Department of Occupational Therapy

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Influencing functional outcomes: a look at role performance and satisfaction with life following liver transplant
(2008-09) Scott, Patricia J.; Misra, Vijay Laxmi; Mangus, Richard S.; Tector, A. Joseph; Lacerda, Marco A.; Vinayek, Rakesh; Munsch, Linda; Musick, Beverly; Kwo, Paul
Abstract 572 The success of orthotopic liver transplantation (OLT), originally measured as survival, now extends to quality of the life saved. Return to work (RTW) is also a desired outcome. Our AIM was to explore the relationship between 5 pre-OLT factors & 5 post-OLT quality of life (QOL) domains with life satisfaction and primary productive role to better understand how to improve both. METHODS: Patients (pts)1-3 yrs post-OLT filled QOL form during follow-up clinic visits between 7/04 to 6/05. The Liver transplantation Database-Quality of life (LTD-QOL) form yielded data on 5 domains: measure of disease (MOD), psychological distress/well-being (PDW), personal function (PF), social/role function (SRF) & general health perception (GHP). Results: 229 pts were first categorized as satisfied overall with life (79%), or dissatisfied, and then assigned to groups based on primary productive role (51%), no primary productive role, or retired. Pre-OLT variables were age, gender, marital status, education, & etiology of liver disease; HCV (33%), alcohol liver disease (ALD)(11%), HCV+ALD (10%), & others (46%). Marital status & age were not significantly related to the outcome variables. Etiology of liver disease, education, and time since OLT and 5 post-OLT QOL domains were significantly associated with both outcome variables; satisfaction and primary productive role (p<.0001).To understand the differences, the 5 physical & men-tal QOL domains were regressed on primary productive role and satisfaction. Pts (mean age 54 yrs (19-74 yrs), males, 70%) fell into the category of primary productive role rates (51%). Pts transplanted for ALD were significantly (p<.05) more likely to be satisfied with life, whereas individuals with HCV±ALD, had lowest satisfaction and were most likely to be unable/uninterested in work. Stepwise logistical regression analysis of satisfaction demonstrated that GHP and SRF correlated most highly. Although satisfaction was significant in bivariate analysis, regression analysis of the influence of domains of QOL, as well as employment, demonstrated that SRF & GHP correlated most highly with life satisfaction. CONCLUSIONS: SRF and GHP correlate with good QOL post OLT. HCV patients have low levels of satisfaction whereas the highest level of satisfaction is in the ALD group. Further studies should address methods to improve satisfaction in those with HCV.
Pancreas Transplantation: Personal Factors Associated with Good and Poor Post-Transplant Adaptive Response
(2013-05) Scott, Patricia J.; Krause, Audrey; Samiran, G.; Taber, T.; Fridell, J.
Notable differences in patient adaptation after pancreas transplant cause some to thrive and return to independent living, while others struggle with emotional and social problems. In order to prepare vulnerable individuals to better cope after transplant, we investigated pre-transplant factors associated with post-transplant adaptive capacity. The pancreas transplant team de ned; good adaptive response (GAR) in patients who were responsible, resourceful, and optimistic. Poor adaptive response (PAR) was associated with patients who tended to complain and were emotionally dependent. METHODS: Experts included 3 nurse coordinators and 3 social workers. A modified Delphi approach was used to achieve consensus on the de nition of GAR and PAR. 200 of the last transplanted pancreas recipients were selected if they: received a pancreas transplant for type 1 DM, with, or without a kidney, and survived a minimum of six months post-transplant. The experts classified cases into GAR and PAR, contextualized by confidence. We completed a chart abstraction of all 200 cases using pre-transplant data and the extracted variables were regressed on the 54 top weighted GAR cases and the top 40 weighted PAR cases. RESULTS: In the final model, past smoker, currently on disability, simultaneous pancreas and kidney (SPK), and less than high school education significantly predicted probability of having a PAR (p<0.05). The model was a well-fitting model with a Hosmer and Lemeshow goodness of  t test of (p=0.8250 < 0.05). Given the lack of inclusion of any of the predicted social variables for PAR patients we looked at predictors of GAR. The goodness of fit test was a well-fitting model (p= 0.6294 < 0.05). In addition to pancreas after kidney (PAK) having an odds ratio of 10.39, past smoker was 10.99 and current disability was 5.8. Discussion: The association of PAK with GAR and SPK with PAR suggests a possible effect from prior experience with transplant aiding in coping afterwards. Our findings support the need for a prospective study of coping with pancreas transplant and points to more intensive pre-transplant preparation of recipients, particularly those with lesser education.
