Community occupational therapy for people with dementia and their family carers: A national survey of United Kingdom occupational therapy practice

Introduction: A national survey was conducted with United Kingdom (UK) occupational therapists to scope occupational therapy service provision for people with dementia and their family carers in the community. / Method: This was an online questionnaire with topics on occupational therapists’ roles, service provision, referral, assistive technology and assessment tools. Recruitment was through direct invitation, and promotion via occupational therapy networks, websites and newsletters. / Results: A total of 197 responded. Occupational therapy referrals most commonly came from the multidisciplinary team. Over half primarily undertook profession-specific work, with occupational therapy assessments the most common profession-specific task. Two-thirds of referrals for initial assessments were for people with mild-to-moderate dementia. A median of 2.5 hours for assessment/intervention was spent for each person with dementia. Almost two-thirds used the Model of Human Occupation Screening Tool. Most could prescribe personal activities of daily living equipment and Telecare, with few able to prescribe equipment for reminiscence or leisure. / Conclusion: This national survey increases knowledge of UK community occupational therapy practice and service provision for people with dementia and their family carers. It informs occupational therapists about national trends within this practice area, and development of the community occupational therapy intervention (COTiD-UK) as part of the Valuing Active Life in Dementia research programme

Enablers and challenges to occupational therapists’ research engagement: A qualitative study

Introduction: To develop occupational therapy’s evidence base and improve its clinical outcomes, occupational therapists must increase their research involvement. Barriers to research consumption and leadership are well documented, but those relating to delivering research interventions, less so. Yet, interventions need to be researched within practice to demonstrate their clinical effectiveness. This study aims to improve understanding of challenges and enablers experienced by occupational therapists who deliver interventions within research programmes. Method: Twenty-eight occupational therapists who participated in the Valuing Active Life in Dementia (VALID) research programme reported their experiences in five focus groups. Data were analysed thematically to identify key and subthemes. Results: Occupational therapists reported that overwhelming paperwork, use of videos, recruitment and introducing a new intervention challenged their research involvement, whereas support, protected time and a positive attitude enabled it. The impact of these challenges and enablers varied between therapists and organisations. Conclusion: Challenges and enablers to research involvement can be identified but must be addressed within individual and organisational contexts. Multifaceted collective action to minimise challenges and maximise enablers can facilitate clinicians’ involvement in research. Using this approach should enable occupational therapists to increase their research involvement, thus demonstrating the clinical effectiveness of their interventions

Making connections and promoting the profession : social media use by World Federation of Occupational Therapists member organisations

Background World Federation of Occupational Therapists (WFOT) member organisations comprise 77 national occupational therapy organisations across the world. Each national organisation interacts with its members and the public using diverse methods. Increasingly, national organisations are broadening their communication methods. Objective The objective of this study was to examine if and how occupational therapy organisations are using social media for communication, and if so, the types of concerns or barriers they experience and what role they anticipate social media might play in the near future. Methods An online survey was developed; 57 of 77 WFOT member organisations responded. Findings This study identified that WFOT national organisations are using social media, to varying degrees, with or without an individual formally assigned to manage social media. Respondents reported that they used social media to: communicate with members, promote the organisation and promote the profession. Commonly expressed needs included assistance with guidelines for ethical social media use, developing technical expertise, and recognition of limits of time and competing priorities. Recommendations arising from this research are at the global, national, local and individual levels and incorporate active dissemination and pure diffusion approaches. Taking steps to increase the use of social media could indirectly impact occupational therapy practice through enhancing organisations’ abilities to support practitioners to enhance their practice. Limitations and recommendations for further research Although 57% of WFOT member organisations returned usable responses, there may be some additional perspectives that were not captured. It would be helpful to contact non-responding organisations to explore their social media use and plans. Further research could examine how future initiatives put in place by WFOT impact social media use by member organisation

Causes of crises and appropriate interventions: the views of people with dementia, carers and healthcare professionals

The aims of this study were to identify which factors may lead to crisis for people with dementia and their carers and identify interventions these individuals believe could help in crisis. Qualitative study using focus groups to compare the perspectives of people with dementia, family carers and healthcare professionals on causes of crises and crisis interventions. To help in a crisis, people with dementia were favourable towards support from family and friends, access to mobile phones and home adaptations to reduce risks. Carers were keen on assistive technology and home adaptation. Both carers and staff valued carer training and education, care plans and well-coordinated care. Staff were the only group emphasizing more intensive interventions such as emergency home respite and extended hours services. In terms of causes of crises, people with dementia focused on risks and hazards in their home, whereas family carers emphasized carer stress and their own mental health problems. Staff, in contrast were concerned about problems with service organization and coordination leading to crises. Physical problems were less commonly identified as causes of crises but when they did occur they had a major impact. Practical interventions such as home adaptations, assistive technology, education and training for family carers, and flexible home care services were highly valued by service users and their families during times of crisis and may help prevent hospital admissions. Specialist home care was highly valued by all groups

