The Top 10 research priorities for occupational therapy in the UK.

This week’s #OTalk is hosted by the Royal College of Occupational Therapists (RCOT). On Monday 27th July 2020, the RCOT/James Lind Alliance Priority Setting Partnership, which has been running over the past 19 months, culminated in the final workshop to agree the Top 10 research priorities for occupational therapy in the UK, which is the focus of this week’s #OTalk.

The chat will be co-hosted by @JoWatson22, @RCOT_Jenny and @DrGillianWard

Way back in June 2017, RCOT hosted a symposium to launch a Research and Development (R&D) Review, which involved a comprehensive review of all of RCOT’s R&D related activity. The primary outcome was the publication, last November, of the new RCOT Research and Development Strategy 2019-24. Throughout the many opportunities to engage with occupational therapists as part of the R&D Review, there was a resounding message highlighting the value of, and desire for, a revised statement of research priorities for occupational therapy in the UK. 

In March 2019, we launched the RCOT/James Lind Alliance (JLA) occupational therapy priority setting partnership. The JLA is a non-profitmaking organisation whose infrastructure is funded by the National Institute for Health Research. It brings together patients, carers, healthcare professionals and the public in Priority Setting Partnerships (PSPs), to identify and prioritise ‘uncertainties’ or ‘unanswered questions’ that they agree are most important in a particular area. The central focus of the JLA’s robust and high-profile methodology is on giving equal voice to professionals and those who access services and their carers, which resonates strongly with the fundamental person-centred philosophy of occupational therapy. 

More information about the approach taken to identify the Top 10 is available in this short video and via the PSP webpage on the RCOT website. However, to summarise:

• 2000+ questions were submitted by 927 participants in our opening consultation survey, which ran between August and November in 2019.
• The PSP Information Specialist reviewed all of this data and developed overarching summary questions agreed by the Steering Group to capture the essence of the individually submitted questions they represented.
• The Information Specialist then reviewed the available research evidence to make a judgement about whether any of the questions had already been fully answered. None of them had.
• The initial prioritisation survey ran between February and May 2020. People with lived experience of occupational therapy services, occupational therapists themselves and others working alongside them, were asked to identify up to 10 of the long-list of 66 summary questions that they considered the most important for research to answer. 
• Using the data from the second survey, we were able to calculate the rank of each of the 66 questions according to respondents with lived experience of occupational therapy services and according to those with a professional perspective. 
• With a clear difference between the questions prioritised by the two groups, the Steering Group took the decision to ensure that the 10 top-ranked summary questions identified by each group were included in the short-list of 18 questions that was developed (there being a small degree of overlap between the two groups).

On Monday 27th July 2020, we held the final priority setting workshop which bought together ten occupational therapists and ten people with experience of accessing occupational therapy services or their carers, to work collaboratively to consider the short-list of 18 summary questions and agree the Top 10 research priorities for occupational therapy in the UK. 

RCOT will be officially announcing the Top 10 on Thursday 30th July. From that date, you will be able to access the Top 10 here. 

Each priority is best thought of as a summary question within which there might be multiple research question focused on an array of practice areas and contexts, and addressing an array of specific issues and uncertainties.

The questions forming the basis of the #OTalk discussion are:

1. What are your initial thoughts about and reactions to the Top 10? 
2. How might they apply to your area of practice?
3. What might you do to help begin to address the priorities?
4. As part of informing our next steps, what might RCOT do to support you to take the actions you’ve identified? 

The new Top 10 priorities set the research agenda for occupational therapy in the future and will help to focus attention on addressing the unanswered questions that matter most to people accessing and delivering occupational therapy services. We very much look forward to hearing your thoughts.

Post Chat Updates:

Online transcript from HealthCare#

The Numbers

1.638M Impressions
450 Tweets
54 Participants

This weeks #OTalk is being hosted by Katy Williams (@Katy_WilliamsOT) and Paul Wilkinson (@PaulWilkinson94) both of whom are part of the Year One: Thriving Not Surviving project team. Katy is newly qualified, currently working at Gloucestershire Royal Hospital on a rotational post. Paul is also newly qualified, working at South Tees Hospitals NHS Foundation Trust on a rotational post. We are both extremely interested in exploring the changes to practice which have occurred during the Covid-19 pandemic and their impact upon the profession moving forward. 

Unprecedented, unchartered, the new normal, phrases that have shot into common parlance over the last few months, along with key worker, frontline and hero. Behind every use of these words lies a personal story. Triumph in the face of adversity, tragedy, a story of renewal and even, at times, moments of laughter. Personal accounts of living and working through a unique moment in global history. A time we will undoubtedly start to mark as pre and post COVID. 

The media has been full of stories of the heroism of people working on the front line. The country has come together to support our courage, bravery and self-sacrifice. However, this generic narrative is challenged by many of the personal stories that are starting to emerge from those working in health and social care. 

Some occupational therapists have indeed experienced working ‘on the front line’ in life and death situations either in their role as occupational therapists or in roles to which they have been deployed.  Across the profession as a whole however, the experiences are more varied. 

None of us could have envisioned that one of the challenges of our career paths would be playing a role in a worldwide pandemic. Covid-19 has influenced services, procedures and the way we practice. Some of us have been continuing in our usual roles experiencing a reduced case load whilst others have started new jobs or rotated into new specialties. Those in managerial positions have been challenged by a level of logistics they may never have faced before and those leading our profession have been required to lead through completely uncharted territory. The majority of us have been required to adjust considerably our mode of practice. 

