OT 1201 cheat sheet PDF

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Define EBP: A process whereby research evidence, clinical knowledge and reasoning are used to make decisions about interventions that are effective for a client. Law & Baum 1998. Why? Efficient and effective method. (Gray, 1997): Provides accountability to patients & their families that you are ‘doing the right thing right’ Provides an important link between practice and research. (Baker & Tickle-Degnen) Organise evidence for clinic task1.Know a client background-- typical OT experiences & needs of clients from population 2.Diagnosis--Quality (e.g. reliability, validity, trustworthiness, usefulness of OT Ax procedures. 3.Chose effective intervention--Relative effectiveness of diff. types of treatments designed for this population. 4. Estimate outcomes (prognosis)--Based on factors: comorbidities, previous & present circumstances identify the outcomes most commonly occurring for these populations. How is EBP done? ****** 1. Asking the question -- relevant & answerable (PICO: Problem/Pt/population, e.g. primary disease, co-existing conditions, gender, age, or race of the patient. Intervention/Exposure/ risk factors, Comparison, Outcome) 2. Finding the evidence/information: General database: PubMed, Medline, EMBASE, CINAHL Psychlnfo, Google scholar// EBP data: Cochrane library, PEDro, OT seeker //Open access: Free Medical Journals, Directory of open access Journal, Biomedcentral //Position statement and guideline --Professional web: AOTA, OTA // OTH. web: the national institute for health and care excellence (NICE), the agency for Clinical Innovation (ACI), Alzheimer’s Australia (CPGs for dementia in aus) Cancer council or Cancer Care Ontario// Support evi. Into practice: Clearing houses—TRIP database, Prim. Health care research n information service, knowledge translation 3. Evaluate/appraise the literature: Critical appraisal checklist n guideline—McMaster Uni, centre for EB-med. Critical appraisal skills program (CASP) 4. Implement useful findings in clinical practice Best evid. order: Lv 1 systematic review Lv 2 properly designed randomized controlled trial lv3 non-random/control. Study lv4cohort/ case-control analytic studies preferably from multi source lv5 – uncontrol study with dramatic result lv 6 expert opinion • Evaluating the Evid.: purpose? Were there major flaws/biases/ interpretation/ Centre for Evid.-Based Medicine/ University guildlines • Using the evid: Apply what you read to one/gp of Pt, Reconsider your treatmt plan and goal (info. in progress reports to management, funding bodies or in evaluation reports) • Develop pt handout on topic wif oth. who are interested – task for clinical groups What is critical appraisal? determine the applicability of research findings to the practice situation. (USE the CASP checklist: Critical appraisal skills programme) The basics: What was the purpose/ research question/hypothesis? - What was the design of the study? Does the design allow the question to be answered? - What were the results? Are the explanation given by the authors valid? - What is your assessment of internal/external validity? - How are the results relevant to my practice? - Can I use the results in practice? Study design/approaches: 1. Experimental Specific research approaches --- Active independent variable* can be random/ nonrandom, control/comparison group -- Systematic Review: Rigorous and systematic selection of studies based on keywords and inclusion criteria, include meta-analysis (combination of all research method)  Randomized Controlled Trial (RCT): random >> AIM is to compare groups/treatment conditions*  Quasi-Experimental Designs: Non-randomized Trial>> (same AIM with RCT)

2. Non-experimental: no independent/ mutually occur (e.g. observation/ Case-Control study / Cohort study.) Cannot random assign to group  Comparative >> aim to to compare groups  Associational >> to examine the relation btw 2 variables  Descriptive >> describe a phenomenon / tell if there are problem or not  Qualitative >> understand and/or explore a phenomenon from the perspective of those experiencing it. Da t at e ndst o bet e x t ual EBP --- 3 equal components: (Shin et al., 2010) 1) The current best evidence 2) The treatment environment 3) Each client values and circumstances. Creating evidence through practice DDDM --- Data-Driven Decision Making (Schaaf, 2015) • Clinical reasoning in OT, each step, data is generated, • Data is used to generate hypotheses, design interventions and document progress • Outcomes are measured and documented DDDM Steps 1. Identify participation challenges and goals 2. Describe current level and factors affecting participation 3. Conduct systematic assessment 4. Identify strengths and barriers 5. Generate hypotheses – what is likely to be successful? 6. Design the intervention – evidence-based strategies, document frequency, intensity & duration 7. Identify proximal and distal outcomes 8. Conduct the intervention 9. Collect, display and analyse data on progress & outcomes 10. Monitor progress to refine hypotheses

