bluuebunny/crossref_metadata_2025 huggingface dataset:
True to Our Philosophy? Sexual Orientation and Occupation
Authors: Kingsley Penny , Molineux Matthew
Published: April 2015

Occupational science and occupational therapy suggest that people engage in occupations that are meaningful and relevant to them on personal and cultural levels. Sexual orientation is one theme of meaning in a person's life which influences his or her choice of occupations and the meaning and relevance those occupations hold. Sexual orientation, as it is conceptualised here, encompasses far more than a person's choice of sexual partner and is, therefore, an important area for an occupational therapist to consider. It is, however, an often neglected area in both curricula and the literature.

This paper presents the results of a qualitative study which investigated the perspectives of basic grade occupational therapists regarding working with clients of gay, lesbian or bisexual sexual orientation. Six basic grade occupational therapists were interviewed using a semi-structured format and four themes emerged. The findings included that the basic grade occupational therapists interviewed did not consider occupation in its complexity and so did not appreciate how sexual orientation might be expressed in a person's occupations. The interviews also indicated that the subject of sexuality is still taboo in occupational therapy.
Policy Changes in the National Health Service: Implications and Opportunities for Occupational Therapists
Authors: Godfrey Alice
Published: April 2015

Recent changes in the philosophy and structure of the National Health Service give greater emphasis to the prevention of ill health within locally defined communities. Occupational therapists, by virtue of their unique philosophy, have an opportunity to influence primary care strategy and practice by highlighting the links between environment, occupation and health.

The recent changes in the structure of the National Health Service are described and the philosophy of occupational therapy is discussed in relation to these changes. This description provides the basis for recommendations as to how occupational therapists can work to build a recognition of the fundamental importance of adaptive occupation to individual health and, hence, to health at a community and population level. Working at a community and population level will require occupational therapists to strengthen links with health promotion and public health in order to help promote health through meaningful occupations within local settings.
Occupational Therapists: Is Our Therapy Truly Occupational or are We Merely Filling Gaps?
Authors: Fortune Tracy
Published: April 2015

This article is concerned with role identity and its relationship to the professional thinking and action of occupational therapists. In this informed viewpoint, the notion that occupational therapists could be perceived as gap fillers is explored, based on empirical data that focused on the roles adopted and the guiding philosophies enacted by occupational therapists working in child and adolescent mental health.

Following the presentation of interview data from four occupational therapists, two cogent issues are presented and discussed. The first issue posits that a failure to ground practice in occupational philosophies contributes to perpetuating an incoherent role identity. The second issue discusses whether the recovery of an occupational paradigm in practice can liberate occupational therapists from role incoherence and enable them to reclaim their identity as therapists of occupation.
Occupational Therapy for Stroke Patients: A Survey of Current Practice
Authors: Walker M F , Drummond A E R , Gatt J , Sackley C M
Published: April 2015

A survey was carried out in order to ascertain the treatment approaches used in stroke care by senior I occupational therapists in the Trent Region of the United Kingdom. A random selection of these therapists was subsequently interviewed using semi-structured interviews and a case vignette in order to obtain more detailed information. Of the 83 questionnaires sent, 61 (73%) were returned; 14 therapists were interviewed.

The two most common approaches identified were the functional approach and the Bobath approach. The main indications for the choice of approach were the age of the patient, progress with other approaches and discharge date. Of concern in the current climate of evidence-based practice was the high number of occupational therapists who were unfamiliar with standardised assessments and unable to describe adequately the theoretical basis for the treatment used.
Football and Tin Cans: A Model of Identity Formation Based on Sexual Orientation Expressed through Engagement in Occupations
Authors: Williamson Peter
Published: April 2015

Occupational therapy is grounded in the use of purposeful activity. Current practice standards insist that such activity be meaningful for the participant. What makes an activity meaningful is a combination of an individual's identity, life experiences, intrinsic characteristics and the physical, social and cultural environments in which the person finds himself or herself. Sexuality is one of the frameworks that provide scaffolding for identity formation, developed alongside and because of engagement in occupations.

This paper presents a six-stage model, developed by a psychologist in Australia, of identity formation based on sexual orientation. This model is illustrated using the oral history of a gay man. The influence of occupation at crucial moments in the developmental stages for this individual is illustrated. The meaning of this model for occupational therapy practice, education and theory is discussed.
Advertising for and Recruiting Basic Grade Occupational Therapists in the United Kingdom
Authors: Ferguson Marian , Rugg Sue
Published: April 2015

Occupational therapy managers engage in fierce continuing staff recruitment competition, knowing that the outcome influences both patient care and contractual obligations. Professional experience suggests that many such individuals receive little or no formal training to complete this process. An extensive literature review found no research on recruitment advertising among British occupational therapists.

