The Occupational Therapist Chooses the Easel
This article was researched and documented by Adria B. MS, OTR/L.
Home-based occupational therapists (OTs) are in a unique position to address the friction between a client’s physical abilities and their home environment: we treat individuals in the midst of all those factors that challenge them practically and motivate them to convalesce.
It is at this juncture that we can treat basic activities of daily living (ADL) deficits most optimally through meaningful, occupation-based interventions. Recent research supports the notion that occupational therapy provided in the home results in improved ADL performance outcomes, and I would argue that the field’s broader push towards using meaningful activities to improve ADL performance is ideally suited to home-based services.
In a recent systematic review of occupational therapy interventions aimed at increasing ADL independence in older adults living at home, Liu, Chang and Chang (2018) found that there is particular value in providing occupational therapy interventions in the home environment.
In five of their cited studies, analysis revealed that older adults with ADL deficits demonstrated significantly improved ADL performance following home visits by occupational therapists in conjunction with other specialists. The authors cite two additional studies that support the benefits of incorporating task-specific interventions – including transfer practice and a walking group, respectively – to improve ADL performance at home. In contrast, the same review cited three studies reporting no significant improvement in ADL performance with the incorporation of multimodal exercise versus home exercise programs, exercise education, or mobility activities in adults with diminished ADL performance.
Similarly, an evidence-based review by Wolf, Chuh, Floyd, McInnis and Williams (2015) supports the thesis that occupation-based interventions in the home are of particular use therapeutically.
In their review of occupation-based interventions post-CVA, they cited three distinct studies indicating that function-based interventions provided at home increased ADL independence while diminishing the likelihood of patient mortality following a stroke.
If home services are so clearly beneficial to clients with ADL performance limitations – yet home exercise programs have limited impact on ADL performance – occupational therapists must turn to the roots of our field: the incorporation of meaningful, occupation-based interventions.
Per Glen Gillen’s recent interview in OT Practice (Richardson, 2018), “[p]urposeful activities build on a person’s ability and lead to achievement of personal and functional goals. Conversely, non-purposeful activities do not stimulate interest or motivation, resulting in reduced patient participation and suboptimal outcomes.” Gillen’s statement provides an important counterpoint to a clinical model that too often relies on biomechanical interventions, cones, pegs and arm bikes; his assertion is part of a larger movement in the field to return to purposeful, occupation-based interventions.
In their homes, our clients are surrounded by what gives their lives meaning.
Our job as home-based occupational therapists is to identify our clients’ most meaningful activities and incorporate them into our interventions in order to facilitate optimal functional outcomes. When given the choice between using a Thera-Band or an easel to strengthen a retired artist’s arms, the occupational therapist chooses the easel.