Nottingham ePrints (University of Nottingham), Mar 5, 2014
Background: A quarter of UK strokes occur in working age people. Fewer than half resume work. Reh... more Background: A quarter of UK strokes occur in working age people. Fewer than half resume work. Rehabilitation frequently fails to address work needs and evidence for post-stroke vocational rehabilitation is lacking. This pilot trial tested the feasibility of delivering SSVR and measuring its effects and costs compared to usual care (UC). Method: Previously employed stroke survivors (SS) aged ≥16 recruited from a stroke unit were randomised to receive SSVR or UC. Exclusion criteria: refusing consent; not intending to work, medical preclusion. Primary outcomes: occupational and benefit status. Mood, function, participation, quality of life and resource use were measured using standardized and bespoke postal questionnaires at 3, 6 and 12 months. Service use was cross-referenced in 10% of participants and costs calculated. Results: 46/126 patients screened (36 men, mean 56 (SD 12.7, 18-78 years) were recruited in 15 months; 40 declined. Most (29) had NIHSS scores ≤ 15, were in professional roles (65%), self-employed (21.7%) at onset. 32 available at 12-month follow-up, with poorer response (61%) among UC. Intervention successfully deployed in 22/23 cases. 39% returned to work at 12 months-twice as many in SSVR. More depression and productivity loss in UC, especially at 6 mths. Cross-referencing for 5 participants involved 51 phone calls, 23 letters/emails. Self-reported and actual service use data were discrepant. SS underestimated GP& consultant and overestimated therapy input. Discussion: SSVR can be delivered and its effects and costs measured. More reliable methods of capturing service use, income and benefit data and clearer definitions of work are needed. Conclusion Findings inform the definitive trial. Conclusion: Findings inform the definitive trial.
British Journal of Occupational Therapy, Sep 1, 2012
Background: Little is known about day-today procedures in conducting predischarge home visits in ... more Background: Little is known about day-today procedures in conducting predischarge home visits in occupational therapy. The aim of this study was to identify current practice in relation to people with stroke. Method: A questionnaire was designed and piloted; 184 were posted to stroke units in England. Results: Responses were analysed from 85 stroke units from 10 regions. The main reason for conducting visits was to 'assess or practise activities of daily living in the home environment' (93%), closely followed by to 'identify or address safety issues' (92%). Wide variations exist in time spent on the actual visit (range 10-135 minutes), with a mean time of 63 minutes (SD 20.36), and a mean time of 61 minutes (SD 33.13) for writing a report. Visits were generally conducted by an occupational therapist, with an occupational therapy/physiotherapy assistant. The majority (95%) of therapists reported having a home visit bag and the most common item included was incontinence pads (83%). Conclusion: This research has provided valuable information on, and highlights the variation in, day-today predischarge home assessment visits for patients after stroke. The next step must be to use this knowledge to evaluate patient selection and to examine the costs and effectiveness of such visits.
There is nothing streamlined about this system.1 We have submitted separate Site Specific Informa... more There is nothing streamlined about this system.1 We have submitted separate Site Specific Information (SSI) forms (nine pages long) to the different trusts in England. The systems in Wales, Scotland, and Northern Ireland are all different and require a separate SSI form submitted ...
British Journal of Occupational Therapy, Jul 1, 2011
Obtaining research governance approvals for research involving the National Health Service (NHS) ... more Obtaining research governance approvals for research involving the National Health Service (NHS) has become increasingly complex. In order to obtain the necessary approvals to interview 20 occupational therapists from a range of locations across the United Kingdom, the authors had to submit lengthy applications to all 20 sites. Before issuing their approvals, some sites raised numerous queries, whilst others did not raise any. The time taken to obtain approvals ranged from 6 to 197 days. These disparities highlight that the current research governance procedure for multisite studies is complex and subject to local interpretations. This opinion piece argues that the procedure is excessive for research that does not involve patients and involves NHS staff only. It also argues that this is an injudicious use of resources at a time of national austerity. Implications for the future of occupational therapy research in the United Kingdom are discussed.
