Author: lgpersonaldev

As you will know by now the blog squad had a very busy time writing about their conference experience. Many of the posts were published during conference and a few after and we know there are a lot.

To make it easier to find your way around here is a quick reference with links to the relevant posts.

General Posts

Introducing the blog squad

Sheffield occupational therapists prepare for conference

Be brave: 5 tips for networking as a student

My first RCOT conference

Sessions

S1 Opening Plenary

S5 Unlocking Potential: occupational case formulation in a prison setting.

S7 RCOT Insights. Work, health and disability – occupational therapists as health and work champions

S10 Children and Families (research and practice development)

S11Keynote address RCOTSS Older People. Enabling a healthy and active older age

S12. Facilitated Poster Session

S25 Transforming healthcare for homeless people: the value of occupational therapy

S28 Older People Research. Lived experience of engagement in occupations by older people during the first year of widowhood & Social groups – exploring occupational engagement in older me.

S29 Elizabeth Casson Memorial Lecture. 

S30 Occupation Station. Hooked on Crochet

S30A Occupation Station. STARTwork: an art-based intervention to support people experiencing mental ill health move towards employment

S31 Combined Facilitated posters  (the occupation of cycling: an intervention for patients in rehab & recovery & promoting cycling and walking in the psychiatric rehab setting) and seminar (the value of cycling as a meaningful occupation)

S35 RCOT Insights. Media relations for occupational therapists

S38 Spirituality embedded into acute adult health occupational therapy

S39 Arthritis: products and life hack

S44 Doing beading and becoming: exploring beadmaking as therapeutic media.

S45 Facilitated Posters

S57 Don’t find fault, find a remedy. Building professional leadership in occupational therapy

S68 RCOT Debate. This house believes that diverse roles are a vital tool in the future of our profession.

S72 RCOT insights. Working in prisons – how occupational therapy can have the biggest impact.

S74 The value and meaning of a drop-in centre for asylum seekers and refugees.

S75(1) Brag and Steal. Perceptorship for newly qualified practitioners & Occupational therapists’ research engagement: enablers and challenges.

S75 (2) Interactive Journal Club

S84 Occupational Science. Exploratory study of skilled participation in embroidering & Exploring the meaning of creative writing as a meaningful occupation

S97 RCOTSS Older People Keynote: You don’t stop dancing because you grow old, you grow old because you stop dancing. 

S90 Neurology

S92.2 Pre-post evaluation of an occupational therapist led group lifestyle and resilience course for well employees in a public sector workplace.

S98 Closing Plenary

Posters

P26.Clicking your way through continuing professional development

P33 Leadership from the ashes: influencing change and promoting occupational therapy

P54 Bridging the gap between inpatient and community within a forensic learning disability service.

P56 Creating community connections: using photography, green spaces and a hot cup of tea to improve volition and bridge the gap between the low-secure unit and the community.

P60 The changing face of Birmingham City Council’s adult occupational therapy service

P81 Participation in advanced age: enacting values, an adaptive process.

As an Occupational Therapist working in the NHS I have seen many staff become burnt out or trying to attend work and “soldier on” when really they should be anywhere but at work.  I’ve observed lots of things put on offer by the NHS for managing staff sickness for example counselling sessions, supervision, occupational health etc. However it’s always struck me that not a lot has been done to prevent workers getting to this point and the literature in Occupational Therapy involvement is scarce.  When I saw this talk in the programme I knew I had to attend.

Miranda described in her talk how many companies offered tele-care for their staff, this was seen as a tick box measure to say that staff were offered support. This is neither effective or personal.  It also does not address the issue of presenteeism – attending work when a person’s mind is not on the job and really should be on sick leave. Presenteeism leads to a decrease in productivity and becoming a burden for the team – ultimately leading to dysfunctional unhealthy teams.  Companies however are very focussed on absence rates. Miranda discussed that once presenteeism was described to employers she received comments such as “ah yes I have 6 of those”. They could see that something else had to be done.  This concept also had to be sold to companies using their own language – using words such as resilience resonates with companies who will commission services.

