Case study:

16 October 2011

Occupational therapy: assessment, care planning and review

---

Key points

---

Hillary* knew she probably had lung cancer and had an extensive history of chronic obstructive pulmonary disease (COPD) that had limited her activities of daily living (ADLs) for many years. She was uncertain about the future but was concerned more by her worsening shortness of breath and the impact this had on her function and life than by her probable new diagnosis.

Her clinical specialist occupational therapist (OT) assessed mobility and transfers during an initial visit, using the Australian Therapy Outcome Measures (AusTOMs) 0-5 scale** to rate current function (5 being fully able and independent, 0 being unable).

The OT didn’t attempt stairs as Hillary had been up and down the stairs just before arrival. She became short of breath just when talking, so the OT did not wish to distress her further. It was very clear from the information Hillary and her husband gave, together with the OT’s assessment of her mobility, that stairs were the main issue, made even more important by the fact that the toilet, bedroom and shower room were all located upstairs.

This part of the interview demonstrated that Hillary was:

• Managing stairs with physical assistance from her husband (AusTOMs activity rating 3)
• Unable to go out at all (AusTOMs activity rating 0)
• Managing to sleep independently but lacking quality (AusTOMs activity rating 4).

The OT rated her impairment as 1 on the 0-5 scale because her shortness of breath was so severe and was evident on low level activities such as talking.

The initial interview schedule also covers energy levels (fatigue), mental health and well-being, tissue viability, and respiratory, cognitive, neurological and general issues, such as pain, mouth care and nausea/vomiting.

Hillary’s shortness of breath and poor sleep indicated problems within the energy and respiratory sections. Pain in her chest and back was also identified. The OT was able to assess Hillary’s physical and social environment, which again demonstrated the problem using the stairs. She was generally continent but her shortness of breath had worsened so she was having accidents on her way to the toilet. There was already a level access shower with seat – she was independent with this set-up as long as she paced her activity. Her armchair was appropriate and her bed was a good height with a rail.

Hillary was unable to lie flat because of her shortness of breath. The OT used the distress thermometer*** to allow the individual to measure their own distress. She circled the distress thermometer at 8/10 – because of her incontinence/ difficulty reaching the toilet throughout the day and also getting so short of breath whenever she did.

Participation is also measured by the therapist. This relates to the participation/control the person has and ability to reach potential. The OT rated this as 3 on the 0-5 scale (5 being no issue) as Hillary was relying on her husband a lot.

The summary of needs and action plan/goals is formulated with the individual. Hillary was clear on her own goals:

1. To manage the stairs independently (and thereby reach the toilet)
2. To get out with assistance from her husband or son and to increase leisure activities, particularly when the weather became warmer
3. To manage bed transfers independently and improve sleep. Hillary was unable to lie flat at night and pillows ending up on the floor were waking her regularly.

The action plan was:

• The OT was to explore stair lift options – this was
  needed urgently given Hillary’s likely diagnosis and prognosis
• Hillary and her husband were to arrange a short-term loan wheelchair. They were given contact details of the service and their son was to collect the wheelchair
• The OT was to refer for a wheelchair assessment to also take into account Hillary’s husbands needs, as he was not only her carer but also had his own cancer diagnosis
• The OT was to order and trial a mattress variator
• The OT was to provide some breathing techniques to improve Hillary’s control over her breathing on activity.

*All names have been changed to protect confidentiality

**Each of the AusTOMs for occupational therapy considers impairment, activity limitation, participation
restriction and well-being. For further information about AusTOMs see About the AusTOMs for occupational therapy (Unsworth/Duncombe) on LaTrobe University’s website

***Information about the distress thermometer is available on the website of the UK Oncology Nursing Society

Author
Penny Wosahlo, clinical specialist occupational therapist

---

Back to top