British Journal of Occupational Therapy

There are increasing demands on professionals within health care to provide a service that meets the needs and expectations of patients. This requires the patient to be placed at the centre of the care pathway. Occupational therapy is well placed to contribute to this change in emphasis because of its fundamental client-centred philosophy. Experience has shown, however, that the realisation of these aims has been a challenge for all health care professionals. Increasingly, the National Health Service is drawing upon expertise from outside and, in particular, the quality improvement tools that are used within industry.

This article explores the use of the traditional quality tool of process mapping in the evaluation and review of occupational therapy processes. The use of this tool is explained in relation to a clinical audit within a medical admissions unit.

The results of the process mapping exercise, and the associated audit that was undertaken, demonstrated the value of the approach. In particular, process mapping enabled the occupational therapy service to evaluate systematically the service being provided and to visualise the optimum pathway of care.

The use of orthotics in the management of rheumatoid arthritis appears to be relatively commonplace within occupational therapy departments. The aim of this study was to identify the frequency of orthotic use by occupational therapists, their beliefs about the efficacy of orthotic use, what they aimed to achieve by orthotic provision and any outcome measures used. The total membership of the British Association of Hand Therapists who were both occupational therapists and self-identified as working and/or having an interest in rheumatology (n = 132) were surveyed through a postal questionnaire. Of the responses received (n = 89, 67%), all the respondents (100%) were regular users of orthotics in the management of rheumatoid arthritis.

The results showed that the most highly rated reasons for orthotic provision were to decrease hand and wrist pain and to improve hand function. Subjective comments from the respondents provided evidence of positive beliefs about the efficacy of orthotic use, despite a lack of objective outcome measures to support such comment. Given the complexity of the intervening variables that occur with orthotic use, perhaps there is no easy answer; however, with the expectation of evidence-based practice and intervention, it is suggested that an increased use of standardised outcome measures may provide additional strength in presenting, often subjective, evidence.

Occupational therapists are increasingly embracing qualitative research methods yet little published advice exists in the occupational therapy literature to enable readers to gauge the quality and relevance of researchers' work. If qualitative research is to provide convincing evidence with which to inform theory and practice, it must be capable of withstanding critical scrutiny and practitioners must be given sufficient information with which to evaluate the strength and plausibility of the evidence reported. The process of undertaking qualitative research and of writing and critiquing subsequent reports is not about assessing adherence to rigid rules but of ensuring the appropriateness and thoroughness of data collection, analysis and reporting, given the nature and context of the issue. The espousal of a client-centred ethic also demands consideration of research relevance and usefulness to clients and the degree of consumer involvement throughout the research process.

This paper examines an evaluative framework that may be used to assess the quality of qualitative evidence as this is both researched and reported. Recourse to a set of general strategies — used where appropriate – will serve to enhance the quality of qualitative research and assert its potential to inform the client-centred, evidence-based practice of occupational therapy.

This paper examines some of the methodological and ethical issues that arose during the course of a qualitative study, which aimed to gain an understanding of the experience of head injury and the impact of rehabilitation. It focuses particularly on the problems that may be relevant for clinicians and researchers investigating aspects of their practice. The questions of the relationships between the researcher and the respondents, reflexivity and the dynamics of power during data collection and data analysis are discussed. These could be important considerations for others who wish to conduct research in their practice setting.