Introduction
Stroke survivors recovering in rural and remote locations often have little or no access to rehabilitation services. The purpose of this study was to review the literature on recovering ...in rural and remote Australia, from the perspective of stroke survivors. Use of technology to support recovery was also explored.
Methods
A systematic mixed studies review was conducted and reported according to the ENTREQ and PRISMA statements. MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, PsycINFO (ProQuest), Cochrane Library and Google Scholar were searched from inception to May 2021 for studies investigating stroke survivors' perspectives on recovering in rural or remote Australia. Qualitative, quantitative or mixed methods studies were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Studies were not excluded or weighted according to methodological quality. To review the perspectives of stroke survivors on recovering, findings of included studies were mapped to the Living My Life framework and integrated using a convergent qualitative synthesis. The review protocol was registered on PROSPERO (CRD42017064990).
Results
Eight studies met the inclusion criteria: six qualitative, one quantitative and one mixed methods. Methodological quality of the small number of studies ranged from low to high, indicating further high‐quality research is needed. Included studies involved 152 stroke survivors in total. Review findings indicated that recovering was driven by working towards what mattered to stroke survivors, in ways that matched their beliefs and preferences and that worked for them in their world, including use of technology.
Conclusion
Stroke survivors recovering in rural and remote locations want to live their life by doing what matters to them, despite the challenges they face. They want support in ways that work for them in their environment. Further research is required to tailor support for stroke survivors that is specific to their life in rural and remote locations.
Background/Aim
Occupational participation is often claimed as a human right and determinant of health by occupational science and therapy scholars. Yet, maintaining occupation at the centre of ...practice is a challenge. The Capabilities, Opportunities, Resources and Environments (CORE) approach provides a mechanism for occupational therapists to address this challenge by viewing their practice through an inclusive lens, and enacting inclusive, occupation‐centred occupational therapy. This paper presents applications of the CORE approach via three case narratives. The aim is to increase occupational therapists’ understanding of how to apply the CORE approach and to facilitate research‐to‐practice knowledge translation.
Methods
The CORE approach is introduced and applied through three case narratives, each highlighting one of the CORE elements within the context of the broader approach.
Findings
The narratives contain critical reflective case narratives on the application of the CORE approach in the context of three different practice settings in Australia based on the authors’ experiences. Practice settings include working within the National Disability Insurance Scheme, in a secure forensic mental health facility, and in rural community health. The forensic health case narrative documents findings from the authors’ research which applied the CORE approach as an analytical tool, providing an additional layer of analysis of the identified themes from the original study.
Conclusion
This paper provides occupational therapists with a practical understanding of how to apply the CORE approach through diverse case narrative examples. The practical “how to” questions that guided the development of the case narratives can be used by occupational therapists and occupational therapy students in individual or group critical reflection to support development and application of socially inclusive and occupation‐centred praxis. If occupational therapists are to claim expertise in enabling occupation and social inclusion, then using the CORE approach is vital to designing and implementing inclusive, occupation‐centred interventions.
Background/aim
Coaching has been identified as a core enablement skill of occupational therapists. Occupational therapists have begun to embrace the use of coaching as a therapeutic tool to promote ...client‐centeredness in their practice. As the use of coaching becomes more popular it is important to examine and evaluate coaching use in occupational therapy practice to clarify what is meant by coaching and inform future research and practice in this area.
Methods
An integrative literature review was conducted to examine how coaching is being used by occupational therapists, identify the similarities and differences between coaching interventions and to identify the empirical evidence for the use of coaching in occupational therapy.
Results
The literature search resulted in 24 articles describing 11 different interventions that reported use of coaching methods by occupational therapists with various populations. Similarities among interventions included goal setting, problem solving and an educational component. Differences in the directiveness of the occupational therapist were evident. The level of research evidence for individual interventions ranges from low to moderate.
Conclusions
Differences are evident in the coaching theories and methods used in occupational therapy. While evidence of effectiveness of these interventions is promising, study designs used to date are vulnerable to bias and have had small sample sizes, limiting the strength of evidence. More research using clear descriptions of the coaching approach and more robust research methods is needed to better inform clinical practice.
Introduction
To establish the responsiveness of the Danish version of the Canadian Occupational Performance Measure (COPM-DK).
Method
A cross-sectional study was performed in three Danish settings, ...including 88 clients, 40 men, aged 16–90 years, with a variety of diagnoses. To determine construct responsiveness, the mean changes of the COPM performance and satisfaction score (COPM-P/S) were compared and correlated with the mean changes in the five-item World Health Organization (WHO) Well-Being Index (WHO-5) and the EuroQol–five domains–five levels questionnaire (EQ-5D-5L). To determine the responsiveness, data were analysed with ROC curves to establish the optimal cut-point values for the COPM-DK scores. Minimal important change (MIC) was assessed in relation to anchor-based questions.
