bluuebunny/crossref_metadata_2025 huggingface dataset:
Process Mapping Occupational Therapy Activity within a Medical Admissions Unit
Authors: Welch Amanda
Published: April 2015

There are increasing demands on professionals within health care to provide a service that meets the needs and expectations of patients. This requires the patient to be placed at the centre of the care pathway. Occupational therapy is well placed to contribute to this change in emphasis because of its fundamental client-centred philosophy. Experience has shown, however, that the realisation of these aims has been a challenge for all health care professionals. Increasingly, the National Health Service is drawing upon expertise from outside and, in particular, the quality improvement tools that are used within industry.

This article explores the use of the traditional quality tool of process mapping in the evaluation and review of occupational therapy processes. The use of this tool is explained in relation to a clinical audit within a medical admissions unit.

The results of the process mapping exercise, and the associated audit that was undertaken, demonstrated the value of the approach. In particular, process mapping enabled the occupational therapy service to evaluate systematically the service being provided and to visualise the optimum pathway of care.
Informing Client-Centred Practice through Qualitative Inquiry: Evaluating the Quality of Qualitative Research
Authors: Hammell Karen Whalley
Published: April 2015

Occupational therapists are increasingly embracing qualitative research methods yet little published advice exists in the occupational therapy literature to enable readers to gauge the quality and relevance of researchers' work. If qualitative research is to provide convincing evidence with which to inform theory and practice, it must be capable of withstanding critical scrutiny and practitioners must be given sufficient information with which to evaluate the strength and plausibility of the evidence reported. The process of undertaking qualitative research and of writing and critiquing subsequent reports is not about assessing adherence to rigid rules but of ensuring the appropriateness and thoroughness of data collection, analysis and reporting, given the nature and context of the issue. The espousal of a client-centred ethic also demands consideration of research relevance and usefulness to clients and the degree of consumer involvement throughout the research process.

This paper examines an evaluative framework that may be used to assess the quality of qualitative evidence as this is both researched and reported. Recourse to a set of general strategies — used where appropriate – will serve to enhance the quality of qualitative research and assert its potential to inform the client-centred, evidence-based practice of occupational therapy.
Keeping in Shape: Achieving Fitness to Practise
Authors: Warne Catherine
Published: April 2015

Following the changeover from the Council for Professions Supplementary to Medicine to regulation by the Health Professions Council, therapists will need to be able to demonstrate their fitness to practise. This article explores the meaning and implications of the term ‘fitness to practise’, discusses the related influences of fitness for purpose and clinical governance; and considers some means of demonstrating fitness to practise.
Advancing Practice through Continuing Professional Education: The Case for Reflection
Authors: Roberts Anne E K
Published: April 2015

This short discussion paper is inspired by the belief that continuing education is an essential catalyst for advancing professional practice. It proposes that reflection on practice is an essential component of continuing professional education and that experienced practitioners must reflect on practice in order both to develop personally and to move the profession forward. Inevitably, this entails questioning the status quo, facing conflict and initiating change. These processes are discussed here and the discussion concludes by considering some strategies for incorporating reflection through continuing professional education.
Rehabilitation of Motor Control following Stroke: Searching the Evidence
Authors: Dickson Maria
Published: April 2015

Evidence-based practice is becoming an increasingly important issue and occupational therapists are frequently reminded that they must search the literature to find evidence to support their interventions. However, in many areas of practice this evidence is simply not available to be found. An example of this is in the remediation of motor control following stroke. As new ideas about motor control have emerged, some occupational therapists have expressed concern about the approaches that are currently used, in relation to their efficacy and their appropriateness.

This article considers the meaning of evidence-based practice and the advantages and difficulties that it presents. The literature is then reviewed to consider evidence for traditional and contemporary approaches to motor control by occupational therapists. The disturbing lack of evidence for traditional approaches and the limited amount of evidence for new approaches are discussed. Recent studies of current practice are then explored, revealing that many occupational therapists are continuing to use approaches for which there is no supporting evidence.

The article concludes with the suggestion that, rather than asking occupational therapists to search for evidence that does not exist, they should be encouraged to produce the evidence by being involved in research studies that seek to demonstrate the efficacy of different approaches.
The Group Activity Form: Is it Valid and Reliable?
Authors: Thorgrimsen Lene , Kennedy Louise , Douglas Cathy , Garcia Chris , Bender Mike
Published: April 2015

The Group Activity Form (GAF; expanded from Bender et al 1987), a tool for evaluating group members' participation in group sessions, has been successfully used, but its reliability and validity have not been established. This was the aim of the present study.

