Date of Award

2020

Document Type

Scholarly Project

Degree Name

Master of Occupational Therapy (MOT)

Department

Occupational Therapy

First Advisor

Anne Haskins

Abstract

Background: Home programs (HPs) are an important part of the rehabilitation experience and are regularly recommended by occupational therapy practitioners (OTPs) and other rehabilitation clinicians for continuation and supplementation of care, to address a client’s continual needs at home and in the community (DeForge et al., 2008; Donoso Brown, & Fichter, 2017; Emmerson et al., 2017; Picha, & Howell, 2018; Proffitt, 2016). Home programs created by rehabilitation professionals for clients typically include therapeutic exercises, activities, and lifestyle behavior modifications to compliment treatment and/or discharge recommendations. Issuing home programs is an established standard of care to help clients meet targeted client goals and outcomes (Proffitt, 2016). The data in the literature suggests that rates of adherence to rehabilitation home programs are lower than acceptable ranging from 40-70% across various populations (DeForge et al., 2008; Donoso Brown, & Fichter, 2017; Emmerson et al., 2017; Picha, & Howell, 2018; Proffitt, 2016). According to the World Health Organization (2003), adherence is considered a key factor influencing treatment effectiveness and optimal client outcomes, especially when considering lifestyle interventions. Adherence is a complex and multifactorial issue, which may explain why it goes largely unaddressed by practitioners due to the many associated barriers of healthcare systems, providers, and clients (WHO, 2016). Currently, literature is limited regarding occupational therapy’s role in assessing and addressing barriers to home program adherence.

Purpose: The purpose of this scholarly project was to develop a user-friendly guide and toolkit designed for rehabilitation practitioners to therapeutically “tackle” the complex, multifactorial challenges and barriers associated with a client’s adherence to HPs, many of which are potentially modifiable with targeted interventions (Picha, & Howell, 2018).

Methods: The contributing developers of this product conducted an extensive literature review to determine: (1) current use and prescription of HPs in rehabilitation; (2) barriers and facilitators of adherence to HPs; (3) current use of adherence tools used in rehabilitation; and (4) best practice principles for promoting adherence for HPs.

Conclusion: The results of the literature review guided the development of the product, the Home Program Adherence Tackle Box. The Home Program Adherence Tackle Box contains client centered strategies and critical guiding resources that OTPs, and other clinical rehabilitation enthusiasts, can use to skillfully facilitate client adherence to home program recommendations to enhance one's function and occupations in life. This themed booklet includes evidence-based strategies and intervention resources to help efficiently guide rehabilitation professionals in holistically promoting HP adherence. It includes the development, collection, and organization of a multitude of relevant "tackle tools.

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