bluuebunny/crossref_metadata_2025 huggingface dataset:
Older People and Mobility in the Home: in Search of Useful Assistive Technologies
Authors: McCreadie Claudine , Seale Jane , Tinker Anthea , Turner-Smith Alan
Published: April 2015

A number of assistive technologies exist to help older people with their indoor mobility needs and there is an increasing recognition that older people are capable of being critical and active consumers of these technologies. This paper reports on a study that used focus groups and informal trials to explore older people's perspectives on their indoor mobility problems, their ideas on what assistive technologies might resolve these problems and their evaluation of assistive technologies that were developed in response to these ideas.

The analysis of the results from the four focus groups led to the development of a stair-climbing aid and a new cataloguing aid. The analysis of the results from the informal trials produced useful feedback on the design of the two products and indicated some limitations to the focus group methodology which could be addressed in future research.
Occupational Therapy and Rehabilitation for Work
Authors: Joss Malcolm
Published: April 2015

The use of occupational therapy in work rehabilitation has diminished over the last 20 years. Therapy resources have been diverted to the acute sector as a response to the pressure within National Health Service trusts to achieve early discharges. Occupational therapy in the United Kingdom has therefore suffered a loss of facilities and of therapists experienced in returning injured or ill employees to work. This contrasts with the development of occupational therapy in work rehabilitation abroad.

Occupational therapists, through their education and training, have the potential to develop the necessary skills to assess and treat injured employees to return them to work. There exists a significant number of employees at work and absent from work with musculoskeletal problems, who need the services of occupational therapists specialising in work rehabilitation.

The aim of this article is to provide an overview of the current status of work rehabilitation, to give an example of a therapist-led work rehabilitation intervention with a client and to demonstrate the unique role that occupational therapy played in assisting in the client's return to work.
Methodological Issues in Qualitative Research for the Researcher/Practitioner
Authors: Conneeley A Louise
Published: April 2015

This paper examines some of the methodological and ethical issues that arose during the course of a qualitative study, which aimed to gain an understanding of the experience of head injury and the impact of rehabilitation. It focuses particularly on the problems that may be relevant for clinicians and researchers investigating aspects of their practice. The questions of the relationships between the researcher and the respondents, reflexivity and the dynamics of power during data collection and data analysis are discussed. These could be important considerations for others who wish to conduct research in their practice setting.
Fact and Fiction: A Clarification of Phantom Limb Phenomena
Authors: Fraser Carole
Published: April 2015

Phantom limbs are widely recognised but poorly understood phenomena. Most health professionals dealing with amputees are aware that, post-amputation, some amputees may feel that at least part of their amputated limb is still there. However, there are inconsistencies in the literature regarding the variety, complexity, prevalence and impact of the phenomena. In an attempt to address this problem, a systematic descriptive survey was carried out on a clinic population of upper limb amputees.

The results revealed that 73 of the 76 participants who took part in the study had experienced phantoms. Sixty-six were still experiencing phantoms, of whom 44 stated that their phantoms were painful. It was also found that the amputees claimed that they were provided with very little information about the phenomena and demonstrated a reluctance to discuss their experiences with others apart from their close families.

Based on the findings of the survey, this paper discusses the main characteristics of phantom limb phenomena and separates fact from fiction in order to clarify therapists' understanding of the phenomena.
Modernising Fieldwork, Part 2: Realising the New Agenda
Authors: Fisher Angela , Savin-Baden Maggi
Published: April 2015

In recent years, many discussions have taken place regarding the need for new and different forms of fieldwork education. Research was undertaken to explore the capacity for and barriers to placement provision in the West Midlands Region (reported in part 1 of this article) and to investigate the views of fieldwork educators about the Role Emerging and the Collaborative (2:1) Models of Fieldwork Education. While these have been reported to be viable approaches, as yet few attempts have been made to implement them in practice and issues of context were found to have an impact on their implementation and the provision of placements.

Part 2 of this article examines these two models of fieldwork education in the light of the findings of this study and an innovative approach that emerged from discussions with participants is presented. It is argued here that choice and diversity, in terms of the different models of fieldwork education meeting the needs of different service environments and different students, is valuable; however, the development of an appropriate infrastructure and the provision of adequate resources to support these alternatives are key issues.
The Casson Memorial Lecture 2002: A Culture to Care for
Authors: Willson Moya
Published: April 2015

The Casson Memorial Lecture 2002, given on 14 June at the 26th Annual Conference of the College of Occupational Therapists, held at the Brighton Centre. The conference theme was ‘Making Waves’.
Psychoeducation in Acute Mental Health Settings: Is There a Role for Occupational Therapists?
Authors: Eaton Polly
Published: April 2015

Acute mental health facilities have been under scrutiny in recent years. One of the results of government directives was the creation of a 12-bed women's ward in an acute mental health unit. After concerns about a lack of female-specific treatment, a psychologist and an occupational therapist sought to establish a group specifically for the ward. They used a psychoeducational model to facilitate a ward-based group. A psychologist, an occupational therapist and a staff nurse devised and ran the programme.

