Diane Cox

Therapeutic videoconferencing interventions for the treatment of long-term conditions

We conducted a systematic review of literature relating to videoconferencing in therapeutic interventions for chronic conditions. Two hundred articles were reviewed in detail, 35 of which were relevant to the study. Of these, eight were randomized controlled trials (RCTs) and the remainder were service evaluations, pilot studies and case studies. Two major themes emerged, relating specifically to videoconferencing: clinical outcomes and patient satisfaction. There were 14 studies which measured clinical outcomes of interventions for chronic conditions delivered by videoconferencing. A range of evidence, including four RCTs of high quality, indicates that interventions for a variety of conditions, including psychological and physical, delivered by videoconferencing produce similar outcomes to treatment delivered in-person. Evidence suggests that levels of patient satisfaction with telerehabilitation are high and that the formation of a good therapeutic alliance is possible. Several papers reported that clinical staff showed lower levels of satisfaction in using telerehabilitation than patients. It is feasible to use videoconferencing as a means of delivering therapeutic interventions for people with chronic conditions in rural communities.

What Happened to the Time? The Relationship of Occupational Therapy to Time

Introduction: Time has a reciprocal relationship with occupation: each helps to define and give meaning to the other. This paper explores how this interconnection has been embraced within occupational therapy. Method: Literature from a variety of disciplines was critically reviewed, in order to discern how occupational therapy has engaged with the temporal dimensions of occupation since its inception and the relevance of time to current practice. Findings and discussion: Although theoretical discussions demonstrate the importance of aspects of time within occupation, there has been only limited translation of these into occupational therapy practice. Aspects of time use, tempo and temporality are discussed in relation to their application to clinical practice. As the pace of life increases and humanitys relationship with time changes, this presents the profession with both challenges and opportunities. Conclusion: Time is a vital aspect of occupation. Occupational therapists need to return to core values of time awareness, rhythm and balance, because the profession once again needs to find time.

The management of chronic fatigue syndrome in an inpatient setting: presentation of an approach and perceived outcome

This paper describes chronic fatigue syndrome (CFS) and methods of management in a National Health Service Neurological Sciences Facility. A retrospective postal survey was carried out to determine the perceived level of ability of CFS inpatients 6 months following discharge from an inpatient programme of CFS treatment and management. One hundred and ninety-nine patients were admitted into the CFS inpatient programme, aged 16–68 years and with a mean age of 39 years. A specifically designed self-report questionnaire was used to ascertain duration of fatigue, change in work pattern and current level of ability (6 months following the inpatient programme). One hundred and nine patients fulfilled the Centre for Disease Control 1994 criteria for CFS. At 6 months post-discharge, 89 (82%) patients had a perceived increase in level of ability compared with prior to their admission to hospital. The duration of symptoms appeared to affect outcome. A further controlled trial using published rating scales is currently under way to substantiate the findings.

The integration of clinical and managerial supervision: a critical literature review

The introduction of a new development review process, the Knowledge and Skills Framework (KSF), has placed a greater demand on occupational therapists within the health service to be more accountable for practice. It has been proposed that the KSF may provide a useful structure for supervision in order to ensure continual development. Therefore, this literature review looked at the appropriateness of addressing both clinical and managerial issues within the supervisory process. The results indicate that despite many professions being unsure of how best to deliver supervision, there is a common understanding that a structure combining clinical and managerial supervision, such as the KSF, may be useful. It is, however, recommended that the roles of appraiser and supervisor remain separate, because many researchers found conflict within this duality of role as having an impact upon the effectiveness of supervision. It is also recommended that further research be undertaken in order to evaluate formally the effectiveness of integrating the KSF into supervision.

Wheelchair needs for children and young people: a review

This work was commissioned by a charity, the Physical Disability and Sensory Impairment Forum, owing to local parental concerns relating to the assessment for and provision of mobility equipment. The project was set up as a preliminary investigation to consider those concerns. A literature review was carried out in order to establish current practice in the National Health Service wheelchair service in England, the role of the wheelchair in childrens mobility, the wheelchair and seating needs of children and the met and unmet need. A questionnaire was distributed to children and their parents to gain their views. The response rate was disappointingly poor and, therefore, the results are not presented. However, the full report is available from the author.

