bluuebunny/crossref_metadata_2025 huggingface dataset:
Transition from Student to Practitioner: The Role of Expectations, Values and Personality
Authors: Sutton Gigi , Griffin Mark Anthony
Published: April 2015

Research into occupational therapy job satisfaction has been driven largely by concerns regarding recruitment and retention. There is a need to develop more robust theoretically sound methodologies for the investigation of job satisfaction within the profession.

This article presents the initial findings of a national longitudinal study of Australian occupational therapists. The respondents (n=295) were investigated immediately prior to graduation with respect to their expectations about working as an occupational therapist, their work values and their work preferences. A personality profile was also administered.

The findings indicate that students hold inflated expectations about their first job and retain traditional occupational therapy work values. Demographic and personality profiles reflect those of the international student body and can assist in the prediction of student expectations.
Basic Grade Occupational Therapists: A Descriptive Evaluation of a Community Rotation Scheme
Authors: Ryrie Iain , Williams Hilary , Wamsley Richard , Dwyer Jo
Published: April 2015

Difficulties in recruiting staff to National Health Service (NHS) facilities have been noted in the literature and, among occupational therapists, this problem is particularly acute in urban areas. One inner-city NHS trust responded to this difficulty by establishing a rotation scheme that allowed basic grade occupational therapists to gain experience in a range of community-based posts. There appear to be few precedents for such a scheme and the experience of newly qualified staff in non-traditional settings is rarely documented in the literature.

The present study sought to evaluate the basic grade community rotation scheme in terms of the postholders' perceptions. A semi-structured questionnaire was administered which elicited their views on role clarity, multidisciplinary working practices, access to professional support, levels of occupational stress and job satisfaction. The findings indicate a number of benefits from the community rotation scheme, such as the development of autonomous practice and the varied nature of the work. Disadvantages were also evident, such as a lack of role clarity and the tendency for generic working practices to emerge within multidisciplinary teams. The findings are considered in relation to the literature and the implications for further investigation are discussed. It is concluded that further work is needed in this area to facilitate the recruitment and retention of current and future practitioners.
Sexual Aspects of Rehabilitation: The Client's Perspective
Authors: Northcott Rebekah , Chard Gill
Published: April 2015

This paper outlines the findings of a small-scale study that explored disabled people's experiences of the sexual aspects of rehabilitation. It focuses on whether this should be the role of the occupational therapist or not. Sexuality is a complex area that encompasses many facets of the individual and is different to sexual functioning. The literature demonstrates that disability in any form may potentially result in problems with respect to sexuality as well as sexual functioning.

Seven in-depth interviews were carried out with disabled people aged between 30 and 50 years. Although the sexual functioning of six participants was affected, only two had received information on sexual aspects of rehabilitation. All believed that they should receive advice and information on the sexual aspects of their rehabilitation, but were uncertain as to who should take responsibility for this role.

The findings from this study suggest that any health professional would be appropriate for this responsibility, including occupational therapists, but that they would need specialist training. Undergraduate education and training for occupational therapists should address basic issues of sexuality and disability, and provide opportunities for individuals to explore their own values and beliefs so that they feel confident in discussing sexual issues with clients. Health professionals who work with clients with specific sexual needs are likely to require additional training in this sensitive area.
An Introduction to Play and the Preschool Child with Autistic Spectrum Disorder
Authors: Ziviani Jenny , Boyle Moira , Rodger Sylvia
Published: April 2015

As the main occupation of childhood, play is considered by occupational therapists as an important vehicle for the assessment and treatment of preschool children. For the child with autistic spectrum disorder (ASD), play not only offers a mechanism whereby the severity of the disorder can be ascertained but also enables interventions to be implemented and monitored.

This paper aims to summarise the current literature as it relates to the play of children with ASD. By doing so, it alerts the reader to the complexity of the issue of play as a means of assessment and intervention and highlights areas of continuing clinical and research concern.
The Impact of the Different Disabilities Arising from Head Injury on the Primary Caregiver
Authors: Connolly Deirdre , O'Dowd Tom
Published: April 2015

One of the major challenges of coping with head injury is that people are often unprepared for, and unaware of, the potentially harsh reality that can have an impact on the family. This study was carried out to examine the association between motor, cognitive, behavioural, perceptual, and speech and language disabilities and the levels of stress and strain on the carers.

Two scales were used to measure stress and strain. The results showed that, in this group (n = 70), behavioural disabilities were most strongly associated with the carers' self-concepts, such as self-esteem and feelings of competence. Motor and cognitive disabilities were associated with strain on roles and activities outside the caregiving situation.

