The Conceptual Analysis of Collaboration in the Occupational Therapy by Combining the Scoping Review Methodology

BACKGROUND

Collaboration is an important concept in goal-setting in occupational therapy. However, this concept is not stable due to various definitions. The purpose of this study was to clarify the concept of collaboration in occupational therapy.

METHOD

A scoping review was used to search for all articles related to occupational therapy and collaboration. PubMed, Web of Science, CINAHL, and OT Seeker searches were conducted using predetermined keywords. Three examiners independently reviewed and assessed the quality of each study using Walker and Avant's concept analysis method.

RESULTS

Results of the database searches yielded 1873 studies, 585 of which were deemed eligible to include in this review. Results showed five attributes ("active participation for the common objective", "existence of something to share", "matured communication and interaction", "relationship founded on the respect and trust" and "complementing each other") and two antecedents and several consequences.

CONCLUSIONS

Our findings may contribute to collaborative goal-setting and occupational therapy.

Exploring stroke survivors' experiences and understandings of occupational therapy

BACKGROUND

Occupational therapists view people with stroke as occupational beings who may experience occupational issues. Concurrently, occupational therapy practice is guided by research evidence that supports predominantly impairment-based practices. There has been limited exploration of how people with stroke experience and understand occupational therapy in the context of the potential tension between the professional philosophy and the research-based evidence.

AIMS/OBJECTIVE

To explore the experience and understanding of occupational therapy with stroke survivors.

MATERIAL AND METHODS

Interpretative phenomenology guided semi-structured interviews with nine participants from five states across Australia.

RESULTS

Three themes emerged: Understanding of occupational therapy grows by 'doing' outlines how participants understood occupational therapy based on their individual experiences over time; Personal factors influence the experience highlights how participants had diverse expectations for recovery that influenced their occupational therapy experience. Context shapes occupational therapy experience identified that the therapeutic relationship and context of occupational therapy were important factors in shaping experiences.

CONCLUSION

Both impairment-based and occupation-based therapy were considered valuable aspects of occupational therapy, representing the proposed tension between the professional philosophy and research-based evidence. Occupation-based and client-centred practice was more often experienced in the outpatient setting, with challenges described for both within the inpatient setting.

Understanding the factors influencing the implementation of participatory interventions to improve care coordination. An analytical framework based on an evaluation in Latin America

Healthcare coordination is considered key to improving care quality. Although participatory action research (PAR) has been used effectively to bridge the gap between evidence and practice in other areas, little is known about the key success factors of its use in healthcare organizations. This article analyses the factors influencing the implementation of PAR interventions to improve clinical coordination from the perspective of actors in public healthcare networks of Brazil, Chile, Colombia, Mexico and Uruguay. A qualitative, descriptive-interpretative study was conducted in each country's healthcare network. Focus groups and semi-structured individual interviews were conducted to a criterion sample of: local steering committee (LSC) (29), professional platform (PP) (28), health professionals (49) and managers (28). Thematic content analysis was conducted, segmented by country and themes. The PAR process led by the LSC covered the return of baseline results, selection of problems and interventions and design, implementation and adjustment of the intervention, with PP. Interventions were implemented to improve communication and clinical agreement between primary and secondary care. Results reveal that contextual factors, the PAR process and the intervention's content influenced their implementation, interacting across time. First, institutional support providing necessary resources, and professionals' and managers' willingness to participate, emerge as contextual pivotal factors, influenced by other factors related to: the system (alignment with policy and political cycle), networks (lack of time due to work overload and inadequate working conditions) and individuals (not knowing each other and mutual mistrust). Second, different characteristics of the PAR process have a bearing, in turn, on institutional support and professionals' motivation: participation, flexibility, consensual decision-making, the LSC's leadership and the facilitating role of researchers. Evidence is provided that implementation through an adequate PAR process can become a factor of motivation and cohesion that is crucial to the adoption of care coordination interventions, leading to better results when certain contextual factors converge.

