The importance of maintaining a focus on performance components in occupational therapy practice

Some authors have promoted the need for occupational therapists to prioritise occupation over performance components in their clinical work (Fisher 1992, Mathiowetz 1993, Trombly 1995, Baum and Law 1997, Fortune 2000, Molineux 2004). Nevertheless, there is a strong case to be made for maintaining concurrently a focus on performance components. This case is based on a review of relevant literature, which yielded three ways in which performance component functioning could be used to enhance a person's experience of occupational therapy. It is concluded that there is a sound rationale for maintaining a dual focus on occupational performance and performance components in occupational therapy practice

A description of a functional screening assessment developed for the acute physical setting

This article provides a description of the development, process and introduction of the Structured Anchored Approach to Functional Assessment (SAAFA).1 The approach was designed to include a person-centred and time-efficient occupational therapy functional screening assessment that would meet the needs of patients and be appropriate for use in an acute physical inpatient setting. SAAFA assessments were developed to incorporate the strengths of both quantitative and qualitative occupational therapy assessments and research methods. Taken in the round, SAAFA assessments follow a process that corresponds with the four processes of qualitative research: data gathering, analysis, interpretation and reflexivity (Miller and Crabtree 2003). The SAAFA is a dynamic approach that continues to evolve in response to developments in theory and practice. Information from occupational therapists' reports of their day-to-day practice indicate that SAAFA assessments reflect the complexity of individual patients' functioning and lead to the development of recommendations based on pragmatic consideration of a wide range of contextual influences. Research on the SAAFA commenced in 2002

The lived experience of diabetes: conceptualisation using a metaphor

Introduction: It is important for healthcare professionals to understand the reality of living with diabetes in order to better engage and enable people to self-manage. The purpose of this research was thus a preliminary exploration of the lived experience of diabetes. Method: This qualitative study involved seven people with a diagnosis of type 1, type 2 or pre-diabetes. Data was collected via semi-structured interviews and analysed using a phenomenological approach including the use of metaphor. Findings were shared with participants using a felted metaphor of charting a course of health and wellbeing through a choppy sea. Findings: Themes explored within the elements of the metaphor included the boat (self-identity, control, balance, compliance and empowerment, emotions), the sea (physical and social environment, lifestyle, life events), the course (information gathering, change, self-action) and the boatyard (relationships with healthcare providers). Conclusion: For those with type 1, type 2 and pre-diabetes, the elements of charting a course of health and wellbeing through a choppy sea are very much focused on the person in their own context, impacted by their environment, life stage, occupations and attitudes to diabetes self-management, all of which fall within the remit of occupational therapy

Family-carers’ perspectives of involvement in stroke rehabilitation of a family member

Stroke has the potential to have a major impact on health and quality of life (Stroke Association, 2012). Occupational therapy supports people to participate in meaningful occupations and return home post stroke (Edmans, 2010). Since the target of 45 minutes of rehabilitation on five days out of seven was recommended (Kwakkel et al, 1997), creative ways to help meet this target have been explored and promoted. Family involvement in rehabilitation has been identified as one option for extending rehabilitation opportunities (Stroke Association, 2012). On return to home following inpatient rehabilitation, many people receive informal care from family members (Kniepmann, 2012). The purpose of this small-scale, qualitative study was to explore the nature of carers’ participation in their family members’ rehabilitation, carers level of involvement, and the support and preparation families felt they needed. Family carers were recruited to the study via a voluntary organisation for people post stroke. Semi-structured interviews were used to explore participants’ perspectives. Data analysis was conducted using thematic analysis. Ethical approval was gained from the University of Cumbria and permission granted by the charity. The study was self-funded by the researcher. Four family carers participated in the study. Six key themes were identified: Carer involvement, Satisfaction with involvement, Desired level of involvement, Working hours, Carer role, and Information and support. These findings highlight the challenges raised and additional support required by carers. These findings could assist decision-making regarding the involvement of carers and the development of strategies to aid their participation. Such investment could enable and support family carers in making a valuable contribution to their family members’ rehabilitation and to the achievement of the NICE rehabilitation intensity targets, both in in-patient units and on return to home. Edmans, J. (2010). Occupational therapy and Stroke. Hoboken: Wiley-Blackwell. Kniepmann, K. (2012). Female family carers for survivors of stroke: occupational loss and quality of life. British Journal of Occupational Therapy, Vol 75(5), p.p. 208–216. Kwakkel, G., Wagenaar, R. C., Koelman, T. W., Lankhorst, G. J., & Koetsier, J. C. (1997). Effects of Intensity of Rehabilitation After Stroke. Stroke, Vol(28), pp. 1550–1556. Stroke Association. (2012, Spring). Struggling to Recover. from Stroke Association: Available at: http://www.stroke.org.uk/sites/ default/files/files/StrugglingRptFIN%20lowres.pdf (Accessed: September 10, 2013)

