friday, Time: 13:30-13:55, Session: F64
Introduction
Occupational Therapists (OT) are versatile clinicians who work in a variety of clinical settings. However, OTs often have varying levels of expertise and limited opportunities to collaborate with colleagues in similar settings. The Canadian Stroke Best Practice Recommendations (CSBPR) are well established and should be implemented into Occupational Therapy practice for optimal patient outcomes, however there are limited discipline specific resources available to support this.
Objectives
Review the experience of joining an established OT community of practice focused on standardization of care and the implementation of stroke best practices for therapists who are new to the region.
Approach
An onboarding process is in place to support new OTs working in acute stroke care in Toronto. New members are provided with standardized orientation and practice resources. Face to face meetings occur on a bi-monthly basis, supplemented by online communication and practice support.
Practice Implications
Several benefits were experienced through membership in this committee. These benefits include (1) region-specific resources for processes in acute stroke care (2) a community of practice where collaboration and discussion are encouraged (3) standardized resources, grounded in best practice or clinician consensus, to be utilized in practice and (4) access to a virtual platform and CoP for further discussion to enhance professional development and support colleagues.
Conclusions
The Stroke OT Leadership Committee is an innovative method for regional support in enhancing clinical expertise and access to best practice resources
Day: Friday, Time: 13:30-13:55, Session: F64
Introduction
Occupational Therapists (OT) are versatile clinicians who work in a variety of clinical settings. However, OTs often have varying levels of expertise and limited opportunities to collaborate with colleagues in similar settings. The Canadian Stroke Best Practice Recommendations (CSBPR) are well established and should be implemented into Occupational Therapy practice for optimal patient outcomes, however there are limited discipline specific resources available to support this.
Objectives
Review the experience of joining an established OT community of practice focused on standardization of care and the implementation of stroke best practices for therapists who are new to the region.
Approach
An onboarding process is in place to support new OTs working in acute stroke care in Toronto. New members are provided with standardized orientation and practice resources. Face to face meetings occur on a bi-monthly basis, supplemented by online communication and practice support.
Practice Implications
Several benefits were experienced through membership in this committee. These benefits include (1) region-specific resources for processes in acute stroke care (2) a community of practice where collaboration and discussion are encouraged (3) standardized resources, grounded in best practice or clinician consensus, to be utilized in practice and (4) access to a virtual platform and CoP for further discussion to enhance professional development and support colleagues.
Conclusions
The Stroke OT Leadership Committee is an innovative method for regional support in enhancing clinical expertise and access to best practice resources
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Modelling OT/OTA Practice in Canadian OTA/PTA Education
Leeanne Sadowsky and Grace Torrance
Day: Thursday, Time: 13:30-13:55, Session: T66
Introduction: Formalized education for the Canadian Occupational Therapist Assistant/Physiotherapist Assistant (OTA/PTA) has been occurring for nearly 25 years, with standardized accreditation processes since 2012. In order to prepare students for fieldwork and the delivery of occupational therapy services, modeling the therapist and assistant relationship in educational programs is critical. Objectives: The purpose of this internet based qualitative study was to determine what experiential impact having an OTA, PTA or OTA/PTA in educational preparation had on student performance in fieldwork and in future practice. Methods: A purposive sample of OTA/PTA students in their final fieldwork placement were recruited for the study. The participants completed online, asynchronous, structured interviews. Indirect probing and clarifications were performed via follow up emails from the principal investigator. Deductive coding by two investigators identified key themes. Results: Three themes related to the role of the OTA/PTA evolved: Communicator, Collaborator and Reflective Practitioner. These were linked to the Standards of Accreditation which were based on the Canadian OTA and PTA Competency Profiles. Additional qualitative data included the value added from real patient and clinical stories and experiences provided by the graduate OTA/PTA. Students were motivated by the involvement of the graduate OTA/PTA and found the learning experience validating to their career choice and helped further develop their professional identity. Conclusion: The results of this study support the integration of graduate therapist assistants into an OTA/PTA educational program helping prepare students for fieldwork and practice in various environments.
Day: Thursday, Time: 13:30-13:55, Session: T66
Introduction: Formalized education for the Canadian Occupational Therapist Assistant/Physiotherapist Assistant (OTA/PTA) has been occurring for nearly 25 years, with standardized accreditation processes since 2012. In order to prepare students for fieldwork and the delivery of occupational therapy services, modeling the therapist and assistant relationship in educational programs is critical. Objectives: The purpose of this internet based qualitative study was to determine what experiential impact having an OTA, PTA or OTA/PTA in educational preparation had on student performance in fieldwork and in future practice. Methods: A purposive sample of OTA/PTA students in their final fieldwork placement were recruited for the study. The participants completed online, asynchronous, structured interviews. Indirect probing and clarifications were performed via follow up emails from the principal investigator. Deductive coding by two investigators identified key themes. Results: Three themes related to the role of the OTA/PTA evolved: Communicator, Collaborator and Reflective Practitioner. These were linked to the Standards of Accreditation which were based on the Canadian OTA and PTA Competency Profiles. Additional qualitative data included the value added from real patient and clinical stories and experiences provided by the graduate OTA/PTA. Students were motivated by the involvement of the graduate OTA/PTA and found the learning experience validating to their career choice and helped further develop their professional identity. Conclusion: The results of this study support the integration of graduate therapist assistants into an OTA/PTA educational program helping prepare students for fieldwork and practice in various environments.
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The CAT Clean Rooms Pilot Project
Courtney Brennan
Day: Saturday, Time: 11:30-11:55, Session: S87
Introduction: Safewards suggests aggression flashpoints on inpatient mental health units can be prevented through modification of staff, client, or environment factors. Client rooms on inpatient units are often disorganized and pose potential safety risks. Cognitive Adaptation Training (CAT) is a compensatory strategy that aims to reduce the performance deficits caused by the cognitive impairments associated with schizophrenia through environmental supports.
Objectives: In this pilot, Focused CAT strategies were applied to help inpatient clients organize their rooms and keep them organized. Unit staff were trained to support the CAT intervention.
Methods: 26 inpatient clients from 5 units were seen in their rooms on the units by a CAT clinician and unit point person twice a week for 4 weeks. Clutter Image Rating Scale (CIRS) ratings and Goal Attainment Scale (GAS) scores were taken pre, post, and 3-weeks post intervention. Clients, staff, and unit point people completed qualitative feedback forms post intervention.
Results: CIRS ratings and GAS scores significantly improved following the CAT Clean Rooms intervention. These ratings did not significantly change in the 3 weeks post-intervention. The majority of clients reported CAT helped them organize their rooms and that cleaning their room was less of a hassle following intervention. The majority of staff reported knowing more about CAT than they did 3 months ago and that other clients would benefit from the CAT Clean Rooms approach.
Conclusions: Both staff and clients indicated the focused CAT Clean Rooms approach improved the organization of client inpatient rooms. Formal research required.
Day: Saturday, Time: 11:30-11:55, Session: S87
Introduction: Safewards suggests aggression flashpoints on inpatient mental health units can be prevented through modification of staff, client, or environment factors. Client rooms on inpatient units are often disorganized and pose potential safety risks. Cognitive Adaptation Training (CAT) is a compensatory strategy that aims to reduce the performance deficits caused by the cognitive impairments associated with schizophrenia through environmental supports.