Results
The mean change for COPM-P/S was 3.1 and 3.0, respectively. Small positive correlations were found between the COPM-DK scores and the WHO-5 and EQ-5D-5L scores. The AUC were 0.76 and 0.75, respectively. The optimal cut-point values for the COPM-P/S-scores based on either all positive answers or to the two highest, were 1.2 or 4.20 (COPM-P) and 1.67 or 5.80 (COPM-S), respectively
Conclusions
The capability of the COPM to detect changes in perceived occupational performance issues is supported. We recommend an MIC on 3.5 points on both scales.
Purpose: Client-centred practice is widely considered a key element of rehabilitation. However, there is limited discussion of how it should be implemented. This study explored how client-centred ...practice was operationalized during a clinical trial of innovative goal-setting techniques. Method: This study drew on principles of co-autoethnography. The personal experiences of three clinical researchers were explored to identify insights into client-centred practice, and seek understanding of this within the broader socio-cultural context. Data were collected through group discussions and written reflections. Thematic analysis and coding were used to identify the dominant themes from the data. Results: The primary way that client-centred practice was operationalized was through listening in order to get to know, to uncover and to understand what was meaningful. Four strategies were identified: utilizing mindful listening, allowing time, supporting clients to prioritize what is meaningful and viewing the therapists' role differently. Conclusion: While technical competence in rehabilitation is important, our study suggested a starting point of 'being with' rather than 'doing to' may be beneficial for engaging people in their rehabilitation. We have highlighted a number of practical strategies that can be used to facilitate more client-centred practice. These approaches are consistent with what clients report they want and need from rehabilitation services.
Implications for Rehabilitation
At face value, clinical practice may appear to be client-centred. However, critical reflection of existing practice suggests that in reality, it is not well operationalized.
Prioritizing getting to know the client, their story and what is meaningful to them appears fundamental to client-centred practice. A number of strategies may facilitate this process, including mindful listening on the part of the clinician and allowing time.
Structures and processes need to be instituted to support implementation of client-centred practice.
Autoethnography is an approach that may support clinicians' to reflect on their practice.
Background/aim
The introduction of sensory rooms within acute psychiatric settings provides a therapeutic space that promotes emotional self‐regulation and reduces distress and disruptive behaviours. ...The current research investigated the clinical benefit of a sensory room within an adolescent psychiatric unit. It examined whether guided sensory room use can reduce distress for adolescents and identified characteristics of sensory room users. Seclusion rates 12 months pre‐ and post‐sensory room introduction were compared.
Methods
The matched sample comprised 56 sensory room users and 56 sensory room non‐users, aged 12–18 years (M = 15.35, SD = 1.35). Sensory room users were administered a pre‐ and post‐measure of distress. Further demographic and clinical data were collected from hospital files and results analysed.
Results
Adolescents’ distress was reduced following sensory room use. The greatest reduction of distress was predicted by a history of aggression. Female gender was associated with sensory room use, as was the presence of an anxiety disorder. There was no significant difference in seclusion rates after introducing the sensory room.
Conclusions
Sensory rooms could provide occupational therapists with a valuable tool for reducing distress for adolescents in psychiatric units, especially for those with a history of aggression. Results suggested that female adolescents or adolescents with anxiety disorders may be particularly receptive to using the sensory room. This research provides evidence that can inform occupational therapists when tailoring therapeutic treatment strategies and guide the development of prevention and management of emotional dysregulation and aggression within adolescent psychiatric settings.
Appropriate care delivery for patients with severe mental illness (SMI) requires a high level of collaboration quality between primary, mental health, and social care services. Few studies have ...addressed the interpersonal and inter-organizational components of collaboration within one unique study setting and it is unclear how these components contribute to overall collaboration quality. Using a comprehensive model that includes ten key indicators of collaboration in relation to both components, we evaluated how interpersonal and inter-organizational collaboration quality were associated in 19 networks that included 994 services across Belgium. Interpersonal collaboration was significantly higher than inter-organizational collaboration. Despite the internal consistency of the model, analysis showed that respondents perceived a conflict between client-centered care and leadership in the network. Our results reveal two approaches to collaborative service networks, one relying on interpersonal interactions and driven by client needs and another based on formalization and driven by governance procedures. The results reflect a lack of strategy on the part of network leaders for supporting client-centered care and hence, the persistence of the high level of fragmentation that networks were expected to address. Policy-makers should pay more attention to network formalization and governance mechanisms with a view to achieving effective client-centered outcomes.
This study explored the impact of an Australian regional university's Clients-as-Tutors Program (CTP) on speech-language pathology students' perception and understanding of client-centred practice.
...Two focus group interviews comprising three final-year students and four newly graduated speech-language pathologists who had completed the CTP. An inductive thematic analysis was undertaken to identify salient themes.
Three themes were identified: (a) learning from theory, (b) learning from others, and (c) learning from yourself. These themes represented all participants' experiences in the CTP, yet there were unique, individual journeys that each participant experienced.
Findings from this study have the capacity to affect change in how client-centred practice is taught at universities across speech-language pathology and other health courses, to disrupt the traditional power structure between client and clinician, and to provide an evidence base for the role of experiential learning in this area.
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