Pub Date : 2023-06-17DOI: 10.1177/03080226231174795
Kirsten Sarah Smith, E. Kinsella, Sheila Moodie, Lisa McCorquodale, G. Teachman
Introduction: Metaphors are commonly used linguistic devices that can encourage deep reflection and offer new insight. Metaphors have been used within the both the occupational therapy and mindfulness literature to describe complex phenomena. The aim of this phenomenological study was to identify, analyze, and interpret metaphors used by pediatric occupational therapists to describe mindfulness in their clinical practices with children and youth. Method: Eight North American Occupational Therapists participated in semi-structured interviews which were transcribed verbatim. Transcripts were read to identify idiographic or naturally occurring metaphors used by participants. Metaphors of mindfulness were also elicited from participants as an interview question. Findings: Three themes were identified within participants’ idiographic metaphors of mindfulness: mindfulness as a tool, mindfulness as exploration, and mindfulness as a support. Two additional themes were identified within participants’ idiographic metaphors of themselves as facilitators of mindfulness: therapist as a guide, and therapist as a gardener. Elicited metaphors generally aligned with the themes identified for idiographic metaphors while some offered additional unique insights. Conclusion: The findings open conversations about therapists’ framing of the use of mindfulness within the context of pediatric occupational therapy.
{"title":"Metaphors of mindfulness in pediatric occupational therapy practice","authors":"Kirsten Sarah Smith, E. Kinsella, Sheila Moodie, Lisa McCorquodale, G. Teachman","doi":"10.1177/03080226231174795","DOIUrl":"https://doi.org/10.1177/03080226231174795","url":null,"abstract":"Introduction: Metaphors are commonly used linguistic devices that can encourage deep reflection and offer new insight. Metaphors have been used within the both the occupational therapy and mindfulness literature to describe complex phenomena. The aim of this phenomenological study was to identify, analyze, and interpret metaphors used by pediatric occupational therapists to describe mindfulness in their clinical practices with children and youth. Method: Eight North American Occupational Therapists participated in semi-structured interviews which were transcribed verbatim. Transcripts were read to identify idiographic or naturally occurring metaphors used by participants. Metaphors of mindfulness were also elicited from participants as an interview question. Findings: Three themes were identified within participants’ idiographic metaphors of mindfulness: mindfulness as a tool, mindfulness as exploration, and mindfulness as a support. Two additional themes were identified within participants’ idiographic metaphors of themselves as facilitators of mindfulness: therapist as a guide, and therapist as a gardener. Elicited metaphors generally aligned with the themes identified for idiographic metaphors while some offered additional unique insights. Conclusion: The findings open conversations about therapists’ framing of the use of mindfulness within the context of pediatric occupational therapy.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"630 - 638"},"PeriodicalIF":1.3,"publicationDate":"2023-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43012297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-12DOI: 10.1177/03080226231178396
Karen Aguía-Rojas, R. Bracewell, J. Castillo, Jonathon O’Brien
Introduction: Stroke is a leading cause of death and impairment in Colombia. There is unequal access to occupational therapy for stroke survivors and few data on services provided by occupational therapists. The study explored the experiences of Colombian occupational therapists working in stroke rehabilitation. Method: A total of 11 occupational therapists involved in the stroke rehabilitation in Colombia took part in two focus groups. Responses were analysed using thematic analysis within a critical realist theoretical framework. Findings: Three main themes were identified. First, participants discussed the ‘occupational therapy service’, highlighting changes since the 1970s, examples of contemporary good practice, and a range of barriers. Second, ‘attitudes’ included the impact of other professions views of occupational therapy and also the effects of low pay. Third, ‘action/way forward’ involved proposals for improving the current situation. Conclusion: Occupational therapists engaged in stroke rehabilitation in Colombia report a number of barriers. However, some draw inspiration from their past while others stress some strengths in current services. Future research should focus on occupational therapy stroke rehabilitation in Colombia’s regions and explore the impact of conflict and post-conflict contexts. In addition, occupational therapists’ efforts to improve professional representation should be explored.