These results have implications for practice and service providers. They indicate that services and intervention strategies must place greater emphasis on addressing the possible impact of behavioural disabilities on the carer's self-concept and that respite services should be available to allow the carer time to fulfil other roles and responsibilities that are neglected due to cognitive and motor disabilities.
Fieldwork within the Context of Higher Education: A Literature Review
Authors: Bonello Marjorie
Published: April 2015

Fieldwork education is a critical and an indisputable component within occupational therapy curricula. It presents the opportunity for the integration of theory and practice, enabling the development of professional behaviour in students.

Over the last decade, several authors have evaluated, debated and reflected upon the processes and contents of fieldwork so as to present the best practices which would truly provide meaningful learning experiences for the students. This article documents a cross-section of the literature as seen within the context of higher education and professional practice in a climate of changing health care systems.
Occupational Therapists' Views and Perceptions of Evidence-Based Practice
Authors: Curtin Michael , Jaramazovic Emily
Published: April 2015

In spite of the developments within health and social care, little research has been published that specifically identifies the views and perceptions that occupational therapists working in England have of evidence-based practice (EBP).

This study used qualitative and quantitative methodologies in two distinct phases. Initially, focus groups were used to explore the views and perceptions that senior occupational therapists working in different settings had of EBP. In the second phase, the findings from the focus groups, alongside the results from a study conducted by Wiles and Barnard (1998), were used to design a questionnaire to canvass the views and perceptions of a larger number of occupational therapists within the South and West Region of England. Of 653 questionnaires distributed, 500 (76.5%) were returned and analysed.

The findings indicated that the respondents were positive about EBP. The lack of time and the high staff turnover and staff shortages were seen as major barriers to the implementation of EBP. Support from managers and colleagues, along with personal motivation and access to resources, enabled the implementation of EBP. Many respondents felt that they required more training about EBP. This research indicates that practical initiatives assisting the implementation of EBP are likely to be met with enthusiasm by occupational therapists.
Independence and Empowerment: Evidence from the Student Perspective
Authors: Taylor M Clare
Published: April 2015

The terms ‘independence’ and ‘empowerment’ are used to underpin much of what occupational therapists do. This paper presents a study that explored how occupational therapy students' knowledge and understanding of these concepts change and develop throughout the initial stages of their professional socialisation (their undergraduate years).

Using a qualitative methodology and a case study approach, the longitudinal study followed one cohort of occupational therapy students through the 3 years of their undergraduate course. Data were collected during a series of three in-depth, semi-structured interviews with 10 participants from the student cohort.

The findings highlight not only how ideas linked to independence and empowerment change and develop, but also the factors perceived by the participants as central to this process of change. The implications of these findings are discussed in relation to students' ability to engage in reflection and to articulate their reasoning and the values that underpin their practice.
The Use of Transport by Stroke Patients
Authors: Logan P A , Gladman J R F , Radford K A
Published: April 2015

The objectives of this research were to survey the use of transport by stroke patients in the community and study its relationship to their activities of daily living and mood.

The records of 90 consecutive stroke patients receiving community occupational therapy in a rehabilitation trial were surveyed for entries of therapy related to transport. A further 50 stroke patients in the same study were surveyed about their use of transport one year after discharge from hospital.

In the survey of occupational therapy notes, a transport assessment had been recorded for all 90 patients. Of these, 22 patients had been given leaflets describing the range of transport options locally but had been unable to use these options.

In the survey of transport use, 42/50 (84%) patients surveyed at one year responded. Twenty-one (50%) had used transport on their own, six of whom scored <26/66 on the Extended Activities of Daily Living scale (indicating that they needed help in most activities of daily living). Twenty-one (50%) patients had not travelled alone, four of whom scored >48/66 on the Extended Activities of Daily Living scale (very able in activities of daily living). Only 1 (2%) patient had used specialist transport and 22 (52%) reported that they did not get out as much as they wished.

Despite receiving advice, these patients did not use specialist transport options, yet many still wanted to get out more. The reason for this is unclear but it is not due simply to physical disability.
A Survey of Post-Registration Research Students in Occupational Therapy
Authors: Bannigan Katrina , Duncan Edward A S
Published: April 2015

In 1999, the College of Occupational Therapists' Research and Development Board was expanded. Two new members were appointed to represent post-registration research students. As little was known about this constituency of the membership of the British Association of Occupational Therapists, the Research and Development Board approved a study of post-registration students. The aims were to identify the needs of post-registration research students in occupational therapy and to develop an action plan based on the findings.

