British Journal of Occupational Therapy

This study explored factors influencing occupational therapists' clinical decision making when choosing to assess upper limb post-stroke sensory impairments (ULPSSI) and selecting interventions.

A survey of 187 American occupational therapists working with stroke survivors.

Respondents most commonly assessed ULPSSI to determine the impact on occupational performance and guide interventions, and most commonly did not undertake assessment if clients either reported no impairments or were unable to participate in testing. Being unaware of interventions, believing motor interventions addressed ULPSSI and lack of time most commonly led to the decision not to use interventions for ULPSSI. Clients' cognitive status, severity of ULPSSI and time since stroke influenced therapists when choosing between compensatory or remedial approaches. Prior experience, effects seen when trialling interventions and consulting other therapists most commonly influenced specific intervention choice.

Deciding to assess ULPSSI was influenced by theoretical knowledge and domain-specific clinical knowledge while decisions about interventions were largely influenced by the therapists' domain-specific clinical knowledge, clinical experience and by specific contextual factors such as time available for therapy. Respondents used both automatic and reflective or deliberate decision-making processes. Education on evidence-based interventions and strategies for decision making in areas of clinical uncertainty is warranted.

Refugees experience a number of difficulties when settling in the United Kingdom and may be faced with occupational injustice due to their restricted occupational engagement. This study explores the value of an allotment group for refugees of working age, aiming to explore the role of horticulture and the social environment on health, wellbeing and social inclusion.

This was an exploratory study using qualitative methodology based on ethnographic principles. Data collection included observation of the group, semi-structured interviews with five participants, with four of these participants also taking part in photo-elicitation interviews. Data analysis involved using a ‘framework’ approach to produce three themes and associated sub-themes.

Analysis identified firstly gardening as a meaningful activity; secondly, the importance of the social environment and, lastly, the value of occupational engagement for refugees. Further theoretical analysis led to the conclusion that these themes linked to the dimensions of occupation: doing, being, belonging and becoming.

The findings identify how occupational engagement can have a positive impact on the health and wellbeing of refugees, specifically with the use of social and therapeutic horticulture.

This exploratory study sought to answer the question, ‘What are the experiences of neurological occupational therapists when having bad news conversations with disabled people regarding likely levels of long-term disability?’.

The study design was a retrospective qualitative method within a phenomenological methodology. Convenience sampling was used to identify occupational therapists working with neurologically impaired adults. Ten semi-structured interviews using a topic guide were conducted. Ethical approval was granted by the Faculty Research Ethics Committee.

Participants had bad news conversations prior to discharge and there was a functional focus. Four approaches to these conversations emerged: collaboration, being direct, avoidance and using a client-centred approach. Strategies included use of pre-discharge home visit, goal setting, using others, maintaining hope and communication skills. The participants agreed that this task has an emotional cost.

Bad news conversations are an important and sometimes difficult clinical task that can have an impact on the quality of the therapeutic relationship. Little has been documented regarding occupational therapists' conversations relating to living with long-term disability. This study has underlined the importance of addressing this task in undergraduate education and also in the supervision of junior occupational therapists.

Chronic pain has an impact on the working life of those affected, but what about other areas of daily living? The objective in this research paper is to review the relationship between chronic pain and engagement in instrumental activities of daily living (IADLs), sleep and family life.

A search in the Medline (2006–2010) and the Cumulative Index to Nursing and Allied Health (CINAHL) (2004–2010) databases using the key terms ‘chronic pain’, ‘family’, ‘sleep disorders’ and ‘occupation’ was carried out. To be included, articles had to refer to the effects of chronic pain on IADLs, on sleep or on the family. Studies in which a specific diagnosis or condition was discussed were excluded to provide a more general view of the effects of chronic pain. Quality was assessed using the STROBE statement scale (for descriptive studies, from Strengthening the Reporting of Observational studies in Epidemiology), the Qualitative Research Guidelines Project (for qualitative studies) and the PRISMA statement scale (for systematic reviews, from Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Of the 256 articles obtained from the search, 13 met the inclusion criteria. The articles show that chronic pain indeed has an impact on the lives of those affected in other areas besides work rehabilitation.

Occupational therapists must consider levels of performance and engagement in all occupational domains of an individual, even when focusing on a single domain due to the work setting or commissioning process.