Development of the Occupational Therapy Stroke Arm and Hand Record: An Upper Limb Treatment Schedule

Abstract

This study aimed to develop a comprehensive occupational therapy treatment schedule of upper limb interventions for stroke survivors with reduced upper limb function. Method: In a three-phased qualitative consensus study, 12 occupational therapists from acute and community settings in North West England contributed to interviews and subsequently group discussions to design and pilot a treatment schedule. Interview data were analysed using thematic analysis; the themes were used to develop a framework for the schedule that was supported by and reflected the International Classification of Functioning, Disability and Health framework. A draft schedule was the subject of a focus group and the resultant schedule was piloted in clinical practice by eight local occupational therapists working in neurological rehabilitation. Findings: Consensus was reached on three themes summarizing aspects of function: interventions that address preparation for activity, functional skills (that is, an aspect of function), and function. Three additional themes summarized other aspects of therapy: advice and education, practice outside therapy sessions, and psychosocial interventions. These themes became the main headings of the treatment schedule. The Occupational Therapy Stroke Arm and Hand Record treatment schedule was piloted and found to be comprehensive and potentially beneficial to clinical practice. Conclusion: The Occupational Therapy Stroke Arm and Hand Record treatment schedule provides a tool for use in stroke research and clinical practice.

Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice

“…A further limitation of this study is that we developed and used yet another treatment schedule. Although several robustly designed schedules for the hemiplegic arm exist today (e.g., Donaldson et al, ; Jarvis & Reid, ), these schedules were not designed to be used by both PTs and OTs nor were they based on a universally comparable system such as the ICF. Having monitored details about intensity (level of resistance and number of repetitions) during our study would also have been helpful, and for future research, we therefore suggest to adhere to the recently introduced Template for Intervention Description and Replication (TIDieR) checklist (Hoffmann et al, ).…”

“…Although research into treatment duration does offer some insight into the highly heterogeneous content of conventional arm physiotherapy (PT) and occupational therapy (OT) after stroke, duration alone is inadequate in determining treatment dose and composition (Ballinger et al, 1999). Therefore, more knowledge about the content of PT and OT during treatment sessions (relating to, e.g., goals and activities, treatment time, detailed schedule, and intensity) is necessary in order to replicate interventions (Hoffmann et al, 2014), to provide insight into the specific types of interventions (Hunter, Crome, Sim, Donaldson, & Pomeroy, 2006;Jarvis & Reid, 2014) and their characteristics that influence treatment success (Ballinger et al, 1999;Parry, Lincoln, Appleyard, & Words, 1999;Tyson & Selley, 2004;DeJong, Horn, Conroy, Nichols, & Healton, 2005). Further, treatment type and dose are considered potential sources of variability to be included in predictive models (Stinear, 2010).…”

“…Although several PT and OT treatment schedules exist today (Tyson & Selley, ; Donaldson, Tallis, & Pomeroy, ; Jarvis & Reid, ) and some data about the specific content of PT and OT for the hemiplegic arm have been published previously (Ballinger et al, ; Horn et al, ; Jette et al, ; Richards et al, ; Askim et al, ), these reports offer very little or indistinct detail about the interventions used. Comparison between the available studies is also hindered, because the recording tools used were based on different classification systems or underlying frameworks such as bespoke intervention codes (Ballinger et al, ; Richards et al, ), or physiotherapy practice guides (Jette et al, ).…”

Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

“…Some have reported the content of therapy for the upper limb used in clinical trials,9 10 but treatments delivered as part of a clinical trial may not necessarily reflect therapy routinely delivered in clinical practice. Similarly, others have developed upper limb treatment templates to standardise therapy in research trials11–13 however these templates seek to guide therapy or categorise current treatment, and so do not describe routine clinical practice. Several researchers have observed the number of repetitions, time given to and overall dose of therapy occurring during clinical therapy sessions for the upper limb10 14–16 and others have observed and recorded the time spent on activities while staying in rehabilitation facilities 17–21.…”

The Effects of Virtual Reality on Upper Limb Function in Chronic Stroke Patients: A Clinical Trial

“…Each of the mentioned disabilities might occur in anyone. Therefore, improving upper limb impairments is a fundamental aim of any rehabilitation program, specially for occupational therapists who specifically work on promoting upper limb function in daily living activities [5][6][7].…”