A survey was conducted. The response to the questionnaire was varied: some respondents felt very isolated within their studies whilst others felt well supported. There was general agreement that it was helpful to be in contact with other occupational therapists actively involved in research. A consultation process based on the findings of the survey was carried out to develop an action plan. This process also produced varied results, which made it difficult to make specific recommendations other than that a network was wanted.

At the Research and Development Board meeting in August 2000, the action plan recommended by the post-registration research student members, in which the main recommendation was to set up a post-registration research student network, was approved.
Using Nominal Group Technique to Explore Competence in Occupational Therapy and Physiotherapy Students during First-Year Placements
Authors: Steward Barbara
Published: April 2015

Exploring supervisors' opinions about student competence is a complex issue. The nominal group technique offers an alternative to focus groups and individual interviewing, allowing opportunities for individual data generation and group discussion and evaluation. This paper records and critically appraises its use as part of an investigation of the qualities therapists value in students in their first full fieldwork placement.

This small-scale and exploratory qualitative study suggests that occupational therapists and physiotherapists appear to value very similar personal qualities in students, but that departments and individuals may give different weightings to skills and knowledge. The findings have implications for students, fieldwork supervisors and college educators when preparing for clinical placements.
Assessing the Outcomes of Equipment and Adaptations: Issues and Approaches
Authors: Heaton Janet , Bamford Claire
Published: April 2015

Current government policy emphasises professional accountability, Best Value, evidence-based practice and outcomes for users and carers. In this context, being able to demonstrate the effectiveness of routine practice is increasingly important.

This article considers the key issues in collecting information about the outcomes of equipment and adaptations. These include: the assessment of the full range of outcomes; the timing of data collection; the use of standardised and individualised measures; and linking outcomes to interventions. Three approaches to evaluating the outcomes of equipment and adaptations are distinguished: functional status measures; health status or quality of life measures; and indirect approaches. Examples of each approach are provided and their strengths and limitations discussed.

Previous work on the outcomes of equipment and adaptations has neglected the perspectives of carers and the impact of service delivery (service process outcomes); further work on these areas is needed to ensure that all the outcomes of equipment and adaptations are fully evaluated.
The Leisure Participation of Clients with a Dual Diagnosis
Authors: Hodgson Susan , Lloyd Chris , Schmid Thérèse
Published: April 2015

People with a dual diagnosis experience disruption in carrying out their daily occupations. This article describes a study in which an occupational therapist explored the leisure participation of clients with a dual diagnosis. In-depth, semi-structured interviews were conducted with four outpatients from an alcohol and drug rehabilitation programme. Inductive analysis of the informants' interviews identified two main themes: leisure as part of the recovery process and the barriers to leisure participation.

This study provides support for the need to understand the leisure occupations of the clients with whom occupational therapists work. Further research is required to examine the interventions that assist clients with a dual diagnosis to develop meaningful leisure activities.
Breaking Moulds — Shifting Thinking
Authors: Ryan Susan
Published: April 2015

Have you ever read statements that have stopped you in your tracks and changed the way that you looked at things? One comment had a major impact on my thinking with regard to professional education. It pulled me up, made me think hard and was the initiator for pursuing further knowledge and ideas. It was from the educator Eraut (1994, p49), who stated:

…certain systems of thought or paradigms dominate a profession's thinking in such a way that they are passed on unquestioned from one generation to the next.

There is mounting evidence from researchers, students and therapists in the United Kingdom that educators, including fieldwork educators, need to look again at some of the time-honoured ways of facilitating learning.

From Australia, a different type of ‘interactive therapist’ is being advocated (Higgs and Edwards 1999). Beyond technical competence, professionalism and a commitment to quality health care, such a person embraces the unique and uncertain situations that contemporary practice presents. This includes the conflicting values and ethical stances seen in social and cultural contexts. Ways of educating need to encompass and encourage these qualities.
The Computation of Fieldwork Achievement in Occupational Therapy Degrees: Measuring a Minefield?
Authors: Westcott Lyn , Rugg Sue
Published: April 2015

Fieldwork is a distinct element of undergraduate occupational therapy degrees. Students are seconded from educational institutions to fieldwork educators in practice settings, where their vocational competence is developed and assessed. Fieldwork procedures are devised by individual educational institutions. This paper reports the findings of a survey based on data from fieldwork coordinators, which investigated the incidence of and reasoning behind the computation of fieldwork achievement in England and Ireland.

