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Objective There is emerging evidence that individual levels of sensory sensitivity may impact treatment outcomes for people recovering from burn injuries. For example, individuals with higher levels of sensory sensitivity were less adherent with compression garment wear, often used for scar management. The purpose of this study was to characterise sensory patterns for a sample of burn-injured patients as a cohort, using normative data as the reference. As different patterns of sensory processing can have implications clinically, understanding this at the cohort level may provide valuable insight for therapy. Method This was a secondary analysis of data collected during a cross-sectional study. Adults (N=117) attending the Professor Stuart Pegg Adult Burns Unit outpatient clinic completed the Adolescent/Adult Sensory Profile and the following quantitative sensory tests: two-point discrimination; mechanical detection threshold; and pressure pain threshold. Results Compared to matched normative data, burn-injured patients reported higher levels of sensory sensitive and avoiding patterns, and experienced lower detection thresholds for touch and pain. Conclusions Higher reports of sensory sensitivity and sensory avoiding, and lower thresholds for touch and pain, have been correlated with tactile defensiveness. Tactile defensiveness has been associated with social withdrawal and isolation, all of which could contribute to decreased engagement in therapy. The ways in which these sensory characteristics impact on burn-related treatments, such as compression garment adherence, warrant further investigation.

PurposeThis paper aims to investigate infant sensory patterns and their associations with previous perinatal loss, maternal-foetal attachment and postnatal maternal sensory patterns.Design/methodology/approachIn a prospective cohort study, women with and without perinatal loss (N= 57) were recruited from an Australian public hospital. Participants were surveyed during pregnancy (maternal-foetal attachment, loss) and again postnatally (maternal/infant sensory patterns). Chi-square tests and logistic regression analyses controlling for previous perinatal loss were conducted with infant sensory patterns as outcome variables.Findings“More than typical” infant low registration was associated with poorer quality of maternal-foetal attachment. “More than typical” infant sensory seeking was associated with previous perinatal loss and higher levels of maternal sensory seeking. “More than typical” infant sensory sensitivity was linked with previous perinatal loss, poorer quality of maternal-foetal attachment and higher maternal low registration. “More than typical” infant sensory avoidance was associated with poorer quality of maternal-foetal attachment and higher levels of maternal sensory sensitivity.Practical implicationsTo support more typical infant sensory patterns, results point to the potential benefit of occupational therapists supporting pregnant women with previous perinatal loss; facilitating favourable maternal-foetal attachment; and educating new mothers on how their sensory patterns impact on interactions with their infant. Sensory modulation strategies that consider the sensory patterns of both mother and infant may be beneficial to promote engagement in co-occupations.Originality/valueThese findings are the first to suggest that previous perinatal loss, poorer quality of maternal-foetal attachment and higher levels of maternal postnatal sensory patterns represent risk factors for infant sensory patterns that are “more than typical.”

Maternal–fetal attachment (MFA) describes the thoughts, feelings, and behaviors of a pregnant woman toward her unborn baby. With MFA increasingly seen as an important predecessor of future outcomes, understanding the factors associated with MFA may reveal targets for treatment, potentially optimizing outcomes for mothers and infants. The primary aim of this research was to examine associations between MFA and maternal sensory and attachment patterns, when controlling for psychological distress. The secondary aim was to compare MFA and distress for women with and without previous perinatal loss. Pregnant women (N = 108) were recruited from two antenatal clinics at an Australian maternity hospital. During pregnancy, participants completed the Maternal Antenatal Attachment Scale, Adolescent/Adult Sensory Profile, Mental Health Inventory-38, and Attachment Style Questionnaire. Hierarchical linear regression models, controlling for psychological distress as the second step, were performed. Final models revealed that more favorable quality of MFA was associated with lower sensory sensitivity and higher sensory seeking. More time spent in MFA was associated with younger maternal age and higher levels of maternal sensory seeking. Women with previous perinatal loss had more distress but similar levels of MFA compared to women without loss. We provide the first evidence of links between MFA and maternal sensory patterns, and further elucidate links between adult attachment and mental health in women with and without previous perinatal loss. Consideration of maternal sensory patterns, adult attachment, and mental health status antenatally may inform new directions for services seeking to facilitate the relationship between a mother and her unborn baby.