The course consists of a closed group with 6 sessions that were 2 hours long and which took place every other week. The key was that it was in the workplace, people wanting to attend snowballed from the first group through word of mouth.  Feedback was that the attendees didn’t like the venue – it was in work! However other colleagues could hear and see laughter from the group sessions and were curious. Soon there was the creation of a culture to talk about balance and resilience in the office. Outstandingly there was virtually no drop out – the ones who did drop out said it was due to sessions clashing with meetings rather than choice – so therefore wasn’t a true drop out.  Miranda completed measures of participants before and after to determine whether the group was having the desired effect.

Groups consisted of sessions covering sleep hygiene, self-esteem/respect, lifestyle diaries (which were colour coded) and stealthy exercise.  Miranda stated that stealthy exercise is essential forf the sedentary office based worker – plus “why preach about having all your fruit and veg and 40 minutes of exercise every other day when I don’t even do this myself!?”

The results from the pre and post measures demonstrated significant changes in depression, anxiety and presenteeism scores. On top of this morale in the office was on the increase. Staff sickness absence, although already low as these were well members of staff, also dropped.  Feedback from the group was resoundingly positive with every session being rated as invaluable

The difference between running this type of group in an office environment rather that offering a call centre is that Occupational Therapists can offer adaption to people’s need rather than a one size fits all.

A paper collaboration with Professor Diane Cox is currently in process and will be submitted to the BMJ. After all, our conference take home message had to be “Publish! Publish! Publish! Good luck and I look forward to reading it in print!

For more information on Miranda Thew’s work:

Follow her on Twitter: @ThewMiranda

View her Healthy Living – Breathing Techniques video on YouTube: https://www.youtube.com/watch?v=Y3QXDpSCr3o

Or read her book: Thew, M. and Mckenna, J. (2008) Lifestyle Management in Health and Social Care. Chichester: Blackwell.

Blog post by: Catherine Gray (@CGray_OT)

Factors associated with participation in life situations after stroke in community dwelling adults: a systematic review

By Leisle Ezekiel (@lezeki ‏)

Ezekiel presented part one of her three planned systematic reviews that explored factors associated with participation in life situations after stroke in community dwelling adults. The lack of long-term support after stroke and the changing stroke demographic (an increase in the under 55 population) were highlighted. We were reminded that, as Occupational Therapists, we work at adapting the intersection between person and environment making participation modifiable.

The criteria for inclusion in this systematic review was outlined to include studies that investigated biopsychosocial factors over time in quantitative data. I found the discussion around bias useful to remember when reading research. For example, studies that excluded people after experiencing a severe stroke or people with communication difficulties were omitted. These would be the populations that would have increased difficulty in participation and therefore, we would be eager to record their experiences. This resulted in a review of over 11,000 participants between the ages of 18-99 years old living at home or a care facility.

Time was tight in this session so I couldn’t record all the findings but in summary, every factor of life effected participation after stroke apart from the type of stroke (a clot or a bleed) and more evidence was needed around the factor of driving. It was clear little research has been carried out past one year after stroke but commented that having poor participation after one year resulted in continued poor participation. Of course, the more severe strokes experienced resulted in poorer participation. Social support looked to be a positive factor for participation. Studies commented depression after stroke was difficult to treat which led us nicely into the next study by Aisling Durkin. Finally, Ezekiel suggested treatment plans need a change in vision creating a top-down approach. Personally, I have just finished my first placement in acute stroke rehabilitation and enjoyed the overview of the research available that this session brought.

Exploring the current education levels and practices for the assessment and treatment for post-stroke anxiety and depression: a survey of occupational therapists, physiotherapists, and speech and language therapists in the UK

By Aisling Durkin (@ais_d)

Figures show that 30% of people after stroke experience depression and 25% with post-stroke anxiety (PSA). Durkin concurred with our previous speaker, Leisle Ezekiel, that psychological changes such as depression and PSA effects participation but also mobility and cause an increase in clients’ length of hospital stay. It was also reiterated that not all people are receiving their review six months after stroke. This study recruited its 421 participants through social media comprising of occupational therapists, physiotherapists, and speech and language therapists working across the United Kingdom.

