The effect of cancer diagnosis and treatment on hand function

Cancer diagnosis and treatment can have a profound effect upon hand function, presenting a challenge to the occupational therapist. The therapist who specializes in oncology or hand therapy must have knowledge of the medical treatment model in regard to cancer conditions and must be able to set realistic goals that consider the patient's medical prognosis as well as the effect the disease or medical treatment has on the patient's physical and emotional functioning. The challenge to therapists in this area of practice will be to conduct research to verify or validate the effectiveness of the occupational therapy interventions currently provided. As cancer is diagnosed at earlier stages of the disease and survival improves after cancer treatment, hand therapy may improve the functional outcomes of persons with cancer. This judgment of rehabilitation oncology practice will need to be confirmed by research.     

Physical therapy for a patient through six stages of amyotrophic lateral sclerosis

BACKGROUND AND PURPOSE: This case report describes the use of Sinaki and Mulder's approach to staging amyotrophic lateral sclerosis (ALS) and functional outcome measures in designing a treatment program for a 59-year-old woman with ALS. CASE DESCRIPTION AND OUTCOMES: As the patient progressed from stage I through stage VI, over 12 months, the physical therapy goals changed from optimizing remaining function, to maintaining functional mobility, and finally to maximizing quality of life. DISCUSSION: Disease staging and the use of functional outcome measures provide a framework for physical therapy evaluation and treatment of patients with ALS throughout the disease process. Physical therapists can assist patients with ALS through the provision of education, psychological support, rehabilitation programs, and recommendations for appropriate equipment and community resources.     

Atrioventricular nodal reentry tachycardia in patients with sinus node dysfunction: electrophysiologic characteristics, clinical presentation, and results of slow pathway ablation

BACKGROUND AND PURPOSE: The purposes of this study were to describe the use of ultrasound by Dutch physical therapists and to address the question of whether this use is what would be considered correct. SUBJECTS AND METHODS: Physical therapists in the Dutch primary health care system gathered data on 17,201 patients, addressing reasons for referral, treatment goals (in terms of impairments and disabilities), and physical therapy interventions. Patients treated with ultrasound (n = 3,959) were compared with a reference group of patients who were not treated with ultrasound (n = 13,242). RESULTS: Physical therapists applied ultrasound for soft tissue injuries of recent onset, mainly aiming to reduce pain and swelling. Ultrasound was used in all phases of treatment and was not restricted to the first 3 weeks of treatment. Ultrasound was combined relatively infrequently with exercise and relatively frequently with massage. CONCLUSION AND DISCUSSION: Regarding the indications for referral and treatment goals chosen, the actual use of ultrasound corresponds to assumptions about expected use. The timing of its application and the combination with other forms of therapy do not correspond in all aspects to the assumptions made.     

Psychometric properties of the rehabilitation therapy engagement scale when used among individuals with acquired brain injury.

Objective: To examine the properties of the Rehabilitation Therapy Engagement Scale (RTES), a new scale developed to assess patient engagement in physical and occupational therapies in the acute rehabilitation setting quantitatively. Design: Psychometric analysis to test the reliability and validity of the RTES in a Midwestern acute rehabilitation facility. Participants: 75 individuals with acquired brain injury admitted to an acute rehabilitation program in a Midwestern urban setting. Main Outcome Measures: Physical therapists (PTs) and occupational therapists (OTs) completed a rating scale designed to measure each patient's level of engagement, or involvement, in therapy. Functional status at admission and discharge was measured with the Motor and Cognition scales of the Functional Independence Measure (FIM; J. M. Linacre, A. W. Heinemann, B. D. Wright, C. V. Granger, B. B. Hamilton, 1994). Results: The RTES showed high internal consistency in both physical therapy and occupational therapy settings, as well as significant correlation across those settings (r = .56, p = .001). Conclusions: The RTES appears to be a reliable and relatively unidimensional measure to identify and describe issues affecting patient engagement in rehabilitation therapies. Additional research is suggested to better understand and define the construct of engagement and to provide additional evidence of convergent and discriminant validity in the RTES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation therapist goals for physically disabled patients as a function of attitude similarity.