Objectives: In this pilot, Focused CAT strategies were applied to help inpatient clients organize their rooms and keep them organized. Unit staff were trained to support the CAT intervention.
Methods: 26 inpatient clients from 5 units were seen in their rooms on the units by a CAT clinician and unit point person twice a week for 4 weeks. Clutter Image Rating Scale (CIRS) ratings and Goal Attainment Scale (GAS) scores were taken pre, post, and 3-weeks post intervention. Clients, staff, and unit point people completed qualitative feedback forms post intervention.
Results: CIRS ratings and GAS scores significantly improved following the CAT Clean Rooms intervention. These ratings did not significantly change in the 3 weeks post-intervention. The majority of clients reported CAT helped them organize their rooms and that cleaning their room was less of a hassle following intervention. The majority of staff reported knowing more about CAT than they did 3 months ago and that other clients would benefit from the CAT Clean Rooms approach.
Conclusions: Both staff and clients indicated the focused CAT Clean Rooms approach improved the organization of client inpatient rooms. Formal research required.
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HEALTH OF CANADIAN FIREFIGHTERS: THE IMPACT OF SLEEP AND WORK
Heidi Cramm, Megan Edgelow, Dianne Groll, Amanda Roi, Paula Campbell, Rachel Richmond
Day: Saturday, Time: 11:30-11:55, Session: S88
Introduction: Shift work, including night shifts, rotating schedules, and extended hours, places workers at a greater risk for disordered sleep and subsequent health risks. In addition to dealing with the impact of shift work, up to seventy five percent of public safety personnel (PSP), including firefighters, police officers, correctional workers, and paramedics, are also faced with potentially traumatic events on a regular basis. Irregular, lengthy hours and increased trauma exposure causes greater risk of disordered sleep, which elevates their susceptibility to both physical and mental health concerns. The occupation of sleep is central to daily life rhythm and structure; while there is ample research on shiftwork and health, there is limited research on the impact of shiftwork in relation to Canadian firefighters’ health. Objectives: This study was conducted to explore how Canadian firefighters’ sleep is affected by their work and the impact it has on their physical and mental health. Approach: An online survey was made available in English and French from September 2016 to January 2017. The survey assessed current symptoms of mental disorders, and participation was solicited from national PSP agencies and advocacy groups. Results: Quantitative and qualitative data from firefighter respondents will be presented. Conclusions: This study is the first to examine Canadian firefighters and the impact of their work on sleep and health. Occupational therapists may work with these vulnerable populations to address sleep issues; results can inform occupational therapy interventions and health policy for these workers.
Day: Saturday, Time: 11:30-11:55, Session: S88
Introduction: Shift work, including night shifts, rotating schedules, and extended hours, places workers at a greater risk for disordered sleep and subsequent health risks. In addition to dealing with the impact of shift work, up to seventy five percent of public safety personnel (PSP), including firefighters, police officers, correctional workers, and paramedics, are also faced with potentially traumatic events on a regular basis. Irregular, lengthy hours and increased trauma exposure causes greater risk of disordered sleep, which elevates their susceptibility to both physical and mental health concerns. The occupation of sleep is central to daily life rhythm and structure; while there is ample research on shiftwork and health, there is limited research on the impact of shiftwork in relation to Canadian firefighters’ health. Objectives: This study was conducted to explore how Canadian firefighters’ sleep is affected by their work and the impact it has on their physical and mental health. Approach: An online survey was made available in English and French from September 2016 to January 2017. The survey assessed current symptoms of mental disorders, and participation was solicited from national PSP agencies and advocacy groups. Results: Quantitative and qualitative data from firefighter respondents will be presented. Conclusions: This study is the first to examine Canadian firefighters and the impact of their work on sleep and health. Occupational therapists may work with these vulnerable populations to address sleep issues; results can inform occupational therapy interventions and health policy for these workers.
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Developing KNee Education to Enhance Delivery of health Services (KNEEDS)
Holly Reid, Patricia Huijbregts, William Miller, Julie Robillard, Somayyeh Mohammadi
Day: Thursday, Time: 13:00-13:25, Session: T52
Introduction: Osteoarthritis (OA) is largely prevalent among the aging population, often resulting in total knee replacement (TKR). Prehabilitation allows patients to prepare and informs their expectations and actions before, during, and after surgery. Yet, patient perspectives regarding prehabilitation has not been studied sufficiently. Development of effective resources requires further understanding of the gaps based on patients’ perspectives of prehabilitation and barriers to access. Objectives: To identify participant preferences and educational gaps regarding prehabilitation content and delivery method (e.g. online education). Methods: Semi-structured interviews and focus groups will be conducted, lasting 60-90 minutes. Eligible participants will be over the age of 50 with OA of the knee, who will be scheduled for or have previously undergone TKR. Interviews and focus groups will be transcribed and analyzed, using a phenomenological approach, to identify and define themes, which will be summarized and supported using excerpts. Results: We anticipate several educational factors to emerge, including access and ability to utilize technology, health information literacy, overabundance of online information, accuracy and awareness of available resources. We anticipate that online resources will be an acceptable approach due ease of accessibility, being self-paced and interactive. However, those with less familiarity with technology are anticipated to prefer more conventional alternatives, such as in-person sessions or hard copy information. Conclusion: This study will inform the development of prehabilitation tools to benefit clinicians, patients and the health care system. Providing necessary information based on patients’ preferences will set realistic expectations and better prepared them for surgery.
Day: Thursday, Time: 13:00-13:25, Session: T52
Introduction: Osteoarthritis (OA) is largely prevalent among the aging population, often resulting in total knee replacement (TKR). Prehabilitation allows patients to prepare and informs their expectations and actions before, during, and after surgery. Yet, patient perspectives regarding prehabilitation has not been studied sufficiently. Development of effective resources requires further understanding of the gaps based on patients’ perspectives of prehabilitation and barriers to access. Objectives: To identify participant preferences and educational gaps regarding prehabilitation content and delivery method (e.g. online education). Methods: Semi-structured interviews and focus groups will be conducted, lasting 60-90 minutes. Eligible participants will be over the age of 50 with OA of the knee, who will be scheduled for or have previously undergone TKR. Interviews and focus groups will be transcribed and analyzed, using a phenomenological approach, to identify and define themes, which will be summarized and supported using excerpts. Results: We anticipate several educational factors to emerge, including access and ability to utilize technology, health information literacy, overabundance of online information, accuracy and awareness of available resources. We anticipate that online resources will be an acceptable approach due ease of accessibility, being self-paced and interactive. However, those with less familiarity with technology are anticipated to prefer more conventional alternatives, such as in-person sessions or hard copy information. Conclusion: This study will inform the development of prehabilitation tools to benefit clinicians, patients and the health care system. Providing necessary information based on patients’ preferences will set realistic expectations and better prepared them for surgery.