In order to investigate the interrater reliability of the GAF, three independent raters used the GAF to score 96 people with dementia attending a reminiscence group. The group was conducted by the occupational therapy department in an assessment ward for people with dementia. To explore the concurrent validity of the GAF, it was hypothesised that, with this client group, a correlation could be expected between how successful the group members were in engaging in group activity, measured by the GAF, and their cognitive abilities. To measure the latter, the Clifton Assessment Procedure for the Elderly (CAPE; Pattie and Gilleard 1979), a measure well established and validated in this setting, was used.

The results showed a significant interrater reliability on all the items of the GAF. There was some evidence for the hypothesised correlation between the GAF and the CAPE. This study is a useful starting point for further research to investigate other aspects of the validity and reliability of the GAF.
Community Care and Rehabilitation after Stroke in Japan
Authors: Butler Jenny , Smith Teresa
Published: April 2015

The purpose of the research project was to determine, from a cross-cultural perspective, the care services and rehabilitation for elderly people with stroke living in the community in Japan. A written questionnaire and a semi-structured interview were used. The participants were a purposive sample of 21 elderly people and family/carer living in the metropolitan area of Tokyo, Japan. There were 11 men and 10 women with an average age of 70 years (range 42–86 years). The mean age at onset of stroke was 66.5 years (range 42–81 years) and the mean time since stroke was 3.2 years (range 3 months to 8 years).

Varying levels of dependency were found, with an average Barthel Index score of 9.32 (range 0–18). Varying experiences of rehabilitation services were also reported: six people received physiotherapy only, six received physiotherapy and occupational therapy, and nine received no formal rehabilitation service either in hospital or in the community. Many participants were living in multi-generational households. Women had frequently given up jobs to care for their elderly relative, but were assisted in the caring role by community care workers (mainly nurses and home helpers). Environmental changes and disability equipment were evident in the homes.

The project concluded that elderly people in Japan were supported by good community health care, although rehabilitation resources were limited. Cultural understanding as a key factor in rehabilitation processes is explored in the paper.
Views from the Inside, Part 2: What the Children with Arthritis Said, and the Experiences of Siblings, Mothers, Fathers and Grandparents
Authors: Britton Carrie A , Moore Ann
Published: April 2015

This second article in a series of three presents some of the findings from a study involving 46 families of children with juvenile idiopathic arthritis (JIA). The aim of the study overall was to describe and explore what life was like for families that included a child with JIA in the United Kingdom today. The study deployed a grounded theory approach, collecting different sorts of data over time in order to build up a picture of how these families lived with such a changeable long-term condition.

In the first stage, data were collected using a self-completion questionnaire from 46 families, whose children attended a regular outpatient appointment at the paediatric rheumatology clinic. These data formed the contextual landscape to further in-depth data collected in stage two, from a cohesive group of nine families of girls selected from those who had already taken part in stage one. In stage two, the families were interviewed in their own homes, the children wrote diaries and the families recorded a video diary. All the data related to the respondents' recollections of events and their thoughts, feelings and perspectives: they formed the insiders' view of the experiences.

This article presents the findings about the common themes that emerged from the data about children with JIA and their siblings, mothers, fathers and grandparents. It also discusses the key elements of the families' experiences and concludes with recommendations for health care practitioners. A distillation of the views of the majority of parents is provided in these two statements by different mothers: ‘Immobility and pain makes the joy of play, just armchair viewing’ and ‘It's a stolen childhood, really, isn't it?’
Pro-Motion: A Positive Way Forward for Clients with Severe and Enduring Mental Health Problems Living in the Community, Part 2
Authors: Heather Frances
Published: April 2015

This is the second part of a two-part article describing a clinical therapeutic intervention, planned and organised by a senior occupational therapist and mental health nursing staff for clients with severe and enduring mental health problems living in the community. The six participants had a diagnosis of schizophrenia or schizoaffective disorder or bipolar illness. Four were receiving the atypical antipsychotic medication, Clozapine. One was receiving Olanzapine, also atypical, and the last was receiving traditional antipsychotic medication, a phenothiazine. These clients were all receiving long-term support from the mental health rehabilitation unit. Participation was voluntary and each client gave written consent to participate and for the findings to be published later.

