151
NeuroRehabilitation 45 (2019) 151–161
DOI:10.3233/NRE-192799
IOS Press
Occupational therapy for adults
with brain tumors in the acute care setting
Gillian Burgessa,b,∗ and Lou E. Jensenb,c
a University
of California, San Francisco, Medical Center, San Francisco, CA, USA
of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
c Department of Occupational Therapy, Creighton University, Omaha, NE, USA
b School
Abstract. The number of adults diagnosed with brain tumors is increasing, as are the survival rates. Neurological impairments
from brain tumors can impact activity and participation. Adults with brain tumors benefit from post-acute rehabilitation.
However, there is limited evidence from the acute care setting. The purpose of this study was to examine how acute care
occupational therapy services were utilized and whether patients made functional gains after receiving occupational therapy
services. A retrospective chart review of 153 electronic medical records was completed for patients who received occupational
therapy services at a large teaching hospital. Data collected included number of occupational therapy visits, the types of
interventions, and patient performance using the Boston University Activity Measure for Post-Acute Care “6 Clicks for
Daily Activity” short form (AM-PAC). More than half the patients received one occupational therapy visit (54.2%) with
a median length of stay of three days. Most interventions focused on activities of daily living (ADLs). Of those patients
who received more than one visit, 67% showed improvements in their AM-PAC scores. Occupational therapy practitioners
provided interventions that addressed ADLs, and patients demonstrated gains in functional performance. These findings
suggest that patients benefit from occupational therapy services provided in the acute care setting.
Keywords: Neurorehabilitation, occupational therapy, oncology, rehabilitation
1. Literature review
Brain tumors account for approximately 2% of
all cancers (Khan, Amatya, Drummond, & Gallea, 2014). Each year, more than 200,000 adults in
the United States are diagnosed with a primary or
metastatic brain tumor (Greenberg, Treger, & Ring,
2006). Not only are more people being diagnosed
with brain tumors, but the survival rate for adults
with brain tumors has increased (Khan et al., 2014;
Tang, Rathbone, Dorsay, Jiang, & Harvey, 2008).
Tang et al. (2008) cited an increase in the 5-year survival rate for people with brain tumors from 22% to
33% over the past three decades. Porter, McCarthy,
Freels, Kim, and Davis (2010) suggested that this was
∗ Address for correspondence: Gillian Burgess, 2500 California
Plaza, Omaha, NE 68178, USA. Tel.: +1 478 227 3896; E-mail:
gillianburgess@creighton.edu.
due to more standardized data collection on this population. However, other authors cited improvements
in early detection and advances in the treatments for
brain tumors as factors contributing to the improved
survival rates (Bartolo et al., 2012; Formica et al.,
2011; Vargo, Henriksson, & Salander, 2016).
1.1. Rehabilitation in adults with brain tumors
The most common medical and surgical interventions for brain tumors are surgical resection,
chemotherapy, and radiation, each with its own
potential complications and sequelae (Campbell, Pergoletti, & Blaskowitz, 2009). Brain tumors and the
subsequent medical/surgical treatments can result in
sensorimotor, visual-perceptual, cognitive, and emotional deficits which can impact an individual’s ability
to perform basic activities of daily living (ADLs) and
ISSN 1053-8135/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved
152
G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
affect quality of life (Campbell et al., 2009). Overall prognosis for recovery and survival varies based
on several factors, including a person’s age, size and
location of tumor, selected treatment, and the person’s
functional status (Campbell et al., 2009). Nevertheless, as reflected in the increase in survival rates, more
adults with brain tumors are living longer with potentially devastating neurological effects of their tumor
or their selected treatment.