This paper describes the aims, challenges and outcomes of the group. It discusses the role of the occupational therapist in delivering this intervention based on observations and relevant literature. The paper concludes by suggesting that occupational therapists, with their knowledge of group processes and activity, are well placed to deliver psychoeducational interventions.
Getting the Evidence into Practice: The Challenges and Successes of Action Research
Authors: Atwal Anita
Published: April 2015

In health and social care, occupational therapists are acknowledging the importance of being evidence-based practitioners. The challenge is not only how to find the evidence but also how to implement research findings or best evidence in clinical practice. Furthermore, the pressure for more effective implementation of research findings is likely to increase. This paper discusses the issues and challenges that occupational therapists may face and must overcome when doing action research from the inside. Action research can be used to improve clinical practice by identifying and solving practical problems.

The paper demonstrates the use of action research to change practice by implementing a new interprofessional discharge model with fractured neck of femur patients in an inner-London teaching hospital. The strategies used to help to overcome the challenges of action research are discussed. The main problems encountered were the difficulties in reaching amicable solutions and in empowering health care professionals who often had little or no influence on decision making. While the aims of the research project were not met, it did highlight further areas that needed to be resolved in order to enhance interprofessional working.
Clinical Applicability of an Educational-Behavioural Joint Protection Programme for People with Rheumatoid Arthritis
Authors: Hammond Alison , Jeffreson Paula , Jones Nerys , Gallagher Jane , Jones Tracy
Published: April 2015

Joint protection is a major part of rheumatology occupational therapy. Recent research emphasises that an educational-behavioural approach is more effective than current practice in enabling people with rheumatoid arthritis (RA) to increase their use of joint protection and benefit from reduced pain and inflammation and improved function. The aim of this study was to evaluate whether occupational therapists, following a 2-day training course in delivering an educational-behavioural joint protection programme, could enable people with RA to improve use of joint protection significantly and obtain similar results to previous clinical trials. This tested whether it would be feasible to introduce the programme into clinical practice.

Three occupational therapists attended a ‘Looking After Your Joints’ training course for leaders. A single-blind crossover trial was conducted. Three centres participated, with each therapist delivering two or three joint protection programmes. Thirty participants with RA attended: 27 women and 3 men, with a mean age of 52.3 years (SD 12.08) and a mean disease duration of 6.76 years (SD 7.02). The primary outcome measure was an observational assessment of use of joint protection, the Joint Protection Behaviour Assessment (JPBA; Hammond and Lincoln 1999b). The median baseline JPBA score for all 30 participants was 15.39% (IQR 11.45–26.82%), which rose significantly to 35% (IQR 25–42.40%) (Z = −3.97; p = 0.0001) at 6 months following the programme.

Both participants and therapists expressed positive views of the efficacy of this training approach. Sixteen participants increased use of joint protection by 20% or more. The findings highlight that the 2-day training course facilitated therapists in delivering the programme effectively and they could gain similar behavioural improvements to previous clinical trials.
Frames of Reference: Their Use in Paediatric Occupational Therapy
Authors: Berry Jane , Ryan Susan
Published: April 2015

The aim of this study was to explore how paediatric occupational therapists provide intervention for children with cerebral palsy in the United Kingdom. A survey design was used with a sample of 120 paediatric occupational therapists. The results of this study were representational of practice among members of the National Association of Paediatric Occupational Therapists.

It was found that 91.7% of occupational therapists in this study used an eclectic treatment approach. Treatment was usually provided on a case-by-case basis, taking into consideration the individual needs of the child, and family-centred functional therapy was valued. Postgraduate training in the areas of neurodevelopmental treatment and sensory integration is recommended in a continuing capacity if therapists choose to use these frames of reference to guide treatment for children with cerebral palsy.
Preventing Unnecessary Hospital Admissions: An Occupational Therapy and Social Work Service in an Accident and Emergency Department
Authors: Carlill Gill , Gash Elizabeth , Hawkins Glenis
Published: April 2015

In spite of the recent increase in occupational therapy services being provided to accident and emergency departments, and the anecdotal evidence that these are beneficial, there is very little published research to substantiate the need for such services. This paper describes the occupational therapy and social work service set up to serve an accident and emergency department in an acute NHS trust. The pilot service was audited after a 6-month period (December 1998 to May 1999) and the results of the audit are also presented.

