A study of occupational therapy and activity pacing with older adults who are inpatients at a rehabilitation hospital.

Activity pacing has been defined as the regulation of activity. For the purpose of this research, activity pacing will be operationalized as seven activity pacing techniques which include - 1. Use self-monitoring to listening to your body 2. Use short regular rests during the day and during activities 3. Find a sustainable baseline and then gradually increase activity 4. Break tasks into manageable parts 5. Plan tasks and set goals 6. Alternate high energy tasks with low energy tasks 7. Prioritise tasks and delegate where able Occupational therapy with activity pacing will include- a. An occupational performance review and the establishment of occupational performance goals-involves the standard occupational therapy initial assessment where a patient’s past and current occupational performance (personal, domestic and community) is reviewed and goals are determined to enable the patient to return to their home environment and participate in their previous lifestyle (30 mins at admission to the hospital) b. Occupational therapy interventions to achieve goals as directed by the treating occupational therapist- will be variable depending on the goals of the patient but could include occupational therapy assessment and interventions (facilitating the occupation/person/environment balance, education, service provision, equipment prescription) in the areas of personal care, domestic tasks (meal preparation, housework, gardening, laundry etc.), community tasks (shopping, leisure, banking, etc.), work, driving and a home assessment. (Variable session length depending on goals set-4-7 hours, across the whole length of stay which could be 10-14 days) c. An initial individual education session about activity pacing and how this technique can be used to improve participation in daily occupations. The session will be conducted using a standard iPad presentation and the content of the session will include what is deconditioning, what is a reconditioning program, what is activity pacing is and the activity pacing technique. The patient will be given an activity pacing education booklet and orientated to the information in the booklet. The booklet is for the patient to keep and read in their own time (30 mins, second day after admission) d. Five group sessions with the aim of building the level of participation, confidence and independence in occupation through the use of the activity pacing techniques in everyday tasks. Four sessions will be activity based and each day will focus on different activity pacing technique as follows: Day One-Use self-monitoring to listening to your body Day Two-Break tasks into manageable parts and use short regular rests during the day and during activities Day Three-Find a sustainable baseline and then gradually increase activity and plan tasks and set goals Day Four-Prioritise tasks and delegate where able and alternate high energy tasks with low energy tasks One of the group sessions will be conducted as a group education session where the activity pacing techniques are reinforced. The use of the activity pacing techniques will be generally applied to different occupations. The education will refer to the booklet that was given in the individual activity pacing education session. The group education session will follow a structured format (power point presentation) and will encourage group discussion and problem solving about independence in daily occupations (5 hours over 5 days, three or four days after admission) e. A final individual session reviewing the activity pacing intervention and how this applies to the patients usual daily occupations in hospital and in their home environment. Occupation based handouts are used to reinforce the use of the activity pacing techniques in occupations post discharge. Individualised agreed instructions for use of the activity pacing techniques will be written on these handouts. (30 mins, day before discharge) Total number of OT sessions: between 12-15 times Resources: patients will be provided with an Activity Pacing booklet and occupation based Activity Pacing handouts related to tasks done in their own environment Adherence will be recorded attendance at each of the above sessions