Neurological deficits that can result from brain
tumors and/or the medical or surgical management
of brain tumors are similar to the deficits that may be
found in persons who have sustained stroke or traumatic brain injury (TBI). These may include vision
impairment, upper and/or lower limb hemiparesis, cognitive impairment, and sensory impairment
(Vargo et al., 2016). Occupational therapy practitioners play a key role in addressing many of these deficits
across the rehabilitation continuum (Campbell et al.,
2009; Chan, Xiong, & Colantonio, 2015; Hansen,
Boll, Minet, Søgaard, & Kristensen, 2017). There is
ample evidence to support the benefits of rehabilitation, including occupational therapy, for adults with
neurological conditions such as stroke, spinal cord
injury, and TBI (Langhorne, Bernhardt, & Kwakkel,
2011; Levine & Flanagan, 2010; Nas, Yazmalar, Şah,
Aydın, & Öneş, 2015).
In contrast, evidence to support the same rehabilitation considerations for patients with brain tumors is
lacking (Formica et al., 2011; Greenberg et al., 2006).
Several authors have found that people with brain
tumors should receive multidisciplinary care (Bartolo et al., 2010; Huang et al., 2013; Khan et al.,
2014; Langbecker & Yates, 2015). Yet, Vargo and
colleagues (2016) noted that referrals to multiple
members of the healthcare team are not commonly
made, particularly for persons with malignant brain
tumors. These authors identified the person’s poor
prognosis for survival as a factor contributing to this
oversight (Vargo et al., 2016). Formica and colleagues
(2011) suggested that the ethical dilemma of prolonging a patient’s time away from family when s/he
may have a poor prognosis for survival and, therefore limited life expectancy, may contribute to limited
research related to rehabilitation with this patient
population. However, studies from the post-acute
arena have shown that when people with brain tumors
did receive appropriate rehabilitation services, they
made functional improvements similar to those made
by people after a stroke, for example, in the areas of
ADL performance and mobility (Bartolo et al., 2010;
Formica et al., 2011; Hansen et al., 2017; Roberts
et al., 2014). These findings indicate that principles
for neurorehabilitation that are well-documented for
people with neurological conditions such as stroke
and TBI also apply to people with brain tumors.
Vargo and colleagues (2016) identified cognitive
deficits, weakness, and visual-perceptual deficits as
the most commonly reported impairments amongst
patients with brain tumors undergoing rehabilitation.
Emotional functioning and quality of life for both
patients and their caregivers may also be affected
(Roberts et al., 2014). Consequently, people with
brain tumors may have difficulty participating in
meaningful occupations such as ADLs, work, and
leisure activities. Occupational therapy practitioners
are skilled at evaluating a client’s occupational performance and developing a client-centered intervention
plan to facilitate engagement in meaningful occupation.
1.2. Occupational therapy and brain tumors
The Patient Protection and Affordable Care Act
of 2010 (ACA; Pub. L. 111-148) emphasizes quality over quantity of care (Leland, Crum, Phipps,
Roberts, & Gage, 2015). The ACA and the Triple Aim
(Berwick, Nolan, & Whittington, 2008) have forced
a shift in healthcare to focus on patient outcomes,
satisfaction, and cost of services. Additionally, with
hospital lengths of stay decreasing (Leland et al.,
2015), patients are often discharged from the hospital with ongoing physical impairments related to
their hospitalization. It is the responsibility of the
occupational therapy practitioner to evaluate and
manage these impairments using assessments and
interventions based on sound evidence to facilitate
the individual’s return to maximal ability to engage
in meaningful occupation (American Occupational
Therapy Association, [AOTA], 2014). With both incidence of brain tumors and survival rates for adults
with brain tumors increasing, and in a health-care climate where patient value for services is considered
a priority metric, occupational therapy practitioners
should be prepared to address the ongoing needs of
this patient population and be able to articulate the
value of occupational therapy to promote engagement
in meaningful occupation.
Interestingly, much of the evidence informing the
rehabilitative care of people with brain tumors comes
from research studies conducted in the post-acute
care arena. There is a paucity of evidence for the
benefits of rehabilitation in the acute hospital setting.
