Maternal perceptions of supervision in preschool-aged children: a qualitative approach to understanding differences between families living in affluent and disadvantaged areas

Aim: To explore maternal perceptions of supervision and childhood unintentional injury in order to develop understanding and explanation for differences in unintentional injury rates between an advantaged and disadvantaged area. Background: Unintentional injury is the second cause of mortality and a significant cause of morbidity in the zero to four year age group. Children living in socio economic disadvantage are at a greater risk of unintentional injury than their more affluent counter-parts. Methods: Qualitative study using semi-structured interviews; content data analysis was undertaken. Participants included 37 mothers with a child aged less than five years; 16 living in an area of disadvantage (and high rate of childhood unintentional injury) and 21= living in an advantaged area (and low rate of childhood unintentional injury). Findings: Parents in both areas described the importance of parental supervision in reducing child unintentional injury risks. Parents in both areas used listening as a supervision strategy. Parents in both areas described how ‘when the child goes quiet’ that is a cue for them to make a visual check on the child. Listening was used more for boys than girls in both areas, but parents in the advantaged area used listening as a supervision strategy more frequently than those in the disadvantaged area. Parents described supervision strategies as being shaped by child character and age rather than child gender. Parents in both areas described similar strategies for managing distractions. An important difference was found with regard to older siblings; parents living in the advantaged area described older siblings as an injury risk to younger children. Parents in the disadvantaged area described older siblings as providing some supervision for younger children. Parents living in disadvantaged circumstances may face greater challenges with regard to supervision than parents living in advantaged circumstances and this may partly explain differences in injury risk

Developing a fatigue programme : protocol for the Nottingham Fatigue After Stroke (NotFAST2) study

Introduction: Post-stroke fatigue (PSF) is common and is one of the most distressing symptoms after stroke. It has a negative impact on physical, social and psychological functioning: it is also associated with poor outcomes and increased mortality. The effective management of PSF is therefore regarded as a clinical priority. Method: Mixed-methods design with three overlapping phases. Phase 1 will be a survey of existing fatigue management within the UK. In phase 2, interviews and focus groups will be conducted with stroke survivors with fatigue, carers and clinicians to determine strategies used to manage fatigue successfully. In phase 3, data from phases 1 and 2 will contribute to the co-design of a fatigue management programme with the [NotFAST2] study Patient and Public Involvement group. This will be further refined through subsequent focus groups which will include those with fatigue associated with other health conditions.Results: Survey data will be analysed using descriptive statistics. Interview and focus group data will be analysed using a framework approach.Conclusion: PSF requires a comprehensive management programme necessitating input from key stakeholders. A PSF programme will be developed which will be tested in a future randomised controlled trial

Using occupational therapists in vocational clinics in primary care: a feasibility study

Background: GPs are under considerable pressure providing routine care. However, they may not be the most appropriate professionals to manage getting patients back to work, and keeping them there. Objective: To test the feasibility of delivering occupational therapy-led vocational clinics (OTVoc) to provide return to work advice and support for people with musculoskeletal conditions and mental health problems, in primary care. Methods: Prospective mixed methods study in two primary care centres (eight GP surgeries). We collected anonymised service level data on all patients receiving OTVoc. Next, patient participants who met inclusion criteria and consented, undertook baseline and 3-month follow-up assessments. Interviews were also conducted to explore stakeholders’ views- GPs, Nurse Practitioners, Front Desk Staff, Occupational Therapists, patients and their employers about OTVoc- and included study eligibility, referral, experiences and attitudes to return to work. Data were analysed using descriptive statistics and thematic analysis. Results: The majority of standardized measures showed some improvement over the study period: the sickness absence rate dropped from 71 to 15% and use of GP ‘fit’ notes reduced from 76 to 6%. Interview data indicated positive attitudes to OTVoc, the use of the fit note and the Allied Health Professions Health and Work Reports (AHP H&WRs). GPs felt that OTVoc reduced their workload. Conclusion: Further research is feasible and warranted. OTVoc was positively received and stakeholders believed it was effective in getting patients back to work or preparing for their return. There was enthusiasm for extending service eligibility criteria, suggesting potential for further development and evaluation

Comparing face-to-face with online training for occupational therapists in advising on fitness for work: Protocol for the CREATE study

