British Journal of Occupational Therapy最新文献

Introduction: Occupational therapy roles are increasing across General Practice in primary care. The evidence base is growing; however, the best way to evaluate outcomes and the impact of practice in this setting remains unclear. Consideration for how methods used align to ambitions of value-based healthcare is also required. This study explored evaluation methods used by occupational therapists, providing services to General Practice in Wales within the context of value-based healthcare.

Method: An online focus group was conducted with 13 members of a Welsh Primary Care Occupational Therapy network. Mixed methods were used and Mentimeter results and findings from group discussion were analysed through content and framework analysis.

Results: A multifaceted but inconsistent approach to evaluation was reported. Methods used, strengthened by professional core values, broadly aligned practice to shared ambitions of value-based healthcare. The use of validated patient rated scales were most commonly used to evaluate patient experience, whilst cost-effectiveness was least well considered.

Conclusion: Further research is required to understand occupational therapy evaluation in this setting to identify what is needed by stakeholders to determine impact and establish value. This could inform care at both an individual level and across populations if consistent data are collected at scale.

Background: Goal-oriented care is prominent in primary care settings due to the rising number of people living with (multiple) chronic conditions. Before goal-oriented care can be fully implemented, a better understanding about the concept of goals needs to be gained. This study aimed to elicit in-depth knowledge through the narratives of people with (multiple) chronic conditions regarding their view on goal setting.

Method: In a qualitative research design within a phenomenological-hermeneutical paradigm, 15 in-depth interviews were performed with people living with (multiple) chronic conditions (mean age 65; 38-81) based on a homogeneous sampling strategy.

Results: This study revealed that goal setting starts from talking about everyday activities embedded in a real-life context. A well-defined goal should consist of the context, the life narrative of the patient, the engagement towards a particular goal, the reason why this goal is important in terms of underlying values, the emotions going along the activity, and the relevance for the patient. This leads to CLEVER goals.

Conclusion: These findings prompt a reconsideration of traditional goal setting in healthcare, which typically adheres to SMART. Based on the participants' experiences, goals should be defined as CLEVER first before they can be transposed into SMART goals.

Introduction: Rheumatic diseases significantly impact daily activities, emphasizing the need to understand their occupational profiles. Identifying these profiles using the Occupational Circumstances Assessment Interview and Rating Scale can aid in tailoring treatment approaches. This study aimed to evaluate the validity and reliability of the Turkish version of Occupational Circumstances Assessment Interview and Rating Scale in rheumatic diseases.

Method: The scale's internal construct validity was examined using the Rasch measurement model. Convergent validity of Turkish version of Occupational Circumstances Assessment Interview and Rating Scale was evaluated through Spearman's correlation coefficient, assessing associations with the Community Integration Questionnaire, World Health Organization Disability Assessment Schedule, Second Version and Canadian Occupational Performance Measure.

Results: Correlation analyses demonstrated a positive correlation between Turkish version of Occupational Circumstances Assessment Interview and Rating Scale Rasch-transformed scores and Canadian Occupational Performance Measure total (r = 0.208; p = 0.009), along with negative correlations with Community Integration Questionnaire (r = -0.210; p = 0.008) and World Health Organization Disability Assessment Schedule, Second Version (r = -0.539; p < 0.000).

Conclusion: Findings confirm Turkish version of Occupational Circumstances Assessment Interview and Rating Scale as a valid and reliable tool for assessing the occupational profiles of individuals with rheumatic diseases. It can guide treatment plans and help develop effective strategies to enhance daily life participation.

Background: Atypically developing children often present with a variety of sensory processing difficulties which have been proposed to reflect abnormal development of pathways integrating sensation and action. A brain system in which the process of sensorimotor integration is particularly well understood is the oculomotor system, but no studies to date have used computerised eye tracking to assess eye movements in children with sensory processing difficulties.

Method: Ten children with sensory processing difficulties completed a battery of oculomotor tasks comprising pro-saccades, anti-saccades, smooth pursuit tracking and sustained fixation. Eye movements were recorded using a high-resolution eye tracker.

Results: Compared to age-matched controls, children with sensory processing difficulties were found to make more directional errors in the anti-saccade task and less-accurate smooth pursuit and sustained fixation.

Conclusion: Consistent differences were found in oculomotor ability in children with sensory processing difficulties which are likely to impact children's ability to process and respond to visual information within home and school contexts. Further research is needed to understand the relationship between oculomotor deficits in children with sensory processing difficulties and the presence/absence of neurodevelopmental diagnoses. Eye tracking may be of value in the future for assessment and objective evaluation of interventions for sensory processing difficulties such as sensory integration therapy.

Introduction: People on chronic hemodialysis identify fatigue and its negative impact on their life participation (i.e., ability to accomplish valued daily occupations) as central to their illness experience. We explored how fatigue, as experienced by people on hemodialysis, shaped their participation in daily occupations, and participants' experiences in the Personal Energy Planning programme.

Method: This qualitative follow-up study to a pilot randomized controlled trial used an interpretive description approach with six participants who completed an energy management programme for people treated with hemodialysis in Calgary, Canada. Each participant completed one semistructured interview about their experiences with fatigue management, life participation and the programme. Data were analyzed using modified constant comparative analysis.

Findings: Participants described moving from an illness experience to one of living, where they could envision participation in both activities of daily living and social leisure occupations. Participants also described how they felt supported by the programme with its focus on applying the learning from the programme to improve their participation.

Conclusion: Fatigue has an extensive impact on various facets of life participation. For people treated with hemodialysis, the reconstruction of their occupational lives can be enabled through energy management education programmes focused on the development of personal metacognitive strategies.

