Ritchard Ledgerd

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.

Exploring the need for a new UK occupational therapy intervention for people with dementia and family carers: Community Occupational Therapy in Dementia (COTiD). A focus group study

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.

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.

Identifying the causes, prevention and management of crises in dementia. An online survey of stakeholders

Crisis situations in dementia can lead to hospital admission or institutionalisation. Offering immediate interventions may help avoid admission, whilst stabilising measures can help prevent future crises.

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.

Targeting the globe: internationalisation in occupational therapy education

ABSTRACT Through international placements, student occupational therapists (SOTs) provide direct services and consultation with communities, organisations and local governments. SOTs work with international partners to assess needs, develop new programs, and adopt new practices. SOTs support individuals and groups to build and sustain capacity in health, function and rehabilitation. However, more comprehensive preparation of SOTs for international involvement is required. The objectives of this paper are: (a) to develop recommendations for best practice for the educational preparation of globally bound SOTs; (b) to disseminate findings that reflect global and culturally sensitive perspectives; and (c) to provide recommendations that support engagement in international placement learning. The World Federation of Occupational Therapists (WFOT) assisted in connecting the investigators and participating countries. Data analyses outlined clear trends related to strengths and gaps in student preparation. Ongoing development of international clinical education resources and partnerships is needed to support dynamic and sustainable global learning in occupational therapy.

Developing international research priorities for occupational therapy

The World Federation of Occupational Therapists (WFOT) is the international representative of the occupational therapy profession. As such, WFOT promotes the development and practice of occupational therapy around the world, demonstrating its relevance and contributions to communities and societies. In 2014, the research programme area of WFOT was first established in the management structure of WFOT at the council meeting in Japan. This important change reflected the vision of WFOT and its more than 100 member organisations – to promote the development of research evidence to support responsive, ethical, culturally sensitive and contextually relevant occupational therapy practice, and to partner with member organisations to build local research capacity in response to national and international research priorities. One key strategy to achieve this vision was to develop the first global occupational therapy research agenda, through collaborative actions with member organisations. Since then, WFOT’s research programme has worked to develop the international research priorities project, which culminated in the first dynamic international agenda for research in our profession. This editorial will outline the WFOT research priorities developed since 2014, to provide a framework to develop research partnerships across the WFOT membership. Occupational therapy is concerned with a broad range of health and social care issues that affect engagement in meaningful occupation, and diverse research activities are needed to support the profession on the world stage. These priorities were designed to capture the range of research endeavours by occupational therapists internationally. Therefore, they are not a prescriptive set of priorities meant to limit the range of our research efforts but, rather, they reflect a starting point that enables international collaborations and increases visibility for our contributions. Moreover, this is a dynamic document that WFOT is committed to update as the needs of the international community change and as societies are faced with new and unexpected challenges that call for the kind of innovation that only occupational therapists can provide. The development of the research priorities project was entrusted to a subgroup of WFOT delegates from every continent, who convened to undertake this task (see Figure 1 for the original group). Research priorities are strategic areas of research activity that are considered of key importance for occupational therapy. They have the potential to inform occupational therapy theory and to contribute to the advancement of practice as well as the building of research capacity in response to local needs. Some research priorities have been published for occupational therapy in the UK (Bannigan et al., 2008), Ireland (Health Research Board, 2010), and the USA (American Occupational Therapy Foundation, 2015), and for particular client groups such as mental health (Duncan et al., 2003; Hitch and Lhuede, 2015) and cerebral palsy (McIntyre et al., 2010). The project group identified the existing range of international research priorities relevant to occupational therapy, and then identified a list of international occupational therapy research priorities that would be relevant across the membership of WFOT. Following ethics approval, a survey was distributed among the WFOT member organisations and WFOT approved education programmes to gather information about existing research priorities. These were coded and thematically analysed. A Delphi process, using two rounds, was then implemented to reach consensus about research priority areas of relevance for occupational therapy. A total of 46 countries were represented across the Delphi research process. Responses to the initial survey were received from 34 WFOT member organisations and 26 universities. Research priority themes involved targeted areas of occupational therapy practice, outcome measurement and occupational therapy education, practice and professional issues. A total of 40 research priorities were identified for rating and ranking in the following Delphi round, which involved 38 member organisations and 40 universities. The final Delphi round rated and ranked the findings from round two which involved 19 member organisations and 15 universities. A final list of eight generic research priorities was developed. These are listed in Figure 2. A full explanation of the rationale and scope for each of the research priorities listed is given in World Federation of Occupational Therapists et al. (2017). We hope that these research priorities are only the start of developing the research capacity of occupational

