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EP.057
The evolving role of occupational therapists in adult critical care: A mixed methods analysis

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The evolving role of Occupational Therapists in adult critical care: A mixed methods analysis

Background: Rehabilitation has not traditionally played a role in the critical care pathway. Occupational Therapists have a relatively new role in adult critical care. Methods: An online questionnaire and semi-structured interviews were used to explore the role. Occupational Therapists with critical care experiencewere recruited via the Royal College of Occupational Therapists (RCOT) Specialist Section Trauma and Orthopaedics. Results: Three key-themes emerged: role characteristics, internal characteristics and building Occupational Therapy within critical care Conclusion: Occupational Therapists have a diverse and holistic role in critical care that is influenced by role and internal characteristics. For the role to evolve, Occupational Therapists have identified the need for earlier input, increased awareness of the role, funding for adequate staffing, and building an evidence-base.
 
A recent paradigm-shift in patient care advocates for early intervention in physical, psychological and cognitive rehabilitation in adult critical care.
Occupational Therapy is defined as ‘a client-centered profession concerned with promoting health and well-being through occupation’, with the primary goal of enabling individuals to participate in activities of daily living.
Literature surrounding role description of Occupational Therapists in adult critical care is both limited and dated.
Limited evidence however suggests Occupational Therapy input in critical care can result in shorter duration of delirium123, greater ventilator-free days1, improved functional-status at hospital discharge123, and reduced hospital length of stay3
Despite promising outcomes, poor understanding of the role by the multi-disciplinary team appears to impact on service delivery, including inappropriate and untimely referrals. 4
Future research is needed to clarify the specific interventions and role of Occupational Therapists in adult critical care5
 
1) What is the role of the Occupational Therapist in adult critical care in the United Kingdom?
2) What are the facilitators and barriers that impact on the service delivery of occupational therapy in critical care?
3) What is the potential future of the role of the Occupational Therapist?

Email: naomialgeo@gmail.com

Twitter: naomialgeo_OT

 

Methods used to conduct the study included:

A mixed methods design based on role theory 6

Occupational Therapists with adult critical care expertise recruited via the RCOT Specialist Section Trauma and Orthopaedics between March-May 2017.
A locally-developed online questionnaire and semi-structured interview.
Analysis included:
Descriptive statistics (frequencies and percentages), were generated using SPSS.
Qualitative analysis using the seven-stage framework approach 7 (Figure 1)
 
Twelve Occupational Therapists were recruited, with five participants continuing on to a once-off interview. The majority of OccupationalTherapists work in Greater London (75%, n=9), and full-time on critical care (58%, n=7). The median Occupational Therapy critical care service has been running four years (IQR 2.0-7.5, range one-fifteen years). Eighty-two percent of patients (n=9) are seen 2-3 times a week for a median of 45 minutes per contact (IQR 40-52.5, range 40-60). Staffing levels of 0.003-0.1875 working time equivalent Occupational Therapist per critical care bed were reported by participants.Three key-themes emerged (Figure 2).

Occupational Therapists have an evolving, diverse and holistic role that is influenced by role and internal characteristics.

Common areas of assessment and treatment include upper limb function, seating and positioning, transfers, psychological sequelae, cognition, and discharge planning.
Occupational Therapists are equipped in addressing non-physical morbidity, stemming from their broad education in medical, social behavioural, psychological and occupational science.
Despite promising potential, findings of this study indicate that patients are not receiving the recommended levels of Occupational Therapy input as per Core Standards for ICU8.
Although no new therapies were identified for the future, it is envisaged that earlier intervention, a greater evidence-base, raising awareness, and adequate staffing will be features for future development.

Implications for practice: need for a role protocol, staff welfare support mechanisms, highlight role through audit.

Implications for education: exposure to students, need for staff core competencies, post-graduate education.

Implications for research: Examine impact of early Occupational Therapy input on patient outcomes, the need for gold standard research methods, and health economic evaluations. 

 

1 Schweikert et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised control trial. Lancet. 373 (9678), 1874-82.

2 Alverez et al (2016) Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care: A pilot randomized clinical trial. J Crit Care,(37), 85-90.

3 Needham et al (2010) Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Archives of Physical Medicine and Rehabilitation, 91, 536–542.

4 Foreman, J. (2005) Occupational therapists’ roles in intensive care. Available at: https://caot.in1touch.org/document/3880/OTNow_Mar_05.pdf [Accessed 14th November 2016].

5 Weinreich et al (2017) Occupational therapy in the intensive care unit: A systematic review. Occupational Therapy in Health Care, 31(3), 205-213.

6 Gross, N., Mason, W.S. & McEachern, A.W. (1958) Expectations in Role Analysis: Studies in the School Superintendency Role. New York: Wiley.

7 Ritchie J & Lewis J (2003) Qualitative research practice: a guide for social science students and researchers. London: Sage.

8 Faculty of Intensive Care Medicine & Intensive Care Society (2013) Core Standards for Intensive Care Units. Edition 1. Available at: https://www.ficm.ac.uk/sites/default/files/Core%20Standards%20for%20ICUs%20Ed.1%20(2013).pdf

[Accessed: 11th March 2017].

 


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