Development and evaluation of occupational therapy - Mahidol Clinic System (OT-MCS) for post-stroke rehabiliation in Thailand

In 2011 it was estimated that in Thailand there were 498,800 stroke survivors of both sexes but most were over the age of 65. They were served by only 625 occupational therapists (OTs). Occupational therapy (OT) plays a key role in the rehabilitation service for stroke patients, in particular, by enabling stroke survivors to reengage with activities of daily living and to resume work or family tasks. OT needs to be culturally appropriate and relevant to the therapists, stroke patients and their families. The Occupational Therapy Mahidol Clinic System (OT-MCS) has been designed to be culturally relevant and is based on collaborative teamwork which can better address the needs of the stroke patients. OT-MCS was introduced in 6 regional OT clinics. This study compared perceptions of stroke clients who took part in the new approach 8 weeks before and during the rehabilitation. One hundred and twenty stroke participants were divided into 2 functional groups (slow and fast stream rehabilitation). Stroke participants (N=120) and OTs (N=60) explored the arrangement of activity items into domains for creating a new activity card sort (ACS). Sixty stroke participants (slow stream rehabilitation) and 60 OTs were surveyed to investigate the attitudes of “satisfaction” and “importance” via 40 therapeutic activities. Sixty stroke participants (fast stream rehabilitation) evaluated the levels of their activity engagement in diverse cultural-therapeutic activities. Lastly, 23 stroke participants (slow and fast stream rehabilitation) were interviewed in order to ascertain their lived experiences after the use of OT-MCS and the data were analysed using thematic analysis. The integrated analysis demonstrated strong satisfaction and engagement with OT-MCS. The use of the activity catalogue met with positive attitudes from the stroke participants and in particular the collaborative approach of OTs and participants gave meaning to the activities and a sense of self management. In addition in the fast stream rehabilitation participants reported satisfaction with the transferability of the activities to the home and external environment and their relevance to supporting family life. The OT-MCS for Thai stroke rehabilitation is a comprehensive OT service, which improves the perception of benefit in stroke clients enabling them to perform meaningful and purposeful activities based on their local and regional lifestyles. This culturally appropriate approach helps stroke clients to re-develop their life-skills. Through the use of meaningful and relevant activities which meet their specific needs, stroke clients can lead more satisfying and fulfilling lives

Family Caregivers of Older Adults with Physical Disabilities in Rural Thailand

Thailand is one of many countries experiencing changes in the demographics of its population. People are living longer and having fewer children resulting in an increasing percentage of older adults in the general population. This presents a challenge in providing care for older adults, especially in countries where there is a culture of family caregiving. This study aims to investigate the experience of family caregivers, exploring the problems of caring for older people with physical disabilities and the needs of family caregivers. This is done to better understand ways to support caregivers. Using a descriptive qualitative approach, 15 family caregivers were enrolled who provide care to older adults with physical disabilities in a rural community in Northern Thailand. The interviews were conducted face-to-face and were analyzed by thematic analysis. Findings showed two main categories from the data: problem areas and needs. The “problem area” themes are low-income households, management of activities of daily living, and access to resources. The “needs” themes are home modifications and adaptive equipment and development of a support system. The identified themes provide guidance for long term care, home adaptation, and assistive products. Future research can be done into the impact of these interventions

Development of Thai sensory patterns assessment tool for children aged 3–12 years: Caregiver-version

Most existing tools for measuring sensory patterns of children have been developed in Western countries. These tools are complex and may not be culturally appropriate for other contexts that require specific knowledge in the clinical perspective. The aim of this study was to develop a simplified tool called the Thai Sensory Patterns Assessment (TSPA) tool for children. It is designed for children ages 3–12 years old to be completed by their caregiver. The process of creating the tool consisted of drafting a questionnaire and interpreting the result. Partial psychometrics were completed during item development, content validity of items was assessed by five expert ratings. Construct validity and internal consistency were assessed using data from 414 caregivers and intra-rater reliability was assessed with 40 caregivers. The two parts of the TSPA tool for children results, sensory preference, and sensory arousal, were designed to be presented as a sensory pattern in a radar chart/plot. The data analysis showed that both parts of the TSPA tool for children had acceptable psychometric properties with the retained 65 items. Only proprioceptive sensory arousal had a low Cronbach’s α coefficient, suggesting more information sharing between caregivers and professionals is needed. This research is an initial study and must be continuously developed. Future development of this tool in technology platforms is recommended to support use within healthcare services

