Best Practices
Integrating Meaningful Activity Experts into Clinical Care: A Role for Occupational Therapy
Benjamin E. Canter, BA; Amy M. Linsky, MD, MSc
Mr. Canter (bcanter@bu.edu ) is an Occupational Therapy Doctoral (OTD) Candidate at the College of Health & Rehabilitation Sciences, Sargent College, at Boston University. Dr. Linsky (Amy.Linsky@va.gov ) is an associate professor of medicine at Boston University Chobanian and Avedisian School of Medicine and a clinician-investigator in the Section of General Internal Medicine; the Center for Healthcare Organization and Implementation Research; and the Geriatric Research, Education, and Clinical Center at VA Boston Healthcare System.
Age-friendly care prioritizes patient quality of life, which can address one or more of the 5Ms: Mind, Mobility, Medications, Multicomplexity, and What Matters Most. A 2021 JAMA Internal Medicine report delineates that meaningful activities cultivate feelings of purpose or satisfaction and are essential to older adults’ well-being.1 Participation in activities that matter most to patients can occur despite physical or mental health challenges.
Occupational therapists and occupational therapy assistants (collectively, occupational therapy professionals [OTPs]) specialize in promotion of meaningful activity engagement and are optimally situated to collaborate with other clinicians to improve health outcomes. However, one of the largest barriers to successfully integrating OT in primary care settings is low understanding of its value.2 This article defines the role of OTPs as specialists in meaningful activity and discusses benefits of integrating OTPs into clinical care.
Occupational Therapy: Mission, Scope, and Practice
Using a biopsychosocial approach, OTPs help patients increase, maintain, or recover ability to engage in meaningful activities by addressing function, motivation, and independence. OTPs work in numerous settings, including acute care, long-term care, ambulatory, and home-based care. Ensuring that physicians and other practitioners understand OT’s scope of practice, clinical domains, and processes will allow effective interprofessional team collaboration.
Patient-centered OT practices are evidence-based and effective in promoting physical and mental health, decreasing pain, and improving social function.3 The hallmark OT expertise is in occupational analysis (i.e., understanding the physical, mental, and cognitive demands of activities and observing potential areas for modification) and adaptation (i.e., designing environmental, personal, or activity-specific modifications). Thus, OTPs promote engagement in activities that are completable and safe for the patient, yet physically and cognitively challenging enough to allow meaning to be derived.
OTPs can assess and modify home environments to address needs so patients with disabilities or illnesses may successfully live in their own homes without need for institutionalization. For an older adult with declines in balance, this may mean adapting the home environment (e.g., adding grab bars, removing tripping hazards). For someone with dementia, an OTP might provide guidance on cognitive strategies to improve performance in complex activities (e.g., sticky notes, repetition of statements). For an older adult with serious mental illness, an OTP may observe the patient’s interpersonal behaviors and provide strategies encouraging socialization. Individuals engaged in meaningful activities with the assistance of an OTP can have improved physical, mental, and emotional health outcomes compared to those engaging in meaningful activities without OT involvement.3 Primary care clinicians concerned about a patient’s ability to participate in and derive benefit from meaningful activities should consider referral to OT for evaluation and treatment.
Some activities become engrained as habits, and some habits (e.g., tobacco use, unhealthy eating) are associated with worse health outcomes. OTPs specialize in determining the meaning behind these habits through a nuanced understanding of activities’ complexities and examination of patients’ personal and environmental factors. They can provide tailored treatment by prescribing interventions for behavior modification. For example, cognitive-behavioral techniques can be used if eating is a coping mechanism and nutrition-literacy techniques (e.g., reading food labels) can address knowledge deficits.
Integrating Occupational Therapy into Clinical Care
As activity experts, OTPs have a strong background in functional cognition and movement. Their unique therapeutic approach can enhance efforts by physicians and other healthcare professionals to integrate patient purpose into goals of care, improving quality of life. Integrating OT into clinical care may reduce workload and time pressures for physicians. This is particularly applicable to time-intensive processes, such as improving treatment adherence and reducing unhealthy behaviors, where OTPs can work with patients to make healthy adjustments to unhealthy activities. Clinicians in primary care and subspecialties may see patients only a few times per year or may not have time or expertise in behavior change to identify the meaning behind specific unhealthy habits. OTPs often can see patients more regularly and are situated to support lifestyle habit changes. Expanding interprofessional delivery of care where OTPs promote necessary behavior change can allow all clinicians to practice to the top of their license, delivering comprehensive care to patients.
Occupational therapy practitioners can also work with individuals using a preventive approach, mitigating risk of future bodily pain and physical and mental health declines.3 Preventing functional decline decreases need for caregiving and other social services (e.g., prepared meal delivery). Thus, physicians should strongly consider OT referrals, even for relatively healthy patients.
As primary care, geriatrics, and other medical specialties adopt age-friendly principles of care, with explicit inclusion of and emphasis on what matters most to patients, OTPs can contribute to improving health outcomes. Occupational therapy professionals are meaning-making healthcare experts who help patients flourish through purpose-filled activity. SGIM members are encouraged to consult with OTPs and capitalize on their unique and tailored expertise to better integrate meaningful activities into patient care.
References
Oh A, Gan S, Boscardin WJ, et al. Engagement in meaningful activities among older adults with disability, dementia, and depression. JAMA Intern Med. 2021 Apr 1;181(4):560-562. doi:10.1001/jamainternmed.2020.7492.
Halle AD, Mroz TM, Fogelberg DJ, et al. Occupational therapy and primary care: Updates and trends. Am J Occup Ther. 2018 May/Jun;72(3):7203090010p1-7203090010p6. doi:10.5014/ajot.2018.723001.
Clark F, Azen SP, Zemke R, et al. Occupational therapy for independent-living older adults: A randomized controlled trial. JAMA. 1997;278(16):1321-1326.
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