Introduction: Immersive virtual reality is increasingly used to treat chronic pain. Commercial virtual reality experiences offer a way to integrate immersive virtual reality into clinical practice, but selecting appropriate virtual reality experiences for specific patient goals is challenging. We developed the Virtual Reality Activity Analysis for Pain to help occupational therapy professionals assess virtual reality experience physical, sensory, mental, and psychosocial components relevant to chronic pain treatment. This study aimed to evaluate the interrater reliability of the virtual reality activity analysis for pain instrument.

Method: Raters assessed 10 virtual reality experiences using the virtual reality activity analysis for pain instrument, which includes 30 items across physical, sensory, mental, and psychosocial categories. We conducted 40 measurements per item and compared them using inter-class correlation coefficients.

Results: The virtual reality activity analysis for pain demonstrated excellent interrater reliability (inter-class correlation coefficients = 0.91), with four out of five sections and 55% of items showing good to excellent reliability. Only 16% of items exhibited poor reliability.

Conclusion: The virtual reality activity analysis for pain is a reliable tool for analyzing virtual reality experience characteristics, with potential to standardize reviews of commercially available virtual reality experiences, aiding occupational therapy professionals to implement immersive virtual reality into chronic pain management.

Introduction: Menstruation is known to have potentially adverse impacts at multiple levels of occupational performance. However, little research has directly investigated the everyday menstruation experiences of autistic individuals, for whom menses and menarche are widely thought to be particularly occupationally disruptive.

Method: A qualitative research design was employed to address the lived experiences of menstruation among N = 6 autistic adults living in the United Kingdom. With institutional ethical approval, in-depth online interviews were conducted, yielding 34,734 words of transcript. Thematic analysis of these revealed interconnected global themes.

Findings: The global themes identified were: (1) 'Sense of self', addressing participants' sensory overload and experiences of anxiety, 'brain fog' and concern with cleanliness. (2) 'Attributional work', addressing events and contexts which were taken to trigger and/or exacerbate key problems (such as the need to use public restrooms). (3) 'Reclaiming orderliness', addressing participants' pragmatic strategies for overcoming increased unpredictability in their lives during periods.

Conclusion: Menstruation poses specific, significant challenges for autistic individuals that require autism-specific solutions. These challenges impact individuals' ability to perform occupations of self-care, productivity and leisure. As such, Occupational Therapists have a key role in the provision of support to address the impact of menstruation on occupational engagement and participation.

Introduction: In the Danish public healthcare sector, leading occupational therapists (LOTs) and physiotherapists (LPTs) hold key managerial roles. However, fewer LOTs engage in management development activities compared to LPTs, despite both needing similar tools for effective management. This study explores (1) the leadership styles of LOTs and LPTs, (2) their expectations from management practices, and (3) any discrepancies in their leadership roles.

Method: A phenomenological-hermeneutic design was used, with in-depth interviews conducted with eight LOTs and eight LPTs. A comparative analysis identified differences in their leadership practices. The interview guide was based on Danish management studies and theories of motivation and leadership identity. The data were analyzed using qualitative content analysis.

Results: Both LOTs and LPTs, with 10 years of managerial experience, are motivated by personnel management and value a modern leadership style. LOTs appear to have a stronger professional identity as occupational therapists. Minor differences were observed, with LOTs being more reserved in decision-making and seeking internal support, while LPTs were more direct and sought external guidance.

Conclusion: The study found slight discrepancies between LOTs and LPTs regarding management identity, decision-making, and support needs. LPTs may benefit from strategic management support, while LOTs could strengthen their managerial identity.

Background: The menopause transition is a significant stage of a woman's life, marking the transition from reproductive to postreproductive life. Occupational identity often shifts in response to life transitions but this has not been explored in relation to menopause. Therefore, our study aims to explore women's experiences of menopause through an occupational perspective, in relation to occupational participation and occupational identity.

Method: A descriptive qualitative design was implemented. Semistructured interviews were completed with five perimenopausal women online via Microsoft teams. Reflexive thematic analysis was employed to analyse data gathered.

Findings: The findings of this study revealed that a lack of understanding and awareness during the initial stages of menopause negatively affected women's well-being. Women faced disruptions to their engagement in meaningful occupations, which in turn, impacted their occupational competence and occupational identity. The experience of menopausal-related changes influenced women's sense of self-efficacy in engaging in occupations and roles that aligned with their occupational identity.

Conclusion: Women face significant occupational disruption during the menopause transition. Negative impacts on occupational identity and participation were evident from the participants. This study explores menopausal women's experiences from an occupational perspective and findings offer potential direction for future research.

Aim: To explore occupational therapy students' perspectives on ableism and its implications for occupational therapy practice. This formed part of a wider study that also explored occupational therapy educators' perspectives.

Method: An online survey was used to collect students' perspectives, using a mixture of Likert scales and open-ended questions.

Findings: The sample comprised 56 occupational therapy students from the United Kingdom (n = 36), United States of America (n = 16) and Canada (n = 4) enrolled in a mixture of undergraduate (n = 13) and postgraduate (n = 43) pre-registration degree programmes. Thirty-four percent of respondents perceived occupational therapy as inherently ableist. This rose to 50% after respondents were presented with a comprehensive definition of ableism. Students reported witnessing and/or experiencing ableism within education (63%) and practice placements (55%). Eighty-six percent of students recognised they may hold unconscious ableist views, and 96% agreed they would like more support to engage in disability studies.

Conclusion/impact: Findings indicated a potential link between understanding of ableism and students' views that occupational therapy is ableist. Most students were aware of the potential they hold unconscious biases and welcomed support to engage further with disability studies. Further qualitative research is needed. Following this, systemic changes to address the harm of ableism can begin to be addressed.