© The Author(s) 2020. Introduction: Occupational therapists play a key role in advising on fitness for work; however, there is a concern that they lack knowledge and confidence in using the Allied Health Professions health and work report (formerly the Allied Health Professions advisory fitness for work report), developed in the United Kingdom. Comparing a reusable learning object with face-to-face training for occupational therapists in advising on fitness for work (CREATE) compares face-to-face training with online training for occupational therapists in completing the Allied Health Professions health and work report. Method: A mixed methods study. Phase 1, occupational therapists will co-design an online training resource. A standardised face-to-face group-based training session will also be developed based on the same content. Phase 2, a feasibility study will be conducted. Thirty occupational therapists will either attend face-to-face group training or access the online resource. Data on self-reported knowledge and confidence in using the Allied Health Professions health and work report will be collected at baseline, 1 week and 8 weeks post-training. Feedback on the training will be collected by interview and, for the online resource, using an online tool. Results: Quantitative results will be predominantly analysed descriptively. If appropriate, between-group responses will be compared using the Mann–Whitney test. Qualitative findings will be analysed thematically. Conclusion: CREATE will have made a significant contribution to the debate around appropriate training methods in advising on fitness for work

Approaches used by parents to keep their children safe at home: a qualitative study to explore the perspectives of parents with children aged under five years

BACKGROUND: Childhood unintentional injury represents an important global health problem. Many unintentional injuries experienced by children aged under 5years occur within the home and are preventable. The aim of this study was to explore the approaches used by parents of children under five in order to help prevent unintentional injuries in the home and the factors which influence their use. Understanding how parents approach risk-management in the home has important implications for injury practitioners. METHODS: A multi-centre qualitative study using semi-structured interviews. A thematic approach was used to analyse the data. Sixty five parents of children aged under 5years, from four study areas were interviewed: Bristol, Newcastle, Norwich and Nottingham. RESULTS: Three main injury prevention strategies used by parents were: a) Environmental such as removal of hazards, and use of safety equipment; b) parental supervision; and c) teaching, for example, teaching children about safety and use of rules and routine. Strategies were often used in combination due to their individual limitations. Parental assessment of injury risk, use of strategy and perceived effectiveness were fluid processes dependent on a child's character, developmental age and the prior experiences of both parent and child. Some parents were more proactive in their approach to home safety while others only reacted if their child demonstrated an interest in a particular object or activity perceived as being an injury risk. CONCLUSION: Parents' injury prevention practices encompass a range of strategies that are fluid in line with the child's age and stage of development; however, parents report that they still find it challenging to decide which strategy to use and when

Recruitment and retention strategies and the examination of attrition bias in a randomised controlled trial in children’s centres serving families in disadvantaged areas of England

Background Failure to retain participants in randomised controlled trials and longitudinal studies can cause significant methodological problems. We report the recruitment and retention strategies of a randomised controlled trial to promote fire-related injury prevention in families with pre-school children attending children’s centres in disadvantaged areas in England. Methods Thirty-six children’s centres were cluster randomised into one of three arms of a 12-month fire-related injury prevention trial. Two arms delivered safety interventions and there was one control arm. Retention rates compared the numbers of participants responding to the 12-month questionnaire to the number recruited to the trial. Multivariable random effects logistic regression was used to explore factors independently associated with participant retention. Results The trial exceeded its required sample size through the use of multiple recruitment strategies. All children’s centres remained in the study, despite increased reorganisation. Parent retention was 68% at 12 months, ranging from 65% to 70% across trial arms and from 62% to 74% across trial sites. There was no significant difference in the rates of retention between trial arms (p = 0.58) or between trial sites (p = 0.16). Retention was significantly lower amongst mothers aged 16–25 years than older mothers [adjusted odds ratio (AOR) 0.57, 95% CI 0.41, 0.78], those living in non-owner occupied accommodation than in owner occupied accommodation (AOR 0.53, 95% CI 0.38, 0.73) and those living in more disadvantaged areas (most versus least disadvantaged quintiles AOR 0.50, 95% CI 0.30, 0.82). Conclusions Studies recruiting disadvantaged populations should measure and report attrition by socioeconomic factors to enable determination of the extent of attrition bias and estimation of its potential impact on findings. Where differential attrition is anticipated, consideration should be given to over-sampling during recruitment and targeted and more intensive strategies of participant retention in these sub-groups. In transient populations collection of multiple sources of contact information at recruitment and throughout the study may aid retention

Improving occupational therapists’ confidence in completing the Allied Health Professions Health and Work Report: Results from the CREATE feasibility study

