Understanding and negotiating: Reasoning processes used by an occupational therapist to individualize intervention decisions for people with upper limb hypertonicity

Stroke survivors' experiences and meaning of digital technology in daily life: a phenomenological study

PURPOSE

The aim of the study was to explore the experiences and meaning of digital technology in daily life by stroke survivors.

MATERIALS AND METHODS

A phenomenological study design helped to collect rich and in-depth understanding of stroke survivors' experiences and meaning of digital technology in their daily life and their perspective of applying digital technology in the implementation of stroke-related telerehabilitation services. Thematic analysis was used for data analysis.

FINDINGS

An overarching theme emerged: A spectrum of challenges, personal preferences, strategies to manage, and attitudes towards the use of digital technology in daily life.

CONCLUSION

The findings revealed that participants' different experiences influenced their perceived meaning of digital technology in daily life and the interest to participate in telerehabilitation services.

Decision-making aids for upper limb interventions in neurological rehabilitation: a scoping review

PURPOSE

To summarise the range and nature of decision-making aids that guide upper limb (UL) neurorehabilitation.

METHODS

Our scoping review followed Arksey and O'Malley's 6-step framework. Electronic databases were systematically searched; grey literature was hand-searched. Included papers were: (1) published in English; (2) related to UL rehabilitation for people with upper motor neuron conditions; and (3) provided a description of, or research on, a decision-making aid that guides therapists when choosing between two or more intervention approaches, techniques, or applications of a technique. Levels of evidence were rated. An expert panel of occupational therapists working in UL neurorehabilitation was consulted.

RESULTS

The 24 included articles described 15 decision-making aids with varying breadth and depth of the assessment process and suggested interventions. Six aids had published research, but lacked high quality evidence. The expert panel identified four key decision-making aids as being clinically useful. Preferred aids either included client-centred goal-setting within a holistic assessment or matched specific intervention options to distinct UL assessment results. Prompts to re-evaluate client performance are desirable.

CONCLUSION

Few decision-making aids guide therapists to holistically assess and make specific intervention decisions across all domains of UL neurorehabilitation. Their usefulness depends on the purpose, setting, and therapist experience.Implications for rehabilitationConsidering the complexity and heterogeneity of upper limb (UL) neurorehabilitation, a selection of evidence-based and purpose-designed decision-making aids may assist therapists across different experience levels and practice settings to choose individualised interventions.Decision-making aids for UL interventions in neurorehabilitation may be more clinically useful if they include a holistic and client-centred information gathering process that focuses on daily life goals.Decision-making aids should illustrate a clear clinical picture based on UL assessment results, with corresponding UL intervention recommendations provided.Inclusion of a cyclic process to re-evaluate client performance and function could also enhance the usefulness of a decision-making aid.

How Qualitative Case Study Methodology Informs Occupational Therapy Practice: A Scoping Review

Qualitative case study methodology (QCSM) is a useful research approach that has grown in popularity within the social sciences; however, it has received less attention in the occupational therapy literature. The current scoping review aims to explore how studies utilizing a QCSM help inform occupational therapy knowledge and practice. Electronic searches were conducted in April 2017, and the resultant 388 publications were screened by three reviewers in Covidence. In all, 27 publications met the inclusion criteria and were included in the scoping review. Case studies in the occupational therapy literature have explored phenomena relating to the delivery of intervention, theoretical concepts, clinical reasoning, and education and research methods and were situated in a range of different practice areas and contexts. QCSM is a valuable approach in occupational therapy research that contributes to the body of knowledge and theory that informs occupational therapy practice.

I looked to her as a guide: the therapeutic relationship in hand therapy

PURPOSE

To illustrate important dimensions of the therapeutic relationship in a hand therapy patient-therapist dyad.

METHOD

This instrumental case study utilised narrative analysis of semi-structured interviews of a patient-therapist dyad.

RESULTS

Four dimensions of the therapeutic relationship were identified. These were (1) humour to promote reciprocity, (2) ordinary conversation to build rapport, (3) social comparison to promote acceptance and (4) attention as caring.

CONCLUSIONS

The therapeutic relationship is not a one-way flow from therapist to patient but a mutual exchange between equals. However, it is the therapist who is responsible for establishing the environment for the therapeutic relationship to develop and flourish.