bluuebunny/crossref_metadata_2025 huggingface dataset:
Writing a Literature Review
Authors: Steward Barbara
Published: April 2015

The processes of searching for literature and appraising evidence critically are well documented. Yet effective ways to report literature reviews, either as pieces of research in their own right or as part of primary research reports, are less easily found. Reviews are often criticised for their lack of coherent construction, of synthesis of key themes and of well argued analysis. More importantly though, reviews are often the Cinderella of research, being less valued than primary research, or dull preludes to research reports.

This article considers the structure and content of a good literature review and calls for a new injection of enthusiasm to reflect the fascination of finding ideas, engaging with others' research and building new theories from the assembled evidence. Publishing a review demands art as well as skill to help readers to make sense of a particular world of evidence and make them want to go and find out more for themselves. The article suggests ways to write better reviews and encourages the writing of more papers based on reviews.
Can Occupational Therapists be Hand Therapists?
Authors: Fitzpatrick Niall , Presnell Scott
Published: April 2015

Occupational therapists working in the field of hand therapy tend to follow a reductionist biomedical approach in their practice. This emphasis means that there is the potential to lose the occupational focus in interventions with this client group. The International Classification of Functioning, Disability and Health (World Health Organisation 2001) could be used as a framework to examine the consequences of hand injuries. By taking all four conceptual domains into account when treating this client group, it may be possible not only to examine, for example, range of movement and tendon glide but also to start looking at the occupational impact on people's activity performance and social participation following hand impairment, as well as to explore the variations of the occupational impact that these injuries have on people's lives.
The Use of Psychodynamic Observation as a Tool for Learning and Reflective Practice when Working with Older Adults
Authors: Mackenzie Alice , Beecraft Sue
Published: April 2015

Working with clients can arouse thoughts and feelings in clinicians that, if not thought about, can limit or undermine their practice. This article, using the experiences of both authors, describes a method of using observation as a learning and reflective practice tool when working with older adults. The method is based on psychoanalytical theory and involves the use of psychodynamic observation, the recording of the observations and regular seminars to facilitate reflection and thinking. It is suggested that such a method of observation, based on psychoanalytical theory, is a valuable learning tool for occupational therapists.
What's Cooking? Theory and Practice in the Kitchen
Authors: Bryant Wendy , McKay Elizabeth
Published: April 2015

Occupational therapists are challenged to demonstrate how their practice is informed by evidence of effectiveness. In the absence of evidence from scientific investigation, theories are used to frame judgements about clinical situations. This paper explores how the process of adapting a kitchen can be informed by occupational theories, based on the first author's experiences as a social services occupational therapist. The kitchen is a familiar space in occupational therapy and forms a key environment for meeting nutritional and social needs in the domestic setting.

The process of altering a kitchen is used to illustrate concepts associated with occupation in everyday life. Issues arising from two kitchen adaptations are investigated using categories from the Canadian Model of Occupational Performance and the definition of therapeutic occupation (Nelson 1996). The limitations of applying theory to practice are explored, alongside analysis of how theory enhances practice. Finally, a synthesis, of knowledge based on science and creative practice based on art, is proposed.
Perceptions of Occupational Therapy compared with Physiotherapy and Nursing among Minority Ethnic and White United Kingdom School and College Students: Implications for Recruitment
Authors: Greenwood Nan , Lim Kee Hean , Bithell Christine
Published: April 2015

There is currently a recruitment crisis in occupational therapy in the United Kingdom and also evidence that minority ethnic groups are underrepresented in the profession. This study comprised 651 self-completion questionnaires and 43 depth interviews with minority ethnic and white school and college students to investigate factors influencing attitudes to careers in occupational therapy.

Occupational therapy was much less well known than nursing or physiotherapy and, compared with the white participants, the minority ethnic group participants were less familiar with it. Differences were also found in what the minority ethnic and the white participants wanted from careers. Significantly, the minority ethnic participants were more likely to regard doing a degree as important but were also less aware that occupational therapy was studied at degree level. The participants tended to perceive similarities between occupational therapy and nursing and the implications of this are discussed.

In conclusion, while 1 in 10 participants would consider a career in occupational therapy, with lower proportions from the minority ethnic than the white participants, many characteristics of careers considered important by these students applied to occupational therapy. Efforts should be made to increase awareness of occupational therapy with, for example, emphasis placed on degree level study, job security and the level of responsibility and professional nature of the career.
Using the Measure of Processes of Care to Assess Parents' Views of a Paediatric Therapy Service
Authors: Knox Virginia , Menzies Shona
Published: April 2015

Bobath Scotland is a tertiary referral centre providing therapy for children with cerebral palsy. The staff wanted to find a standardised tool that could assess parents' views regarding the care that their children had received. The aim of this study was to conduct a trial using a recently developed tool, the Measure of Processes of Care (MPOC) (King et al 1995), to investigate families' perceptions of the care received at Bobath Scotland and the extent to which they considered it ‘family friendly’.