This study explored the factors attracting newly qualified occupational therapists to job advertisements and identified the timing of their initial search. It also investigated the success of various methods of advertising, in terms of their cost-effectiveness, efficiency and effectiveness. The data were gathered using two postal questionnaires, sent to a random sample of 200 occupational therapy managers and 200 of their most newly qualified staff.

The results showed that most recruitment advertisements addressed applicants' practical concerns, but were less than comprehensive. Recruitment activity was greatest between February and July, with the British Journal of Occupational Therapy proving the most popular vehicle. The findings suggested that well-timed, well-placed and well-targeted advertisements could save all much time and effort. By increasing the number of successful appointments, they could also reduce costs. The study concluded that managers seemed largely aware of when and where to advertise, but could focus their advertisements more closely on the needs of potential applicants.
The Role of Computer Simulation in the Development of Clinical Reasoning Skills
Authors: Stewart Lisa S P
Published: April 2015

A multidisciplinary project is under way to develop a computer model which will simulate the hip fracture care process in both a large teaching hospital and a district general hospital (Currie et al 1998). This paper describes the occupational therapy contribution to the project.

The complex process of care will be simulated by integrating each clinical group's patient intervention (strategy) at each point of the patient's journey. As part of this research, the literature was referred to for evidence to support current occupational therapy and to form a structure for simulation. The occupational therapy strategy is represented as a flow chart which leads the patient from admission to the acute orthopaedic ward, through to assessment, rehabilitation and, finally, discharge. The literature suggested that the way in which each occupational therapist individualised this strategy (based on Hagedorn's [1997] model) was influenced by his or her own clinical reasoning, which might in turn affect outcome.

The notion that mental modelling (clinical reasoning) might be simulated has led to the suggestion that computer simulation could be used as a learning tool to develop clinical reasoning skills in the novice, with the aim of improving patient care.
Don't Despise the Fluffy Bunny: A Reflection from Practice
Authors: Perrin Tessa
Published: April 2015

Have occupational therapists lost the art of using occupations as therapy? This article proposes that in moving away from its art and craft roots towards an increasingly scientific paradigm over the past 50 years or so, the profession has jettisoned one of its core values ± creativity. The loss of awareness of and appreciation for creativity in the therapeutic dynamic has radically altered and constrained the practice of many occupational therapists and engendered a shift away from using occupations in healing.

An illustration drawn from continuing care for older people demonstrates how occupational therapy is failing the field of chronic disability. It suggests that the profession must urgently consider the establishment of a new kind of practitioner for chronic disability settings, allied to but independent from occupational therapists.
The Use of Evidence-Based Practice by Occupational Therapists Who Treat Adult Stroke Patients
Authors: Sweetland Jeanette , Craik Christine
Published: April 2015

The study identified the extent to which members of the National Association of Neurological Occupational Therapists (NANOT) who treated adult stroke patients used evidence-based practice (EBP). A random sample of NANOT members (n = 200) was surveyed by a postal questionnaire on the use of EBP and the results were analysed for the 125 therapists who worked with adult stroke patients.

The principal factor that ‘greatly’ influenced the choice of intervention of three-quarters of the respondents was working with other therapists, followed by attendance at postgraduate courses; gaining postgraduate qualifications had the least influence. Although over 90% of the respondents considered that they used EBP at some time, the most frequently reported levels of evidence used were custom and practice and expert opinion, which were at the lower end of the hierarchy. Therefore, although the respondents who treated adult stroke patients did use EBP, they did not use the higher levels recommended. The respondents who used the higher levels of evidence were those who were most recently qualified. The factors influencing the use of EBP were the relevance of research to practice, time, lack of therapists' knowledge and lack of support.
The Management of Altered Body Image: A Role for Occupational Therapy
Authors: Shearsmith-Farthing Karen
Published: April 2015

While historically a number of approaches and disciplines have proved to be effective in the management of altered body image, there is little evidence within the occupational therapy literature to suggest that this is an area actively pursued outside the realm of eating disorders. The concept of altered body image in relation to occupational therapy is explored, within the context of life-threatening disease. A review of multidisciplinary input in this area indicates that a number of factors contribute to the difficulty in identifying, assessing and treating this complex concept.

