Evidence‐based practice guidelines for prescribing home modifications for clients with bariatric care needs

• Published in: Australian occupational therapy journal Vol. 65; no. 2; pp. 107 - 114
• Main Authors: Lange, Laura, Coyle, Emma, Todd, Helen, Williams, Cylie
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01.04.2018
• Subjects: bariatric; Clients; Clinical medicine; Clinical practice guidelines; Evidence-based practice; Habits; home assessment/modification; intervention and service provision; Obesity; Personal safety; Prescribing; Terminology; Therapists; Uncertainty; Australia; home assessment/modification; evidence-based practice; intervention and service provision; bariatric; obesity
• ISSN: 0045-0766; 1440-1630
• DOI: 10.1111/1440-1630.12443

Background/aim Home modifications maintain people's functional independence and safety. No literature exists to guide the prescription of home modifications for clients with bariatric care needs. With Australia's increasing obesity rate, more evidence is needed to support home modification prescribers. This study aimed to map Australian home modification prescribing practices for clients with bariatric care needs and to establish and evaluate a clinical resource for this prescription process. Methods The study included two phases. Phase 1 conducted a cross‐sectional survey of therapists practicing in Australia, and Australian industry partners who prescribe or install home modifications for clients with bariatric care needs. Phase 2 included design, implementation and evaluation of a clinical resource. Data were analysed with means and frequencies; multivariable regression analysis was used to explore prescribing habits. Results Therapists surveyed (n = 347) reported 11 different bariatric weight definitions. Less than 3% constantly or regularly prescribed home modifications for these clients; rails were most commonly prescribed. Many therapists (n = 171, 58%) ‘never’ or ‘rarely’ knew rail load capacity. Therapists’ knowledge of rail load capacity was associated with previous experience prescribing home modifications (P = 0.009); rail manufacturer's advice (P = 0.016) and not using advice from builders (P = 0.001). Clinical resources were used by 11% (n = 26) of therapists to support their prescription, and industry sporadically relied on therapists to specify modification design requirements (n = 5, 45%). Post‐implementation of a clinical resource increased consensus regarding understanding of the term bariatric and increased consultation with builders and manufacturers. Conclusion There was a lack of consistency in bariatric terminology, uncertainty of rail load capacities and minimal use of clinical practice guidelines. Additional resources will assist with consistency in prescribing practices to maximise occupational performance for clients with bariatric care needs.