Process of occupation-centered evaluation: referral, gather data, OT profile, select and administer/manage evaluation measures, analysis doc, evaluate outcome OT type of Ax:  -Descriptive (use for diagnosis), -Evaluative (detecting clinical change, grades behviors and performance) -Predictive, - Standardised and Non-standardised - Top-down Ax: focus on OT issues & meaningfulness to define each of the roles, whether they can do reasons for an inability to do (e.g. access performance skill/patterns, activity demands, self-care, leisure and productivity. E.g. Canadian Occupational Performance Measure and tools based on the MOHO. - Bottom-up approach: focus on OT performance, to assessment and treatment focuses on the deficits of client’s function, E.g. biomechanics (strength, endurance, range of movement), cognition (processing skills – attention to task, concentration etc.), perception, or sensory processing. Factors to choose Ax Tools: (Creek, 2002) o Theoretical framework o Information required o Client’s level of ability o Nature of the client’s difficulties o Stage of assessment Con’t. with factor to choose tools (Pitts, 2005) o Relevance, Feasibility, Utility, Role of OT (case management), Setting – time frames, Age, Diagnosis – level of distress Features of Non-standardised test: Classen & Velozo, 2014 - Guided by a theoretical framework - Inform further clinical reasoning - Client-centered - Based on strong therapeutic rapport – supports narrative reasoning - Acknowledge client diversity Example: • Canadian Occupational Performance Measure (COPM)

• Interview (based on Kawa model) • ‘Home grown’ initial interview forms • Informal observation/ Questionnaires • OT performance Ax: such as cooking Ax. • OT self Ax (OSA) / COSA child OT self ax • Goniometer Features of Standardized test: • Results can be compared over a number of test occasions or with test norms • Uniform procedures for administration and scoring • Fixed/defined population for testing • Reliability & validity • Fixed items, protocol for administration • Fixed guideline for scoring Example: Interest Checklist (identify occupations and hobbies that are important to the client) Non-reference test vs Criterion refer. test: NRT: compare client’s performance test with another group/ normative sample  large sample population  Use standardized administration and scoring  Scope is general and multi-dimensional  Items are chosen for statistical performance rather than functional relevance  May (not) relate to functional skills or therapy objectives CRT: compare client’s performance with specific skills or criteria  Items are detailed and specific, scope is narrow  Useful for intervention planning  Chosen for functional and developmental importance  May/may not be standard in admin and scoring Types of standard scores used in standardized assessments: (Statistical score that indicate level of individual performance, meaningful)  Z-score: client’s score from the mean of sample  T-score: redistribute scores on scale where mean is 50, and SD is 10  Percentile score: % of normative sample score at or below percentile score  Age equivalent: age at which raw score is at the 50th percentile Good or bad assessment? Check….. see the Ps y c home t r i cp r op e r t i e s( b e l o w) :  Clinical utility—cost, format, time to administer What is test measuring? Validity 合法 How to test? Simple? Consistent? Free of bias? Reliability. How good is test to detect problem? Sensitivity.  How food is test at identifying typical performance? Specificity. Define Reliability: gives consistent results. Coefficient over 90= excellent; 80= good. 1. I nt e r nalc ons i s t e nc y :us ei nps y c home t r i ct e s t s& q ue s t i on na i r e s .Se ea l lpa r t soft het e s tc on t r i but ee q ua l l yt o wh a ti sbe i n gme a s ur e d. 2. Te s t r e t e s t :us ei nps y c home t r i ct e s t sa n dque s t i onna i r e s . Ta k e sal on gt i met oc he c kr e s ul t sc o ns i s t e nt 3. I nt e r r a t e r :c a nus ei ni nt e r vi e w.Thi sr e f e r st ot hede gr e et o wh i c hd i ffe r e ntr a t e r sgi v ec ons i s t e nte s t i ma t e soft hes a me be ha vi our ;us i ngt heg oni ome t e rf orme a s ur efin g e rj oi nt s . Define Validity: the degree to which a test measures what it claims to measure. 1) Content: use literature – factor analysis. E.g Pediatric Evaluation of Disability Inventory 2) Criterion-related: a) Concurrent: the scores on a new test are related to the scores on another test; moderate correlations are expected. b) Predictive validity 3) Construct: involves testing hypotheses deduced from the test’s construct, Discrimination analysis Principles of administration: (Plan, prepare, practice) Use the right test at the right time Learn the test – prepare

