Sally Bennett

Expert Clinicians' and Students' Views on Clinical Reasoning in Occupational Therapy:

In this study, an examination was made of the clinical reasoning processes used by expert occupational therapists and post-clinical fourth-year occupational therapy students. Using nominal group technique, the factors involved in clinical reasoning were derived and their relative importance determined. The most highly valued skill for the experts was good communication, while the most highly valued skill for the students was a knowledge of and understanding of disability. The experts considered a wider range of factors when making clinical decisions than did the students, and rated their level of clinical reasoning at a higher level than did the students. For the experts, the factors identified as important in clinical reasoning were concerned more with gaining an understanding of the patients both by using general principles of diagnosis and illness and by gaining an understanding of the illness as it affected the individual patient. Meanwhile, for the students, greater emphasis was placed upon the influence of pragmatic factors on treatment, such as resources, time constraints and other environmental factors.

A Systematic Review of Cognitive Interventions to Improve Functional Ability in People Who Have Cognitive Impairment Following Stroke

Abstract Purpose: Cognitive impairment is a frequent consequence of stroke and can impact the ability of people who have had a stroke to perform everyday activities. There are a number of intervention strategies that various health professionals may use when working with people who have cognitive impairment post stroke. The purpose of this systematic review was to determine whether interventions for people with cognitive impairment after a stroke improve their functional performance of basic and/or instrumental activities of daily living (ADL). Method: Searches were performed in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, PsycBITE, OTseeker, and Dissertation Abstracts. Studies were eligible for inclusion if they were a randomised controlled trial or quasi-randomised controlled trial that evaluated an intervention that focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment and measured functional ability, either basic or instrumental ADL, as either a primary or secondary outcome measure. Results: Four studies, involving a total of 376 participants, were included in this review. There was no statistically significant difference between groups on basic ADL performance in any of the four studies or on instrumental ADL in the one study that measured this. Conclusion: There were not an adequate number of high quality trials to be able to make recommendations that support or refute the use of specific cognitive retraining interventions to improve functional outcomes following a stroke. More research is required before conclusions can be made about the effect of cognitive interventions on functional outcomes post stroke.

A multidimensional examination of correlates of fatigue during radiotherapy.

Cancer‐related fatigue can be measured as both a unidimensional and a multidimensional construct. Unidimensional fatigue and its symptom correlates have undergone some previous investigation; however, minimal research has considered the differential effect of correlates on individual dimensions of fatigue. The objective of the current study was to investigate cancer‐related fatigue in a radiotherapy sample using a multidimensional conceptualization to determine whether correlates of fatigue are consistent across all dimensions or whether each fatigue dimension has its own unique pattern of correlates.

Occupational therapy practice in Australia with people with dementia: A profile in need of change

BACKGROUND/AIM Dementia significantly impacts on the individuals and caregivers quality of life. The aim of this study was to describe Australian occupational therapy practice with people with dementia. METHODS A questionnaire was piloted and sent to occupational therapists in Australia working with people with dementia. Participants were recruited in one of three ways: (i) identified by OT AUSTRALIA as working in aged care; (ii) through dementia-specific facilities in Australia; or (iii) through occupational therapy aged care list serves. The questionnaire asked occupational therapists about referrals received, assessments and interventions used, perceived barriers to the delivery of interventions and perceived educational needs. Data were analysed descriptively and presented as frequencies and percentages. RESULTS One hundred and thirty-four occupational therapists responded to this survey. Referrals were predominantly for environmental modification, home assessment or falls prevention and for assessment of activities of daily living. Therapists spent most of their time on assessment, with brief cognitive and functional assessments used most frequently. The most common interventions were environmental modification advice and prescription of assistive equipment. Lack of time was the most commonly reported barrier to the delivery of interventions with therapists also identifying concerns about staffing and role restrictions imposed by organisations. Therapists also identified that further training in this area would be useful. CONCLUSIONS Therapists working in dementia care indicated that they are constrained in terms of time, staffing and organisational restrictions. Recommendations include enhanced training, further research into the most viable occupational therapy interventions, and advocating for improved funding, staffing and resources.

