The role of occupational therapists

Occupational therapy (OT) does more than exercise muscles. OT builds strength and improves quality of life for residents in long-term care (LTC).

Occupational therapists are instrumental in determining the healthcare needs of the LTC population and providing therapies that help residents perform activities of daily living (ADLs).

Although OT is common in skilled nursing facilities (SNFs), literature suggests medical staff lack understanding of the occupational therapists’ roles and scope of practice in long-term care.^1,2 While OT is offered as a resident service alongside physical and speech therapy, it is the most misunderstood and underappreciated of all three disciplines, according to research.^3,4

This is unfortunate given the role of the therapist in enabling individuals to achieve and maintain an independent, functional and meaningful life through therapeutic interventions.⁵ Limited or inaccurate information presents significant barriers to providing the best possible care for residents. Knowledge deficits include the understanding of splinting, physical agent modalities and evidence-based practice.

Optimizing outcomes

Using specialized skills in assessment and treatment, occupational therapists provide care to prevent injury or impairment, restore functional activity and enhance participation in daily life.

Splinting is a crucial component of a comprehensive long-term rehabilitation program that emphasizes contracture management. Research has found that long-term care splinting reduced treatment time, eliminated the need for multiple medical providers, promoted faster recovery resulting in decreased medical costs, resulted in functional outcomes ensuring a faster return to productive lifestyles and enhanced the skills of others to provide the most comprehensive care for the residents.

Physical Agent Modalities (PAMs) optimize treatment outcomes and improves quality of life without use of surgery or medications.^6-8 PAMs do not replace therapists, but do represent valuable clinical tools that can enhance outcomes for a range of conditions, including pain, edema, neuromuscular dysfunction, stroke recovery, contracture, arthritis, urinary incontinence, slow-healing wounds, carpal tunnel syndrome, peripheral neuropathy, falls prevention and Chronic Obstructive Pulmonary Disease (COPD). The key to effective PAM use is the thorough understanding of indications for use.

OT falls prevention programs increase residents’ self-confidence during daily functional routines, decrease frequency of falls during functional mobility, reduce rates of injury and re-injury, improve perceptions of environmental safety within LTC units and enhance their sense of self-efficacy and well-being.

Evidence indicates OT bed and wheelchair positioning programs significantly decrease risk of wound occurrence, wound healing time and pain while significantly increasing adherence to positioning protocols for high-risk residents. Evidence also indicates the presence of OT contracture management programs in LTC are significant predictors of increased levels of functional independence, decreased levels of caregiver assistance, reduced risk of pressure sores and improved quality of life and well-being.

Clinical liaisons and therapy

Medical and other inter-professional disciplines act as critical liaisons to OT services. Physicians, nurse practitioners and nurses are often the source of referrals in LTC and originate the pathway from medical services to therapy services. Overlooking residents and inaccurately identifying needs minimizes residents’ opportunities to enhance quality of life and mastery within environments.

Occupational therapists play an important role in the interdisciplinary team. They are focused on providing client-centered, short-term and long-term rehabilitation services to improve residents’ functional level of performance of daily roles and routines. They also provide consultative services to facility staff and residents to improve quality of life and client satisfaction.

Richard J. Dressel III, OTD, OTR/L, is an Occupational Therapist with Select Rehab at Westminister Village at Dover in Dover, Del.

References

1. American Occupational Therapy Association. Occupational therapy practice framework: Domain and process (2nd ed.). AJOT 2008;625-83.
2. Ferris M. Fall prevention in long-term care: Practical advice to improve care. Topics in Advanced Practice Nursing 2008;8:4-5.
3. Jyoti A. Occupational therapists: Understanding the potential role in long-term care. Long-Term Care 2009;18:34-6.
4. Petrella R, DeCaria J. Physical rehabilitation for older persons in long-term care: A revierw. Clinical Journal of Sport Medicine 2011;21:150-1.
5. Dewey W, Richard R, Parry I. Positioning, splinting, and contracture management. Physical Medicine and Rehabilitation Clinics of North America 2011:229-47.
6. Richards R. The role of physical agent modalities in therapy. Advance 2011;20:24.
7. Hayes K, Hall K. Manual for physical agents (6th ed.). New York:Pearson, 2009.
8. Thapa P, Brockman K, Gideon P. Injurious falls in non-ambulatory nursing home residents: A comparative study of circumstances, incidence, and risk factors. Journal of the American Geriatrics Society 1996;44:273-78.

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