The MPOC questionnaire was sent to the families who attended Bobath Scotland during a 12-month period. The MPOC consists of five scales: enabling and partnership; general information; specific information; coordinated and comprehensive care; and respectful and supportive care. Items are scored on a 7-point scale, from the behaviour ‘never’ occurs (1) to ‘occurs to a great extent’ (7). Mean scores are calculated for each scale.

Questionnaires were sent to 114 families and 72 were returned completed (63%). The mean scale scores were as follows: enabling and partnership, 6.3 (SD 0.64); general information, 4.3 (SD 1.69); specific information, 6.5 (SD 0.75); coordinated and comprehensive care, 6.3 (SD 0.75); and respectful and supportive care, 6.5 (SD 0.60).

The overall mean scale scores were high, demonstrating that families were satisfied with their care. The MPOC proved an appropriate tool to investigate the perceptions of care of families attending a paediatric centre.
Occupational Therapy for People with Progressive Neurological Disorders: Unpacking the Black Box
Authors: Jain Shilpa , Kings Jill , Playford E Diane
Published: April 2015

Progressive neurological disorders often present a challenge to occupational therapists owing to their variable presentation and relentlessly deteriorating course. The literature available to guide therapists either is process driven or describes key roles without detail of the specific therapeutic intervention used. This report describes an occupational therapy programme provided for eight people with multiple system atrophy as part of a randomised controlled trial.

The framework given illustrates the three stages of the client-centred programme and provides a comprehensive account of the therapeutic interventions used to change occupational performance. The treatment included techniques to enhance skills, increase knowledge and change attitude. Upon completion of the 8-week programme, the clients reported benefit. Although it cannot be asserted that all these techniques are effective, the occupational therapy programme described constitutes a ‘black box’ and may be useful in formulating further research questions.
The Importance of Independence in Toileting: the Views of Stroke Survivors and their Occupational Therapists
Authors: Clark Joanne , Rugg Sue
Published: April 2015

The profession of occupational therapy claims to be patient centred; however, research shows that the views of patients and health care professionals often differ. Toileting is a fundamental daily activity, yet to date there have been few studies investigating the perceived importance of independence in toileting.

A qualitative study was conducted to determine the views of stroke survivors and their occupational therapists regarding the importance of independence in toileting. A symbolic interactionistic framework was used, allowing the views of these two disparate groups to be compared. Thirteen stroke survivors and seven occupational therapists were interviewed.

Five categories were identified in the data collected: the occupational form normally used in toileting; incontinence and continence; independence and dependence in toileting; issues relating to toileting and hospital discharge; and the role of occupational therapy. Both participant groups agreed that independence in toileting was important in avoiding the need for assistance and in avoiding feelings of decreased self-esteem. However, the patient participants' views extended further in that they stated that the method of toileting was important, not merely that it was conducted independently.

In conclusion, it is essential that occupational therapists consider how they can facilitate a return to the method usually undertaken for toileting by patients. If a return to the previous methodology for toileting will not be possible, then the occupational therapists must give consideration as to how to facilitate adjustment by the patients.
Continuing Professional Development: The Impact of the College of Occupational Therapists' Standard on Dedicated Time
Authors: White Elizabeth
Published: April 2015

The 2001 College of Occupational Therapists' Research and Development Strategic Vision and Action Plan (Ilott and White 2001) gave as an objective that ‘managers will allocate regular, dedicated time within the work schedule for agreed research/quality-enhancement activities for all occupational therapy personnel’ (p275).

This article describes a survey undertaken to establish the impact of the standard on the continuing professional development (CPD) activities of occupational therapy staff. The 1205 responses received demonstrated an increase in access to dedicated CPD time, which was used for individual study, group activities or service development. The monitoring of outcomes from this time investment was patchy.

Dedicated CPD time was found to be beneficial to the individual, his or her service and the service users, although additional work pressure and a lack of study skills were noted. Some respondents were prevented from accessing CPD time owing to workload expectations, whereas others preferred to undertake development activities in their own time.

