OT 637 Midterm Exam- Intervention and evidence based practice
engaging in occupations allows clients to .... in environment
achieve mastery
determining sequence and timing; when describing be sure to include: ..., ..., .. , .., ..
action verb; how action takes place; objects used/interacted w/ , time elements if needed; amounts used if needed
practice fasteners prior to dressing, practicing dry tub transfer
activities
The sequence of steps and timing of those steps The body functions, performance skills, and body structures required to perform the activity
activity analysis
allows for us to have an understanding of the tools and equipment needed An understanding of where and with whom the activity takes place
activity analysis
two types of activity analysis
activity analysis that looks at typical demands of activity and occupation-based activity analysis
activity analysis process (10 steps)
activity awareness, decide type of analysis, determine relevance and importance to client, identify steps required and determine objects/properties required, determine space demands, determine social demands, determine required body functions, required body structures, required performance skills and analyze for therapeutic intervention
procedural task analysis: determine ... to be analyzed; .../... tasks should be included only if necessary; begin statement with ...- observable (squeeze); statement should next include ... necesssary (squeeze the bottle); statement should next include ... (carefully); include .. elements if necessary; list steps in correct ..., keep steps ..and ..., don't indicate .../.... unless necessary, don't list .../... requirements of task in this section; include ... if necessary (remove cookies from oven-tray may be hot"
activity; preparatory and cleanup; verb; objects; how; time; sequence; simple and concise; right or left hand; physical/mental; precautions
at beginning of intervention typically used before engaging client in other categories of intervention
adjunctive
first phase of intervention continuum; used to PREPARE clint fro participation in purposeful/occupation-based intervention
adjunctive intervention
massage, contrast baths, orthotic devices, education, issuing/viewing AE, sensory integrative techniques (swinging)
adjunctive intervention
this should be used with goals of preparing client for participation in their occupations
adjunctive intervention
Pedretti classified intervention into what 4 categories?
adjunctive intervention, enabling, purposeful, and occupation-based
may be beneficial in the remediation of performance skill impairments
adjunctive or enabling
efforts promoting occupational justice and empowering clients to seek and obtain resources to fully participate in daily life occupations
advocacy
serving on policy board, educating public on disability
advocacy
physical display of emotions, usually portrayed in facial expressions
affect
Large activities or occupations may need to be broken down into smaller ones Consider: (3)
are there more then 10-15 steps; multiple criteria for successful completion (getting dressed vs. donning shirt)?, diff. objects/space demands for diff. parts?
interpretation (can say well/good/poor); my description
assessment
allows for ability to discriminate between sounds, tones, and pitches
auditory perception
distringuishing between thoughts and what is truly occurring requires and awareness
awareness of reality
body's ability to maintain upright position while standing, sitting, or moving
balance
logging the clients step patterns and eliminating bedroom ... that are not conducive to sleep is a CBT guideline for sleep intervention
behaviors
social participation involves organized patterns of .. which are expected during ...
behaviors; social exchange
when evaluating evidence, we are focused on detecting .. and differentiating between higher and lower quality studies
biases
person's awareness of physicality and image of his or her own body
body image
retirement patterns vary and many people are ... to full retirement
bridging
... and .. may be impacted by issues related to sleep
cardiovascular disease and type II diabetes
in-depth study of a bounded system such as a process, activity, event, program, or interaction
case study
formulating a ... and .. question derived from a client's problems or needs is involved when posing a clinical question
clear and answerable
OT practitioners understand and focus intervention to include issues and concerns surrounding complex dynamics among ..., ., and .. regardless of type of service delivery
client, caregiver, and family
once the info. you are seeking is obtained, you as a practitioner along with ... should make decision on what to do with info. ; it involves ...
client; collaboration
steps of evidence-based practice: posing ..., searching for .., appraising ..., making ..., assessing ... of intervention or test/assessment and one's proficiency of EBP process
clinical question, evidence, literature, decision, effectiveness
to integrate EBP into practice: ask a .., formulate the question into .., .. the evidence
clinical question; PICO; critically appraise
once a clinical problem/issue is identified, the therapist can carry out these steps: write a .., search for the ... related to the question, .../... evidence to determine the evidence that best informs the clinical question, speak with client and decide whether to ... the evidence; .. the outcomes of these actions, ... info. you have required
clinical question; evidence; evaluate/critically appraise; act upon; evaluate; save
diff. study designs are needed for diff. types of ..
