Actual vs. best practices for young children with cerebral palsy: a survey of paediatric occupational therapists and physical therapists in Quebec, Canada.
School of Physical & Occupational Therapy, Faculty of Medicine, McGill University and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montreal, Quebec, Canada. maysoun.saleh@mail.mcgill.ca
Cerebral palsy (CP) constitutes a substantial portion of paediatric rehabilitation, yet little is known regarding actual occupational therapy (OT) and physical therapy (PT) practices. This study describes OT and PT practices for young children with CP in Quebec, Canada.
This was a cross-sectional survey. All eligible, consenting paediatric occupational therapists (OTs) and physical therapists (PTs) were interviewed using a structured telephone interview based on vignettes of two typical children with CP at two age points--18 months and 4 years. Reported practices were grouped according to the International Classification of Functioning, Disability and Health (ICF).
91.9% of PTs (n=62; 83.8% participation rate) and 67.1% of OTs (n=85; 91.4% participation rate) reported using at least one standardized paediatric assessment. OT and PT interventions focused primarily on impairments and primary function (such as gait function and activities of daily living). Both professions gave little attention to interventions related to play and recreation/leisure. Clinicians reported the need for more training and education specific to CP and to the use of research findings in clinical practice.
Wide variations and gaps were identified in clinicians' responses suggesting the need for a basic standard of OT and PT management as well as strategies to encourage knowledge dissemination regarding current best practice.
The Sexual Health Clinician is a health care specialist who is able to assess the sexual potential of physically disabled persons and assist them in the development of acceptable alternatives in sexual practices. This specialty role was first developed at the Spinal Cord Injury Unit, Shaughnessy Hospital in Vancouver, B.C., Canada, to answer a need of spinal cord injured patients, their partners and family. The opportunity to join the Service arose in May, 1981 following one year as the Senior Occupational Therapist on the Spinal Cord Injury Unit. This paper, which describes the experience of an occupational therapist as a member of the Sexual Health Service, is presented in five brief parts: 1. a background history; 2. a description of the sexual problems of the spinal cord injured and the goals of rehabilitation in this area; 3. the role of the Sexual Health Clinician; 4. the strengths and limitations of Occupational Therapy in this new role; 5. a brief discussion of the the need for a sex-related role and curriculum for students of Occupational Therapy.
This paper outlines the process of incorporating the "Guidelines For the Client-Centred Practice of Occupational Therapy" into the practice of occupational therapy in an out-patient rehabilitation facility serving young people with physical disabilities. Specifically, the areas of practice addressed are screening and assessment. The process started in 1987 with an identification of the need to find a holistic framework that meets the complex needs of clients with chronic physical disabilities. The conceptual model of occupational performance, as outlined in the Guidelines, provided such a framework. The process of incorporating the Guidelines into the screening and assessment practices of occupational therapists at Erinoak Serving Young People With Physical Disabilities is described, with examples of documents developed by the department. Suggestions are given to integrate the conceptual model of occupational performance into the practice of occupational therapists working with children and adolescents with physical disabilities.
Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.
Clinical competence is generally defined as a combination of knowledge, skill and professional behaviour. It is typically assessed using written tests, direct observation, chart audit, client satisfaction surveys and supervisor ratings. This paper describes the development and evaluation of a chart-stimulated recall (CSR) measure that combines the methods of chart audit and clinician interview to assess the clinical competence of practicing occupational therapists. The CSR tool was developed using the Canadian Guidelines for Client-Centred Practice and taps global domains of competence: use of theory, assessment, program planning, intervention, discharge planning, follow-up, program evaluation, clinical reasoning and professional behaviours. This pilot study involved two independent raters/interviewers who assessed twelve occupational therapy clinicians on two occasions using a random sample of client cases/records on each occasion Results indicate that the CSR tool is not only reliable and valid, but also sufficiently generic to be used in a variety of practice settings as a global measure of on-the-job performance.