Community Occupational Therapy in Dementia intervention for people with mild to moderate dementia and their family carers in the UK: the VALID research programme including RCT

BACKGROUND: People with dementia find it increasingly difficult to carry out daily activities (activities of daily living), and may require increasing support from family carers. Researchers in the Netherlands developed the Community Occupational Therapy in Dementia intervention, which was delivered in 10 1-hour sessions over 5 weeks to people with dementia and their family carers at home. Community Occupational Therapy in Dementia was found to be clinically effective and cost-effective. OBJECTIVES: Translate and adapt Community Occupational Therapy in Dementia to develop the Community Occupational Therapy in Dementia - the UK version intervention and training programme and to optimise its suitability for use within the UK. To estimate the clinical effectiveness and cost-effectiveness of Community Occupational Therapy in Dementia - the UK version for people with mild to moderate dementia and their family carers compared with treatment as usual. DESIGN: The development phase used mixed methods to develop Community Occupational Therapy in Dementia - the UK version: translation, expert review, and adaptation of the manual and training materials; training occupational therapists; focus groups and interviews, including occupational therapists, managers, people with dementia and family carers; consensus conference; and an online survey of occupational therapists to scope UK practice. A multicentre, two-arm, parallel-group, single-blind individually randomised pragmatic trial was preceded by an internal pilot. Pairs were randomly allocated between Community Occupational Therapy in Dementia - the UK version and treatment as usual. A cost–utility analysis, fidelity study and qualitative study were also completed. SETTING: Community services for people with dementia across England. PARTICIPANTS: People with mild to moderate dementia recruited in pairs with a family carer/supporter. INTERVENTIONS: Community Occupational Therapy in Dementia - the UK version is an activity-based, goal-setting approach for people with dementia and family carers, and is delivered at home by an occupational therapist for 10 hours over 10 weeks. Treatment as usual comprised the usual local service provision, which may or may not include standard occupational therapy. MAIN OUTCOMES MEASURES: Data were collected through interviews conducted in person with dyads at baseline and at 12 and 26 weeks post randomisation, and then over the telephone with a reduced sample of just carers at 52 and 78 weeks post randomisation. The primary outcome was the Bristol Activities of Daily Living Scale at 26 weeks. The secondary outcomes were as follows: person with dementia – cognition, activities of daily living, quality of life and mood; carer – sense of competence, quality of life and mood; all participants – social contacts, leisure activities and serious adverse events. RESULTS: The Community Occupational Therapy in Dementia manual and training materials were translated and reviewed. In total, 44 occupational therapists were trained and delivered Community Occupational Therapy in Dementia to 130 pairs. A total of 197 occupational therapists completed the survey, of whom 138 also provided qualitative data. In total, 31 people attended the consensus conference. Community Occupational Therapy in Dementia - the UK version has more flexibility than Community Occupational Therapy in Dementia in terms of content and delivery; for example, occupational therapists can use the wider range of assessment tools that are already in regular use within UK practice and the time span for delivery is 10 weeks to better meet the needs of pairs and be more feasible for services to deliver. In total, 31 occupational therapists provided Community Occupational Therapy in Dementia - the UK version within the randomised controlled trial. A total of 468 pairs were randomised (249 pairs to Community Occupational Therapy in Dementia - the UK version, 219 pairs to treatment as usual). People with dementia ranged in age from 55 to 97 years (mean 78.6 years), and family carers ranged in age from 29 to 94 years (mean 69.1 years). The majority of those with dementia (74.8%) were married; 19.2% lived alone. Most family carers (72.6%) were spouses but 22.2% were adult children. At 26 weeks, 406 (87%) pairs remained in the trial, and the Bristol Activities of Daily Living Scale total score did not differ at the 5% level when comparing groups (adjusted mean difference estimate 0.35, 95% confidence interval –0.81 to 1.51; p = 0.55). The adjusted (for baseline Bristol Activities of Daily Living Scale total score and randomised group) intracluster correlation coefficient estimate at week 26 was 0.043. There were no significant differences in secondary outcomes. At 52 and 78 weeks, there were no differences between the two groups in Bristol Activities of Daily Living Scale total score and secondary outcomes. The probability that Community Occupational Therapy in Dementia - the UK version is cost-effective at a threshold of willingness to pay per quality-adjusted life-year of £20,000 is 0.02%. In the qualitative interviews, participants reported positive benefits and outcomes. Of the 249 pairs allocated to Community Occupational Therapy in Dementia - the UK version, 227 reached the goal-setting phase, and 838 of the 920 goals set (90.8%) were fully or partially achieved. LIMITATIONS: The development phase took longer than estimated because of translation time and organisational delays in delivering the intervention. Recruitment to the randomised controlled trial took longer than expected. Fidelity overall was moderate, with variation across sites and therapists. It is possible that Community Occupational Therapy in Dementia - the UK version did not work well in the UK service model in which usual care differs from that in the Netherlands. CONCLUSIONS: This programme used a rigorous process to develop Community Occupational Therapy in Dementia - the UK version but found no statistical evidence of clinical effectiveness or cost-effectiveness compared with usual care. Qualitative findings provided positive examples of how Community Occupational Therapy in Dementia - the UK version had enabled people to live well with dementia. FUTURE WORK: Developing tools to measure more meaningful outcomes, such as goals achieved or the quantity and quality of activity participation, with less reliance on proxy data, to collect the views and experiences of people with dementia themselves. TRIAL REGISTRATION: This trial was registered as ISRCTN10748953 (WP3 and WP4). FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information