Introduction: There is a concern that occupational therapists lack confidence in advising on fitness to work. The aim of this study was to compare two training methods of improving occupational therapists’ confidence in completing the Allied Health Professions Health and Work Report (AHP H&WR). Method: A mixed-methods study was conducted. Occupational therapists were recruited to face-to-face (n = 14) or online (n = 18) training. Data were collected via questionnaires at baseline, one week and eight weeks post-training, and using semi-structured telephone interviews. Questionnaire data were analysed descriptively; interviews were analysed thematically. Results: It was possible to recruit and retain participants to the study. Occupational therapists from both groups reported that the training improved their confidence in completing the AHP H&WR. However, the majority did not have the opportunity to complete an AHP H&WR in practice during the follow-up period. Conclusion: Similar results for both training methods shows promise for further development and testing. There is therefore potential to conduct a definitive study in this area

Evaluation of hip precautions following total hip replacement: a before and after study

Purpose: To evaluate the effect of hip precautions following total hip replacement (THR) by comparing outcomes of patients who received hip precautions with those who did not. Methods: Before (phase 1) and after (phase 2) study with two consecutive cohorts of patients. In phase 1, patients were strictly educated about hip precautions. In phase 2, patients were not advised about precautions but encouraged to move as able. The primary outcome was the Oxford Hip Score (measuring pain and function) at threemonths. Secondary outcomes included Oxford Hip Score, activities of daily living (ADLs) (Nottingham Extended Activities of Daily Living), sleep (Pittsburgh Sleep Quality Index), mood (Hospital Anxiety and Depression Scale), and quality of life (QoL) (EQ-5 D). Results: A total 237 participants successfully underwent THR surgery, 118 participants in phase 1 and 119 in phase 2. At threemonths postoperatively, participants had significantly equivalent Oxford Hip Scores (MD= −0.82, 95% CI: −2.64 to 1.00). No significant differences between the groups were observed at sixweeks and threemonths postoperatively for secondary outcomes. Conclusions: Patients recovered at a similar rate regardless of whether they received hip precautions or not, with no increase in complications observed. The findings lend evidence to support decision-making around the removal of precautions.Implications for rehabilitation The use of no hip precautions resulted in no additional benefit following primary total hip replacement surgery in terms of functional recovery. Patients who were not prescribed precautions had significantly less pain and greater function during the first week after surgery. Total hip replacement patients had similar outcomes at six weeks and threemonths postoperatively regardless of whether they received hip precautions or not. The study provides evidence to suggest that hip precautions may not be needed routinely following elective primary total hip replacement

Results of a UK-wide vignette study with occupational therapists to explore cognitive screening post-stroke

Background. There is a paucity of evidence in the UK regarding occupational therapy (OT) cognitive screening, and whether, and how, cognitive impairments are identified and assessed. AimsTo identify current OT practice for the assessment of cognitive problems in patients following stroke.MethodsOTs were invited to complete an online vignette study. Participants were asked to identify any presenting cognitive problems, decide whether to complete cognitive assessments and list any assessments they would use. Data were analysed using descriptive analysis.Findings Fifty-three OTs from across the UK participated. OTs identified key cognitive issues but some problems, such as apraxia and attention, were overlooked. A large number of potential assessments were suggested: the most common were the Montreal Cognitive Assessment and Oxford Cognitive Screen. Conclusion The variation found in OTs’ recognition and assessment of cognitive problems has potential to impact on management and rehabilitation in stroke services, survivor outcomes, education and research

Managing post-stroke fatigue : a qualitative study to explore multifaceted clinical perspectives

IntroductionPost-stroke fatigue (PSF) is common and debilitating. However, while its effective management is a priority for clinicians and stroke survivors, there remains little evidence to provide guidance or underpin practice. Our aim, therefore, was to gain insights into the experiences of clinicians who routinely manage patients with fatigue.MethodQualitative interview study. The target was to recruit a purposeful sample of approximately 20 participants with expertise in managing PSF and fatigue arising from other conditions. Maximum variation sampling was used to ensure a balance of participants across different settings. Data were analysed using a framework approach, iteratively developed and refined by including emergent themes.ResultsWe recruited 20 participants: nine occupational therapists (OTs), five physiotherapists, three nurses and three psychologists, which included three ‘fatigue experts’ from Europe and Australia. Analysis generated core themes around management and strategies used; these were similar regardless of professional background, clinical or geographical setting or condition treated. OTs felt a particular responsibility for fatigue management, although multidisciplinary teamwork was stressed by all.ConclusionThere are clear similarities in clinicians’ experiences of managing PSF and fatigue across different conditions and also across professional groups. Clinicians rely predominantly on their own clinical knowledge for guidance