The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature

BACKGROUND

The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework.

METHODS

This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail.

RESULTS

The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated.

CONCLUSIONS

In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.

Analysis of the occupational therapist's professional identity when working in acquired brain injury rehabilitation within a municipal service

Background

Changes in rehabilitation pathways are reducing the amount of time patients spend in hospital, resulting in an earlier return to municipal care. Studies show that occupational therapists find working with patients with acquired brain injury to be complex and that, in some situations, they fail to believe in their own professional expertise. This qualitative study aimed to explore how the professional expertise of occupational therapists working in acquired brain injury rehabilitation within a municipal service is understood.

Methods

One monoprofessional focus group interview with occupational therapists and five focus group interviews with professionals from municipal interprofessional rehabilitation coordinating units formed the basis for the study. Data were analysed using systematic text condensation.

Results

A holistic view and strategically selected areas of expertise were found to characterise the work of occupational therapists in the municipal setting. A composed base of knowledge enables occupational therapists to be rehabilitators while working in collaboration with multiple professional partners.

Conclusions

Expertise in the areas of adaptation, assistive devices and cognition are considered to be valuable in acquired brain injury rehabilitation in a municipal setting. A practical synthesis of knowledge, transprofessional collaboration and role release enable the occupational therapist to act as a multifarious rehabilitator.

Key components of knowledge transfer and exchange in health services research: Findings from a systematic scoping review

AIMS

To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research.

BACKGROUND

There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research.

DESIGN

A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts.

DATA SOURCES

Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, health care.

REVIEW METHODS

Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders' consultation of the findings was performed to ensure accessibility.

RESULTS

Of the 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. In addition, specific operational elements of each component were identified.

CONCLUSIONS

The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.

Training by Using an Adaptive Foot Switch and Video Games to Improve Balance and Mobility Following Stroke: A Randomised Controlled Trial

In this study, an altered switch for rehabilitation was invented to make home training accessible for the stroke patients, by modifying a computer mouse into a foot switch. This study examined the effects of training with an adaptive foot switch and video games (VG) on walking performance and balance abilities (Centre of Pressure (CoP) sway) in people after stroke.

The intervention was evaluated through a randomised controlled trial. The intervention group received 10 weeks of VG rehabilitation, for approximately 3.5 hours/week, using a pressure-activated electronic foot switch, in addition to standard rehabilitation. The control group received regular rehabilitation only. The experiment included a force platform (measuring CoP sway kinematics) and a 10-Metre Test of Walking (10MWT) to measure the standing balance and walking performance of 56 stroke patients.

There were no differences between the two groups (intervention and control) at baseline in terms of the demographic or dependent variables. Multivariate tests indicated a significant interaction between the Patient Group and the Time-type variables. Subsequent analysis of the main effects revealed significant between-group differences over time in all dependent variables (10MWT, sway area, CoP sway in anterior–posterior direction (AP sway) and CoP sway in medial–lateral direction (ML sway)). Patients in the intervention group demonstrated better performance than those in the control group after the VG rehabilitation according to the post-test.

This study suggests that ankle muscle training using an adaptive foot switch and VG may improve exercise compliance and enhance recovery of balance and mobility following stroke.

Novel occupational therapy intervention in the early rehabilitation of patients with brain tumours

Statement of context

The Danish Health Authority recommends that patients with brain tumours should have their rehabilitation needs evaluated prior to hospital discharge.

Critical reflection on practice

To our knowledge, no specific recommendations for specialised occupational therapy intervention in patients with glioma have been published. We rationalise how occupational therapy practices founded on shared decision-making and common goal-setting are implicated to patients with brain tumours and elaborate on how an occupation-centred approach with occupation-focused and based intervention has the potential to impact a patient’s performance ability and satisfaction in performing occupations established by the Canadian Occupational Performance Measure. This practice was embedded in a randomised controlled trial investigating the effectiveness of intensive rehabilitation efforts and involving occupational therapy compared with standard care in patients with glioma (ClinicalTrials.gov Identifier NCT02221986).