20 physical, occupational, and corrective therapists filled out an opinion survey. Two weeks later, they were given biographical data about a bogus 26-yr-old male patient and an opinion survey purported to be that of the patient but actually 80% or 20% similar to their own survey answers. Results indicate significantly greater attraction for an 80% similar patient and greater expected achievement for that patient. Occupational therapists had significantly higher expectancies for the patient than the other therapies, and rehabilitation expectancies were not influenced by attitude similarity. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Programming for occupational outcomes following traumatic brain injury.

Examines the occupational outcomes reported from 3 traumatic brain injury (TBI) rehabilitation models: comprehensive neuropsychological rehabilitation, comprehensive neuropsychological rehabilitation and occupational trials, and supported work. It is argued that programming for occupational entry or reentry must include precise specification of barriers to rehabilitation outcome goals and systematic planning for skill generalization and maintenance. The Barriers Profile and the New Medico Barriers to Anticipated Rehabilitation Outcomes Scale are offered as tools to assist interdisciplinary treatment teams in identifying the number and magnitude of personal and environmental barriers to occupational resettlement; their use is illustrated with a case example. Procedures for enhancing generalization and maintenance of treatment goals are discussed. A comment by T. Kay follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral treatment of urinary incontinence: a complementary approach

When treating urinary incontinence, the first choice for treatment should be the least invasive and with the fewest side effects. Behavioral intervention is one such treatment modality. Behavioral interventions are defined as a change in the relationship between the patient's symptoms and his/her environment. Behavioral interventions include fluid and dietary management, toileting assistance, bladder retraining, urge suppression, and pelvic muscle rehabilitation. Intermittent self-catheterization is also considered a behavioral intervention when combined with fluid/dietary or toileting changes. Before selecting a treatment option, a detailed history, physical examination, and environmental assessment should be taken. In addition, to effectively employ behavioral interventions, the patient's goals should be determined, the patient should be taught about the underlying causes of his/her problem, and he/she should be provided with not only motivation, but also support. Finally, behavioral interventions recognize the significant contribution that the patient makes in his/her own recovery.     

Resolution: a 15-year-old with spastic quadriplegia and a 60 degree scoliosis should have a posterior spinal fusion with instrumentation. The American Academy for Cerebral Palsy and Developmental Medicine 50th anniversary meeting debate

Functional goals and treatment are the basis for occupational therapy. Following upper extremity amputation patients can benefit significantly from a program that concentrates on setting and achieving functional goals. Few hand therapists have the opportunity to treat a large number of amputees. This case study of treatment of above-elbow amputation discusses the use of an activities of daily living form as an aid to developing and meeting short-term goals in treatment planning.     

Combination insulin and sulfonylurea therapy in insulin-requiring type 2 diabetes mellitus

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported by 118 occupational and 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists.     

Comparing therapist and client perspectives on reasons for psychotherapy termination.

Examines the extent of agreement on the reasons for psychotherapy termination given by therapists and their clients. 194 client files in a psychology training clinic were reviewed to obtain reasons for termination cited by therapists in treatment termination reports. Telephone interviews were conducted with 87 of these former clients to determine their perspectives on reasons for termination. Consistent with previous research, there was little concordance among the reasons cited by therapists and by clients regarding clients' decisions to terminate therapy. Of the clients identified by therapists as terminating because of the successful attainment of therapeutic goals, three-quarters reported this reason as important in their termination decision; of those clients reporting termination because of attaining therapeutic goals, only half were identified by therapists as having achieved their goals. Dissatisfaction with therapy and/or the therapist were reported by many clients as important in their termination decisions; such factors were rarely cited by therapists as reasons for termination. Attention to discrepancies between client and therapist expectations of therapy and therapy termination is necessary to reduce the high rate of premature termination in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients

BACKGROUND and PURPOSE: A number of studies have indicated that acupuncture might improve the functional recovery of stroke patients. These studies vary in inclusion criteria, sample size, and evaluation methods. The present study was designed to investigate whether electroacupuncture treatment favorably affects stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services. METHODS: One hundred four consecutive patients >40 years of age admitted to hospital because of an acute stroke were randomized to 3 groups: deep, superficial, and no acupuncture treatment. The acupuncture treatment given by 4 physiotherapists started 4 to 10 days after randomization and was given twice a week for 10 weeks. All patients underwent conventional stroke rehabilitation as well. Two occupational therapists, blinded regarding the patients' allocation, evaluated the treatment effects. The assessments were performed 4 times during the first year after randomization by means of interviews and observations. RESULTS: There were no differences between the groups with reference to changes in the neurological score and the Barthel and Sunnaas activities of daily living index scores after 3 and 12 months. Regarding the Nottingham Health Profile, the no acupuncture group had somewhat fewer mobility problems. No differences in health care and social services were found between the groups. CONCLUSIONS: The present study does not give support to the previous studies, which indicates that acupuncture treatment may have a beneficial effect on acute stroke patients' ability to perform daily life activities, their health-related quality of life, and their use of health care and social services.     

A comment on Martin''s relation

Interviews with 80 therapists and 50 patients at a community mental health center revealed that peer review effectively monitored the appropriateness of treatment and allocated limited treatment funds without unduly interfering with established treatment patterns, relationships, or outcomes. Most therapists reported receiving helpful consultation from the peer review committee, and the process encouraged them to focus more clearly on treatment goals. On the other hand, patients were concerned about the committee's role in making decisions about their treatment. Therapists noted as a problem the lack of certainty in establishing a treatment contract prior to peer review since the contract with the patient must remain fluid during the evaluation period. The therapists and patients demonstrated remarkable agreement in their assessment of treatment progress and whether further therapy was needed.     

Clinical management of carpal tunnel syndrome: a 12-year review of outcomes

Carpal tunnel syndrome (CTS) is a disorder frequently encountered by occupational health care specialists. The health care management of this disorder has involved a diverse set of clinical procedures. The present article is a review of the literature related to CTS with an emphasis on occupational-related CTS. MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycLIT, and NIOSHTIC databases from 1985-1997 were searched for treatment outcome studies related to CTS. Treatments of interest included surgery, physical therapy, drug therapy, chiropractic treatment, biobehavioral interventions, and occupational rehabilitation. A systematic review of the effects of these interventions on symptoms, medical status, function, return to work, psychological well-being, and patient satisfaction was completed. Compared to other treatments, the majority of studies assessed the effects of surgical interventions. Endoscopic release was associated with higher levels of physical functioning and fewer days to return to work when compared to open release. Limited evidence indicated: 1) steroid injections and oral use of B6 were associated with pain reduction; 2) in comparison to splinting, range of motion exercises appeared to be associated with less pain and fewer days to return to work; 3) cognitive behavior therapy yielded reductions in pain, anxiety, and depression; and, 4) multidisciplinary occupational rehabilitation was associated with a higher percentage of chronic cases returning to work than usual care. Workers' compensation status was associated with increased time to return to work following surgery. Conclusions are preliminary due to the small number of well-controlled studies, variability in duration of symptoms and disability, and the broad range of reported outcome measures. While there are several opinions regarding effective treatment, there is very little scientific support for the range of options currently used in practice. Despite the emerging evidence of the multivariate nature of CTS, the majority of outcome studies have focused on single interventions directed at individual etiological factors or symptoms and functional limitations secondary to CTS.     

Cost-benefit analysis of six alternative payment incentives for child therapists.

The outcomes and costs of 6 different methods of motivating therapists to meet service delivery goals at a community mental health center for children and adolescents were evaluated over a 5-yr period. The costs and cost-savings benefits of each motivational method were compared with each other and with 2 baselines. Four incentive interventions generated more cost savings than they required in monetary outlays. Most cost-beneficial were bonuses paid to therapists for each hour of service they delivered over their monthly goals and bonus plans that rewarded therapists for exceeding their goals while also rewarding staff if total department goals were exceeded. The most cost-beneficial system saved $25,542 over 6 mo that would have been paid to compensate for therapy hours not delivered, for an incentive investment of $9,726 over the 6 mo. This yielded a net benefit of $15,816, or $31,632 annually. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of acute care physical therapy practice: issues for physical therapist preparation

