This project has strongly suggested that acute occupational therapists do bring about functional improvements for patients they see , using a variety of methods ...”
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seen , clinicians identified the following interventions as the ones that they felt contributed to the improvements seen :
• functional rehabilitation ( for example , kitchen or personal care practice , cognitive rehabilitation , gym-based sessions ) ( 20 people )
• issuing of equipment ( seven people )
• a combination of rehabilitation and equipment issue ( seven people )
• a combination of rehabilitation and counselling / psychological support ( six people ). For the 21 patients where no measurable outcome was seen , but referrals were still considered appropriate , three interventions were one-off contacts for signposting or advice , and 10 patients were transferred to a rehabilitation setting before changes in outcome could be observed .
Two interventions were to make an onward referral to a community therapy team for ongoing input at home post-discharge , so changes in outcomes were not observed before discharge . And six patients deteriorated or died .
Some challenges
As anticipated , outcomes were only observed in a small majority of patients within the sample . Of those patients in whom a change in outcomes was not observed , the interventions were standard brief / oneoff interventions routinely carried out by occupational therapists in acute inpatient settings across the country .
This suggests that , while occupational therapists are confident in the efficacy of these interventions , the means of evaluating their effectiveness , such as referring to an outside agency for ongoing intervention following discharge , is challenging .
A potential solution would be to employ post-discharge patient reported outcome measures ( PROMs ). However , this would rely on patients recalling that they were seen by an occupational therapist within the acute inpatient setting , to be able to comment on the effectiveness of the intervention provided .
Given the vast range of professionals many patients encounter during an acute inpatient stay , and the likelihood of them only having had a one-off contact from an occupational therapist , often while they may have been feeling unwell , responses to PROMs may be inconsistent and unreliable .
From a staff point of view , coordinating the administration of PROMs for all patients may be difficult on top of the fast-paced nature of acute inpatient throughput .
Did it add value ?
This leads on to the question as to the value of routinely using an outcome measure across a full caseload to demonstrate the effectiveness of an acute inpatient occupational therapy service .
The primary purpose of longer-term occupational therapy services , such as inpatient rehabilitation settings , community rehabilitation teams , or structured therapy outpatient programmes , is to facilitate functional improvement in patients and service users .
The wide battery of outcome measures available can meet the needs of measuring outcomes for such services , and effectively demonstrating that they are fulfilling their primary functions .
Within acute inpatient settings , the primary function of an occupational therapy service is to prevent complications associated with medically-induced inactivity and to facilitate a discharge either to a patient ’ s / carer ’ s home ( or placement ) with the appropriate supports identified and actioned or to an appropriate rehabilitation setting ( NICE 2018 ), not necessarily bringing
40 OTnews February 2022