Survey Results Are In - Very Encouraging! A Little Statistical Background.

Over the last few weeks we have been trialing and tailoring our survey. I'd like to thank all the people who helped us by taking the survey. In the end we had a very good tool that participants praised as interesting and enjoyable.

Someday I'll tell you about our $49 lesson but right now I'll tell you of ALOFT's wonderful success.

First, a bit of statistical background. In order to make our survey results as generalizable to the public as we could we sought to have a stratified random sample. The factors we decided on were that we could accept a 5% error rate in the responses. Also we wanted a 95% confidence level, or only a 5% possibility that the results could be due to chance. We set our expected variance to require the maximum number of responses by setting it to 50% (as in equal chance a subject would pick one or the other). Then we wanted to generalize this to the population of the U.S.A. These mean that we would have a sample that would cover 304 Million (as of summer 2008) so we added many more and found we could cover the world's population with 385 subjects.

Then again we were only sampling people in the U.S.A. so we can really only generalize to the U.S.A. We went with the higher number to allow internally guided exclusion criteria and sampling methods to allow exclusion from certain aspects of the study based on background factors.

In the end we had 500 completed surveys with 87 partially completed or eliminated due to just randomly hitting the keyboard rather than answering. So, of the 500 we confirmed many of the intuitions we had had and learned several new and supportive things that we had been unable to quantify.

So far it is saying to us at ALOFT "keep going, this can be a very helpful and positive thing." We had several criteria for the study that would have indicated that we were on the wrong track, none of those were evident. We will be sharing different results from the study as we go along.

If you are interested in this data we are interested in sharing it with you in a meeting. We can setup online meetings if you would like to delve further into any results.

Look for our results in the coming days and weeks.

Yours,

Ed Kaine, OTR, RFT
Member and President of ALOFT

RegisteredFunctionalTherapist@gmail.com

How Language May Shape Our Thoughts.

Please check out this article in the July 9, 2009 Newsweek. What’s in a Word? Language may shape our thoughts. By Sharon Begley It has some very interesting insights into language and how people think about things.


I previously discussed this topic related to the use of our title, in particular asking whether we should use the O-Word (Occupation). The answer was and is, "yes". It allows us to expand the way we think about function. However; with this is a warning that the meaning of this word for most people is not what it is for an Occupational Therapist. What about the O-word?

The challenge is open to try to expand the definition of Occupation. It does not appear that this will be possible in this year or in the next few. I discussed this with a representative of Mirriam Webster's Dictionary and it was not possible. Let's get our definition in the Dictionary!


What does this mean for us? To me it means we need to consider the words we use to promote our profession and that it does matter whether people understand the word we are using.

With only a very limited definition of Occupation available to people how can we blame them for not understanding. It is up to us to reach out to the people. We can do this by using words that have positive meaning and capture the essence of what we do.

In the word "Functional" we have the basic idea of the way we work. We structure our treatments with a focus on the function task you must do. This may involve addressing the cognitive skills, the physical skills, the motivational and social skills that go into the task. Then the functional task itself, be it work, self care or leisure, is can be the focus of our treatment. It is the emphasis on doing something functional (not just fixing the structure) that Occupational Therapy has brought to the world. By using the protected title of Registered Functional Therapist we can more clearly help people understand how we can help them.

Functional versus Occupational on the Visual Thesaurus

It's something to think about.

Yours,

Ed Kaine, OTR, RFT
President of the League of Functional Therapists

Functional Therapy... the Next Generation of Occupational Therapy!

ALOFT Sponsors A Survey Of Health Care.

In our pursuit of real information about the state of understanding of various healthcare fields ALOFT has sponsored a survey. It is a general health care information survey and we would like you to take it.

There are 3 arms of the study and each will be handled differently (statistically speaking). We have a randomly selected group which is a stratified sample that may give us the best picture of the general population. There are particular people we have requested to take the survey and there's you. You represent the cutting edge of thought and the awareness of technology and the markets.

Please take our survey to help us tailor our services and positively influence health care.

Please follow this link here:
http://www.surveymethods.com/EndUser.aspx?C3E78B97C2819291

Thank you so much for your input. We appreciate your opinion and support.

Thanks so much,

Ed Kaine, OTR, RFT
President of ALOFT

P.S. If you have any questions, comments or suggestions please send them to us at ALOFTSurveys@gmail.com

A gift in a question... what have you always wanted to do?

We have long had "Patient Goals" on all our assessment documentation. We always ask patients what they want to acheive in their therapy. As an OT and RFT we would still get the most common answer "I want to be able to walk." Instead of ever being discouraged by this response (and especially if ambulation seemed like a distant possibility) I would try to get the functional aspects of why the patient wants to walk. The patient's goal would rapidly become "to be able to walk into the kitchen and make myself a sandwich" or up to "walk into the woods to sit by a stream". Then if ambulation was a long way off I'd see if there were a way to meet the functional need from another level, hence independent at wheelchair level could be more palatable. Again, if ambulation was appropriate and the functional barrier to the goal, it has always seemed that functional mobility is right up OT's alley.