This article suggests that occupational therapists, with their unique perspective of activity as a facilitator of change in occupational performance, are well placed to address altered body image concerns. Education and training in this area are required if occupational therapists are to do so with confidence and competence, irrespective of clinical condition or setting, in order to contribute positively to the rehabilitation process and the individual's overall quality of life. Further research in the management of altered body image by occupational therapists is recommended.
Activity Use in Occupational Therapy: Occupational Therapy Students' Fieldwork Experience
Authors: Drew Julie , Rugg Sue
Published: April 2015

This article explores the results of a small quantitative study conducted with 54 occupational therapy students. The data, gathered using a purpose-designed questionnaire, were based on respondents' reports of the 662 activities seen during their fieldwork education. These were categorised using headings from the Canadian Occupational Performance Measure (Law et al 1994).

The findings showed that client-related leisure activities were the most frequently seen in all practice settings (physical disability, mental health and learning disability). The activities seen most often consisted of those in the ‘quiet recreation’ category. Activities aimed at productivity, and particularly at household management, were also widely spread. Such activities formed a smaller but consistent percentage of those seen in all fields of practice. Self-care, and in particular personal care, activities were most prevalent in physical disability settings, but formed a lower percentage of the activities seen elsewhere.

This article discusses these findings in relation to previous research in the field and considers the continuing place of activity in occupational therapy and in undergraduate occupational therapy education.
Some Factors influencing Occupational Engagement for People with Schizophrenia Living in the Community
Authors: Chugg Amanda , Craik Christine
Published: April 2015

With the emergence of occupational science, there has been renewed interest in the health benefits of occupational engagement and a call for more research into the occupational nature of humans. Engaging in occupations is known to have a positive effect on an individual's health and sense of wellbeing. A common feature of people with schizophrenia, however, is a decrease in volition and a reduction in the occupations performed. This study explored some of the influences on occupational engagement for people with schizophrenia living in the community.

A qualitative approach was chosen, using semi-structured interviews. Four male and four female participants, aged 23 to 49 years, described the influences on their occupational engagement. Content analysis, primarily using coding and memoing, was employed to categorise the data. Four main themes emerged: health, routine, external factors and internal factors. Some specific factors identified within these themes were medication, daily schedules, staff, family, work, self-concept and challenges. The implications of the results are discussed, with particular reference to assisting occupational therapists to enable clients with schizophrenia to engage more successfully in occupations.
Changing Rooms: the Impact of Adaptations on the Meaning of Home for a Disabled Person and the Role of Occupational Therapists in the Process
Authors: Hawkins Rachael , Stewart Sandra
Published: April 2015

Accessible housing is crucial both to enable the implementation of community care and to assist in giving disabled people equal rights to independent living. In order to meet these demands, occupational therapists often play a key role in recommending adaptations to the home environment. Although there can be important benefits in this process, the meaning of home to the disabled person and his or her family can be overlooked and compromised by the changes that occur to it.

It is suggested that in order to redress this balance, the social model of disability should be applied to the assessment process. This would result in a more holistic view of the environmental barriers faced by the disabled person within his or her home and a deeper understanding of the wider meaning of home to the disabled person and the family. The provision of adaptable housing, such as Lifetime homes, is also considered as a way of minimising the need for home adaptations in the longer term. A broader role for the occupational therapist within the framework of the social model is discussed.
Generic and Specialist Interventions for People with Severe Mental Health Problems: Can Interventions Be Categorised?
Authors: Cook Sarah , Cook Sarah
Published: April 2015

This study of a primary care based service investigated the type and frequency of occupational therapy and care management interventions delivered to people with severe mental health problems. The sample for the case study of one service was 25 people with enduring psychotic conditions who received 12 months' interventions from occupational therapy staff. The routinely recorded case data for each client were retrospectively analysed to generate intervention categories using content analysis and categorical aggregation. The total number of recorded interventions was then quantified using descriptive statistics. The most frequently recorded interventions are reported.

It was found that 60% of the 1877 interventions were categorised as specialist therapy (54% occupational therapy and 6% psychological interventions) and 40% were categorised as generic care management. It is suggested that clients may be better served by increasing the proportion of specialist occupational therapy interventions delivered by occupational therapists.

The case study design is limited because the results are not generalisable to other settings and several problems with the methods were found when attempting to analyse the interventions into separate and mutually exclusive categories. This small study contributes to debates about the role of community mental health occupational therapists and how to investigate what they do in routine practice.
Returning to Work after a Stroke: An Important but Neglected Area
Authors: Corr Susan , Wilmer Sorrel
Published: April 2015

Work is key to participating in society. This paper reports two independent studies, which addressed different aspects of returning to work after a stroke. Study I, using the Canadian Occupational Performance Measure and the Role Checklist, established the perception of returning to work of 26 participants aged 34–55 years post-stroke. Study II, using interviews, established the support required and obtained for six participants who returned to work post-stroke.