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Physical restraint use in acute care geriatrics – legislation and practice
Jaclyn Gilpin
Day: Thursday, Time: 13:30-13:55, Session: T64
Introduction: Across Canada, restraint minimization legislation, with subsequent and multiple policies and procedures exist to maximize geriatric patient safety and occupational engagement across care contexts. Complying with these directives can be challenging for healthcare practitioners due to a lack of ongoing education and resources in fast-paced and high-pressure work environments. Incorrect restraint application may result in lower functional outcomes of patients, increased length of stay, decreased patient and family satisfaction, and increased risk of morbidity and mortality. Objectives: 1) To review restraint minimization legislation, and policies and procedures in light of acknowledged best practice; and 2) To share clinically relevant options and approaches that can be adopted by occupational therapists when working with geriatric populations in acute care settings. Approach: The poster will present a variety of challenges, considerations and recommendations related to the topic of restraint minimization legislation, and policies and procedures. Practice Implications: Inappropriate use of physical restraints can impact on the functional outcomes of geriatric patients while in hospital. By understanding the rationale for rules governing the use and application of physical restraints in geriatric populations, occupational therapists can more effectively support safe patient care, and maximize occupational engagement and performance in acute care settings. Conclusions: Improving occupational therapists’ knowledge of physical restraint options in geriatric populations is essential to reducing inappropriate restraint use during hospital admissions, ultimately maximizing functional outcomes of their patients.
Day: Thursday, Time: 13:30-13:55, Session: T64
Introduction: Across Canada, restraint minimization legislation, with subsequent and multiple policies and procedures exist to maximize geriatric patient safety and occupational engagement across care contexts. Complying with these directives can be challenging for healthcare practitioners due to a lack of ongoing education and resources in fast-paced and high-pressure work environments. Incorrect restraint application may result in lower functional outcomes of patients, increased length of stay, decreased patient and family satisfaction, and increased risk of morbidity and mortality. Objectives: 1) To review restraint minimization legislation, and policies and procedures in light of acknowledged best practice; and 2) To share clinically relevant options and approaches that can be adopted by occupational therapists when working with geriatric populations in acute care settings. Approach: The poster will present a variety of challenges, considerations and recommendations related to the topic of restraint minimization legislation, and policies and procedures. Practice Implications: Inappropriate use of physical restraints can impact on the functional outcomes of geriatric patients while in hospital. By understanding the rationale for rules governing the use and application of physical restraints in geriatric populations, occupational therapists can more effectively support safe patient care, and maximize occupational engagement and performance in acute care settings. Conclusions: Improving occupational therapists’ knowledge of physical restraint options in geriatric populations is essential to reducing inappropriate restraint use during hospital admissions, ultimately maximizing functional outcomes of their patients.
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Is pain a barrier to participating in rehabilitation after stroke?
Tara Packham, Nicole Last, Yasar Abu-Awad, Jocelyn Harris
Day: Thursday, Time: 10:00-10:25, Session: T1
Introduction. Pain in stroke survivors is considered a barrier to reaching target levels of participation in rehabilitation programs and functional recovery. However, this has primarily been reported from therapists’, not stroke survivors’ perspectives. Objectives. This qualitative study explored the experiences of persons participating in upper extremity rehabilitation after stroke to understand if the pain experience is distinct from the general rehabilitation experience. Methods. We interviewed 11 stroke survivors (6 experiencing pain), transcribing audio-recordings, and coding using interpretive description to develop themes to inform clinical practice. Results. Several participants with pain described hiding their pain from therapists and carers to preserve therapy intensity. They reported pushing through pain for anticipated benefits from stretching and activities, and utilizing available medications for pain control rather than limiting participation. Others explained pre-existing pain conditions like arthritis were exacerbated by changed movement patterns and functional demands, but did not want this to limit their opportunities to participate in rehabilitation. Participants without pain also desired more therapy, more often, and felt staff/program resources were more limiting than their energy and motivation. Conclusions. While stroke survivors who experienced pain described it as barrier to participation in rehabilitation, they contextualized pain as an external barrier from the behaviours of others, rather than influenced by their own ability or motivation to participate. Other survivors also reported external barriers to participation and unmet needs for rehabilitation intensity. These findings are in contrast to previous reports from therapists who identified pain as a primary barrier to achieving rehabilitation intensity.
Day: Thursday, Time: 10:00-10:25, Session: T1
Introduction. Pain in stroke survivors is considered a barrier to reaching target levels of participation in rehabilitation programs and functional recovery. However, this has primarily been reported from therapists’, not stroke survivors’ perspectives. Objectives. This qualitative study explored the experiences of persons participating in upper extremity rehabilitation after stroke to understand if the pain experience is distinct from the general rehabilitation experience. Methods. We interviewed 11 stroke survivors (6 experiencing pain), transcribing audio-recordings, and coding using interpretive description to develop themes to inform clinical practice. Results. Several participants with pain described hiding their pain from therapists and carers to preserve therapy intensity. They reported pushing through pain for anticipated benefits from stretching and activities, and utilizing available medications for pain control rather than limiting participation. Others explained pre-existing pain conditions like arthritis were exacerbated by changed movement patterns and functional demands, but did not want this to limit their opportunities to participate in rehabilitation. Participants without pain also desired more therapy, more often, and felt staff/program resources were more limiting than their energy and motivation. Conclusions. While stroke survivors who experienced pain described it as barrier to participation in rehabilitation, they contextualized pain as an external barrier from the behaviours of others, rather than influenced by their own ability or motivation to participate. Other survivors also reported external barriers to participation and unmet needs for rehabilitation intensity. These findings are in contrast to previous reports from therapists who identified pain as a primary barrier to achieving rehabilitation intensity.
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Rethinking the assistive technology system from the human rights perspective
Natasha Altin
Day: Friday, Time: 09:00-09:25, Session: F19
Introduction: Assistive technology (AT) is one of the key enablers of occupational performance. Occupational therapists (OTs) have expertise to assist Canadians with selecting, training and using assistive technology, which will facilitate their occupational performance. However, the current AT system is underfunded; restricted; unresponsive to the needs of the people it is intended to benefit; and lacks central engagement of its users. The current state of the AT system creates system-level barriers that prevent OTs from providing an optimal client-centered care. Objectives: This paper aims to identify the root causes behind the inadequate AT system to inform development of sustainable solutions. Methods: This paper draws on the Human Rights Based Approach, a conceptual framework that seeks to understand and address the root causes of systemic problems by analyzing implicit inequalities and discriminations within the existing systems. Results: The current AT system inadequacies are attributed to an out-dated conceptualization of disability reflected within the policies and practices of the AT system. The current AT system is grounded within the medical model of disability, which perceives disability as ‘anomaly’ requiring medical intervention. Within the AT policies and practices, AT is perceived not as an enabler of participation but as an intervention tool aiming to reduce dis-function brought about by disability to attain ‘normalcy’, therefore, systemically diminishing AT users’ active participation in decision making process and preventing OTs from efficiently supporting their clients. Conclusions: The AT system advancement requires a systemic shift towards a social model of understanding disability. OTs must understand systemic factors impeding their professional philosophy and practice to work together with their clients towards a social change within the AT system.
