Use of a Logic Model to Develop an Innovative Hand Therapy Clinic to Provide Experiential Learning for Occupational Therapy Students

Occupational therapy (OT) students seek experiential learning opportunities to help them construct knowledge and meaning. Student clinics are increasing in prevalence as an effective means to engage in experiential learning. The student experiential learning clinic for hand therapy (SELC-HT) is a newly opened student clinic providing OT to under-insured individuals with upper extremity impairments. The SELC-HT used the student run free clinic (SRFC) logic model to systematically plan, implement, and evaluate its effectiveness. Planning started with evaluating the need and the context of the SELC-HT, allowing developers to state the long-term impacts of preparing students for future clinical practice, reintegrating patients without healthcare back to their roles, and contributing to the OT body of knowledge. Planning then progressed in a backward manner by first identifying measurable outcomes leading to these impacts. The output is data on the SELC-HT’s reach, indicating the clinic is moving toward these outcomes. Development of the activities followed, which will produce the output and outcome data. Lastly inputs were identified to carry out the activities. Following this careful planning, the clinic opened by moving forward through the SRFC logic model. At the conclusion of the first semester, evaluation of the SELC-HT occurred by examining the output data and measurable outcomes. Program evaluation occurred throughout the semester to assess whether the planned components were carried out effectively. As outlined in the SRFC logic model, iterative changes were made to the SELC-HT, with new outcomes, outputs, activities, and inputs implemented in the following semester to continue moving toward the impacts

Occupation-Centered Anatomy and Applied Biomechanics Courses: Design and Outcomes

Occupation-centered course design allows occupational therapy (OT) educators to differentiate ourselves from other professions while communicating the distinct value of occupation to our students. While there have been numerous calls to action for centering occupation in the OT classroom and proposed models to approach course design, there is limited literature on occupation-centered course design in specific courses, notably foundational science courses like anatomy and applied biomechanics. In this study, we outline our course design process in two courses taught concurrently, as well as our prospective study to determine if an occupation-centered course design allowed students to meet objectives and the effect of undergraduate preparation on objective achievement. We also explored students’ agreement with importance of occupation-centered instruction, and our ability to stay occupation-centered. Fifty-five students completed pre and post course surveys rating their ability to perform the five objectives for each course and their level of agreement about the role of occupation in these courses. We found statistically significant increases in all objective ratings, with some ratings more than doubling. Post-course ratings among students with different undergraduate backgrounds were similar despite being statistically different at baseline. Students placed high value in occupation-centered course design at both time points. Students rated the ability to stay occupation-centered lowest in the first few weeks, with Anatomy rated lower than Applied Biomechanics in all weeks. This suggests that the incremental improvements made in the course delivery were effective; however, it was more challenging to create an occupation-centered course in Anatomy

Evaluation of a Student Experiential Learning Clinic for Hand Therapy Using a Logic Model

Student clinics (SC) provide experiential learning opportunities in occupational therapy (OT) education that develop clinical reasoning, while providing much needed rehabilitation to under and un-insured patients in the community. The Student Experiential Learning Clinic for Hand Therapy (SELC-HT) is a SC that used a logic model for planning, implementing, and evaluating the SELC-HT. The purpose of this study is to report on outcome data on students and patients, as outlined in the evaluation phase of the logic model. The 13 OT master/doctorate students, who delivered care in the SELC-HT, demonstrated growth in self-reported hand therapy knowledge (p=0.002) measured with the Hand Therapy Certification Commission Self-Assessment Tool. Nine of the 12 students responding to alumni survey were employed in hand therapy positions shortly after graduation. Five students authored six manuscripts published in peer-reviewed journals or practice journals about their work in the SELC-HT. Of the 57 patients with baseline data, fractures were the most common diagnosis, and most patients were Black and males. One-third of injuries were due to violence, primarily gunshot wounds. At discharge (n=25) mean disability, measured with the Disability Arm Shoulder Hand, decreased 14.8 points (p=.001), which exceeds minimal clinical difference of 10.83. Statistically significant improvements in work disability (n=18) and work ability (n=21) also occurred. Most importantly, five patients who were not able to work at baseline had returned to work at discharge. These positive student and patient outcomes are due in part to the systematic planning and implementation of procedures defined in the SELC-HT logic model