clinical questions
occupations that require more than 1 person; includes occupations in which social interaction is required or rely on another person's actions
co-occupations
... is utilized to change the way client thinks and acts in relation to sleep
cognitive behavioral therapy
requires changing strategies in confronting problem or changing a set of thoughts
cognitive flexibility
teaching wellness, use good ..., accept clients for who they are, begin intervention at client's ..., acknowledge client's .... and ..., encourage .., provide opportunity for ..., provide opportunities for ..., encourage client to set own goals, practice skills in diff. .., check for understanding, encourage .., acknowledge everyone handles stress diff.
communication skills; current level; culture and environment; active learning; trial/error; practice; situations; problem solving
social participation consists of .., ..., ..
community, family, peer
intervention for helping to establish new roles if necessary
compensation (modifying/adapting)
ability to organize info and develop ideas based on common qualities of objects or situations
concept formation
involves conversation
consultation
we must be aware and sensitive to these needs and expectations of clients
cultural context
our .. shapes our social rules and expectations for our activities and or occupations
culture
its important to utilize available .. that provide published research to support topic of interest
databasess
important elements of CAT- ..."shelf life", the ...- if utilizing all aspects of PICO, it will likely yield usable results, the ...- where you summarize your findings-report your critical evaluation and clinical judgment on how those results can be used, the ... - the CAT is lifeline- your backup for decisions made for client treatment
date of completion; question; clinical bottom line; evidence
this step is only performed of conducting an occupation-based activity analysis
determine relevance and importance to client
most detailed and extensive step of activity analysis process
determine required body functions
for common activities there are clear ways to ...- washing hands
determine success
5 major types of CATS (critically appraised topics): .../.., .., evaluating risk and harm in ... study, evaluating risk and harm in .. study, ...
diagnosis/screening, prognosis, case-control, cohort, intervention studies- treatment, prevention, and screening
the same intervention may be categorized differently for ...
diff. clients
service delivery ctaninclude both ... and ... services
direct and indirect
include settings such as hospitals, schools and homes
direct services
our social activities provide ... for intervention
direction
... allows us to keep track of patient progress/response from intervention plans
documentation
many IADLs can be impacted by lack of sleep such as ..
driving
Formal Education Participation, Informal Personal Educational Needs or Exploration of Interests, and Informal Personal Educational Participation
education
imparting of knowledge and info. about occupation, health, well-being and participation that enables client to acquire helpful behaviors, habits and routines that may or may not require application at time of intervention sesssion- providing to clients, caregivers, officials, etc.
education
during intervention, your client should be continually reassessed for ..
effectiveness of intervention
... is impacted by sleep
emotional state of mind
dowel rod exercises
enabling
exercise-oriented- improves skills that may be remediated through exercise-oriented interventions
enabling
focus on performance of select skills and are typically exercise-oriented
enabling interventions
interventions used in tx session that would appear to activity and are not directly purposeful but incorporate use of PERFORMANCE SKILLS
enabling interventions
We view occupations not only as the ... of our interventions, but also the .. by which we reach goals
ends; means
sleep is important for restoring .., ..., .... , and ...
energy; cognitive function; repairing physical body; regulating body temperature
allows you to feel what activity is like and better understand sequence and timing of step; con- we don't always have time to do this/contexts limit participation
engage in activity yourself
the client receives immediate feedback on his or her own personal experience
engaging in occupations
instruments/appliances that serve to equip someone to complete activity; often larger than tools
equipment
intervention focusing on work readiness
establishing, remediating and maintaining work functions
to study a particular culture or group of people to identify their daily life patterns, meanings, and beliefs
ethnography
discharge planning begins at ..
evaluation
what always comes first?
evaluation
include goal-directed behaviors, planning, abstract thinking
executive functions
process of mentally sequencing and coordinating purposeful movements
executive movement patterns
it's our responsibility to seek.. rom other professionals(other OTs, SLPs, Its, social workers, teachers, dietitians, and therapeutic recreations)
expertise
we focus on volunteer .. and ...