The results showed that the service was beneficial in terms of both preventing unnecessary hospital admissions and arranging suitable community support when patients were discharged home from the accident and emergency department.

There were clearly ways in which the service could be improved and expanded; these are discussed, together with the implications of the results for future practice. The most important expansion for the service is an increase in staffing to allow 7 days a week cover.
Axonal Sprouting and Neuronal Connectivity following Central Nervous System Insult: Implications for Occupational Therapy
Authors: Kelly Muriel , Shah Surya
Published: April 2015

Based on selected contemporary research, this paper presents a critical analysis of central nervous system (CNS) reorganisation following insult and the need for therapists better to understand the processes that constitute reorganisation and their possible contribution to the development of spasticity. In the treatment of the sequelae of CNS lesions, the synaptic reorganisation as a result of losses caused by injury - in the form of axonal sprouting - is illustrated, focusing on neuronal reconnectivity. Critical analysis of laboratory, electron microscopy and other animal and human studies is also conducted to integrate the controversies identified and to highlight the concepts that become relevant for occupational therapists, in order to optimise therapeutic intervention for maximising restitution in patients with CNS insult. The paper further discusses the capacity of the CNS to compensate and the need to utilise occupational therapy interventions, such as imagining, mental rehearsals, constraint-induced therapy, virtual reality, biofeedback and the traditional repetitive tasks, which leads to ensuring and facilitating the emergence of new synapses to perform motor tasks and manual skills and to prevent secondary changes. These external stimulations provided by the therapists are likely to stimulate both the damaged hemisphere cross-innervation and/or collateral sprouting. These scientifically based treatment strategies and neurological rehabilitation programmes would, in turn, contribute to improving the quality of life of people with CNS insult.
Characteristics of Students Who Enter Occupational Therapy Education through the Universities and Colleges Admissions Service (UCAS) Clearing System
Authors: Craik Christine , Wyatt-Rollason Tracey
Published: April 2015

Since the 1960s, there has been substantial research outside the United Kingdom (UK) on recruitment to occupational therapy education. Recent UK studies have explored the characteristics of mature students (Craik and Alderman 1998), first-year students (Craik et al 2001) and students with a first degree (Craik and Napthine 2001). Based on these studies, a semi-structured, self-report, postal questionnaire gathered data from 50 students who entered the BSc(Hons) Occupational Therapy course at Brunel University, London, via the Universities and Colleges Admissions Service for the UK (UCAS) clearing system.

The students tended to be younger and were more likely to be female and Caucasian and to have similar or higher academic qualifications than standard-entry students at the same university. The majority first became aware of occupational therapy through previous work in a health care setting, although some did so while researching allied health professions. Although one-third originally had physiotherapy as their first career choice, 92% now considered that occupational therapy was what they wanted to do. The principal reason for applying through the clearing system was timing, with some applicants deciding late in the academic year to study occupational therapy. These findings add further weight to the need to promote the profession.
An Exploratory Investigation of Undergraduate Students' Perceptions of Cultural Awareness
Authors: Cheung Yvonne , Shah Surya , Muncer Steven
Published: April 2015

As the British population becomes increasingly diverse, cultural differences pose challenges for health and social care workers. The aim of this exploratory study was to investigate occupational therapy students' perceptions of cultural issues and their perceived level of cultural awareness. A self-administered questionnaire was designed to target the occupational therapy students from a university occupational therapy degree course in the North East of England. Fifty-one of the 65 questionnaires were completed. Two questionnaires were returned as address unknown and, therefore, were excluded from the study. The overall response rate was 81%.

The results showed that the students seemed to have a positive attitude towards cultural influences on occupational therapy services. However, a lack of knowledge and skills about different cultures was expressed. The need for more information and education on these issues was emphasised. The findings confirmed that there was a significant negative correlation between the stage of education and training and the amount of exposure to cultural issues in occupational therapy theory. This study offers some insights, which would be beneficial in the development of a culturally sensitive education curriculum and the provision of quality occupational therapy services for people from different cultural commitments.
Time Use of People Living with Schizophrenia in a North London Catchment Area
Authors: Shimitras Leah , Fossey Ellie , Harvey Carol
Published: April 2015

Time use provides one means to study the lifestyles and community participation of people with disabilities. Previous clinical studies suggest that people with a mental illness experience difficulty in using their time meaningfully. This study examines the time use of 229 adults diagnosed with schizophrenia from an epidemiological survey in London, England. Twenty-four hour time budgets were collected and time use was calculated for 10 major categories of occupations.

