Research by MGH Institute team shows how occupational therapists improve outcomes by being involved in care plans early on

Traditionally, patients with end-stage heart failure would work with an occupational therapist only after it was determined they would get a pump, called a left ventricular assist device (LVAD), that would act as a short-term bridge while they waited for the possibility of having a life-saving heart transplant, or as a longer-term permanent way to extend their lives.

But a team at Massachusetts General Hospital, including Jessica Asiello, an assistant professor of occupational therapy at the MGH Institute, saw things differently. They thought that these end-stage heart failure patients could have far better outcomes if OTs were involved during pre-operative evaluations when interprofessional teams that included physicians and nurses were determining whether or not a patient was a candidate to receive the device. Pre-operative occupational therapy could also allow for earlier planning to support patients’ abilities to return to their life roles and routines with an LVAD.

“Everyday living with the LVAD is complex, particularly for people with physical or cognitive impairments or limited social supports,” said Dr. Asiello, noting that the pumps require constant attention because they must operate 24/7 to keep blood flowing through the body. “Being part of those conversations really early in the process, we felt we could identify family members or people in the community to help them if needed, or look at possible adaptations to the device or individual strategies to help them be more independent.”

5 people sitting at a table
Assistant professor Jessica Asiello (second from right) with ADE student mentees (L-R) Maggie Newman (OTD '24), Christiana Jussome (OTD '25), Sophie Nash (OTD '25), and Sydney Georgiou (OTD '24), all of whom are supporting the next stage of the LVAD study.

Working with Christina Kelley, occupational therapy clinical specialist for Mass General’s Cardiac, Oncology, Transplant and Medicine Services, where they worked together for several years prior to becoming a faculty member, Asiello and a team of IHP occupational therapy students began looking at the results of more than 200 pre-operative OT consultations with LVAD candidates. Over the past five years, with funding from a School of Health and Rehabilitation Sciences faculty research grant, ten OT clinicians at MGH – which include several IHP graduates, nine students, and other IHP faculty – determined that including OTs at the start made a big difference.

Kelley said she now sits in on weekly rounds with the LVAD team where she is an integral part of the conversation of determining patient care.

“I have to give a lot of credit to the team of nurses that oversees these patients,” she said. “They really saw what OTs can do because of our unique lens and advocated for us to become a louder voice at the table. And my opinions are received well.”

The paper that presented the results, Addressing the functional needs of left ventricular assist device candidates: Development and feasibility of an occupational therapy pre-operative evaluation, was recently published in the journal Heart & Lung. Asiello’s co-authors included Institute associate professor Dr. John Wong and Kelley. Other authors were 2020 graduate Alyssa Taubert and 2021 graduate Nicole “Nikki” Lam (both of whom now work at MGH), and 2023 graduates Kellie Cannone and Lauren McInnis.

As students, they played an integral role in the study’s results. Cannone, for example, coded patient evaluations and added them into a database that was used to analyze results and determine the insights that occupational therapists were able to provide to the team by being involved with patients early in the process.

“I've always had an interest in research, so it’s fulfilling to be able to see how the research has become something that is now being used,” said Cannone, who currently works per diem at Spaulding facilities in Charlestown and on Cape Cod.

And she did more than just collect data. For her Advanced Doctoral Experience (ADE) project during her last year in the entry-level Doctor of Occupational Therapy program, she and McInnis created accessible patient education materials for LVAD self-management, as well as exercise guidelines and tip sheets that OTs now use when working with patients.

“What students like Kellie provided are deliverables that have a purpose,” said the MGH’s Kelley. “It's not like she created something and it got stuck up on a shelf because we’re using it with patients all the time. It’s an example of how it’s been a really nice partnership between the IHP and our team here at Mass General.” 

Asiello is continuing to work with students as the study continues. Her current ADE mentees are Maggie Newman and Sydney Georgiou from Class of 2024 and Christiana Jussome and Sophie Nash from Class of 2025, who are supporting the next stage of the LVAD study.

Asiello, who also received the Podium Presentation Award for research at the American Association of Heart Failure Nurses annual meeting for “Occupational Therapy Pre-Operative Evaluation of Left Ventricular Assist Device (LVAD) Candidates: A New Standard of Care to Focus on Function,” believes their results can have a far wider impact than just at Mass General, based on having heard from OTs and LVAD coordinators at several other hospitals since the article was published that they plan to use this evidence to involve occupational therapy in LVAD patients’ pre-operative care

“The results showed that it is feasible to integrate a comprehensive functional assessment into routine care because these patients have complex multifactorial needs,” said Asiello. We hope that this will influence practice across the country,” she said.

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