OPTIMIZE RECOVERY WITH HOME PROGRAMS & UP-LEVEL YOUR OT PRACTICE

HOME EXERCISE PROGRAMS

Occupational therapists often recommend and establish home exercise programs when clients are ready for discharge. Is this the best time or even the right time? I don’t think so and I’ll tell you why....

People need time and practice to learn and build habits. This is especially true of occupational therapy (OT) clients experiencing interruptions in health. People in the midst of a health crisis or concern are not functioning at their best. They are often in pain and worried; many do not understand their conditions and some experience cognitive deficits. Caregivers often do not understand the medical system and have other life events happening simultaneously. That’s a LOT!

Consider the amount of practice and memorization required when you want to learn something new - when you’re feeling good and have a level of knowledge about a topic. As healthcare providers we must incorporate our skills in ways that support client success. Practice models that empower clients to take responsibility for their health are needed now more than ever and are super simple to implement. Establishing home programs at the start of care provides more learning and practice opportunities for clients while you’re available to guide and support them.

Support during challenging times can put your clients’ minds at ease, allow you to build the appropriate home program and give you the chance to see what they’re capable of. This gives them time to heal, learn and progress. Additionally, starting a home program right away provides opportunities for repetition (a key learning ingredient) and facilitates habit building (an OT superpower) that may translate into a routine once they’re home. Routine is key for follow through, successful recovery and future health.

HOME PROGRAM vs. HOME EXERCISE PROGRAM

Eliminate the word “exercise” and you’ve got an entirely new and more versatile approach! Occupational therapy practice brings so much more to the table than exercise. Essentially, OT’s should only use exercise if our clients value it as an occupation – unless recovering motor skills following stroke and even then it depends on client ability. Otherwise, we can and should use our other, OT specific, super-powers. Energy conservation techniques are one excellent example of a perfect home program. Point to Ponder: What are some other strategies we use in occupational therapy that should be used as home programs?

HOME PROGRAMS & PRACTICE UP-LEVEL

Establishing appropriate home programs should be done immediately as part of a skilled OT plan of care (not when it’s time for discharge so you can check of a care path box). Not only will this increase your practice value, but it will also drive client success. NOTE: If you don't currently establish home programs immediately upon start of care, that’s ok. It’s not too late to begin. We are always learning new ways to do things to create positive change in our practices. Read on to learn more about how to get started.

ESTABLISHING A HOME PROGRAM

It is understood that OT practitioners incorporate proper clinical reasoning skills when establishing any and all programs whether they are skilled, maintenance, habilitative or rehabilitative. If you are a client or caregiver, referring to this information can help you identify if your provider is meeting this need for you.

Some OT skills used through proper set up of home programs include:

• Diagnosis knowledge

• Skilled intervention techniques

• Environmental supports, barriers, modifications

• Caregiver supports & training

• Task analysis & grading

• Task modification strategies

• Clinical reasoning

Here is a simple, 5-step process for establishing a home program that OT practitioners can use now:

STEP 1 – IDENTIFY NEED: With the understanding that a client will continue to benefit from the program after discharge from skilled OT, select your topic. Examples include diaphragmatic breathing for a person with COPD or mirror therapy for a stroke survivor. NOTE: the home program must be safe for the client and/or caregiver to complete on their own.

STEP 2- CREATE PROGRAM: Create the home program with the client's input. Gather appropriate materials to support client education and training. Your program should include a variety of media. Examples include visual images such as pictures and videos, required equipment and tracking forms along with your skills. HELPFUL HINT: video technology is a simple and effective way to provide educational content that supports client learning. It’s time to start using modern technology in OT practice, don’t you think?

Did you know...

“...the narrative presentation of educational information is possibly not always the best choice. Video-assisted patient education can also be effective when a model patient demonstrates the best practice. This assumption is supported by Bandura’s ‘Social Cognitive Theory’, which places observational learning at the center of behavioral modelling [30]....”(Abed, Himmel, Vormefeld & Koschak, 2014).

STEP 3 – EDUCATE & TRAIN: Begin educating the client on the program. Education can and should include the purpose and benefits; proper activity completion and self- monitoring; your skilled demonstrations and input. You should also ask for client feedback. The goal is to lead the client towards independent completion. If the client will not be independent upon discharge, caregiver training may be appropriate.

STEP 4 – FOLLOW UP: Follow up with the client during your skilled time together to determine progress. You may:

• Ask for feedbackabout how the home program is going.

• Have the client demonstratewhat they've been doing.

• Provide your skilled feedback and input, demonstrating or encouraging performance modifications as necessary. Do this until the client (or caregiver) is competent. At this point, your skill is no longer required and the client should continue on their own.

STEP 5 – GRADUATE TO INDEPENDENT: Be sure to incorporate strategies that can be used when improvement occurs (grade up) or if they are having a bad day (grade down). Remember...Once they or the caregiver demonstrate independence and feel confident, you no longer need to address this during your skilled sessions. If the client remains on a skilled OT program with you, establish regular check-in periods until therapy is discontinued. If you are a private clinic owner, consider establishing a regular check-in protocol – this can contribute to continued improvement for clients with chronic conditions while allowing you to maintain rapport – a key ingredient for them selecting you should they have any future therapy needs.

SUMMARY

That’s all there is to it. This simple strategy will no doubt change your clients’ views of occupational therapy and their time with you. Taking ownership of one’s health requires time, especially when behavioral change is involved. OT’s have the skills to empower clients to continue towards better health and improvement beyond their time on a skilled OT program. A multitude of benefits will occur from making this one simple shift in practice – outcomes will improve for all - clients, caregivers, clinic owners and the profession. Are you willing to give it a try?

Reference:

Abed, M., Himmel, W., Vormfeld, S., & Koschak, J. (2014). Video assisted patient education to modify behavior: A systematic review. Patient education and counseling, 97(1), 16–22. https://doi.org/10.1016/j.pec.2014.06.015