Objective To determine whether occupational therapy focused specifically on personal activities o... more Objective To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients after stroke. Design Systematic review and meta-analysis. Data sources The Cochrane stroke group trials register, the Cochrane central register of controlled trials, Medline,
British Journal of Occupational Therapy, Apr 18, 2018
Introduction: Despite clear compatibilities between the tenets of occupational therapy and re-abl... more Introduction: Despite clear compatibilities between the tenets of occupational therapy and re-ablement, there is limited research on occupational therapy in homecare reablement services. This paper describes the content of an occupational therapy intervention that was delivered in homecare re-ablement services as part of a feasibility randomised controlled trial (OTHERS). It also evaluates whether the intervention was acceptable to the participants who received it. Method: There were three phases. 1.) A bespoke pro forma was completed recording the activities undertaken after each therapy visit. 2.) An acceptability questionnaire was sent by post to every intervention participant. 3.) Semi-structured interviews were completed with key informants who received the intervention. Results/Findings: The principal activities undertaken were: assessment; case management; goal setting; advice and support; and practising activities. It was possible to implement a graded programme for participants' main goals in relation to bathing/showering or kitchen activities. Participants particularly valued the advice and support provided, however, there were difficulties due to fluctuations in circumstances and with activities of daily living (ADL) outside the home. Participants also had outdoor mobility goals but there were difficulties working on these within the 6-weeek timescale. Conclusion: An intervention focussing on ADL within the home was acceptable for participants and consistent with their goals and objectives; however, they also had goals beyond personal ADL and the timescale of the re-ablement episode which were not met. Further research should focus on extended ADL at a later stage beyond the time-limited period.
Objective: To assess the feasibility of conducting a randomized controlled trial of occupational ... more Objective: To assess the feasibility of conducting a randomized controlled trial of occupational therapy predischarge home visits for people after stroke. Design: Randomized controlled trial and cohort study. We randomized eligible patients for whom there was clinical uncertainty about the need to conduct a home visit to a randomized controlled trial; patients for whom a visit was judged 'essential' were enrolled into a cohort study. Setting: Stroke rehabilitation unit of teaching hospital. Participants: One hundred and twenty-six participants hospitalized following recent stroke. Interventions: Predischarge home visit or structured, hospital-based interview. Main outcome measures: The primary objective was to collect information on the feasibility of a randomized controlled trial, including eligibility, control intervention and outcome assessments. The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale at one month after discharge from hospital. Secondary outcomes included mood, quality of life and costs at one week and one month following discharge. Results: Ninety-three people were allocated to the randomized controlled trial; 47 were randomized to intervention and 46 to control. Thirty-three were enrolled into the cohort study. More people were allocated to the randomized controlled trial as the study progressed. One hundred and thirteen people (90%) received the proposed intervention, although there was a need for stricter protocol adherence. Follow-up was good: at one month 114 (90%) were assessed. There were no significant differences Article
To systematically review evidence that can inform the rehabilitation of adults recovering from CO... more To systematically review evidence that can inform the rehabilitation of adults recovering from COVID-19
Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiE... more Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): Perceptions in the Assessment and Treatment of Pubic Rami and Sacral Fragility Fractures Amongst Healthcare Professionals in Geriatric Medicine and Surgery—A Qualitative Study by Opinder Sahota, Paul Leighton, Maribel Cameron, Rachael Taylor, Terence Ong, Avril Drummond, Paul Hendrick, Nasir Quraishi, Khalid Salem and On Behalf of the ASSERT Research Team in Geriatric Orthopaedic Surgery & Rehabilitation
Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no lo... more Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of 'no precautions' which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice. Material and methods: Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically. Results: Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced. Conclusion: Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning 'Hip Champions' and staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model.
International Journal of Therapy and Rehabilitation
Background/Aims There is a paucity of evidence in the UK regarding cognitive screening performed ... more Background/Aims There is a paucity of evidence in the UK regarding cognitive screening performed by occupational therapists and whether, and how, cognitive impairments are identified and assessed. The aim of this study was to identify current occupational therapy practice for the assessment of cognitive problems in patients following stroke. Methods Occupational therapists were invited to complete an online vignette study. Participants were asked to: identify any presenting cognitive problems; decide whether to complete cognitive assessments; and list any assessments they would use. Data were analysed using descriptive analysis. Results A total of 53 occupational therapists from across the UK participated. Participants identified key cognitive issues, but some problems, such as apraxia and attention, were overlooked. A large number of potential assessments were suggested, the most common being the Montreal Cognitive Assessment and Oxford Cognitive Screen. Conclusions The variation f...
