Intensity of Rehabilitation Interventions As a Predictor of Outcomes in Skilled Nursing Facility Residents

Stroke is the leading cause of disability among adults in the United States. Research that continues to unpack the ‘black box’ of rehabilitation services specific to diagnostic groups (such as stroke) will contribute to the development of evidence-based clinical best practices for rehabilitation service provision to improve functional outcomes. The purpose of this study was to describe the types of rehabilitation interventions implemented (impairment-based and function-based as derived from Current Procedural Terminology billing codes) and intensity of these interventions (measured in minutes) as they are administered to skilled nursing facility residents admitted with a diagnosis of stroke, at two time points (5-day and 30-day reporting periods). In addition, this study examined what types of rehabilitation interventions at what level of intensity contributed most to a change in the level of activities of daily living disability (ADL end-split) between these two time points. At the 5-day and 30-day time points, the proportion of impairment-based and function-based interventions differed significantly, with the greatest proportion of time focused on function-based interventions at both time points. Function-based interventions decreased in proportion from 5 to 30 days and the impairment-based interventions increasing in proportion from 5 to 30 days. Function-based occupational therapy interventions were significant predictors of positive changes in functional outcomes (ADL end-split), however, in subsequent models, when other significant predictors of a change in functional outcomes entered (bed mobility and the presence of fecal incontinence), the unique contribution of occupational therapy was no longer significant. Results of this study also indicated strong and significant associations between both impairment-based and function-based interventions and the presence of urinary incontinence and fecal incontinence, dependence in toilet use, and the presence of an active discharge plan to return to the community

Passing the NBCOT Examination: Preadmission, Academic, and Fieldwork Factors

All occupational therapy students are required to successfully complete the certification examination administered by the National Board for Certification in Occupational Therapy (NBCOT) before they can practice independently. The need to repeat the examination can result in stress, anxiety, and financial hardship. This paper explores the relationship of preadmission factors, academic and fieldwork performance, and demographic variables to successful first-time attempts on the certification examination for occupational therapists. Data were gathered from 144 student files in a Master of Occupational Therapy (MOT) Program at a single university. Of the sample, 82% passed and 18% failed their first NBCOT test trial. Considered independently, preadmission recommendation letters and writing sample scores, graduate MOT program GPA, lack of MOT program difficulty, fieldwork self-reports, and gender predicted NBCOT certification examination outcomes. When considered together in logistic regression models predicting outcome, this combination of factors correctly predicted 86.2% of student outcomes (or 20% to 32% of the variance in certification examination success), with OT program GPA and preadmission recommendation scores predicting unique outcome variance. This information may be helpful to admissions committees as well as to occupational therapy faculty as they identify strategies and practices to facilitate first-time test taking success on the NBCOT certification examination