British Journal of Occupational Therapy

This qualitative study adds to the client-centred literature by focusing on occupational therapists' experience of working on teams that support clients with a severe and persistent mental illness from a client-centred perspective. The paper reports on the second category of data relating to a previously published paper, which replicated the work of Sumsion (2004).

Interviews were conducted with 12 therapists to capture their experience and interpretation of this approach to practice. The multiphased analysis included template analysis and open coding. It resulted in the creation of the category of meaningful goals, which addressed the work done to ensure that the goals towards which everyone was working were meaningful for the client. The facilitators related to these goals included team cohesion, the structure of the system and family collaboration and support. The challenges were differing perspectives and paradigms, competitive frameworks and time.

This study identified the unique contribution that families provided to a client-centred approach. Overall, the study makes a significant contribution to the literature and to therapists' understanding of the factors that influence the therapist's ability to facilitate client-centred practice.

This study was carried out to explore the current usage of standardised assessments and outcome measures by occupational therapists working with adults with physical disabilities. A survey research design, using a postal questionnaire specifically designed for the study, was employed.

Completed questionnaires were returned by 109 occupational therapists working in a variety of settings, including acute care, community and inpatient rehabilitation. A range of standardised assessments and outcome measures was in use, with an average of four different measures being used by the individual respondents. The most commonly used measures were the Mini Mental State Examination (Folstein et al 1975), Rivermead Behavioural Memory Test (Wilson et al 1985), Functional Independence Measure (Uniform Data System for Medical Rehabilitation 1999), Barthel Index (Mahoney and Barthel 1965) and the Chessington Occupational Therapy Neurological Assessment Battery (Tyerman et al 1986). However, the consistency of use tended to be low. The barriers to a more consistent use of standardised assessments and outcome measures included time restraints, the unsuitability of the available measures and a lack of sensitivity of the available measures to capture the effectiveness of occupational therapy.

The findings support those of previous studies exploring this issue among occupational therapists from different areas of practice. The respondents in this study highlighted the need for a multifaceted approach, encompassing educational, managerial and individual responsibility, to address the issue of the usage of standardised assessments and outcome measures among occupational therapists.

The visual perceptual skills of children are often evaluated by health care and education practitioners. Even though the Test of Visual Perceptual Skills - Revised (TVPS-R) is one of the most frequently used instruments with school-age children, its construct validity has not been evaluated thoroughly. The purpose of the study was to evaluate the scalability/interval level measurement, unidimensionality, lack of differential item functioning (DIF), and hierarchical ordering of items of the TVPS-R and its seven subscales using the Rasch Measurement Model (RMM). The TVPS-R scores from a sample of 356 normally developing children (171 boys and 185 girls), ranging in age from 5 to 11 years, were used to complete the RMM analysis.

When the seven individual TVPS-R scales were analysed, they all exhibited adequate measurement properties (scalability/interval level measurement, unidimensionality, lack of DIF, and hierarchical ordering). However, when they were collapsed together to form an overall composite scale of motor-free visual perceptual skills, the TVPS-R items failed to group together to measure a unidimensional construct. In addition, many scale items exhibited RMM misfit or DIF.

The results suggest that the seven TVPS-R subscales can be used on an individual basis with clients to generate a profile of their motor-free visual perceptual skills, but that they cannot be summed together to calculate an overall summary motor-free visual perceptual score or perceptual quotient. The TVPS-R composite scale does not exhibit adequate construct validity.

Cancer-related fatigue is reported as the most common and distressing symptom experienced by people with cancer. There is limited research published to guide occupational therapists working with people with cancer to help address this distressing symptom. This article reviews literature on cancer-related fatigue and identifies several factors associated with the development of fatigue, including underlying medical factors and other factors.

The underlying medical factors reported in the literature include biomedical mechanisms, such as anaemia, proinflammatory cytokines and specific cellular processes; disease-related factors; treatment-related factors; and comorbid conditions. Other factors reviewed include physical or behavioural factors, such as poor nutrition, decreased activity, sleep disturbance and pain; psychological factors, including anxiety and depression; and sociodemographic factors, such as social support, employment and education.

The review identified a variety of factors associated with cancer-related fatigue, which must be considered by occupational therapists working with people with cancer. This presents a challenge to the clinical reasoning of occupational therapists attempting to treat such people. A framework of factors contributing to cancer-related fatigue is proposed in order to guide both the practice of occupational therapists working with adults with cancer and future research in this area.

With the relocation of local authority roles to primary care trust occupational therapy services, an additional set of criteria for aids and adaptations has been introduced alongside the existing criteria used by health-based occupational therapists. This has led to questions over implementation and use, and highlighted the need for further training. The use of Fair Access to Care Services eligibility criteria potentially enables a wider range of interventions by the occupational therapy service and gives access to a greater range of services. However, the implementation has been inconsistent and further appropriate investment in training and support is required.

Congratulations to the following who have achieved the qualifications in occupational therapy indicated. The College of Occupational Therapists wishes them every success in the future and hopes that their careers will be both interesting and rewarding.

The list contains the names of successful candidates from all higher education institutions in the United Kingdom that offer pre-registration occupational therapy programmes accredited by the College and notified to the College between August 2008 and January 2009. A further list will be published in the May 2009 issue.

*With Merit **Distinction ***Commendation