Implications for practice

Occupational therapy makes an important contribution in neurorehabilitation, which may also apply to patients with brain tumours.

Evaluating the Impact of Audits and Feedback as Methods for Implementation of Evidence in Stroke Rehabilitation

Introduction:

This paper evaluates audits and feedback as methods to increase implementation of evidence in stroke rehabilitation.

Method:

The study used an action research approach and theories of knowledge translation. A sample of 22 occupational therapists participated from two Danish hospitals that admitted stroke patients. Data collection methods included audits of occupational therapy medical records, documentations of daily practice, and collaborative discussions. Active feedback and discussions of the findings took place, at a group level in four local clinical audits. Data analysis of daily self-reported recordings and audits was descriptive. Audit data were analysed using descriptive statistics. A phenomenological hermeneutical interpretive methodology was used for analysing qualitative data.

Findings:

Audits and feedback were based on clear standards and contextual developing action plans. Daily practice in both settings adapted to the clinical guidelines. Implementations of the standardized assessment tools seemed to be the most successful.

Conclusion:

The effects of audit and feedback profited from the active participation of the therapists, as well as local gatekeepers having formal responsibilities for implementing change. The process was strengthened by providing the audits and feedback more than once. The effect of audits and feedback was positively influenced by being in line with current conceptual frameworks, local policies, and values.

Occupational Therapists' Attitudes, Knowledge, and Implementation of Evidence-Based Practice: A Systematic Review of Published Research

Introduction:

Evidence-based practice is the procedure whereby clinicians incorporate best research evidence, clinical expertise, and patient values to provide best patient care. Recently, there has been a significant push towards occupational therapists' adoption of evidence-based practice. This systematic review aimed to determine occupational therapists' attitudes, knowledge, and utilization of evidence-based practice.

Method:

A search of literature published between 2000–12 was conducted in relation to occupational therapists' practice. Academic Search Complete, Cumulative Index of Nursing and Allied Health Literature Plus, PsycARTICLES, Ingenta, Medline, Science Direct, and Journal Storage were systematically searched using MeSH and free-text keywords. Google Scholar and reference lists were also searched.

Findings:

Thirty-two papers were selected for review: 23 were quantitative, 8 were qualitative, and 1 used a mixed methods design. Studies demonstrated that occupational therapists hold positive attitudes towards evidence-based practice. However, these attitudes do not translate into practice, with research indicating a lack of evidence-based practice utilization. Occupational therapists perceive a number of barriers to evidence-based practice, including lack of time, lack of availability and accessibility of research, and having limited research skills.

Conclusion:

It is essential that educational and training initiatives provide therapists with the tools and support they need to engage fully with research evidence and its application within clinical care.

What Actually Informs Practice: Occupational Therapists' Views of Evidence

Introduction:

This research aims to explore what New Zealand occupational therapists consider ‘evidence’ to be and how the search for evidence is accomplished in their practice.

Method:

Semi-structured interviews were conducted with 14 therapists who had shown variations in comfort levels with locating and implementing evidence.

Findings:

Four themes emerged from the data: (1) finding evidence to support practice: informal quick methods were favoured; (2) the nature of available evidence: evidence was considered to be of limited value in practice as the context of the research was often very different to the context of local practice; (3) the organisational influences: the culture of the work environment played a key role in the dissemination of knowledge and (4) the importance of evidence: the need to use evidence to support practice was appreciated by most therapists. In general, using reliable resources was regarded as key to evidence-based practice with availability of resources, therefore, deemed essential.

Conclusion:

Therapists value trustworthy research information that is pre-digested and can be readily used in practice. Where there is limited research evidence, the focus should be on the generation and dissemination of information from critical reflections on practice.