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Background. Illness perceptions have been shown to predict patient activities. Therefore, studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain (CLBP) are needed. Objective. The purpose of this study was to compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLBP. Design. This was a prospectively registered randomized controlled trial with an assessor blinded for group allocation. Setting. The study was conducted in an outpatient rehabilitation clinic. Participants. The participants were 156 patients (18-70 years of age) with CLBP (>3 months). Intervention. Patients were randomly assigned to either a treatment group or to a waiting list (control) group. Trained physical therapists and occupational therapists delivered 10 to 14 one-hour treatment sessions according to the treatment protocol. Measurements. The primary outcome measure was change in patient-relevant physical activities (Patient-Specific Complaints questionnaire). The secondary outcome measures were changes in illness perceptions (Illness Perceptions Questionnaire) and generic physical activity level (Quebec Back Pain Disability Scale). Measurements were taken at baseline (0 weeks) and after treatment (18 weeks). Results. A baseline-adjusted analysis of covariance showed that there were statistically significant differences between intervention and control groups at 18 weeks for the change in patient-relevant physical activities. This was a clinically relevant change (19.1 mm) for the intervention group. Statistically significant differences were found for the majority of illness perception scales. There were no significant differences in generic physical activity levels. Limitations. Longer-term effectiveness was not studied. Conclusions. This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinically relevant improvements in patient-relevant physical activities at 18 weeks., Chronic nonspecific low back pain (CLBP) is a major cause of activity limitations, absenteeism, and high health care expenses. (1) The prevalence of CLBP is estimated at approximately 23%, and [...]

Background/AimsOrthoses are often used to promote mobility and rehabilitation for patients in the UK after a stroke. The perspective of stroke therapists in the UK is an important factor determining current practice and orthotic provision. The purpose of this study was to investigate the views of orthotists, physiotherapists and occupational therapists on the delivery mechanisms and relationships that influence orthoses intervention and provision for patients with stroke in the UK.MethodsA UK-based online survey was conducted. Participants were stroke therapy clinicians within acute and community settings, recruited through their membership of the British Association of Prosthetists and Orthotists, the Association of Chartered Physiotherapists Interested in Neurology, and the Royal Collage of Occupational Therapists—Specialist Section for Neurological Practice. Data were analysed using descriptive statistics and content analysis.ResultsA total of 305 questionnaires were completed (64 orthotists, 131 physiotherapists, 110 occupational therapists). Some 67% (n=190) of respondents identified the optimal timing for initial orthotic assessment as within the first days following a stroke or before discharge from hospital. Waiting times and operational barriers to orthoses provision were perceived to have a negative impact on patients’ rehabilitation. A closer working relationship between orthotists and the stroke rehabilitation team is desirable.ConclusionsThe survey found that the use of orthoses and orthotic specialist input are perceived to play an important role within the stroke rehabilitation pathway. Further evaluative research is warranted to explore the optimal timing and benefits, and the orthotist's role within the stroke rehabilitation team.

Introduction Despite clear compatibilities between the tenets of occupational therapy and re-ablement, there is limited research on occupational therapy in homecare reablement services. This article describes an occupational therapy intervention that was delivered as part of a feasibility randomised controlled trial (Occupational Therapy intervention in HomEcare Re-ablement Services), and evaluates whether the intervention was acceptable to participants.Method There were three phases: (1) a bespoke pro forma was completed, recording the activities undertaken after each therapy visit; (2) an acceptability questionnaire was sent to every intervention participant and (3) semi-structured interviews were completed with key informants who received the intervention.Results The principal activities undertaken were assessment, case management, goal-setting, advice and support, and practising activities in relation to bathing/showering or kitchen activities. Participants particularly valued the advice and support provided. However, there were difficulties due to fluctuations in circumstances and with activities of daily living outside the home within the 6 week timescale.Conclusion An intervention focusing on activities of daily living within the home was acceptable for participants and consistent with their goals; however, they also had goals beyond personal activities of daily living and the timescale of the re-ablement episode. Further research should focus on extended activities of daily living, beyond this time-limited period.