Bridging the gap between clinical service and academic education of hand-splinting practice: Perspectives and experiences of Thai occupational therapists

A gap in knowledge about current splinting practice exists between the educational program and clinical service. To bridge this gap, we investigated the perspectives and experiences of Thai occupational therapists regarding contemporary hand splinting practices in clinical use. A mixed-method study was designed. An explanatory sequential mixed methods design was used. In the first quantitative phase, a survey questionnaire was mailed to occupational therapists. The questions were regarding contemporary hand splinting practices in clinical use at seven hospitals in the capital city of Bangkok and outskirt areas. In the second phase, semi-structured interviews were completed to explore expert occupational therapists\u27 perspectives on practice in the same hospital settings. Transcripts were analyzed using thematic analysis. The results showed that most conditions receiving splints were nerve injuries, orthopedics, and stroke, which represented the service frequency of splint types: functional resting (100 %), cock-up (93.3 %), and thumb spica splints (80 %). Bone and joint deformity prevention ranked first with muscle contracture prevention being ranked second, and the third-ranked was maintaining range of motion. Three themes emerged from the interviews: starting with the patient condition; effective function and value; knowledge and experiential skills. Perspectives and experiences of occupational therapists in splinting practice contribute to education based on the reality of practice. Integrated numerical and textual data of professional skills and knowledge in actual splinting practice can be reflected through splints and orthoses program revisions to meet future learning outcomes

Delivering Occupation-Based Practice in Stroke Rehabilitation of Hospital Settings: Thai Occupational Therapists’ Experiences

Occupation-based practice (OBP) is central to the practice of occupational therapists where occupations or meaningful activities become the focus of the assessment, intervention, and outcomes measurement process. Although occupational therapists practising in Thailand claim that they engage in OBP, this claim warrants empirical investigation. This study aimed to investigate the experiences and perceptions of hospital-based occupational therapists of OBP within stroke rehabilitation. Utilizing a qualitative design, fourteen occupational therapists were recruited through purposive sampling. Data were collected through semi-structured interviews until data saturation was reached. Each interview was recorded and transcribed verbatim, and data were analyzed using thematic analysis. Five themes were identified (1) Perspective towards OBP, (2) OBP as professional value and cultural identity, (3) Implementing OBP for stroke rehabilitation in hospital settings, (4) Environmental factors of using OBP in stroke rehabilitation, and (5) OBP in the service management. Occupational therapists perceived that OBP is important for professional identity. Using OBP provides positive changes in stroke clients. This study provides evidence that will help implement OBP into occupational therapy in Thailand

Occupational Therapists\u27 Experience of Using Home Adaptation and Assistive Products as Interventions for Older Individuals and Persons with Disabilities in Thailand

As Thailand becomes an aged society it is important to promote advancements in geriatric medicine to provide the best care for older individuals. The right assistive facilities and household mobility equipment are essential for everyday activities. The use of home adaptations and assistive products can maximize the quality of life for older individuals and make life more convenient for those with disabilities. This study aimed to investigate the experience of occupational therapists, using home adaptations and assistive products. An individual interview was conducted with eight occupational therapists who worked at regional hospitals and centers of excellence throughout Thailand using a qualitative study. The results were interpreted through thematic analysis. Five main themes emerged: (1) empowering independent living at home, (2) accident prevention and safety, (3) family financial constraints and barriers, (4) availability and accessibility of products, and (5) matching products with clients’ capabilities and needs. Based on an occupational therapy approach, this study examines Thailand\u27s needs for home adaptations and assistive products, as well as barriers to accessing those products and services. Through a contribution to knowledge and information based on occupational therapists\u27 experience, the laws and regulations regarding home adaptations and assistive products for people with disabilities can be improved. Additionally, the interdisciplinary team and authorities involved in this issue should also collaborate to formulate guidelines for home adaptations and assistive products for older individuals and persons with disabilities in the future

Delivering Occupation-Based Practice in Stroke Rehabilitation of Hospital Settings: Thai Occupational Therapists’ Experiences