Part 1 described the aims and objectives of the initial group, the selection criteria, and the content and process of the group over a period of 6 weeks. Part 2 describes a subsequent group held with the same clients for another 6 weeks. The outcome measures used in part 1 were the Beck Anxiety Inventory (BAI) (Beck and Steer 1993) and the State-Trait Anxiety Inventory (STAI) (Speilberger 1983) together with verbal and written evaluation. In the second group, it was decided not to repeat the use of the BAI and STAI; instead, a more detailed qualitative questionnaire was issued. The reasons for this are explained.

Part 2 goes on to describe the progress of the subsequent group and gives a brief overview of what has happened in further groups since. Client evaluations are illustrated by two case vignettes. The benefits to the other clients are highlighted, together with the possible drawbacks. There is discussion about the possible potential for such groups in the future.
Clinical Application of the Canadian Model of Occupational Performance in a Forensic Rehabilitation Hostel
Authors: Clarke Channine
Published: April 2015

In order to improve the quality and effectiveness of occupational therapy service provision, therapists should be using models of practice. This paper describes the Canadian Model of Occupational Performance and critically evaluates its application within a forensic rehabilitation hostel. It provides examples from practice and discusses the strengths and limitations of the model.
A Survey of Current Occupational Therapy Practice for Parkinson's Disease in the United Kingdom
Authors: Deane K H O , Ellis-Hill C , Dekker K , Davies P , Clarke C E
Published: April 2015

Little is known about the current character of occupational therapy practice for Parkinson's disease in the United Kingdom. The study aimed to document this in order to inform plans for a future multicentre randomised controlled trial.

Two hundred and forty-two occupational therapists that treated people with Parkinson's disease were sent a questionnaire regarding demographics, service organisation and therapy content. One hundred and sixty-nine occupational therapists (70%) responded. They had worked with people with Parkinson's disease for a median of 6 years and personally treated a median of 15 people with Parkinson's disease annually. Most (86%) were at senior grade or above; 87% worked in the National Health Service and 12% in social services. Forty per cent worked in specialist Parkinson's disease clinics. Most (79%) felt that they needed more specialist postgraduate training.

Occupational therapists are employed in both health and social care settings. The character of the occupational therapy is often determined by the location in which it is provided. Current occupational therapy appears to focus on functional activities rather than on the wider social and psychological aspects of occupation. Many occupational therapists felt that they needed more specialist postgraduate training to treat people with Parkinson's disease effectively.
Occupational Therapy Research: Building Capacity
Authors: White Elizabeth
Published: April 2015

At a time when the need for the generation and application of occupational therapy research has never been greater, this opinion piece explores the agenda that currently has an impact on the profession's research capacity. The opportunities available to all occupational therapy personnel to develop research skills and apply research findings to enhance their practice are identified and the support offered to members by the College of Occupational Therapists is described.
Determining the Effectiveness of a Falls Prevention Programme to Enhance Quality of Life: An Occupational Therapy Perspective
Authors: Tolley Louise , Atwal Anita
Published: April 2015

Falls are common in older people and become more frequent with advancing age. Falling in older people is associated with mortality, decreased mobility, premature nursing home admissions and a reduced ability to perform activities of daily living. In an attempt to reduce the incidence of falls, the National Service Framework for Older People has emphasised the need to develop falls services that provide support for older people who have fallen and use health promotion initiatives. While there is evidence to suggest that home modifications can reduce falls in older people, there has been little research to evaluate the effectiveness of occupational therapy falls prevention programmes.

This paper reports the findings of an evaluation of a multifaceted falls prevention programme, which aimed to determine whether occupational therapy could enhance quality of life by educating people aged 65 years and over about the risk of falls. A pre-intervention and post-intervention non-standardised self-administered questionnaire was completed at week 1 and at week 14. Of the 172 older people attending the falls prevention programme, 78 (45%) completed both questionnaires.

The findings from this study suggest that an occupational therapy falls prevention programme can reduce the impact of falls on older people by enhancing confidence to perform activities, which in turn can increase quality of life. However, further research is needed to determine the effectiveness of anxiety management techniques.
A Systematic Review of the Effects of Stress and Coping Strategies Used by Occupational Therapists Working in Mental Health Settings
Authors: Edwards Deborah , Burnard Philip
Published: April 2015

A systematic review of the research literature published in the United Kingdom between 1966 and 2000 was carried out to determine the effectiveness of stress management interventions for occupational therapists working in mental health settings. Studies from other countries were examined as potential models of good practice. The review was limited to primary research papers that involved occupational therapists working in the mental health arenas, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data were provided.

