Running Head: CLIENT PARTICIPATION AND QUALITY OF LIFE On-Campus Student Occupational Therapy Clinic’s Impact on Client’s Participation and Quality

The purpose of this study was to examine the impact of occupational therapy at an on-campus student clinic on clients’ activity participation and quality of life, as measured by the Activity Card Sort (ACS) and the World Health Organization Quality of Life-BREF measure (WHOQOLBREF). Data were collected on 6 participants for the ACS, and 8 participants for the WHOQOLBREF, at the beginning and end of a 10-week, 20-session treatment program. Pretest and posttest scores for the ACS current activity participation and WHOQOL-BREF Social Relationship Domain and Satisfaction with Life were statistically significant (p < .05). Physical Health, Psychological Health, and Environment subtests also increased, but not in a statistically significant way. The Cohen’s effect size value (d = 1.13) suggested very large practical significance on the WHOQOL-BREF for the Social Relationships Domain, moderate to large for Satisfaction with Life and Psychological Health, and small to moderate for overall Quality of Life (QOL). The Cohen’s effect size value (d = 0.83) on the ACS suggested a practical significance. The findings from this pilot study are promising and demonstrate that student occupational therapy may benefit activity participation and QOL of clients. Further research in this area is needed to confirm these results. 3 CLIENT PARTICIPATION AND QUALITY OF LIFE Participation in society, social relationships, hobbies and leisure, lead to good health and mobility, which allows people to enjoy life, and maintain control and independence (Gabriel & Bowling, 2004). When a person cannot perform familiar and valued activities, their sense of who they are is threatened (Robinson et al., 2009). Restrictions can result from the disease or trauma itself, the limitation of assistive equipment (e.g., a wheelchair limiting access to locations and making shopping and flying difficult), or prejudice of uninformed individuals believing certain activities cannot or should not be done by individuals with disabilities (Specht, King, Brown, & Foris, 2002). Patients now spend less time in the hospital after a life altering illness or accident. The length of stay for patients with a spinal cord injury has decreased from 98 days in the seventies, to 37 days thirty years later (Whiteneck et al., 2011). In twenty years, stays for patients who have experienced a stroke decreased from 10.3 to 5.5 days, and from 15.3 to 7.8 days for patients with Alzheimer’s (Center for Disease Control and Prevention, 2010). While these shortened hospital stays may be fiscally responsible and sufficient for basic medical needs, the potential for occupational therapy services is limited and therapists frequently do not have time to address participation beyond activities of daily living (ADL) and selected instrumental activities of daily living (IADL). Baum and Law (1997) found that if occupational therapy focused on occupational performance, and patients received more therapy, the patients overall cost to society decreased because they had increased skills and modifications to overcome barriers and were more independent. Similarly, Clark et al. (2011) found that when occupational therapy intervention is used it reduces health decline and promotes life satisfaction in senior citizens, leading to less health related costs. 4 CLIENT PARTICIPATION AND QUALITY OF LIFE Background Quality of life (QOL) is influenced by many factors. Wolf and Baum (2011) stated that quality of life was not being stronger or having better balance or coordination, but rather it was fulfilling life roles, such as having meaningful relationships, a job, leisure activities or being a good parent. When people no longer believe they are able to participate in pleasurable and/or necessary activities, they have reduced hope (Borell, Lilja, Sviden & Sadlo, 2001) and are more likely to be depressed (Brock et al. 2009). A substantial proportion of persons who have survived a stroke had depression and reported poor QOL (Haacke et al., 2006), even for those who had a mild stroke and minimal physical impairments (Edwards, Hahn, Baum, & Dromerick, 2006). It has been found that many persons who have experienced a stroke had lower health related quality of life scores and were dissatisfied with their inability to perform self-care, have a vocation, and enjoy leisure activities (Hartman-Maeir, Soroker, Ring, Avni, & Katz, 2007; Xie et al., 2006). Asche, Miller, Eng and Noreau (2008) found that all people tend to be less active as they age, and this was especially true for those with disabilities. Hartman-Maeir, Soroker, et al. (2006) found that participation in meaningful activities was a significant predictor of life satisfaction in people who had experienced a stroke. The International Classification of Functioning, Disability and Health (World Health Organization [WHO], 2001) states that participation is “involvement in a life situation.” A life altering illness or accident that results in a chronic disability may necessitate a major unanticipated shift in the roles of the patient, their family and support system without planning or preparation (Wolf, Baum & Connor, 2009). Albert, Bear-Lehman and Burkhardt (2009) found that adults over 70 years of age who had trouble with their ADL and IADL were only able to do 32% of