Having a good CPD structure in place was found to contribute to clinical effectiveness and improved staff morale and recruitment. Creative approaches were described to manage competing time demands. It was evident that managerial support was crucial to the progress of development activity within the workplace.
Effective Measurement of the Functional Progress of Stroke Clients
Authors: Jacob-Lloyd Hilary A , Dunn Orla M , Brain Nicola D , Lamb Sarah E
Published: April 2015

There is a need for occupational therapists to establish a range of outcome measures that can measure change effectively. The aim of this study was to identify effective methods of measuring the functional performance of individuals who had experienced a stroke and had been discharged from a rehabilitation ward. Measures with recorded validity and reliability and in clinical use were selected. The measures were the Barthel Index (Shah version), Nottingham Extended Activities of Daily Living scale, Motricity Index (Upper and Lower Limb), Rivermead Mobility Index and Nine-Hole Peg Test. Assessments were carried out at the point of discharge from hospital and 6 months later.

Responsiveness was analysed using effect size and relative efficiency statistics. The practicality (feasibility) was established by comparing completion rates. The Nottingham Extended Activities of Daily Living scale and the Rivermead Mobility Index were found to be more responsive than the Barthel Index and Lower Limb Motricity Index respectively and to be practical after discharge from hospital. The Nine-Hole Peg Test was found to be more responsive than the Upper Limb Motricity Index but less practical. The analysis suggested that some measures are more suitable than others for tracking change in function after discharge from hospital for a wide case mix of people who have experienced a stroke.
Scholarship of Practice: Making Occupation-Focused, Theory-Driven, Evidence-Based Practice a Reality
Authors: Forsyth Kirsty , Mann Lynn Summerfield , Kielhofner Gary
Published: April 2015

National and local policies require the profession to provide evidence on which practice is based. This paper illustrates an approach to meeting the expectations of these policies. Specifically, it describes the development of the United Kingdom Centre for Outcomes Research and Education (UKCORE).

UKCORE was developed within a ‘scholarship of practice’ framework, which supports the development of robust partnerships between academia and practice whereby academic knowledge influences practice and practice knowledge influences academia. Within the partnership, all academic participants (educators, researchers and students) and practice participants (clinicians, clients and administrators) are called ‘practice scholars’ and are focused on practice scholarship.

UKCORE was founded in London in 2001 in order to support the delivery of existing evidence into occupational therapy practice while simultaneously supporting practice to engage in generating new evidence for occupational therapy practice. This article provides an overview of the academic and practice changes that have been put into place. The changes are designed to support the development of practice that is occupation focused, theory driven and evidence based.
Developmental Coordination Disorder and Self-Esteem: Do Occupational Therapy Groups Have a Positive Effect?
Authors: McWilliams Steve
Published: April 2015

Children with developmental coordination disorder (DCD) have motor difficulties that impede the acquisition of both functional and academic skills and evidence suggests that these children may also have reduced self-esteem. One approach to treatment often adopted by occupational therapists is in the form of group therapy. Anecdotal evidence indicates that although these groups may produce little improvement in motor skills, there may be an associated increase in the children's self-confidence and self-esteem. This pilot study aimed to evaluate whether this was the case.

A mixed methodology was used to evaluate the self-esteem of 12 children with DCD and to obtain the views of their parents/carers. A repeated measure design was used to assess the children using a validated measure of self-esteem, the Culture-Free Self-Esteem Inventories (CFSEI-2, Battle 1992), at initial assessment and pre and post therapy group. The parents/carers of the children were asked to complete a questionnaire during the last therapy group session and this formed the basis of a post-group interview.

The results indicated that for this group of children the therapy groups did have a positive effect on their self-esteem in the majority of cases. Although it is unreasonable to draw definite conclusions from this pilot study because of the small sample size, possible implications for policy and practice are discussed and suggestions for further research are given.
Living with Impairment: Learning from Disabled Young People's Biographies
Authors: Curtin Michael , Clarke Gill
Published: April 2015

Little research has been published investigating the experiences of growing up with an impairment from the perspective of disabled young people. The aim of the present research was to investigate the life stories of a small number of disabled young people through their biographies. Nine young people who had a motor impairment, three girls and six boys aged between 10 and 14 years, were recruited through two segregated special schools. Each young person participated in several open interviews and was encouraged to tell his or her life story, collaborating in the co-construction of his or her own biography.

Once the biographies were completed, they were thematically analysed. Four themes emerged from the analysis: family, friends, education and living with an impairment. The focus of this article is on the last theme. The findings indicate that the young people were positive about their lives even though they implied that it was a struggle at times, primarily due to the negative perceptions that the general public had of disabled people. They did not consider that their medical and therapy interventions contributed to their feeling different, but saw these interventions as important to maintaining and improving their function. They accepted that they had an impairment, but did not see this as a reason for not getting on with their lives.