The findings revealed there is limited guidance on what education all professions should receive regarding assessing and treating depression and PSA with only some speech and language therapists reporting they attended formal counselling training for depression. Those that had had formal or informal training were shown to assess for depression and PSA. The most popular formal assessment was the Hospital and Depression Score (HADS) but many were assessing informally or within a general hospital questionnaire. Surprisingly, among many interesting statistics, 4.25% of Speech and Language Therapist did not assess for PSA when patients had aphasia post-stroke. As for treatment, Occupational Therapists were performing lifestyle, group, peer-supported, and individual self-help workbook interventions for depression post-stroke. Whereas, goal-setting, relaxation, graded approaches to activities, CBT, and individual self-help workbook interventions were reported as being used to treat PSA.

A positive finding for many in the audience was the fact the majority of all the professions either agreed or strongly agreed that it is their responsibility to assess for these conditions after stroke. It was also encouraging to see the work physiotherapists were doing already in this area but on the other hand, there was room for improvement for speech and language therapists.

In conclusion, Durkin reveals the gap between guideline expectations and reality in practice regarding gaining education in this area. Echoes from Diane Cox’s Casson address, ‘publish, publish, publish,’ were heard in my mind as non-validated tools and interventions are being undertaken in stroke rehabilitation at present. The agreement of every profession accepting responsibility for assessing depression and PSA after stroke is a big encouragement and was discussed in the question period after this presentation.

 Blog Squad writer: Orla Hughes (@orlatheot)

 

It’s always great to come together at the end of conference rather than all drifting off homeward and boy was this a session worth coming together for.

A session which informed, provoked thought, was full of humour and ended with the usual video roundup of photos you may have wished you knew were being taken at the time.

Jennifer Creek started the session by taking us on a journey from the origins of our profession to present day proposing that we should pay more attention to practice that is happening on the margins if we want to seek answers to some of the major challenges we face currently. It really challenged by thinking about what how power is invested in the centre and the influence this power exerts on a profession and the way it practices.

I had never really thought about the relationship between the origins of our profession and the rise in women’s movement from the late 19th century onwards but of course it made sense. How the liberation of women from the home and the domestic roles they had been cast in previously opened the door for them to take on wider more influential roles and responsibilities within society. Education, housing, contributing to the war effort and supporting those marginalised within society all became a focus of their work. Women started moving into professions where they had greater influence and ability to effect change.

Jennifer traced this journey across the Atlantic to the founding of the first school of occupational therapy and back to the origins of occupational therapy in the UK. It is of course always important to be reminded of our history but Jennifer’s journeying didn’t stop there.

Rather than this closing plenary being a lesson in our history we were taken one step further a step which felt a little less comfortable as Jennifer explored how thinking and practice in the USA and UK began to colonise our practice on a global level and dominate the centre ground of occupational therapy practice. Perhaps sharing her definition of margin may help illustrate this:

a physical place, a social space or a personal experience on the periphery of the social mainstream or dominant order. For every margin there is a core that represents some form or position of authority, power and privilege.

Jennifer shared how her experiences in South Africa had provided her with an opportunity to witness the resourcefulness, innovation and expertise that are occurring when you move further away from the constraints of the centre ground. She explored some of the characteristics of working at the margins – summarised on the slide below

Having worked in a small voluntary sector user led organisation in the late 1980s where funding was always an issue, the organisation was transitioning to becoming user led at the height of the rise of the disability movement and we were seeking new responses to meet demand – these all sound familiar. Exciting, challenging, liberating and scary are all be words I would use to describe that time.

Jennifer’s call: Explore the margins, places and spaces away from the mainstream if you want to discover places where creativity happens. This resented strongly with me.

Tina Coldham. Chair of the Social Care Institute for Excellence (SCIE) Co-Production Network, SCIE Trustee and Mental Health Campaigner

Last night an OT Saved my Life

Well, what can I say – I’m not even going to try to summarise Tina’s presentation for you as I know I won’t do it justice. There are some great moment captured on twitter for you to explore – just explore the hashtag #COT2017.  You really did need to be in the room to experience the heartfelt, side splittingly funny way in which Tina talked about the impact of occupational therapy on her life.