BACKGROUND AND PURPOSE: Acute care physical therapists have experienced the effects of dramatic changes in health care reimbursement systems and population demographics. Acute care hospitals now serve a patient population of much older, chronically ill patients who are hospitalized for shorter periods of time in a practice environment in which physical therapy staffing resources are often inadequate. The purposes of this study were to document common experiences in the practice of acute care physical therapy and to identify differences in the perceptions of physical therapists with varying levels of experience and in various sizes of acute care facilities. SUBJECTS AND METHODS: A survey questionnaire was mailed to 500 randomly selected physical therapists employed in acute care facilities. The therapists answered questions regarding the frequency of various physical therapy evaluation and treatment practices, problems encountered in delivering physical therapy services, coordination of the discharge planning process, and perceptions of staffing trends in the acute care setting. The responses of 188 physical therapists who completed the survey were compared by their experience levels and the size of the institutions in which they practiced. RESULTS: Subjects reported that patient factors, such as medical complications and cooperation; organizational factors, such as staffing shortages and large caseloads; and health care system constraints, such as difficulty changing orders and limited time in which to work with the patient interfered with patients reaching physical therapy goals. CONCLUSION AND DISCUSSION: Inadequate skills for successful acute care practice and maladaptive therapist beliefs about acute care career possibilities may adversely affect physical therapist career longevity in the acute care setting.     

Differences between more and less effective psychotherapists: A study of select therapist variables.

Examined differences between more and less effective trainee psychotherapists. Therapists were assigned to one of two groups depending on whether the preponderance of their patients' changes in symptomatology indicated more or less improvement over the course of therapy. Therapist variables included emotional adjustment, relationship skills, eliciting patient involvement, credibility, directiveness, and theoretical orientation. Less effective therapists were revealed to have lower levels of empathic understanding, to rate their patients as more involved in treatment, and to rate themselves as more supportive than the more effective therapists. Less effective therapists also valued comfort and stimulation significantly more and valued intellectual goals significantly less than did more effective therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecosystemic play therapy.

Summarizes the key elements of Ecosystemic Play Therapy (EPT). It emphasizes the flexibility of the theory, allowing therapists to work with children at any developmental level in a variety of contexts. EPT requires therapists to always consider the children, their problems, and the therapy process within the context of the children's entire ecosystem. The basic tenets of the approach are described. EPT is heavily grounded in theory, which is used by the therapist to develop well-defined treatment goals and to design creative interventions geared toward achieving those goals. Play supports both the relationship between the child and therapist, as well as supporting the therapeutic process. EPT focuses on helping all children function optimally in the contexts in which they live. However, the therapist is also venturing out of the playroom to advocate for children and push for changes in the systems that most impact their lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The national occupational therapy practice analysis: findings and implications for competence

OBJECTIVE: This article reports some of the findings from a national study of occupational therapy practice conducted by the National Board for Certification in Occupational Therapy (NBCOT) as part of its fiduciary responsibility to ensure that its entry-level certification examination is formulated on the basis of current practice. METHOD: The NBCOT developed a survey with input from approximately 200 occupational therapy leaders and then used it to solicit information about current practice from 4,000 occupational therapists and 3,000 occupational therapy assistants. The sample included geographical location, experience level, and practice area distributions. RESULTS: Approximately 50% of the sample responded to the survey. Data indicate similarities and differences in occupational therapist and occupational therapy assistant practice (e.g., occupational therapists spend more time conducting evaluations, planning interventions, and supervising, whereas occupational therapy assistants spend more time providing interventions), an increased emphasis on population-based services (e.g., serving a business or industry rather than an individual worker), and an emphasis on occupation as a core knowledge base for practice. From a continuing competency perspective, the data can be useful to the profession; we can plan continuing education to address topics that practitioners have indicated are critical to their practice. CONCLUSION: The findings will be useful for revising the entry-level certification examination and may guide thinking about the parameters of continuing competence because the responses represent a cross-section of the profession.