Functional Transfers in Acute Care: How Occupational Therapists Assign Performance Levels

PURPOSE: The purpose of this study was threefold: to understand the procedural reasoning acute care occupational therapists and occupational therapy assistants use to evaluate functional transfers, to understand how they choose performance levels, and to understand how they instruct students in this process. Currently, there is little evidence-based instruction that informs students and clinicians how to evaluate functional transfers and apply performance levels (e.g., minimal assistance). The results are intended to be used to improve student teaching both didactically and clinically.

METHOD: A mixed methods survey was completed by 106 occupational therapists (92%) and occupational therapy assistants (8%) working at least part time in an acute care setting. Practitioners were recruited via email using the university clinical educator database targeting acute care sites across the United States. The survey was also posted on the occupational therapy department social media site. Practitioners responded to an electronic survey developed by the researchers containing both closed- and open-ended questions. The survey was piloted with acute care occupational therapists to improve clarity. The survey included basic demographics and questions related to procedures used when evaluating transfers. Respondents were asked to watch a video of a patient being transferred and to apply a performance level with supporting rationale. Data analysis included descriptive and inferential statistics and qualitative analysis of open-ended questions.

RESULTS: After watching the video of a patient transferring with a therapist, 101 participants assigned widely variant performance levels, including contact guard (2%), minimal assistance (20%), moderate assistance (59%), maximal assistance (18%), and other (1%). Seventy-five participants focused primarily on the actions of the therapist rather than the abilities or impairments of the patient when describing the procedural reasoning used to support their chosen performance level. Practitioners who were currently or had previously been certified in administering the FIM® demonstrated no greater consistency in their application of a performance level. Half (51%) of respondents indicated they found teaching students how to evaluate transfers challenging, with many stating the process is very subjective. FIM-certified therapists reported no greater confidence in teaching students. A majority (89%) indicated that they had learned the process from a clinical educator and not in occupational therapy school.

CONCLUSION: These findings suggest that there are significant inconsistencies in the process used for evaluating functional transfers in acute care settings. These inconsistencies are perpetuated during the process of student instruction in the clinical setting; participants reported that training was challenging and subjective. Key occupational therapy textbooks, including Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (Pendleton & Schultz-Krohn, 2013), teach the process of transferring but do not address how to evaluate the transfer. This can lead to inconsistencies in didactic teaching of this important skill. Doucet (2014) challenged occupational therapy researchers to design objective, quantifiable instruments to measure function. These results may be used as foundational knowledge for future research and the development of assessment tools.

IMPACT STATEMENT: The inconsistencies highlighted in this study may result in decreased patient safety and inappropriate intervention planning, goal setting, and discharge. The results highlight the urgent need for the development of assessment tools to increase consistency in the transfer evaluation process.

References

Doucet, B. M. (2014). Quantifying function: Status critical. American Journal of Occupational Therapy, 68, 123–126. https://doi.org/10.5014/ajot.2014.010991

Pendleton, M. H., & Schultz-Krohn, W. (Eds.). (2013). Pedretti’s occupational therapy: Practice skills for physical dysfunction (7th ed.). St. Louis, MO: Mosby/Elsevier.