Seanne Wilkins

Implementing client-centred practice: why is it so difficult to do?

This paper explores the challenges of implementing client-centred occupational therapy practice. While many occupational therapists believe in the principles of client-centred practice and espouse them, it seems much more difficult to implement these into everyday practice. Findings from three qualitative studies with three different populations (i.e., family-centred care for children and their families, community-based home care, facility-based care for older adults) are used to illustrate the challenges which are divided into three broad categories: challenges at the level of the system, at the level of the therapist and at the level of the client. Suggestions for change at each level are addressed. Organizations, therapists and clients must work together to facilitate these changes and ensure that each occupational therapy client receives respectful, supportive, coordinated, flexible and individualized service.

The role of the theoretical drive in maintaining validity in mixed-method research

In this article we focus on the role of the theoretical drive in maintaining validity in mixed-method research. Methodological problems often occur when the incomplete supplementary component is from a contrasting paradigm to the core component–for instance, if the core components theoretical drive is quantitative and the supplemental component is qualitative (ie, QUAN-qual designs) or, conversely, if the theoretical drive of the core component is qualitative and the supplemental component is quantitative (ie, QUAL-quan designs). The principles and assumptions of the overall theoretical drive have profound implications for sampling, analysis and the interpretation of data for the supplementary component. Attention to the mechanics of decision-making throughout a mixed-method research project is crucial for avoiding pitfalls posing a serious threat to validity, and a researchers advanced knowledge of both qualitative and quantitative methods is essential.

The physical environment as a fall risk factor in older adults: Systematic review and meta‐analysis of cross‐sectional and cohort studies

BACKGROUND/AIM Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. METHODS Eight databases (1985-2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. RESULTS Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. COHORT Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97-1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03-1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59-2.71) and institutional (OR = 1.77; 95% CI: 1.66-1.89) settings. CONCLUSIONS Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.

Self-management interventions for chronic disease: a systematic scoping review

Objective: To investigate the contributions of physiotherapy and occupational therapy to self-management interventions and the theoretical models used to support these interventions in chronic disease. Data sources: We conducted two literature searches to identify studies that evaluated self-management interventions involving physiotherapists and occupational therapists in MEDLINE, the Cochrane Library, CINAHL, EMBASE, AMED (Allied and Complementary Medicine), SPORTdiscus, and REHABDATA databases. Study selection: Four investigator pairs screened article title and abstract, then full text with inclusion criteria. Selected articles (n = 57) included adults who received a chronic disease self-management intervention, developed or delivered by a physiotherapist and/or an occupational therapist compared with a control group. Data extraction: Four pairs of investigators performed independent reviews of each article and data extraction included: (a) participant characteristics, (b) the self-management intervention, (c) the comparison intervention, (d) outcome measures, construct measured and results. Data synthesis: A total of 47 articles reported the involvement of physiotherapy in self-management compared with 10 occupational therapy articles. The type of chronic condition produced different yields: arthritis n = 21 articles; chronic obstructive pulmonary disease and chronic pain n = 9 articles each. The theoretical frameworks most frequently cited were social cognitive theory and self-efficacy theory. Physical activity was the predominant focus of the self-management interventions. Physiotherapy programmes included disease-specific education, fatigue, posture, and pain management, while occupational therapists concentrated on joint protection, fatigue, and stress management. Conclusions: Physiotherapists and occupational therapists make moderate contributions to self-management interventions. Most of these interventions are disease-specific and are most frequently based on the principles of behaviour change theories.

The effectiveness of community-based occupational therapy education and functional training programs for older adults: a critical literature review

Background. This paper examines the results of a critical literature review describing the provision of education and functional training programs by occupational therapists with older adults to maximize their occupational performance. Purpose. The critical review addressed the following question: What is the effectiveness of education and functional training programs in improving occupational performance and quality of life for older adults? Review methods are described and the outcomes of the critical review discussed. Results. The results indicate that there is evidence that programs are effective in three areas: prevention of functional decline and falls, stroke and rheumatoid arthritis. Methodological limitations exist in some studies. There are several randomized controlled studies in this area, though the description of specific occupational therapy interventions is often vague and the programs could not be easily duplicated by occupational therapists. Practice implications. Occupational therapists are provided with information through this critical review to facilitate evidence-based practice when working with older adults.