This presents a challenge for occupational therapy
G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
practitioners working in acute care who have been
urged to provide interventions based on sound evidence. Campbell and colleagues (2009) identified
short lengths of stay and the difficulty in determining whether a functional improvement is due to
the therapy intervention or reduction in swelling in
the brain as factors contributing to the limited evidence in the acute care setting. Nevertheless, these
authors found that occupational therapy practitioners
performed comprehensive assessments, engaged in
client-centered care, provided interventions to facilitate participation in meaningful occupation, and
contributed to discharge planning to appropriate postacute resources (Campbell et al., 2009). Information
gathered on occupational therapy service provision in
the acute hospital setting can be used to guide clinical
practice and facilitate appropriate allocation of therapy resources to promote positive patient outcomes.
1.3. Purpose statement and research questions
The purpose of this research study was to examine the types of occupational therapy interventions
provided, the frequency of occupational therapy sessions, and the effectiveness of occupational therapy
services for adult patients with brain tumors in the
acute care hospital setting. Specifically, the following
research questions were addressed:
1) What is the frequency of acute care occupational therapy visits for adults with brain
tumors?
2) What interventions are occupational therapy
practitioners providing for adults with brain
tumors in the acute care setting?
3) Do adults with brain tumors who receive occupational therapy services in the acute care
setting improve in ADL performance?
2. Methods
2.1. Research design
This was a descriptive retrospective chart review.
Quantitative data obtained from a thorough review
of patients’ electronic medical records (EMRs) were
analyzed. Sarkar and Seshadri (2014) identified retrospective chart reviews as effective methods of
obtaining data that are routinely recorded. In this
case, the data obtained from the patients’ EMRs were
recorded as standard practice for occupational ther-
153
apy practitioners at the chosen facility. Vassar and
Holzman (2013) observed that retrospective chart
reviews are frequently used in clinical practice and
research and can be useful in guiding subsequent
prospective studies to further inform clinical practice.
2.2. Participants
2.2.1. Inclusion and exclusion criteria
Participants were selected using convenience
sampling of patients admitted to a specialized neuroscience services unit at an acute care hospital
between December 2017 and March 2018. Both
female and male patients were included if they had
a primary diagnosis of brain tumor (primary or
metastatic), received a referral to occupational therapy, and received at least one session of occupational
therapy. Due to the characteristics of the neuroscience
service at the selected site for this study, all patients
were over the age of 18 years. No exclusion criteria
were determined.
2.3. Instrument
A standardized data collection form was created
to record information from the EMR (Fig. 1) and
included data from the occupational therapy evaluation. The occupational therapy evaluation utilized
by therapists at this acute care hospital comprises
an assessment of ADLs; upper extremity range
of motion, strength, sensation, and coordination;
bed mobility; transfers; static and dynamic sitting
and standing balance; vision; general orientation;
problem-solving; and safety awareness. A component of this general evaluation is the Boston
University Activity Measure for Post-Acute Care
(AM-PAC) “6 Clicks” Daily Activity Inpatient Short
Form (Jette, Haley, Coster, & Ni, 2013). This instrument measures the level of assistance required for
putting on and taking off regular upper and lower
body clothing, bathing, toileting, taking care of personal grooming, and eating meals. The raw score is
obtained through skilled observation of performance
in each task, and/or the clinician’s professional judgment on the individual’s ability to perform the tasks,
and converted to a standardized score (Jette et al.,
2013). This outcome measure has been validated for
the in-patient population (Jette et al., 2014a; Jette
et al., 2015) and has been shown to assist therapists in
predicting an appropriate post-acute discharge destination (Jette et al., 2014b).
G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
Fig. 1. Data collection form.