I was reading a thread on the OTNow list about a particular patient's goals when I recalled an old lesson that I have incorporated many times since. When the patient cannot come up with any goal, or only states a raw task like walking with no functional reason for it, I've asked the more "bucket list" type question. "What is something you always wanted to do?" It had been put to me in university as "what is something you've always wanted to do before you die?" I haven't always used the weight of "before you die" but having it in my mind keeps me focused on what I want them to think about. What a gift if we can get someone out of ruminating on the physical limitations and seeing the possibilities.

In particular this has played out in patients with paraplegia/quadriplegia. Where the "I just want you to get me walking again!" can really turn into a new and positive direction if we open up this type of conversation. Also, having it can remind people that they always wanted to play an instrument or write a book.

We have so much to offer, sometimes it may just be a simple question that helps someone think about a future that isn't dealing with an acute illness or injury.

Yours,

Ed Kaine, OTR, RFT
President of the League of Functional Therapists
http:www.FunctionalTherapist.org

Functional Therapy... the Next Generation of Occupational Therapy!

A link to a nice summary of the SOAP note along with a comment from me about DAP notes.

http://metaot.com/quick-notes-note-writing-in-soap-notes#comment-29656

It's a nice article, very useful. The following was my explanation of the DAP note:

What do you think of DAP notes?

Our Inpatient Rehab has been using them for a long time and the Acute Rehab in the Hospital has been for about a year. It essentially melds the S and the O into a D... for DATA.

The DAP note then mixes the subjective comment into the objective thing you are saying. Here's an extreme example (for effect):

S: Patient states "It hurts." Patient states, "that feels better." Patent states, "I don't feel too good."

O: Patient reported pain on deep palpation of supraspinatus. Patient performed pendulum exercises followed by reaching and placing cans with internal and external rotation at abdomen level with relief noted above. Patient vomited right after they said line 3 above.

Instead of

Data: Patient reported pain on deep palpation of supraspinatus. Patient stated, "It's hurts." Patient performed pendulum exercises followed by reaching and placing cans with internal and external rotation at abdomen level, when asked how it felt patient stated "That feels better." On performance of a follow up deep palpation patient became pale, stated "I don't feel too good." and vomited.

Again, an extreme example, but it might help to anchor the benefit of the alternative note structure. DAP might not spell something that we wash with but it is useful. I contend that S and the O are only broken out that way because they spell SOAP... Does anyone know the history?

A and P (Assessment and Plan are the exact same as in the SOAP format). So it's:

D: Data

A: Assessment

P: Plan

Hope this helps in the pursuit of the perfect note.

Yours,

Ed Kaine, OTR, RFTPresident of the League of Functional Therapists

Website: http://www.functionaltherapist.org/

Blog: http://www.registeredfunctionaltherapist.blogspot.com/

email: RegisteredFunctionalTherapist@gmail.com

Functional Therapy... the Next Generation of Occupational Therapy!

Crucial Converstations Training being considered for League of Functional Therapists

Over the last 30 years an innovative company call Vital Smarts has done research to find skills for exceptional communication. It has been applied in particular to Health Care in several settings. At Maine General Hospital they found that the training alone improved care.

Check out: Crucial Conversations® Training Improves Patient Safety at Maine Healthcare System http://www.vitalsmarts.com/userfiles/File/pdf/case_studies/mainegeneral_health.pdf

Just by taking this training their hospital improved in all the following ways.

They took the training across the board and they saw massive improvements.

What could you do if you were a better communicator? How would your health care facility improve? How would your relationships in your work and in your life improve? Who wouldn't be better if they were better able to hold conversations where emotions were strong?

These skills are skills for life. We are considering offering this course for practicing and non-practicing RFT and RFTAs, and our supporter members. This may be in mid 2010 depending on interest. To let you know, the course could cost $995 is you were just taking this training. However; since you are members or considering membership we should be able to significantly reduce that price. We are in dialogue about it currently with Vital Smarts team.

We are very excited about the prospect of offering these life changing lessons to our membership. Let us know what you think about it.

Please check out http://www.vitalsmarts.com/ and http://www.vitalsmarts.com/crucialconversationstraining.aspx?id=frombanner to get more information on these exciting courses.

Yours,

Ed Kaine, OTR, RFT

President of the American League of Functional Therapists

RegisteredFunctionalTherapist@gmail.com

Functional Therapy... the Next Generation of Occupational Therapy!

Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

This is a very important article for patients anticipating or recovering from ICU stays. In this randomized controlled clinical trial, Occupational And Physical Therapists took ventillated patients through a course of functional tasks. In the process they had a trememdous impact on patient's lives.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60658-9/fulltext

This shows that it is not just about surviving. Healthcare has the technology to save your life, but it's therapy, and particularly "Functional Therapy", that cares about getting you back to a life of purpose and meaning.

Congratulations to the excellent teams at the University of Pennsylvania, University of Chicago and University of Iowa. The effort to take and confirm scientifically things we know (or think we know) intuitively is very appreciated.

Go Therapy, even in this critical and frightening time in a person's life, the worry that you are too sick to do therapy is turned on it's head. You might be too sick not to do therapy.

Yours,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists
http://www.functionaltherapist.org/

Functional Therapy... the Next Generation of Occupational Therapy!