Katie Loomis MA, OTR/L, CHT(she/her/hers)
Faculty Mentor: Shawn C. Roll PhD, OTR/L, RMSKS, FAOTA, FAIUM
Research Lab: Musculoskeletal Sonography and Occupational Performance Laboratory
Year of Entry: 2020
I am a certified hand therapist (CHT) and an occupational therapist with almost a decade of clinical experience. Currently, I am a PhD student in the Chan Division of Occupational Science and Occupational Therapy and a research assistant in the Musculoskeletal Sonography and Occupational Performance Laboratory working on projects related to sonographic imaging and rehabilitation for upper extremity musculoskeletal conditions. I am also a hand therapy educator, an active member of the American Society of Hand Therapists (ASHT) Research Division, and an ad hoc reviewer for the Journal of Hand Therapy.
My research interests include understanding and quantifying the multidimensional process of upper extremity musculoskeletal rehabilitation and advancing care effectiveness and individualization through the development of comprehensive data collection, database building, and analysis.
Master of Arts (MA)
in Occupational Therapy
2012 | University of Southern California
Loomis, K., Roll, S. C., & Hardison, M. (2022). Therapist–patient relationships in outpatient upper extremity rehabilitation: Facilitating engagement & adherence. American Journal of Occupational Therapy, 76(Supplement_1), 7610505027p1. https://doi.org/10.5014/ajot.2022.76S1-PO27 Show abstract
This multimethod study identified four themes within the therapist-patient relationship that affect the provision of holistic and collaborative care. Therapists developed a complex relationship with their patients, leading to high scores on measures of adherence and engagement. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care to produce effective outcomes.
Purpose. Holistic and collaborative treatment planning and patient care are essential components of best practice occupational therapy (OT). This approach to care must consider patient factors and therapeutic techniques, but success will also be dependent on the therapist-patient relationship itself. There has been limited examination of this relationship within OT settings, particularly related to core concepts such as engagement and adherence. This study identified factors within the therapist-patient relationship that impacted the provision of holistic and collaborative services within an outpatient setting.
Design. A multi-method study design was used to obtain quantitative and qualitative data to describe therapists’ perspectives of their patients’ adherence and engagement, and the relative role of therapist-patient relationship. The study participants were a convenience sample of four OTs working at a hospital-based outpatient upper extremity rehabilitation clinic.
Method. Data were collected over three months. A series of weekly group interviews (n = 13) were conducted using a semi-structured guide. Interviews explored the interaction between therapist and patient roles within the therapeutic environment, including balances of power and barriers/facilitators to therapeutic engagement and adherence. Therapists completed surveys following visits from a sub-sample of patients receiving treatment during the study period (n = 16). Specifically, the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) were used to assess therapists’ perspectives of patient adherence and engagement. Descriptive statistics were generated from the survey data. Principles of constructivist grounded theory were used to analyze interview transcripts through an iterative process of initial and focused coding until saturation was reached. Themes connecting the codes were created by the primary coder. Two additional researchers who conceptualized the study and conducted the interviews engaged with the coder in iterative discussions to refine the qualitative themes and situate these findings within the context described by the quantitative results.
Results. Therapists consistently rated their patients highly on SIRAS and RTES measures. SIRAS scores averaged 14.4/15 (SD: 1.0, range: 10-15) and RTES scores averaged 42.5/45 (SD: 3.4, range: 23-45). These high scores may have been facilitated by complex and dynamic interactions across multiple factors within the therapist-patient relationship. Four themes emerged from therapist interviews: (1) Power within the therapist-patient relationship was fluid, often impacted by patient preference, personal contexts, and medical environment restrictions; (2) engagement was reciprocal and co-constructed between the therapist and patient; (3) therapist-patient interaction modulated emotional states to influence mutual engagement; and (4) the therapist-patient relationship is defined by different spatial and temporal contexts within the therapy process.
Conclusion. This study found that, in a highly engaged and adherent treatment setting, the therapist-patient relationships were complex, intimate, and dynamic, and extended beyond patient education and physical interventions. Careful management of this relationship was central to facilitating active patient participation and engagement.
Keywords. arm, outpatients, rehabilitation