British Journal of Occupational Therapy

High energy expenditure by healthy older individuals has numerous benefits, and housework and exercises done at home are among the most common physical activities. However, there is little knowledge about how characteristics of the urban built environment could impact energy expenditure for moderate and vigorous daily activities. This study characterizes accessibility and a number of physical barriers, investigates the relationship between home environmental press and energy expenditure at home, and identifies the environmental characteristics that could explain variability in energy expenditure.

The home energy expenditure of 35 healthy older women was determined from retrospective geolocation data and a multi-sensor device measuring energy expenditure (SenseWear Armband®). Barriers at home were identified with the Housing Enabler.

The median was 51 environmental barriers with only 7.5 barriers between the 1st and 3rd quartile, on a total of 161 possible environmental barriers of the Housing Enabler. The number of home environmental barriers was positively and moderately correlated with energy expenditure at home (r_s = 0.47, p = 0.01). No characteristic of the home built environment was identified that could explain the variability in energy expenditure.

Future research should identify the characteristics of the home associated with a lower or higher energy expenditure according to the characteristics of the person. This could be carried out by occupational therapists for the purpose of preventing deconditioning, energy management, promotion of social participation, recommendations for home adaptations or relocation.

Cognitive problems are common after stroke and their identification and management is important for survivors, carers and clinicians. However, the appropriateness of the screening methods and ways in which results inform community clinical care have not been established. The aim of this phase of the Cognitive Management Pathways in Stroke Services study was to explore key issues to undertaking cognitive assessment, particularly in community settings.

Participants recruited via local and national contacts, and from an earlier phase of the Cognitive Management Pathways in Stroke Services research, took part in face-to-face or telephone semi-structured interviews. Data were analysed using framework analysis.

Findings: Twenty-one occupational therapists were recruited. Availability of cognitive tests, personal knowledge, previous experience, training, cost, time and familiarity were key factors in conducting cognitive screening assessments and interpreting results. Other factors included patient language or mood deficits, the assessment environment, lack of experience, confidence and workload.

There is variation in the cognitive screening of stroke survivors in the community. Screening assessments are being used by occupational therapists based on availability and familiarity, rather than evidence of their validity and sensitivity. There is also variation in the interpretation of such assessments, which has implications for clinical practice.

The call for occupational therapists to embrace occupation-based practice has increased in recent decades. Little is known about how occupational therapists perceive and implement occupation-based practice. This study aims to uncover the experiences of new and recent graduates using occupation in their practice.

A phenomenological design guided the development of semi-structured interviews. New and recent Australian occupational therapy graduates were interviewed about their experiences of occupation in their practice. Interview transcripts formed the data and themes were developed by thematic analysis.

Eighteen occupational therapists were interviewed. Three main themes emerged from the data. Overall, graduates found it challenging to embrace occupation in their everyday practice, deciding it is more pressing to remediate impairments than to enable occupations. Some participants stated that occupation-based practice was unrealistic given the efficiency pressures of their practice environments. However, graduates felt that with more experience they would be able to implement occupation in their daily practice.

Recently graduated occupational therapists in Australia find it challenging to consistently implement occupation in their daily practice. Confidence to apply occupation-based skills is an important factor for implementing occupation in practice. Some recent graduates are choosing impairment-based techniques over occupation-based practice.

Global migration as well as migration to Sweden has increased during the last few decades. A self-rating instrument that measures cultural competence could support occupational therapists’ professional knowledge when they encounter clients from different cultural backgrounds. The purpose of this study was to evaluate the content validity and utility of the Swedish version of the Cultural Competence Assessment Instrument among occupational therapists. Nineteen occupational therapists participated in four focus groups.

Qualitative analysis was used to evaluate content validity and utility.

The results revealed that all 24 items of the Cultural Competence Assessment Instrument were valid, even though six of the items were in need of reformulations and exemplifications. The category Interactions with clients showed that the Cultural Competence Assessment Instrument – Swedish version could be utilised individually to raise awareness on cultural issues in practice. The category Workplace and its organisational support showed that the Cultural Competence Assessment Instrument – Swedish version had potential for use in different workplaces, and indicated the importance of organisational support in the development of communications and cultural competence.

The evaluation indicated positive content validity for the Cultural Competence Assessment Instrument – Swedish version, and that it had the potential to be utilised in the Swedish context.

Occupational therapists are increasingly referred children who experience difficulty with social interaction at school. Research indicates that social difficulties are impacted by inefficient use of cognitive strategies. The Perceive, Recall, Plan and Perform system of intervention targets underlying cognitive strategies during task performance. This study aimed to investigate the impact of a playground social skills programme based on the Perceive, Recall, Plan and Perform intervention.

A quantitative, experimental, crossover design was used to evaluate the effectiveness of the Perceive, Recall, Plan and Perform intervention on developing social competence for a group of children in primary school (Kindergarten to Grade Three). Sixteen children participated in the study. Goal attainment scaling scores and Perceive, Recall, Plan and Perform assessment scores rated by teachers were used as outcome measures. Data were analysed using a series of two-way repeated-measures analysis of variance.

Outcome measures taken at three time-points indicated that the children improved in social performance significantly more when receiving the Perceive, Recall, Plan and Perform intervention compared to opportunities for regular playground activities. This was apparent across both goal attainment scaling change scores and change in intervention total scores.

This strategy-focused approach appeared to be effective in developing the thinking strategies that facilitate children’s social participation at school.

Occupational therapy home programmes for children with cerebral palsy have a robust evidence-base, but their content and usage in United Kingdom practice is unknown.

A national online survey questionnaire was conducted with occupational therapists to explore their current occupational therapy home programme practices, and attitudes toward using home programmes with children with cerebral palsy. Recruitment was through members of two sections of the Royal College of Occupational Therapists, a University’s Fieldwork-Supervisor’s Database and self-selection following promotion on occupational therapy networks, social media and newsletters.

Of all survey respondents (n = 123), the majority of respondents (n = 74; 60%) used occupational therapy home programmes. The uptake and use of evidence-based home programme content varied, revealing evidence-practice gaps. Respondents clearly articulated their professional reasoning and acknowledged benefits of using home programmes. However, they reported barriers to implementing them within a family-centred framework, citing time constraints, lack of knowledge, skills and training, and insufficient support.

Occupational therapists report challenges to implementing evidence-based interventions and the routine, systematic application of a range of standardised measurement tools pre/post occupational therapy home programmes. Such tools would enhance quality outcomes for children with cerebral palsy and their families. However, occupational therapists indicated the need for greater organisational support, further education and skill development in these areas.