Introduction Whilst it is recognised that cancer may present numerous challenges for the adolescent or young adult during treatment, experiences after this stage as the young person transitions to life without cancer have received little attention. The purpose of this study is to understand the implications of having survived cancer for the young person’s choice of, and participation in, meaningful occupational roles. Method In this qualitative descriptive study, four participants were interviewed on two occasions using semi-structured interviews, with the subsequent interview supplemented with photo elicitation. Participants were male and female, aged 19 and 24 years, and medically cleared of (living beyond) cancer. Thematic analysis was used. Results Three main themes emerged: changes in relationships; moving beyond; and future perspectives. Adolescents and young adults identified the impact of the cancer experience on interpersonal relationships and related occupational roles (for example parenthood), and described how cancer affected their participation in, and the meaning of, occupational roles, and altered present and future occupational priorities. Conclusion Having cancer as an adolescent or young adult has lasting impacts on occupational roles. Understanding the opportunities and challenges this population may face when living beyond cancer can assist in providing enhanced age-aware occupational therapy, potentially optimising outcomes for young people.

Background: Adolescence and young adulthood are periods of increased substance use, with insecurely attached individuals at greater risk of abusing substances. With recent evidence linking insecure...

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

Background. Increasingly, occupational therapists are working with women in the perinatal period, including supporting the developing mother-child relationship. Purpose. To examine prenatal predictors of maternal-infant attachment (maternal-fetal attachment, sensory patterns, adult attachment, perinatal loss, and mental health) that may provide possible avenues for assessment and intervention by occupational therapists. Method. Women (N = 60) were assessed during pregnancy and within one year postpartum in a cohort study. Independent t-tests, correlations, and multivariate regression models were conducted. Findings. Low threshold maternal sensory patterns, more insecure adult attachment, and poorer quality of maternal-fetal attachment were each correlated with less optimal maternal-infant attachment. Quality of prenatal attachment was the best predictor of overall postnatal attachment in multivariate regression models. Implications. Occupational therapists working in a range of clinical settings (e.g., mental health, substance use, and perinatal care) may work with women during pregnancy to promote their relationship with their developing baby in utero and after birth.

Importance: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain. Objective: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain. Design: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires. Setting: Tertiary pain management clinic. Participants: Children (ages 8–12 yr) and adolescents (ages 13–18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently. Measures: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection. Results: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL. Conclusion and Relevance: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain. What This Article Adds: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.

Objective Compression garments are well accepted as routine practice for scar management after burn. In a recent systematic review, six main reasons for compression garment non-adherence were identified including sensory disturbances. To further understand the impact of sensory issues, the aim of the present study is to investigate associations between sensory variables and compression garment wear. Method Adults (N = 117) attending a quaternary adult burns outpatient clinic completed: The Adolescent/Adult Sensory Profile; a custom-designed compression garment wear questionnaire; and three quantitative sensory testing procedures (Two-Point Discrimination, Mechanical Detection Threshold and Pressure Pain Threshold). Results Patients who reported lower Pressure Pain Threshold or Mechanical Detection Threshold, higher acuity for Two Point Discrimination, and higher than average sensory avoiding and sensory sensitivity patterns were less adherent with garment wear. Conclusions Overall, sensory factors assessed using both self-report and quantitative sensory testing were associated with compression garment adherence. This knowledge suggests the value in developing and evaluating sensory-informed treatment strategies to improve compression garment wear.

Beyond expert suggestions as to the appropriate subject matter for chronic pain assessments, little is known about the actual content of multidisciplinary pain centre (MPC) clinical assessments. The International Classification of Functioning, Disability and Health Low Back Pain Core Set (ICF LBP-CS) provides a universal language to support the consistent description of LBP-related assessments across disciplines within multidisciplinary teams (MDTs). This study sought to map the content of MPC clinical assessments to the ICF to: (1) identify and compare the content of clinical MDT assessments using a cross-disciplinary framework and (2) examine the content validity of the LBP-CS. A qualitative examination of MPC team clinical assessments of chronic low back pain was undertaken. Multidisciplinary team (pain medicine, psychiatry, nursing, physiotherapy, occupational therapy, and psychology) assessments were audio-recorded and transcribed. Concepts were extracted from transcripts using a meaning condensation procedure and then linked to the ICF. Across 7 MDT assessments, comprised 42 discipline-specific assessments and 241,209 transcribed words, 8596 concepts were extracted. Contextual factors (ie, the person and environment), except for physiotherapy, accounted for almost half of each discipline's assessments (range: 49%-58%). Concepts spanned 113 second-level ICF categories, including 73/78 LBP-CS categories. Overall, the findings revealed novel insights into the content of MPC clinical assessments that can be used to improve health care delivery. International Classification of Functioning, Disability and Health-based assessment profiles demonstrated unique contributions from each discipline to chronic low back pain assessment. Finally, users of the LBP-CS can be confident that the tool exhibits sound content validity from the perceptive of MDT assessments of functioning, disability, and health.

