Adult Learning and Employment Opportunities for Older Workers in Australia and the United States: Lessons for Adult Education

This study examined the role community colleges (U.S.) and Technical and Further Education (TAFE; Australia) institutes play in providing educational opportunities to older workers in the U.S. and Australia. Employment for adults of all ages has been impacted by job automation in recent decades. We analyzed national level data to estimate the impacts of job automation by age group. In both the U.S. and Australia, about 65% of older workers in sales occupations are at risk for job loss due to automation. Additionally, we reviewed occupational projection data and employment opportunities for workers who may be displaced by automation. Needs for health care support occupations, such as nursing assistants and occupational and physical therapy assistants are expected to grow rapidly. We will provide several recommendations based on the integration of our findings related to education/training programs and the aging workforce in the context of community colleges and TAFEs.

Are Stakeholder Prioritized Post-Acute Care Practices Documented and Do They Improve Outcomes?

The receipt and intensity of rehabilitation services, such as occupational and physical therapy, have been associated with lower risk of readmissions. Yet, little is known about the care. This study quantified the frequency of documented post-acute care (PAC) stakeholder-prioritized practices and their associations with hospital readmissions. A PAC stakeholder advisory board (e.g., physicians, rehabilitation providers across settings) prioritized key practices to evaluate. Medicare claims and electronic medical records were used to construct an episode of care for patients age 65 or older. Eligible patients were discharged from one of nine acute hospitals to a PAC setting (i.e., inpatient rehabilitation, skilled nursing, home health) within one large health system between August 2016 and August 2018. Descriptive statistics characterized the cohort and frequency of documented practices. Logistic regression examined associations among the practices and readmissions, by setting. Stakeholders prioritized (a) education, (b) cognition assessment and treatment, and (c) medication management. Among these PAC patients (n=3,227) there was variation in documentation for each practice by setting. Documentation of medication management at any point during the stay ranged from less than 1% to 54% of patient stays among settings. There was a significant relationship between the practices and readmissions. Within inpatient rehabilitation, every additional day patient and caregiver education was documented by occupational therapy was associated with 21% lower odds of readmission (p<0.05). This study highlights the variability in documentation of stakeholder-prioritized practices across PAC and their associations with readmissions. Future work is needed to enhance the systematic delivery and documentation of these practices.

The effect of forearm position on elbow flexion strength in nursing, occupational, and physical therapy students

BACKGROUND: Novice nurses, occupational and physical therapist’s injury rates are alarming. OBJECTIVE: To test for differences in peak elbow flexion forces (PEFF) by profession using different forearm positions. METHODS: Entry-level RN, OT, and PT students performed 3-repetitions of standing PEFF in forearm supination, pronation, and neutral. A one-way repeated measures ANOVA determined the forearm position with the greatest PEFF. A one-way ANOVA assessed differences in PEFF between professions. The alpha level was set at p≤0.05 for all analyses. RESULTS: Thirty 30 RN, 25 OT, and 30 PT students (x = 23.27 + /–3.29 yrs.) were studied. A one-way repeated measures ANOVA revealed a significant difference in PEFF between positions (F(2,168) = 144.3, p < 0.0001). A significant (p < 0.0001) pairwise comparison revealed neutral produced the greatest (28.15 + /–12.64 kg) and pronation the least PEFF (17.27 + /–7.40). PEFF was significantly different between position by profession (supination: F(2,82) = 10.14, p < 0.0001; pronation: F(2,82) = 10.33, p < 0.0001; neutral: F(2,82) = 13.39, p < 0.0001). PTs were significantly stronger than OTs and RN students in all forearm positions (p < 0.01). CONCLUSIONS: Neutral PEFF was greatest and PT students demonstrated greater PEFF than OT and RN students.

Occupational and physical therapy for pain in pediatric clients

Occupational therapists (OTs) and physical therapists (PTs) are rehabilitation therapists with distinct but complementary roles who contribute to pain assessment and management in young people either as solo providers, or as a critical component of the interdisciplinary treatment team. Pain in infants, children, and adolescents interferes with their ability to engage in essential interactions with caregivers, acquisition of developmental milestones, and with participation in activities related to self-care, leisure, play, school, and work. OTs and PTs use specific treatment strategies, such as positioning, splinting, adaptive equipment, exercise, manual therapy, electrophysical agents, education on energy conservation, joint protection strategies, and pain self-management training to facilitate participation in valued life activities and occupations. This chapter provides an overview of important theoretical frameworks for rehabilitation therapists, reviews evidence for OT and PT interventions, and describes a framework for planning procedural pain management for rehabilitation therapists when working with pediatric clients.

Rapid Implementation of Telerehabilitation for Pediatric Patients During COVID-19

The COVID-19 pandemic necessitated a sudden limitation of in-person outpatient occupational and physical therapy services for most patients at a large, multisite pediatric hospital located in the Midwest, United States. To ensure patient and staff safety, the hospital rapidly shifted to deliver most of these services via telerehabilitation. The purposes of this study were to (1) describe the rapid implementation of telerehabilitation during the COVID-19 pandemic, (2) describe the demographic characteristics of patients who continued in-person services and those who received telerehabilitation, and (3) evaluate the therapists’ perceptions of telerehabilitation for physical and occupational therapy. Most of the children (83.4% of n=1352) received telerehabilitation services. A family was more likely to choose to continue in-person visits if their child was <1-year-old, had a diagnosis of torticollis, received serial casting, or was post-surgical. Occupational and physical therapy therapists (n=9) completed surveys to discern their perceptions of the acceptability of telerehabilitation, with most reporting that telerehabilitation was as effective as in-person care.

Occupational and Physical Therapy Strategies for COVID-Related Guillain-Barré Syndrome: A Case Report (Preprint)

UNSTRUCTURED Background and Purpose: While several reports have described the diagnosis and treatment of patients with COVID-19 associated Guillian-Barré Syndrome (GBS), there is a paucity of literature describing the occupational and physical therapy strategies used in the long-term acute care hospital (LTACH) setting to rehabilitate these patients. Case Description: A 61 year-old male was admitted to an LTACH for the rehabilitation of GBS following COVID-19 infection and intravenous immunoglobulin treatment. Intervention: Rehabilitation in the LTACH setting uses a variety of skilled treatment interventions to meet patient driven goals and maximize their function to the highest level possible in preparation of their discharge to a subacute or homecare setting. In this case, this was accomplished through individual occupational and physical therapy sessions, occupational and physical therapy co-treatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. Outcomes: With the occupational and physical therapy standard of care, the patient’s improvement was demonstrated by several outcome measures including manual muscle testing, range-of-motion, grip-strength, and the Activity Measure for Post-Acute Care. The patient was successfully rehabilitated and returned to the community after presenting with COVID-19 associated GBS. Discussion: This report highlights the complex rehabilitation needs patients require to regain independence after diagnosis of COVID-19 associated GBS.