Describing herself as, “a practicing depressive – because I’m still practicing!” and through all the laughter, banter and jokes there was a serious message as Tina reflected on the different ways in which her encounters with occupational therapists have supported her at different times in her life. She talked about what it meant to have someone who was interested in her rather than her diagnosis. How no area of discussion was out of bounds.

Perhaps it is enough to leave you wth Tina’s description of occupational therapy as ‘the art of the possible rather than the science of the impossible.’

If you didn’t make it to conference I really want to flag up that Tina will be hosting one of the weekly #OTalk researchers on co-creation in research. Watch this space because I just need to pin them down to a date but it will be the 1st Tuesday of the months some time in the future!

What a fitting note to end conference on – but then of course came the photos!

Written by @lynnegoodacre

 

After a whirlwind two days the conference was almost over. This was the last session I would attend before the closing plenary and my mind was already buzzing with thoughts from other sessions I had seen. I wondered if I had made a mistake signing myself up to cover a session so close to the end of the conference. However, when Kathryn Jarvis sprung into life on stage I knew it was going to be an engaging and thought provoking session…

Implementing constraint induced movement therapy: a mixed methods study

Kathryn provided a simple outline of constraint induced movement therapy (CIMT);

A complex intervention to increase upper limb function, usually post stroke, made up of two components:

1. Constraint of the less affected upper limb with a mitt or sling.
2. Intense training of the affected limb.

She then relayed a story of a “bouncy” consultant who had heard about CIMT and with enthusiasm had asked – why aren’t we doing it? This question has stayed with Kathryn and prompted her to think critically about the evidence base for CIMT, and start her own research in to the area.

CIMT is not widely used in practice, and where it is practiced we are not using existing evidence based protocols. Kathryn’s mixed methods design used both quantitative outcome measures and qualitative interview to capture the impact of CIMT for four participants. For me, one of the most interesting aspects of Kathryn’s presentation of this research was her acknowledgement that where she expected to see the most gains in terms of performance (and there were improvements in performance for all four participants, some more marked than others), the biggest observable benefits of the CIMT protocols were in areas of volition and habituation. Kathryn thinks that “mixed methods ROCK” because had they not been using qualitative methods alongside the quantitative outcome measures, this aspect would not have been captured in the research.

What Kathryn’s research reveals is that evidence based protocols for CIMT are feasible for patients, with patient’s benefiting from a protocol that involves 3 hours training and 3 hours constraint. Feasibility in practice is not necessarily the same, the intensity of the training requires huge investment of time from staff and the trust where this research was carried out are still not implementing this protocol. Kathryn also highlighted that we still do not know what the active ingredients of CIMT are – we know the core components are training, constraint, routine, hope and the role of the therapist, but which elements are producing the outcomes? Complex interventions require a complex web of research.

Application of a conceptual framework to facilitate return to paid work following a brain injury

Karen Beaulieu has over thirty years experience as an occupational therapist working with patients who have had a brain injury. Both her own experience and the existing literature highlighted to her that returning to work is often a high priority for those who have experienced a brain injury, however a return to sustained paid employment is very difficult. Karen has conducted qualitative phenomenological research with 16 brain injury patients who have returned to work, and 11 employers who have been involved in this process, to explore how we as occupational therapists can begin to better facilitate this priority goal for our patients.

Karen acknowledged the short window of time she had to discuss this complex piece of research, and discussed her plans to take this research project forward. In the mean time, though she wants to be sharing the conceptual framework she has devised from her research and urges us to think about applying it. The four key themes of facilitating factors that came out of her research were occupational needs (including neglected areas such as drive and engagement), experiencing loss, grief and adjustment, looking at self identity (How are they different? What anchors them to their former selves?), and the importance of social inclusion and understanding in returning to work. These themes then lead to the conceptual framework below:

Karen urged all those who work with brain injury patients to be thinking about the elements outlined in the framework much earlier than usual, starting this process of managing expectations and addressing the grief from the beginning of a patient’s rehabilitation. I really look forward to seeing how this framework develops and hearing more of Karen’s findings in this area.

By Ayla Greenwood, @AylaOT