Day: Friday, Time: 09:00-09:25, Session: F19
Introduction: Assistive technology (AT) is one of the key enablers of occupational performance. Occupational therapists (OTs) have expertise to assist Canadians with selecting, training and using assistive technology, which will facilitate their occupational performance. However, the current AT system is underfunded; restricted; unresponsive to the needs of the people it is intended to benefit; and lacks central engagement of its users. The current state of the AT system creates system-level barriers that prevent OTs from providing an optimal client-centered care. Objectives: This paper aims to identify the root causes behind the inadequate AT system to inform development of sustainable solutions. Methods: This paper draws on the Human Rights Based Approach, a conceptual framework that seeks to understand and address the root causes of systemic problems by analyzing implicit inequalities and discriminations within the existing systems. Results: The current AT system inadequacies are attributed to an out-dated conceptualization of disability reflected within the policies and practices of the AT system. The current AT system is grounded within the medical model of disability, which perceives disability as ‘anomaly’ requiring medical intervention. Within the AT policies and practices, AT is perceived not as an enabler of participation but as an intervention tool aiming to reduce dis-function brought about by disability to attain ‘normalcy’, therefore, systemically diminishing AT users’ active participation in decision making process and preventing OTs from efficiently supporting their clients. Conclusions: The AT system advancement requires a systemic shift towards a social model of understanding disability. OTs must understand systemic factors impeding their professional philosophy and practice to work together with their clients towards a social change within the AT system.
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Examining access to Assistive Technology in Canada through the Human Rights Based Approach
Natasha Altin
Day: Thursday, Time: 14:00-14:25, Session: T72
Introduction: Assistive technology (AT) has been proposed by the World Health Organization as a global strategy to equalize opportunities for people with disabilities. However, without equitable access to AT, its benefits are futile. Access to AT has been identified by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) as a human right. Canada, who has ratified the UNCRPD in 2010, has an obligation to make AT accessible to all. Objectives: This paper examines if current access to AT is equitable and representative of Canada’s obligation to UNCRPD. Methods: This paper draws on the accessibility principle of the Human Rights-Based Approach (HRBA) and AT literature. Results: The HRBA framework illuminates AT access inequities in four dimensions of accessibility: non-discrimination; economical, physical and information accessibility. Indirect inequities in access are evident through inconsistencies in federal provisions. Federal provisions apply to only specific subset of Canadians. Economic accessibility (affordability) is a key barrier to AT access. With high cost of AT and inadequate levels of funding, AT users are forced to go without AT or choose less appropriate but more affordable options. Limited selection of AT restricts AT users’ choices, resulting in compromises that do not adequately meet users’ needs. AT programs are highly disintegrated, leading to the lack of information accessibility and difficulty in navigation for AT users. Conclusions: Current access to AT is inequitable and does not support Canada’s obligation to UNCRPD, therefore often preventing occupational therapists from efficiently supporting their clients.
Day: Thursday, Time: 14:00-14:25, Session: T72
Introduction: Assistive technology (AT) has been proposed by the World Health Organization as a global strategy to equalize opportunities for people with disabilities. However, without equitable access to AT, its benefits are futile. Access to AT has been identified by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) as a human right. Canada, who has ratified the UNCRPD in 2010, has an obligation to make AT accessible to all. Objectives: This paper examines if current access to AT is equitable and representative of Canada’s obligation to UNCRPD. Methods: This paper draws on the accessibility principle of the Human Rights-Based Approach (HRBA) and AT literature. Results: The HRBA framework illuminates AT access inequities in four dimensions of accessibility: non-discrimination; economical, physical and information accessibility. Indirect inequities in access are evident through inconsistencies in federal provisions. Federal provisions apply to only specific subset of Canadians. Economic accessibility (affordability) is a key barrier to AT access. With high cost of AT and inadequate levels of funding, AT users are forced to go without AT or choose less appropriate but more affordable options. Limited selection of AT restricts AT users’ choices, resulting in compromises that do not adequately meet users’ needs. AT programs are highly disintegrated, leading to the lack of information accessibility and difficulty in navigation for AT users. Conclusions: Current access to AT is inequitable and does not support Canada’s obligation to UNCRPD, therefore often preventing occupational therapists from efficiently supporting their clients.
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Occupational Therapists’ Perspective Regarding Their Professional Practice in Emergency Departments
Catherine Ouellet, Nathalie Veillette
Day: Saturday, Time: 09:00-09:25, Session: S14
Introduction: Occupational Therapists (OTs) intervene in emergency departments (ED), but their role remains misunderstood and their own perception of practice is poorly documented. Objectives: To portray OTs’ perceptions regarding their practice in the ED (roles, facilitators\obstacles), benefits for patients\treatment teams and practice’s evolution potential. Methods: In this qualitative study, semi-directed individual interviews were conducted with OTs who are practicing or have practiced in an ED. The issues discussed were based on roles from the Profile of Occupational Therapy Practice (CAOT, 2012). The descriptive analysis of the participants' sociodemographic data combined to the content analysis of the interviews made it possible to achieve the desired objectives. Results: All roles are undertaken by OTs in the ED, but some more extensively than others: Change Agent (role understanding by other professionals and patients), Expert (evaluation, intervention and reasoning) and Collaborator (with ED team and external partners). Participants identify some facilitators (manager’s support, mentorship), but mainly barriers (lack of understanding of their role, inadequate physical layout, limited material/human resources, limited training opportunities, lack of coordination with external partners). Participants have a generally positive perception of benefits and are optimistic about the potential for change in their practice. Conclusion: In the ED, OTs can apply all of their skills to intervene with patients with loss of autonomy. Their ability to work in an interdisciplinary environment is a pillar on which their practice is based. However, misunderstanding of their role remains a major barrier to the potential evolution of occupational therapy practice in EDs.
Day: Saturday, Time: 09:00-09:25, Session: S14
Introduction: Occupational Therapists (OTs) intervene in emergency departments (ED), but their role remains misunderstood and their own perception of practice is poorly documented. Objectives: To portray OTs’ perceptions regarding their practice in the ED (roles, facilitators\obstacles), benefits for patients\treatment teams and practice’s evolution potential. Methods: In this qualitative study, semi-directed individual interviews were conducted with OTs who are practicing or have practiced in an ED. The issues discussed were based on roles from the Profile of Occupational Therapy Practice (CAOT, 2012). The descriptive analysis of the participants' sociodemographic data combined to the content analysis of the interviews made it possible to achieve the desired objectives. Results: All roles are undertaken by OTs in the ED, but some more extensively than others: Change Agent (role understanding by other professionals and patients), Expert (evaluation, intervention and reasoning) and Collaborator (with ED team and external partners). Participants identify some facilitators (manager’s support, mentorship), but mainly barriers (lack of understanding of their role, inadequate physical layout, limited material/human resources, limited training opportunities, lack of coordination with external partners). Participants have a generally positive perception of benefits and are optimistic about the potential for change in their practice. Conclusion: In the ED, OTs can apply all of their skills to intervene with patients with loss of autonomy. Their ability to work in an interdisciplinary environment is a pillar on which their practice is based. However, misunderstanding of their role remains a major barrier to the potential evolution of occupational therapy practice in EDs.