Few of the participants were engaged in work, active leisure, education or volunteer occupations, their predominant occupations being sleeping, personal care and passive leisure. The women spent significantly more time in domestic occupations and less time in passive leisure occupations than the men. The younger participants spent significantly more time in social occupations than the other age-groups. The older participants, and those attending day centres, spent most time in passive leisure.

These findings indicate that many people diagnosed with schizophrenia are not engaged in occupations that support active lifestyles or social inclusion, highlighting the need to improve their opportunities to participate in mainstream social, active and productive occupations. Occupational therapists must work with service users and agencies beyond the mental health system to enable service users' participation in such occupations. Barriers to participation also require further exploration to address these occupational needs better.
Profiting from Consensus Methods in Occupational Therapy: Using a Delphi Study to Achieve Consensus on Multiprofessional Discharge Planning
Authors: Atwal Anita , Caldwell Kay
Published: April 2015

In occupational therapy, there is much debate regarding many aspects of practice. In order to make effective decisions in situations where there is contradictory or insufficient information, it is important to reach a consensus decision. The Delphi technique is a survey method of research, which aims to gain consensus among a panel of experts using repeated rounds of a questionnaire.

This article is based on the first author's experience of using a Delphi survey as part of an action research project, located in a large acute National Health Service trust. This project aimed to analyse and improve multidisciplinary teamwork in discharge planning. The aim of the article is to focus on the Delphi technique as a methodological approach and, to illustrate this, examples are used from the research study. However, before using the Delphi technique, occupational therapists must understand the strengths and weaknesses of this approach.
Improvement in Activities of Daily Living Using the Freehand: A System Designed for People with Tetraplegia
Authors: Esnouf Julie , Taylor Paul , Hobby John
Published: April 2015

The Freehand system is an implanted device for people with C5/6 tetraplegia, international classification 0, 1 and 2. The implant is designed to improve hand function, particularly in those who lack voluntary muscles suitable for tendon transfer. This study investigated how the Freehand system was being used at home, work and leisure. Twelve participants, who were assessed, implanted and trained with the Freehand system, were reviewed against their preoperative goals.

Prior to surgery, eight activities of daily living goals that the participant would like to perform with the Freehand system were selected by him or her. Each task was assessed in three sections: the set-up of the task, the performance and the take-down. The amount of assistance for each section was recorded. This was repeated after training had been completed and daily use established. Each participant was also asked to state a preference on how the tasks would be completed, whether with the system or by the method prior to surgery.

The results of this study show an improvement in the participants' functional ability in their selected goals when using the Freehand system. The preference for using the Freehand system to complete tasks applied to 84% of the total 96 tasks chosen by the 12 participants in this study.
Narrative Methods: Talk, Listening and Representation
Authors: Clouston Teena
Published: April 2015

The involvement of the user in decisions about his or her own health and social care has become a key element of the changes encapsulated in the Government's legislation. Listening to the service user and responding to his or her needs is an integral part of that change. Occupational therapy philosophy has always engendered client-centred practice and, therefore, listening to and valuing the voice of the user. Now, more than ever, occupational therapists have to show that this is an integral part of their everyday practice.

Narrative is one method that could be used to explore the lived experiences of users of occupational therapy. This study explored the relevant literature about narrative using qualitative methodology. The emerging themes from the data suggest that narrative, in its varied forms, could be a useful tool in clinical and research-based occupational therapy activity. Also, occupational therapists' own approach and reflexivity within the narrative process are key elements in the effectiveness of this technique.
Grounded Theory: Exploiting the Potential for Occupational Therapy
Authors: Stanley Mandy , Cheek Julianne
Published: April 2015

Occupational therapy possesses few mid-range substantive theories, particularly those that have been derived empirically or generated within the profession. Grounded theory offers a systematic and well recognised approach to study the richness and diversity of human experience, in order to generate relevant theory. This paper describes grounded theory, its theoretical orientation and its elements, and offers a critique of the approach. A selection of grounded theory studies related to occupational therapy and occupational science are reviewed to demonstrate the contribution that the approach has begun to make to, and the potential that the approach offers for, developing empirically derived occupational therapy theories.
Women's Leisure Activities, Their Social Stereotypes and Some Implications for Identity
Authors: Taylor Jackie
Published: April 2015

An understanding of leisure as an area of occupational performance that can contribute to the individual's personal and social development is important to the occupational therapist. The knowledge bases from other disciplines, such as sociology and psychology, have much to offer in developing this understanding. Social identity and stereotype theories and symbolic interactionism suggest that leisure stereotypes may exist and could have an impact on identity.