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G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
2.4. Procedure
The study was approved by the Institutional
Review Boards at both the medical center from which
the participants were selected and the researchers’
academic institution. The principal investigator (PI)
conducted a pilot study targeting 10% of the overall final study sample, which is the recommended
size for a pilot study (Gearing, Mian, Barber, &
Ickowiz, 2006; Vassar & Holzman, 2013). On completion of the pilot study, the PI and co-researcher
determined that no changes to the data collection
sheet were needed. The EMRs for all participants who
met inclusion criteria were housed within the electronic documentation system used at the facility, in
compliance with the institution’s cyber-security policy. The EMRs were sorted by medical record number
and reviewed by the PI. Once the EMR was reviewed,
the PI transferred each record to a newly-created list
to ensure there were no duplicates. The total sample (N = 153) contained data that were extracted from
EMRs of patients who had discharged from the acute
hospital setting. This reduced the risk of bias from
therapists working on the unit being aware of the
study.
155
patients were deceased by the time of data collection (females = 5; males = 7). Gliomas were the most
commonly occurring tumors (n = 87; 58.6%) and over
one quarter of patients had glioblastoma multiforme
(GBM). The majority of patients who were admitted to the service with a diagnosis of a brain tumor
underwent a surgical intervention of either a biopsy
or a craniotomy (n = 148; 96.7%). In addition, two
patients received brachytherapy, where radioactive
seeds are placed within the brain tissue to target cancer cells (National Cancer Institute, 2012). Only five
patients elected not to pursue further surgical intervention during their admission (3.3%). Over a third of
patients had previously undergone surgical resection
of a tumor (n = 59; 38.6%). Similarly, over a third of
patients had previously received a non-surgical intervention including Gamma Knife®, radiation and/or
chemotherapy (n = 53; 34.6%; 2 not reported). One
patient had participated in a vaccine trial and one
patient had received stem cells in addition to receiving
chemotherapy. Almost 60% of patients were identified as having a need for post-acute occupational
therapy and were referred for follow up services, with
107 discharging home (69.9%). Table 1 represents
demographics and client characteristics from the data
collection sheet.
2.5. Data analysis
The researchers used descriptive statistics to
present the demographic and clinical data of the
patients whose EMRs were reviewed. Microsoft
Excel was used to present data on length of stay
and occupational therapy visits, interventions and
billing data. For those patients who received more
than one occupational therapy visit and therefore had
more than one AM-PAC score documented, a paired
t-test was performed to examine the change in the
scores. SPSS® was used by a statistician to analyze
the differences between AM-PAC scores on initial
occupational therapy evaluation and at the last documented occupational therapy visit. AM-PAC scores
were not included for patients who only received one
occupational therapy visit.
3. Results
The sample comprised EMRs of 153 participants.
There was no significant difference in the number of
female patients compared with male patients amongst
all EMRs reviewed. The mean age was 57.18 years
(range 23 to 97 years; median 58.5 years). Twelve
3.1. Length of stay and occupational therapy
visit data
The mean length of hospital stay was 5.01 days
(range 2 to 47 days; median 3 days). Twenty-eight
percent of patients stayed just two days (n = 43).
Fewer than half the patients stayed longer than three
days (n = 75; 49%). Figure 2 represents the lengths of
stay. Over 50% of patients received only one occupational therapy session (n = 83; 54.2%). The number
of occupational therapy visits ranged from 1 to 18
(mean = 1.8). Figure 3 represents occupational therapy visit data.
3.2. Occupational therapy billing and
intervention data
Occupational therapy practitioners account for
their skilled services by using discreet billing
categories which are determined using Current Procedural Terminology® (CPT®) codes (American
Medical Association, 2018). These can include
ADL training, activities to promote cognitive development, neuromuscular re-education, therapeutic
activities and therapeutic exercises (AOTA, 2018a).
