Saudi Cultural Missions Theses & Dissertations
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Item Restricted ACUTE CARE REHABILITATION UTILIZATION, ACCESS, AND OUTCOMES AMONG HOSPITALIZED ADULTS WITH TRAUMATIC BRAIN INJURY(Colorado State University, 2024) Bukhari, Rayyan; Graham, JamesObjective: The purpose of this dissertation was to conduct three research studies aimed at gaining a comprehensive understanding of the barriers and facilitators to equitable access to and timing of rehabilitation services, community discharge, and unplanned 90-day post-discharge hospital readmission among individuals hospitalized with Traumatic brain injury (TBI). Introduction: There are approximately 2.5 million TBI-related emergency department visits, 288,000 TBI-related hospitalizations, and 61,000 TBI-related deaths reported each year (Center for Disease Control and Prevention, 2019). TBI is associated with high rates of disability, including limitations in performing basic activities of daily living (ADLs), such as self-care, and/or in performing physical tasks, such as mobility (Klima et al., 2019; Jessica Lo et al., 2021; Whiteneck et al., 2016). Individuals who are hospitalized with TBI should receive equitable access to multidisciplinary care, including rehabilitation services (occupational therapy [OT], and physical therapy [PT]) to address potential self-care issues, physical limitations, and cognitive deficits (National Academies of Sciences & Medicine, 2022). Early onset of acute care rehabilitation services can have positive long-term benefits for patients, including improved function, increased mobility, and enhanced quality of life (Andelic et al., 2012; Bernhardt et al., 2017; C. Y. Wang et al., 2021). A primary focus of settings (Department of Health and Human Services [HHS], 2019). Readmission is a common concern for those who have chronic illnesses or injuries, and it is associated with higher healthcare expenses and lower quality of care (Jencks et al., 2009). Readmission rates after TBI contribute considerably to these costs, making lowering readmission rates a universal goal (Canner et al., 2016). Despite research advances and policy changes, barriers and challenges remain facing individuals with TBI (National Academies of Sciences & Medicine, 2022). Not all individuals with TBI have early access to rehabilitation services, are discharged to the community, or can avoid hospital readmission. Although several studies have addressed these issues in general population, variability in community and personal level factors among individuals with TBI need to be addressed (Office of Disease Prevention and Health Promotion & Services., 2020). Therefore, these dissertation studies are aimed at providing empirical support, further understanding, and increasing our knowledge around factors that influence individuals with TBI acute care rehabilitation services utilization and outcomes. Method: This dissertation is comprised of three studies. In Study One, we investigated how Social Determinants of Health (SDoH) impact access to and timing of rehabilitation services. Multivariable logistic and Cox regression analyses (i.e., time-to-event analyses) were used to calculate odds ratios for the likelihood of receiving OT and PT services, and hazard ratios for the duration to initiation of services among those who received these services. In Study Two, we explored whether the relationship between acute care OT/PT utilization and community discharge is moderated by functional or physical performance at discharge. Multivariable moderation logistic regression models were used to calculate odds ratios for the likelihood of community discharge among those who utilized OT/PT services. In both OT and PT models, we computed the main effect of OT/PT utilization on community discharge, the main effect of acute care rehabilitation services is to improve patients’ functional performance (Ejlersen Wæhrens & Fisher, 2007). Following acute care stays, community discharge is generally viewed as quality care indicator in acute care functional/physical (ADL/Mobility) performance scores at discharge on community discharge, and the moderating effect of ADL/mobility scores on the relationship between OT/PT utilization and community discharge. In Study Three, we examined the association between discharge functional status and unplanned hospital readmission. Logistic regression was performed to calculate odds ratios for the likelihood of unplanned 90-day hospital readmission among those who received rehabilitation services during their acute care stay. Results: In Study One, all community-level SDoH such as education attainment, income, and rurality did not show significant associations with access to or timing of acute rehabilitation services (p-values= 0.09 – 0.95). In Study Two, both ADL/mobility performance scores at discharge significantly moderated the relationship between OT/PT utilization and community discharge (ORs= 0.99, 95% CIs [0.98, 1.00]). In Study Three, neither discharge functional nor mobility scores were associated with readmission (p-values= 0.14 – 0.17). Among the three dissertation studies, several covariates such as age, presence of a significant other, race/ethnicity, health insurance type, TBI severity, length of stay, and comorbidity burden showed significant associations with access to or timing of acute rehabilitation services, community discharge, and readmission status (p-values= 0.04 – <0.001). Conclusion: Further investigations are needed to 1) ascertain whether our community-level SDoH variables, based on the first three digits of zip codes, adequately capture individual experiences and their impact on healthcare, or if community-level education, income, and rurality genuinely do not affect access to and timing of therapy services for hospitalized patients with TBI; 2) determine whether the consideration of ADL/mobility scores at discharge alone limits our understanding of the relationship, failing to encompass other patient-level factors that could either facilitate or impede a safe community discharge; and 3) determine whether discharge functional and mobility scores were too restrictive in capturing the full benefits of acute care rehabilitation services in reducing the risk of unplanned 90-day readmission risk in hospitalized patients with TBI.16 0Item Restricted An exploration of the knowledge and attitudes of Saudi occupational therapists (OTs) regarding people living with HIV\AIDS in Saudi Arabia(Saudi Digital Library, 2023-01-20) Bin Numay, Abdulelah; Sakellariou, DikaiosIntroduction: Relatively 38 million people are living with the acquired immunodeficiency syndrome (AIDS) in addition to the virus which causes AIDS, the human immunodeficiency virus (HIV). AIDS-related complications were responsible for the deaths of 35 million people globally between the beginning of the pandemic and the end of 2020, with the disease's prevalence continuing to rise across the Middle East and North Africa. Due to an early misunderstanding of HIV transmission patterns, many Muslims incorrectly think that only "sinners" may get HIV/AIDS. Consequently, stigma and prejudice are seen as the greatest challenges for persons with HIV/AIDS in Saudi Arabia. Therefore, the purpose of this research is to get an understanding of and investigate the experience and knowledge of Saudi Arabian Occupational Therapists. Methodology: The researcher selected the framework qualitative design as the research's methodology to collect data from six participants, 4 male and 2 female Occupational Therapy practitioners. Semi-structured audio recorded interviews were conducted, recordings were transcribed digitally for data analysis. Then, the qualitative data were thematically analysed. Result: The analysis concluded four main themes and eight subthemes. Proceeded with the participants' general perception of HIV/AIDS, then move on to their knowledge development in relation to the virus, their clinical practise in the context of working with a person living with HIV/AIDS, and finally, the socio-cultural obstacles and future prospects from the perspective of the participants. Conclusion: Participants mentioned they lacked significant understanding about HIV/AIDS and the occupational therapy role with HIV+ patients. Their collective understanding of HIV/AIDS was derived from the theory they studied, movies, television programmes, chats with others, and books or articles, owing their lack of understanding to the incomplete HIV/AIDS education incorporated in the curriculum. In addition, while they would not mind working with an HIV- positive client, HIV/AIDS related discrimination in the study population was presented by altering the treatment approach, take extra contact precautions, minimize interaction between HIV positive patients with other patients9 0Item Restricted Telerehabilitation in occupational therapy practice in Saudi Arabia(Saudi Digital Library, 2023-06-18) Aljabri, Naif Q; Cusick , AnneBackground: In line with Saudi Vision 2030, ways to make rehabilitation accessible and available need to consider telerehabilitation as a potential, but to date, no information is available about Saudi occupational therapy (OT) and this model of care. Aim: to develop an evidence base to support the introduction and implementation of telerehabilitation in OT practice in Saudi Arabia. To do this, existing research about telerehabilitation in Saudi Arabia is identified, characteristics of the OT profession in Saudi Arabia are presented, and OTs' knowledge, perspectives, and attitudes about the current and future use of telerehabilitation are explored. Methods: The study series used a non-clinical case study of OT development in Saudi Arabia, a structured review of the literature regarding telerehabilitation in the Middle East and North Africa (MENA) region, a cross-sectional survey of OTs in Saudi Arabia regarding telerehabilitation based on the Technology Acceptance Model (TAM), and interviews that explored Saudi OTs experiences and perspectives of telerehabilitation in their practice which included the use of this model of care during the Covid-19 pandemic lockdown. Results: OT is a rapidly growing but emerging profession in Saudi Arabia. There is evidence that telerehabilitation is used across MENA, with most activities in physiotherapy but non-Saudi examples in OT. The TAM survey revealed positive attitudes and readiness to use telerehabilitation among OTs, with 48.6% of the variability in the intention to use telerehabilitation affected by gender, education level, type of care, attitude towards telerehabilitation, perceived usefulness, technical infrastructure, and sharing of information. The Saudi OTs have had positive experiences using telerehabilitation during the pandemic and identify ways to use and sustain OT telerehabilitation in the future. Conclusion: Telerehabilitation is promising in OT practice in Saudi Arabia.49 0