Pilot Study Evaluating a Brief Chronic Pain Education Program in Occupational Therapy Practitioners, Occupational Therapy Students, and Lay People

Background: Chronic pain and resultant disability can persist long after tissue healing. Past research suggests educating individuals about chronic pain is efficacious in changing knowledge, health beliefs, and healthcare utilization. This study piloted an educational intervention to teach participants about the nature of chronic, nociplastic pain. Design: Pre-post study using three groups: occupational therapy (OT) practitioners, OT students, and lay people. Methods: Participants rated their agreement with four statements pre-intervention regarding the relationship between chronic pain, tissue damage, and activity performance to ascertain accurate knowledge. Participants were presented with studies comparing acute and chronic pain and acknowledging that some people have chronic pain after tissues heal. The intervention lasted approximately fifteen minutes. Results: Eleven OT practitioners, 11 OT students and 18 lay people participated. The entire cohort demonstrated improvements with each statement post-intervention. Lay people demonstrated statistically significant improvements in three statements, OT students in two statements, and none for OT practitioners. OT practitioners demonstrated significantly higher pre-intervention knowledge than students in two statements and lay people in one statement. Lay people had the lowest accurate knowledge pre-intervention, demonstrated by a composite score, but made the greatest improvements post-intervention. Conclusion: This educational program shows promise as an intervention to educate individuals including potential patients, current students, and practicing clinicians about the nature of chronic, nociplastic pain and to address potential incorrect health beliefs regarding pain. The program was brief, included multiple stakeholders, and included easy-to-understand language all key components of successful knowledge translation

A Dyad Model of Peer-Assisted Learning in an Occupational Therapy Student Experiential Learning Clinic for Hand Therapy

Peer-assisted learning (PAL) in healthcare education encourages critical thinking, professional development, knowledge acquisition, and enhancement of clinical skills. In this paper, we describe the pilot of a dyad model of PAL used in an occupational therapy (OT) student experiential learning clinic for hand therapy, where two students at the same knowledge level provided peer support to one another in clinical responsibilities. Example activities where dyad learning occurred include evaluation and treatment planning, care delivery, documentation, presenting during clinic rounds, practicing administering assessments and treatment techniques, and role-playing sensitive patient conversations. We developed two supplemental tools to support feedback between peers: the Session Rating Tool for post-treatment feedback and the Documentation Checklists for evaluating documentation. We assessed the effectiveness of the dyad model and the two tools by first exploring students’ anticipated impact on a total of nine criteria essential to professional growth and hand therapy clinical practice, which was rated on a Likert Scale. After a six-week pilot period, the same questions investigated students’ perception of actual impact. Students also provided qualitative feedback via open text on each survey. Students rated the dyad learning model highest for overall confidence in clinical skills/treating patients and rated the model’s impact higher than anticipated on clinical reasoning skills, therapeutic use of self and other communication skills, upper extremity diagnoses and conditions, and OT process. Students rated the Session Rating Tool similarly to anticipated impact. The dyad model of PAL supported student learning and clinical performance in this student experiential learning clinic

Barriers and enablers to Caregivers Responsive feeding Behaviour (CRiB): A mixed method systematic review protocol

Background: Childhood overweight and obesity is a major public health issue. Responsive feeding has been identified as having a protective effect against child overweight and obesity, and is associated with healthy weight gain during infancy. Responsive feeding occurs when the caregiver recognises and responds in a timely and developmentally appropriate manner to infant hunger and satiety cues. Despite its benefits, responsive feeding is not ubiquitous. To better support caregivers to engage in responsive feeding behaviours, it is necessary to first systematically identify the barriers and enablers associated with this behaviour. This mixed-methods systematic review therefore aims to synthesise evidence on barriers and enablers to responsive feeding using the COM-B model of behavioural change. Methods: 7 electronic databases will be searched (Maternal and Infant Care, CINAHL, Cochrane, PubMed, Medline, PsycINFO, EMBASE). Studies examining factors associated with parental responsive and non-responsive feeding of infants and children (<2 years) will be included. Papers collecting primary data, or analysing primary data through secondary analysis will be included. All titles, abstracts and full texts will be screened by two reviewers. Quantitative and qualitative data from all eligible papers will be independently extracted by at least two reviewers using pre-determined standardised data extraction forms. Two reviewers will independently assess the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). This review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA). Ethics and dissemination: Ethical approval is not required for this review as no primary data will be collected, and no identifying personal information will be present. The review will be disseminated in a peer reviewed journal