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Using virtual reality as a strategy to reduce student test-anxiety
Shaniff Esmail, Brendan Concannon, Susan Mulholland, Suzette Bremault-Phillips, Mary Roduta-Roberts
Day: Friday, Time: 08:30-08:55, Session: F12
Introduction: Practical exams, which are frequently used to assess student clinical competencies, can be highly stress-inducing. A study in 2015 by Gerwing et al. found that 38.5% of students experience test-anxiety. Strategies are needed to help students manage stressors so as to successfully complete practical exams and demonstrate clinical competencies. This research explores the use of immersive virtual reality to help first year MScOT students better prepare for clinical practical exams and reduce their test-anxiety. Objective: To provide an immersive virtual simulation of a clinical practical examination that enables students to mentally prepare for high-stakes testing situations. Methods: This mixed methods study involves comparing the state-anxiety, test-anxiety and self-efficacy of first year MScOT students pre/post use of an immersive virtual reality clinical practical exam. Focus groups and interviews were also conducted to better understand students’ experiences of anxiety and practical exams. Results: Results pre/post exposure to an immersive virtual reality clinical practical exam will be presented, including students levels of anxiety, self-efficacy and study preparation methods. Triangulation of quantitative and qualitative results are expected to relate to students’ anxiety levels, mental levels of preparedness and exam preparation strategies. Conclusions: Immersive virtual reality has the potential to support mental preparation and psychological stress management in workplace and clinical practical exam settings. This research demonstrated how virtual reality simulations might reduce test-anxiety and contribute to the development of MScOT student clinical competencies.
Day: Friday, Time: 08:30-08:55, Session: F12
Introduction: Practical exams, which are frequently used to assess student clinical competencies, can be highly stress-inducing. A study in 2015 by Gerwing et al. found that 38.5% of students experience test-anxiety. Strategies are needed to help students manage stressors so as to successfully complete practical exams and demonstrate clinical competencies. This research explores the use of immersive virtual reality to help first year MScOT students better prepare for clinical practical exams and reduce their test-anxiety. Objective: To provide an immersive virtual simulation of a clinical practical examination that enables students to mentally prepare for high-stakes testing situations. Methods: This mixed methods study involves comparing the state-anxiety, test-anxiety and self-efficacy of first year MScOT students pre/post use of an immersive virtual reality clinical practical exam. Focus groups and interviews were also conducted to better understand students’ experiences of anxiety and practical exams. Results: Results pre/post exposure to an immersive virtual reality clinical practical exam will be presented, including students levels of anxiety, self-efficacy and study preparation methods. Triangulation of quantitative and qualitative results are expected to relate to students’ anxiety levels, mental levels of preparedness and exam preparation strategies. Conclusions: Immersive virtual reality has the potential to support mental preparation and psychological stress management in workplace and clinical practical exam settings. This research demonstrated how virtual reality simulations might reduce test-anxiety and contribute to the development of MScOT student clinical competencies.
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How does virtual reality align with occupational therapy? A scoping review
Sarah Hunt, Kayla McDonald, Jacklyn Upchan, Patrick Duong, Heidi Sveistrup, Mary Egan
Day: Saturday, Time: 11:00-11:25, Session: S77
Introduction. Stroke rehabilitation guidelines encourage occupational therapists to utilize virtual reality (VR). There are many potential uses of VR and it is not yet clear how these uses align with occupational therapy goals and processes. Objectives. The purpose of this project was to determine which occupational therapy uses of VR are currently described in the research literature, and how these uses align with occupational therapy goals and processes. Methods. A scoping review was carried out. A systematic search strategy was used to identify peer-reviewed papers that described VR in occupational therapy in descriptive or research papers. Articles in English or French were included if there was an occupational therapist author or the publication was in an occupational therapy journal, or the terms occupational therapy, stroke and virtual reality were found in the title, abstract or keywords. Uses of VR were organized under Golledge’s classification of occupation: diversional activity, activity, purposeful activity and occupation. Results. Bibliographic searches resulted in 396 articles, of which 36 met the inclusion criteria. Current occupational therapy uses of VR are primarily in the context of activity in stroke rehabilitation. Of the articles retained, 27 (75%) described VR as activity and 9 (25%) described VR as purposeful activity. There were no descriptions of diversional activity or occupation. Conclusions. This paper provides an important starting point for considering whether VR in occupational therapy can be developed in ways more consistent with occupation-focused practice.
Day: Saturday, Time: 11:00-11:25, Session: S77
Introduction. Stroke rehabilitation guidelines encourage occupational therapists to utilize virtual reality (VR). There are many potential uses of VR and it is not yet clear how these uses align with occupational therapy goals and processes. Objectives. The purpose of this project was to determine which occupational therapy uses of VR are currently described in the research literature, and how these uses align with occupational therapy goals and processes. Methods. A scoping review was carried out. A systematic search strategy was used to identify peer-reviewed papers that described VR in occupational therapy in descriptive or research papers. Articles in English or French were included if there was an occupational therapist author or the publication was in an occupational therapy journal, or the terms occupational therapy, stroke and virtual reality were found in the title, abstract or keywords. Uses of VR were organized under Golledge’s classification of occupation: diversional activity, activity, purposeful activity and occupation. Results. Bibliographic searches resulted in 396 articles, of which 36 met the inclusion criteria. Current occupational therapy uses of VR are primarily in the context of activity in stroke rehabilitation. Of the articles retained, 27 (75%) described VR as activity and 9 (25%) described VR as purposeful activity. There were no descriptions of diversional activity or occupation. Conclusions. This paper provides an important starting point for considering whether VR in occupational therapy can be developed in ways more consistent with occupation-focused practice.
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Cerebellar Differences with Rehabilitation in Children with Developmental Coordination Disorder
Kamaldeep Gill, Donna Lang, Dan Goldowitz, Jill G. Zwicker
Day: Friday, Time: 09:00-09:25, Session: F20
Introduction: Cognitive Orientation to Occupational Performance (CO-OP) is effective in helping children with Developmental Coordination Disorder (DCD) to achieve functional motor goals, but the neural mechanism underlying this intervention is unknown. Objective: Given the hypothesized role of the cerebellum in DCD, we sought to determine if CO-OP was associated with changes in cerebellar structure and if these changes were associated with improved motor outcomes. Methods: Sixty children with DCD (8-12 years) were randomized into the treatment or waitlist group. Each child participated in weekly, 1-hour CO-OP sessions for 10 weeks. Magnetic Resonance Imaging (MRI) was performed pre- and post-intervention and Voxel Based Morphometry (VBM) was used to explore differences in cerebellar grey matter volume between the treatment and waitlist groups. Linear correlation will be used to explore the relationship between grey matter volume and clinical measures of motor skills. Results: Using quality scans suitable for VBM [n=18; treatment (8); waitlist (10)], preliminary findings indicate that following CO-OP, children in the treatment group had increased grey matter volume in motor regions of the cerebellum (Lobule IX & Lobule VI, both p<0.001) compared to the waitlist group. Children in the treatment group also had increased grey matter volume in regions associated with cognitive skills (Crus I & Crus II, both p<0.001). Data collection and analysis are ongoing. Conclusion: Children with DCD show increased grey matter volume in sensorimotor and cognitive regions, indicating that CO-OP intervention is associated with structural changes in the cerebellum. Findings provide neuroscientific evidence for this occupational therapy intervention.