The initial search identified 30 papers, of which 13 met the inclusion criteria. One study has been reported since the completion of the review and has been included in this article. All the papers focused on the stressors, moderators and stress outcomes. There was no paper that specifically investigated the effectiveness of stress management interventions for occupational therapists working in the mental health arena. The only literature available was aimed at the occupational therapy profession as a whole and was in the form of a number of recommendations at an organisational and an individual level. Methodological flaws, however, detracted from the rigour of many of the studies.

The review demonstrated that a great deal is known about the sources of stress at work, about how to measure stress and about the impact of stress on a range of outcome indicators. What was found to be lacking was a translation of these results either into practice or into research that assessed the impact of interventions that attempted to moderate, minimise or eliminate some of these stressors.
Food Cent$: Educating Mothers with a Mental Illness about Nutrition
Authors: Bassett Hazel , Lloyd Chris , King Robert
Published: April 2015

People with a mental illness can have deficits in a range of areas, including food skills. Mothers who have a mental illness and have residential care of their children are particularly vulnerable to experiencing food insecurity. The food skills programme known as Food Cent$ is a new way of spending money on food using the 10-plan, so that people can learn to balance their diet and their food budget.

Occupational therapists in a mental health rehabilitation service incorporated the use of Food Cent$ into a parenting programme for mothers with a mental illness. A pilot study was conducted to identify whether the Food Cent$ programme influenced behaviours and attitudes towards food and food selection and preparation and reduced grocery expenditure. The participants were six mothers with a mental illness who had children under 5 years of age in their care. A focus group was conducted to gain insight into the experiences of mothers who had attended the programme.

Supermarket receipts were collected before and after the project to determine changes in dietary practices. The results indicated that attending Food Cent$ contributed to an improvement in dietary intake, food selection and preparation, and grocery expenditure. Further research is required into the effectiveness of this programme with other target groups likely to experience food insecurity.
Doing Systematic Reviews in an Occupational Therapy Department
Authors: Massy-Westropp Nicola , Masters Margot
Published: April 2015

The occupational therapy department of a teaching hospital wanted to review the evidence for the treatments that they used regularly. A temporary occupational therapist project officer was appointed to introduce the systematic review process to the staff. This report describes the process of performing the systematic reviews.

The occupational therapists gained skills in forming an evidence-seeking question, identifying sources of bias within studies and deciding whether the findings of the study were applicable to their clients. They found it most difficult to understand research design, statistical principles and how to synthesise the findings. Suggestions are made for other departments that wish to implement the systematic review process.
‘Named in the Lexicon’: Meanings Ascribed to Occupation in Personal and Professional Life Spaces
Authors: Denshire Sally , Mullavey-O'Byrne Colleen
Published: April 2015

The research undertaken by the primary author into the phenomenon of reflection in occupational therapy focused on the relation of personal and professional life spaces. A combination of lexicography-based analysis and metaphor analysis was used to explicate the autobiographical knowing within her published writings.

The main method reported in this paper is a lexicography-based analysis derived from the style of dictionary making based on historical principles, as epitomised by the Oxford English Dictionary (OED). A broader rather than a narrower meaning was found to be ascribed to the key word ‘occupation’ in the literature of occupational therapy and, more recently, in that of occupational science. However, the present OED entry for ‘occupation’ does not adequately track these changes in meaning.

The combination of language-based methods used offers a new strategy for exploring implicit knowledge in the human-related professions. By integrating personal and professional life through the concept of occupation, the research has produced a deeper understanding of reflective practice. It contributes to the literature that suggests that congruent use of the term ‘occupation’; (and related terms) may interpret a person's life experiences in a more coherent way than the use of language with clinical connotations. Future research into language for practice is proposed.
Disabled People, Manual Handling and Human Rights
Authors: Mandelstam Michael
Published: April 2015

Word has spread about a significant manual handling legal case in East Sussex, yet many occupational therapists appear to remain unclear about the facts and their ramifications. Principally, it centres on how disabled people's needs, rights and wishes should be balanced with employee safety in the context of community care. In the author's opinion, the judgment is important, thoughtful and complex. It addresses questions typically asked by those working in the manual handling field and is likely to be welcomed by many occupational therapists. It has the potential, in principle, to help in achieving a better quality of decision making. At the same time, the practical problems standing in the way of better decisions and services relating to manual handling should not be underestimated.
Exploring the Meanings of Artistic Occupation for Women Living with Chronic Illness: a Comparison of Template and Interpretative Phenomenological Approaches to Analysis
Authors: Reynolds Frances
Published: April 2015