exploration and participation
it is necessary to provide interventions in set sequence based on continuum (T/F)
false
allows us to distinguish shape but also serves to distinguish and identify color, orientation, and edge
form discrimination
our performance patterns can .. or .. our engagement in social participation
foster or limit
BOT Ot and OTA are responsible for monitoring and reassessment of client intervention plans and making sure they are ..
goal oriented
it is important to note not all evidence is .. quality or useful
good
used when generating or verifying theoretical concepts
grounded theory
group in mental health focusing on social connections, support groups for disabilities, etc.
group interventions
use of distinct knowledge and leadership techniques to facilitate learning and skills acquisition across the lifespan through dynamics of group and social interaction
group interventions
ADL and IADL are positively impacted by healthy sleep ... and ..
habits and routines
Performance Patterns are the .., .., .. and .. that influence and surround participation in occupations
habits, routines, rituals, and roles
many people retire in less than ideal circumstances impacting overall .. and..
health and wellness
OT is concerned w/ using the individual's skills to promote ...
healthy living
includes judgment, concept formation, metacognition, praxis
higher-level cognitive functions
consultation
indirect services
both types of activity analysis can be conducted for .., .. or ..
individual, group of individuals or population
having realistic concept of one's physical and mental capabilities
insight
utilized to categorize interventions to determine if the occupational therapy intervention plan is directed toward engaging the client in occupations to support participation
intervention continuum
consider: put plan into action, outcomes, documentation, consultation, therapeutic use of self, education, reassessing
intervention implementation
as result of reassessment, .. changes may be necessary
intervention plan
based upon evaluation process and is created in cola. with client
intervention plan
consider: environment-setting (payment source), discharge plan, client's goals/values/beliefs; theory/FOR/model; performance skills, approach (what are their needs?), interaction with support system; evidence-based practice; knowledge of disease/human body
intervention plan
steps to intervention process
intervention plan, implementation, review
consider: assess our effectiveness (continue? modify?), look at goals
intervention review
treatment, prevention and screening
intervention studies (CAT)
mentally examining the assets of different options and discriminating the variation in order to form an opinion or believe
judgment
leisure consists of
leisure exploration and participation
retirement often linked to areas of ... and .. which are also in framework
leisure; volunteerism
the highest internal validity
level 1 studies
these enhance our confidence that if we select an intervention, we will achieve similar outcomes used in the study
level 1 studies
loos randomization, less protection against biases
level 2
evidence for treatment effectiveness occurs when studies are case controlled
level 3
systematic review of case control studies that agree with each other
level 3A
individual case-control study
level 3B
consists of case series- evaluates the clinical outcomes of a single group of patients
level 4
expert opinion without explicit critical appraisal- in rehab can be viewed in high regard
level 5
using what we know to make decisions that make sense
logical reasoning
sleep is essential for adequate .., ..., .. and ..
memory, sequencing, attention, and processing
relies on ability to recall and understand steps of activity; con-may forget steps; as OTs we do this throughout process
mentally process steps
having an awareness of one's own cognitive processes
metacognition
three basic approaches of QUANTITATIVE research: instruments that assess the ... quality of studies; instruments that assess the quality of the .. of clinical studies, and tools/processes for assessing the risk of ..
methodological, reporting, bias
preparatory methods include .., .., .., .. and ..
modalities, splints, assistive technology, and environmental modifications and wheeled mobility
missing something that may not come back
modification and compensation approach
we are responsible for understanding client's needs/ wants in regards to social participation; ..., .., .. and.... skills all influence social participation
motor, processing, communication, interaction
in deciding whether and how you can apply your obtained info. ask yourself the following: were the study participants similar to ..., is the intervention..., were the outcomes in line with our ..., does the strength of the evidence warrant ..
my clients; realistic; treatment goals, clinical use
sticking to a sleep-wake schedule and avoiding ... may aide in sleep training
naps
consultation process: identify ... for consultation, ... group , program, org. or community that can provide service, determine if .../... needs to occur, ... created, continual ... of plan, ...