{"title":"‘It is never-ending work’: Colombian occupational therapists’ experiences of working in stroke rehabilitation","authors":"Karen Aguía-Rojas, R. Bracewell, J. Castillo, Jonathon O’Brien","doi":"10.1177/03080226231178396","DOIUrl":"https://doi.org/10.1177/03080226231178396","url":null,"abstract":"Introduction: Stroke is a leading cause of death and impairment in Colombia. There is unequal access to occupational therapy for stroke survivors and few data on services provided by occupational therapists. The study explored the experiences of Colombian occupational therapists working in stroke rehabilitation. Method: A total of 11 occupational therapists involved in the stroke rehabilitation in Colombia took part in two focus groups. Responses were analysed using thematic analysis within a critical realist theoretical framework. Findings: Three main themes were identified. First, participants discussed the ‘occupational therapy service’, highlighting changes since the 1970s, examples of contemporary good practice, and a range of barriers. Second, ‘attitudes’ included the impact of other professions views of occupational therapy and also the effects of low pay. Third, ‘action/way forward’ involved proposals for improving the current situation. Conclusion: Occupational therapists engaged in stroke rehabilitation in Colombia report a number of barriers. However, some draw inspiration from their past while others stress some strengths in current services. Future research should focus on occupational therapy stroke rehabilitation in Colombia’s regions and explore the impact of conflict and post-conflict contexts. In addition, occupational therapists’ efforts to improve professional representation should be explored.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"705 - 713"},"PeriodicalIF":1.3,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45477845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-06DOI: 10.1177/03080226231175574
B. Madroñero-Miguel, C. Cuesta-García
Introduction: There is a lack of explicit tool recommendations for upper limb (UL) assessment in stroke, occupational therapists are frequently underrepresented in consensus studies, and the frequency of use of tools is highly variable between countries. The objective was to generate national occupational therapy consensus recommendations on UL assessment tools in stroke, and to classify the tools that achieve consensus according to the International Classification of Functioning, Disability and Health (ICF) components. Methods: Three-round e-Delphi study of national scope. Occupational therapists working in Spain with training and experience in neurorehabilitation were recruited. Rounds were based on the completion of questionnaires on UL stroke assessment tools. Consensus was reached when ⩾75% of experts gave a ⩾7 rating on a nine-point Likert scale. Results: A total of 29 occupational therapists comprised the expert panel. Twenty-three (17.8%) assessment tools achieved consensus and were classified according to the ICF components of body functions and structures (7), activities (11), participation (3) and other (2). Conclusion: The expert panel recommended 23 outcome measures for UL recovery in stroke, representing all ICF components. The consensus recommendations are intended to assist occupational therapists in their clinical decision-making process, and to reduce the heterogeneity of research tools.
{"title":"Spanish consensus of occupational therapists on upper limb assessment tools in stroke","authors":"B. Madroñero-Miguel, C. Cuesta-García","doi":"10.1177/03080226231175574","DOIUrl":"https://doi.org/10.1177/03080226231175574","url":null,"abstract":"Introduction: There is a lack of explicit tool recommendations for upper limb (UL) assessment in stroke, occupational therapists are frequently underrepresented in consensus studies, and the frequency of use of tools is highly variable between countries. The objective was to generate national occupational therapy consensus recommendations on UL assessment tools in stroke, and to classify the tools that achieve consensus according to the International Classification of Functioning, Disability and Health (ICF) components. Methods: Three-round e-Delphi study of national scope. Occupational therapists working in Spain with training and experience in neurorehabilitation were recruited. Rounds were based on the completion of questionnaires on UL stroke assessment tools. Consensus was reached when ⩾75% of experts gave a ⩾7 rating on a nine-point Likert scale. Results: A total of 29 occupational therapists comprised the expert panel. Twenty-three (17.8%) assessment tools achieved consensus and were classified according to the ICF components of body functions and structures (7), activities (11), participation (3) and other (2). Conclusion: The expert panel recommended 23 outcome measures for UL recovery in stroke, representing all ICF components. The consensus recommendations are intended to assist occupational therapists in their clinical decision-making process, and to reduce the heterogeneity of research tools.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"648 - 658"},"PeriodicalIF":1.3,"publicationDate":"2023-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45878318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.1177/03080226231174102
Rebecca Matson, Joanne Linforth, Christi U. Edge
Introduction: Distance methods of supervision rapidly increased in use during the coronavirus disease 2019 (COVID-19) pandemic, and it is important to consider if these methods meet the needs of supervisees when deciding whether to retain these practices moving forward. Methods: An interpretative phenomenological approach was used to gain insight into the lived experience of distance supervision. Semi-structured interviews were completed with six occupational therapists who had experience receiving distance supervision as a supervisee, all of whom work in inpatient mental health units within a private healthcare company. Results: Interpretative phenomenological analysis revealed four superordinate themes of an altered interaction; the importance of a protected space; factors within the supervisory relationship and maximising the best of both worlds. Conclusion: Distance supervision methods afford increased access for supervisees and a reduction in the practical demands when supervised by an off-site supervisor. There are, however, clear differences in the nature of the experience which need to be considered to ensure that supervisee needs are met. This study provides insight into how distance supervision methods impact on the experience for supervisees and suggests areas for further consideration in moving forward with such approaches.