Objective Up to 40% of adult burn-injured patients are non-adherent with prescribed compression garment wear. The aim of this paper is to systematically review the literature to understand barriers to adherence with compression garment wear. Method Papers were included if they: investigated adults who required compression garment wear for the management of burns scars; focussed on reasons for non-adherence to compression garment wear; and were available in English. The process of meta-ethnography was then followed to synthesise the findings. Results The factors impacting adherence to compression garment wear were grouped into six themes: sensory factors, psychological state, the impact of the garment on the patient’s function, the availability of social support, the degree of choice, and the education provided to patients by their therapists. A model of compression garment adherence was developed detailing how these factors fit within the continuum of treatment for a burn-injured patient. Conclusions Adherence to compression garment wear post-burn injury is a complex, dynamic phenomenon impacted by a range of factors. Findings from this review may inform approaches to support more consistent and/or extended garment wear, potentially improving scar outcomes and quality-of-life. Further research is recommended to investigate how each of the six identified themes impact adherence.

With increasing concerns about the potential harm of long-term opioid therapy, there is a need for the development and implementation of alternative treatment strategies for patients with chronic pain who have been using opioids for a prolonged period of time. Based on the findings from a recent qualitative investigation that suggested there may be a bidirectional association between opioid reliance and habitual overactivity behaviour (activity engagement that significantly exacerbates pain), this study was designed to quantitatively investigate the association between opioid use and habitual overactivity over a 5-day period in a group of chronic pain patients. Participants provided a list of their prescribed pain medication, completed a self-report measure of habitual overactivity, and then commenced 5 days of data collection. Data collection required participants to wear an activity monitor and to complete a diary that detailed their daily activities and the time at which they took medication. Individuals reporting higher levels of habitual overactivity were more likely to be prescribed opioids. In addition, higher levels of habitual overactivity were associated with more frequent pro re nata ("as needed") opioid use over the 5 days, and with a discrepancy between the prescribed and actual oral morphine-equivalent daily dose, where more medication was taken than was prescribed. There was no predominant context for pro re nata use. The results of this study support the idea that habitual overactivity behaviour may play a role in the development of reliance on opioid medication and that such an association may provide a potential treatment target for opioid therapy rationalisation.

Sensory modulation patterns contribute to altered pain perception and disengagement in activities; atypical sensory modulation patterns have been associated with higher pain sensitivity, catastrophizing, and reduced function. Objectives of this study were to ascertain whether: adolescents with persistent pain had atypical sensory modulation patterns, atypical sensory modulation was associated with reduced functioning and higher pain, and pain catastrophizing mediated the relationship between sensory modulation and functional disability.Adolescents (N=70, females=63, males=7) attending tertiary level interdisciplinary team assessment for persistent pain completed sensory modulation (Adolescent/Adult Sensory Profile), pain catastrophizing (Bath Adolescent Pain Questionnaire), pain intensity, functional disability (Functional Disability Index), and quality of life (QOL) (Pediatric QOL Scales) questionnaires.Adolescents with persistent pain had atypical patterns of sensory modulation compared with normative data. Sensory modulation patterns were not associated with pain intensity; however, higher sensitivity was associated with greater disability (r=0.36, P0.01), and lower registration of sensation was associated with poorer emotional (r=0.31, P0.01), social (r=0.35, P0.01), and school-related (r=0.49, P0.001) QOL. Sensory modulation, pain intensity, and catastrophizing contributed independently to disability; catastrophizing mediated sensory sensitivity and both functional disability and emotional QOL.This study is the first to show that atypical sensory modulation patterns are associated with poorer function for adolescents with persistent pain, suggesting that individualized sensory-informed interventions can potentially facilitate participation in daily activities and improve QOL.

Objectives: Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. Methods: Questionnaire data were collected consecutively from a 1-year cohort of whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). Results: Both attachment dimensions were significantly associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. Conclusion: Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after whiplash injury.