Day: Friday, Time: 09:00-09:25, Session: F20
Introduction: Cognitive Orientation to Occupational Performance (CO-OP) is effective in helping children with Developmental Coordination Disorder (DCD) to achieve functional motor goals, but the neural mechanism underlying this intervention is unknown. Objective: Given the hypothesized role of the cerebellum in DCD, we sought to determine if CO-OP was associated with changes in cerebellar structure and if these changes were associated with improved motor outcomes. Methods: Sixty children with DCD (8-12 years) were randomized into the treatment or waitlist group. Each child participated in weekly, 1-hour CO-OP sessions for 10 weeks. Magnetic Resonance Imaging (MRI) was performed pre- and post-intervention and Voxel Based Morphometry (VBM) was used to explore differences in cerebellar grey matter volume between the treatment and waitlist groups. Linear correlation will be used to explore the relationship between grey matter volume and clinical measures of motor skills. Results: Using quality scans suitable for VBM [n=18; treatment (8); waitlist (10)], preliminary findings indicate that following CO-OP, children in the treatment group had increased grey matter volume in motor regions of the cerebellum (Lobule IX & Lobule VI, both p<0.001) compared to the waitlist group. Children in the treatment group also had increased grey matter volume in regions associated with cognitive skills (Crus I & Crus II, both p<0.001). Data collection and analysis are ongoing. Conclusion: Children with DCD show increased grey matter volume in sensorimotor and cognitive regions, indicating that CO-OP intervention is associated with structural changes in the cerebellum. Findings provide neuroscientific evidence for this occupational therapy intervention.
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Multi Disciplinary Collaboration in Pediatric Fieldwork Placements
Valavaara, O'Krafka, Kingwell
Day: Friday, Time: 14:00-14:25, Session: F73
Introduction. At a tertiary pediatric hospital, early intervention rehabilitation services offer multi-disciplinary case management, assessment and intervention to provide holistic, family-centred care to patients and their families. However, occupational therapy and physical therapy student fieldwork placements operate in a single discipline model that is not reflective of multi-disciplinary rehabilitation programs and limits opportunities for students to develop competencies in multi-disciplinary collaboration. Objectives. Develop fieldwork placements to meet both the discipline specific fieldwork goals and provide opportunities to learn alongside their multidisciplinary student colleagues while providing early intervention rehabilitation services. Approach. Building on an established student led program, this poster details the process of program evaluation and stakeholder consultation where the site developed multidisciplinary, peer based, learning opportunities for occupational and physical therapy students. Practice Implications or Results. This fieldwork placement provided opportunities for students to refine their knowledge of their own discipline, learn more about the roles and scope of other disciplines and practice family-centred, team based care in a supportive learner environment. Occupational and physical therapy students were integrated into group programming that is typically single discipline (i.e) pool therapy, which challenged clinicians to think differently about incorporating multidisciplinary practice into group programming. Conclusions. Students and clinicians report benefits in learning about scope and roles of other disciplines and providing care in a multidisciplinary fieldwork practice setting. Additionally, this multidisciplinary fieldwork introduced occupational therapy services into new programs and groups, opening up possibilities for increased access to occupational therapy services within rehabilitation programming.
Day: Friday, Time: 14:00-14:25, Session: F73
Introduction. At a tertiary pediatric hospital, early intervention rehabilitation services offer multi-disciplinary case management, assessment and intervention to provide holistic, family-centred care to patients and their families. However, occupational therapy and physical therapy student fieldwork placements operate in a single discipline model that is not reflective of multi-disciplinary rehabilitation programs and limits opportunities for students to develop competencies in multi-disciplinary collaboration. Objectives. Develop fieldwork placements to meet both the discipline specific fieldwork goals and provide opportunities to learn alongside their multidisciplinary student colleagues while providing early intervention rehabilitation services. Approach. Building on an established student led program, this poster details the process of program evaluation and stakeholder consultation where the site developed multidisciplinary, peer based, learning opportunities for occupational and physical therapy students. Practice Implications or Results. This fieldwork placement provided opportunities for students to refine their knowledge of their own discipline, learn more about the roles and scope of other disciplines and practice family-centred, team based care in a supportive learner environment. Occupational and physical therapy students were integrated into group programming that is typically single discipline (i.e) pool therapy, which challenged clinicians to think differently about incorporating multidisciplinary practice into group programming. Conclusions. Students and clinicians report benefits in learning about scope and roles of other disciplines and providing care in a multidisciplinary fieldwork practice setting. Additionally, this multidisciplinary fieldwork introduced occupational therapy services into new programs and groups, opening up possibilities for increased access to occupational therapy services within rehabilitation programming.
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Readability of Occupational Therapy Research Articles
Heather Robertson, MOT student, Rachelle Abotswat, MOT student, Suzanne Huot, PhD, Skye Barbic, PhD, OT
Day: Friday, Time: 13:00-13:25, Session: F54
Peer-reviewed articles in occupational therapy are a primary source of information for clinicians and researchers. To maintain the standard of practice, clinicians and researchers need to make sense of emerging evidence. To achieve the timely implementation of new information, papers need to be clear and highly readable. Clear communication is especially important in occupational therapy, which brings together different research approaches. The readability assessment of occupational therapy articles has not been performed. Objectives: To assess and compare the readability of articles in four prominent occupational therapy journals. Methods: We tested the readability over time of articles from the four most cited occupational therapy journals (AJOT, BJOT, CJOT, and AOTJ). We randomly sampled 400 articles from different years and issues of publication (2008-2018) and collected information about the type of characteristics. We analyzed the Abstract, Introduction, and Discussion sections of each paper using ten validated readability metrics [1]. We will complete a linear regression analysis to understand the impact of study characteristics on readability. Results: Our analysis is nearing completion. Based on preliminary findings, we expect that the readability level of occupational therapy journals will be good and higher than articles published in general medicine journals. We also hypothesize that readability will be predicted by journal impact factor and article type. Conclusions: A study of this nature has not been previously conducted in occupational therapy. To improve practice and ensure efficient exchange of information, it is imperative that we optimize the readability of articles in occupational therapy journals.
Day: Friday, Time: 13:00-13:25, Session: F54
Peer-reviewed articles in occupational therapy are a primary source of information for clinicians and researchers. To maintain the standard of practice, clinicians and researchers need to make sense of emerging evidence. To achieve the timely implementation of new information, papers need to be clear and highly readable. Clear communication is especially important in occupational therapy, which brings together different research approaches. The readability assessment of occupational therapy articles has not been performed. Objectives: To assess and compare the readability of articles in four prominent occupational therapy journals. Methods: We tested the readability over time of articles from the four most cited occupational therapy journals (AJOT, BJOT, CJOT, and AOTJ). We randomly sampled 400 articles from different years and issues of publication (2008-2018) and collected information about the type of characteristics. We analyzed the Abstract, Introduction, and Discussion sections of each paper using ten validated readability metrics [1]. We will complete a linear regression analysis to understand the impact of study characteristics on readability. Results: Our analysis is nearing completion. Based on preliminary findings, we expect that the readability level of occupational therapy journals will be good and higher than articles published in general medicine journals. We also hypothesize that readability will be predicted by journal impact factor and article type. Conclusions: A study of this nature has not been previously conducted in occupational therapy. To improve practice and ensure efficient exchange of information, it is imperative that we optimize the readability of articles in occupational therapy journals.