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G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
Table 1
Demographics and Client Characteristics
Characteristic
Gender
Female
Male
Tumor origin
Primary
Metastatic
Tumor type
Glioma
Astrocytoma
GBM
Oligodendroglioma
Unspecified
Meningioma
Metastatic
Breast
Colon
Esophagus
Melanoma
Renal
Other
Procedure
Biopsy
Craniotomy
None
Other disciplines
Physical Therapy
Speech Language Pathology
Occupational Therapy in ICU
Yes
No
Discharge recommendation
Home
No services
Home Health OT
Out-Patient
Hospice
Acute Rehabilitation Unit
Skilled Nursing Facility
N
%
79
74
51.6
48.4
132
21
86.3
13.7
11
42
7
27
40
21
4
1
1
2
1
5
7.2
27.5
4.6
17.6
26.1
13.7
2.6
0.6
0.6
1.3
0.6
3.3
3
145
5
2.0
94.7
3.3
153
21
100
13.7
88
65
57.5
42.5
65
24
14 (2 SLP; 1 PT)
4
38
8
42.5
15.7
9.1
2.6
24.8
5.3
Note: ICU = intensive care unit; OT = occupational therapy;
SLP = speech language pathology; PT = physical therapy.
Fig. 3. No. of occupational therapy visits each patient received.
Fig. 4. Occupational therapy interventions. Note: Data for categories other than Evaluation will exceed N as multiple billing
codes may be used for each visit. Neuro re-ed = neuromuscular reeducation; Ther act = therapeutic activities; Ther ex = therapeutic
exercises.
Subsequent to the evaluations, over 67% of all interventions provided were coded as ADL training.
Examples of interventions provided that were coded
as therapeutic activity included addressing visual
scanning and neglect syndromes, and family training.
Thirteen percent (n = 21) of all patients were evaluated with no additional intervention billed, indicating
no skilled needs were identified by the evaluating
occupational therapist.
Providers are not required to use specific billing
intervention codes when billing therapy services
to Medi-CAL, California’s Medicaid program.
Therefore, specific data for occupational therapy interventions provided are not available for
20 patients who were covered under Medi-CAL
(13.07%). Figure 4 represents the billing and intervention data for all EMRs reviewed.
3.3. AM-PAC 6-click for daily activity data
Fig. 2. Length of stay data.
Since only 45.8% of patients received more than
one occupational therapy visit, potential changes in
AM-PAC data are only available for 70 patients.
G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
157
Fig. 5. AM-PAC data difference between initial evaluation and last documented occupational therapy visit for patients who received more
than one visit (n = 68).
There were two EMRs where the initial AM-PAC
score was not reported, resulting in an n for this analysis of 68. The mean AM-PAC raw score on admit was
17.6 (median 18; range 9 to 24; SD = 3.42). The mean
AM-PAC raw score from last documented occupational therapy visit was 19.8 (median 21; range 8 to
24; SD = 3.91). More than two-thirds of these patients
demonstrated an improvement over the course of their
hospital admission (67.6%). There was a statistical
significance between AM-PAC raw score on initial
evaluation and at last documented occupational therapy session (t = 6.77; df = 67; p < 0.001). Figure 5
represents the difference in the AM-PAC raw scores
for patients who received more than one occupational
therapy visit.
4. Discussion
This study examined the provision of occupational
therapy services for adults with brain tumors in the
acute care setting. There were more women than men
in the sample, which contrasts data from the American Society of Clinical Oncology ([ASCO]; 2018)
who reported a higher incidence of men than women
having brain tumors. Conversely, more men than
women were deceased by the time of data collection.
This is consistent with national statistics on mortality
rates from brain cancer (ASCO, 2018). The over-
all results suggest that occupational therapy played
a valuable role in the care of adults with brain tumors
for the participants in this study, and that occupational
therapy practitioners at this site provided interventions that align with the foundation of occupational
therapy practice. The short lengths of hospital stay
impact occupational therapy service provision in the
acute care setting, and yet the occupational therapy
practitioners adhered to the profession’s core values
by facilitating participation.