In order to test this concept, 12 leisure activities were used as a means to assess whether leisure stereotypes exist for women. Stereotypes consisting of between 4 and 11 words were obtained using the checklist method, with 40 participants contributing to each stereotype (120 participants contributed in total). The stereotypes were found to include characteristics that were both positively and negatively valued and, consequently, they had a range of favourableness ratings. All but one, golf, were positively evaluated images. The implications of these results are discussed, in the context of relevant theories from sociology, psychology and feminist literature.
Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder: A Survey on the Level of Involvement and Training Needs of Therapists
Authors: Chu Sidney
Published: April 2015

There has been a substantial increase in clinical activity related to the identification and treatment of children with attention deficit hyperactivity disorder (ADHD) in the United Kingdom. The accurate diagnosis and successful management of children with ADHD requires a multifaceted evaluation and treatment package provided by a team of medical, psychological, educational and therapy professionals. Occupational therapists can make distinctive contributions in the processes of evaluation, diagnosis and multifaceted intervention.

A national survey was carried out to investigate the level and nature of involvement of paediatric occupational therapists in services for children with ADHD in the United Kingdom. The learning needs of the therapists were also explored in this survey. A questionnaire was sent to all 941 members of the National Association of Paediatric Occupational Therapists.

The response rate of this survey was 30%, that is, 282 completed questionnaires were returned. The results showed that only 8.5% of the therapists who responded had involvement in a designated service for children with ADHD. Twenty-seven per cent of the therapists indicated that they did not see children with ADHD. The 63.8% of therapists who did see children with ADHD as part of their overall caseload in a community service did so mainly because of the children's associated problems in different sensory, perceptual, motor and functional performance areas. The reasons for non-involvement are explored and discussed and the learning needs of the therapists and their preferred modes of training are identified.
Consultant Therapists: Recognising and Developing Expertise
Authors: Craik Christine , McKay Elizabeth Anne
Published: April 2015

The introduction of consultant therapists provides an unprecedented opportunity for the occupational therapy profession and for individual therapists. The literature on clinical reasoning suggests the characteristics of experts, which may be a useful guide both for those who wish to create consultant therapists posts and for those who aspire to fill them.
Culture, Cultural Competency and Occupational Therapy: A Review of the Literature
Authors: Awaad Jerri
Published: April 2015

Many cultural challenges and questions are raised for Western practitioners developing occupational therapy services within non-Western societies, particularly in specialties, regions or countries where occupational therapy has not previously been recognised. Setting up a new service anywhere can be a daunting task, but it is perhaps more so in the absence of precedent.

In an effort to establish a sound, evidence-based approach to a new service development in mental health services in the United Arab Emirates, the literature was reviewed to identify occupational therapy research and perspectives related to culturally competent practice. Three key themes were identified and their relationship to psychosocial, and more general, occupational therapy practice is explored. Guidelines for culturally competent practice, arising from the literature, are also proposed.
Clinical Incidence of Sensory Integration Difficulties in Adults with Learning Disabilities and Illustration of Management
Authors: Green Dido , Beaton Lindsay , Moore Denise , Warren Lin , Wick Vanessa , Sanford J Ellen , Santosh Paramala
Published: April 2015

This project investigated the prevalence of sensory processing problems in a clinical group and also examined the clinical effectiveness of a specialised therapeutic technique, sensory integrative therapy (SIT), in the treatment of maladaptive behaviours in two adults with learning disabilities. The Sensory Integration Inventory — Revised for Individuals with Developmental Disabilities (SII-R, Reisman and Hanschu 1992) was used to identify two clients suspected of having poor sensory processing. A single-subject experimental design (ABAB) was used to assist the objective measurement of the effects of SIT.

The results suggest that the SII-R has some limitations in identifying clients who would benefit from SIT. One client (Ms D) was seen to instigate more positive interactions with her environment during and following the treatment phases; however, the overhabituated behaviours of the other client (Mr K) showed little response to SIT. These results are discussed in the form of a practitioner's update, with respect to the indicators of sensory processing dysfunction and the potential therapeutic benefits of SIT as an adjunct to therapeutic interventions for individuals with learning disabilities.
The Career Choice of First-Year Occupational Therapy Students: A Follow-up Study
Authors: Craik Christine , Zaccaria Jean-Marie
Published: April 2015