Conceptualising diabetes self‐management as an occupation

Diabetes self management requires the ability to cope with the symptoms of diabetes, manage testing and medication, deal with psychosocial consequences and make lifestyle changes. Approaches to self management are typically medical, although occupational therapists have recently started to recognize the opportunities for the profession in understanding self-management in terms of an individual’s life context, roles and routines (Fritz 2014 Pyatak 2011 Thompson 2014). Following ethical approval from the University of Cumbria, a total of 22 participants with type 1, type 2, gestational or pre-diabetes were recruited in three separate stages to the first author’s doctoral study exploring the role of occupational therapy in diabetes self-management. Following initial analysis of digitally recorded semi-structured interviews on the lived experience of diabetes, the findings were taken as a whole to conceptualise the experience of diabetes self-management as an occupation, using the Model of Human Occupation (MOHO) (Kielhofner 2008). The presentation will discuss the occupational forms of the occupation of diabetes self-management, the impact of other occupations on diabetes self-management, and the impact of diabetes on other occupations. Using MOHO and examples from the participants, it will illustrate the interaction between occupational identity, volition, habituation and the environment on diabetes self-management. This research adds to the growing literature on an occupational therapy approach to diabetes. Understanding diabetes self management as an occupation brings a particular non-medical focus that may complement existing services and show how occupational therapy could enable improved diabetes management for those who require it

Diabetes: charting a course of health and wellbeing in the sea of life

In the UK 2.9 million people are diagnosed with diabetes and an estimated further 850,000 people may not be aware that they have this condition (Diabetes UK, 2012). The impact on health and social care costs is significant, with increased risk of further chronic complications, as well as considerable personal difficulties for the individual and their family. The aim of this study is to describe the lived experience of those with type 1, type 2 and pre-diabetes, to ascertain what helps or hinders successful self-management in relation to lifestyle. This qualitative study forms the first part of the first author’s doctoral thesis enquiring into the role of occupational therapy in meeting the demands of this health issue, to promote and drive change in approaches to prevention and self-management. Following ethical approval from the University of Cumbria, seven people with type 1, type 2 or a diagnosis of pre-diabetes were recruited using a self-selecting convenience sample. Digitally recorded unstructured interviews focussed on the lived experience of each participant and were analysed using qualitative mixed methods, including the use of creative metaphor. Findings have revealed the complex interplay between the person and their life circumstances when managing or attempting to prevent diabetes. Examples will be given of participants’ stories and their feelings about living with, or with the threat of, diabetes. The contribution of creative metaphors in analysis will also be discussed and how this shaped the next stage of the research. Diabetes is not an easy condition to control. An in-depth understanding of the pressures of living with (or with the threat of) diabetes will enable occupational therapists to take a specific occupational, rather than medical, approach to enabling people to manage successfully in the context of their particular lifestyle, and to drive change in this area. Diabetes UK (2012) Diabetes in the UK 2012. Key statistics on Diabetes. London: Diabetes UK

The power & the glory? Exploring how occupational therapists address the spirituality of children with physical disabilities

Within the United Kingdom the statutory services’ policy emphasis on daily activity and the requirement for equipment provision to enable function appears to be leading the focus of discussions between Occupational Therapists, Children and Parents away from the holistic exploration of the child’s sense of self, their occupational balance and their ambitions for the future. This led to a personal questioning of current Occupational Therapy practice culminating in the decision to conduct a PhD to explore this area further: to determine how OTs are currently addressing the spirituality of children with physical disabilities, and to determine the extent to which OTs working with children with physical disabilities feel that spirituality should or should not be a part of their professional practice. Interpretative Phenomenological Analysis was used to interpret the attitudes & perceptions of clinicians and academics with experience of working with children with physical disabilities regarding spirituality. A mix of creative workshops and individual interviews, along with reflexivity, was used to collect data which were analysed inductively. This presentation will discuss the findings of the research so far. In particular, the findings currently reveal a potentially tokenistic view of spirituality that, instead of being child centred and holistic, is in danger of generating a power imbalance between the therapist and child. This aspect will be explored further in relation to the potential for occupational deprivation for children and the collective impact Occupational Therapists may generate by further developing their understanding of the spiritual aspect of our philosophy and practice

