Occupational Therapy for Care Home Residents with Stroke: What is Routine National Practice?

Abstract

Introduction: Information is currently lacking on the provision of occupational therapy for care home residents with stroke. The aim of this study was to identify current routine occupational therapy practice for this stroke population. Method: A questionnaire targeting qualified occupational therapists with work experience in a care home setting was designed, piloted, and transferred to an online survey. An invitation to participate was distributed via three of the College of Occupational Therapists Specialist Sections, social networking sites, and flyers at conferences. Findings: Responses were analysed from 114 respondents representing the United Kingdom, the majority (72%) of whom were employed by the National Health Service. Ninety-two respondents (81%) had delivered occupational therapy to a care home resident with stroke in the last year but only 16% were ‘stroke specialists’. The most common aims of intervention were to: maintain participation in activities of daily living, improve posture and positioning, and provide training. Non-standardized assessment was the most common form of assessment used. The functional approach was most frequently adopted. The most frequently provided intervention was ‘seating and positioning’. Conclusion: Occupational therapy is available to some stroke survivors in care homes; however, interventions are not commonly evidence based and are not routinely delivered by stroke specialists.

Care home reforms should prioritise quality of life

“…Crises notwithstanding, any reforms should prioritise quality of life for the duration of residents’ stays. We have found, as has previous research,3 that residents can lack access to, for example, specialist stroke therapies. There must be clarity for all regarding what homes can offer.…”

An occupational therapy intervention for residents with stroke living in care homes in the United Kingdom: A content analysis of occupational therapy records from the OTCH trial

“…Goals were set most commonly to promote greater participation and independence in functional mobility, washing and dressing, and eating, which was in keeping with the main aims of the overall study intervention and also standard NHS occupational therapy practice in stroke rehabilitation (Steultjens et al, 2003). Few sessions involved addressing the facilitation of social activities, arranging discharge home and offering memory and cognition techniques, which is in keeping with findings from a national survey of routine occupational therapy conducted with residents with stroke living in a residential setting (Fletcher-Smith et al, 2014).…”

“…However, purposive sampling ensured sample characteristics were representative of the main trial intervention group. Furthermore, dependability of the results is increased as study findings are comparable to a much larger national review of routine occupational therapy for care home residents living with stroke, (Fletcher-Smith et al, 2014). Detailed information about the therapist's level of experience and specialism was not collected, therefore this limits the data, as it was not possible to compare different therapists.…”

Towards a programme theory for fidelity in the evaluation of complex interventions

“…Illuminating the scope and scale of the environmental work that therapists did within the care home setting complements other research, which highlights a commitment to interventions such as splinting and those targeting practicing of ADLs [30]. In addition, this theory area has demonstrated that making small changes to the environment could bring observable benefits for patients, which in turn enhanced therapists' commitment to the trial intervention.…”