The aims of this study were to investigate associations between attachment and the presence of persistent pain in women following treatment for breast cancer and to investigate the relationship between attachment, pain, and quality of life (QOL) in women with persistent pain.Women (N = 335) previously diagnosed with primary non-metastatic breast cancer completed an online survey with measures of attachment, pain, QOL, demographics, and medical history. Variables were compared between women with (N = 128) and without (N = 207) persistent pain. For those reporting pain, regression analyses were conducted to investigate relationships between attachment, pain, and QOL.Higher attachment anxiety, but not attachment avoidance, was related to the presence of persistent pain. Among women with persistent pain, associations between attachment anxiety and avoidance and greater pain intensity were lost when pain catastrophizing was considered in analysis. Significant associations between attachment and diminished QOL and perceived effectiveness of pain management were identified in multivariate analysis.These findings extend the available literature regarding associations between pain and attachment insecurity. In women with pain after breast cancer treatment, attachment anxiety and avoidance were associated with negative pain and QOL outcomes. Further attention regarding the use of attachment-informed approaches in supporting women following breast cancer treatment is indicated.

A small body of literature has considered associations between attachment theory and a range of chronic health conditions, with particular attention to mechanisms linking attachment insecurity and the development and management of these conditions. In this paper, two inceptive models are reviewed, followed by consideration of the emerging literature in this field, stimulated by emerging physiological and neurobiological evidence. Although implications for treatment are available, treatment protocols and outcome studies are rare. Further research is needed to develop a more comprehensive and nuanced understanding of the links between insecure attachment and chronic conditions with a view to developing and implementing treatment protocols. These emerging interventions must recognize the complex personal and social/physical environmental contexts within which chronic conditions manifest.

Although adult attachment theory has been revealed as a useful theoretical framework for understanding a range of health parameters, the associations between adult attachment patterns and a range of oral health parameters have not yet been examined. The aim of this study was to examine potential associations between attachment insecurity and: (1) oral health-related quality of life (OHRQoL), (2) oral health behaviours, and (3) self-rated oral health. In association with this aim, sample characteristics were compared with normative data. The sample in this cross-sectional study was comprised of 265 healthy adults, recruited via convenience sampling. Data were collected on attachment patterns (Experiences in Close Relationships Scale-Short Form, ECR-S), OHRQoL (Oral Health Impact Profile-14, OHIP-14), oral health behaviours (modified Dental Neglect Scale, m-DNS), and self-rated oral health (one-item global rating of oral health). Multivariate regression models were performed. Both dimensions of attachment insecurity were associated with lowered use of favourable dental visiting behaviours, as well as decreased OHRQoL for both overall well-being and specific aspects of OHRQoL. Attachment avoidance was linked with diminished self-rated oral health. This study supports the potential value of an adult attachment framework for understanding a range of oral health parameters. The assessment of a client’s attachment pattern may assist in the identification of people who are at risk of diminished OHRQoL, less adaptive dental visiting behaviours, or poorer oral health. Further research in this field may inform ways in which attachment approaches can enhance oral health-related interventions.

Background: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. Methods: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an expert panel' was assembled to review and rank these using a Policy Delphi approach. Results: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 Essential', 25 Important' and 44 Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. Conclusion: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice.

Background/aim: Occupational therapy programs must prepare graduates for work in mental health. However, this area of practice is complex and rapidly changing. This study explored the alignment between educational priorities identified by occupational therapists practising in mental health and level of coverage of these topics in occupational therapy programs in Australia and New Zealand. Methods: Surveys were distributed to heads of all occupational therapy programs across Australia and New Zealand. The survey included educational priorities identified by occupational therapists in mental health from a previous study. Respondents were requested to identify the level of coverage given to each of these priorities within their curriculum. These data were analysed to determine a ranking of educational topics in terms of level of coverage in university programs. Results: Responses were received for 19 programs from 16 universities. Thirty-four topics were given High-level coverage' in university programs, and these were compared against the 29 topics classified as Essential priorities' by clinicians. Twenty topics were included in both the Essential priorities' and High-level coverage' categories. Topics considered to be Essential priorities' by clinicians which were not given High-level coverage' in university programs included the following: mental health fieldwork experiences; risk assessment and management; professional self-care resilience and sensory approaches. Conclusion: While there appears to be overall good alignment between mental health curricula and priorities identified by practising occupational therapists, there are some discrepancies. These discrepancies are described and establish a strong foundation for further discussion between clinicians, academics and university administration to support curriculum review and revision. Refereed/Peer-reviewed

