Better access to mental health : mapping the evidence supporting participation in meaningful occupations

Introduction: The purpose of this scoping and mapping project is to assess evidence for the use of focused psychological strategies (FPS) under the Better Access to Mental Health (BAMH) scheme to enable people with mental health problems to increase their functional performance and to participate in meaningful occupations. In particular, it aims to provide an accessible summary of evidence for practitioners who use FPS with their clients.

Methods: Evidence scoping and mapping is a relatively new technique, used to provide an overview of key findings in an area of practice. A five stage process of scoping and mapping was used in this project.

Results: A total of 81 studies which addressed the use of focused psychological strategies to promote functional performance and participation in meaningful occupations were found. Surprisingly, only three were published in occupational therapy journals with one further article being authored by occupational therapists. Three maps are provided showing this evidence by diagnosis, intervention and level of evidence.

Conclusion: Clinicians can say with some confidence that cognitive behavioural therapies are effective functional tools, particularly when working with people with depression or schizophrenia. They can also be confident that good quality evidence exists across a range of diagnoses, although there are many gaps where little to no research has been conducted. Suggestions for further research are provided which take into account the findings of these maps.

Creating high challenge/high support academic environments through constructive alignment: student outcomes

Higher education needs to provide challenging yet supportive learning environments catering for students with diverse academic needs. There is also an emphasis on using student-driven outcome measures to determine teaching effectiveness. How can these measures be used to reflect upon and evaluate teaching initiatives? Using an undergraduate occupational therapy programme as the site for exploration, this article reports on an application of constructive alignment principles and describes how available empirical data were used to explore student outcomes. A comparison was made between student evaluations and academic grades prior to, and after the implementation of the initiative. Results provide evidence of improvement in student satisfaction and academic grades as a result of implementing constructive alignment. Whilst it is acknowledged that changes in academic grades and student evaluations can be attributed to a number of factors, findings of this study support a view that constructive alignment facilitates students' learning and experiences.

Ocupação, bem-estar e satisfação de vida: a experiência de um modelo alternativo de estágio em terapia ocupacional na Austrália

An alternative training model within occupational therapy developed at Deakin University, in Australia, named Occupation, Wellness and Life-Satisfaction (OWLS) is presented. OWLS provides students with opportunities to practice in nontraditional settings, thus enabling strategic learning in non-clinical settings, including working with professionals who are not occupational therapists and with different work cultures and practices, in response to gaps identified within the community. It promotes opportunities for developing skills such as health promotion, health education and assessment and interventions in schools, thus improving the health and wellbeing of the community. The program has contributed towards development of new projects, with positive results achieved by students, thereby representing an important educational strategy for professional occupational therapy training and expanding the field of activities.

Changes and challenges in higher education : what is the impact on fieldwork education?

Although fieldwork practicums have long been mandatory and integral requirements of our professional education, there is now an increasing focus on integrating work experience more broadly into a range of academic programs. These activities are increasingly coming under the spotlight of universities and the Federal government (Patrick et al., 2008). The provision of quality fieldwork education for both occupational therapy students and fieldwork educators remains critical, requiring strong collaboration and partnerships between universities, the profession and representative bodies. However, we argue that as the characteristics of universities and students has changed considerably in recent years, the planning and implementation of fieldwork needs to be informed by an understanding of these ongoing changes.

Discriminant validity of the sensory profile in Australian children with autism spectrum disorder

Objective. The discriminant validity of the Sensory Profile was evaluated by comparing the sensory processing scores of Australian children, 5 to 8 years of age, diagnosed with autism spectrum disorder (ASD) to a control group of children with typical development matched for age and gender. Method. Twenty-six parents of children with ASD and 26 parents of typically developing children without ASD completed the Sensory Profile. Sensory Profile category, factor, and quadrant scores were compared using multivariate analysis to investigate if there were differences between the two groups. Results. The results indicated that the children with ASD had significantly lower sensory processing scores on all fourteen categories, eight out of nine factors, and all four quadrants of the Sensory Profile. Conclusion. The results also provide evidence of discriminant validity of Sensory Profile scores between children with ASD and children with typical development. In addition, the study findings indicate that the Sensory Profile can be used with confidence in cross-cultural contexts, such as Australia.

A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

Background
Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service.
Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial.
Discussion This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services.

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial

Background

Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.

This was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged ≥18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.

We randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n = 496) or usual care Monday to Friday rehabilitation (n = 500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio = 0.81, 95% CI 0.61 to 1.08).

Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation. 

Barriers and enablers to clinical fieldwork education in rural public and private allied health practice

There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect quantitative and qualitative data about the barriers and enablers that AHPs encounter when supervising students in their clinical setting. A total of 113 public and private AHPs from Southwest Victoria, Australia, returned the questionnaire. The AHPs were trained in the disciplines of occupational therapy, physiotherapy, speech pathology, dietetics, podiatry or psychology. The majority of respondents (75%) had previously supervised students. Most respondents had only provided fieldwork education in the public sector. Allied health professionals working in public and private sectors had positive experiences with clinical fieldwork education and often had increased job satisfaction while supervising students. They experienced similar enablers to involvement in clinical fieldwork education programs, however the barriers they encountered were different. The findings highlight the differing issues between rural public and private settings that need to be addressed for successful clinical fieldwork education and work-integrated learning. Strategies to address the identified barriers need to be specific to the work conditions of each setting.

Assistive technology costs and outcomes

Assistive technologies (AT or aids and equipment) are a key intervention used by occupational therapists and others to minimise the impact of disability or the effects of ageing upon life participation. Our capacity to provide optimal AT is however subject to pragmatic factors such as the availability of public funding and the complexities of government policy and service provision. The Equipping Inclusion Studies conducted in Victoria between 2008 and 2010 were designed to encompass both health sector and individual perspectives on the effectiveness of AT as it is currently delivered, compared with optimal delivery.