In her practice as an occupational therapist, Diana Feldhacker, Ph.D., O.T.D., OTR/L, BCPR, LSVT-BIG Certified, has witnessed the positive impact of occupational therapy on patients’ lives. The chair of Des Moines University’s doctor of occupational therapy department and director of the program has further demonstrated that impact with recent systematic reviews published in the American Journal of Occupational Therapy. The bimonthly peer-reviewed medical journal published by the American Occupational Therapy Association is considered the premier journal for occupational therapy research.
Feldhacker led two teams across multiple institutions to summarize available primary research to inform practitioners, stakeholders and researchers. The first review was a sizeable two-part study of the literature published between 2009 and 2019 on the Improving Medicare Post-Acute Care Transformation Act of 2014. The researchers stated that the act “continued a growing movement toward quality- and value-based care, which is care that cuts costs while providing safe and effective intervention.”
Defining O.T.’s Impact on Outcomes
One of the IMPACT Act’s primary aims, passed into law as an amendment to Title XVIII of the Social Security Act, was to standardize post-acute care assessment data to improve the quality of services and facilitate payment and discharge planning. In part one of their review, she and her research colleagues addressed three outcome areas: prevention and reduction of falls, facilitation of community discharge and reintegration, and prevention of hospital readmission.
“We reviewed the evidence on what occupational therapy practitioners are currently doing to address these three areas of this act, highlighting strengths and ideas for future research,” the authors stated in the article. “Occupational therapy interventions aiming to help clients reduce or prevent falls, navigate discharge and reintegrate into the community, and avoid hospital readmissions will support clients’ occupational participation and improve their health outcomes, ultimately securing the value and worth of the occupational therapy profession now and into the future.”
In part two of the review, Feldhacker and her colleagues focused on three other outcome areas of the IMPACT Act: functional status, medication reconciliation and skin integrity. They found evidence to support occupational therapy interventions that align with value-based measures in the three areas.
“The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients and payers,” they stated in the article.
O.T. Telehealth Shown to Benefit Patients
In another review published in the American Journal of Occupational Therapy, Feldhacker and her research colleagues examined the effectiveness of telehealth interventions. They reviewed peer-reviewed articles, published between 2009 and 2019, that included an occupational therapy intervention delivered via telehealth.
“Given a need to provide services using this service delivery method, especially for clients in rural or underserved areas or who have difficulty accessing OT services, we sought to inform practitioners about which interventions can be effectively provided via telehealth and for which conditions,” she says. “Though initiated before COVID-19, this is increasingly relevant for today’s practitioners. We have actually begun a subsequent review of the available evidence from 2019 to 2023 to update our findings.”
In the articles they reviewed, telehealth services were used to address a variety of occupational performance issues, including those related to strength, balance, pain, cognition, mobility, motor control, dexterity, educational performance, quality of life, activities of daily living, caregiver stress, depression, fatigue and overall activity participation and occupational performance, among others. They found evidence to support that occupational therapy interventions delivered via telehealth are similarly effective as those delivered face-to-face, especially for neurological and pain conditions.
“This review was unique in considering the breadth of interventions and outcomes within occupational therapy’s scope of practice, including health promotion, disease prevention, and other wellness strategies,” the researchers stated in the article. “Overall, positive outcomes were found within groups for most occupational therapy interventions provided via telehealth.”
In their review articles, Feldhacker and her fellow authors called for “continued advocacy for the value of occupational therapy” and further research.
The Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association has granted DMU’s new O.T.D. program candidacy status. It will enroll its first class this August.