{"title":"Distance supervision as experienced by occupational therapists in mental health: An interpretative phenomenological study","authors":"Rebecca Matson, Joanne Linforth, Christi U. Edge","doi":"10.1177/03080226231174102","DOIUrl":"https://doi.org/10.1177/03080226231174102","url":null,"abstract":"Introduction: Distance methods of supervision rapidly increased in use during the coronavirus disease 2019 (COVID-19) pandemic, and it is important to consider if these methods meet the needs of supervisees when deciding whether to retain these practices moving forward. Methods: An interpretative phenomenological approach was used to gain insight into the lived experience of distance supervision. Semi-structured interviews were completed with six occupational therapists who had experience receiving distance supervision as a supervisee, all of whom work in inpatient mental health units within a private healthcare company. Results: Interpretative phenomenological analysis revealed four superordinate themes of an altered interaction; the importance of a protected space; factors within the supervisory relationship and maximising the best of both worlds. Conclusion: Distance supervision methods afford increased access for supervisees and a reduction in the practical demands when supervised by an off-site supervisor. There are, however, clear differences in the nature of the experience which need to be considered to ensure that supervisee needs are met. This study provides insight into how distance supervision methods impact on the experience for supervisees and suggests areas for further consideration in moving forward with such approaches.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"622 - 629"},"PeriodicalIF":1.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41425476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.1177/03080226231177842
Shoval Galili-Simhon, Adina Maeir
Introduction: Attention deficit hyperactivity disorder among adults has been associated with deficits in executive functioning and poor quality of life. The purpose of this study is to examine feasibility of the Cognitive Functional Remote Group intervention among adults with attention deficit hyperactivity disorder. Method: Mixed-method feasibility study. Five adults with attention deficit hyperactivity disorder received 16 weekly sessions of Cognitive Functional Remote Group. Results: The target population was easily recruited and showed interest in the treatment. All participants completed the intervention and were moderately-very highly satisfied with different aspects of the intervention. Additionally, pre–post measures demonstrated high rates of clinically significant improvements in the quality of life measure and less so in executive functioning. Three central themes emerged from qualitative analyses of participants experiences relating to (a) Identity development through group process; (b) Occupation-based learning of self-awareness and cognitive functional strategies and (c) Feedback on group setting and content and relating to advantages and disadvantages of remote (Zoom) format. Conclusion: This study supported Cognitive Functional Remote Group feasibility among adults with attention deficit hyperactivity disorder. Quantitative findings point to the responsiveness of quality-of-life measures. Qualitative findings suggest gains in identity development, awareness and acquisition of cognitive functional strategies through occupation-based learning in a telerehabilitation group therapy format. Further controlled studies are warranted.
{"title":"Cognitive Functional Remote Group intervention for adults with attention deficit hyperactivity disorder: A feasibility study","authors":"Shoval Galili-Simhon, Adina Maeir","doi":"10.1177/03080226231177842","DOIUrl":"https://doi.org/10.1177/03080226231177842","url":null,"abstract":"Introduction: Attention deficit hyperactivity disorder among adults has been associated with deficits in executive functioning and poor quality of life. The purpose of this study is to examine feasibility of the Cognitive Functional Remote Group intervention among adults with attention deficit hyperactivity disorder. Method: Mixed-method feasibility study. Five adults with attention deficit hyperactivity disorder received 16 weekly sessions of Cognitive Functional Remote Group. Results: The target population was easily recruited and showed interest in the treatment. All participants completed the intervention and were moderately-very highly satisfied with different aspects of the intervention. Additionally, pre–post measures demonstrated high rates of clinically significant improvements in the quality of life measure and less so in executive functioning. Three central themes emerged from qualitative analyses of participants experiences relating to (a) Identity development through group process; (b) Occupation-based learning of self-awareness and cognitive functional strategies and (c) Feedback on group setting and content and relating to advantages and disadvantages of remote (Zoom) format. Conclusion: This study supported Cognitive Functional Remote Group feasibility among adults with attention deficit hyperactivity disorder. Quantitative findings point to the responsiveness of quality-of-life measures. Qualitative findings suggest gains in identity development, awareness and acquisition of cognitive functional strategies through occupation-based learning in a telerehabilitation group therapy format. Further controlled studies are warranted.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"686 - 696"},"PeriodicalIF":1.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43981655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.1177/03080226231176412
Young Joo Kim, Carley Overman, Brooke Davis, Kimberly Fitzgerald, Samantha McLawhorn
Introduction: The effectiveness of inpatient rehabilitation services has been well supported. However, patients receiving inpatient rehabilitation may be physically inactive outside of therapy. The primary objectives were to determine differences in activity levels between rehabilitation time and non-rehabilitation time and rehabilitation day and non-rehabilitation day during inpatient rehabilitation stay. The secondary objective was to determine differences among rehabilitation services. Methods: In all, 50 participants wore an ActiGraph GT9X Link on their non-dominant wrist during their inpatient rehabilitation stay. Results: We found significant differences in total activity counts between rehabilitation time and non-rehabilitation time (z = 6.15, p < 0.001) and between rehabilitation day and non-rehabilitation day (z = 5.82, p < 0.001). We found significant differences in total activity counts between occupational therapy and physical therapy (z = 5.71, p < 0.001), occupational therapy and speech-language pathology (z = 3.41, p < 0.001), and physical therapy and speech-language pathology (z = 3.07, p = 0.002). The degrees of all differences were large. Conclusion: To increase the activity levels during non-rehabilitation times and days, patients receiving inpatient rehabilitation may benefit from strategies which increase activity levels such as an individualized program that can be safely and independently performed outside of rehabilitation sessions.