The results showed that every programme had considered computing fieldwork performance at some time and that most were actually doing this. Many programmes that were not computing fieldwork performance expressed the desire to do so, but were uncertain about this action. Highly inconsistent practice was found regarding fieldwork assessment procedures and the weightings given to fieldwork elements; consequently, students' practical fieldwork skills may not be conveyed by their degree classification award. Various factors influenced fieldwork computation, with many inconsistencies and contradictions emerging.

The study concluded that computation of students' fieldwork achievement was highly inconsistent. Further development is vital to improve this situation for students, educators, clinicians and employers alike. It is suggested that development be coordinated at a national level.
Measuring Clinical Effectiveness in Mental Health: is the Canadian Occupational Performance an appropriate Measure?
Authors: Chesworth Clunis , Duffy Ruth , Hodnett Jacqueline , Knight Amanda
Published: April 2015

Assessing the impact of occupational therapy with mental health clients within community settings has received relatively little attention in the research literature. Where such studies have been undertaken, there has been inconsistency in the types of instrument used and considerable variation in the sample sizes.

In this study, the Canadian Occupational Performance Measure (COPM) was used to detect what changes, if any, had occurred on the completion of an occupational therapy programme. This instrument seeks to assist clients in the identification of the problems with occupational performance that cause them most concern. Sixty clients, who were in receipt of occupational therapy, participated in a 4-year study. Data were collected using the COPM at the commencement of their interventions and again on completion of the programme.

The findings suggest that this was an appropriate instrument for detecting significant changes in this client group on completion of their occupational therapy. The implications of these findings are discussed, with a view to improving the efficacy of interventions by occupational therapists in mental health care in the future.
A Survey of Australian Mental Health Occupational Therapists
Authors: Lloyd Chris , King Robert , Bassett Hazel
Published: April 2015

Mental health reform in the western developed world has resulted in new models of care and changed work practices for all mental health professionals. Occupational therapists, as with other mental health professionals, have been required to assume new roles and responsibilities. Literature from the United Kingdom has reflected concern about this new way of working. The aim of this exploratory study was to examine the current work practices of and issues faced by Australian mental health occupational therapists. One hundred and forty-eight respondents (74%) answered an occupational therapy practice in mental health questionnaire.

The results from this survey suggest that there are two quite distinct groups of occupational therapists working in mental health settings in Australia. One group works as rehabilitation therapists in traditional activity-focused work roles. The other group works as case manager therapists and employs a much broader spectrum of clinical and support roles. The issues facing therapists include the development and maintenance of a clearly defined role, generic case management versus discipline-specific roles, recruitment and retention, the need for research and evidence-based practice, professional standing, and education and professional development.

The concerns over the role of occupational therapy in mental health were similar to those in previous British studies. The implications of these findings include a need for education and training at the undergraduate and postgraduate levels to equip mental health occupational therapists with both discipline-specific and generic skills.
Childhood Transformed? Risk Perceptions and the Decline of Free Play
Authors: O'Brien Jonathon , Smith Jenny
Published: April 2015

Occupational therapists have been concerned with the health-promoting aspects of children's play. The evidence suggests that children's freedom to play away from adult supervision has declined in recent years and that parental perception of risk may be a factor in this. This research used a qualitative approach to explore six parents' views on how their fear of risk might be shaping their children's play. The parents stated that their children were now more likely to take part in activities supervised by adults.

The article shows that these findings may be linked to national trends and that occupational therapists should be concerned about the health implications of these changes. It is suggested that further research should take into account other factors that might affect children's play.
Pain and Function: Occupational Therapists' Use of Orthotics in Rheumatoid Arthritis
Authors: Henderson Sarah Elizabeth , McMillan Ian R
Published: April 2015

The use of orthotics in the management of rheumatoid arthritis appears to be relatively commonplace within occupational therapy departments. The aim of this study was to identify the frequency of orthotic use by occupational therapists, their beliefs about the efficacy of orthotic use, what they aimed to achieve by orthotic provision and any outcome measures used. The total membership of the British Association of Hand Therapists who were both occupational therapists and self-identified as working and/or having an interest in rheumatology (n = 132) were surveyed through a postal questionnaire. Of the responses received (n = 89, 67%), all the respondents (100%) were regular users of orthotics in the management of rheumatoid arthritis.

