Graduation Date

5-2013

Document Type

Master's Thesis

Degree Name

Master of Science in Occupational Therapy

Department or Program

Occupational Therapy

Department or Program Chair

Ruth Ramsey, Ed.D., OTR/L

First Reader

Kitsum Li, OTD, OTR/L

Abstract

Purpose: The literature reported the frequent use of shoulder slings by occupational therapy practitioners for the management of post-stroke shoulder subluxation despite the low evidence for its efficacy. We investigated the prevalence and clinical reasoning in the use of shoulder sling in order to understand the clinical context that defies the current research evidence.

Methodology: The study is a quantitative descriptive design using self-report survey questionnaire. Online and on-site surveys were distributed among the members of Occupational Therapy Association of California (OTAC) between January and April, 2012, and attendees to OTAC Spring Symposium on March 31 and April 1, 2012.

Findings: 168 occupational therapy practitioners responded to the survey. 81.5% of the California occupational therapy practitioners reported the use of shoulder sling. However, the actual sling prescription was limited to only 28.4% of their patients. The common clinical reasoning in the use of sling was for specific clinical management, such as functional mobility and pain reduction. The orthopedic sling was the most frequently used sling, followed by the GivMohr sling. The pragmatic reasoning pattern was prominent in choosing orthopedic sling, such as high availability in facility’s stock and low cost. The procedural reasoning pattern was prominent in choosing GivMohr sling, such as better support and alignment for the glenohumeral joint. The results implicated that the clinical management of shoulder subluxation in post-stroke rehabilitation might be compromised by convenience and cost factors. On the other hand, occupational therapy practitioners with advanced trainings were less likely to use the orthopedic sling and more likely to choose sling based on the procedural reasoning.

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