de Lange Laura, Coyle Emma, Todd Helen, Williams Cylie
Domiciliary Care Service, Peninsula Health, Frankston, Victoria, Australia.
Peninsula Health, Frankston, Victoria, Australia.
Aust Occup Ther J. 2018 Apr;65(2):107-114. doi: 10.1111/1440-1630.12443. Epub 2018 Jan 5.
BACKGROUND/AIM: Home modifications maintain people's functional independence and safety. No literature exists to guide the prescription of home modifications for clients with bariatric care needs. With Australia's increasing obesity rate, more evidence is needed to support home modification prescribers. This study aimed to map Australian home modification prescribing practices for clients with bariatric care needs and to establish and evaluate a clinical resource for this prescription process.
The study included two phases. Phase 1 conducted a cross-sectional survey of therapists practicing in Australia, and Australian industry partners who prescribe or install home modifications for clients with bariatric care needs. Phase 2 included design, implementation and evaluation of a clinical resource. Data were analysed with means and frequencies; multivariable regression analysis was used to explore prescribing habits.
Therapists surveyed (n = 347) reported 11 different bariatric weight definitions. Less than 3% constantly or regularly prescribed home modifications for these clients; rails were most commonly prescribed. Many therapists (n = 171, 58%) 'never' or 'rarely' knew rail load capacity. Therapists' knowledge of rail load capacity was associated with previous experience prescribing home modifications (P = 0.009); rail manufacturer's advice (P = 0.016) and not using advice from builders (P = 0.001). Clinical resources were used by 11% (n = 26) of therapists to support their prescription, and industry sporadically relied on therapists to specify modification design requirements (n = 5, 45%). Post-implementation of a clinical resource increased consensus regarding understanding of the term bariatric and increased consultation with builders and manufacturers.
There was a lack of consistency in bariatric terminology, uncertainty of rail load capacities and minimal use of clinical practice guidelines. Additional resources will assist with consistency in prescribing practices to maximise occupational performance for clients with bariatric care needs.
背景/目的：家庭改造可维持人们的功能独立性和安全性。目前尚无文献指导为有肥胖症护理需求的患者开具家庭改造处方。随着澳大利亚肥胖率的上升，需要更多证据来支持家庭改造处方开具者。本研究旨在梳理澳大利亚为有肥胖症护理需求的患者开具家庭改造处方的实践情况，并建立和评估这一处方流程的临床资源。
该研究包括两个阶段。第一阶段对在澳大利亚执业的治疗师以及为有肥胖症护理需求的患者开具或安装家庭改造设施的澳大利亚行业合作伙伴进行了横断面调查。第二阶段包括临床资源的设计、实施和评估。数据采用均值和频率进行分析；多变量回归分析用于探究处方习惯。
接受调查的治疗师（n = 347）报告了11种不同的肥胖症体重定义。不到3%的治疗师经常或定期为这些患者开具家庭改造处方；扶手是最常开具的项目。许多治疗师（n = 171，58%）“从未”或“很少”了解扶手的承重能力。治疗师对扶手承重能力的了解与之前开具家庭改造处方的经验（P = 0.009）、扶手制造商的建议（P = 0.016）以及不采用建筑商的建议（P = 0.001）有关。11%（n = 26）的治疗师使用临床资源来支持他们的处方，行业偶尔依赖治疗师来指定改造设计要求（n = 5，45%）。临床资源实施后，对肥胖症一词的理解达成了更多共识，并增加了与建筑商和制造商的咨询。
肥胖症术语缺乏一致性，扶手承重能力存在不确定性，临床实践指南的使用极少。额外的资源将有助于处方实践的一致性，以最大限度地提高有肥胖症护理需求患者的职业表现。