Whilst responding to the daily situation we continue to find ourselves in, it is easy to lose sight of the path travelled on a personal level. Due to the service focused values of health professionals the focus tends to be outwards with less attention being paid to self-care and personal wellbeing. Add to this the backdrop of responding to the impact of the pandemic on home life and taking time to reflect, make sense, heal and recharge, for many, has been at a premium.

We started working on the Year 1 Thriving Not Surviving project at the start of the pandemic. Many of our plans have had to be adapted but over the last three months but we have found support in sharing our COVID-19 experiences. It’s been interesting to learn how occupational therapists working in different environments and different parts of the country are responding to the pandemic. 

This led us to think about extending the conversation into an OTalk, which is what we hope to achieve in this talk. A chance for a community to come together and share this experience. The questions we will be exploring are:

1. How has Covid-19 impacted on your role & the way you practice? 

2. What have been your biggest challenges during Covid-19?

3. What have you done to promote/manage your own wellbeing during Covid-19?

4. What are the important things have you learnt about yourself and the way you practice during the COVID-19 pandemic?

5. What changes to practice have occurred that you hope will remain? 

Like all shifts, it wasn’t an overnight change, but gradual and perhaps clearest to see on reflection. When I first started getting involved with patient and public involvement (and patient leadership), many conversations felt like persuading researchers ‘why’ they needed to involve and engage patients and the public in their work. In recent years, most conversations have moved on and are more often initiated by researchers asking about the ‘how’, and it’s the ‘how’ to make PPI meaningful, impactful and effective that I want to explore with OTs in this chat! 

After being asked by Jenny to host this chat, and saying a very enthusiastic yes, the next obvious  thing to do was to talk with people who live with health conditions and are involved in research about what questions they feel are important to pose… Although I have plenty of experience as a patient and patient leader, none of which are invalidated by being an OT student, it felt important get other perspectives, and practice what I preach! 

So in conversations with Tina Coldham (@TinaColdham), Carol Liddle (@LiddleCarole) and Natasha Liddle (@NatashaGarswood), we talked about the range of positive and challenging experiences we’ve had as patients involved in research, including making it meaningful, appealing and being respectful to those we are ‘engaging’. 

Many of our experiences and perspectives are summed in this letter (hyperlink to https://onlinelibrary.wiley.com/doi/10.1111/hex.13087) by e-patient Sara Rigarre (@SaraRiggare) and colleagues very recently published in the journal Health Expectations, in response to a paper on PPI in research studies, in terms of PPI as an approach underpinned by person-centred values rather than isolated actions within a research project. 

And these are the questions that we’d like to use to stimulate some healthy debate on Tuesday 7^th July! 

Questions 

1. How can we engage and use PPI in our research as OTs? 
2. How can we make the language and activities of PPI in research more relevant to the person on the street?
3. How can you bring the national standards for PPI to life, to make PPI in your research meaningful throughout the research process? 
4. What transferable skills do we have as OTs that lend themselves to supporting PPI?

Just in case you need a reminder about the ‘why’, here are some of the key references regarding PPI in research for OTs. It’s a core part of the higher levels of the Evidence, Research and Development Pillar in the RCOT Career Development Framework:

“Facilitate the involvement of service users, staff and/or students to co-design and co-produce aspects of research and/or service development with more experienced colleagues.” (RCOT, 2017, pg. 44)

The first of 10 key principles underpinning the RCOT Research and Development Strategy 2019-2024 is: 

“The individuals, groups and communities that we work with are at the core of occupational therapy practice, and the effectiveness and efficiency of service delivery are at the core of this R&D Strategy. RCOT expects people who access occupational therapy services not only to benefit from the evidence base underpinning practice, but also to play an active role in shaping research to develop new knowledge in line with national standards for public involvement in research.” (RCOT, 2019, pg. 9)

Indeed, the RCOT are already working with service users, patients and clients as key stakeholders in setting the research agenda for occupational therapy via their Priority Setting Partnership with the James Lind Alliance. 

Within healthcare research more generally, the NIHR have collaborated with many stakeholders to develop the UK Standards for Pubic Involvement in Research, which are a great place to start to think how to embed these principles across all aspects of health and care research. 

Anya de Iongh (@anyadei) is a first year pre-registration OT MSc student at UEA. Having been diagnosed with a number of health conditions in her early twenties, she got heavily involved in research as a patient leader, inspired by a gang of emerging patient leaders (see The Patient Revolution by David Gilbert, 2019, to get inspired yourself!) and having met OT and PPI research guru, Claire Ballinger. Her roles within the world of research have included working on research projects around nursing staffing with Wessex CLAHRC and online patient feedback with a team at Oxford University, as a PPI representative reviewing funding bids as part of a regional NIHR panel, and as Patient Editor at the British Medical Journal. 

References

Gilbert, D. (2019) The Patient Revolution: How We Can Heal The Healthcare System, Jessica Kingsley Publishers 

RCOT (2017) The Career Development Framework: Guiding Principles for Occupational Therapy. Available at: https://www.rcot.co.uk/sites/default/files/CAREER_FRAMEWORK.pdf

(Accessed: 18 June 2020) 

RCOT (2019) Royal College of Occupational Therapists’ Research and Development Strategy 2019-2024. Available at: https://www.rcot.co.uk/practice-resources/rcot-publications/royal-college-occupational-therapists-research-and-development-strategy-20192024 (Accessed: 18 June 2020) 

RCOT (2020) Setting the research agenda for occupational therapy, Available at: https://www.rcot.co.uk/setting-research-agenda-occupational-therapy (Accessed: 18 June 2020) 

NIHR (2019) UK Standards for Public Involvement in Research. Available at: https://drive.google.com/file/d/1U-IJNJCfFepaAOruEhzz1TdLvAcHTt2Q/view (Accessed: 18 June 2020)