Establish inter-rater reliability Consider the environment Fluency in administration Read the scoring instructions & follow the rules COAST---Client, Occupation, Assist level, Specific condition (which client is expected to perform the desired action – location, adaptive equipment, or modified technique), Timeline Theory in level: • Paradigm (Foundational knowledge)– the shared consensus/belief regarding the most fundamental beliefs of the profession • Conceptual model of practice (Applied knowledge)occupation-focused theoretical constructs and propositions that have been developed specifically to explain the process and practice of occupational therapy. Also described as occupation-focused models of practice (Ashby & Chandler, 2010) • Frame of reference – theoretical or conceptual ideas that have been developed outside the profession but which with judicious use, are applicable in occupational therapy practice. E.g. CPPF Canadian practise process framework  Set the stage, assess, agree on plan, implement, monitor/modify, evaluate and conclude  Krefting (1985): provide a bridge between theories and structure specific treatment interventions.  Turpin and Iwama (2011, p.19): “It is favoured for theoretical systems that are not limited to the profession of OT and the term is used interchangeably with terms, such as treatment or intervention approaches because they provide a level of detail that enables their direct use in practice”. OTPF: Intervention approaches 1) Create, promote: Not assume a disability is present 2) Establish, restore (remediation, restoration): change client variables to establish a skill that hasn’t yet developed or restore the ability that impaired. 3) Maintain: provide support to help, if not, performance decrease and affected quality of life 4) Modify (compensation, adaptation): compensatory /adaptive techniques e.g. enhancing some features to provide cues to reduce disability 5) Prevent (disability prevention) Grading: to changing the complexity of what is to be performed (Neistadt & Crepeau,1998) or “systematically increasing the demands of an occupation to stimulate improved function or reducing the demands to respond to client difficulties in performance” (Gillen, 2014) - Grade task progression from easier to harder - Increase complexity within the task - Same task in varied performance contexts Adapting: to modifying or substituting objects (or processes) used in performing the activity - Change task demands - Provide adaptive equipment - Modify the environment/context (Neistadt & Crepeau, 1998) Biomechanical FOR: All occupations involve a person stabilising and moving their bodies - Explains function in terms of anatomy and physiology and kinesiology - Treatment to overcome damage to a particular part results in return of function - Therapeutic exercise or activity improves functional movement, leading to á sense of well-being Components of stability and motion • Joint range of movement • Active range of motion & Passive range of motion

Muscle strength The ability of muscles to produce tension and act on joints (stabilise or move) • Responds to repetitive use; act in groups- primary or second mover • Endurance: - Ability to sustain muscle activity • Directly related to muscle physiology and dependent on supply of oxygen •

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Assessment using Biomech FOR: (McMillan (2006) • Joint range – goniometer Muscle power- Oxford rating scale Grip strength - dynamometer Muscle bulk – tape measure Endurance - length of time, number of repetitions,Distance or any other precisely quantifiable factor Sitting and standing tolerance Manual handling skills - Functional Capacity evaluation Joint protection—involves transferring pressure from smaller joints to larger joints to enable activity completed Energy conservation- invoves activity analysis n adaptation to the occupation or environment Splinting of affected joint Remedial vs compensatory approach: 1) Compe ns at or yt r e a t me ntappr oa c h:  Ad a pt i onofoc c upa t i on:r e duc es t e ps( e ne r gyc ons e r v e ) , supply equipment (splinting) etc  Ad a p t a t i onofe nv i r onme nt( bui l di n gmod s ,ht ,s i z ee t c ) 2)Re me di alt r e at me ntappr oac h  Re ha bi l i t a t i on/ Us eofoc c up a t i ont os t r e n gt he n,i nc r e a s er a ng eof mo v e me nt ,ore ndur a nc e ) Merits of biomech FOR: - Promote physical function i.e. Wii - Increase knowledge of anatomical, physiological and kinesthetic processes in human - Develop of measure techniques for movement, strength and endurance; Apply in creative and constructive thing Limitation of biomech FOR: - Only focus on physical performance but no psychological, emotional, social of rehab - Not address the need for balance in ADL - Not for CNS impaired people >>belongs to primary FOR Example of biomech FOR: • In hand therapy in using graded approach to strengthen and increase fine finger movement • Rotator cuff surgery- positioning, increasing ROM, • MS: compensatory approach, equipment, splints, modifying work activities to compensate for decreased function. Narrative reasoning: personal and focused on the client; know the client’s particular condition and effect of illness/disability on client’s daily lives and culture // Example questions: - Ho wha st hehe a l t hc ond i t i ona ffe c t e dt hepe r s on ’ sl i f es t or yor a bi l i t yt oc ont i nuewi t ht he i rl i f es t or y ? - Wha tOTa c t i vi t i e sa r eb ot hme a ni n gf ult ot hi spe r s ona ndu s e f ul / i mpor t a n tf orme e t i n gt he r a p yg o a l s ? Interactive reasoning: Building positive interpersonal relationships with clients; Identify collaborative problem and solve problem; Concern what client likes or does not like; Praise, empathy and non-verbal behaviours to encourage client’s cooperation // Example questions: - What nonverbal strategies should I used in this situation? - What is the best way for me to encourage this person? - Where should I place myself relative to this person to provide support but not ‘invade’ personal space? CCP- client centered- Definition: - partnership between the client and the therapist that empowers the client to engage in functional performance and fulfil his or her roles in a variety of environments - The client participates actively in negotiating goals, which are at the centre of assessment, intervention and evaluation - The therapist listens to and respects the clients needs and enables the client to make informed decisions - Emphasises the Person in PEO -Involves fostering therapeutic alliances which involves acknowledging the Client

