Allied health assistants and what they do: A systematic review of the literature

Figures & data

Figure 1 Publication selection process.

Figure 2 Health discipline affiliation of assistants.

Table 1 Summary of findings from individual studies

Author, Date	Type of Study	Country	Role	Barriers	Benefits
General health care assistant/rehabilitation assistant
Conway and Kearin^Citation16	Survey	Australia	Cleaning, general assistance, and housekeeping Assistance to nursing, physiotherapist, and medical staff with heavy and difficult to manage patients	Lack of clarity regarding role Being expected to achieve cleaning tasks and provide patient support, assist with aggressive patients, work with other assistants
Lin et al^Citation17	Survey	Australia	Facilitates individual therapy Facilitates group therapy Performs administrative duties Participates in health promotion
Pullenayegum et al^Citation18	Audit	UK	Assists in speech therapy Communication Lip seal and facial exercises Swallowing practice Specific fluid thickness Use of communication board Nonverbal communication methods Assists in physiotherapy Stroke positioning Safe transfers with aids Passive ROM and massage for UL Posture correction and alignment Orthotic use UL and LL strengthening and ROM exercises Transfer practice Standing practice Assists in occupational therapy Bilateral UL exercise Handgrip Dressing Wash and dress practice Massage for edema Equipment usage Feeding aids		Rehabilitation assistants provide consistent and goal-directed rehabilitation to patients who received treatment from a multidisciplinary team
Stanmore and Waterman^Citation19	Qualitative ethnographic	UK	Works with patients towards individual rehabilitation goals, as prescribed by clinicians, covering nursing, occupational therapy, and physiotherapy aspects of their treatment Supports and supervises patients in ADL Carry on therapy as delegated by professionals Promotes independence Promotes patients’ rights and identity Monitors progress Monitors the activities of other care providers Feeds back to professionals on patient progress and service provision Assists clinicians in identification, provision, fitting, and safe use of equipment for patients and carers Maintains records of work undertaken with patients Variations in the roles between types of setting (eg, more personal patient care in hospital, liaise with a range of professionals and other agencies, promote patient independence and social recovery, less personal care in the community); may vary depending on clinical specialty within the area of work
Knight et al^Citation20	Mixed	UK	Performs a wide range of tasks, eg, mobility, washing, dressing, and ADL Roles depend on team focus, structure, and process Some have administrative duties	Confusion over role demarcation and time management issues Difficulty with complex patient care packages	Role was organized to link all the disciplines within the multidisciplinary team together and to integrate community rehabilitation Role offered patients a more continuous, holistic and patient focused service (pass information on from one therapist to another and helping provide an adaptive health care environment consisting of enhanced continuity and patient focused holistic care) The role allowed therapists extra freedom to carry out more complex cases
Nancarrow et al^Citation21	Survey	UK	Working individually and as teams to carry out formalized, competency-based rehabilitation programs in the patient’s own home; to provide a holistic approach to rehabilitation; promote maximum independence for the service user with regard to all aspects of care, lifestyle and independence; encourage service users to adhere to their rehabilitation program Assists with all aspects of patient care Focus on enablement, ie, provide enablement to promote independence
Psychology assistant
Woodruff and Wang^Citation22	Mixed (survey, literature review and qualitative)	UK	Assists in the provision of clinical psychology service and assists in client and carer assessments by using psychometrics, assists in statistical analysis, assists in observations, and involvement in report writing. Responsible for maintenance of equipment and resources, liaising with other staff and professionals, undertaking literature searches and audit activities, and psychologic treatment under supervision. Assistants would be required to carry out “… any other duties, appropriate to grade, which may be required by …” the supervisor.
Occupational therapy assistant
Nancarrow and Mackey^Citation23	Qualitative approach	UK	Varies according to the setting in which they work (health or social care setting); their relationship with their supervising OT, and the supervisory arrangement within the service Discharge home visits were the only tasks that participants identified as a role that OT could do that an assistant practitioner could not deliver.	Other service providers and users did not understand the role, and supervising OTs were concerned that assistants may be seen as a cheap way of delivery of occupational therapy services.	OTs become free to undertake other tasks OT assistant helps with referral of clients to appropriate services OT assistant can identify with patients better because they use the same language as patient Patients valued the increased time spent with them by the AHA
Physical therapy assistant
Conti et al^Citation24	Narrative	US	Facilitates treatment plan by physiotherapist		Successful patient outcomes: skin breakdown rates decreased, average ventilator days per patient and pneumonia rate declined, complete continuity of therapy, early intervention of each patient and family, a dramatic increase in mobilization and overall fewer complications
Ellis et al^Citation25	Survey	UK	Tasks routinely performed by more than 75% Writing in records Clerical administration tasks Domestic tasks Supervising a patient: walking, practicing transfers, performing exercises Other patient care tasks Mobilizations Obtaining a history Application of superficial heat/cold modalities

Abbreviations: ADL, activities of daily living; OT, occupational therapist; UL, upper limb; LL, lower limb; ROM, range of movement.

Table 2 Clinical and nonclinical duties and responsibilities of AHAs as reported in the literature

Clinical duties

Nonclinical duties

Assist allied health professional Physical and social support to patient Administer clinical services and modalities Transfer patients Communication of patient progress/communication with other staff Assist with mobility and gait Provision of equipment Patient education Provision of health care to patients Supervise/conduct exercise classes Prepare patients for treatment Individual or group therapy Coordinate and assist in the operation of services Assist and coordinate health service

Administration Stock ordering/requisition Prepare/maintain environment Equipment maintenance Health promotion Monitor and update health care-specific database Recording/statistics/database Housekeeping Cleaning

ConwayJKearinMThe contribution of the patient support assistant to direct patient care: An exploration of nursing and PSA role perceptionsContemp Nurse20072417518817563326

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LinIGoodaleBVilanuevaKSpitzSSupporting an emerging workforce: Characteristics of rural and remote therapy assistants in Western AustraliaAust J Rural Health20071533433917760918

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PullenayegumSFieldingBDu PlessisEPeateIThe value of the role of the rehabilitation assistantBr J Nurs2005141477878416116384

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StanmoreEWatermanHCrossing professional and organizational boundaries: The implementation of generic rehabilitation assistants within three organizations in the northwest of EnglandDisabil Rehabil200729975175917453998

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KnightKLarnerSWatersKEvaluation of the role of the rehabilitation assistantInt J Ther Rehabil2004117311317

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NancarrowSAShuttleworthPTongueABrownLSupport workers in intermediate careHealth Soc Care Community200513433834415969705

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WoodruffGWangMAssistant psychologists and their supervisors: Role or semantic confusion?Clin Psychol2005483336

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NancarrowSMackeyHThe introduction and evaluation of an occupational therapy assistant practitionerAust Occup Ther J200552293301

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ContiSLaMartinaMPetreCVitthuhnKIntroducing a vital new member to the critical care team. Our physical therapy assistantCrit Care Nurse20072746768

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EllisBConnellNADEllis-HillCRole, training and job satisfaction of physiotherapy assistantsPhysiotherapy19988412608616

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