Fatigue as Reported at 12 Time Points during the First Year Post-Liver Transplant
(2013) Scott, Patricia J.; Krause, Audrey; Tector, A. Joseph; Kwo, Paul
BACKGROUND: Although liver transplantation has evolved as an effective procedure, fatigue remains a post-transplant complaint [1]. As yet, there are no published accounts of the experience of fatigue at temporal intervals during the first post-transplant year, and this information would benefit LT candidates in recovery planning. Van Ginneken [2] found that time since transplant was not associated with physical fatigue and reduced activity, but was associated with albumin levels less than 25g/l and with lower GFR. METHODS: Data used in this study were collected through an ongoing, longitudinal, prospective design. Results presented here are for fatigue and biometric data at 12 data points starting one week post hospital discharge, continued weekly for the first 8 weeks, then monthly at 3, 6, 9, and 12 months. RESULTS: We sampled 30 subjects: 19 (70.4%) male and 8 (29.6%) female, age 55.4 ± 9.8 years. A mixed models analysis of variance was done to investigate a change in FACIT over time. The initial model included age, MELD, sex, week, albumin, ALT, BILI T, and CREAT. The final model included age, BILI T, and week. Increasing age and BILI T were associated with greater fatigue (p=0.0376 and p=0.0005, respectively). There was significant decrease in fatigue over time (p<0.0001). Pair-wise comparisons were done to determine which weeks significantly differed. Tukey’s adjustment for multiple comparisons was used. Figure 1 indicates which visits significantly differed. DISCUSSION: Our subjects experienced decreased fatigue over time. The data set was rich with prospectively collected longitudinal information helpful for establishing realistic expectations for post-transplant fatigue. Finding include early weeks of recovery (weeks 2-3) differ from weeks 7+ and that there is no significant change after 3 months, up to one year. No association was seen with Albumin levels although total bilirubin and age were associated with greater fatigue.
Progressive resistance strength training for improving physical function in older adults
(Wiley, 2009-07-08) Liu, Chiung-ju; Latham, Nancy K.; Occupational Therapy, School of Health and Rehabilitation Sciences
Liu, C., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. The Cochrane Database of Systematic Reviews, (3), CD002759. http://doi.org/10.1002/14651858.CD002759.pub2
Using the role checklist version 2: Quality of performance
(2014) Aslaksen, Maya; Scott, Patricia J.; Haglund, Lena; Ellingham, Brian; Bonsaksen, Tore
For several decades, occupational therapy researchers have collected data about clients’ role performance with the Role Checklist, a widely used assessment tool, which collects self-reported information about clients’ roles. The Role Checklist includes two parts; Part 1 gathers data about role incumbency and Part 2 gathers data about role value. In 2008, Part 3 for the Role Checklist was developed to address occupational role performance, specifically prompting clients to rank the quality of their current role performance compared to their highest prior level. This reflects the client perspective of occupational participation corresponding to the performance capacity component of MOHO; thus establishing the Role Checklist Version Two: Quality of Performance (RC V2: QP). This paper illustrates by a case example how a therapist used the recently translated RC V2: QP in a psychiatric hospital setting in Norway in order to determine the extent to which the RC V2: QP supports the goal setting process as well as the therapist-client experience to verify subjective feasibility. It was reported that use of this instrument to guide the clinical interview was a positive experience for both the client and the therapist. The client had an opportunity to reflect upon his roles and how he would like to change them. The occupational therapist experienced that the interdisciplinary team working with this patient gradually developed a more comprehensive understanding of the patient’s challenges and resources. The RC V2: QP provided a basic set of information about the patient’s roles that was useful for setting treatment goals.
Does the Role Checklist Measure Occupational Participation?
(2015-07-01) Bonsaksen, Tore; Meidert, Ursula; Schuman, Deana; Kvarsnes, Hildegunn; Haglund, Lena; Prior, Susan; Forsyth, Kirsty; Yamada, Takashi; Scott, Patricia J.; Department of Occupational Therapy, IU School of Health and Rehabilitation Sciences
Peer Observation and Evaluation Tool (POET): A Formative Peer Review Supporting Scholarly Teaching
(2016-07-01) Crabtree, Jeffrey L.; Scott, Patricia J.; Kuo, Fengyi; Department of Occupational Therapy, IU School of Health and Rehabilitation Sciences
The Modified Role Checklist as a cross-culturally valid measure of participation?
(2016-06) Meidert, Ursula; Scott, Patricia J.; Bonsaksen, Tore; Fenger, Kristjana
Presented here is the work of the International Role Alliance for Participation. Its mission is to establish the Role-Checklist v2 (RCv2) as a cross-culturally valid measure of occupational participation consistent with the ICF. Included are 4 abstracts: feasibility of translation procedure; results from a survey examining role examples and their association with occupational participation; role examples for an ICF-linkage; and finally development of a scoring system.
The 4th International MOHO Institute: Summary and Reflections
(2015) Nakamura-Thomas, Hiromi; Van Antwerp, Leah R.; Ikiugu, Moses N.; Scott, Patricia J.; Bonsaksen, Tore
The 4th International Institute on the Model of Human Occupation (MOHO) was held October 23-24, 2015 at Indiana University-Purdue University in Indianapolis, USA. The title of the institute was: Reaching Out: Application of MOHO in Academic-Practice Partnerships.
Clinical Applications of the Role Checklist Version 2: Quality of Performance
(2015-10) Bonsaksen, Tore; Scott, Patricia J.
The three-part Role Checklist Version 2: Quality of Performance (RC V2: QP) assesses role performance, role valuation, and current compared to past functioning. This session will illustrate by two different case examples how occupational therapists can make use of the RC V2: QP to support the clients’ process in diverse clinical settings: 1) In a psychiatric hospital setting with mental health clients, and 2) upon discharge from a medical setting to track recovery with transplant clients.

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