Background Following previous perinatal loss, women in a subsequent pregnancy may experience heightened emotions, such as anxiety and fear, with a range of longer-term implications. To support these women, the Mater Mothers’ Bereavement Support Service in Brisbane, Australia, developed a Pregnancy After Loss Clinic (PALC) as a specialised hospital-based service. The present study investigated the experiences of mothers with previous perinatal loss in relation to: (a) their subsequent pregnancy-to-birth journey, and (b) the PALC service. Such research seeks to inform the ongoing development of effective perinatal services. Method A qualitative interview-based research design was employed with a purposive sample of 10 mothers who had previously experienced perinatal loss and who attended the Mater Mothers’ PALC during their subsequent pregnancy in 2015. All mothers had subsequently delivered a live baby and were in a relationship with the father of the new baby. Women were aged between 22 and 39 years, primiparous or multiparous, and from a range of cultural backgrounds. Semi-structured interviews, conducted either at the hospital or by telephone by an experienced, independent researcher, lasted between 20 min and one hour. All interviews were audio-recorded and transcribed verbatim, with participant names changed. Interviews were analysed using content analysis by two researchers who were not involved in the service delivery or data gathering process. Results Seven themes were identified from the interview material: The overall experience, The unique experience of first pregnancy after loss, Support from PALC, Experiences of other services, Recommendations for PALC services, Need for alternative services, and Advice: Mother to mother. Conclusions Participants spoke positively of the PALC services for themselves and their families. Anxieties over their subsequent pregnancy, and the desire for other health professionals to be more understanding were frequently raised. Recommendations were made to extend the PALC service and to develop similar services to support access for other families experiencing perinatal loss. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1200-9) contains supplementary material, which is available to authorized users.

Occupational therapists working in mental health who experience burnout, low work engagement or poor job satisfaction are at risk of poor wellbeing at work and may be more likely to leave their jobs. The aim of this project was to explore factors associated with wellbeing at work and turnover intention in a sample of occupational therapists working in mental health.One hundred and three occupational therapists working in mental health in Queensland completed a survey exploring work/life balance, effort invested in work, rewards received from work, wellbeing at work (job satisfaction, burnout and work engagement) and turnover intention. Analyses were conducted to explore relationships between work/life balance, effort, reward, wellbeing at work and turnover intention.All measures of wellbeing at work were significantly associated with turnover intention. A large proportion (33%) of the variance in turnover intention was predicted by job satisfaction. Perceptions of both work/life balance and effort invested in work, as well as perceived rewards in terms of recognition, prestige and personal satisfaction were significantly associated with work-related wellbeing scores.Results from this study deepen the understanding of factors associated with wellbeing at work and turnover intention for occupational therapists in mental health. This knowledge will support the development of interventions aimed at reducing turnover intention and enhancing retention of occupational therapists in the mental health workforce.

Many contemporary support services for children and young people (CYP) in out-of-home-care have adopted a collaborative approach to service provision in order to best meet the complex needs of clients. The purpose of this study was to gain a better understanding of the perceptions of Evolve Behaviour Support Services (EBSS) frontline and managerial staff delivering services to CYP in out-of-home-care with disability and complex behaviours regarding interagency/stakeholder collaboration. Views about the number and nature of collaborative partnerships, factors which facilitate or hinder effective relationships and advantages (including unintended benefits) of collaboration were sought. Qualitative interviews with 21 participants highlighted issues around: (1) general and agency/stakeholder specific issues and barriers, and (2) benefits of collaboration. The collaborative approach to service provision was seen as greatly enhancing the effectiveness of EBSS' response and ability to meet the range of CYP's complex needs, as well as having benefits for carers and service providers. Nevertheless, difficulties with collaboration were also encountered. Frequently identified challenges included reduced stakeholder engagement, differences in professional backgrounds and practice frameworks, unequal initiation of contact and follow-up, organisational disparities, communication and information sharing problems, frequent stakeholder turnover and geographical barriers in rural/remote areas.

Background Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. Objectives To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. Selection criteria We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Data collection and analysis Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. Main results We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision. There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention. Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some. No adverse events were reported in any of the studies. Authors' conclusions Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions. The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research.