A critical evaluation of systematic reviews assessing the effect of chronic physical activity on academic achievement, cognition and the brain in children and adolescents: A systematic review

Background. International and national committees have started to evaluate the evidence for the effects of physical activity on neurocognitive health in childhood and adolescence to inform policy. Despite an increasing body of evidence, such reports have shown mixed conclusions. We aimed to critically evaluate and synthesise the evidence for the effects of chronic physical activity on academic achievement, cognitive performance and the brain in children and adolescents in order to guide future research and inform policy. Methods. MedLine, Embase, PsycINFO, Cochrane Library, Web of Science, and ERIC electronic databases were searched from inception to February 6th, 2019. Articles were considered eligible for inclusion if they were systematic reviews with or without meta-analysis, published in peer-reviewed (English) journals. Reviews had to be on school-aged children and/or adolescents that reported on the effects of chronic physical activity or exercise interventions, with cognitive markers, academic achievement or brain markers as outcomes. Reviews were selected independently by two authors and data were extracted using a pre-designed data extraction template. The quality of reviews was assessed using AMSTAR-2 criteria. Results. Of 908 retrieved, non-duplicated articles, 19 systematic reviews met inclusion criteria. One high-quality review reported inconsistent evidence for physical activity-related effects on cognitive- and academic performance in obese or overweight children and adolescents. Eighteen (critically) low-quality reviews presented mixed favourable and null effects, with meta-analyses showing small effect sizes (0.1–0.3) and high heterogeneity. Low-quality reviews suggested physical activity-related brain changes, but lacked an interpretation of these findings. Systematic reviews varied widely in their evidence synthesis, rarely took intervention characteristics (e.g. dose), intervention fidelity or study quality into account and suspected publication bias. Reviews consistently reported that there is a lack of high-quality studies, of studies that include brain imaging outcomes, and of studies that include adolescents or are conducted in South American and African countries. Conclusions. Inconsistent evidence exists for chronic physical activity-related effects on cognitive-, academic-, and brain outcomes. The field needs to refocus its efforts towards improving study quality, transparency of reporting and dissemination, and is urged to differentiate between intervention characteristics for its findings to have a meaningful impact on policy

An evaluation of collaborative research partnerships in occupational therapy education

A lack of skills and confidence in carrying out research has been identified amongst occupational therapists (Pighills et al, 2013). The consequent predominance of university-led research threatens to exacerbate the practice-research gap (Kielhofner, 2005). This poster describes the benefits and challenges of collaborative research partnerships (Crist, 2010) for occupational therapy students, practice partners and academic supervisors. The aim of the project was to explore the benefits and challenges of the research partnerships from the perspectives of key stakeholders. Action research methodology was used. Five BSc, two MSc (pre-registration) students, six practice partners and four academic supervisors were recruited. Data was collected using questionnaire surveys and semi-structured interviews. All data were analysed thematically. Ethical and research governance approvals were gained from University of Cumbria and relevant NHS trusts respectively. The study was funded by the Higher Education Academy and the University of Cumbria. Findings identified benefits for each stakeholder group. Students emphasised increased confidence and a sense of value and purpose in contributing to future service improvements. Practice partners valued the research findings to aid reflection on working practices and potential service development. Academic supervisors described satisfaction in building enhanced research capacity through practice-based projects. Communication challenges and increased stress and workload were reported; however, these did not outweigh the benefits. Importantly, the research collaborations were perceived to contribute to service enhancements and therefore yield benefits for service-users. These findings illustrate the potential of collaborative research partnerships to build confidence and research capacity in future occupational therapists and thereby assist in reduction of the practice-research divide and support service development. Crist, P.A. (2010) Adapting Research Instruction to Support the Scholarship of Practice: Practice-Scholar Partnerships. Occupational Therapy in Health Care, 24(1), 39–55. Kielhofner, G. (2005) A scholarship of practice: Creating discourse between theory, research and practice. Occupational Therapy in Health Care, 19(1/2), 7–16. Pighills, A. C., Plummer, D., Harvey, D., Pain, T. (2013) Positioning occupational therapy as a discipline on the research continuum: Results of a cross-sectional survey of research experience. Australian Occupational Therapy Journal, 60(4), 241–251