This study replicated a survey of first-year occupational therapy students at Brunel University (Craik et al 2001) and 114 students (91.2%) responded. Their profile was similar to that of the students in the previous study, with 90% being female, 65% being over 21 years of age and 20% coming from minority ethnic groups. The most frequent way that the students had heard about occupational therapy remained through informal means, with variety and challenge continuing to be the most important factors in attracting potential students to the profession. The results of this study, taken with those of Craik et al (2001), provide data on 444 first-year students and further emphasise the importance of occupational therapists in encouraging recruitment to the profession.
Occupational Therapy in Multicultural Contexts: Issues and Strategies
Authors: Chiang Michael , Carlson Glenys
Published: April 2015

The profession of occupational therapy aims to recognise and value cultural diversity. The purpose of this review is to examine occupational therapy in Western multicultural contexts. First, culturally competent practice is discussed. Secondly, concepts relating to culture in two occupational therapy models (the Model of Human Occupation and the Occupational Performance Model) and in occupational science are examined. Thirdly, occupational therapy in Western multicultural contexts is examined in relation to immigrant cultural groups and indigenous cultural groups: issues, cultural variations and strategies are identified. Fourthly, the implications for occupational therapy education are discussed. In conclusion, the implications for the profession of occupational therapy are identified.
Pursuing the Client's Goals Really Paid Off
Authors: Sumsion Thelma
Published: April 2015

This paper reports on a qualitative study undertaken to examine the barriers to the application of a recently created British definition of client-centred occupational therapy. Twelve therapists in one mental health National Health Service trust were engaged in semi-structured interviews. Three themes and a number of subthemes emerged from the analysis of the data. These three themes were initiating client-centred practice, therapist as partner and client as partner. Overall, the study found that there were barriers to the application of the definition of client-centred occupational therapy but that the therapists in this study found ways to overcome these barriers.
Spirituality in Occupational Therapy: Theory in Practice?
Authors: Belcham Cara
Published: April 2015

Spirituality is recognised as an essential component of holistic practice, which can have a significant impact on individuals' health and occupation (Christiansen 1997). As such, the need for occupational therapists to recognise and address this area of clients' lives has been identified. However, occupational therapists appear to have some difficulty in addressing this area in practice.

This study aimed to examine the factors contributing to any such gap between professional theory and practice and to highlight the ways that any difficulties could be overcome. Postal questionnaires of primarily quantitative design were sent to 98 randomly selected hospital-based occupational therapy departments across England; 79 (81%) were returned completed.

Role ambiguity and the lack of inclusion of spirituality in assessments were found to be factors increasing the perceived difficulty of some respondents in addressing religious/spiritual beliefs in practice. The awareness of occupational therapy models was found to increase respondents' perceived confidence and clarity regarding addressing religious/spiritual beliefs in practice. Practical training and information were identified as methods by which confidence in addressing these aspects may be increased.
A Survey of Assistive Equipment Use by Older People following Hospital Discharge
Authors: Hoffmann Tammy , McKenna Kryss
Published: April 2015

Occupational therapists prescribe assistive equipment to increase clients' independence in self-care activities. This study examined clients' use of assistive equipment post-discharge and explored the factors that might have influenced use. The participants were 127 clients (mean age 78.7 years, 62.2% men) who were issued one or more items of assistive equipment while inpatients at a metropolitan hospital. At approximately 10 weeks post-discharge, the participants completed a postal questionnaire.

Of the 407 items of equipment prescribed, 363 (89.2%) were used, with three types of equipment (bathboards, hand-held shower hoses and stair rails) having 100% use. The participants who lived alone were more likely to use toileting equipment and shower chairs than the participants who did not live alone (p<0.05). The long-handled equipment had the lowest usage rates. For unused equipment, 16.5% was not used because it was no longer needed and 9.3% because the participants reported that they had never really needed it. Overall, 91.3% of the participants reported that they had received adequate training in the use of the equipment.

Although most of the participants used prescribed assistive equipment, recommendations based on a client-centred approach to the prescription process are made to increase clients' use of equipment further.
The Morriston Occupational Therapy Outcome Measure (MOTOM): Measuring What Matters
Authors: James Sharon , Corr Susan
Published: April 2015

Occupational therapists recognise the importance of outcome measures, but few appropriate and valued measures are available for use in daily practice. This paper describes a study designed to validate and improve a tool, the Morriston Occupational Therapy Outcome Measure (MOTOM), which measures individual change in occupational performance. It is considered to be an outcome measure that is appropriate for and reflects the nature of occupational therapy.