Dimensions 1994-95

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Barriers and enablers to Caregivers Responsive feeding Behaviour (CRiB): A mixed method systematic review protocol [version 1; peer review: awaiting peer review]

Background: Childhood overweight and obesity is a major public health issue. Responsive feeding has been identified as having a protective effect against child overweight and obesity, and is associated with healthy weight gain during infancy. Responsive feeding occurs when the caregiver recognises and responds in a timely and developmentally appropriate manner to infant hunger and satiety cues. Despite its benefits, responsive feeding is not ubiquitous. To better support caregivers to engage in responsive feeding behaviours, it is necessary to first systematically identify the barriers and enablers associated with this behaviour. This mixed-methods systematic review therefore aims to synthesise evidence on barriers and enablers to responsive feeding using the COM-B model of behavioural change. Methods: 7 electronic databases will be searched (Maternal and Infant Care, CINAHL, Cochrane, PubMed, Medline, PsycINFO, EMBASE). Studies examining factors associated with parental responsive and non-responsive feeding of infants and children (<2 years) will be included. Papers collecting primary data, or analysing primary data through secondary analysis will be included. All titles, abstracts and full texts will be screened by two reviewers. Quantitative and qualitative data from all eligible papers will be independently extracted by at least two reviewers using pre-determined standardised data extraction forms. Two reviewers will independently assess the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). This review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA). Ethics and dissemination: Ethical approval is not required for this review as no primary data will be collected, and no identifying personal information will be present. The review will be disseminated in a peer reviewed journal

World Allergy Organization (WAO) diagnosis and rationale for action against Cow\u27s milk allergy (DRACMA) guidelines update – X – breastfeeding a baby with cow\u27s milk allergy

Cow’s milk allergy is rare in exclusively breastfed infants. To support the continuation of breastfeeding an infant after diagnosis with a cow’s milk allergy, it is critical to examine the evidence for and against any form of cow’s milk elimination diet for lactating mothers. In this narrative review, we highlight the lack of high-quality evidence, hence subsequent controversy, regarding whether the minuscule quantities of cow’s milk proteins detectable in human milk cause infant cow’s milk allergy symptoms. Current clinical practice recommendations advise a 2–4 week trial of maternal cow’s milk dietary elimination for: a) IgE-mediated cow’s milk allergy only if the infant is symptomatic on breastfeeding alone; b) non-IgE-mediated associated symptoms only if the history and examination strongly suggest cow’s milk allergy; and c) infants with moderate to severe eczema/ atopic dermatitis, unresponsive to topical steroids and sensitized to cow’s milk protein. There should be a clear plan for home reintroduction of cow’s milk into the maternal diet for a period of 1 week to determine that the cow’s milk elimination is responsible for resolution of symptoms, and then subsequent reoccurrence of infant symptoms upon maternal cow’s milk reintroduction. The evidence base to support the use of maternal cow’s milk avoidance for the treatment of a breastfed infant with cow’s milk allergy is of limited strength due to a lack of high-quality, adequately powered, randomised controlled trials. It is important to consider the consequences of maternal cow’s milk avoidance on reducing immune enhancing factors in breast milk, as well as the potential nutritional and quality of life impacts on the mother. Referral to a dietitian is advised for dietary education, along with calcium and vitamin D supplementation according to local recommendations, and a maternal substitute milk should be advised. However, for most breastfed infants with cow’s milk allergy maternal cow’s milk dietary elimination will not be required, and active support of the mother to continue breastfeeding is essentia