4.1. Frequency of occupational therapy visits
Much has been reported on the trend of decreased
lengths of stay in hospitals across the country (Campbell et al., 2009; Leland et al., 2015) and the findings
from this study were consistent with this trend. With
more than half the patients discharging within only
two to three days, there was little time for followup occupational therapy visits. This was reflected in
the finding that the majority of patients only received
one occupational therapy visit. This restriction places
pressure on the occupational therapy practitioner to
conduct a comprehensive evaluation of the patient to
determine his/her current needs, ensure that all education and training for the patient and/or caregiver
is completed, and that appropriate discharge recommendations are made for post-acute care needs within
a short period of time.
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G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
Not all patients required ongoing occupational
therapy services. There was a small number of
patients for whom subsequent intervention was not
indicated or provided upon evaluation. This suggests that these patients may have had no functional
deficits post-procedure and the referral for an occupational therapy evaluation may have been placed
unnecessarily by the ordering physician. The Centers for Medicare and Medicaid Services ([CMS];
2017) provide specific guidelines as to what constitutes an appropriate occupational therapy consult.
Reducing the number of unnecessary consults for
patients with no functional deficits could result in
improved service provision to those patients who
would benefit from limited rehabilitation therapy
resources (Hobbs, Boysen, McGarry, Tompson, &
Nordrum, 2010). Occupational therapy practitioners, and patients with skilled occupational therapy
needs who are not receiving follow-up services inhouse due to limited labor resources, would benefit
from education for prescribing physicians regarding appropriate therapy consults using those CMS
guidelines.
4.2. Occupational therapy interventions
provided
Within the tight parameters of short lengths of
stay, discharge planning is a crucial component of
assessing a patient’s needs in the acute care setting (Connolly et al., 2010). An expected finding
was that adults with brain tumors required postacute follow up. The number of patients who were
discharged to acute rehabilitation facilities supports
the findings from previous research that patients
who received post-acute rehabilitation demonstrated
functional gains (Bartolo et al., 2010; Formica
et al., 2011; Hansen et al., 2017; Roberts et al.,
2014). Occupational therapy practitioners at this
site who recommended acute rehabilitation followup appeared to demonstrate a knowledge of current
evidence.
Surprisingly, the number of patients who were
discharged home with either home health (15.7%)
or out-patient (9.1%) occupational therapy services
exceeded the numbers found in previous studies.
Langbecker and Yates (2015) did not cite any referrals
to home health or out-patient occupational therapy
in patients with brain tumors. Similarly, Chan and
colleagues (2015) reported only 2.9% of patients
with brain tumors receiving home health occupational therapy services.
4.3. ADL Performance
Occupational therapy practitioners are strongly
encouraged to provide occupation-based interventions to meet their clients’ needs (AOTA, 2014). A
reassuring finding was that the majority of interventions provided to these patients were coded as ADL
training. The focus of these interventions aligns with
Rogers, Bai, Lavin and Anderson (2016) who suggested that addressing deficits in self-care may lead
to improved post-acute outcomes and contribute to
value-based service provision. Surprisingly, however,
a reduced focus was placed on cognition and concerns
for decreased quality of life amongst adults with brain
tumors and their caregivers. Both of these areas have
been identified as barriers to resuming prior life roles
and engagement in meaningful occupation for this
population (Roberts et al., 2014; Vargo et al., 2016).
Although intervention codes for cognition were not
frequently used, occupational therapy practitioners
do typically address functional cognition through
patient participation in everyday tasks such as ADLs
(AOTA, 2018b). Nevertheless, a consideration for the
site at which this study was conducted would be
to include formal assessments of functional cognition and development of intervention plans to address
potential deficits.
A surprising finding was that despite the limited
number of occupational therapy visits, patients who
received more than one occupational therapy session
demonstrated an improvement in ADL performance
as measured by the AM-PAC scores. However, this
finding aligns with current evidence showing the benefits of rehabilitation, including occupational therapy,
in adults with brain tumors in post-acute settings
(Bartolo et al., 2010; Hansen et al., 2017; Roberts
et al., 2014). This is a promising outcome for patients
in the acute care setting.
