Developing and Implementing an Occupation-Based Practice Service Delivery Model for Stroke Survivors in a Rural Thai Community Rehabilitation Center: Mixed Methods Feasibility Study.

چکیده اصلی

BACKGROUND: Occupation-based practice (OBP) has been demonstrated to enhance occupational performance and goal attainment in stroke rehabilitation. However, existing evidence is predominantly derived from hospital-based settings, with limited investigations into OBP implementation in community contexts. In Thailand, particularly in rural areas, there remains a need to establish effective OBP service delivery models and to evaluate their outcomes across diverse client populations receiving community-based rehabilitation services. OBJECTIVE: This study aimed to develop an OBP service delivery model for community-based stroke rehabilitation in the Doi Lor community, Chiang Mai Province, Thailand, and to evaluate its effects on occupational performance, goal attainment, and quality of life among community-dwelling stroke survivors. Additionally, the study explored the occupational therapist's experience and perceptions of implementing the model, particularly the practicality of implementation in long-term community-based occupational therapy services. METHODS: This study used an embedded mixed methods feasibility design comprising a 1-group pretest-posttest intervention study and a qualitative descriptive interview. An OBP service delivery model for community-based stroke rehabilitation was developed based on the Dynamic Model of Occupation-Based Practice; the Occupational Therapy Practice Framework, Fourth Edition; and evidence-based stroke rehabilitation principles. The model was implemented by a trained occupational therapist with 7 stroke survivors at a rural community rehabilitation center over 14 sessions spanning 7 weeks. Quantitative outcomes were assessed before and after the intervention using the Canadian Occupational Performance Measure, goal attainment scaling, and the World Health Organization Quality of Life-Brief Version. Qualitative data were collected through a semistructured interview with the occupational therapist to explore experiences of implementing the OBP service delivery model. RESULTS: In the quantitative analysis, participants demonstrated statistically significant improvements in occupational performance and satisfaction as measured by the Canadian Occupational Performance Measure (P=.02), higher levels of goal attainment on the goal attainment scaling (P=.02), and improved overall quality of life as assessed by the World Health Organization Quality of Life-Brief Version (P=.02). Qualitative findings from the occupational therapist interview indicated 2 themes, including facilitating client-centered outcomes through OBP implementation and enhancing professional confidence and supporting the practical implementation of OBP in community-based practice. The occupational therapist described the model as practical and feasible and reported increased confidence in delivering occupation-based interventions. The findings also highlighted the potential applicability of the model within long-term, community-based occupational therapy services. CONCLUSIONS: This preliminary study suggests that an OBP service delivery model grounded in therapist preparation, client-centered goal setting, and outcome-focused intervention may support improvements in occupational performance, goal attainment, and quality of life among stroke survivors receiving community-based rehabilitation. This approach may contribute to strengthening long-term stroke care, particularly in rural communities where access to hospital-based rehabilitation services is limited.

ترجمه فارسی چکیده

هدف این مطالعه توسعه یک مدل ارائه خدمات مبتنی بر شغل (OBP) برای توانبخشی سکته در سطح جامعه در منطقه دوی لور، استان چiang مای، تایلند و ارزیابی اثر آن بر عملکرد شغلی، دستیابی به اهداف و کیفیت زندگی بازماندگان سکته در منزل بود. همچنین تجربه و دیدگاه‌های فیزیوتراپیست در مورد پیاده‌سازی مدل و کاربرد آن در خدمات توانبخشی روستایی درازمدت بررسی شد. این مطالعه از طراحی امکان‌سنجی روش ترکیبی شامل مطالعه مداخله‌ای پیش‌آزمون-پس‌آزمون گروهی و مصاحبه توصیفی کیفی استفاده کرد. مدل بر اساس مدل پویای OBP، چارچوب عملکرد فیزیوتراپی، نسخه چهارم و اصول توانبخشی سکته مبتنی بر شواهد توسعه یافت. این مدل توسط یک فیزیوتراپیست آموزش‌دیده در ۱۴ جلسه در ۷ هفته با ۷ بازماندگان سکته در یک مرکز توانبخشی روستایی اجرا شد. شاخص‌های کمی قبل و بعد از مداخله با استفاده از معیار عملکرد شغلی کانادا، مقیاس دستیابی به اهداف و نسخه کوتاه کیفیت زندگی سازمان جهانی سنجیده شدند. نتایج کیفی از مصاحبه با فیزیوتراپیست نشان‌دهنده دو موضوع شامل تسهیل نتایج متمرکز بر مشتری از طریق پیاده‌سازی OBP و ارتقای اعتماد حرفه‌ای و حمایت از پیاده‌سازی عملی OBP در عملیات مبتنی بر جامعه بود. فیزیوتراپیست مدل را عملی و ممکن دانست و اعتماد بیشتری در ارائه مداخلات مبتنی بر شغل گزارش کرد.

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