Development and evaluation of occupational therapy - Mahidol Clinic System (OT-MCS) for post-stroke rehabiliation in Thailand

Kaunnil, Anuchart (2013) Development and evaluation of occupational therapy - Mahidol Clinic System (OT-MCS) for post-stroke rehabiliation in Thailand. Doctoral thesis, Northumbria University.

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Abstract

In 2011 it was estimated that in Thailand there were 498,800 stroke survivors of both sexes but most were over the age of 65. They were served by only 625 occupational therapists (OTs). Occupational therapy (OT) plays a key role in the rehabilitation service for stroke patients, in particular, by enabling stroke survivors to reengage with activities of daily living and to resume work or family tasks. OT needs to be culturally appropriate and relevant to the therapists, stroke patients and their families. The Occupational Therapy Mahidol Clinic System (OT-MCS) has been designed to be culturally relevant and is based on collaborative teamwork which can better address the needs of the stroke patients.

OT-MCS was introduced in 6 regional OT clinics. This study compared perceptions of stroke clients who took part in the new approach 8 weeks before and during the rehabilitation. One hundred and twenty stroke participants were divided into 2 functional groups (slow and fast stream rehabilitation). Stroke participants (N=120) and OTs (N=60) explored the arrangement of activity items into domains for creating a new activity card sort (ACS). Sixty stroke participants
(slow stream rehabilitation) and 60 OTs were surveyed to investigate the attitudes of “satisfaction” and “importance” via 40 therapeutic activities. Sixty stroke participants (fast stream rehabilitation) evaluated the levels of their activity engagement in diverse cultural-therapeutic
activities. Lastly, 23 stroke participants (slow and fast stream rehabilitation) were interviewed in order to ascertain their lived experiences after the use of OT-MCS and the data were analysed using thematic analysis.

The integrated analysis demonstrated strong satisfaction and engagement with OT-MCS. The use of the activity catalogue met with positive attitudes from the stroke participants and in particular the collaborative approach of OTs and participants gave meaning to the activities and a sense of
self management. In addition in the fast stream rehabilitation participants reported satisfaction
with the transferability of the activities to the home and external environment and their relevance to supporting family life.

The OT-MCS for Thai stroke rehabilitation is a comprehensive OT service, which improves the perception of benefit in stroke clients enabling them to perform meaningful and purposeful activities based on their local and regional lifestyles. This culturally appropriate approach helps stroke clients to re-develop their life-skills. Through the use of meaningful and relevant activities which meet their specific needs, stroke clients can lead more satisfying and fulfilling lives.

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