Academic journal article British Journal of Occupational Therapy

Older Adults' Experiences of Occupational Therapy Predischarge Home Visits: A Systematic Thematic Synthesis of Qualitative Research

Academic journal article British Journal of Occupational Therapy

Older Adults' Experiences of Occupational Therapy Predischarge Home Visits: A Systematic Thematic Synthesis of Qualitative Research

Article excerpt

Background

Predischarge occupational therapy home visits are routinely performed with older adults in Europe (Mountain and Pighills 2003, Nygard et al 2004), Australia (McEneany et al 2002, Mitchell and Unsworth 2004) and North America (Lysack and Neufeld 2003, Neufeld and Lysack 2004). The primary aim of home visits is to facilitate a timely, safe and successful discharge from hospital and to add to the total picture that therapists have of the patient in the real world (Durham 1992, Roughton 2004, Watson 2004).

Traditionally in the United Kingdom (UK), the predischarge occupational therapy home visit process involves taking older adults to their home for a short period of time and assessing their ability to perform activities of daily living within their own environment. Published research has focused on the practice of home visits, such as the number of visits or the seniority of therapists. No systematic reviews have specifically explored the effectiveness of predischarge home visits for older adults, although two systematic reviews about occupational therapy home visits have been published (Patterson and Mulley 1995, Barras 2005). The first systematic review, conducted by Patterson and Mulley (1995), set out to determine the effectiveness of predischarge home visits from a variety of settings. The second systematic review was conducted by Barras (2005), who aimed to collate and assess occupational therapy literature regarding occupational therapy home visits and to identify the reported outcome measures. Barras (2005), rather intriguingly, stated in the title that she conducted both a systematic and a critical review of the literature. However, it is neither one nor the other since it is more a description of the outcomes of the research papers and included both predischarge and postdischarge home visits and interdisciplinary studies. Similarly, Patterson and Mulley (1995) included studies that occurred in different environments, for example within the community or with different client groups, such as stroke patients. Most of the studies that are included in the review are concerned with the rationale for the home visit or about the home visit process (for example, Clarfield 1982, Andrews 1985, Rosenblatt et al 1986, Clark and Gladman 1995). In addition, Patterson and Mulley (1995) do not acknowledge the methodological weaknesses of the studies. Both Barras (2005) and Patterson and Mulley (1995) do make explicit the inclusion/exclusion criteria and/or whether predischarge home visits influence the health and wellbeing of patients.

Establishing older adults' experiences from users' perspectives is an important component of determining whether predischarge home visits are an effective intervention. The aim of this qualitative systematic thematic synthesis was to gather and critique published and unpublished literature regarding older adults' experiences and perceptions of predischarge home visits.

Method

As the authors wished to review literature that considers clients' perspectives and their experiences of predischarge home visits, it was appropriate that the qualitative literature be reviewed. Qualitative research has become increasingly popular within health and social care practice, especially occupational therapy, because it generates data that can facilitate the understanding of clients' experiences of their health condition and also of their health care provision (Carpenter 2004). With such an increase of interest in qualitative research, and also the need to involve users' perspectives in policy and service development, the demand on therapists has increased to incorporate qualitative research findings into their practice (Carpenter 2004). There has been a developing interest in a systematic method of review (or synthesis) of qualitative research and a growing recognition of the importance of incorporating qualitative evidence into systematic reviews (Dixon-Woods et al 2006, Cochrane Collaboration 2007, Thomas and Harden 2007). …

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