Both studies found that the participants considered work to be important, that they wished to return to work and that help was needed to do so. Study II found that occupational therapists had a limited role in providing support and recommends their greater involvement in work rehabilitation service provision for those who have had a stroke. The findings of these studies suggest that there is a gap in providing appropriate support to enable people to carry out an occupation that both they and society value.
Consulting Service Users: The Stroke Association Home Therapy Project
Authors: Gilbertson Louise , Ainge Sally , Dyer Rachel , Platts Gale
Published: April 2015

In 1999, the Stroke Association set up a project to promote home-based occupational therapy for patients who had had a stroke and been discharged home from hospital. As part of the service evaluation, focus groups for service users and carers were set up in two of the sites to consult users about the changes in their quality of life during the period of the home therapy. A total of 11 service users and 9 carers attended the groups, representing 30% of the service users and 27% of the carers involved in the project. The group discussion was taped and transcribed and then analysed using a framework approach.

The group members described their personal experiences of recovery from and limitations after the stroke and reported improvements in life issues during the period of their home therapy. The content and organisation of the service and the relationships with project staff were felt to influence the effectiveness of the occupational therapy. Other issues that affected the perceived outcome for the service users included individual choice, age, stroke consequences, other rehabilitation and community services and social limitations. This consultation process allowed the service users to describe the strengths and weaknesses of the service and provided valuable feedback that could be used to design the content and application of future home therapy services.
Dressing after a Stroke: A Survey of Current Occupational Therapy Practice
Authors: Walker Christina M , Walker Marion F , Sunderland Alan
Published: April 2015

The objective of this study was to determine occupational therapists' beliefs about the influence of cognitive impairment on dressing difficulties and to ascertain current practice when treating dressing problems. The study design was a questionnaire survey of occupational therapists experienced in stroke care who treated patients with dressing difficulties.

Out of 137 questionnaires sent, 76 (55.5%) were returned. The frequency of dressing practice provided by the occupational therapists ranged from two to four times a week. Only 43% of the therapists used standardised assessments and the most common one used was the Rivermead Perceptual Assessment Battery. Apraxia was reported by 76% of the therapists as influencing a patient's ability to dress, neglect by 71 % and memory problems by 63%. Seventy-six per cent of the therapists reported that orientating clothing and relating it to body parts was a major dressing difficulty. Other dressing difficulties reported were sequencing by 56% and failing to dress the affected side by 34%. Ninety-eight per cent of the therapists spent time providing the practice of specific functional skills on a repetitive basis; however, 60% continued to use table-top tasks aimed at targeting a particular cognitive impairment.

The majority of the therapists felt that cognitive impairment was a major reason for dressing difficulties in stroke patients. With the exception of one, all the therapists provided repetitive practice on dressing tasks and over half continued to use table-top tasks. The evidence to support the types of treatment used by occupational therapists remains controversial. Further research into this area is required.
Best Adaptation Redeeming People's Homes: Enlightened Occupational Therapy
Authors: Winfield John
Published: April 2015

This opinion piece looks at the difference between meeting the strict criteria of physical needs in housing adaptations and the approach of supporting the ‘occupation’ of living. It argues that one cannot ‘buy back’ someone's home simply by meeting physical needs. In the area of adaptation, occupational therapists need to return to their core values of maintaining an individual's occupation of living.
Cognitive Impairment in Amyotrophic Lateral Sclerosis: A Consideration for Occupational Performance
Authors: Foley Geraldine , Neely Fiona
Published: April 2015

Traditionally, amyotrophic lateral sclerosis (ALS) has been viewed as a degenerative disease, selective to the motor system. Until recently, research into cognitive impairment in ALS was confined primarily to a small proportion of patients with overt and clinically evident frontotemporal dementia (ALS/FTD). However, evidence from contemporary neuropsychological analysis and functional imaging studies, as identified in this review, indicates that a significantly higher percentage of patients with ALS presents with milder cognitive impairment in frontotemporal function. These deficits are considered progressive in nature, with increasing disability. Disturbances within the supervisory attentional system or central executive are thought to be responsible.