The results showed that the most highly rated reasons for orthotic provision were to decrease hand and wrist pain and to improve hand function. Subjective comments from the respondents provided evidence of positive beliefs about the efficacy of orthotic use, despite a lack of objective outcome measures to support such comment. Given the complexity of the intervening variables that occur with orthotic use, perhaps there is no easy answer; however, with the expectation of evidence-based practice and intervention, it is suggested that an increased use of standardised outcome measures may provide additional strength in presenting, often subjective, evidence.
Social Integration following Traumatic Brain Injury and Rehabilitation
Authors: Conneeley Anne Louise
Published: April 2015

The aim of this qualitative study was to examine the issues involved in social integration for those affected by traumatic brain injury, following a period of rehabilitation. Eighteen patients, their significant other* and members of the rehabilitation team involved in their care were interviewed when the patient was discharged from the ward of a neurological rehabilitation hospital, 6 months later and, again, at one year following discharge from the ward.

When the data were analysed at the time of the final interview, two respondents reported social isolation. Although many others felt that the level of social contact was that of their choice, several issues were discussed that affected social relationships. These included the impact of impairments, the social response of others and the fact that social networks change naturally over time irrespective of injury or disability.

When the data were considered from a sociological perspective, the themes of self-identity, master status and stranger status emerged. This gave a different insight into issues that could be relevant but had not been discussed widely within the head injury literature. Further consideration of the individual in the context of personhood as well as head injury is recommended as a means to develop understanding.
Occupational Therapists' Beliefs regarding Treatment Options for People with Chronic Pain
Authors: Brown Cary A
Published: April 2015

An expanding body of chronic pain research is now evident within occupational therapy and strong support has developed during the last 10 years for the multidisciplinary approach to the management of chronic pain. Although this stand is now subject to growing scrutiny, a multidisciplinary structure continues to be the environment for most outcome studies. Occupational therapists, as accepted and involved members of pain management programmes, need to examine the values and beliefs that they bring to the treatment team.

As part of a wider research study of the congruence between what service providers and service users believe to be necessary treatments for chronic pain, the members of the National Occupational Therapy Pain Association were surveyed in January 2001. The survey asked therapists' opinion about whether specific treatment components were needed or not needed for people with chronic pain. The survey also included Skevington's (1990) Beliefs about Pain Control Questionnaire (BPCQ), which measures beliefs in the internal or personal control of pain, beliefs that powerful others (doctors) control pain and beliefs that pain is controlled by chance events.

The findings showed that there were few treatment components that 100% of the respondents agreed were needed. Endorsements clustered around treatments that focused on self-management and a statistically significant relationship emerged between certain treatment components and BPCQ scores. The paper concludes by discussing some possible influences on occupational therapists' decision making in relation to treatments for chronic pain.
Are Occupational Therapists Losing Sight of Hemianopia?
Authors: Taylor Lisa , Poland Fiona , Stephenson Richard
Published: April 2015

The purpose of this study was to determine the knowledge base surrounding hemianopia and to collate the rehabilitation principles offered by members of the National Association of Neurological Occupational Therapists (NANOT). A questionnaire was sent to 250 randomly selected members of NANOT. The completed questionnaires (n = 120) represented approximately a quarter of the total number of NANOT members at the time of the study.

The mean post-registration time of the respondents was 11 years (SD 0.6). All United Kingdom geographical areas apart from Northern Ireland and the Isle of Man were represented. A wide range of clinical areas was also represented.

The results showed that 92% of the respondents provided an accurate definition of hemianopia as the loss of half of the visual field. However, 48.3% reported that they were not testing every individual with a stroke for hemianopia. A third of the respondents stated that 80–100% of individuals with hemianopia always needed occupational therapy to compensate. The respondents also rated their understanding of eight neurovisual terms and, out of a total possible score of 80 (full understanding of terms), the mean score was 41 (SD 2.9).

The occupational therapist's role in the assessment/rehabilitation of hemianopia emerged in four categories: education, compensation, assessment of effects and diagnosis. Even if individuals were made aware of their hemianopia, 62% of the respondents reported that there were resulting problems in the individual's engagement in occupation (aspects of self-care, productivity and leisure).

These results are discussed in the context of the available literature and conclusions are drawn. A recommendation is made to improve the awareness and rehabilitation of individuals with hemianopia by occupational therapists.
AIDS Dementia Complex: The Perception of Loss of Functional Ability
Authors: Gregory Kate , Gibbs Deanna
Published: April 2015

AIDS Dementia Complex (ADC) is a subcortical dementia often associated with HIV disease. Despite undergoing numerous assessments of cognition and function to determine their need for personal care assistance, there is limited information on how individuals with ADC view their functional and cognitive impairments and the subsequent effect on their lifestyle. This study investigated issues of concern to clients with ADC in order to provide a greater understanding of the psychological effect of the loss of functional ability.

