Building consensus on prescribing self-directed occupational therapy activities: A Delphi study

Background

Occupational therapy practice focuses on occupation-based interventions, considering the interaction between the person, environment, and task. In Australia, combining supervised therapy with self-directed practice is feasible, even for health-care consumers with cognitive impairments. This study aims to explore the self-practice programs developed by occupational therapists and delivered in inpatient rehabilitation and develop core recommendations for such interventions.

Methods

Ethical approval for this Delphi consensus study was granted by Monash University Human Research Ethics Committee. The study involved an online survey and two focus groups with Australian occupational therapists. Participants were recruited via snowball sampling and required to meet specific experience criteria. Content analysis was used to analyse data, and consensus was reached on core recommendations for prescribing self-practice in inpatient rehabilitation.

Consumer and community involvement

Occupational therapists who prescribe self-practice to health-care consumers were the community of interest and directly involved in the Delphi consensus process to inform study findings. Consumers using self-practice activities were not included in the study.

Results

In Round 1 of the Delphi process, 21 occupational therapists participated in an anonymous online survey about prescribing self-practice in inpatient rehabilitation. The survey identified key recommendations across various categories. Round 2 focus groups further refined these recommendations, and Round 3 achieved consensus, incorporating additional feedback and suggestions for implementing self-practice programs. It found variability in implementation, with neurological and general rehabilitation health-care consumers most likely to receive self-practice tasks.

Conclusion

This Australian study explored how occupational therapists prescribe self-practice during inpatient rehabilitation. The study emphasised the importance of clinical reasoning and environmental factors, offering recommendations to guide goal-focused, client-centred self-practice interventions for better health-care consumer outcomes.

PLAIN LANGUAGE SUMMARY

We looked at occupational therapists in Australia. We wanted to know how therapists gave self-practice activities to people. Our focus was on people in recovery hospitals. People do self-practice activities without a therapist. People do these activities outside therapy sessions. This study used a survey and focus groups. Skilled therapists agreed on ideas for self-practice. The results showed differences in self-practice methods. Self-practice is common in stroke and general recovery. The study gave self-practice tips for therapists. It included what, how, and why they prescribe these activities. Therapists should think about each person's goals. They should understand what helps self-practice. We know what therapists are doing. We support therapists to include self-practice programs in regular care.