It would appear that patients diagnosed with ALS may not be equally susceptible to developing cognitive deficits. The relationship between bulbar-onset ALS and increased cognitive decline is noteworthy. In ALS, the impact of cognitive disturbance on occupational performance must be considered in addition to physical disability.
Occupational Therapy Assessment of Self-Awareness following Traumatic Brain Injury
Authors: Simmond Melina , Fleming Jennifer M
Published: April 2015

Impaired self-awareness is a common problem following traumatic brain injury. Without adequate self-awareness, a person's motivation to participate in rehabilitation may be limited, which in turn can have an adverse effect on his or her functional outcome. For this reason, it is important that brain injury rehabilitation professionals, including occupational therapists, both understand this phenomenon and use assessment and treatment approaches aimed at improving clients' self-awareness.

This article provides an overview of self-awareness, reviewing the distinction between intellectual and online awareness. The current role of occupational therapy in the assessment of self-awareness is highlighted and the guidelines for new assessments of self-awareness suitable for use in occupational therapy are explored.
Integrated Care Pathways in Mental Health Settings: An Occupational Therapy Perspective
Authors: Duncan Edward A S , Moody Karen J
Published: April 2015

The requirements for health care professionals to demonstrate evidence-based practice and to adhere to the clinical governance agenda are of pressing importance. These processes have been enhanced by the use of integrated care pathways (ICPs). ICPs outline and document clearly the key components of an individual's care within a given service. The lack of ICPs, in both mental health in general and occupational therapy in particular, is noted and discussed. The benefits of ICPs for occupational therapists are highlighted and an example of such a pathway, within a forensic mental health environment, is discussed.
Assessment of Stimulus Preferences in Multisensory Environment Therapy for Older People with Dementia
Authors: Staal Jason A , Pinkney Lesley , Roane David M
Published: April 2015

Assessment is paramount in the process of selecting appropriate treatment media. This paper presents an overview of suitable assessment procedures that may be used with older people with dementia in order to formulate a multisensory environment therapy programme. Primarily, current literature is explored, in terms of both the assessment procedures used prior to using the multisensory environment and the research outcomes. Secondly, an overview is given of two successful assessment procedures used, which integrate applied behaviour analysis and developmental approaches. This will provide the therapist with an assessment framework to determine the sensory preferences of older people with dementia, who may benefit from the multisensory environment.
Careers Advisers' Opinions of the College of Occupational Therapists' Careers Video
Authors: Craik Christine , Mitchell Suzanne
Published: April 2015

Using a mixed methodology, this study investigated the effectiveness of the College of Occupational Therapists' careers video in increasing the knowledge of six careers advisers about the profession and obtained their views of the video as a promotional tool. To quantify the advisers' knowledge, a pre-test post-test questionnaire was used before and after viewing the video. A short qualitative interview then ascertained their impressions of the video. Despite a high baseline knowledge, viewing the video was effective in increasing it. The advisers had mixed opinions about the video, suggesting that it could be improved and clarified.
The Critical Reflective Muse as a Key Player in Research and Manuscript Review
Authors: Fitzgerald Maureen H , Yau Matthew K
Published: April 2015

The critical reflective muse is not a new role in research. Research supervisors, mentors, professional colleagues and peer reviewers often play this role. However, the critical reflective muse is often not formally recognised as essential to the analytical and interpretive or the personal growth process, particularly in qualitative and alternative paradigm research.

This paper suggests that the people who play this role in its most positive sense are important to the development of sound research projects and analyses and interpretations of data. People who engage in this role responsibly enhance the quality of research and the research literature and can push them to new levels of quality. They enhance validity and personal and professional development. It is proposed that greater attention should be given to this occupational role as a way to develop further the quality of occupational therapy research and the related literature in order to situate them better in the corpus of contemporary health science research.
Factors Enabling and Hindering Participation in Leisure for People with Mental Health Problems
Authors: Pieris Yvonne , Craik Christine
Published: April 2015

Although leisure is recognised as a key aspect of occupational therapy, few studies have explored it in relation to people with enduring mental health problems. Using a qualitative design, semi-structured interviews were conducted with 10 participants with mental health problems living in the community, randomly selected from clients referred to a local assertive outreach service in South-East England. Initially, the data were analysed for content and the phrases, language and words used; subsequently, emerging themes were identified, which were confirmed by a second occupational therapist.