Is chronic fatigue syndrome treatable in an NHS environment

The combined approach of graded activity and cognitive behaviour therapy in the treatment and management of chronic fatigue syndrome within an inpatient NHS neurology ward is discussed. A retrospective medical audit of 28 patients indicated that 57% had an increased activity level six months following discharge. Controlled clinical studies are required to examine the benefit and effect of the combined treatment approach discussed.

Experiences of daily activity in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and their implications for rehabilitation programmes

Abstract Purpose: Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (CFS/ME), has a significant impact upon daily functioning. Most recommended treatments aim to alter activity patterns based upon assumptions of activity avoidance. However, as there is limited research on the experience of activity and occupational beliefs in people with CFS/ME, this study took a qualitative approach to understand the meaning of activity in people with this disabling condition. Method: This study applied a social constructivist grounded theory methodology. Semi-structured interviews took place with 14 participants attending a Specialist CFS/ME Service in England. Findings: The emergent themes described a premorbid state of constant action with difficulty stopping an activity once it had commenced. When this pattern was interrupted by illness, participants attempted to maintain their previous level of occupational engagement. Negative associations and emotions were described in response to the concept of doing nothing or limited activity. A recurring cycle was reported of increasing activity levels when symptoms improved, followed by post exertional symptoms. Conclusions: Consequently, participants’ beliefs about concepts of both activity and inactivity need to be considered within the application of rehabilitation programmes for CFS/ME that aim to modify activity related behaviours. Implications for Rehabilitation Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is commonly treated in the UK using activity modification. In this small qualitative study, patients expressed negative feelings and beliefs towards the concept of doing nothing and therefore sought to push their activity levels when this was available, leading to recurring cycles of symptoms and activity. Rehabilitation programmes need to consider how people with CFS/ME engaged with activity and inactivity before the condition and how this may impact upon engagement with activity-based rehabilitation programmes.

Response to the editorial by Dr Geraghty

This article is written in response to the linked editorial by Dr Geraghty about the adaptive Pacing, graded Activity and Cognitive behaviour therapy; a randomised Evaluation (PACE) trial, which we led, implemented and published. The PACE trial compared four treatments for people diagnosed with chronic fatigue syndrome. All participants in the trial received specialist medical care. The trial found that adding cognitive behaviour therapy or graded exercise therapy to specialist medical care was as safe as, and more effective than, adding adaptive pacing therapy or specialist medical care alone. Dr Geraghty has challenged these findings. In this article, we suggest that Dr Geraghty’s views are based on misunderstandings and misrepresentations of the PACE trial; these are corrected.

Perspectives of Time and Occupation: Experiences of People with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling condition that disrupts the normal rhythms and activity patterns of daily life. Although temporal dimensions such as time use, tempo and temporality have an important relationship to occupation there has been limited study of these factors within CFS/ME. This qualitative study explored how people with CFS/ME perceived the relationship between time and occupation through the experience of their illness. A social constructivist approach to grounded theory involving in-depth interviews with 14 participants, recruited through a specialist service in the UK, revealed emerging concepts of accelerating time before illness, with a focus on imminent tasks. During illness actions slowed, but contrasted with the experience for some participants of time disappearing. As participants adjusted to the condition there was a greater focus on being present and consciously slow, as a sense of control within time emerged. These findings suggest that further consideration is given to the broader aspects of time and rhythm within occupational science, evolving from the current clock time perspective to incorporate event time and resynchronisation of occupational balance.

What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise.

Background Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), in its most severe clinical presentation, can result in patients becoming housebound and bedbound so unable to access most available specialist services. This presents particular clinical risks and treatment needs for which the National Institute for Health and Care Excellence (NICE) advises specialist medical care and monitoring. The extent of National Health Service (NHS) specialist provision in England for severe CFS/ME is currently unknown. Objectives To establish the current NHS provision for patients with severe CFS/ME in England. Setting and participants All 49 English NHS specialist CFS/ME adult services in England, in 2013. Method Cross-sectional survey by email questionnaire. Primary outcome measures Adherence to NICE guidelines for severe CFS/ME. Results All 49 services replied (100%). 33% (16/49) of specialist CFS/ME services provided no service for housebound patients. 55% (27/49) services did treat patients with severe CFS/ME and their interventions followed the NICE guidelines. The remaining services (12%, 6/49) offered occasional or minimal support where funding allowed. There was one NHS unit providing specialist inpatient CFS/ME provision in England. Conclusions Study findings highlight substantial variation in access to specialist care for patients with severe presentation of CFS/ME. Where treatment was provided, this appeared to comply with NICE recommendations for this patient group.