住院康复服务的有效性得到了很好的支持。然而，接受住院康复的患者可能在治疗之外缺乏身体活动。主要目的是确定康复时间与非康复时间、康复日与非康复日在住院康复期间活动水平的差异。次要目标是确定康复服务之间的差异。方法:总共有50名参与者在住院康复期间在他们的非优势手腕上佩戴了ActiGraph GT9X Link。结果:康复时间与非康复时间、康复日与非康复日的总活动计数差异有统计学意义(z = 6.15, p < 0.001);我们发现，在职业治疗和物理治疗(z = 5.71, p < 0.001)、职业治疗和言语语言病理学(z = 3.41, p < 0.001)、物理治疗和言语语言病理学(z = 3.07, p = 0.002)之间，总活动计数存在显著差异。所有差异的程度都很大。结论:为了增加非康复时间和天数的活动水平，接受住院康复的患者可能会受益于增加活动水平的策略，例如可以在康复课程之外安全独立地进行的个性化计划。
{"title":"Inpatient rehabilitation patients are more active during rehabilitation times and days than non-rehabilitation times and days: An observational study","authors":"Young Joo Kim, Carley Overman, Brooke Davis, Kimberly Fitzgerald, Samantha McLawhorn","doi":"10.1177/03080226231176412","DOIUrl":"https://doi.org/10.1177/03080226231176412","url":null,"abstract":"Introduction: The effectiveness of inpatient rehabilitation services has been well supported. However, patients receiving inpatient rehabilitation may be physically inactive outside of therapy. The primary objectives were to determine differences in activity levels between rehabilitation time and non-rehabilitation time and rehabilitation day and non-rehabilitation day during inpatient rehabilitation stay. The secondary objective was to determine differences among rehabilitation services. Methods: In all, 50 participants wore an ActiGraph GT9X Link on their non-dominant wrist during their inpatient rehabilitation stay. Results: We found significant differences in total activity counts between rehabilitation time and non-rehabilitation time (z = 6.15, p < 0.001) and between rehabilitation day and non-rehabilitation day (z = 5.82, p < 0.001). We found significant differences in total activity counts between occupational therapy and physical therapy (z = 5.71, p < 0.001), occupational therapy and speech-language pathology (z = 3.41, p < 0.001), and physical therapy and speech-language pathology (z = 3.07, p = 0.002). The degrees of all differences were large. Conclusion: To increase the activity levels during non-rehabilitation times and days, patients receiving inpatient rehabilitation may benefit from strategies which increase activity levels such as an individualized program that can be safely and independently performed outside of rehabilitation sessions.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"697 - 704"},"PeriodicalIF":1.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43334926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.1177/03080226231172628
E. Duncan
In 2021, The Royal College of Occupational Therapists and the James Lind Alliance released their top ten research priorities for occupational therapy (Watson et al., 2021). Their fourth priority highlighted an important and under-researched question: what are the long-term effects of occupational therapy interventions? Despite occupational therapy research developing exponentially over the last 20 years, surprisingly little research has been undertaken to investigate the longterm benefits of many occupational therapy interventions. In our current economically challenging health landscape, consideration needs to be given to de-implementing interventions that do not demonstrate a sustained difference in people’s lives. Therefore, now more than ever, evaluating the long-term benefits of new and established occupational therapy interventions is crucial to understand their impact on people’s quality of life over time. Conducting high-quality long-term follow-up intervention studies is challenging (Signorell et al., 2022; Wilcox and Ely, 2019). Higher levels of research funding are required to follow up participants over a longer period of time. Participant attrition is considerable in any long-term outcome study as people often drop out of long-term studies and are lost to follow-up. This in turn can lead to smaller sample sizes, diminished returns, limiting and potentially biasing study findings. Strategies to reduce study attrition, such as clear communication of expectations, study incentives such as gift cards, cash or other rewards, personalised communication and follow-up of participants, positive reinforcement and collaboration with participants in the study design have all been shown to help reduce study attrition (Gillies et al., 2021) and should be employed in long-term effectiveness studies. Measuring outcomes over a long period of time can be difficult, as some outcomes change gradually, while others may change rapidly. Finally, long-term data management can become increasingly complex and it can be challenging to ensure that data are collected, stored, and analysed correctly. Many of these challenges can be overcome with advice from clinical trial units and experienced methodologists, who are essential collaborators in any