The Journal of Mental Health Training, Education and Practice
Purpose There has been little research into the use and efficacy of Mental Health First Aid (MHFA... more Purpose There has been little research into the use and efficacy of Mental Health First Aid (MHFA) across UK workplaces. This paper aims to investigate the implementation of MHFA across six UK organisations, identifying key barriers and facilitators. Design/methodology/approach Twenty-seven workplace representatives were recruited from six organisations through purposive sampling and took part in semi-structured interviews exploring their experiences of workplace MHFA. The data underwent thematic analysis, identifying key themes around implementation. Findings Implementation varied across organisations, including different reasons for initial interest in the programme, and variable ways that MHFA-trained employees operated post-training. Key barriers to successful implementation included negative attitudes around mental health, the perception that MHFA roles were onerous, and employees’ reluctance to engage in the MHFA programme. Successful implementation was perceived to be based o...
Additional file 11. Final matrices of change and determinants for each Hospital Orthopaedic Team ... more Additional file 11. Final matrices of change and determinants for each Hospital Orthopaedic Team performance objective
Rationale To address unmet needs, electronic messages to support person-centered goal attainment ... more Rationale To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. Hypothesis Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. Methods and design Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and ...
Nottingham ePrints (University of Nottingham), Mar 5, 2014
Background: A quarter of UK strokes occur in working age people. Fewer than half resume work. Reh... more Background: A quarter of UK strokes occur in working age people. Fewer than half resume work. Rehabilitation frequently fails to address work needs and evidence for post-stroke vocational rehabilitation is lacking. This pilot trial tested the feasibility of delivering SSVR and measuring its effects and costs compared to usual care (UC). Method: Previously employed stroke survivors (SS) aged ≥16 recruited from a stroke unit were randomised to receive SSVR or UC. Exclusion criteria: refusing consent; not intending to work, medical preclusion. Primary outcomes: occupational and benefit status. Mood, function, participation, quality of life and resource use were measured using standardized and bespoke postal questionnaires at 3, 6 and 12 months. Service use was cross-referenced in 10% of participants and costs calculated. Results: 46/126 patients screened (36 men, mean 56 (SD 12.7, 18-78 years) were recruited in 15 months; 40 declined. Most (29) had NIHSS scores ≤ 15, were in professional roles (65%), self-employed (21.7%) at onset. 32 available at 12-month follow-up, with poorer response (61%) among UC. Intervention successfully deployed in 22/23 cases. 39% returned to work at 12 months-twice as many in SSVR. More depression and productivity loss in UC, especially at 6 mths. Cross-referencing for 5 participants involved 51 phone calls, 23 letters/emails. Self-reported and actual service use data were discrepant. SS underestimated GP& consultant and overestimated therapy input. Discussion: SSVR can be delivered and its effects and costs measured. More reliable methods of capturing service use, income and benefit data and clearer definitions of work are needed. Conclusion Findings inform the definitive trial. Conclusion: Findings inform the definitive trial.
British Journal of Occupational Therapy, Sep 1, 2012
Background: Little is known about day-today procedures in conducting predischarge home visits in ... more Background: Little is known about day-today procedures in conducting predischarge home visits in occupational therapy. The aim of this study was to identify current practice in relation to people with stroke. Method: A questionnaire was designed and piloted; 184 were posted to stroke units in England. Results: Responses were analysed from 85 stroke units from 10 regions. The main reason for conducting visits was to 'assess or practise activities of daily living in the home environment' (93%), closely followed by to 'identify or address safety issues' (92%). Wide variations exist in time spent on the actual visit (range 10-135 minutes), with a mean time of 63 minutes (SD 20.36), and a mean time of 61 minutes (SD 33.13) for writing a report. Visits were generally conducted by an occupational therapist, with an occupational therapy/physiotherapy assistant. The majority (95%) of therapists reported having a home visit bag and the most common item included was incontinence pads (83%). Conclusion: This research has provided valuable information on, and highlights the variation in, day-today predischarge home assessment visits for patients after stroke. The next step must be to use this knowledge to evaluate patient selection and to examine the costs and effectiveness of such visits.