Current Practice in Occupational Therapy for COVID-19 and Post-COVID-19 Conditions

The onset of the pandemic highlighted the need for a review of rehabilitation practices to ensure coordinated, effective, and efficient services for people affected by COVID-19. This paper reports on a global survey highlighting the delivery of occupational therapy services to people with COVID-19/post-COVID-19 condition (PCC) and makes recommendations to facilitate quality service delivery for this population. An online cross-sectional descriptive survey was developed and distributed to the global occupational therapy community via member organisations and communication channels of the World Federation of Occupational Therapists to collect information for this study. The survey obtained qualitative and quantitative data from respondents who were occupational therapists or occupational therapy assistants regarding (i) demographic characteristics, (ii) work experience with persons with COVID-19 and PCC, (iii) modes of working, (iv) education and training, (iv) occupational therapy intervention provided to persons with COVID-19 and PCC, and (v) the perceived quality of the occupational therapy services provided. Findings indicate that respondents provided a range of occupational therapy interventions for people affected by COVID-19/PCC aligned with evidence-based practice guidelines. While respondents identified a strong role for occupational therapy and generally rated their services as effective, issues related to the accessibility of their services impacted quality and user satisfaction. The study highlighted the need to advocate for access to occupational therapy to facilitate engagement in desired and needed occupations for COVID-19 survivors. Other recommendations emerging from the findings include the need to develop, disseminate, and use research evidence for guiding services for people with COVID-19/PCC, create quality service standards, and ensure the availability of necessary resources and supports such as referral pathways and screening criteria, availability of staff, training, personal protective equipment, and assistive devices and technology

Relativistische und quantenfeldtheoretische Verallgemeinerungen der de Broglie-Bohm Theorie

Objectives: In the Netherlands, Graff et al. found Community Occupational Therapy in Dementia (COTiD) demonstrated benefits to people with dementia and family carers. In this study, focus groups took place with people with dementia and family carers to explore how to make COTiD relevant to the UK context. Method: Six focus groups (three with people living with dementia (n = 18) and three with family carers (n = 21)) took place. Participants were asked for their impressions of the intervention, the extent to which it could meet their needs, and what modifications were needed. Audio-recordings of the groups were transcribed and analysed. Results: Three key themes emerged covering ‘loss and living with dementia’, ‘what helped us’, and ‘consistency and continuity’. People with dementia and family carers spoke about the impact of their diagnosis on them and their family and what strategies helped. Issues such as timing, follow-up, and the importance of an early intervention in preventing crises were highlighted. There was some concern over the length of the intervention and the disruption it might cause to current schedules. Conclusion: Overall, participants were optimistic about COTiD being used in the United Kingdom if it was to be introduced in a flexible and timely manner, incorporating the needs and existing strategies of the person with dementia. These outcomes have led to changes, such as incorporating more flexibility into COTiD, being made to the intervention prior to its implementation in the United Kingdom.National Institute for Health Research (NIHR) in the UK under its Programme Grants for Applied Research scheme (RP-PG-0610-10108)2016-05-0