The underlying rationale of MOTOM is described first, together with the structure of the instrument prior to the study. The methods used to investigate its clinical utility and validity are then presented. These include a survey by questionnaire of 36 occupational therapists using MOTOM; interviews with two service managers; an audit of 216 occupational therapy records; and interviews with 36 patients. The results demonstrate that the tool can be incorporated into occupational therapy as an appropriate measure of change in occupational performance, but indicate the need for amendments, which are discussed in the final section.
Life Skills Training in Schizophrenia
Authors: Mairs Hilary , Bradshaw Tim
Published: April 2015

Rehabilitation approaches incorporating life skills training are widely employed in the treatment of individuals with schizophrenia. However, whether such approaches are effective is unknown (Nicol et al 2003). This pilot study assessed the effectiveness of a life skills training intervention for people with a diagnosis of schizophrenia, facilitated by occupational therapists working in community mental health teams.

Seventeen clients with a diagnosis of schizophrenia and a life skill deficit or deficits were recruited from two National Health Service trusts and participated in up to 12 sessions of life skills training, based upon a treatment manual written specifically for the study. The intervention was facilitated by eight occupational therapists who received training in life skills therapy. A pre-intervention and post-intervention experimental design was used to assess the effectiveness of the programme, with measures of psychiatric symptoms and social functioning being conducted by an independent assessor who was naïve to the intervention being used.

For the 13 participants who completed the life skills intervention, participation was found to reduce negative symptoms and overall levels of general psychopathology, although this was not reflected in social functioning. Indeed, a statistically non-significant deterioration in social functioning was found upon completion of the intervention. This uncontrolled study does not allow definitive evaluation of the value of life skills training in schizophrenia, but it does provide justification for a larger-scale controlled trial of a manual based approach to life skills training with this client group.
Mental Health Clients Confirm the Value of Occupation in Building Competence and Self-Identity
Authors: Mee Jeannie , Sumsion Thelma , Craik Christine
Published: April 2015

Engagement in occupation is proposed to enhance health and wellbeing. To date, few studies have demonstrated this in relation to people with mental health problems. This study aimed to evaluate occupational therapy's beliefs in the restorative powers of occupation from the perspective of people with enduring mental health problems living in the community.

Qualitative research methods were used in two mental health day service settings: a workshop, where woodwork was provided as a medium for creative therapy, and a drop-in facility. Participant observation was undertaken over 10 sessions and, during six in-depth interviews, the clients were asked about their occupational experiences and whether they had perceived any benefits from engagement in occupation. Content and inductive analysis as well as concept mapping of the data resulted in emergent themes and subthemes.

Occupation was identified both as a means for building competence through the acquisition of skills, coping with challenges and achieving success and as a medium for developing self-identity through the drive to create, feelings of usefulness and engendering a sense of self. These themes help to support the need for an increase in the provision of meaningful occupation for people with enduring mental health problems. However, further research is required to develop and corroborate the findings.
Irrational Beliefs and Job Stress among Occupational Therapists in Singapore
Authors: Tan Bhing-Leet
Published: April 2015

As members of a human service profession, occupational therapists experience substantial amounts of stress. A number of studies have looked into the levels and sources of stress among occupational therapists. However, no study has examined how belief systems are related to occupational therapists' experiences of job-related stress.

This study thus attempted to explore new ground by investigating the relationship between intensity of irrational beliefs and levels of stress. It also sought to examine associations between types of irrational belief and different sources of stress. A cross-sectional survey was carried out, during which self-report questionnaires were either posted or electronically mailed to practising occupational therapists in Singapore. Thirty-seven (53%) occupational therapists responded. The results showed that the intensity of irrational beliefs was unrelated to stress levels among the occupational therapists. However, certain types of irrational belief were related to the experience of certain sources of stress. In particular, low frustration tolerance was associated with stress regarding patient contact and irrationality in self-worth was associated with stress pertaining to rewards and recognition as well as to professional value.

The possible explanations for such findings are explored in this paper. At the same time, the implications for practice are outlined, notably the proposal for cognitive strategies to be included in stress management programmes.
Using Vignettes to Assist Reflection within an Action Research Study on a Preoperative Education Programme
Authors: Spalding Nicola J
Published: April 2015

This paper describes an exploratory use of vignettes in action research. The study was with a group of health care professionals, who were working together to improve their preoperative education programme for patients awaiting a total hip replacement.

One vignette, written after the observation of an education programme, is presented to illustrate how the health care professionals used it within an action research cycle in order to reflect on practice and then to implement changes. These changes were mostly to the programme organisation and in preparing the venue for the education.