Introduction: The daily task of dressing oneself requires multiple complex skills, which are often taken for granted by those free from ill-health or disability. Independence in dressing allows an individual to maintain a sense of dignity and choice over his or her appearance. Occupational therapy aims to restore independent functional performance in daily activities. Dressing independence requires both physical and cognitive skills. For survivors of stroke, impairment of such skills can pose great difficulty to their dressing performance.Method: The aim of this study was to examine the effect of arm paresis and cognitive impairment on upper body dressing ability using a cognitively impaired cohort of stroke participants (n = 70), and to explore the importance of bimanual activity when dressing in the presence of cognitive impairment. Dressing ability was assessed at baseline and immediately following a 6-week period of dressing practice with an occupational therapist.Results: Thirty-six participants were able to use a bimanual dressing method at baseline. The chi-square test for independence indicated a strong association between dressing method (bimanual or unimanual) and independence in upper body dressing, p<0.001. The dressing success of the bimanual group was significantly greater than that of the unimanual group at both assessment time points.Conclusion: Cognitively impaired stroke survivors do perform better at upper body dressing when they are able to use both hands as compared with one, but those with arm paresis preventing bimanual activity may still improve their dressing performance significantly with practice.

Research evidence supporting Early Supported Discharge (ESD) services has been summarized in a Cochrane Systematic Review. Trials have shown that ESD can reduce long-term dependency and admission to institutional care and reduce the length of hospital stay. No adverse impact on the mood or well-being of patients or carers has been reported. With the implementation of many national and international stroke initiatives, we felt it timely to reach consensus about ESD among trialists who contributed to the review.

PDOT (Parkinson's Disease Occupational Therapy) was a pilot randomised controlled trial investigating occupational therapy for people with Parkinson's disease (PD) exhibiting difficulties with activities of daily living (ADL). This article describes the process undertaken to design and record the intervention.Intervention development was informed by the current evidence base and practice consensus. An expert steering group synthesised this information to develop an intervention framework. A recording tool was identified from a previous occupational therapy trial and adopted for PDOT. This was completed for all participants receiving the intervention, capturing the dose and content of therapy delivered.Nineteen participants received occupational therapy. A mean number of 5.7 visits was delivered over 60.3 days, with the initial visit lasting 60 minutes (median) and subsequent visits lasting 50 minutes (median). The intervention log demonstrated that a large proportion of therapist visits involved equipment provision/environmental adaptation, mobility/transfers/ADL training, review/discussion, and the teaching of techniques/provision of education.The intervention developed was found to be feasible and acceptable, and the findings of PDOT have been used to inform a phase III rehabilitation trial (PD REHAB). The intervention log has been revised in light of the findings and will be used within this trial.

Loss of motor function is common after stroke and leads to significant chronic disability. Stem cells are capable of self-renewal and of differentiating into multiple cell types, including neurones, glia, and vascular cells. We assessed the safety of granulocyte-colony–stimulating factor (G-CSF) after stroke and its effect on circulating CD34 stem cells.

Virtual environments for use in stroke rehabilitation are in development, but there has been little evaluation of their suitability for this purpose. We evaluated a virtual environment developed for the rehabilitation of the task of making a hot drink.

This article describes an occupational therapy intervention for stroke that was provided as part of a randomised controlled trial in order to evaluate the effects of the intervention of an occupational therapist in a nursing and residential home setting. The intervention was developed and described to enable it to be reproduced in further evaluations, as recommended by the Medical Research Council's guidelines for clinical trials.Initially, the published evidence was reviewed and advice was sought to identify the process, content and recording methods needed to treat clients in a care home setting. This resulted in a clearly defined, evidence-based treatment package and a predetermined recording system.Sixty residents received occupational therapy: the mean number of visits was 8.5 and the mean total time per participant was 4.7 hours. During 508 visits, the majority of time was spent on activities of daily living training and mobility practice (40%), followed by assessment and goal setting (31%), communication with residents, staff, relatives and other agencies (15%), adaptive equipment (10%) and the treatment of impairments (4%).It is possible to develop evidence-based targeted occupational therapy interventions to be used in the context of a controlled clinical trial. Further work is required to examine the validity of the recording methods and the reproducibility of the intervention.

The Casson Memorial Lecture 2003, given on 11 July at the 27th Annual Conference of the College of Occupational Therapists, held at the Scottish Exhibition and Conference Centre, Glasgow. The conference theme was ‘Design for Living Life’.