study of this nature. However, preceding all of these challenges is a more theoretical question that should be answered by all occupational therapists who are designing or implementing an intervention: How will this intervention produce the sustained outcomes it aims to? Meaningfully answering this question will enable occupational therapists to articulate how they understand their interventions work, support research funding applications to measure the intervention’s impact, and guide the intervention’s long-term evaluation. Not all occupational therapists are required to understand the methodological challenges of studying the long-term effects of occupational therapy interventions. However, all occupational therapist
2021年，皇家职业治疗师学院和詹姆斯·林德联盟发布了职业治疗的十大研究重点(Watson et al.， 2021)。他们的第四个优先事项强调了一个重要但研究不足的问题:职业治疗干预的长期影响是什么?尽管职业治疗研究在过去20年里呈指数增长，但令人惊讶的是，很少有研究对许多职业治疗干预措施的长期效益进行调查。在我们目前经济上具有挑战性的卫生状况下，需要考虑取消那些不能证明对人们的生活产生持续影响的干预措施。因此，现在比以往任何时候都更需要评估新的和已建立的职业治疗干预措施的长期效益，以了解它们对人们生活质量的影响。开展高质量的长期随访干预研究具有挑战性(Signorell等人，2022;Wilcox and Ely, 2019)。为了对参与者进行更长时间的随访，需要更高水平的研究经费。参与者流失在任何长期结果研究中都是相当大的，因为人们经常退出长期研究并失去随访。这反过来又会导致样本量减少，收益减少，研究结果受到限制并可能存在偏差。减少研究损耗的策略，如明确传达期望、研究激励(如礼品卡、现金或其他奖励)、参与者的个性化沟通和随访、在研究设计中与参与者的积极强化和合作，都被证明有助于减少研究损耗(Gillies et al.， 2021)，应该在长期有效性研究中采用。衡量长期的结果可能很困难，因为有些结果会逐渐改变，而另一些可能会迅速改变。最后，长期数据管理可能会变得越来越复杂，确保正确收集、存储和分析数据可能具有挑战性。在临床试验单位和经验丰富的方法学家的建议下，许多这些挑战都可以克服，他们是任何此类研究的重要合作者。然而，在所有这些挑战之前，有一个更理论化的问题，应该由所有设计或实施干预的职业治疗师来回答:这种干预将如何产生其目标的持续结果?有意义地回答这个问题将使职业治疗师能够阐明他们如何理解他们的干预工作，支持研究基金申请来衡量干预的影响，并指导干预的长期评估。并非所有的职业治疗师都需要了解研究职业治疗干预的长期影响的方法学挑战。然而，所有的职业治疗师都应该能够清晰地表达出他们如何相信他们的干预将达到他们设想的长期结果的理论。考虑到研究职业治疗干预的长期影响的挑战，仔细考虑特定的干预是否值得这样的研究是很重要的。确定你的研究问题是重要的(Taylor et al.， 2023)，重要的下一步是阐明你如何相信职业治疗干预将实现其预期结果。最新版本的“复杂干预措施的发展和评估框架”提出了一种逻辑模型的发展，作为一种有效的方式来沟通干预措施是如何被认为是有效的(Skivington等人，2021)。逻辑模型最简单的是线性路径，它提供了干预的关键阶段的可视化表示，包括输入(提供干预需要什么)、活动(在干预期间你做了什么)、输出(结果发生了什么)和结果(干预的即时、中期和长期影响是什么)。逻辑模型提供了一个清晰的模型，说明干预措施是如何起作用的，它提供了一系列简化的“如果-那么”关系，表明是时候衡量职业治疗干预措施的长期效果了
{"title":"It’s time to measure the long-term effects of occupational therapy interventions","authors":"E. Duncan","doi":"10.1177/03080226231172628","DOIUrl":"https://doi.org/10.1177/03080226231172628","url":null,"abstract":"In 2021, The Royal College of Occupational Therapists and the James Lind Alliance released their top ten research priorities for occupational therapy (Watson et al., 2021). Their fourth priority highlighted an important and under-researched question: what are the long-term effects of occupational therapy interventions? Despite occupational therapy research developing exponentially over the last 20 years, surprisingly little research has been undertaken to investigate the longterm benefits of many occupational therapy interventions. In our current economically challenging health landscape, consideration needs to be given to de-implementing interventions that do not demonstrate a sustained difference in people’s lives. Therefore, now more than ever, evaluating the long-term benefits of new and established occupational therapy interventions is crucial to understand their impact on people’s quality of life over time. Conducting high-quality long-term follow-up intervention studies is challenging (Signorell et al., 2022; Wilcox and Ely, 2019). Higher levels of research funding are required to follow up participants over a longer period of time. Participant attrition is considerable in any long-term outcome study as people often drop out of long-term studies and are lost to follow-up. This in turn can lead to smaller sample sizes, diminished returns, limiting and potentially biasing study findings. Strategies to reduce study attrition, such as clear communication of expectations, study incentives such as gift cards, cash or other rewards, personalised communication and follow-up of participants, positive reinforcement and collaboration with participants in the study design have all been shown to help reduce study attrition (Gillies et al., 2021) and should be employed in long-term effectiveness studies. Measuring outcomes over a long period of time can be difficult, as some outcomes change gradually, while others may change rapidly. Finally, long-term data management can become increasingly complex and it can be challenging to ensure that data are collected, stored, and analysed correctly. Many of these challenges can be overcome with advice from clinical trial units and experienced methodologists, who are essential collaborators in any study of this nature. However, preceding all of these challenges is a more theoretical question that should be answered by all occupational therapists who are designing or implementing an intervention: How will this intervention produce the sustained outcomes it aims to? Meaningfully answering this question will enable occupational therapists to articulate how they understand their interventions work, support research funding applications to measure the intervention’s impact, and guide the intervention’s long-term evaluation. Not all occupational therapists are required to understand the methodological challenges of studying the long-term effects of occupational therapy interventions. However, all occupational therapist","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"465 - 466"},"PeriodicalIF":1.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43052736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-29DOI: 10.1177/03080226231178109