The stages of driving cessation for people with dementia: needs and challenges

BACKGROUND The impact of dementia on safe driving is well recognized and is generally accepted that all people with dementia are likely to need to cease driving at some stage in the disease process. Both driving and driving cessation can have poor outcomes for people with dementia and their caregivers in terms of health, safety, community access, and well-being. Although approaches to facilitate better outcomes from driving cessation are being developed, the processes of driving cessation for people with dementia are still not fully understood. METHODS Within a descriptive phenomenological framework, semi-structured interviews were undertaken with key stakeholders, including retired drivers with dementia, family members, and health professionals. RESULTS Findings from four retired drivers with dementia, 11 caregivers, and 15 health professionals characterized driving cessation for people with dementia as a process with three stages and associated challenges and needs. The early stage involved worried waiting, balancing safety with impending losses, and the challenge of knowing when to stop. The crisis stage involved risky driving or difficult transportation, acute adjustment to cessation and life without driving, and relationship conflict. The post-cessation stage was described as a long journey with ongoing battles and adjustments as well as decreased life space, and was affected by the disease progression and the exhaustion of caregiver. CONCLUSIONS The concept of stages of driving cessation for people with dementia could be used to develop new approaches or adapt existing approaches to driving cessation. Interventions would need to be individualized, optimally timed, and address grief, explore realistic alternative community access, and simultaneously maintain key relationships and provide caregiver support.

The value of an evidence database for occupational therapists: An international online survey

BACKGROUND Online evidence databases can provide access to high quality evidence at the point of care, making evidence-based practice more achievable. A discipline-specific online bibliographic database called OTseeker (www.otseeker.com) was designed for use by occupational therapists. The database is free, and contains citations and abstracts of systematic reviews, and critically appraised randomized controlled trials relevant to occupational therapy. OBJECTIVES The aim of this study was to investigate search practices of database users, their views on its functionality, and the reported impact, if any, on their practice from using OTseeker. DESIGN An online survey, placed on the database website for 30 days. SAMPLE Potential participants were users of OTseeker during a 30-day period. A total of 498 people who had used the database more than once from over 40 countries completed the survey. RESULTS Three hundred and nine (62%) participants believed that OTseeker had improved their ability to locate research about the effectiveness of occupational therapy interventions, and 92 (19%) agreed that the information in the database had contributed to a change in practice. Those reporting no practice changes agreed that use of OTseeker had improved their knowledge generally (n=189; 38%), confirmed their practice (n=75; 15%), or revealed that there was insufficient research relevant to their search topic (n=92; 19%). Features of the database which helped respondents locate research evidence included: having discipline-specific content, providing critical appraisal ratings for randomized controlled trials, and presenting search results ranked for methodological quality. CONCLUSION This study confirms the value of a discipline-specific, online database for helping occupational therapists locate high quality research evidence. Information located on databases such as OTseeker can help change or confirm practice, and improve knowledge.

A multi-professional evidence-based practice course improved allied health students' confidence and knowledge.

PURPOSE To evaluate the effectiveness of a semester-long multi-professional university course teaching evidence-based practice principles to allied health students in terms of changes in attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice. METHODS This was a pre-post study of allied health students who completed a multi-professional university course that taught evidence-based practice skills and concepts. The course was run over a 13-week period (2 hours per week) and utilized didactic lectures, tutorial and workshop formats, and a hands-on database searching session. Participants completed a questionnaire which assessed their attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice on the first and last day of the course. RESULTS Ninety-one students participated in the study; however, complete data sets were available for only 59 participants. Attitudes towards evidence-based practice did not significantly improve; however, attitudes were already positive prior to undertaking the course. There was a statistically significant improvement in confidence with a mean increase of 9.02 [score range 6-30, 95% confidence interval (CI) 8.21, 9.82]. Perceived knowledge improved with a statistically significant mean increase of 14.15 (score range 5-25, 95% CI 12.55, 15.75) and there was a statistically significant mean increase in actual knowledge of 3.56 (score range 0-10, 95% CI 2.83, 4.29). CONCLUSIONS Teaching evidence-based practice skills and concepts to allied health students within a multi-professional university curriculum improved confidence and perceived and actual knowledge regarding evidence-based practice. Further research is needed to determine if these changes result in long-term behaviour change once students graduate, and to consider optimal methods for multi- and interprofessional delivery of evidence-based practice training.Purpose  To evaluate the effectiveness of a semester-long multi-professional university course teaching evidence-based practice principles to allied health students in terms of changes in attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice. Methods  This was a pre–post study of allied health students who completed a multi-professional university course that taught evidence-based practice skills and concepts. The course was run over a 13-week period (2 hours per week) and utilized didactic lectures, tutorial and workshop formats, and a hands-on database searching session. Participants completed a questionnaire which assessed their attitudes, confidence, and perceived and actual knowledge regarding evidence-based practice on the first and last day of the course. Results  Ninety-one students participated in the study; however, complete data sets were available for only 59 participants. Attitudes towards evidence-based practice did not significantly improve; however, attitudes were already positive prior to undertaking the course. There was a statistically significant improvement in confidence with a mean increase of 9.02 [score range 6–30, 95% confidence interval (CI) 8.21, 9.82]. Perceived knowledge improved with a statistically significant mean increase of 14.15 (score range 5–25, 95% CI 12.55, 15.75) and there was a statistically significant mean increase in actual knowledge of 3.56 (score range 0–10, 95% CI 2.83, 4.29). Conclusions  Teaching evidence-based practice skills and concepts to allied health students within a multi-professional university curriculum improved confidence and perceived and actual knowledge regarding evidence-based practice. Further research is needed to determine if these changes result in long-term behaviour change once students graduate, and to consider optimal methods for multi- and interprofessional delivery of evidence-based practice training.