The vignette enabled the health care professionals to appreciate a different perspective to their own lived experience. The value of vignettes used in this way is recognised in this paper because they facilitated the health care professionals' reflections within the action research process.
Being in a Secure Forensic Psychiatric Unit: Every Day is the Same, Killing Time or Making the Most of It
Authors: Farnworth Louise , Nikitin Lara , Fossey Ellie
Published: April 2015

Institutional environments are challenging settings in which to provide rehabilitation. This study describes the time use of a group of inpatients, the majority diagnosed with schizophrenia, in a secure forensic psychiatric unit in Australia. Time diaries, interviews and fieldnotes were collected over 5 weeks. Eight participants completed time diaries for two consecutive days, of whom five were also interviewed using the Occupational Performance History Interview II.

The participants' time use was dominated by personal care and leisure occupations. In general, the participants were dissatisfied with their time use, describing themselves as ‘bored’ or ‘killing time’. Many perceived that the environment created barriers to their participation in valued occupations, yet some also found occupations that provided solace, challenge or a connection with the outside world.

The findings indicate the importance of understanding individuals' unique occupational histories, interests and skills in order to create opportunities to engage them in relevant occupations that use personal resources, as part of forensic rehabilitation programmes, and the utility of the Occupational Performance History Interview II in this context. Further research exploring patient and staff perspectives on the challenges of occupational programming in forensic settings and the longitudinal impact of such programming on inpatients' occupational functioning, health and wellbeing is recommended.
Occupational Therapy Predischarge Home Visits: A Study from a Community Hospital
Authors: Renforth Philip , Yapa Ranjith S , Forster Donald P
Published: April 2015

The characteristics of 79 patients in a community hospital having an occupational therapy home visit during a period of one year were monitored. The processes of the home visit were examined and, in particular, the relationships of diagnosis and overall measures of levels of functioning – the Physical Self-Maintenance (PSM) and Instrumental Activities of Daily Living (IADL) scales – with the recommendations of the occupational therapists were analysed.

The 79 patients had a mean age of 78.5 years; 27 (34.2%) were male and 58 (73.4%) lived alone. The mean time spent in the home by the occupational therapist was 49 minutes and the mean time for the whole visit including travelling time was 108.4 minutes. Only one patient (1.3%) was completely independent in all six PSM categories and no patient was completely independent in all eight IADL items. Seventy-two (91.6%) patients were eventually discharged to a non-institutional setting, mainly the patient's own home.

Current diagnosis, except for cerebrovascular disease, was not significantly related to higher overall dependency, recommended equipment or carer visit frequency. Higher overall dependency showed significant relationships with recommended carer frequency and time spent assessing the patient in the home, but not consistently with recommended equipment or home adaptations. When specific categories of equipment were considered, for example that for use in the kitchen, overall low dependency was significantly related to the recommendation for this type of equipment.

The study confirms the need for assessments beyond those of diagnosis alone in rehabilitation. Overall measures of levels of functioning, although useful in measuring outcomes, are of less certain value for assessment. Specific subcategories of dependency scales are probably of more value than overall scores for occupational therapy assessment.
Getting Evidence into Practice: Implementing a Behavioural Joint Protection Education Programme for People with Rheumatoid Arthritis
Authors: Hammond Alison , Klompenhouwer Petra
Published: April 2015

Researchers must disseminate their research findings, but this alone is often insufficient to change practice. To improve research implementation by rheumatology occupational therapists, a 2-day training course for changing joint protection practice was developed. This aimed to improve understanding of joint protection, patient education and health behaviour research; develop skills in delivering a group joint protection programme; and reduce potential barriers to changing practice. To evaluate the course's effectiveness, a postal survey with attendees was conducted.

Of the 48 respondents, 45 subsequently changed individual patient education practice; 13 implemented the group programme, 25 contemplated doing so and 10 did not (precontemplators). The implementers and contemplators rated the joint protection programme as significantly more effective (p = 0.02) and relevant (p = 0.001) in practice than the precontemplators. The barriers to change were limited staffing, access to facilities, time to make practice changes, funding for programme costs and clinical time to deliver the programme. The implementers considered that supportive managers and teams helped to overcome these.

Changing practice needs clinicians, researchers and managers to work together. This research implementation strategy helped most of the participating clinicians to make practice changes that were readily within their control (that is, individual patient education). Group education requires greater organisational change and manager support is important to facilitate this.
Protecting Professional Identities: Service User Involvement and Occupational Therapy
Authors: Wright Cathy , Rowe Nick
Published: April 2015

Service user involvement in the delivery of health care is now a government priority yet, with some exceptions, it does not seem that the occupational therapy profession is meeting the challenges that this poses. In the light of the profession's emphasis on client-centred practice and individual empowerment, this is surprising. The authors argue that professional insecurity and role uncertainty are inhibiting the vigorous development of advocacy in occupational therapy. They propose that a preoccupation with establishing professional demarcations prevents the openness necessary for the lively and genuine involvement of service users.