A qualitative design was used to explore individuals' experience of ADC and clarify their insight and perception regarding the loss of function. The participants were selected by the use of purposeful sampling techniques. Information was obtained through semi-structured interviews and analysed using an analytic induction method. Five main themes were identified as being important in relation to the perception of functional ability.

Discrepancies emerged between the insights of individuals with ADC regarding their level of function and their need for assistance and support with activities of daily living, compared with those of the health care workers involved in their care. Health care workers need to have an awareness of the insight that individuals with ADC may have into their functional ability when addressing issues of supported accommodation and level of assistance required.
An Evaluation of the Canadian Model of Occupational Performance and the Canadian Occupational Performance Measure in Mental Health Practice
Authors: Warren Alison
Published: April 2015

The Canadian Occupational Performance Measure (COPM) is a client-centred outcome measure designed for use by occupational therapists to demonstrate change in a client's self-perception of occupational performance over the course of occupational therapy. A review of the literature indicated that there had been limited research into the use of the COPM in mental health practice. The aim of this study was to formulate an occupational therapy assessment form based on the Canadian Model of Occupational Performance and incorporating the COPM and to evaluate its effectiveness in mental health practice.

A qualitative approach was used in this two-phase study with seven occupational therapists working in mental health practice. First, semi-structured interviews were completed to gain occupational therapists' reflections on the use of the COPM. Headings were then collated to devise an occupational therapy assessment form that incorporated the Canadian Model of Occupational Performance and the COPM. The second phase involved piloting the form in a variety of mental health settings. The form was evaluated by a second interview to highlight the factors that facilitated or hindered the use of the form in mental health practice.

This study indicates that the combination of the COPM with other assessment categories based on the Canadian Model of Occupational Performance has produced an occupational therapy assessment form that can be used in mental health practice.
The Use of Lycra Garments in Children with Cerebral Palsy: A Report of a Descriptive Clinical Trial
Authors: Knox Virginia
Published: April 2015

This study aimed to evaluate the effects of wearing Lycra garments in children with cerebral palsy. Eight participants, aged 3 years 5 months to 13 years (male = 4, female = 4) and with a diagnosis of cerebral palsy, were recruited. A repeated measures design was used, with participants tested with the Gross Motor Function Measure (GMFM) and the Quality of Upper Extremity Skills Test (QUEST) before and after intervention. Both parents and participants recorded the perceived advantages and disadvantages of the participant wearing the Lycra garment at the end of the trial.

Each participant received a baseline test, was then provided with a Lycra garment and was re-tested once wear time was more than 4 hours per day. Four participants withdrew from the trial (discomfort from suit, n = 3; prescribed spinal jacket, n = 1). Of the remaining four participants, all showed an improvement in either GMFM or QUEST score and one showed improvement in both test scores. All but one of the eight participants recorded functional improvements when wearing their suit.

In this population, the participants showed improvements in function when wearing a Lycra garment, but problems with discomfort remained a barrier for some children to their more sustained use.
The Case for Generic Working in Mental Health Occupational Therapy
Authors: Harrison Deborah
Published: April 2015

There has been a lively exchange of views in the British Journal of Occupational Therapy about the role of occupational therapy in mental health. This opinion piece presents an argument that occupational therapy must be more flexible and develop generic working. Suggestions are made for future practice, research and education.
Older Drivers and Driving Cessation
Authors: Liddle Jacki , McKenna Kryss
Published: April 2015

Driving is a complex and valued instrumental activity of daily living, which is associated with a person's freedom, independence and autonomy. With an ageing population and various cohort effects, the number of older drivers is increasing at a nearly exponential rate. While drivers over the age of 65 years have attracted media and research attention because of accident statistics, research has also begun to focus on the outcomes for older people giving up driving.

The outcomes of older people driving or giving up driving need to be considered by occupational therapists because of the potential impact on quality of life, life roles, independence and safety. Occupational therapists must be aware of legislation pertaining to older drivers and health professionals, although this is complicated by the fact that it differs between and within countries. This literature review aims to investigate the issues associated with older drivers and with driving cessation and the implications for occupational therapists.
The Impact of an Allotment Group on Mental Health Clients' Health, Wellbeing and Social Networking
Authors: Fieldhouse Jon
Published: April 2015

The needs of people with serious mental health problems are frequently not met by services and service users' difficulties are further compounded by social isolation and exclusion. Clients attending a community mental health team horticultural allotment group described the importance that they attached to social contact in the group. This study aimed to develop an understanding of how this experience came about so that it could be harnessed more effectively.