The three themes arising from the data reported here were the number and range of occupations engaged in, the factors enabling participation in leisure and the factors hindering participation in leisure. The range of leisure occupations was similar to that noted in the literature. The main enabling factor was having an adequate network of people to provide support, while the main hindering factors were physical limitations, lack of finances and lack of transport. In the absence of paid employment, leisure was important to the clients. Occupational therapists need to recognise that enhancing the factors enabling participation in leisure and assisting clients to overcome the factors hindering participation in leisure will lead to the increased wellbeing of people with enduring mental health problems.
The International Classification of Functioning, Disability and Health provides a Model for Adaptive Seating Interventions for Children with Cerebral Palsy
Authors: McDonald Rachael , Surtees Robert , Wirz Sheila
Published: April 2015

Children with severe types of cerebral palsy use adaptive seating systems to encourage function and assist in delaying the development of deformity. These systems are often assessed for and provided by occupational therapists. However, there has been no unifying policy or theoretical basis on which these systems are provided and research evidence is lacking, with studies tending to be small and non-controlled.

The International Classification of Functioning, Disability and Health (World Health Organisation 2001a,b) aims to establish a common language for clinical practice as well as research, while bringing together the opposing social and medical models of health care delivery. This paper suggests that the ICF model is an ideal theoretical basis for adaptive seating system assessment and provision, given that these systems often conflict between the medical model of reducing or delaying impairment of body functions and structures and the social model of children and families accessing life and environmental situations through mobility and seating equipment.

The paper considers all the domains of the ICF with regard to the current literature. It concludes that using the model in the context of providing adaptive seating gives occupational therapists both a powerful tool for communicating with children and families as well as managers and a basis for evaluating practice.
Deviating from the Norm: A Sceptical Interrogation of the Classificatory Practices of the ICF
Authors: Hammell Karen Whalley
Published: April 2015

The World Health Organisation's systems for classifying disability have been embraced, largely uncritically, by occupational therapists. In contrast, disability theorists critique the idea of normality against which judgements of deviance are made, challenge the privilege to make such judgements and contest the belief that the outcome of classification is necessarily benign or benevolent. Because systems for classifying impairments have been used to justify human rights' abuses, they cannot be used uncritically. Accordingly, this opinion piece draws on the work of disability theorists to undertake a sceptical interrogation of the classificatory practices of the International Classification of Functioning, Disability and Health (ICF).
Record Keeping in Occupational Therapy: Are We Meeting the Standards set by the College of Occupational Therapists?
Authors: Gibson Fiona , Sykes Michael , Young Sue
Published: April 2015

Sixty-four occupational therapists from a range of specialisms in Tayside audited 320 client records against 61 standards from the College of Occupational Therapists' core standard on record keeping. The audit found that there were areas to be celebrated, such as the inclusion of relevant client history and the outcome of interventions. The challenges identified included documenting the views of clients, the recording of treatment goals and the use of abbreviations. The conclusions focused on client involvement, the occupational therapy process and the appropriateness of the College of Occupational Therapists' standards.
Electronic Care Records: An Update on the Garner Project
Authors: Garner Ruth , Rugg Sue
Published: April 2015

Change is omnipresent in modern society. Much of it relates to new technology and, in particular, to information, communication and management technology. To thrive, individuals and organisations must react appropriately to the challenges offered by such change. This opinion piece outlines the most recent phase of a continuing project exploring the use of information and communication technologies in the allied health professions. It focuses on the use of electronic patient records, or electronic care records as they have more recently become known. Such records form an important strand in the National Health Service's vast, ongoing National Programme for Information Technology (Granger 2003, NPfIT 2004). The piece concludes by outlining the steps that occupational therapists and occupational therapy services can take to ensure that they are well placed to participate in current and future electronic care records initiatives.
Images of Occupational Therapy among Secondary Schoolchildren
Authors: Wilkinson Jeremy , Chard Gill
Published: April 2015

There has been no published research in the United Kingdom specific to the promotion of occupational therapy as a career among secondary schoolchildren. A two-part questionnaire was administered to 110 schoolchildren (age 14–16 years) at three schools in England. The questionnaire investigated awareness about occupational therapy as a potential career and opinions about various promotional materials: a video, radio advertisements and careers leaflets issued by the College of Occupational Therapists.

The findings indicate that awareness of occupational therapy is low; careers teachers are the first choice and the Internet the second choice when finding out about a career in occupational therapy. All participants chose the video as the best promotional material. Schoolchildren need to be informed about occupational therapy before the age of 14 years if they are to consider it as a career; careers teachers need ready access to promotional materials; and the College of Occupational Therapists' web pages need to be developed specifically for secondary school-age children.
Cultivating Wildness: Three Conservation Volunteers' Experiences of Participation in the Green Gym Scheme
Authors: Birch Matt
Published: April 2015

The Green Gym – a free scheme run by the British Trust for Conservation Volunteers – encourages people to become fitter and counter the negative impact of increasingly sedentary lifestyles through carrying out practical conservation tasks. This study aimed to identify what participation in one newly established Green Gym meant to three volunteers.