The objective of this study was to determine occupational therapists' beliefs about the influence of cognitive impairment on dressing difficulties and to ascertain current practice when treating dressing problems. The study design was a questionnaire survey of occupational therapists experienced in stroke care who treated patients with dressing difficulties.Out of 137 questionnaires sent, 76 (55.5%) were returned. The frequency of dressing practice provided by the occupational therapists ranged from two to four times a week. Only 43% of the therapists used standardised assessments and the most common one used was the Rivermead Perceptual Assessment Battery. Apraxia was reported by 76% of the therapists as influencing a patient's ability to dress, neglect by 71 % and memory problems by 63%. Seventy-six per cent of the therapists reported that orientating clothing and relating it to body parts was a major dressing difficulty. Other dressing difficulties reported were sequencing by 56% and failing to dress the affected side by 34%. Ninety-eight per cent of the therapists spent time providing the practice of specific functional skills on a repetitive basis; however, 60% continued to use table-top tasks aimed at targeting a particular cognitive impairment.The majority of the therapists felt that cognitive impairment was a major reason for dressing difficulties in stroke patients. With the exception of one, all the therapists provided repetitive practice on dressing tasks and over half continued to use table-top tasks. The evidence to support the types of treatment used by occupational therapists remains controversial. Further research into this area is required.

The aftermath of stroke is commonly managed in the community, often exclusively by the GP. However, a significant proportion of community stroke patients have considerable impairments and disabilities which often go undetected and consequently untreated by the primary healthcare team. This article describes and quantifies the disabilities experienced by stroke patients living in the community and reviews the evidence for community rehabilitation. The roles of the occupational therapist and community nurse in the management of stroke rehabilitation are discussed. The authors conclude that an opportunity exists for better collaboration between the occupational therapist and the community nurse.

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ObjectiveTo evaluate the clinical efficacy of an established programme of occupational therapy in maintaining functional activity and reducing further health risks from inactivity in care home residents living with stroke sequelae.DesignPragmatic, parallel group, cluster randomised controlled trial.Setting228 care homes (>10 beds each), both with and without the provision of nursing care, local to 11 trial administrative centres across the United Kingdom.Participants1042 care home residents with a history of stroke or transient ischaemic attack, including those with language and cognitive impairments, not receiving end of life care. 114 homes (n=568 residents, 64% from homes providing nursing care) were allocated to the intervention arm and 114 homes (n=474 residents, 65% from homes providing nursing care) to standard care (control arm). Participating care homes were randomised between May 2010 and March 2012.InterventionTargeted three month programme of occupational therapy, delivered by qualified occupational therapists and assistants, involving patient centred goal setting, education of care home staff, and adaptations to the environment.Main outcome measuresPrimary outcome at the participant level: scores on the Barthel index of activities of daily living at three months post-randomisation. Secondary outcome measures at the participant level: Barthel index scores at six and 12 months post-randomisation, and scores on the Rivermead mobility index, geriatric depression scale-15, and EuroQol EQ-5D-3L questionnaire, at all time points.Results64% of the participants were women and 93% were white, with a mean age of 82.9 years. Baseline characteristics were similar between groups for all measures, personal characteristics, and diagnostic tests. Overall, 2538 occupational therapy visits were made to 498 participants in the intervention arm (mean 5.1 visits per participant). No adverse events attributable to the intervention were recorded. 162 (11%) died before the primary outcome time point, and 313 (30%) died over the 12 months of the trial. The primary outcome measure did not differ significantly between the treatment arms. The adjusted mean difference in Barthel index score at three months was 0.19 points higher in the intervention arm (95% confidence interval −0.33 to 0.70, P=0.48). Secondary outcome measures also showed no significant differences at all time points.ConclusionsThis large phase III study provided no evidence of benefit for the provision of a routine occupational therapy service, including staff training, for care home residents living with stroke related disabilities. The established three month individualised course of occupational therapy targeting stroke related disabilities did not have an impact on measures of functional activity, mobility, mood, or health related quality of life, at all observational time points. Providing and targeting ameliorative care in this clinically complex population requires alternative strategies.Trial registrationCurrent Controlled Trials ISRCTN00757750.