Although unrelieved pain continues to represent a significant problem, prelicensure educational programs tend to include little content related to pain. Standards for professional competence strongly influence curricula and have the potential to ensure that health science students have the knowledge and skill to manage pain in a way that also allows them to meet professional ethical standards.
To perform a systematic, comprehensive examination to determine the entry-to-practice competencies related to pain required for Canadian health science and veterinary students, and to examine how the presence and absence of pain competencies relate to key competencies of an ethical nature.
Entry-to-practice competency requirements related to pain knowledge, skill and judgment were surveyed from national, provincial and territorial documents for dentistry, medicine, nursing, pharmacy, occupational therapy, physiotherapy, psychology and veterinary medicine.
Dentistry included two and nursing included nine specific pain competencies. No references to competencies related to pain were found in the remaining health science documents. In contrast, the national competency requirements for veterinary medicine, surveyed as a comparison, included nine pain competencies. All documents included competencies pertaining to ethics.
The lack of competencies related to pain has implications for advancing skillful and ethical practice. The lack of attention to pain competencies limits the capacity of health care professionals to alleviate suffering, foster autonomy and use resources justly. Influencing professional bodies to increase the number of required entry-to-practice pain competencies may ultimately have the greatest impact on education and practice.
Understanding of attitudes, knowledge, and behaviour related to evidence-based practice (EBP) and guidelines in Swedish occupational therapy is limited. The study aims were to investigate attitudes, knowledge, and behaviour related to evidence-based practice and guidelines of Swedish occupational therapists in primary care.
A web-based survey of 94 Swedish primary care occupational therapists (response rate 53.7%). Data were analysed using logistic regressions.
Attitudes towards EBP and guidelines were highly positive (97%-98%). About half of the respondents reported confidence in finding and using evidence. Almost two-thirds reported being aware of guidelines and 47% knowing where to find guidelines. Four-fifths stated that they had easy access to guidelines and 75% that they used guidelines frequently. Men were more likely to feel confident to find research (OR 8.58, 95% CI 1.03 to 71.66; p = 0.047) and have easy access to guidelines (OR 9.10, 95% CI 1.94 to 42.83; p = 0.005). Occupational therapists older than 50 years were more likely to integrate patient preferences with guideline use (OR 6.44, 95% CI 1.14 to 36.57; p = 0.035). Few reported reading scientific articles, and many expressed uncertainty in finding research. The main barrier for using guidelines was reported to be lack of time.
Although attitudes among primary care occupational therapists towards EBP are positive and a large proportion report using guidelines, many state that they want to learn more and improve their evidence-based practice skills. The findings suggest that education measures need to be taken to address the identified shortcomings.
Rehabilitation therapists are strongly encouraged to apply research to their practices, but relatively little is known about the processes therapists use for continuing their education. This study examines the strategies used by a sample of therapists to gather new knowledge, evaluate its appropriateness to their clinical problems, and implement new learning into their practices.
Twenty-four randomly selected occupational therapists and physical therapists from a large metropolitan area participated in in-depth interviews. Descriptive codes within interview transcripts described participants' individual approaches to continuing education (CE). Themes derived from comparative analysis across interviews were interpreted, building on prior understandings and suggesting strategies for CE research and programs.
Participants valued formal CE highly and expressed frustration concerning its limited availability. Most participants relied on informal consultations with peers as their first educational resource. Peers also supported participants' evaluation and implementation of new knowledge. Although seven participants reported use of systematic methods to access, evaluate, and implement new knowledge, others described more haphazard approaches toward evaluation and application of their learning. Participants identified economic, administrative, and interprofessional barriers to integration of new knowledge into their practices.
There is a need to develop and incorporate guidelines for evaluating and implementing learning within formal and informal CE programs. The appeal of formal CE suggests that more efficient strategies for continuing rehabilitation are required. Therapists' heavy reliance on peers suggests that educationally influential therapists may be effective media for informal CE interventions. CE targeted to policy makers should focus on promoting organizational change to enhance therapists' translation of research into practice.