A qualitative approach was used to explore the subjective experience of meaning that had underpinned regular attendance by nine group members. Qualitative interviews and a focus group generated data, which were examined in the light of concepts drawn from the literature on therapeutic horticulture, social networking and meaning in occupation. The participants described the restorativeness of the allotment setting, a resurgent destigmatised identity and attachment to a highly valued social network. The study concludes that there are particular qualities of the plant-person relationship that promote people's interaction with their environment and hence their health, functional level and subjective wellbeing. The embeddedness of allotments within communities means that they have great potential as media for occupational therapy and as mechanisms for social inclusion.
Perceptions of Play and Leisure in Junior School Aged Children with Juvenile Idiopathic Arthritis: What are the Implications for Occupational Therapy?
Authors: Hackett Janine
Published: April 2015

Play is the dominant occupation in childhood and is recognised as having an important role in wellbeing. Past research suggests that children with a disability experience a variety of barriers to engagement in play. Despite this, play is often not assessed as a specific area of occupational performance. This qualitative study aimed to explore the perceptions of play and leisure in junior school aged children with juvenile idiopathic arthritis. Twelve children between the ages of 7 years and 11 years were interviewed in order to uncover the barriers to engagement in play and leisure and to consider the implications, if any, for occupational therapy.

The results showed that all children, regardless of disease activity, reported difficulty in engaging in play and leisure activities. The symptoms of the disease, the treatment regimes and their side-effects, and psychosocial factors were all reported to affect play and leisure experiences. The children also reported that play behaviours were often restricted by parents, friends and school personnel. Fear of damage and unclear communication about the effects of activity also resulted in self-imposed restrictions, which further limited play experiences. Although the children reported a number of coping strategies to deal with these difficulties, they reported more indoor play and engagement in sedentary activities which often gave rise to feelings of being different, sadness and loneliness.

These findings may have important consequences for occupational therapy and provide a timely reminder about the significance of assessing play and leisure as distinct areas of occupational performance in children.
Service Evaluation and the Service User: A Pluralistic Solution
Authors: Salmon Niall
Published: April 2015

User involvement is a key pillar in the temple of clinical governance. There are many potential ways in which the service users of health and social care may act in order to achieve positive and constructive change. Service evaluation, however, has not historically been one of these. This paper looks at a model of service evaluation that can offer an empowered voice to service users, enabling participation in service-level evaluation and development.

The pluralistic model for evaluation has a subjectivist epistemology, which stands in contrast to the scientific evaluation methods normally seen in health and social care organisations. It attempts to give all the stakeholders of a service equal authority and explores all perspectives to create a measure of success that is relevant and meaningful at the local level. This paper evaluates the theory behind this model and explores the pros and cons of this approach through recent examples found in the literature. It is hoped that this article will generate further thought and debate on this important and timely subject.
With You, Not against You: Applying Motivational Interviewing to Occupational Therapy in Anorexia Nervosa
Authors: Orchard Roberta
Published: April 2015

Anorexia nervosa is a complex condition which can evoke a range of challenges for the occupational therapist. Conflicts can often arise from the differing viewpoints of client and therapist and may inhibit the client's continuing engagement in treatment and the process of change. Motivational interviewing is an approach that allows the occupational therapist to take a side-by-side stance with the client and is increasingly advocated in working with this client group. This paper explores the practice of occupational therapy within an eating disorders service and discusses the application of motivational interviewing to working with people with anorexia nervosa.
Globalisation and Occupational Therapy: Poles Apart?
Authors: Westcott Lyn , Whitcombe Steven W
Published: April 2015

This opinion piece discusses the concept of globalisation for occupational therapy throughout the world. Factors that enable and inhibit mobile working patterns amongst occupational therapists are highlighted, with emphasis given to the way that occupational therapists are educated in the United Kingdom. The advantages to practitioners and services from the developed nations as opposed to those in the developing countries are recognised. The discussion concludes that, presently, occupational therapists are not optimising the opportunities afforded by globalisation. Educators, practitioners and service providers all have a role to play in taking this agenda forward.
The Relative Importance of Factors Affecting the Choice of Bathing Devices
Authors: Pain Helen , McLellan D Lindsay
Published: April 2015

There is only a small evidence base to draw upon when choosing assistive devices. Evaluations such as those funded by the Medicines and Healthcare products Regulatory Agency,* Department of Health, United Kingdom, generate data from which evidence-based guidelines can be compiled, but it is often difficult to determine the relative importance of the various factors involved.