Becoming a tutor: exploring the learning experiences and needs of novice tutors in a PBL programme

The tutor plays an important role in facilitating learning in a problem-based learning (PBL) curriculum. This paper explored the ways that novice tutors were educated in a PBL programme at McMaster University. Thirteen novice tutors were interviewed in this qualitative, ethnographic study to identify their learning needs and culture at the entry phase of ‘becoming a tutor’. Ten tutor guides were also interviewed to provide additional information and perspectives regarding the data generated by the novice tutors. Categories that emerged were: (1) benefiting from the experience, (2) managing the challenges, (3) transitioning to a new role, (4) uncovering learning opportunities, (5) maintaining vigilance, and (6) explicating the implicit. The overarching framework that wove the categories together was that of the theme of storytelling in the teaching–learning process. Implications for practice for tutor training are addressed considering the oral tradition.

Participation among women living with HIV: A rehabilitation perspective

Abstract The purpose of this phenomenological study was to understand the lived experience of women living with HIV using a rehabilitation lens. Twenty-three women with a mean age of 40.8 years participated in personal interviews regarding barriers and facilitators to participation in society. An open coding analysis revealed the following themes associated with decreased participation: living in poverty, enduring depression and isolation, fearing disclosure and stigma, tolerating the signs and symptoms, experiencing barriers to work and lacking supportive networks. Themes related to women who were participating in their communities included meaning of children, balancing life with HIV, accessing support networks and possessing a strong self-identity. The findings highlight the complexity of the interaction between personal, environmental and health-related factors and the need for supports that incorporate the broader concept of rehabilitation.

Experiences of nurses working in a stroke rehabilitation unit

AIM This paper is a report of a study to explore the perceptions, beliefs and feelings of a group of nurses who provided care to individuals admitted to a stroke rehabilitation unit. BACKGROUND Following a stroke, survivors should ideally be referred to multidisciplinary inpatient rehabilitation programmes, which attain better outcomes compared to the care provided on general medical wards. However, to achieve these outcomes, team members must work closely together. Communication problems have been reported in these teams, and other members may consider that nurses do not practise functional activities with patients. METHODS An interpretive phenomenological approach was adopted. Eight nurses in one Canadian stroke rehabilitation unit were interviewed during 2004-2005 about their experiences of providing care to stroke survivors. FINDINGS The nurses enjoyed giving this type of care, feeling that their role was pivotal to the rehabilitation process. At times, they found it difficult to let patients struggle to complete their activities of daily living. The nurses felt that lack of resources, including time, contributed to stroke survivors being short-changed in their rehabilitation nursing care. Despite holding strong views that others devalued their role within the stroke team, the nurses retained positive attitudes. CONCLUSION Stroke teams need to recognize the constraints nurses experience in fulfilling their stroke rehabilitation role in order to foster the collegial support that could contribute to a more interactive and respectful work environment. They also need to consider ways to increase the job satisfaction of nurses working in stroke rehabilitation settings.

Needs assessment of individuals with stroke after discharge from hospital stratified by acute Functional Independence Measure score

Purpose. To determine the needs, barriers and facilitators of function in individuals with stroke after discharge from hospital. To examine the results stratified by the patients acute score (<41, 41–80, >80) on the functional independence measure (FIM). Method. This was a cohort study of 209 patients who had been admitted to hospital because of stroke. Patients were interviewed following hospital discharge using a semi-structured interview and asked to complete and return a quantitative closed-ended survey. Results. For most domains, frequencies of needs varied across the FIM groups. Combining all FIM groups, the interview showed needs related to: physical impairments (35%), time for recovery (33%), education (28%), medical advice (25%), therapies and services (21%), social needs (19%) and emotional needs (18%). From the interview, the most frequent barriers were physical impairments (55%) and emotional concerns (40%). Common facilitators were family support (54%), therapies and medical care (40%) and personal attitudes (22%). Additional needs from the survey concerned: IADL, mobility, ADL, recreation, finances, communication and employment. Additional barriers from the survey were: attitudes, social participation, environments and limited services. Conclusions. There is a large and varied number of needs and barriers following discharge from hospital that have planning and advocacy implications for rehabilitation teams.

Advocacy in Occupational Therapy: Exploring Clinicians' Reasons and Experiences of Advocacy

Background. Occupational therapy literature encourages therapists to advocate, yet any member of the team could advocate with/for people with disabilities. There is a need to determine why occupational therapists provide these services and how they learn to advocate. Purpose. The objective of this article is to understand the meaning of advocacy for occupational therapists by exploring their reasons for advocating. Methods. Interpretive phenomenology and the social model of disability were used to interview 13 occupational therapists about their advocacy experiences. Data analysis was completed using a Gadamerian-based approach. Findings. Occupational therapists advocate for a number of reasons; some relate to themselves, some relate to clients, and others relate to both. Learning about advocacy may be understood as taking place on a continuum of time. Implications. The occupational therapists unique reason for advocating is to facilitate the clients occupational performance. A new definition of advocacy is presented based on study findings.