There is nothing streamlined about this system.1 We have submitted separate Site Specific Informa... more There is nothing streamlined about this system.1 We have submitted separate Site Specific Information (SSI) forms (nine pages long) to the different trusts in England. The systems in Wales, Scotland, and Northern Ireland are all different and require a separate SSI form submitted ...
British Journal of Occupational Therapy, Jul 1, 2011
Obtaining research governance approvals for research involving the National Health Service (NHS) ... more Obtaining research governance approvals for research involving the National Health Service (NHS) has become increasingly complex. In order to obtain the necessary approvals to interview 20 occupational therapists from a range of locations across the United Kingdom, the authors had to submit lengthy applications to all 20 sites. Before issuing their approvals, some sites raised numerous queries, whilst others did not raise any. The time taken to obtain approvals ranged from 6 to 197 days. These disparities highlight that the current research governance procedure for multisite studies is complex and subject to local interpretations. This opinion piece argues that the procedure is excessive for research that does not involve patients and involves NHS staff only. It also argues that this is an injudicious use of resources at a time of national austerity. Implications for the future of occupational therapy research in the United Kingdom are discussed.
Objective To determine whether occupational therapy focused specifically on personal activities o... more Objective To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients after stroke. Design Systematic review and meta-analysis. Data sources The Cochrane stroke group trials register, the Cochrane central register of controlled trials, Medline,
British Journal of Occupational Therapy, Apr 18, 2018
Introduction: Despite clear compatibilities between the tenets of occupational therapy and re-abl... more Introduction: Despite clear compatibilities between the tenets of occupational therapy and re-ablement, there is limited research on occupational therapy in homecare reablement services. This paper describes the content of an occupational therapy intervention that was delivered in homecare re-ablement services as part of a feasibility randomised controlled trial (OTHERS). It also evaluates whether the intervention was acceptable to the participants who received it. Method: There were three phases. 1.) A bespoke pro forma was completed recording the activities undertaken after each therapy visit. 2.) An acceptability questionnaire was sent by post to every intervention participant. 3.) Semi-structured interviews were completed with key informants who received the intervention. Results/Findings: The principal activities undertaken were: assessment; case management; goal setting; advice and support; and practising activities. It was possible to implement a graded programme for participants' main goals in relation to bathing/showering or kitchen activities. Participants particularly valued the advice and support provided, however, there were difficulties due to fluctuations in circumstances and with activities of daily living (ADL) outside the home. Participants also had outdoor mobility goals but there were difficulties working on these within the 6-weeek timescale. Conclusion: An intervention focussing on ADL within the home was acceptable for participants and consistent with their goals and objectives; however, they also had goals beyond personal ADL and the timescale of the re-ablement episode which were not met. Further research should focus on extended ADL at a later stage beyond the time-limited period.