To explore the relative importance of the factors related to the choice of bathing devices, the Delphi technique was employed. Thirty respondents were recruited following a formal evaluation of bath cushions and agreed to participate in the study (5 users, 10 informal carers and 15 professional care assistants), with 14 completing the process.

Three rounds were conducted, in which the respondents were asked to review a list of factors to consider when choosing bathing devices, to indicate the most important, to rank them and to comment on the results.

The safety of the user was reported to be the primary concern. The factors that eased the care assistant's task were regarded as less important, but several respondents remarked on the interrelationships between the factors. The ranking of the factors may jeopardise a comprehensive consideration of all the needs assessed, especially with people who have complex requirements. The limitations of the Delphi technique in such situations are discussed.
Impact of Second Skin Lycra Splinting on the Quality of Upper Limb Movement in Children
Authors: Corn Kym , Imms Christine , Timewell Georgia , Carter Catherine , Collins Lucy , Dubbeld Stephanie , Schubiger Sascha , Froude Elspeth
Published: April 2015

Spasticity can have serious functional implications for children with neurological deficits. Lycra splints may be recommended by occupational therapists to manage spasticity and improve function. In this study, four children with neurological deficits were assessed for quality of upper limb movement while wearing and not wearing an upper limb lycra splint.

Two participants diagnosed with cerebral palsy were long-term splint users. The other two participants had an acquired brain injury and commenced wearing their splints during the intervention phase of the study. Using a single subject research design, 7–12 baseline (non-wearing phase) and intervention (wearing phase) assessments were conducted for each child using the Melbourne Assessment of Unilateral Upper Limb Function.

The results show that one long-term user had a statistically significant decline in quality of upper limb movement during the intervention phase. One new user had a statistically significant improvement, but only on initial wearing of the splint. The results suggest that the effectiveness of Second Skin lycra splints was highly variable between individual children with spasticity.
A Part of Life's Tapestry: Early Parenting with a Spinal Cord Injury
Authors: Hunter Nicola , Coventry Anna
Published: April 2015

This report outlines the service provided by the Spinal Outreach Team to individuals in the area of parenting following a spinal cord injury. In particular, it focuses on the role of occupational therapists, using a client-centred approach to address the issues identified by these individuals. Services are information based and include advice and ideas to deal with areas such as the effect of pregnancy, selection of baby equipment, identification of suitable hospital resources and home baby care. This information will assist therapists and their clients in making that link between the desire to be a parent and maximising an individual's potential to do so.
The Impact of Adult Education for Mental Health Service Users
Authors: Westwood Jayne
Published: April 2015

Occupational therapists working in mental health are increasingly using adult education as a resource. This paper explores the experience of attending an adult education course from the perspective of the mental health service user. Twelve service users were recruited from the Education Link Team. A qualitative design using a semi-structured interview was chosen to explore the benefits, barriers, drawbacks, enabling factors and impact on mental health for individuals who attend college.

The results indicated that attending college improved confidence, self-esteem, socialisation and motivation. The service users gained knowledge and skills, had an increased purpose to the day and experienced improvements in depression, anxiety and psychosis. The fact that the course was discrete and the support of the health staff enabled the service users to attend college. The biggest barrier was difficulty in getting to the college. The drawbacks included difficult relations with others, work issues and anxiety. Areas for future study are given.
Occupational Therapy targeting Physical Environmental Barriers in Buildings with Public Facilities
Authors: Iwarsson Susanne , Fänge Agneta , Hovbrandt Pia , Carlsson Gunilla , Jarbe Ida , Wijk Ulrika
Published: April 2015

The main aim of this study was to evaluate an occupational therapy based intervention aimed at increasing the accessibility to buildings with public facilities in a Swedish town centre, which targeted physical environmental barriers. The intervention was occupational therapy advice based on the environmental assessments of each facility, given to the facility owners in order to ease the removal of environmental barriers. Another aim was to elucidate the attitudes towards and the practical obstacles to the implementation of accessibility measures among public facility owners. Systematic on-site observations of environmental barriers were administered in five buildings with different facilities, at baseline and at follow-up 18 months later, and were complemented by semi-structured interviews with the facility owners at follow-up.

At baseline, environmental barriers were found in all five facilities, such as at entrances, and at follow-up only minor improvements were identified. Two of the facility owners had made use of the occupational therapy advice, but the results also revealed scarce knowledge of or negative attitudes towards accessibility measures. Much remains to be done when it comes to attitudes towards the inclusion of people with disabilities. Active occupational therapy, as described in this study, can influence the situation only to a limited extent. Nevertheless, the results demonstrate that there is knowledge to be gained through this kind of approach.