need; locate; consultation/referral; plan; reassessment; discharge
end of life issues involve making choices for ... ,d determining choices for ...focusing on .... of chronic conditions, maintaining .., compensating for .., preventing and managing ..., making difficult choices that limit ..-driving
needed care; contexts of care; self-management; physical fitness; sensory loss; cognitive decline; independence
...that are met by an occupation are unique to each of us
needs
discharge planing continues throughout intervention process as the client's ..
needs change
several occupations are conducted at same time and co-occur- listening to music while doing HW
nested occupations
sleep allows brain to form new...
neural pathways
intervention focusing on evaluating and identifying one's ..
new priorities
are enabling interventions required?
no
is adjunctive required?
no
once steps of activity are established, must develop understanding of .. and their .. that are to be used; this allows us better understanding of needed .. and ... ; also how our clients will interact with ..
object; properties; skills and body function; environment
what happened (no room for interpretation); Black and white; level of assist, duration, reps, UE/LE, can't put well/good unless for MMT; min, mod, SBA
objective
ownership
occupation based
performing social activities in own context
occupation-based
considers the particular person's interests, goals, abilities, contexts, and the actual demands of the activity
occupation-based activity analysis
perceived by client as desirable, matching their personal goals and occurring in appropriate context; can be challenge even for experienced OT
occupation-based interventions
retirement preparation and adjustment appears under are of .. in ..
occupation; framework
allow for greater transference toward the client's goals
occupations
dressing with use of adaptive equipment, applying for job, purchasing groceries, making meal
occupations
have start and end
occupations
intentionally executed and repeatable; meaningful to person; labeled by culture
occupations
often help clients go farther and longer toward a goal
occupations
require coordination of different skills and body systems
occupations
are selected for specific clients and designed to meet therapeutic goals and address underlying needs of mind, body and spirit to client
occupations and activities
performance is influenced by interaction of ., .. and ... (Ecology of human performance, PEOP)
person, environment, occupation
not able to change but must be considered
personal context
to understand the lived experience, interpret it and provide info. that can be shared with and used by others
phenomenology
consider what social skills are necessary for the setting
physical context
Contexts and Environments influence our performance in occupations. These include the .., .., ..., .., .. and ...
physical, social, cultural, personal, temporal, and virtual contexts
what we're going to work on (continue per POC)
plan
play consists of
play exploration and participation
sensory function of inner ear that helps us determine position of body
position
ask yourself the following after implementing intervention to determine its effectiveness: did the intervention have ..., did the .. outweigh the .., are my clients .../.., were .... satisfied, is this intervention .. to usual care/no intervention
positive outcomes, benefits; harm, happy/satisfied; you as OT; superior
ability to carry out sequential movements with correct timing and transitions
praxis
relaxation techniques, sensory-based activities, discussion
preparatory
these prepare client for occupational performance, used as part of treatment session in preparatory for or concurrently with occupations and activities
preparatory methods and tasks
used to target specific skills; may not hold meaning to client-folding towels from linen cart to increase ROM
preparatory tasks
intervention for eliminating factors that cause need for early retirement
prevention
sleep deprivation can decrease ..., increase change for... and likelihood of ...
producitivity; health problems; accidents
essential quality/distinctive trait of physical object-oil versus water paint
properties
detecting muscle lengthening and shortening and how fast and in which direction a limb or body part is moving
proprioception
practice and problem solving- doesn't reflex client's priority occupations nor typical performance contexts
purposeful
role playing, engagement in group therapy social setting
purposeful
PREDETERMINED goals and obvious beginning and end; what separates us from other health care professions
purposeful interventions
focus on improvement of areas of occupations; don't necessarily reflect client priority occupations nor client's typical performance context
purposeful interventions
case study, ethnography, phenomenology, grounded theory are examples of .. study designs
qualitative
... research is not always seen as significant in the EBP realm as compared to .. research
qualitative; quantitative
studies are based on sample of people who are used to represent the population; not purposeful sampling
quantitative
..can define how accurate a diagnostic test is or how big a treatment effect is expected
quantitative evidence
main focus of evidence based practice (EBP)
quantitative evidence
is the single most powerful tool for discounting the effects of factors that could potentially bias study findings
randomization
A hallmark of EBP is increased focus on the ..