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Living and working with chronic pain: An integrative review
Ariana Dirk, Mays Sleiman, Lynn Shaw
Day: Thursday, Time: 10:30-10:55, Session: Session ID# T29
Rationale: Approximately 1 in 5 Canadians experience moderate to severe chronic pain, impeding their ability to support self/others, which in turn impacts mental, physical, and spiritual health1,2. Current evidence focuses on intervention program effectiveness rather than work transition from the perspective of the person with pain and whether they live a functional meaningful life.
Objective: This integrative review explored successful RTW transitions using contextualized supports from the perspective of the person with pain.
Approach: Eight databases were searched for the RTW process for adults (18-65) with chronic pain. Search terms included: return to work, chronic pain, and lived experience, returning 189 articles. Twelve studies using qualitative or mixed methods were retained. All were critically appraised and found to have moderate to high quality evidence. The evidence was synthesized using iterative thematic analysis.
Results: RTW is directly related to engagement in other occupations. The ability to engage in activities individuals need, want, and are expected to do prior-to, during, and after paid work is impacted by the emotional/physical toll of pain, self-management of symptoms, self-advocacy, and supports available. These affect – and may undermine – motivation and self-efficacy for returning to and maintaining work. These challenges were explored extensively from the standpoint of the person with pain.
Conclusion: Identifying demands and supports, both internal and external to the workplace, is critical to set the foundation for successfully returning to and maintaining meaningful work. Therapists must consider a holistic approach, enabling self-advocacy and self-management skills while also working with employers to facilitate adaptations. Further research needs to concentrate on RTW facilitators using the lived experience.
Day: Thursday, Time: 10:30-10:55, Session: Session ID# T29
Rationale: Approximately 1 in 5 Canadians experience moderate to severe chronic pain, impeding their ability to support self/others, which in turn impacts mental, physical, and spiritual health1,2. Current evidence focuses on intervention program effectiveness rather than work transition from the perspective of the person with pain and whether they live a functional meaningful life.
Objective: This integrative review explored successful RTW transitions using contextualized supports from the perspective of the person with pain.
Approach: Eight databases were searched for the RTW process for adults (18-65) with chronic pain. Search terms included: return to work, chronic pain, and lived experience, returning 189 articles. Twelve studies using qualitative or mixed methods were retained. All were critically appraised and found to have moderate to high quality evidence. The evidence was synthesized using iterative thematic analysis.
Results: RTW is directly related to engagement in other occupations. The ability to engage in activities individuals need, want, and are expected to do prior-to, during, and after paid work is impacted by the emotional/physical toll of pain, self-management of symptoms, self-advocacy, and supports available. These affect – and may undermine – motivation and self-efficacy for returning to and maintaining work. These challenges were explored extensively from the standpoint of the person with pain.
Conclusion: Identifying demands and supports, both internal and external to the workplace, is critical to set the foundation for successfully returning to and maintaining meaningful work. Therapists must consider a holistic approach, enabling self-advocacy and self-management skills while also working with employers to facilitate adaptations. Further research needs to concentrate on RTW facilitators using the lived experience.
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Transitional Housing in Forensic Mental Health: Considering Consumer Lived Experience
Clark Patrick Heard; Jared Scott; Allan Tetzlaff; Heather Lumley
Day: Saturday, Time: 09:00-09:25, Session: S12
For individuals involved in the forensic mental health system, access to transitional housing can offer a bridge between custody and independence. This qualitative study considers the meaning associated with such participation. In this Canadian study, data was collected via interview with six individuals (n=6) who resided, for a minimum six (6) months, in justice focused transitional housing that involved a partnership between a rural forensic mental health care facility and a nearby urban transitional housing provider.
Day: Saturday, Time: 09:00-09:25, Session: S12
For individuals involved in the forensic mental health system, access to transitional housing can offer a bridge between custody and independence. This qualitative study considers the meaning associated with such participation. In this Canadian study, data was collected via interview with six individuals (n=6) who resided, for a minimum six (6) months, in justice focused transitional housing that involved a partnership between a rural forensic mental health care facility and a nearby urban transitional housing provider.
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Giving people with TBI a voice: Exploring occupational rights violations
Érika Dubuc, Mireille Gagnon-Roy, Mélanie Couture, Carolina Bottari
Day: Thursday, Time: 15:30-15:55, Session: T98
Introduction: Severe traumatic brain injury (TBI) is a chronic condition associated with major life changes, as people must adapt to a new reality. To ease transitions and optimize occupational development, people with TBI should be provided equal opportunities to engage in varied and meaningful occupations adapted to their new abilities. Despite this overarching principle, disparities between ideal and actual engagement are common. Objective: To explore the presence of occupational right violation situations that occurred over the lifetime trajectories of individuals post-severe TBI, where they could have potentially benefitted from rehabilitation and advocacy for their rights to be respected. Methods: Semi-structured interviews were completed with 5 severe TBI participants (average time post-injury: 17.6 years). Interviews were transcribed and analyzed using the critical incident technique. Results: Despite currently being in a relatively stable living situation, all participants experienced violations of their occupational rights over their lifetime. These violations included restrictions in their occupational choices (n=5), limited occupational engagement (n=3) and participation in otherwise meaningless occupations (n=2). Moreover, these violations brought greater challenges, including homelessness (n=2), illegal substance abuse (n=3) and unstable living condition (n=4). Participants were largely dependent of their families support for complex everyday activities. All expressed openness to interventions to optimize their independence. Conclusions: Being unable to advocate for themselves, these individuals experienced a multitude of challenges over the years and lacked the abilities and support needed to overcome those occupational injustices. These results underline the need for more long-term services, with occupational therapy potentially assuming a key role. **Note that the presentation will be wield in french**
Day: Thursday, Time: 15:30-15:55, Session: T98