A qualitative research design was used owing to the small sample available – two unemployed adults and a part-time community worker – at the time that the research was undertaken. Data were collected through participant-observation over four sessions, semi-structured interviews and the participants' visual notebooks. An iterative process of data coding, display in concept maps and interpretation generated themes and subthemes.

In addition to improving fitness, the participants valued the scheme as a means of enhancing mental wellbeing, being stimulated by nature and enjoying social contact, and as a flexible way in which to attain a valued productive role. The findings suggest that Green Gyms can represent a form of mainstream volunteerism to which appropriate occupational therapy clients might be referred in the process of meeting a range of occupational needs. In particular, the flexibility and diversity of tasks at the Green Gym suggest that it has the potential to enable occupationally deprived individuals, including those who have experienced social exclusion through mental ill-health, to access a productive occupation in the community.
Hard Complexities – Soft Complexities: An Exploration of Philosophical Positions Related to Evidence in Occupational Therapy
Authors: Blair Sheena E E , Robertson Linda J
Published: April 2015

The practice of occupational therapy rests upon the ontological assumption that there is a relationship between engagement in occupation and health. Different traditions of knowing about and investigating this relationship are evident within the literature. The professional link with biomedicine has led to an adherence to positivistic methodologies but, as the profession has begun to generate discipline-specific knowledge, inquiry approaches consistent with interpretative and critical theory have become evident.

This paper explores the nature of inquiry underpinning current practice. It suggests that contemporary developments have been a reaction to a climate of uncertainty, generated by rapid political, fiscal, technological and ideological change in the delivery of health and social care in the last four decades. From these rapid changes, different views of ‘best practice’ have developed: evidence-based, reflective and reflexive practice, each with its own source of knowledge and method of inquiry. It is postulated that each of these views has implications for education, practice and research.
Paediatric Occupational Therapy University Programme Curricula in the United Kingdom
Authors: Brown G Ted , Brown Anita , Roever Carsten
Published: April 2015

The paediatric curriculum component of entry-level occupational therapy education programmes in the United Kingdom was examined and comparisons were made with the practice literature to determine if students were being taught current best practices.

Questionnaires were mailed electronically to the identified paediatric faculty members of the 27 universities with an entry-level occupational therapy education programme in the United Kingdom. Ten completed questionnaires were returned, giving a response rate of 37%.

The survey results indicated that paediatrics constituted less than 5% of the total curriculum content of the respondent university programmes. The theory, assessments and treatment approaches taught in the education programmes were similar to those used in clinical practice with children. Some gaps in what was taught to students were apparent, notably in the key paediatric area of visual perceptual dysfunction. The theory, assessments and intervention methods were not always taught as a cohesive stand-alone unit, so gaps occurred in the education programmes. This could lead to graduates using an eclectic approach or using personal conceptual frameworks based on postgraduate learning and work experience.
Children in Vegetative State and Minimally Conscious State: A Survey of Sensory and Cognitive Intervention
Authors: Wales Lorna , Waite Claire
Published: April 2015

There is little information available about the management of children in a vegetative state and a minimally conscious state (VS and MCS), including diagnosis, assessment and treatment. This study investigated the intervention of occupational therapists in VS and MCS in the United Kingdom paediatric population.

A survey design was used and a postal questionnaire was sent to a group of 892 occupational therapists who were members of a paediatric or a neurological specialist section. Two hundred and seventy-one completed questionnaires were returned and the results of these were analysed. Two hundred and six (76%) of the respondents worked in a rehabilitation setting.

Twenty-five occupational therapists who worked with children in VS and MCS completed further questions about their assessments and interventions. The results indicate that children in VS and MCS receive fragmented and inconsistent occupational therapy services. Adult assessments are used with a paediatric population and therapists are not wholly satisfied with their interventions. A core group of occupational therapists involved with this population was identified as a result of this survey. It is suggested that these therapists may be able to form a working party to investigate a consistent therapeutic approach for this complex group of children.
A Cognitive-Behavioural Group Intervention for People with Chronic Insomnia: An Initial Evaluation
Authors: Green Andrew , Hicks Jane , Weekes Rosemarie , Wilson Sue
Published: April 2015

An interest in the nonpharmacological management of chronic insomnia led to the establishment of a treatment group in which occupational therapists have been involved. The outcome data from seven groups are presented. Sleep diaries indicate a modest improvement in total sleep time, with further improvement at 3-month follow-up. Participant feedback shows that people with insomnia value expert advice and support as well as meeting others with similar problems. Additional research and evaluation are planned, but these findings suggest that the programme should be developed further. It is argued that the management of insomnia is an appropriate area of concern for occupational therapists.
Using Video Assessment for Clients with Chronic Low Back Pain: Is it Reliable?
Authors: Trott Melony , Fisher Keren
Published: April 2015

Clients with chronic back pain can benefit from learning strategies to manage their pain. In a 3-week pain management programme, the use of a videotaped assessment on admission and at discharge enables occupational therapists to score functional movement, as well as providing visual feedback for the clients, although evidence of reliability is necessary. This study investigated the reliability of intrarater and interrater scoring between four experienced occupational therapists who scored the video assessment.