World Federation of Occupational Therapists human resources project 2012 and 2014: Demographic profile of WFOT member organisations

ABSTRACT The World Federation of Occupational Therapists (WFOT) Human Resources Project 2012 and 2014 provides demographic statistics of the occupational therapy profession for 97% in 2012 and 99% in 2014 of WFOT Member Organisations. The data show the diversity of the profession’s demography between countries and regions, established and newly established organisations in both low and high resource countries. Some Member Organisations are unable to collect or have limited access to the information that is requested as part of the Human Resources Project. This report respects the limitations that some Member Organisations might have in providing data; equally, it reinforces the importance of maintaining national demographics as a contributing factor to the profession’s development and global identity. The Human Resources Project is an integral part of WFOT’s business, aligned to its strategic and operational objectives. The project has formed part of its continued collaboration with the World Health Organization and various government ministries and departments. WFOT supports the widespread dissemination of this information to facilitate global recognition and commissioning of the valued contribution of the occupational therapy profession.

Competency-based education: A survey study of international occupational therapy educational programmes

Abstract The purpose of this study was to determine how occupational therapy education programmes approved by the World Federation of Occupational Therapists (WFOT) are utilising, implementing and evaluating competency-based education (CBE). The survey was distributed to a sample of 645 participants using the WFOT distribution process. A total of 67 respondents completed the survey. The results indicated that programmes are using WFOT and their country-specific competencies to guide their curriculum and that some programmes are in transition to a competency-based model of education. However, a number of barriers were identified, which impact the uptake and implementation of CBE that include resource intensity, specificity of some competencies to individuals and culture, and lack of understanding of CBE. This paper provides recommendations for further research and actions.

UNDERSTANDING AND MANAGING CRISES IN DEMENTIA

Background: Relearning in semantic dementia Semantic dementia is a subtype of frontotemporal dementia, primarily affecting the anterior temporal lobes. The most distinct and early detectable symptom of semantic dementia is anomia, but semantic dementia is not just a problem of naming objects, it implies a deeper degradation of conceptual knowledge across modalities. In the early stages of semantic dementia episodic memory and other cognitive abilities aremost often relatively spared, and recent studies have demonstrated that patients with semantic dementia can relearn names of objects through cognitive training. However, it has not been clearly demonstrated if any method of cognitivetraining can lead to both improved naming and relearning of semantic knowledge. We wanted to explore whether extensive multimodal cognitive training could improve both naming and enhance semantic knowledge in semantic dementia. Methods: Three patients completed at 3 weeks individualized training program, which implied naming and knowledge training in a clinical setting and at-home training. Two methods of cognitive training were compared within subjects: extensive multimodal cognitive training and simple picture-word association training. Patients were assessed preand post-intervention on naming and knowledge of individualized items, presented as pictures. Results: Results showed that the training programme did improve naming and semantic knowledge of items. However there were no significant differences between the two methods of cognitive training. Unexpectedly we also found improvement in naming of some control-items, which were not trained. This indicates a possibility of a more generalized effect of cognitive training in semantic dementia.Conclusions: This study supported the possible benefits of cognitive training in semantic dementia. More research is needed to develop methods which can improve both naming and semantic knowledge in patients with semantic dementia.