The findings challenge health professionals to believe that it is possible to lead a fulfilling life in spite of having an impairment and that interventions should reinforce the disabled young people's personal acceptance of themselves.
The Reliability of the Occupational Therapy Adult Perceptual Screening Test (OT-APST)
Authors: Cooke Deirdre M , McKenna Kryss , Fleming Jennifer , Darnell Ross
Published: April 2015

The Occupational Therapy Adult Perceptual Screening Test (OT-APST) is designed to screen for impairments in visual perception and apraxia in adults following stroke. The OT-APST is a comprehensive battery that contains 25 items in the following seven subscale areas: agnosia (5 items); visuospatial relations covering elements of body scheme (4 items) and unilateral neglect (5 items); constructional skills (3 items); apraxia (6 items); acalculia (1 item); and functional skills (5 items). Several OT-APST items contribute to more than one subscale, hence there is a difference in the number of items in each subscale and the overall number of items. This study reports three aspects of the reliability of the OT-APST: interrater, intrarater and test-retest reliability.

The participants in the interrater and intrarater reliability study were 15 people following stroke. Videotaped OT-APST performance was scored by nine occupational therapists and the results compared with the scores of the first author as the gold-standard rater. The participants in the test-retest reliability study were 10 people who were neurologically stable one year after stroke and were assessed 2 weeks apart on the OT-APST.

The results obtained for each of the 25 OT-APST items included intraclass correlation coefficients (Type 3,1) for interrater reliability ranging from 0.66 to 1.0, for intrarater reliability ranging from 0.64 to 1.0, and for test-retest reliability ranging from 0.76 to 0.95. These results indicate that the OT-APST has good interrater, intrarater and test-retest reliability and offers a reliable screening tool for use by occupational therapists working in the area of stroke.
Friends United: An Evaluation of an Innovative Residential Self-Management Programme in Adolescent Rheumatology
Authors: Hackett Janine , Johnson Bernadette , Shaw Karen L , McDonagh Janet E
Published: April 2015

Independence in activities of daily living, self-advocacy and peer support are important aspects of adolescent development. These skills are potentially affected by chronic rheumatic diseases and are worthy of attention by occupational therapists and other members of the multidisciplinary team.

An innovative 4-day residential programme for young people diagnosed with chronic rheumatic disease, known as the ‘Independence Break’, was evaluated in order to determine its perceived benefits. The participants were invited to complete a brief evaluation form immediately after the trip to determine the benefits of participation in the programme. The levels of continuing social contact within the group were established 4 months later during a subsequent telephone call.

Thirty young people (median age 14 years) attended the 4-day programme and reported friendship and improved performance in activities of daily living as the major benefits. The majority stayed in touch with at least one other person, with more girls staying in touch than boys. The preferred method of communication was text messaging.

Overall, the programme was perceived to be a valuable experience and offered the young people an opportunity to develop informal peer support networks. The potential of text messaging within adolescent rheumatology is also highlighted.
The Prevocational and Early Employment Needs of Adolescents with Juvenile Idiopathic Arthritis: The Adolescent Perspective
Authors: Shaw K L , Hackett J , Southwood T R , McDonagh J E
Published: April 2015

The purpose of this study was to explore the prevocational needs of adolescents with juvenile idiopathic arthritis (JIA) from their own perspectives.

A focus group discussion was undertaken with eight adolescents with JIA (14.2–16.6 years) attending one United Kingdom hospital. The topics of interest were (i) attitudes towards education, prevocational readiness and employment in relation to JIA; (ii) perceived barriers; (iii) coping strategies; and (iv) preferred sources of support. The data were analysed according to standardised procedures that included data reduction, data display, conclusion drawing and conclusion verifying.

The provision of vocational support for young people with JIA was reported to be uncoordinated, limited and unresponsive to individual needs. A recurrent theme was that professionals generally underestimated adolescents' educational and vocational potential. This was felt to be true of teachers, careers advisers, admissions personnel at colleges and universities and potential employers. Most adolescents worried about discrimination and those in whom the JIA was not visible felt a dilemma about disclosure to potential employers.

The current framework of careers advice appeared to have failed the adolescents in this study who, in the absence of satisfactory support, found themselves consulting health professionals instead. Greater careers advice support for adolescents and professionals is warranted.
Developing Expertise in Judgement Artistry in Occupational Therapy Practice
Authors: Paterson Margo , Higgs Joy , Wilcox Susan
Published: April 2015

This paper presents a follow-up to an earlier paper (Paterson et al 2005) on the topic of judgement artistry. Here the expertise literature is reviewed and the research findings related to developing judgement artistry are presented. Experts use cognitive, metacognitive and humanistic aspects of professional artistry to make highly skilled micro-, macro- and meta-judgements that are optimal for the given circumstances of the client and the context. The professional practice judgement artistry (PPJA) model presented in the earlier paper makes a unique contribution to professional development by offering a creative and challenging perspective on expertise. Finally, the overall research approach is critiqued, considering issues of credibility and rigour, and suggestions for future research are provided.
A Review and Critique of the Touch Inventory for Elementary School-Aged Children (TIE)
Authors: Brown G Ted , Brown Anita
Published: April 2015