as the expert about their illness experience -The clientcentred principles are used in family-centred practice, is sometimes referred to as person-centred practice Patient Vs Client practise Patient centred practice: - Power in the hands of the professionals; recipient of services; based on moral and ethical tradition; wait to be provided medical service; prescriptive programs; experts giving advice; individual; told what to do with an expectation of compliance Client centred practice: - Power to clients; consumer of services; based on legal and economic tradition; choose to be involved; engages the services of others; joint goal setting with the client Professional; experts listening to the needs of client; clients can be organize not just individuals; right to seek info, free to voice an opinion, education of clients is a critical role

Illness experience: － Effects all aspects of a person’s life –have to be holistic －Involves not only the person but also family n friends - Is sometimes strange and frightening - Confront them every moment of every day - Have to contend with stigma, staring, pointing, whispering, second looks and glances - OTs assist the person to cope as they engage in daily OT Reducing the influence of power relationships: - Client as expert abt their illness exp; OT expert abt OT - Fearing and Clark (1997) said: “fostering a therapeutic alliance depends on acknowledging the client as expert.” **IF NOT: OT as expert thinking how non-compliant/stubborn/ the client is …. instead of changing action plan. Being judged as ‘noncompliant’ to a set treatment regime is synonymous with being ‘uncooperative’ an attitude looked on unfavorably by health professionals who believe they are offering the best solution with noble intentions. Therapeutic relationships: 1.) Reason for initiation: Purpose-driven, Formal, Procedural, Agreements 2.) Scope: Highly structured, Defined by discipline, occupational needs and goals, focus on client, specific to therapeutic locations, based on learning & evidence 3.) Ethical and legal responsibility: Accessible to all, Not personal, Competent, Governed by law, Confidential 4.) Time: Time-bound Therapeutic VS Friendship: Therapist: to help the patient overcome traumas The payment is what balances the scale of the relationship. IF NOT, acts as a regressive force in the patient’s evolution. Friends: mutually beneficial selfishness; relationship is freely offered and received mutual support & understanding. “ Therapeutic use of self “ The therapist’s conscious efforts to optimize their interactions with a client // ‘planned use of (therapist’s) personality, insights, perceptions, and judgments as part of the therapeutic process’ (AOTA, 2008) Intentional Relationship Model (IRM) is a frame of reference to guide therapeutic use of self (Taylor, 2008) IRM (Taylor, 2014): Key components - Client-therapist relationships - Client interpersonal characteristics - Interpersonal events - Modes (an intentional change in the way we act): Advocating, Collaborating, Empathsis, Encourage, Instructing, Problem solving - Interpersonal reasoning process: `Anticipate>>Identify and cope>>Determine if a mode shift is required>>Choose a response mode or mode sequence >>Draw any relevant interpersonal skills associated with the mode; e.g. active listening, clarifying, reflecting back, directing, etc >>Gather feedback – verbal and non-verbal Core concept of OT: ** Occupation as end is desired outcome or product of intervention (ie. the performance of activities or tasks that the person deems as

important to life) and derived from person’s values, experiences and culture, therefore: Client, family, and significant others are active participants throughout the therapeutic process in what is referred to as a clientcentred approach. Definition OT (Yerxa 1991): Occupational therapy is a great idea whose time...