Occupation-based practice (OBP) is central to the practice of occupational therapists where occupations or meaningful activities become the focus of the assessment, intervention, and outcomes measurement process. Although occupational therapists practising in Thailand claim that they engage in OBP, this claim warrants empirical investigation. This study aimed to investigate the experiences and perceptions of hospital-based occupational therapists of OBP within stroke rehabilitation. Utilizing a qualitative design, fourteen occupational therapists were recruited through purposive sampling. Data were collected through semi-structured interviews until data saturation was reached. Each interview was recorded and transcribed verbatim, and data were analyzed using thematic analysis. Five themes were identified (1) Perspective towards OBP, (2) OBP as professional value and cultural identity, (3) Implementing OBP for stroke rehabilitation in hospital settings, (4) Environmental factors of using OBP in stroke rehabilitation, and (5) OBP in the service management. Occupational therapists perceived that OBP is important for professional identity. Using OBP provides positive changes in stroke clients. This study provides evidence that will help implement OBP into occupational therapy in Thailand

Psychometric Assessment of the Handwriting Proficiency Screening Questionnaire (HPSQ)—Thai Version for Primary School-Aged Children

In this study, the original Handwriting Proficiency Screening Questionnaire (HPSQ) was translated into Thai and cross-culturally adapted for use among school-aged children in Thailand. Additionally, the initial psychometric properties of the new Thai version were assessed, including internal consistency, construct validity, and content validity. The original HPSQ was forward-translated by two independent translators from English to Thai and then back-translated. A final consolidation was conducted by an expert committee to develop the Thai HPSQ. In the psychometric evaluation, content validity was quantified using the item-objective congruence (IOC) value for each item. Intra-rater and inter-rater reliabilities were also assessed. Internal consistency was measured using Cronbach’s alpha coefficient, and confirmatory factor analysis models were used to examine its construct validity. The Thai version of the HPSQ had excellent internal consistency (α = 0.92), good construct, and content validity (IOC value > 0.6). Intra-rater reliability was good (intraclass correlation coefficient (ICC) = 0.98), and inter-rater reliability ranged from fair to good (ICC = 0.46−0.77). Factor analysis revealed that a three-factor model best fitted the data. Thus, the Thai version of the HPSQ is a reliable and valid instrument for handwriting evaluation among Thai school-aged children. It can be useful for teachers and therapists to identify students with handwriting problems

Development of Thai Sensory Patterns Assessment Tool for Children Aged 3–12 Years: Caregiver-Version

Most existing tools for measuring sensory patterns of children have been developed in Western countries. These tools are complex and may not be culturally appropriate for other contexts that require specific knowledge in the clinical perspective. The aim of this study was to develop a simplified tool called the Thai Sensory Patterns Assessment (TSPA) tool for children. It is designed for children ages 3–12 years old to be completed by their caregiver. The process of creating the tool consisted of drafting a questionnaire and interpreting the result. Partial psychometrics were completed during item development, content validity of items was assessed by five expert ratings. Construct validity and internal consistency were assessed using data from 414 caregivers and intra-rater reliability was assessed with 40 caregivers. The two parts of the TSPA tool for children results, sensory preference, and sensory arousal, were designed to be presented as a sensory pattern in a radar chart/plot. The data analysis showed that both parts of the TSPA tool for children had acceptable psychometric properties with the retained 65 items. Only proprioceptive sensory arousal had a low Cronbach’s α coefficient, suggesting more information sharing between caregivers and professionals is needed. This research is an initial study and must be continuously developed. Future development of this tool in technology platforms is recommended to support use within healthcare services

Bridging the Gap between Clinical Service and Academic Education of Hand-Splinting Practice: Perspectives and Experiences of Thai Occupational Therapists

A gap in knowledge about current splinting practice exists between the educational program and clinical service. To bridge this gap, we investigated the perspectives and experiences of Thai occupational therapists regarding contemporary hand splinting practices in clinical use. A mixed-method study was designed. An explanatory sequential mixed methods design was used. In the first quantitative phase, a survey questionnaire was mailed to occupational therapists. The questions were regarding contemporary hand splinting practices in clinical use at seven hospitals in the capital city of Bangkok and outskirt areas. In the second phase, semi-structured interviews were completed to explore expert occupational therapists’ perspectives on practice in the same hospital settings. Transcripts were analyzed using thematic analysis. The results showed that most conditions receiving splints were nerve injuries, orthopedics, and stroke, which represented the service frequency of splint types: functional resting (100%), cock-up (93.3%), and thumb spica splints (80%). Bone and joint deformity prevention ranked first with muscle contracture prevention being ranked second, and the third-ranked was maintaining range of motion. Three themes emerged from the interviews: starting with the patient condition; effective function and value; knowledge and experiential skills. Perspectives and experiences of occupational therapists in splinting practice contribute to education based on the reality of practice. Integrated numerical and textual data of professional skills and knowledge in actual splinting practice can be reflected through splints and orthoses program revisions to meet future learning outcomes