The paper presents a review of the published literature about and a critique of the Touch Inventory for Elementary School-Aged Children (TIE), a screening tool for children to self-report on their emotional and behavioural responses to tactile stimuli, developed by Royeen (1985, 1986) and Royeen and Fortune (1990). The TIE is used as a screening tool for children aged 6–12 years who have an IQ of at least 80 and no history of physical disabilities. Psychometric properties based on previously published studies of the TIE are discussed and recommendations for further research are made.
Use of Standardised Tests in Paediatrics: The Practice of Private Occupational Therapists Working in the United Kingdom
Authors: Diamantis Andreas D
Published: April 2015

This study is part of a larger research investigating the assessment methods used by occupational therapists working with children in independent practice in the United Kingdom. The focus of this paper is on the use of standardised tests. The research design was a cross-sectional descriptive survey, using a postal questionnaire as the data collection tool.

Out of 89 questionnaires sent, 66 (74%) were returned and 48 (54%) were deemed eligible. The findings demonstrated that 34 (71%) of the 48 respondents used standardised tests. The most common tests used regularly were the Movement Assessment Battery for Children (79%) and the Developmental Test of Visual-Motor Integration (74%). Standardised tests were used mainly to measure outcomes. The main reason that the participants did not use standardised tests or used them cautiously was the lack of suitable tests for the client.

Most of the study's findings were consistent with those of previous studies. The limited use of occupation-centred standardised tests and the necessity of critiquing standardised tests, especially when used as outcome measures, are discussed. It is suggested that further research on whether the standardised tests contribute to or do not contribute to an occupation-centred practice would be of great value.
Occupational Therapy and Vocational Rehabilitation: An Audit of an Outpatient Occupational Therapy Service
Authors: Main Lynne , Haig Jane
Published: April 2015

In response to an increase in requests for vocational interventions to an outpatient occupational therapy department, an audit was carried out over a 6-month period to determine the size and nature of this demand and the outcome of the service provided.

The department provided rehabilitation principally to patients aged 16 to 65 years and, of 118 consecutive referrals, 76 (64%) included requests for work-related interventions. By the end of the audit period, 46 had returned to work, 21 were receiving ongoing vocational input and 9 had decided not to pursue employment. The value of addressing vocational issues within a general rehabilitation programme at an early stage after injury or illness is discussed.
The Influence of Managers on Job Satisfaction in Occupational Therapy
Authors: Moore Katherine , Cruickshank Mary , Haas Marion
Published: April 2015

Promoting job satisfaction in a workplace can make a positive contribution towards the recruitment and retention of staff. The aim of this study, using a hermeneutical phenomenological approach, was to investigate what occupational therapy managers did to have a positive and a negative influence on the job satisfaction of their staff.

It was clear that managers played a key role in influencing job satisfaction through their actions and behaviours. In particular, managers who demonstrated care and support towards their staff, while at the same time demonstrating that they were strong advocates and able to make decisions for the good of the department rather than for the benefit of the individual, influenced job satisfaction positively. Job dissatisfaction was strongest when managers were seen to treat staff differently, which was construed as a demonstration of bias stemming from favouritism.

The results from this study suggest that staff access to benefits, such as flexible working conditions and educational funding, should be transparent and guided by clear policies.
Impairments in Sensory Modulation in Children with Autistic Spectrum Disorder
Authors: Adamson Amanda , O'Hare Anne , Graham Catriona
Published: April 2015

The Short Sensory Profile was used to measure a caregiver report of sensory reactivity in a group of children with an autistic spectrum disorder (ASD). Fifty-six of 78 (72%) families invited to participate returned the questionnaires and the data were complete for 44 children. These 44 children represented a stratified sample out of a total of 443 children, identified through nine different data sets maintained for children affected by ASD from a total geographical region in South East Scotland.

Clinical information was collected retrospectively from contemporaneous paediatric community child health medical notes and also cross-sectionally from caregivers. Sensory reactivity was outside normal limits in over 70% of the children, with the highest percentage of sensitivities occurring in the auditory filtering and the underresponsiveness and seeking sensation domains. Logistic regression analysis showed no significant relationship between sensory reactivity and the child's age at presentation with autism or parental report of regression. The severity of autism was measured by the Gilliam Autism Rating Scale and related to the Short Sensory Profile (r = 0.39, p = 0.001).

