VOL: 98, ISSUE: 17, PAGE NO: 52
Julie Vickerman, Dip COT, SROT, is clinical specialist occupational therapist (continence care), Chorley and South Ribble Primary Care Trust; she is also on secondment as a research OT to PromoCon, Disabled Living, Manchester.
It is important that all health care professionals use the term ‘incontinence’ in an agreed, standard way. If this is not achieved then there may be a lack of basic understanding between nurses, nurses and doctors, physiotherapists and occupational therapists and others involved in the provision of health care. Incontinence is the involuntary loss of urine and/or faeces at an inappropriate time and/or place (Norton et al, 1996).
There are many causes of incontinence - for example, pathophysiological, neurological, muscular or sphincter weakness, and it may be congenital or acquired. Other contributing factors may include the effects of medication, constipation, infection and diet. (Button et al, 1998).
One in four women experiences urinary incontinence at some time in her adult life, while the prevalence for men is one in 10. The Continence Foundation (2000) reported that the average primary care group with a population of 102,700 will have 5,600 people with urinary incontinence and over 900 people with faecal incontinence.
The multidisciplinary approach to continence care
Rivers (1986) stated that the effectiveness of any treatment for urinary incontinence depends in part on the expertise, knowledge and commitment of the staff involved. Close cooperation between specialties is essential in order to provide a comprehensive continence service. This should include professional and public education, prevention strategies, comprehensive assessment and investigation facilities and a range of multidisciplinary options. It should not focus on the supply of continence products (Pomfret, 1996).
The most recent Department of Health guidelines (2000) suggest that continence services should become ‘integrated’ and work towards improved collaborative working. The report emphasised the need to bring professionals together to develop common policies, guidelines and standards.
Historical involvement of occupational therapists
There is very little literature available on the topic of occupational therapy and continence care. What has become increasingly accepted is that the future does lie within the multidisciplinary approach. OTs form an integral part of any multidisciplinary team and they should be involved in the assessment, treatment and management of clients with continence problems.
Services such as OT are rapidly expanding into the community, and the management of continence problems in people’s homes has become a clear multidisciplinary matter (Ashford and White, 2000).
What is occupational therapy?
Occupational therapists are concerned with an individual’s functional ability to carry out the occupations and activities of daily life. Given that going to the toilet and endeavouring to remain continent is an ‘everyday activity’, it would seem that continence care is an area to which many OTs could richly contribute. Many are well placed, for example in the community setting, to identify and help people with continence problems.
What can OTs offer?
In reporting the results of a joint survey of continence advisers and OT managers, Pomfret (1999) concluded that OTs have a strong role to play, ‘given that many problems relating to continence care are not physical but relate to mental state, environment, clothing, functional ability and carers difficulties’.
The emphasis of an OT’s treatment is on using a holistic approach when considering a client’s individual needs and the impact their illness or disability has made on their everyday lives. OTs use their skills of breaking down activities into all their individual components in order to assess their client’s abilities.
The analysis of an everyday task will include consideration of the following:
- Motor/physical demands - position of client, static or dynamic activity, movement analysis (for example, joints involved, range of movement required, grips/grasps needed, unilateral or bilateral activity, coordination);
- Sensory demands - spacial awareness, comprehension of language, auditory cues, olfactory issues;
- Cognitive demands - motivation, achievement potential, memory, information retention, concentration span, numeracy and literacy skills, communication;
- Perceptual demands - agnosia, apraxia, spatial relationship disorders, self-awareness disorder;
- Emotional demands;
- Social demands;
- Cultural demands.
The OT will then work with clients to acquire skills, may adapt activities or the environment or use compensation through equipment to enable individuals to function to their maximum potential.
When assessing a client with continence difficulties, the OT may consider environmental factors, physical functioning, mobility, clothing, reality orientation, behaviour modification techniques as well as bladder training programmes.
Occupational therapists possess a wealth of expertise and experience that can help people with continence problems. It is hoped that with increased education and publication of this specialised work OTs will become integral members of continence promotion teams throughout the country.