The effect of music-based life review on the life satisfaction and ego integrity of elderly people.

Although music-based life review has frequently been used to facilitate personal adjustment in elderly people, minimal empirical evidence exists as to its effectiveness. An experiment was designed to evaluate the effectiveness of music-based life review. It was hypothesized that a programme of music-based life review would more effectively promote life satisfaction and ego integrity than a programme of verbal life review. Twenty-six elderly female patients residing in nursing homes or hostel accommodation were selected, matched and randomly assigned to either a treatment group (music-based life review) or a control group (verbal life review). Following a 6-week intervention period, all subjects completed the Ego Integrity Subscale (EIS) and the Life Satisfaction Index A (LSIA) and indicated on a linear scale the degree to which they enjoyed the treatment or found it helpful. Results provided support for the use of music-based life review by health care professionals aiming to improve the elderly persons personal adjustment.

Upper limb post-stroke sensory impairments: the survivor’s experience

Abstract Purpose: This study described stroke survivors’ experiences of upper limb post-stroke sensory impairment (ULPSSI) and its rehabilitation. Methods: A qualitative descriptive study of 15 stroke survivors with ULPSSI using semi-structured interviews. A focus group of eight survivors reviewed thematic outcomes. Analysis was completed by three authors. Results: Three themes emerged: (1) What happened to my hand?: A description of the significant impact of sensory impairments on survivors roles and participation; (2) I was only just getting started: Survivors felt sensory impairments and the upper limb were ignored in rehabilitation and described being left on their own to devise their own rehabilitation; and (3) If I work hard then maybe someday: Survivors felt sensory impairments recovered slowly and was aided by working towards recovery and maintaining hope. Conclusions: Sensory impairments are significant for survivors and are deserving of greater clinical and research attention. In particular, assessments and interventions need further development and testing. This study’s findings revealed the need to ascertain individual survivors’ preference for involvement in decision making related to their rehabilitation planning. It also found survivors view recovery as extending well beyond current rehabilitation frameworks, necessitating further description of recovery and re-evaluation of service delivery to address survivors’ needs. Implications for Rehabilitation Sensory impairments significantly impact stroke survivors’ roles and participation. Remediation of sensory impairments is important to survivors, but seems to be ignored in the rehabilitation process. Individual survivors’ preference for involvement in decision making related to their rehabilitation planning should be ascertained. Stroke survivors feel left on their own to address their upper limb impairments long after rehabilitation services have ended. The development of services beyond the normal rehabilitation timeframes is warranted.

Contemporary occupational therapy practice: the challenges of being evidence based and philosophically congruent

Several authors have written of the need to embrace occupation and use it to energise our practice, research and education for the benefit of the profession, individual occupational therapists and ultimately, and most significantly, our clients. However, Wilcock (1999) best summarises the issues and the work that must be done, calling for the profession to adopt a consistent professional philosophy. This approach is entirely congruent with the paradigm approach proposed by Kielhofner (2009). Reinforcing the ideas of Doris Sym, Wilcock (p. 192) states that ‘the first essential for each individual in any profession is the acceptance of a philosophy that is the profession’s keystone.’ Wilcock is clear that such a philosophy should not be adopted and enacted in a rigid way, but it should be dynamic so as to enable the profession to respond to research and theories, and changes in the world. In essence, a professional philosophy should guide research, education and practice and be a touchstone when considering potential changes to practice. It is our suggestion that occupational therapists, individually and collectively, need to use our occupational philosophy, currently best operationalised by the Contemporary Paradigm, to inform EBP. In conclusion, we again find ourselves at a cross road for the profession with the occupational philosophy of the Contemporary Paradigm at times challenged by the adoption of research evidence into practice. We would encourage all occupational therapists to engage in EBP but do so ever mindful of its complexity. We would suggest that evidence-based decision making is viewed through the lens of the occupational therapy philosophy, with occupational therapists critically questioning whether or not the ‘procedure’ for which there is evidence is consistent with the Contemporary Paradigm. This is a complex matter, with many remaining issues to be explored. We would encourage all occupational therapists to interrogate the ways in which they implement EBP and consider the extent to which the profession’s philosophy guides practice decisions.