This article examines two approaches to analysing qualitative data, namely the template approach and the interpretative phenomenological approach. Each has been used in an evolving research project, which explores the reasons that women give for engaging in artistic occupation as a means of coping with illness. A discussion of the strengths and limitations encountered in each analytical method is provided. The key objectives of this article are to explore some of the strengths and limitations of each of these two analytical methods and to illustrate how the choice of analytical strategy may affect research findings. This may be helpful for students and therapists who are considering carrying out a qualitative research project.
The Journey of a Visually Impaired Student becoming an Occupational Therapist
Authors: Sivanesan Nanthini
Published: April 2015

This opinion piece outlines the personal reflections of a visually impaired student's experience throughout her studies, both at university and on placement. Its purpose is to raise awareness of students with disabilities in 2003, the European Year of Disabled People. By highlighting relevant literature and drawing on personal experience, some recommendations are made for the future. Government policy in the United Kingdom aims to remove the barriers to education and to subsequent employment for those with disabilities. This may not always be the case, as highlighted by this narrative.
Fool's Gold: Examining the Use of Gold Standards in the Production of Research Evidence
Authors: Hyde Paula
Published: April 2015

Research designs, and the methods that they dictate, normally arise from the nature of the questions being asked. However, in most medical research, a hierarchy of evidence is in common use that influences choice in favour of research designs that include methods with a higher ranking. The acceptance of superior research methods consequently limits the types of question that can be asked. The randomised controlled trial (RCT) has enjoyed a long reign as the gold standard in health research methodology. The RCT is used here as a case example of how hierarchies of research methods can distort the production of evidence relating to health care.

The acceptance of the RCT as a superior method in the hierarchy of evidence production has been promoted by claims that RCTs offer reliability, objectivity and levels of certainty about treatment effectiveness (inferred through statistical significances) that other methods do not. These statistical significances depend upon mathematical probabilities that imply a level of uncertainty. Mathematical significance has been confused with the substantive or practical importance of research results. The importance of research findings cannot be determined by hierarchies, nor by statistical techniques alone; other types of method can provide findings that are equally valid, true or useful to evidence production in occupational therapy.
Dreaming and Occupation
Authors: Collins Mick
Published: April 2015

There is a long history of dream work in the psychotherapeutic and healing traditions. This opinion piece examines how dreams can open people to a deep sense of meaning. It takes into consideration the potential for dream work in relation to therapy; the processes of change, creativity and empowerment that can emerge from therapeutic work using dreams, which are illustrated through two case vignettes; and the connection between dreaming and occupation.
Occupational Therapy in Nursing and Residential Care Settings: A Description of a Randomised Controlled Trial Intervention
Authors: Sackley Catherine M , Atkinson Jo Copley , Walker Marion F
Published: April 2015

This article describes an occupational therapy intervention for stroke that was provided as part of a randomised controlled trial in order to evaluate the effects of the intervention of an occupational therapist in a nursing and residential home setting. The intervention was developed and described to enable it to be reproduced in further evaluations, as recommended by the Medical Research Council's guidelines for clinical trials.

Initially, the published evidence was reviewed and advice was sought to identify the process, content and recording methods needed to treat clients in a care home setting. This resulted in a clearly defined, evidence-based treatment package and a predetermined recording system.

Sixty residents received occupational therapy: the mean number of visits was 8.5 and the mean total time per participant was 4.7 hours. During 508 visits, the majority of time was spent on activities of daily living training and mobility practice (40%), followed by assessment and goal setting (31%), communication with residents, staff, relatives and other agencies (15%), adaptive equipment (10%) and the treatment of impairments (4%).

It is possible to develop evidence-based targeted occupational therapy interventions to be used in the context of a controlled clinical trial. Further work is required to examine the validity of the recording methods and the reproducibility of the intervention.
Reporting Patients' Work Abilities: How the Use of Standardised Work Assessments Improved Clinical Practice in Fife
Authors: Jackson Margaret , Harkess Janet , Ellis John
Published: April 2015

Reporting patients' work abilities accurately is essential in the rehabilitation process. Work assessment and rehabilitation require occupational therapists to be skilled in the use of valid and reliable assessment tools to support clinical reasoning. The aim of this study was to ascertain if the use of two standardised work assessments (SWAs) improved the quality of the information recorded about patients' work abilities.