Jennifer Stadden, A. Morrissey
More than 100,000 strokes occur in the United Kingdom (UK) each year (Stroke Association, 2023). Decreasing stroke mortality rates have resulted in more people living with long-term disabilities, with approximately 50% of survivors demonstrating neurocognitive difficulties (Barbay et al., 2018). Cognitive impairment in the acute phase post stroke has been shown to impact participation in rehabilitation and increase the risk of poorer functional outcomes (D’Souza et al., 2021). Initial cognitive assessments play an important role in informing clinical reasoning for a person’s onward rehabilitation and care decisions; if an upward trajectory of improvement is demonstrated at an impairment and/or functional level, this further supports the need for referrals to inpatient specialist rehabilitation. Therefore, measuring their cognitive baseline following a stroke is pertinent to inform clinical decisions for professionals as well as advocate for patients where onward specialist rehabilitation is required to optimise their recovery. Completing cognitive assessment in the acute phase post stroke is recommended within national stroke guidelines (Intercollegiate Stroke Working Party, 2023) and these are routinely completed by occupational therapists (OTs) (Manee et al., 2020). For individuals with severe cognitive impairment following a stroke, they are highly unlikely to be able to engage in standardised assessments (Elliott et al., 2019), and functional cognitive assessments are recommended (Intercollegiate Stroke Working Party, 2023). OTs hold unique expertise in understanding occupation and the environmental impact on function. Through the utilisation of these specialist skills, we provide a vital contribution to cognitive assessments. Not only this, but we are skilled in implementing cognitive assessment results to support participation, choice and engagement in meaningful occupations. It is now time that our profession stands confident in our ability to be leaders in the field of assessment of individuals with severe cognitive impairments and drive change to improve consistency and quality of care. We completed a systematic review of OTs’ cognitive assessment practices in the acute stroke setting for individuals with severe cognitive impairment. Five academic databases (MEDLINE, CINAHL, PsychINFO, AMED and Embase) were searched and no study was found that explicitly looked at assessment practices for severe cognitive impairment post stroke. Four related studies (Geraghty et al., 2019; Koh et al., 2009; Korner-Bitensky et al., 2011; Pilegaard et al., 2014) focused on the assessment of individuals with mild cognitive impairment post stroke and participants were predominantly experienced OTs, with 5–10 years of stroke experience. These studies found that while OTs preferred using functional cognitive assessments, because they are client centred and meaningful to the patient (Koh et al., 2009), there was a wide variability in their content (Pilegaard et
英国每年发生的中风超过100000例（中风协会，2023年）。中风死亡率的下降导致更多的人长期残疾，约50%的幸存者表现出神经认知困难（Barbay等人，2018）。中风后急性期的认知障碍已被证明会影响康复参与，并增加功能较差的风险（D’Souza等人，2021）。初始认知评估在为一个人的后续康复和护理决策提供临床推理方面发挥着重要作用；如果在损伤和/或功能水平上表现出改善的上升轨迹，这进一步支持了转诊到住院专科康复的需求。因此，测量他们在中风后的认知基线有助于为专业人员的临床决策提供信息，并为需要继续进行专业康复以优化康复的患者提供支持。建议在国家中风指南中完成中风后急性期的认知评估（校际中风工作组，2023），这些评估由职业治疗师（OT）定期完成（Manee等人，2020）。对于中风后有严重认知障碍的人，他们极不可能进行标准化评估（Elliott et al.，2019），建议进行功能性认知评估（校际中风工作组，2023）。OT在理解职业和环境对功能的影响方面拥有独特的专业知识。通过利用这些专业技能，我们为认知评估做出了至关重要的贡献。不仅如此，我们还善于实施认知评估结果，以支持参与、选择和参与有意义的职业。现在是时候让我们的专业人士相信我们有能力成为严重认知障碍患者评估领域的领导者，并推动变革以提高护理的一致性和质量了。我们完成了对OT在严重认知障碍患者急性中风环境中的认知评估实践的系统回顾。检索了五个学术数据库（MEDLINE、CINAHL、PsychINFO、AMED和Embase），没有发现明确关注卒中后严重认知障碍评估实践的研究。四项相关研究（Geraghty等人，2019；Koh等人，2009年；Korner-Bitensky等人，2011年；Pilegaard等人，2014）专注于评估中风后轻度认知障碍的个体，参与者主要是有5–10年中风经验的OTs。这些研究发现，虽然OT更喜欢使用功能性认知评估，因为它们以客户为中心，对患者有意义（Koh et al.，2009），但其内容存在很大差异（Pilegaard et al.，2014）。功能评估的内容主要是根据他们过去的经验和同事的建议制定的，而不是根据研究制定的（Holmqvist等人，2009；Koh等人，2009年）。