Introduction: Severe traumatic brain injury (TBI) is a chronic condition associated with major life changes, as people must adapt to a new reality. To ease transitions and optimize occupational development, people with TBI should be provided equal opportunities to engage in varied and meaningful occupations adapted to their new abilities. Despite this overarching principle, disparities between ideal and actual engagement are common. Objective: To explore the presence of occupational right violation situations that occurred over the lifetime trajectories of individuals post-severe TBI, where they could have potentially benefitted from rehabilitation and advocacy for their rights to be respected. Methods: Semi-structured interviews were completed with 5 severe TBI participants (average time post-injury: 17.6 years). Interviews were transcribed and analyzed using the critical incident technique. Results: Despite currently being in a relatively stable living situation, all participants experienced violations of their occupational rights over their lifetime. These violations included restrictions in their occupational choices (n=5), limited occupational engagement (n=3) and participation in otherwise meaningless occupations (n=2). Moreover, these violations brought greater challenges, including homelessness (n=2), illegal substance abuse (n=3) and unstable living condition (n=4). Participants were largely dependent of their families support for complex everyday activities. All expressed openness to interventions to optimize their independence. Conclusions: Being unable to advocate for themselves, these individuals experienced a multitude of challenges over the years and lacked the abilities and support needed to overcome those occupational injustices. These results underline the need for more long-term services, with occupational therapy potentially assuming a key role. **Note that the presentation will be wield in french**
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Une étude de l'âgisme chez les étudiants en réadaptation
Marion Lack, Johanne Filiatrault, Joseph-Omer Dyer, David Pimenta Da Silva
Day: Friday, Time: 16:00-16:25, Session: F106
Introduction. L’âgisme est encore bien présent dans la société et ce phénomène peut avoir des répercussions négatives sur le bien-être des aînés. Quelques études montrent qu’on le retrouve aussi chez les professionnels de la santé. Il s’avère donc crucial que les programmes de formation en santé considèrent cette réalité. Toutefois, peu d’études ont examiné les attitudes des étudiants en réadaptation à l’égard des aînés. Objectifs. Cette étude avait pour objectifs d’examiner les attitudes des étudiants en réadaptation envers les aînés et d’identifier les facteurs associés. Méthodes. Un questionnaire en ligne a été transmis aux étudiants de première année d’un programme d’ergothérapie (n=126) et d’un programme de physiothérapie (n=106). En plus de colliger des données sociodémographiques, il comportait des questions sur leurs connaissances relatives au vieillissement, la fréquence de leurs contacts avec des aînés et leur satisfaction à l’égard de ces contacts. Diverses mesures d’âgisme ont aussi été incluses. Résultats. Quatre-vingt-neuf étudiants ont répondu au questionnaire. Les analyses indiquent que leur niveau d’âgisme est généralement faible. Les analyses révèlent aussi des associations négatives statistiquement significatives entre le niveau d’âgisme et l’âge, les connaissances sur le vieillissement et la satisfaction vis-à-vis des contacts avec des aînés. Les analyses ne révèlent pas d’association entre la fréquence de ces contacts et l’âgisme. Conclusions. Les résultats soutiennent l’importance des connaissances relatives au vieillissement et de la qualité des contacts avec des aînés dans le développement d’attitudes positives envers ceux-ci. Ces résultats suggèrent des pistes utiles pour le développement d’une formation pour les étudiants en réadaptation.
Day: Friday, Time: 16:00-16:25, Session: F106
Introduction. L’âgisme est encore bien présent dans la société et ce phénomène peut avoir des répercussions négatives sur le bien-être des aînés. Quelques études montrent qu’on le retrouve aussi chez les professionnels de la santé. Il s’avère donc crucial que les programmes de formation en santé considèrent cette réalité. Toutefois, peu d’études ont examiné les attitudes des étudiants en réadaptation à l’égard des aînés. Objectifs. Cette étude avait pour objectifs d’examiner les attitudes des étudiants en réadaptation envers les aînés et d’identifier les facteurs associés. Méthodes. Un questionnaire en ligne a été transmis aux étudiants de première année d’un programme d’ergothérapie (n=126) et d’un programme de physiothérapie (n=106). En plus de colliger des données sociodémographiques, il comportait des questions sur leurs connaissances relatives au vieillissement, la fréquence de leurs contacts avec des aînés et leur satisfaction à l’égard de ces contacts. Diverses mesures d’âgisme ont aussi été incluses. Résultats. Quatre-vingt-neuf étudiants ont répondu au questionnaire. Les analyses indiquent que leur niveau d’âgisme est généralement faible. Les analyses révèlent aussi des associations négatives statistiquement significatives entre le niveau d’âgisme et l’âge, les connaissances sur le vieillissement et la satisfaction vis-à-vis des contacts avec des aînés. Les analyses ne révèlent pas d’association entre la fréquence de ces contacts et l’âgisme. Conclusions. Les résultats soutiennent l’importance des connaissances relatives au vieillissement et de la qualité des contacts avec des aînés dans le développement d’attitudes positives envers ceux-ci. Ces résultats suggèrent des pistes utiles pour le développement d’une formation pour les étudiants en réadaptation.
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Caregiver's preparedness to manage cognitive deficits post-stroke
Jean, Alexandra ; Poulin, Valérie and Viscogliosi, Chantal
Day: Saturday, Time: 09:00-09:25, Session: S30
Introduction : Caregivers play a central role to support their relatives with cognitive deficits post-stroke, but they are confronted to several issues during return to home, as they face an important occupational transition. Objectives : 1) to explore caregivers’ perceived educational and support needs during this transition, and 2) to compare those needs with recommendations of best practices addressed to caregivers after a stroke. Methods : Descriptive qualitative study, including semi-structured interviews with 10 caregivers. Thematic content analysis, validated by two team members, was based on the Framework Approach (Ritchie and Lewis, 2003). Expressed needs were compared to Canadian recommendations (Cameron and al., 2015) and continuum of stroke services (Government of Quebec, 2017). Results : Caregivers wish to be better informed before transition to understand daily impacts of cognitive deficits, but they also express the need to experience real life situations in order to benefit from follow ups by healthcare professionals or peer support after rehabilitation. Perceived needs also support the relevance of a partnership of care, to allow for shareddecision making et development of caregivers’ competencies. Those needs are consistent with recommendations of best practices. Some needs are still partially met, especially individualized follow up post-rehabilitation, and seem even more salient for caregivers providing constant supervision. Conclusion : This study suggests some avenues to be explored for improving services, where occupational therapists could play a key role for empowering caregivers across this transition. Key words | Mots clés : Stroke, Teaching/education
Day: Saturday, Time: 09:00-09:25, Session: S30
Introduction : Caregivers play a central role to support their relatives with cognitive deficits post-stroke, but they are confronted to several issues during return to home, as they face an important occupational transition. Objectives : 1) to explore caregivers’ perceived educational and support needs during this transition, and 2) to compare those needs with recommendations of best practices addressed to caregivers after a stroke. Methods : Descriptive qualitative study, including semi-structured interviews with 10 caregivers. Thematic content analysis, validated by two team members, was based on the Framework Approach (Ritchie and Lewis, 2003). Expressed needs were compared to Canadian recommendations (Cameron and al., 2015) and continuum of stroke services (Government of Quebec, 2017). Results : Caregivers wish to be better informed before transition to understand daily impacts of cognitive deficits, but they also express the need to experience real life situations in order to benefit from follow ups by healthcare professionals or peer support after rehabilitation. Perceived needs also support the relevance of a partnership of care, to allow for shareddecision making et development of caregivers’ competencies. Those needs are consistent with recommendations of best practices. Some needs are still partially met, especially individualized follow up post-rehabilitation, and seem even more salient for caregivers providing constant supervision. Conclusion : This study suggests some avenues to be explored for improving services, where occupational therapists could play a key role for empowering caregivers across this transition. Key words | Mots clés : Stroke, Teaching/education
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