their 5 CLIENT PARTICIPATION AND QUALITY OF LIFE previous activities, as measured on the ACS. The adjustment to this change was influenced by the person’s interests and supported by the “physiological, psychological, cognitive, sensory and motor capacities of the individual” (Wolf, et al., 2009, p. 622). Many people who had experienced a stroke had tried to resume activities but had not been successful due to their physical and cognitive disabilities, environmental factors, non-adaptability or lack of support from others, resulting in a need for their roles to change (Edwards et al., 2006; Mullersdorf, 2002; Robinson et al., 2009; Wolf & Baum, 2011). Occupational therapy is the health profession that is best suited to support participation in occupation. The goal of therapy is to use occupation to support health and participation in activities of daily living, instrumental activities of daily living, work, leisure, play and social participation (American Occupational Therapy Association, 2008). Clark (2010) calls on occupational therapists to help clients engage in activities that make life worth living. A mixture of training and activities designed to develop skills or learn adaptive strategies enable clients’ to fulfill their occupational roles (Baum & Law, 1997; Richards et al., 2005). Occupational therapy has benefited people with a wide variety of disabling conditions by increasing their skills, functions, activities and participation in a variety of settings (Doig, Fleming, Kuipers, & Cornwell, 2010; Macedo, Oakley, Panayi, & Kirkham, 2009; Maitra et al., 2010; Malcus-Johnson, Carlqvist, Sturesson, & Eberhardt, 2005; Murphy & Tickle-Degnen, 2001). Involvement in leisure activities provided participants mental and physical benefits by decreasing stress and increasing relaxation and enjoyment in life (Pressman et al., 2009). Participants had greater satisfaction than others with less severe impairments, after participating in a program that improved leisure activities (HartmanMaeir, Eliad, et al., 2007). People with mobility impairments who engaged in leisure, social activities and community participation, have reported better health and life satisfaction (Crawford, 6 CLIENT PARTICIPATION AND QUALITY OF LIFE Hollingsworth, Morgan & Gray, 2008). Many case studies indicated that reconnecting to a previous important leisure activity through occupational therapy had improved quality of life for the clients (Blacker, Broadhurst, & Teixeira, 2008; Reynolds, Vivat & Prior, 2007). For example, one occupational therapist helped a patient with neurological injuries with skilled interventions, modifications and adaptations that allowed him to reconnect to friends through the Internet and the patient ceased to be combative and agreed to leave his bed and engage in therapy (Blacker et al., 2008). An increase in skills and function has also led to an increase in quality of life for many patients (Dooley & Himojosa, 2004; Eyers & Unsworth, 2005; Hartman-Maeir, Eliad, et al., 2007; Henshaw, Polatajiko, McEwen, Ryan, & Baum, 2011; Trombly & Ma, 2002). Occupational therapists can facilitate clients in regaining or learning new skills, adapting to their current life and different abilities, and helping them find ways to perform valued and necessary tasks (Mullersdorf, 2002). Occupational therapists should go beyond clients’ immediate impairments to focus on their long-term health needs and life satisfaction (Baum & Law, 1997). The patients in a study by Wolf et al. (2009) reported that patients having the ability to do basic body care, get in and out of bed, and go to and from the toilet were discharged with few, if any, services, yet these patients lacked adequate preparation and skills to live a fulfilled life. Robinson et al. (2009) stated that patients who reported improved function in ADL, but still lacking sufficient skills to return to their prestroke life, perceived they had been discharged prematurely. Occupational therapists in rehabilitation units address basic ADL/IADL so the clients can care for themselves, and think that continued care will be available after the client leaves in patient rehabilitation (Richards et al., 2005), yet patients don’t always get more therapy. 7 CLIENT PARTICIPATION AND QUALITY OF LIFE Patients rarely have third party payment for occupational therapy beyond basic self-care training (Howard, 1991). University occupational therapy clinics, when available, can provide intervention for people with chronic diseases who are adapting to resulting disabilities in their home and community settings. Under the supervision of licensed occupational therapists, students in university-based clinics may provide low or no-cost occupational therapy to individuals in the community with unmet needs. Lavelle and Tomlin (2001) found improvement could be made during the post-acute phase for people who had experienced a stroke with occupational therapy student treatment. The improvement was not dependent on the participant’s age, site of stroke or time since the incident. This extended access to therapy also provides an opportunity to study the impact of occupational therapy, specifically on participation and QOL related to needs beyond ADL. Therefore, the purpose of the current study was to examine the impact of occupational therapy on activity participation and satisfaction for clients with chronic disabilities receiving occupational therapy at an on-campus clinic.