{"title":"Turning the spotlight on assessment of severe cognitive impairment: Reducing disparity and inequality in stroke care","authors":"Jennifer Stadden, A. Morrissey","doi":"10.1177/03080226231178109","DOIUrl":"https://doi.org/10.1177/03080226231178109","url":null,"abstract":"More than 100,000 strokes occur in the United Kingdom (UK) each year (Stroke Association, 2023). Decreasing stroke mortality rates have resulted in more people living with long-term disabilities, with approximately 50% of survivors demonstrating neurocognitive difficulties (Barbay et al., 2018). Cognitive impairment in the acute phase post stroke has been shown to impact participation in rehabilitation and increase the risk of poorer functional outcomes (D’Souza et al., 2021). Initial cognitive assessments play an important role in informing clinical reasoning for a person’s onward rehabilitation and care decisions; if an upward trajectory of improvement is demonstrated at an impairment and/or functional level, this further supports the need for referrals to inpatient specialist rehabilitation. Therefore, measuring their cognitive baseline following a stroke is pertinent to inform clinical decisions for professionals as well as advocate for patients where onward specialist rehabilitation is required to optimise their recovery. Completing cognitive assessment in the acute phase post stroke is recommended within national stroke guidelines (Intercollegiate Stroke Working Party, 2023) and these are routinely completed by occupational therapists (OTs) (Manee et al., 2020). For individuals with severe cognitive impairment following a stroke, they are highly unlikely to be able to engage in standardised assessments (Elliott et al., 2019), and functional cognitive assessments are recommended (Intercollegiate Stroke Working Party, 2023). OTs hold unique expertise in understanding occupation and the environmental impact on function. Through the utilisation of these specialist skills, we provide a vital contribution to cognitive assessments. Not only this, but we are skilled in implementing cognitive assessment results to support participation, choice and engagement in meaningful occupations. It is now time that our profession stands confident in our ability to be leaders in the field of assessment of individuals with severe cognitive impairments and drive change to improve consistency and quality of care. We completed a systematic review of OTs’ cognitive assessment practices in the acute stroke setting for individuals with severe cognitive impairment. Five academic databases (MEDLINE, CINAHL, PsychINFO, AMED and Embase) were searched and no study was found that explicitly looked at assessment practices for severe cognitive impairment post stroke. Four related studies (Geraghty et al., 2019; Koh et al., 2009; Korner-Bitensky et al., 2011; Pilegaard et al., 2014) focused on the assessment of individuals with mild cognitive impairment post stroke and participants were predominantly experienced OTs, with 5–10 years of stroke experience. These studies found that while OTs preferred using functional cognitive assessments, because they are client centred and meaningful to the patient (Koh et al., 2009), there was a wide variability in their content (Pilegaard et","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":"86 1","pages":"529 - 530"},"PeriodicalIF":1.3,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47937426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-22DOI: 10.1177/03080226231176413
Ertan Şahinoğlu, Serkan Bakırhan, N. Elibol, B. Ünver, V. Karatosun
No study has been performed to compare patients’ pre- and post-operative knee disability, functional status, and length of hospital stay after surgery between patients with and without using a walking aid. One-hundred forty-five patients were enrolled and divided into four groups based on whether they used any walking aids before surgery: no walking aid, one cane, one elbow crutch, and two elbow crutches. The groups were compared for knee disability (Hospital for Special Surgery (HSS) knee score), functional status (Iowa Level of Assistance Scale (ILAS)), and length of hospital stay. For the pre-operative HSS knee scores, no statistically significant differences were found between the groups ( p > 0.05). For the pre-operative ILAS scores, the patients without using walking aids had better functional status than those using any walking aids ( p < 0.05). For the post-operative outcomes, no statistically significant differences were found between the groups in the HSS knee and the ILAS scores and length of hospital stay after surgery. In this population, using any walking aids before surgery is related to worse pre-operative functional status but not to the pre-operative knee disability. Furthermore, it is not related to the short-term outcomes after surgery.