These findings suggest that all children affected by ASD, regardless of clinical features or age, may potentially be affected by sensory reactivities and may benefit from appropriate occupational therapy assessment and management. ASDs are relatively common among neurodevelopmental conditions and confer lifelong disabilities. As the majority of affected children will have sensory modulation difficulties, this has significant implications for paediatric occupational therapy services.
Self-Esteem and Coping in Children with Developmental Coordination Disorder
Authors: Watson Lindsey , Knott Fiona
Published: April 2015

This study investigated self-esteem in children with developmental coordination disorder (DCD). Fifteen children between the ages of 8 and 12 years diagnosed with DCD were compared with a typically developing group comprising 30 children with average and good motor abilities, using measures of perceived competence, social support and self-esteem. The types of coping strategy generated in response to example vignettes were also compared.

There was no significant difference between the groups in global self-esteem, but the children with DCD reported lower athletic and scholastic competence than their typically developing peers. No difference was found between the groups in level of perceived social support. The DCD group generated fewer coping strategies overall, but more passive and avoidant strategies than the typically developing children.

The implications of the study are discussed with regard to future research directions, such as the investigation of the effects of motor skill intervention on self-esteem and the development of strategies to protect children's self-esteem.
Challenges to Measuring Outcomes in Occupational Therapy: A Qualitative Focus Group Study
Authors: Bowman Julia
Published: April 2015

The aim of this study was to explore the process used by occupational therapists to measure the effect of their interventions. A second aim was to explore the challenges associated with this process. Stroke rehabilitation was chosen as the focus for the study.

This qualitative study was conducted in Sydney, Australia. Ten occupational therapists from both hospital and community-based services participated in one of three focus groups. The data were analysed using constant comparison techniques.

The participants struggled when describing the process used to measure outcomes. They focused more on the challenges to measuring outcomes, which were described as focusing on occupation, deconstructing occupation and lacking knowledge, skills and assistance.

The participants in this study had difficulty in articulating and setting measurable goals linked to interventions. As a result, they could not easily select appropriate outcome measures. Education is needed to help such occupational therapists to develop the required skills and to begin to measure clinical outcomes. Further research should determine if similar experiences and challenges are faced in other areas of practice and by occupational therapists in other countries.
Using Change Management Theory to Implement the International Classification of Functioning, Disability and Health (ICF) in Clinical Practice
Authors: Appleby Heather , Tempest Stephanie
Published: April 2015

The success of the International Classification of Functioning, Disability and Health (ICF) depends on its implementation in practice. This article describes an evaluation of the introduction of the ICF framework into an occupational therapy service. Reflections from the working party responsible for its introduction were related to change management theory. The experiences throughout the implementation project could be mapped to the eight-stage process of creating major change (Kotter 1996). The working party concluded that the explicit use of and closer adherence to change management theory could enhance the uptake of the ICF in clinical practice. Further exploratory research is required to support these reflections.
Occupational Disruption: Living with Motor Neurone Disease
Authors: Brott Tamzin , Hocking Clare , Paddy Ann
Published: April 2015

Little is known of the day-to-day experience of living with motor neurone disease from the perspective of those who have it, apart from what can be found in personal accounts such as those published on web pages. In this study, which was informed by phenomenology, seven people living in an urban setting in New Zealand were asked to describe their experiences.

This report focuses on the study findings that related specifically to disruption to occupation. It describes how early changes in occupational performance alerted the participants to the fact that something was wrong. The findings also showed the pervasive impact of an awkward and unreliable body on participation in occupations that gave meaning to life, expressed identity and filled time. Issues of how the family's world was changed, the introduction of assistive devices into their homes and the betrayal of trust were also powerfully evident in participants' stories.

Although the findings are broadly consistent with those of previous studies, the disruption to occupation and the consequent role losses are new findings. Further research into the impact of the loss of participation in occupation, the ways in which people are perceived when occupations are disrupted and the experience of having occupations taken away prematurely is recommended.
The Importance of Vocation in Recovery for Young People with Psychiatric Disabilities
Authors: Lloyd Chris , Waghorn Geoff
Published: April 2015

Young people with psychiatric disabilities are particularly disadvantaged when it comes to participating in vocational training or higher education or to seeking and maintaining employment. A review of the literature reveals that this is due to a number of factors, including low expectations by health professionals, stigma and discrimination, symptomatology and the lack of a clear responsibility for promoting vocational and social outcomes. A useful approach for occupational therapists to use is a recovery framework combining evidence-based employment and educational assistance with mental health care, provided in parallel with brief vocational counselling, illness management skills, training in stigma countering and disclosure strategies, context-specific social skills and skills in social network development.

