We OTs rarely have the opportunity to see our interventions directly translate into extending our clients’ lives.
But, that is part of what makes this research so exciting, and why it has made such an impact.
This randomized control trial indicated that a breathlessness support program can significantly counteract breathlessness for those with an advanced disease. There was also a correlation with improved survival rates!
Patients in this study all had refractory (persistent/chronic) breathlessness on exertion or rest, and were receiving treatment for underlying conditions which included:
Advanced cancer
Chronic obstructive pulmonary disease (COPD)
Chronic heart failure (CHF)
Interstitial lung disease
Motor neuron disease
Where Does OT Fit in?
The interdisciplinary treatment included an outpatient clinic visit with respiratory medicine and palliative care, followed by a home visit by a PT and/or OT, where the therapist:
Assessed the need for walking and home aids, as well as any home adaptations
Reinforced the self management techniques learned during the home visit
Provided further guidance on pacing and exercises, including providing a educational DVD
Documentation Suggestion
Example language for the “assessment” portion of your evaluation:
The journal article, “An Integrated Palliative and Respiratory Care Service for Patients with Advanced Disease and Refractory Breathlessness 6” (The Lancet Respiratory Medicine, 2014) indicates that breathless support services can be effective in reducing breathlessness. Providing occupational therapy as part of an interdisciplinary team, as was provided in this randomized control trial, represents best practices for addressing breathlessness and has been proven to be effective.
What information/stories about working with clients with breathlessness would you like to share with fellow OTs?
Well this is the first time I’ve heard the term: “breathlessness mastery” how interesting…sounds like a yoga certification!
What’s super cool about this study is they published all of the supplementary materials so you can see exactly what was done and use it in your area too.
I’m trying to sorry out clearly what “care as usual” was though in this case. It appears that the intervention was basically additional care (a substantial amount too).
It’s always good to study added care to determine benefit (especially to argue costs) but there are probably few cases where more care and attention results in worse outcomes. I like to think that anyone who got access to a multidisciplinary program tailored to their health condition would benefit. Not to be a broken record, but what does OT add specifically here? Are we able to pull out some useful tidbits from the study?
Here’s a description of the OT role:
Occupational therapy input
ď‚· assessment of Activities of Daily Living (ADL)
(mobility/transfers, self-care and domestic ADL)
ď‚· assessment for aids and minor adoptions and referral for
provision of equipment
ď‚· wheelchair prescription
ď‚· education on planning, pacing and energy conservation
techniques to patients and carers
ď‚· referral to other community services (local/out of area), as
appropriate
ď‚· assess the need for social support and liaison with the BSS
social worker, as appropriate
ď‚· liaison with the BSS team regarding interventions and
feedback
The model here was cool because they used a combo PT/OT home visit. Does anyone have experience with that sort of set-up?
Hi @DevonCochrane, I’ve done a combo PT/OT home visit! From my point of view, I always found co-treats to be very effective… Unfortunately, I feel like the trend in the U.S. is to discourage them for reimbursement reasons. @Meredith Castin and I were just talking recently about writing an article in support of co-treats! I always feel like our colleagues in the UK are way ahead of us in the US on collaborations like this.
I love co-treating. I learned SO much as a clinician that way. When our hospital started saying we weren’t supposed to do them, they were wrong (you can co-treat in inpatient and bill for the whole session!) You can co-treat and both bill for the services in most settings, it turns out. But for some reason, management frowns on it, and I think that might be because they’re not confident about the rules, so they’re being cautious.
But when they started getting rid of those co-treats, I feel like treatment quality went down b/c therapists were too scared to get patients up and moving without support, and it also made so many of the therapists sad b/c we all enjoyed collaborating and learning.
Hi all, Thanks for calling out that they published all of the supplementary materials. That was cool to see. I’m eager to really see and use the London Chest Activity of Daily Living Questionnaire. I was not able to locate it.
I’ll admit I have often been overwhelmed by the magnitude of research in the past so this is helpful to get to debrief it together.
I do have a concern about how often OT is lumped in with PT (and vice versa) AND also understand each discipline’s unique value that is ALSO intertwined. Does the frequency of combining them (even on referrals) only feed a blurred role and understanding of the distinct and potent value of each of them? (But that’s a conversation for a whole different article/post, lol.)
As for this exact set up of care, I do not have experience. But doing OT in home health, this study resonates. I mostly find use of adaptations in the activity (such as drying off with a hand towel vs full body towel), using adaptive equipment and pacing. This article already helps me think bigger and broader such as offering more/practicing a planning exercise and scoping out more/specific community options for referrals.
I often sense a time crunch with clients (knowing there is often a stack of clients waiting for home health OT evals especially). This being said, I often feel inclined to get them baseline education and application so that I can see and work with other new clients. I wonder if I’m cutting them short. I’d be curious, especially for those in home health, how to balance giving the extra 1-2 visits for deeper and wider application of these strategies and principles (mentioned in the OT role) versus discharging due to making myself available for more acute-need patients.
How do we OTs especially in home health balance giving THE best (i.e. hitting all the bullets listed above) when giving the best may mean someone who has a more acute need isn’t seen? This is a true dilemma for many home health OTs.
One idea is to offer all the options in layman’s terms(energy conservation during your daily routine, planning your daily routine, reviewing community resources, teaching the basic principles of energy conservation/pacing, assessing each piece of mobility aid, assessing for a w/c adjustment/prescription) to the client and ask them for their top 2-3 areas of interest. Start with those.
@monika it is so good to have you in here! This is exactly what I dreamed the club would be about, getting to dive into content with OTs that I respect and admire. I agree, it would be SWEET to give clients a handout of our skills and let them choose what is the most important to them. Maybe this is a handout we need to work on
Oh! And if you click through the link in the summary to the LCADL, you can open the PDF of the article and see the questions from the scale in the summary. I am going to search this week though to see if I can find the scoring instructions. Stay tuned…
