Hello All:
What follows are thoughts and opinion about using occupation as *THE*
goal for OT treatment.
Here's is the premise for my arguments:
(1) When occupation is *THE* goal, outcome statements may be written in
concise occupation-based outcomes. For example:
Patient will safely and independently ambulate to/from toilet
with RW and perform all hygiene without assistive equipment.
Patient will transfer from w/c to bed using slide board
transfers
Patient will dress self using adaptive equipment as necessary
(2) Conversely, when occupation is not *THE* goal, outcomes may be
written so that occupation is a desired outcome but is based on
improving underlying impairment(s). For example:
Patient will increase UE elbow ROM to 115 degree active flexion
to all for donning/doffing of shirt
Patient will increase standing endurance/balance to allow them
to safely and independently carry out toileting hygiene.
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Some argue there is little difference in the above approaches. However,
I believe these approaches frame patient problems very differently. This
is important because how we frame a problem drives our treatment.
The first example clearly identifies that occupation is the goal. There
is no expressed concern for underlying factors impairing occupation.
However, and this if often overlooked, it is IMPLIED that all factors
impairing the goal will be treated within the therapist's abilities.
This is true because occupation includes the following factors:
Physical, emotional, mental environmental, behavioral, social
Thus, as OT's and within our scope of practice, occupation-based
outcomes address all factors impairing the desire occupations.
While the second example does include occupation as an outcome, only
factors addressed in the goals are included for treatment. This severely
limits treatment and in my opinion indicates that remediation of
underlying impairments is the real goal. The implication is that if
underlying impairments are remediated, occupation will improve. However,
is inconsistent with OT theory because occupation is ALWAYS more than
physical. In my opinion, the second example is much more like a PT
rather than an OT goal!
In closing, writing occupation-based goals is important for us and for
the patient. These goals allow us to focus on occupation's many elements
and complexity to best enable our patients.
Thanks,
Ron
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Ron Carson MHS, OT
www.OTnow.com
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