Forty clients and forty controls were chosen to complete the assessment. The assessment consists of tasks with 59 different items to score. Each task is scored on three factors: posture, problem solving and movement.

The results demonstrated that interrater reliability for problem solving was not consistent. However, it was consistent for posture and movement in the client group, although less so for controls, showing increased difficulty in identifying the more subtle principles being used.

Intrarater reliability was less convincing, with the therapist reporting fatigue at the number of items to be scored. However, this could be improved by reducing the number of items in the assessment because analysis showed that 39% of items did not meet the criteria for statistical significance of change. More clarification on the score measures will assist in measuring the efficacy of the treatment programme objectively.

Discriminant validity of the scoring system was indicated by the improvement seen in the clients' performance but not in that of the controls. Further studies to improve reliability and demonstrate better validity are planned.
Description of an Occupational Therapy Intervention Aimed at Improving Outdoor Mobility
Authors: Logan P A , Walker M F , Gladman J R F
Published: April 2015

After a stroke people can find outdoor mobility difficult, but a targeted occupational therapy intervention has been shown to help people to get out of the house more often. This study describes the intervention.

The occupational therapists who provided the intervention kept records of the number and duration of therapy sessions, the goal of therapy and the activities undertaken. As part of the trial, functional and mobility outcome assessments were completed by the participants 4 and 10 months after recruitment and were used to compare the goals set with the goals achieved and the mobility performance.

Eighty-six participants were randomised to, and 78 received, the intervention. They received a median of 6 (mean 4.7, SD 1.9) sessions, with an average of 40 minutes per session. Sixty (77%) of the participants achieved their primary goal. Those who did not had greater functional limitations at the start of the study than those who did. Walking was the most common goal (17/78, 22%) and the most performed activity (135 times, 33%). Thirteen participants achieved walking and 12 of these were still walking outside at the 10-month assessment.

Three-quarters of people with stroke were therefore able to achieve their outdoor mobility goals after an occupational therapy intervention.
Enabling Occupational Therapy Students to Take a Fresh Approach to Psychosis
Authors: Blank Alison , Hayward Mark , Craik Christine , Gallagher Margaret
Published: April 2015

This practice evaluation describes the implementation of a 2-day workshop on psychosis with third-year undergraduate occupational therapy students at Brunel University. The work was undertaken by the teaching team at Brunel University, a clinical psychologist working in assertive outreach and an occupational therapist working in community mental health. The background to the project and the way in which the 2-day workshop was adapted to accommodate the university timetable are outlined. An evaluation of the workshop, its place in the occupational therapy programme and the feedback from students are presented.
Profiles of Occupational Engagement in People with Schizophrenia (POES): The Development of a New Instrument Based on Time-Use Diaries
Authors: Bejerholm Ulrika , Hansson Lars , Eklund Mona
Published: April 2015

Previous time-use research suggests that it is highly relevant for an occupational therapist to estimate time use and occupational engagement in order to understand some of the determinants of wellbeing for people with schizophrenia. This article describes the development and the testing of the psychometric properties of an instrument, Profiles of Occupational Engagement in people with Schizophrenia (POES), with the aim of helping to interpret and evaluate time-use diaries and thus providing a systematic description of status regarding occupational engagement. The first part of POES involves completion of time-use diaries and the second part, the assessment, is based on nine items that are rated on a four-point ordinal scale.

The time-use diaries of 41 people with schizophrenia and the judgements from 12 occupational therapists were used in the study. A test of content validation involved experts from Sweden and the United Kingdom and resulted in two stages of revisions. The strength of agreement between two raters resulted in a mean weighted kappa of 0.70. Internal consistency was calculated for both raters separately and the alpha coefficients were 0.97 and 0.95.

This study provides initial support for the content validity, interrater agreement and internal consistency of POES. Based on the judgements of the occupational therapists in this study, POES seems to have good clinical utility. However, further research on the clinical utility as well as the criterion validity of the construct is warranted.