randomized control trial (RCT)
.. = the gold standard for research about therapy effectiveness
randomized control trials
involves full evaluation
referral
behavioral treatments also have been effective for aiding in sleep; unlike CBT, behavioral treatment focuses on ...
relaxation techniques as well
involves changing direction
remediation and restoration approach
rest and sleep consists of .., .. and ..
rest, sleep preparation and sleep participation
when appraising literature, 3 questions should be asked: 1- what are ..., 2- are the .., 3- how will these ....
results; results valid; results help me work with my client?
to integrate EBP into practice ask the following: do the ... apply to my client? does the treatment first into my client's ... and ..., do i have the .. to implement this treatment? and do i have the ... or .. necessary to implement these interventions
results; values and preferences; resources; training or skills
cessation of paid work; may occur at any age for any reason
retirement
important to understand if social activity is part of client's .. or ..
routines or roles
Six questions to ask when appraising qualitative research: was the .. used in the study appropriate to its research question?; were the data ... appropriately?, were the data .. appropriately; can i... the results of this study to my own setting? , does this study adequately address potential .. issues including reflexivity ?, is what the researchers did .. ?
sample; collected; analyzed; transfer; ethical; clear
engaging in occupations often results in something client can ... or ...-provides sense of ..
see or feel; accomplishment
being aware of your roles and identity in the world
self concept
accommodations in educational setting, using ergonomically designed keyboards in workplace
self-advocacy
space demands involves: ..., ..., .., .., .., ..., .
size (size area needed), arrangement of objects inspire, lighting, temperature, humidity, noise level, and ventilation
clients are often referred to OT for other reasons and ... are brought up during development of occupational profile
sleep disturbances
address manners and expectations
social context
presence of others often influences our performance of activity
social demands
intervention assisting in identifying ...
social opportunities
includes activities that occur w/ family, friends, peers or community members
social participation
organized patterns of behavior that are characteristic and expected of individual
social participation
norms and expectations of how one should act and communicate during activity
social rules
looking at physical environment to perform activity
space demands
After determining what type of analysis you will be conducting, you must determine what..
specific activity/occupation you'll be analyzing
being able to identify steps and timing of activity is important to achieving overall outcome
step 3: determine sequence and timing
each identified step adds new action and challenge for person performing task
step 3: determine sequence and timing
this step of activity analysis involves each identified step in activity analysis holds info. that may be key to successful performance
step 3: determine sequence and timing
common barriers to volunteering we address are : lack of .., inadequate .. of clients in this role, unreasonable ...- burn out, stigma of .., ...., .. and ... contexts must be considered
structure; supervision, expectations; disability; time constraints; physical and social
don't put everything said, but relevant and goal related; " this is more difficult than how i do it at home"; mad b/c there brush; paid n level
subjective
what does SOAP stand for
subjective, objective, assessment, plan
essential steps for determining sequence and timing may seem ... or rely on what .. sees as successful completion
subjective; client
wellness is individualized and very ...; it can be difficult to achieve and even more so to ..
subjective; maintain
physical articles need to make or do something; these are consumed or expended during the activity
supplies
allows us to distinguish different textures by tough
tactile discrimination
good way to obtain info. from someone experienced ; con- client may forget/leave out details
talk to someone who performs activity
requires your client to recall steps and all equipment required. con-client may forger/leave out essential details
talk to your client
varies through lifetime (kids can't make own appointments or eat at bar)
temporal context
objects use to perform activity with hand- these are not disposable
tools
we must consider .., .., .. and ...
tools, supplies, equipment, properties
facilitation of acquisition of concrete skills for meeting specific goals in real-life applied situation-....caregivers, .. teachers, .. client
training
retirement interventions assisting with ... difficulties
transition
client should always be involves with discharge plan (T/F)
true
understanding which steps/timing elements are essential for successful performance are...
unique to each of us
evaluating the evidence is used to examine and analyze the available research to decide what findings are .. and clinically useful
valid
allows you to determine position of your body in space
vestibular perception
must be aware of impact of this interaction
virtual context
unpaid work
volunteering
we can help guide exploration process for ... and identify .../ ...