4.4. Limitations
This study has several limitations related to study
design and data collection. First, the small sample size
lessens the ability to generalize findings to a larger
population (Portney & Watkins, 2015). Additionally,
there is significant variation in the type, grade, and
location of tumor; treatment options; and medical
prognosis in adults with brain tumors. Further, differences in age, symptoms, and level of impairment prior
to surgical/medical intervention can all affect patient
response to occupational therapy interventions.
G. Burgess and L.E. Jensen / Occupational therapy for adults with brain tumors
Consequently, this variety can influence how the
results of the study are applied to all adults with brain
tumors.
Second, a retrospective chart review may introduce
bias through missing or incorrect data in the EMR,
inconsistencies with data abstraction, and the lack
of blinding of the data abstractor to the study (Kaji,
Schriger, & Green 2014; Vassar & Holzman, 2013).
The researchers followed existing recommendations
to enhance reliability and validity of retrospective chart reviews, including use of a standardized
abstraction tool, developed following collaboration
between the two researchers, and confirmation of data
abstraction by a second reviewer (Wickson-Griffiths,
Kaasalainen, Ploeg, & McAiney, 2014). Additionally, EMRs containing documentation from several
occupational therapists were included in the sample.
Furthermore, documentation in the selected EMRs
was completed before the study proposal was submitted, minimizing the primary investigator’s influence
over documentation.
Third, the data were obtained from one site and
may not represent clinical practice of occupational
therapy practitioners across all acute care settings
for this population. Although there is standardization
in occupational therapy practice for coding specific interventions for billing purposes, there can be
differences in the way clinicians document their interventions (Flink et al., 2016). These authors raised
the concern whether the use of checklists associated
with electronic documentation, which is utilized at
the selected site, is an accurate representation of the
therapeutic interventions and patient response to the
intervention (Flink et al., 2016).
4.5. Future research
There are several implications for clinical practice that emerged from this study. The evidence is
promising that adults with brain tumors benefitted
from occupational therapy services in the acute care
setting, not only to address functional limitations, but
to facilitate referrals to post-acute follow-up services.
Findings suggest that more frequent occupational
therapy interventions may result in greater functional
gains. Further research may be helpful to examine
the patients’ perspectives on the benefit of occupational therapy in assisting them in engaging in
meaningful activity following a brain tumor resection. Additionally, there are opportunities to educate
referring providers on the appropriateness of occupational therapy referrals to optimize the use of limited
159
occupational therapy services for those patients who
truly have skilled needs. Finally, the focus on cognitive skills development was not specifically addressed
in the coding and documentation of occupational therapy interventions at this site. A recommendation for
program development would be to further explore the
role of occupational therapy in this area and include
focused interventions in clinical practice.
5. Conclusion
Occupational therapists who provided the interventions in this study identified that adults with
brain tumors may experience functional limitations
that affect engagement in meaningful occupation
and targeted their interventions accordingly. Despite
limitations in patient lengths of stay, occupational
therapy practitioners provided interventions primarily focused on training in activities of daily living to
improve a patient’s functional performance, as measured using the AM-PAC, in the acute care setting.
Patients with brain tumors who received occupational
therapy interventions demonstrated functional gains,
a finding that is reflected in the available literature
conducted in post-acute care settings. Furthermore,
the findings from this study suggest that patients
who received more frequent occupational therapy services, may make greater functional gains. Results of
this study will contribute to the body of knowledge in
occupational therapy practice. This information can
be used by occupational therapy practitioners who
treat adults with brain tumors to best utilize limited
resources to meet each client’s individual need. Furthermore, education programs can utilize the results
of this study to inform curricula for occupational therapy students.
Acknowledgments
Thanks for Dr. Yongyue Qi and Dr. Vanessa Jewell
from Creighton University, and Michael Covington,
PhD for their guidance throughout this process.
Conflict of interest
The authors have no conflicts of interest to declare.
This research study was completed in partial fulfillment of Creighton University’s post-professional
doctorate of occupational therapy degree.
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