Case note review using a local standard and audit tool was carried out before (n = 42) and after (n = 41) use of the Valpar Component Work Samples and the Worker Role Interview. Anecdotal evidence was also collected. The results demonstrated an improvement in the reporting of most of the areas matched against the standard and the anecdotal evidence was supportive of the use of SWAs. It was concluded that the use of SWAs by skilled occupational therapists improved the reporting of patients' work abilities.
Attachment Styles and Factors affecting Career Choice of Occupational Therapy Students
Authors: Roney Anita , Meredith Pamela , Strong Jenny
Published: April 2015

Adult attachment theory, a theory of personality, has been connected to a range of factors that may contribute to one's professional choice, job satisfaction and performance. To date, the implications of this theory for the profession of occupational therapy have not been investigated. This study examined the adult attachment styles of 124 first and fourth year occupational therapy students at The University of Queensland in relation to factors affecting career choice and satisfaction with career choice.

The results showed that the majority of the participants had a secure attachment style, were people orientated and were satisfied with their choice of career. In accordance with adult attachment theory, the participants with a secure attachment style rated people-orientated factors as important when choosing occupational therapy as a career and were more satisfied with their choice of career than the participants with an insecure attachment style. The study suggests that adult attachment style might warrant consideration in light of recruitment and retention.
How Successful are We at Getting our Clients Back to Work? The Results of an Audit
Authors: Brewin Jane , Hazell Alexa
Published: April 2015

Because of changes in clinical practice, it became evident within a rehabilitation unit that there was a need to try to address employment issues with clients in a coordinated multiagency manner. A project was therefore set up in 2000 to develop guidelines in order to assist clients in returning to work.

This article describes a retrospective audit, which was carried out in this rehabilitation unit for adults aged 16–65 years who had either a neurological or a rheumatoid problem. The guidelines were used to record and collect data on clients who were receiving occupational therapy between March 2000 and May 2001 and had expressed a wish to look at employment issues. Information from occupational therapy notes and a follow-up phone call to one client were also used to collect data.

The audit highlighted several areas where the process had not been successful. However, it did show that when a coordinated multiagency team is involved, a successful return to work can be achieved.
Description of a Substance Abuse Relapse Prevention Programme conducted by Occupational Therapy and Psychology Graduate Students in a United States Women's Prison
Authors: Tayar Shari Gail
Published: April 2015

Prison inmates who have engaged in substance abuse often have decreased functioning in many areas of activities of daily living. This article describes a unique interdisciplinary substance abuse relapse prevention programme conducted by occupational therapy and psychology graduate students under faculty supervision in a northwestern rural United States women's prison.

The psychology students taught the inmates the theoretical bases for the programme, trigger identification and coping skills, social support development and assertive communication. The occupational therapy students used activities to help the inmates to identify their values and interests, develop ideas and resources for leisure and jobs, structure and manage their time, practise assertiveness and identify strengths. Although programme effectiveness was not formally measured, it appeared to both the students and the faculty members that the inmates experienced personal growth and that the student therapists gained professional skills in working with another discipline and in leading groups.
Actual and Preferred Work Activities of Mental Health Occupational Therapists: Congruence or Discrepancy?
Authors: Lloyd Chris , King Robert , McKenna Kryss
Published: April 2015

The reform of Australian mental health services has resulted in new models of care and changed work practices for all mental health professionals. Occupational therapists today are as likely to be working in multidisciplinary teams performing a range of generic clinical roles as they are to be working in specialist rehabilitation units. These kinds of changes have taken place in other countries, with anecdotal and some empirical evidence that the changes have resulted in concerns about loss of professional identity and roles.

This study sought to identify the current work activities carried out by occupational therapists and to determine whether there was a discrepancy between their actual and desired work activities. It was expected that, overall, they would indicate a preference to do more specialist rehabilitation focused work and less generic case management work. A survey of 196 occupational therapists investigated their actual and preferred work activities in 55 specific roles across four broad categories (senior administration, specialist clinical, general clinical and community development).

As expected, the participants indicated that they would prefer to be undertaking more specialist rehabilitation oriented work activities than they were actually doing. Contrary to expectations, they also wished to undertake more rather than less generic clinical work activities, to be more engaged in community development work and to take on more senior and administrative roles. They indicated a preference for less rather than more activity on only 5 of the 55 work roles examined. On examining a subset of 113 participants who reported that 50% or more of their time was spent in case management, there was greater evidence of resistance to generic clinical roles.