volunteering; opportunities; roles
allows us great way to get essential info. including necessary physical and cog. skills required to perform activity for determining key step s
watch someone perform
hospice care: OT role: enabling occupations that help clients tie up loose ends, continuing routine occupations that maintain client sense of ..., enabling occupations and deepen ...; being ... for client
well being; spiritual experience; advocate
we need to promote .. w/ each client and educate and support decisions regarding it
wellness
Employment Interests and Pursuits, Employment Seeking and Acquisition, Job Performance, Retirement Preparation and Adjustment, Volunteer Exploration, and Volunteer Participation
work
predictable problems identified w/ retiring: 1. loss of ..., lack of .., changes in .. / .., loss of .../ ..., financial factors and loss of .., increased.., decline in ...
worker role; time structure; social interaction/relationships; purpose / daily meaning; income; stress; social status
.. will determine if client is finished w/ therapy / needs continued service
you as clinician
Care of Others, Child Rearing, Care of Pets, Communication Management, Driving and Community Mobility, Financial Management, Health Management and Maintenance, Home Establishment and Management, Meal Preparation and Cleanup, Religious and Spiritual Activities and Expression, Safety and Emergency Maintenance, & Shopping
IADLS
systematic review of cohort studies that are similar in direction and size of the effects obtained
Level 2A
completing grooming while standing at your sink
O
making dinner for spouse
O
preparing child's meal
O
styling hair with own supplies
O
transcribing notes on chalkboard
O
transferring ina dn out of own car in facility parking lot
O
Collaborates with client to develop and implement intervention pan
OT
Responsible for development, documentation and implementation of intervention
OT
Uses professional and clinical reasoning to select appropriate interventions
OT
intervention plan is documented as appropriate
OT
documents OT services provided as appropriate
OTA
able to modify intervention plan by exchanging information with and providing documentation to OT
OTAs
able to select appropriate interventions
OTAs
modify intervention plan as appropriate
OTAs
baking cookies in OT kitchen
P
bean bag toss game
P
cleaning mirror in OT bathroom
P
copying paragraph from magazine
P
folding towels that belong to the OT clinic
P
loading dishes in OT department kitchen
P
safety obstacle course
P
stringing beads to make necklace
P
the clinical question is referred to as ...
P (target population), I (the intervention), C (comparison to another group/intervention - may or may not have), O (desired outcomes of intervention)
strategy used to define clinical questions is:
PICO (patient, intervention, comparison choice/intervention, and outcome of interest)
searching the evidence requires search for the best available research to help answer the clinical ...
PICO question
.. research is essential to support our practice- why?
Quantitative; harder to dispute numbers/more objective
considered the level 1 evidence of treatment effectiveness
RCT
optimal design for questions about interventions including prevention, treatment and rehabilitation
RCT
the ... is the only experimental design that can ascertain effectiveness
RCT
some forms of evidence may never have level .. evidence thus it is then necessary to draw upon ... of evidence
1; lower levels
consists of systematic review of a number of RCTs
1A
3 situations can be labeled as level 1:
1A, 1B, 1C
an individual RCT
1B
absence of randomization, but large impact occurs (vaccines)
1C- unusual circumstance
single-high-quality cohort study with less than 80% follow-up patients
2B
compression wrap to decrease edema
A
fabircating and fitting splint
A
hot or ice pack
A
issuing adaptive equipment
A
issuing handout listing stress management strategies
A
paraffin wax dips
A
providing letter strip for student's desk
A
providing teachers with info. related to sensory integration techniques
A
scar massage
A
wheelchair positioning techniques
A
written info. for caregivers
A
life activities organized into what 8 areas
ADL, IADL, rest/sleep, education, work, play, leisure, social participation
Bathing and Showering, Toileting and Toilet Hygiene, Dressing, , Swallowing/Eating, Feeding, Functional Mobility, Personal Device Care, Personal Hygiene and Grooming, & Sexual Activity
ADLs
occupation based intervention is not limited to ..
BADLs
UE exercises with resistive band
E
discussion of relaxation techniques and brainstorming of potential applications
E
finger ladder
E
handwriting exercises
E
locating and removing items from rice ben
E
placing pegs in a peg board
E
pulling small pegs out of putty
E
shoulder ROM arc
E
stacking cones
E
