Explore the vast range of titles available.

BackgroundOlder people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.MethodsA randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.ResultsIntervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.ConclusionsA lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.Trial Registrationclinicaltrials.gov identifier: NCT0078634.

The role of measurement and the benefits of outcome measures are defined as important tools used to document change in one or more constructs over time, help to describe a client's condition, formulate a prognosis, as well as to evaluate the effects of occupational therapy intervention. Occupational Therapy Assessments for Older Adults: 100 Instruments for Measuring Occupational Performance presents over 100 outcome measures in the form of vignettes that encompass a brief description of each instrument, a review of its psychometric properties, its advantages and disadvantages, administration procedures, permissions to use, author contact information, as well as where and how to procure the instrument. Occupational Therapy Assessments for Older Adults by Dr. Kevin Bortnick narrows down the list of possible choices for the occupational therapy student or clinician to only those with an amount of peer review, bibliographic citations, as well as acceptance within the profession. The text also includes research-based information with text citations and has over 100 tables, diagrams, and figures. Included in the review of each outcome measure: Description: A brief record of the measure. Psychometrics: A review of the level of research evidence that either supports or does not support the instrument, including such items as inter-rater, intra-rater, and test-retest reliabilities, as well as internal consistencies and construct validities among others. Advantages: Synopsis of the benefits of using the measure over others including its unique attributes. Disadvantages: A summary of its faults. For example, the amount of research evidence may be limited or the measure may be expensive. Administration: Information regarding how to administer, score, and interpret results. Permissions: How and where to procure the instrument, such as websites where it may be purchased or journal articles or publications that may contain the scale. Summary: A brief summation of important information. Occupational Therapy Assessments for Older Adults: 100 Instruments for Measuring Occupational Performance encourages occupational therapy and occupational therapy assistants to expand their thinking about the use of appropriate outcome measures with older adult populations. Using the appropriate outcome measure based on evidence can aid in the promotion of health, well-being, and participation of clients.

\"In this book, we use a transactional approach to examine the person-occupation-environment interaction and provide therapists with a detailed understanding of the various dimensions of the home environment that impact on home modification decisions. We also examine the context of home modification services and the impact of various demographic, legislative, policy, and service delivery traditions on the development and delivery of home modification services. In particular, we explore the roles and perspectives of each stakeholder in the home modification process, and we present a range of strategies to assist occupational therapists to achieve effective and positive service delivery outcomes. Additionally, we review the current legislative environment and the funding schemes that facilitate service delivery. We examine, in detail, the home modification process, including a review of approaches to evaluating, measuring, and drawing the environment; identifying and evaluating interventions; applying design standards; and reporting and legal issues. To assist the reader in identifying bases for evidence-based practice and topics for future research and theory development, we provide an overview of the literature on evaluating home modification outcomes and review the evidence for home modification interventions. The book concludes with a series of case studies that highlight the application of the home modification process in developing effective solutions for a range of client groups\"-- Provided by publisher.

Abstract Background Optimising quality of life (QOL) for service users in a forensic hospital is an important treatment objective. The factors which contribute to QOL in this setting are currently unclear. The aim of this study was to analyse the predictors of QOL amongst service users within an inpatient forensic mental health hospital. Methods This study is a naturalistic, cross-sectional, observational study. Fifty-two male service users with schizophrenia or schizoaffective disorder participated in the study. QOL was measured using the World Health Organisation QOL Bref. We used the Engagement in Meaningful Activity Survey (EMAS), ward atmosphere was measured using the Essen Climate Evaluation Schema (EssenCES), occupational functioning was assessed using the Social and Occupational Functioning Scale (SOFAS). We also collected level of ward security, length of stay and community leave data. Results Stepwise regression showed that meaningful activity, level of ward security, and therapeutic hold on the EssenCES significantly predicted QOL on a range of specific QOL domains. These variables accounted for 40% of the variance for total QOL score. Engagement in meaningful activity added the largest contribution to total QOL score accounting for 30% of the variance. Conclusions This study shows that provision of meaningful activities, level of ward security and therapeutic hold may contribute to QOL amongst forensic mental health inpatients.

Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design. We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses. In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay. Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796.

Background Integrating complex interventions within healthcare settings can be challenging. Mentoring can be embedded within a randomised controlled trial (RCT) to upskill and support those delivering the intervention. This study aimed to understand, from a realist perspective, how mentoring worked to support implementation fidelity for occupational therapists (OTs) delivering a vocational rehabilitation (VR) intervention within the context of an RCT. Methods A realist evaluation using secondary data (emails, mentoring record forms, interviews) collected as part of an RCT. Three researchers coded the data following content analysis, focused on refining or refuting an initial programme theory by exploring the interactions between context, mechanisms, and outcomes. The research team met to further refine the programme theories. Results Data from 584 emails, 184 mentoring record forms, and 25 interviews were analysed following a realist approach. We developed a programme theory consisting of two contexts (trial set-up, ongoing mentoring), nine mechanisms (collective understanding, monitoring, timely support, positive reinforcement, reflective practice, support data completeness, facilitation strategy, shared learning experience, management of research and clinical duties), and three outcomes (improved confidence, improved fidelity, reduced contamination). Conclusions Offering mentoring support to OTs delivering a VR intervention as part of an RCT improves intervention fidelity and reduces the risk of contamination. It improves OTs’ understanding of the differences between their clinical and research roles and increases their confidence and competence in trial paperwork completion and identification of potential contamination issues.