| Summary: | 博士 === 國立臺灣大學 === 職能治療研究所 === 104 === Background: Occupational therapy knowledge (OTK) refers to important knowledge about occupational therapy (OT) for clients and their families. However, there are few comprehensive OTK educational materials and corresponding OTK tests suitable for patients with stroke and their families. A lack of OTK educational materials and corresponding tests may lead to difficulties in providing OTK education tailored to patients and families’ OTK level and discrepancies in treatment goals among patients with stroke and their families and occupational therapists, which may hamper patients’ participation in OT and patients’ functional recovery.
Purposes: There were three purposes of this study: (1) to develop an OTK framework and educational topics for patients with stroke and their families, (2) to develop OTK educational materials and corresponding OTK tests according to the OTK educational topics, (3) to investigate the effects of tailored OTK education.
Methods: This study involved 3 sub-studies. Sub-study 1. Development of a comprehensive OTK framework and educational topics: Delphi methods were applied to collect OT experts’ opinions to develop the OTK framework and educational topics. Sub-study 2. Development of OTK educational materials and tests: the comprehensive OTK educational materials were developed in response to the topics in Sub-study 1. The appropriateness, the content related to life after stroke, and the readability were respectively confirmed by OT experts, patients with stroke and their families, and grade 7 students and analyzed with the Chinese Readability Index Explorer (CRIE). The OTK tests were developed corresponding to the materials. The relevance between materials and tests was confirmed by OT experts and grade 7 students. Sub-study 3. Investigation of effects of tailored OTK education: Patients with stroke and their families were enrolled and randomized into two health education groups: tailored OTK education and stroke knowledge (SK). Primary outcomes were the participants’ OTK test score and patients’ engagement in OT programs. Secondary outcome was the patients’ performance in activity of daily living (ADL).
Results: Sub-study 1: The OTK framework contained three domains (core value of OT, places of OT service, and laws related to OT service), and a total of 38 OTK educational topics were developed. Sub-study 2: forty-six OTK educational materials were developed. The appropriateness of the content was determined by 3 OT experts, and relevance to life after stroke were determined by 40 patients with stroke or their families. The readability was determined by 18 grade 7 students and the CRIE (readable for students in grades 1 to 6). The OTK tests were developed to contain 56 items and were highly related to the OTK educational materials. The 18 grade 7 students determined the OTK tests to have good readability and had significant improvement in the accuracy rates of the OTK tests (from 0% to 50-70%). Sub-study 3: Forty-nine patients with stroke or their families participated and 31 of them (53.4%) were lost to follow up after 1 week. The OTK group showed a significantly greater improvement in OTK level than the SK group (large effect size, partial η2 >0.48), but small effect on OT engagement (partial η2=0.02-0.04). Furthermore, the OTK group showed greater improvement in ADL performance than the SK group (large effect, partial η2>0.14) when participants were patients.
Conclusion: A comprehensive OTK framework, educational topics, educational materials and tests were established. After receiving tailored OTK education, the participants had large improvements in the scores of OTK test. However, the effects of tailored OTK education on patients’ OT engagement and ADL performance were limited. Further research investigating the effects of OTK education are suggested to decrease the number of patient''s lost-to-follow-up to yield more convincing results.
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