{"title":"The use of a walking aid before surgery is not related to worse short-term outcomes after simultaneous bilateral total knee arthroplasty","authors":"Ertan Şahinoğlu, Serkan Bakırhan, N. Elibol, B. Ünver, V. Karatosun","doi":"10.1177/03080226231176413","DOIUrl":"https://doi.org/10.1177/03080226231176413","url":null,"abstract":"No study has been performed to compare patients’ pre- and post-operative knee disability, functional status, and length of hospital stay after surgery between patients with and without using a walking aid. One-hundred forty-five patients were enrolled and divided into four groups based on whether they used any walking aids before surgery: no walking aid, one cane, one elbow crutch, and two elbow crutches. The groups were compared for knee disability (Hospital for Special Surgery (HSS) knee score), functional status (Iowa Level of Assistance Scale (ILAS)), and length of hospital stay. For the pre-operative HSS knee scores, no statistically significant differences were found between the groups ( p > 0.05). For the pre-operative ILAS scores, the patients without using walking aids had better functional status than those using any walking aids ( p < 0.05). For the post-operative outcomes, no statistically significant differences were found between the groups in the HSS knee and the ILAS scores and length of hospital stay after surgery. In this population, using any walking aids before surgery is related to worse pre-operative functional status but not to the pre-operative knee disability. Furthermore, it is not related to the short-term outcomes after surgery.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44652394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-19DOI: 10.1177/03080226231168008
Jan Eichler, Karen M. Keptner
Increasing rates of anxiety and depression, higher numbers of students with diverse needs, and a decrease in life skill readiness at the point of transition to higher education settings has led institutions around the world to consider novel approaches to improving student retention and success. Occupational therapists, trained in physical, mental, and psychological impacts on function, can address barriers to student success in higher education environments/institutions, especially for students not responding to available campus programs and resources. However, there are no commonly defined roles, training qualifications, or practice guidelines that guide the work of occupational therapy (OT) practitioners in higher education settings. To create a standardized model of OT services on a higher education campus, a more detailed practice area description is needed. This mixed methods study describes a group ( N = 58) of globally practicing OT professionals on post-secondary campuses through a detailed census of practice. OT professionals articulated their roles and experiences on campus along with their beliefs about successful OT practice. The results of the census provide a path toward the design and implementation of OT services on higher education campuses at the individual, faculty/staff, and institutional levels. Further implications for practice and research are discussed.
{"title":"Defining occupational therapy practice for students in higher education: A census from practitioners","authors":"Jan Eichler, Karen M. Keptner","doi":"10.1177/03080226231168008","DOIUrl":"https://doi.org/10.1177/03080226231168008","url":null,"abstract":"Increasing rates of anxiety and depression, higher numbers of students with diverse needs, and a decrease in life skill readiness at the point of transition to higher education settings has led institutions around the world to consider novel approaches to improving student retention and success. Occupational therapists, trained in physical, mental, and psychological impacts on function, can address barriers to student success in higher education environments/institutions, especially for students not responding to available campus programs and resources. However, there are no commonly defined roles, training qualifications, or practice guidelines that guide the work of occupational therapy (OT) practitioners in higher education settings. To create a standardized model of OT services on a higher education campus, a more detailed practice area description is needed. This mixed methods study describes a group ( N = 58) of globally practicing OT professionals on post-secondary campuses through a detailed census of practice. OT professionals articulated their roles and experiences on campus along with their beliefs about successful OT practice. The results of the census provide a path toward the design and implementation of OT services on higher education campuses at the individual, faculty/staff, and institutional levels. Further implications for practice and research are discussed.","PeriodicalId":49096,"journal":{"name":"British Journal of Occupational Therapy","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49428106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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