It is concluded that there is an urgent need to link evidence-based vocational practices with quality mental health care, in order to restore hope among young people of ever realising their vocational goals and once again feeling included as valued members of society.
Investigating Research Capacity: A Survey of Occupational Therapists undertaking Research Degrees
Authors: Reid Helen
Published: April 2015

A priority for the College of Occupational Therapists' Research and Development Group is to identify and strengthen occupational therapy research capacity. Attainment of, or work towards, an MPhil/PhD is one indicator of a developing research capacity. A postal survey undertaken between April and June 2006 sought to discover the size and nature of the population of occupational therapists obtaining a research degree within the United Kingdom. The survey found that 194 occupational therapists had completed or were registered for a research degree. Of those registered, 90% (78/87) were undertaking their studies on a part-time basis and 79% (69/87) were receiving funding.
Occupational Therapists' Perceptions and Management of Aggression Related to Adults with a Brain Injury
Authors: Beaulieu Karen
Published: April 2015

In response to an increasing level of aggression experienced by health care staff in the workplace, the then Secretary of State for Health launched a campaign tackling violence against staff in the National Health Service (Dobson 1998). Occupational therapists recognise aggression as a symptom often following a brain injury and as a potential barrier to rehabilitation. This study explored how occupational therapists perceived and managed aggression with adults post brain injury.

A grounded theory qualitative research methodology was used. A purposive sample of 15 occupational therapists working with adults with a brain injury participated in semi-structured audiotaped interviews. The data analysis identified that the participants experienced and perceived aggression as verbal, physical and gestural.

The findings suggest that occupational therapists need to increase their awareness of the problems associated with aggression. The study identified that in the presence of the elements of close physical contact or fear, and where adults with a brain injury were unsure about what was going to happen next, aggression was more likely to take place. It appears necessary to explore further why this is and to establish strategies to reduce the perceived threat to adults with a brain injury and the potential risks to therapists.
Before Preceptorship: New Occupational Therapists' Expectations of Practice and Experience of Supervision
Authors: Morley Mary , Rugg Sue , Drew Julie
Published: April 2015

Newly qualified health care practitioners generally have high expectations of practice. Stress, value conflict and role uncertainty (‘reality shock’) can result where such expectations remain unmet. Good quality professional supervision can mitigate the deleterious effects of such change. Agenda for Change initiatives have the potential to improve the new practitioners' lot in this area by mandating a year-long period of ‘preceptorship’ support. Such support pairs newly qualified individuals (preceptees) with senior colleagues as role models and resources (preceptors).

This article reports a questionnaire-based survey conducted with 45/74 (61%) newly qualified occupational therapists based in London. The respondents reported high initial expectations of their first posts, particularly with regard to professional supervision and client care, which varied according to their age and education. Most (76%) received weekly professional supervision, focused on primarily clinical issues, although this did not always reflect the respondents' desired time use. Although varied development opportunities were cited, the respondents spent little time with their senior colleagues.

This study showed that the respondents' expectations and experience of supervisory practice varied. A structured approach to the respondents' personal and professional development, and/or supervision, was not always apparent. Given this, preceptorship seemingly has much to offer newly qualified occupational therapists in the United Kingdom.
Early Perspectives of Patients, Practice and the Profession
Authors: Hocking Clare
Published: April 2015

This article draws on an analysis of the British Journal of Occupational Therapy and texts published in England from 1938 to 1951 to describe the ways in which early British occupational therapists perceived themselves and their practice. To give context, the impact of World War II, the medical advances of the time and the profession's overarching goals are outlined.

Three themes are presented. First, therapists' use of craft activities, the knowledge that they held about the therapeutic application of craft and the demands of using craft activities in hospital environments are described. The therapists' efforts to articulate a theory base and to demonstrate the efficacy of occupational therapy are the second and third themes.

The analysis reveals the circumstances that brought about a shift from craft activities to rehabilitation and workplace technologies, and how the diversional activities that characterised practice in mental health and long-stay physical settings lost ground to remedial and vocational outcomes.
The Challenge of Working in Mental Health Settings: Perceptions of Newly Graduated Occupational Therapists
Authors: Lloyd Chris , King Robert , Ryan Liz
Published: April 2015

Working in mental health settings is a growing area of practice for occupational therapists. The work nowadays is mostly within the community, where occupational therapists may be found in a wide variety of teams. This study investigated the specific challenges that new graduate occupational therapists are faced with when commencing work in a mental health setting.

One-to-one semi-structured interviews were carried out with 15 newly graduated occupational therapists, working in mental health settings in south-east Queensland. The interview transcripts were analysed using a consensual qualitative research approach.