Objective: To assess the feasibility of conducting a randomized controlled trial of occupational ... more Objective: To assess the feasibility of conducting a randomized controlled trial of occupational therapy predischarge home visits for people after stroke. Design: Randomized controlled trial and cohort study. We randomized eligible patients for whom there was clinical uncertainty about the need to conduct a home visit to a randomized controlled trial; patients for whom a visit was judged 'essential' were enrolled into a cohort study. Setting: Stroke rehabilitation unit of teaching hospital. Participants: One hundred and twenty-six participants hospitalized following recent stroke. Interventions: Predischarge home visit or structured, hospital-based interview. Main outcome measures: The primary objective was to collect information on the feasibility of a randomized controlled trial, including eligibility, control intervention and outcome assessments. The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale at one month after discharge from hospital. Secondary outcomes included mood, quality of life and costs at one week and one month following discharge. Results: Ninety-three people were allocated to the randomized controlled trial; 47 were randomized to intervention and 46 to control. Thirty-three were enrolled into the cohort study. More people were allocated to the randomized controlled trial as the study progressed. One hundred and thirteen people (90%) received the proposed intervention, although there was a need for stricter protocol adherence. Follow-up was good: at one month 114 (90%) were assessed. There were no significant differences Article
To systematically review evidence that can inform the rehabilitation of adults recovering from CO... more To systematically review evidence that can inform the rehabilitation of adults recovering from COVID-19
Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiE... more Supplemental Material, sj-pdf-2-gos-10.1177_21514593211026794 for ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): Perceptions in the Assessment and Treatment of Pubic Rami and Sacral Fragility Fractures Amongst Healthcare Professionals in Geriatric Medicine and Surgery—A Qualitative Study by Opinder Sahota, Paul Leighton, Maribel Cameron, Rachael Taylor, Terence Ong, Avril Drummond, Paul Hendrick, Nasir Quraishi, Khalid Salem and On Behalf of the ASSERT Research Team in Geriatric Orthopaedic Surgery & Rehabilitation
Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no lo... more Hip precautions are routinely provided in the UK, despite evidence suggesting that they are no longer needed. A change in practice was introduced into an orthopaedic service whereby provision of routine hip precautions was discontinued for selected individuals receiving a primary total hip replacement. The change involved implementing a new regime of 'no precautions' which was facilitated using a number of key strategies. The aim of this study was to explore the experiences of clinicians associated with the change in practice. Material and methods: Individual semi-structured interviews were conducted with clinicians who had experience of delivering both hip precautions and no hip precaution regimes. Data were analysed thematically. Results: Ten orthopaedic staff (two senior occupational therapists, one occupational therapy support worker, three senior physiotherapists, two surgeons, and two senior nurses) were interviewed. Three main themes were identified: changes experienced, perceptions of the new regime, and challenges experienced. Conclusion: Several barriers and facilitators to the successful changeover were identified. Successful strategies in changing practice included assigning 'Hip Champions' and staff education and targeted training. It is proposed that holding multidisciplinary education and training would be the ideal model.
International Journal of Therapy and Rehabilitation
Background/Aims There is a paucity of evidence in the UK regarding cognitive screening performed ... more Background/Aims There is a paucity of evidence in the UK regarding cognitive screening performed by occupational therapists and whether, and how, cognitive impairments are identified and assessed. The aim of this study was to identify current occupational therapy practice for the assessment of cognitive problems in patients following stroke. Methods Occupational therapists were invited to complete an online vignette study. Participants were asked to: identify any presenting cognitive problems; decide whether to complete cognitive assessments; and list any assessments they would use. Data were analysed using descriptive analysis. Results A total of 53 occupational therapists from across the UK participated. Participants identified key cognitive issues, but some problems, such as apraxia and attention, were overlooked. A large number of potential assessments were suggested, the most common being the Montreal Cognitive Assessment and Oxford Cognitive Screen. Conclusions The variation f...
The Journal of Mental Health Training, Education and Practice
Purpose There has been little research into the use and efficacy of Mental Health First Aid (MHFA... more Purpose There has been little research into the use and efficacy of Mental Health First Aid (MHFA) across UK workplaces. This paper aims to investigate the implementation of MHFA across six UK organisations, identifying key barriers and facilitators. Design/methodology/approach Twenty-seven workplace representatives were recruited from six organisations through purposive sampling and took part in semi-structured interviews exploring their experiences of workplace MHFA. The data underwent thematic analysis, identifying key themes around implementation. Findings Implementation varied across organisations, including different reasons for initial interest in the programme, and variable ways that MHFA-trained employees operated post-training. Key barriers to successful implementation included negative attitudes around mental health, the perception that MHFA roles were onerous, and employees’ reluctance to engage in the MHFA programme. Successful implementation was perceived to be based o...
Additional file 11. Final matrices of change and determinants for each Hospital Orthopaedic Team ... more Additional file 11. Final matrices of change and determinants for each Hospital Orthopaedic Team performance objective
Rationale To address unmet needs, electronic messages to support person-centered goal attainment ... more Rationale To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. Hypothesis Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. Methods and design Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and ...
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