It was therefore concluded that occupational therapists in Australia are seeking to deploy their specialist skills to a greater degree than the current practice environment permits. They have broadly accepted the generic roles required in multidisciplinary community case management, but those who are actually working in these roles are most likely to have reservations about this kind of work.
Evaluating Practice Education Models in Occupational Therapy: Comparing 1:1, 2:1 and 3:1 Placements
Authors: Martin Marion , Morris Jane , Moore Ann , Sadlo Gaynor , Crouch Victoria
Published: April 2015

Practice education is an essential part of the education of health professionals, yet in spite of this there is an acknowledged shortage of placements. At the same time, educational research indicates that peer learning, and in particular problem-based learning, has advantages for students. Studies that have investigated models of placements where more than one student at a time share an educator have shown that this may bring benefits for both educators and students.

This study was carried out with the aim of determining the impact of different models of practice placement (1:1, 2:1 and 3:1) on the quality of education for students and on the quality of the experience for educators, in both occupational therapy and physiotherapy courses at a university in the South of England. This article focuses on the occupational therapy component of the study. Six occupational therapy educators and 11 students took part, providing examples of all three models of placement.

The findings indicated that while all three models provided both advantages and disadvantages for educators and students, the 2:1 model offered more opportunities for peer support and enhanced the quality of the educational experience through peer learning. In some settings, however, it is probably the case that only the 1:1 model is possible. The findings also suggest that the success of any placement model depends heavily on how well the placement has been planned.
Piecing Together the Jigsaw: How do Practice Educators define Occupational Therapy Student Competence?
Authors: Duke Lynsay
Published: April 2015

This study addressed how practice educators define occupational therapy student competence. A qualitative approach was used to gain the beliefs and viewpoints of five occupational therapy practice educators working in neurological rehabilitation through semi-structured interviews and group discussion. Verified thematic analysis was used to structure and describe the information collected.

The complexity of the concept of competence was highlighted by the participants, who felt that it was part of their professional responsibility to ascertain whether a student had achieved a sufficiently high level of competence to pass into the professional status. However, the participants found it difficult to articulate explicitly what it was that they searched for. Four main areas were highlighted - observable behaviour, clinical reasoning, continuing development and professional and personal attributes - but the importance of student self-awareness, risk assessment and reasoning skills over theoretical knowledge was identified as a major influencing factor on competence.
Interdisciplinary Collaborative Goal Planning in a Post-Acute Neurological Setting: A Qualitative Study
Authors: Conneeley Anne Louise
Published: April 2015

The aim of this qualitative study was to explore the use of interdisciplinary collaborative goal planning from the perspective of patients, their relatives and professional staff. Eighteen patients and their relatives who had been involved in collaborative goal planning were interviewed individually after the patient was discharged from the ward of a neurological rehabilitation hospital. The members of the interdisciplinary team responsible for implementing the goal planning process were also interviewed.

The findings showed that the majority of the patients and their relatives valued highly the opportunity to become actively involved in their care and discussed the impact of this on motivation, perceptions of control and freedom in decision making. The professional staff also identified benefits, which included giving clarification and direction to treatment and further opportunities for patient-centred practice. Challenges emerged as well, including the question of how to implement collaborative goal planning with people with severe language or cognitive impairment, those with poor insight or those in low awareness states. Further consideration of the issues raised is recommended as a means to promote patient-centred care.
Understanding the Effects of Problem-Based Learning on Practice: Findings from a Survey of Newly Qualified Occupational Therapists
Authors: Reeves Scott , Mann Lynn Summerfield , Caunce Maria , Beecraft Sue , Living Ruth , Conway Maggie
Published: April 2015

This report presents the findings from a postal survey of five cohorts of graduates who successfully completed a 2-year accelerated problem-based postgraduate diploma in occupational therapy. The study aimed to elicit the graduates' views of how problem-based learning (PBL) had affected their professional practice 8 months after qualification.

It was found that the majority of the graduates considered PBL to have equipped them well for their entry to clinical practice. Specifically, it was felt that PBL had made a positive contribution to their problem-solving and teamworking abilities and their clinical knowledge and skills. However, it was also found that some of the graduates were more sceptical about the effects of PBL. For this group, PBL was viewed as having had a limited effect on their abilities, knowledge and skills. The findings are discussed before conclusions and the implications for pre-qualification occupational therapy education are presented.
Participation in Occupations: Some Experiences of People with Parkinson's Disease
Authors: Benharoch Jude , Wiseman Tania
Published: April 2015

Evidence suggests that people with Parkinson's disease can experience difficulties participating in occupations. This article describes a qualitative study that explored how seven people with Parkinson's disease perceived their participation in occupations.

The analysis of the semi-structured interviews led to the identification of three themes: changes, addressing changes and perspectives on living with Parkinson's disease. Many findings supported the existing literature; for example, difficulties with self-care occupations and the desire to maintain normality. The new findings included the participants describing positive changes in their lives that were attributable to having Parkinson's disease and using occupations purposefully to enhance wellbeing.

