Therapy Groups in a Physical Rehab Setting

Sophie Kennish

OT Student

Presentation Outline

• Theory of groups• Benefits of groups on Alder

Ward (my opinions)• Effectiveness of group

interventions – evidence• Mental Wellbeing and Older

People• ‘Lifestyle Matters’• Baking group – evidence

and clinical reasoning• Aim/purpose of survey• Findings of survey• Discussion questions

Theory of Groups

• The Group Work Applied Frame of Reference (Hagedorn 2001)

• The group process in itself is a dynamic and potent therapeutic medium

• Activity focus as a means of facilitating the group process (only)

• Assessing deficits in communication, personal appearance and cultural appropriateness

• Opportunities to initiate and sustain appropriate and effective interactions with other individuals

• Taking account of the needs and experiences of every group member

What do the groups offer which other interventions do not?

• Social interaction – communication, understanding

• Peer support (Finlay 1997)• Activities which are

‘normalised’ and age appropriate

• Complex cognitive tasks, not requiring so much physical effort

• Meaningful activity for rehabilitation practice (eg upper limb movement)

• Opportunities for further assessment (motor and process skills)

• Enjoyment!

Are group interventions effective?

• Benefits of group intervention vs lack of individualised treatment.

• Example – Exercise for Falls Prevention– Exercise in groups should not be discouraged as a

means of health promotion, but there is little evidence that exercise interventions that were not individually prescribed for community-dwelling older people are effective in falls prevention (NICE 2005)

– Stepping On (a small group learning falls prevention intervention based on a CBT approach) is effective at reducing falls (Clemson et al 2004)

– What about other outcomes (Quality of life, fear of falling, depression/anxiety)?

Mental wellbeing and older peopleWe should:1. Offer regular group and/or individual sessions to

encourage older people to identify, construct, rehearse and carry out daily routines and activities that help to maintain or improve their health and wellbeing

2. Increase older people’s knowledge and awareness of where to get reliable information and advice on a broad range of topics.

3. Offer tailored exercise and physical activity programmes in the community

4. Offer a range of walking schemes of low to moderate intensity with a choice of local routes to suit different abilities

(NICE 2008 Mental wellbeing and older people) - Community

Lifestyle Matters

• ‘Lifestyle Matters’ Programme fosters peer support and ‘ownership’ of activities (Craig et al 2007)

Evidence:• Qualitative interviews showed individualised benefits

experienced by the participants, with greater self-efficacy being a significant theme

• Quantitative comparison (pre- post- intervention) showed an upward trend on all dimensions of quality of life (including depression), but not cognitive symptoms.

• More Research required (RCTs)(Mountain et al 2008)

Baking Group - Reflection

• Opportunity for Daily routines and activities

• Sensory experiences • Reminiscence opportunities• Expressing choice

(Polatajko 1992)

• Difficulties with space / facilities

• Appealing only to women?• Pt satisfaction data• Outcome measurement –

valid?

Evidence for Baking Interventions

• Lack of evidence base for effectiveness in any setting• Baking is a culturally appropriate activity: cooking and

baking is something older people enjoy doing despite activity restrictions caused by health (Bruzelius & Teng 2010).

• Baking is meaningful: In an acute mental health setting, the participants perceive the value of the baking group, in terms of it being both a meaningful activity, and also a productive experience (Haley & McKay 2004).

• Baking has an end product: Participants work significantly longer on a chosen activity when the end-product could be kept (or consumed), and rated themselves significantly more self-determined and competent after performing the activity (Murphy et al 1998).

Aim of my ‘study’/Survey

• Qualitative study to explore people’s perspectives about the use of Occupational Therapy groups on the ward

• Research Questions:– Do patients enjoy participating in groups, and see the benefit of

attending groups?– Do therapy and nursing staff see the benefit of patients attending

groups?– Is priority given to group interventions, compared with other

rehab interventions (access visits, equipment etc)?– How could groups be improved, from everyone’s perspective?

• Methodology – Data from pt satisfaction questionnaires, surveys and interviews with a selection of Therapy staff, Nursing staff and patients.

Survey Questions

Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree

• The groups give patients an opportunity to socialise with other patients

• The groups are a part of patients' physical rehabilitation• The groups provide distraction for patients• The groups are part of patients' cognitive and social

rehabilitation• The groups are an assessment opportunity for staff• The groups are as important as other interventions by

therapy staff• The groups provide structure to the day and the week

Findings and conclusions from study

• Don’t know yet!

Discussion Questions• Are the groups an important part of the rehabilitation process?• Do patients enjoy the groups so much that they don’t want to leave?• Are we reluctant to carry out groups which others see as ‘fun’ and a

‘distraction’ rather than therapeutic? Or interventions with a traditional (feminine) OT focus (eg baking, basket-weaving)?

• Can theory / evidence from community/care home settings be applied successfully to a ward physical rehab setting?

• Do we have the time to assess and intervene in leisure occupations in preparation for discharge? If not, why not?

• How should we be addressing common mental health issues (ie cognitive decline, anxiety, lack of motivation) with our patients?

• What do you think about the lack of evidence base of many rehabilitation interventions?

References• Berenbauma R (1995) Cooking as Therapy with the Confused Elderly. Activities,

Adaptation & Aging, Volume 19(1); 53 – 60• Bruzelius & Teng 2010 I feel well even though I have illnesses. Elderly people’s

thoughts on everyday life – a pilot study. Gothenburg University Publications Electronic Archive Available http://gupea.ub.gu.se/handle/2077/21786 accessed Jun 2010.

• Clemson et al (2004) The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. J Am Geriatr Soc 52:1487–1494, 2004

• Finlay (1997) Groupwork in occupational therapy Cheltenham : Stanley Thornes, 1997• Hagedorn (2001) Foundations for practice in occupational

therapy. Edinburgh : Churchill Livingstone   • Haley L.; McKay E.A. (2004) 'Baking Gives You Confidence': Users' Views of Engaging

in the Occupation of Baking. The British Journal of Occupational Therapy, 67(3) pp. 125-128(4)

• Mountain et al (2008) Occupational therapy led health promotion for older people: exploring the feasability of the Lifestyle Matters programme. BJOT 71(10), 406-13

• Murphy S, Trombly C, Tickle-Degnen L, Jacobs K (1998) The effect of keeping an end product on intrinsic motivation. American Journal of Occupational Therapy, 53(2), 153-58.

• NICE (2008) Mental wellbeing and older people, Quick Reference Guide http://www.cot.co.uk/MainWebSite/Resources/Document/PH16QuickRefGuide.pdf