Three domains were identified from the transcripts. The first related to the ideas of the participants about the skills and knowledge needed by new graduates commencing mental health practice; the second related to the extent to which undergraduate studies had prepared them for practice; and the third related to the means by which they acquired capacity to practise and overcame deficits in skills and knowledge. The core ideas and themes associated with these domains are examined and the implications of the findings for education and training and for orientation to practice are discussed.
An Audit of an Integrated Care Pathway for a Crisis Resolution/Home Treatment Team
Authors: Rigby Lindsay , Hannah Jeannette , Haworth Katharine , Molloy Lynn , Scutts Kerry
Published: April 2015

The development of crisis resolution/home treatment (CRHT) teams was outlined as a requirement in the National Health Service Plan (Department of Health 2000) and reiterated in the recent guidelines to have an impact on the provision of mental health care (Care Services Improvement Partnership [CSIP] 2006). The Home Option Service in Central Manchester, one of the first CRHT teams in the United Kingdom, provides support and a range of interventions, 24 hours a day, 7 days a week, for those service users experiencing a crisis in their mental health, as an alternative to hospital admission. The need for team working is explicit in the guidance statement to ensure fidelity and best practice for crisis services and it urges teams to provide clarity regarding their roles and responsibilities within the team approach (CSIP 2006).

This paper illustrates a model for occupational therapists working within a crisis team in order to ensure that service users have access to occupational therapy when admitted to crisis care. Specific standards, in accordance with those outlined in the research and development strategic vision for occupational therapists in mental health (Association of Occupational Therapists in Mental Health 2006), have been identified to instigate a clear pathway for the stakeholders of crisis teams. A description of the development, implementation and evaluation of an integrated care pathway is provided, alongside a subsequent audit to measure the effectiveness of this model.
Redesigning Occupational Therapy Service Provision to Increase Efficiency, Effectiveness and Stakeholder Satisfaction
Authors: Horton Ayana , Hall Jennifer
Published: April 2015

The Newham Children's Services Occupational Therapy Department faced a number of major challenges, including an insufficient capacity to meet the growing demand for services, insufficient funding, an inability to fill posts consistently and an extremely long waiting list. It used business process redesign (BPR) techniques to address these problems. The redesign process involved a systematic and thorough approach to problem solving and the implementation of the solutions. Within 3 years, the team had decreased significantly both the rate of formal complaints and the length of the waiting list. It had also increased staff retention and morale. The team's success demonstrates that BPR can be a useful tool in improving the efficiency and effectiveness of occupational therapy services and stakeholder satisfaction.
Professionalism, Personal Taste and Social Inclusion: Does it Matter What Clients Wear?
Authors: Pope Kirsty , Davys Deborah , Taylor Jackie
Published: April 2015

An earlier opinion piece considered the professional issues surrounding the occupational therapist's dress code within the workplace (Davys et al 2006). This second paper considers the role of the occupational therapist when a client's choice of clothing may conflict with social expectations and have a negative impact upon social inclusion. Three hypothetical cases that reflect clinical realities are presented, which serve as prompts for reflection upon informed choice, professional responsibilities and the therapeutic relationship. It is concluded that there needs to be debate about the conflict between each of these areas and the concept of social inclusion.
The Experience of Poor Sleep and its Consequences: a Qualitative Study involving People referred for Cognitive-Behavioural Management of Chronic Insomnia
Authors: Green Andrew , Hicks Jane , Wilson Sue
Published: April 2015

Six patients seeking treatment for chronic insomnia participated in two focus groups as a first stage of questionnaire design. Despite the low attendance at the groups, the results are presented because they offer an illuminating insight into the experience of insomnia.

The participants reported major disruption to their daytime activities, especially in terms of safety and reliability, which could affect their life choices and, they believed, could affect their health. They did not feel understood by others, especially doctors, and wanted better information about insomnia and its management. The study also highlighted practical problems involved in running focus groups as well as ethical considerations that arise when conducting research with current patients. These issues are discussed along with the implications of the research, which raise questions about the role of sleep in maintaining lifestyle balance.

Further research with a larger and more varied group is recommended in order to consolidate the findings and it is suggested that further reflection is necessary to determine the extent to which sleep is a legitimate concern for occupational therapists.
Mainstream Technology as an Occupational Therapy Tool: Technophobe or Technogeek?
Authors: Verdonck Michele C , Ryan Susan
Published: April 2015

Occupational therapists need to embrace the use of mainstream technology in their quest to ensure that therapy remains current and meaningful to their clients. Technology can be useful to improve both functional independence and occupational performance. This opinion piece introduces how occupational therapists can apply mainstream technologies, including information and communication technologies such as the internet, computer software, portable devices and computer games, in their everyday interventions.