The results support the use of a client-centred approach to consider the implications of participation in occupations for people with Parkinson's disease, because this may encourage clients to use their own expert knowledge to enhance existing coping strategies. The recommendations for further research include an investigation as to whether the themes identified apply to a larger population and including people with Parkinson's disease in designing future research questions about the impact of occupational participation on wellbeing.
Occupational Therapists as Primary Health Promoters: Opportunities and Barriers
Authors: Scriven Angela , Atwal Anita
Published: April 2015

Over the last two decades, there has been a growing international interest by some associations of occupational therapy and their respective members in the contribution that occupational therapists can make to the multidisciplinary field of health promotion. More recently, the College of Occupational Therapists in the United Kingdom has recommended that occupational therapists take a more proactive stance in the health promotion arena and has advocated the World Health Organisation's Ottawa Charter principles to inform this professional development.

In this paper, a critical assessment is made of the opportunities for and the barriers to the adoption of a primary health promotion role by occupational therapists working in the United Kingdom and how the principles advocated in the charter might reflect a more distinctive occupational therapy approach to the promotion of health. It is argued that a paradigm shift would be required if the profession moved towards a primary health promotion agenda.
Vocational Rehabilitation: The Enable Employment Retention Scheme, a New Approach
Authors: Robdale Neil
Published: April 2015

Enable is a ground-breaking service that was piloted in Shropshire to provide support for people with mental health problems in order for them to return to their work. It began in October 2002 and proved so successful that it has been extended and refunded on a permanent basis into the future. Because of the social and economic changes over the past decade, the time appears right for occupational therapists to reinvolve themselves in the area of employment. The project leader, an occupational therapist, makes the case for this new type of vocational rehabilitation.
A Study to Investigate the Available Range of Movement in Two Makes of Commercial Wrist Orthoses
Authors: Sawyer Tracey , Ellis Bridget
Published: April 2015

This study compared the degree of wrist movement available in two commercial wrist orthoses of the same design but constructed of different fabrics. Twenty participants with normal wrist movement had their right dominant wrist range of flexion and extension measured using an isokinetic dynamometer. The results showed that neither orthosis immobilised the wrist. The mean total range of movement in the neoprene orthosis (73.55°) was significantly greater (p<0.001) than that in the elastic orthosis (53.30°). The elastic orthosis provided a greater degree of restriction of movement and more consistent control than the neoprene orthosis. Neither orthosis should be used where immobilisation is the treatment aim.
Improvement in Upper Limb Motor Performance following Stroke: The Use of Mental Practice
Authors: Bell Alison R , Murray Bridget J
Published: April 2015

Mental practice is a technique that involves imagery and rehearsal of movement without movement actually occurring. This study considers the evidence that indicates whether mental practice is successful in improving upper limb motor performance after a stroke. The use of mental practice in the traditional fields of sport, music and dance is identified and a theoretical premise for its application in stroke rehabilitation is presented. Eight studies on the use of mental practice in the rehabilitation of motor performance following a stroke are critiqued. These studies suggest that mental practice improves upper limb motor ability and appears to be applicable to a range of participants, especially those with moderate impairment, although good cognitive and communication skills are required.

The article suggests reasons that this relatively new approach should be considered by occupational therapists involved in stroke rehabilitation. The limited number of studies and small sample sizes are highlighted. Further research is recommended in order to identify people who will benefit from mental practice, to investigate the generalisation of results and to establish guidelines for the effective provision of mental practice in terms of length, format and content in stroke rehabilitation.
The Active Advice Pilot Project: Leisure Enhancement and Social Inclusion for People with Severe Mental Health Problems
Authors: Heasman David , Atwal Anita
Published: April 2015

The social and occupational consequences of mental illness have a considerable impact on quality of life. In addition to high levels of unemployment, many users of mental health services experience significant barriers to satisfying leisure participation.

The Active Advice project is a systematic client-centred approach to leisure enhancement for adults with severe mental health problems, which involves identifying latent interests, facilitating leisure participation and helping to bring together isolated individuals through a shared interest.

This paper reports the findings from the pilot study, which suggest that adults with enduring mental health problems can participate successfully in leisure occupations and achieve greater social inclusion when individualised support is provided to enable the barriers to be overcome. However, it is essential that subsequent programmes devise strategies to maintain participants' initial enthusiasm and motivation since 53% of participants did not carry through their action plan.