The application of sensory modulation approaches in mental health settings is growing in recognition internationally. However, a number of barriers have been identified as limiting the implementation of the approach, including workplace culture and a lack of accessible and effective sensory approaches training. The aim of this project was to investigate the efficacy of providing this training through a custom-designed e-learning package. Participants in the present study were predominately nurses and occupational therapists working in mental health settings in Queensland, Australia. Data were collected from 121 participants using an online survey. Significant improvements were found between pre- and post-training in participants' real and perceived levels of knowledge, their perceived levels of confidence, and their attitudes towards using sensory modulation approaches in mental health settings. The findings of the study suggest that the custom-designed sensory approaches e-learning package is an effective, accessible, acceptable, and usable method to train health professionals in sensory modulation approaches. As this study is the first to analyse the efficacy of an e-learning sensory approaches package, the results are considered preliminary, and further investigation is required.

Background The International Classification of Functioning, Disability and Health (ICF) Low Back Pain Core Set (LBP-CS) has been proposed as a tool to facilitate the description and measurement of chronic low back pain (CLBP) related disability. Patient ratings of ICF categories may serve as a practical and effective method for acquiring patient input on activity limitations and participation restrictions. Objective To investigate the test-retest agreement and reliability of patient ratings of activity and participation according to the LBP-CS. Methods A cross-sectional repeated-measures questionnaire study was undertaken with thirty-one medically stable adults with CLBP who presented for treatment at two public Australian hospitals. Participants completed the LBP-CS Self-Report Checklist (LBP-CS-SRC) on two occasions (mean = 12.5 (SD = 4.5) days between administrations). The LBP-CS-SRC permits patients to self-rate their functioning according to the LBP-CS activity and participation categories and enables the derivation of activity limitation and participation restriction scales. Results Patient ratings of individual LBP-CS categories generally exhibited good – excellent test-retest agreement (percentage exact agreement: 74.19–100.00%) and reliability (kappa: 0.53–1.00). The test-retest reliability coefficients of the LBP-CS-SRC activity (ICC = 0.94) and participation (ICC = 0.90) scales were excellent. The minimum detectable change values for the activity and participation scales were 8.11 and 15.26, respectively. Conclusions This study is the first to demonstrate that patients can provide reliable ratings of functioning using the LBP-CS. The LBP-CS-SRC was shown to be acceptably reliable and precise to support understanding of patients' perspectives on disability in rehabilitation practice and research.

Introduction: With cardiovascular disease (CVD) increasing for female workers, there is a need to understand the factors associated with CVD in members of the occupational therapy, predominantly female, profession. The association between burnout and physical health effects, such as CVD, has not been investigated in paediatric occupational therapists. Method: Associations between CVD and demographic and work-life factors were investigated in a nationwide postal survey of 486 paediatric occupational therapists. Results: The prevalence of CVD in the study population was 11.02%. Private practitioners, older therapists and those with additional self-reported health problems from respiratory disease had increased odds of reporting CVD. In contrast, lower odds of CVD were found for therapists with access to social support, a secure attachment style and income satisfaction. Conclusion: Understanding demographic, personal and work-related variables associated with CVD in paediatric occupational therapists provides valuable information about members of the profession. The identification of potentially modifiable work-life factors that are inversely associated with CVD, such as social support and having a secure attachment style, suggests further avenues for research and intervention. Ongoing vigilance, and education directed towards self-care as well as client care, is required to ensure optimal health for colleagues.

Context In Australia, government policies support therapeutic interventions for children and young people (CYP) with challenging behaviours related to or secondary to disability, who are in out-of-home care. The aims of interventions are to enhance the skills of both CYP and foster caregivers/parents in order to enhance placement stability, community participation and the overall well-being of the CYP. These interventions are costly and time consuming for CYP, their foster caregivers/parents and the professionals/agencies involved, and evaluation of their effectiveness is warranted. Objectives To review the effectiveness of current practices and interventions for CYP in out-of-home care who have challenging behaviours related to disabilities. Data sources Databases searched included: PsycINFO (1840–September 2010), ERIC (1966–September 2010), MEDLINE (1950–September 2010), CINAHL (1982–September 2010), Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2010), Social Services Abstracts (1979–September 2010), PAIS international (1972–September 2010), PsycARTICLES (1894–September 2010), Sociological abstracts (1952–September 2010). Study selection Randomised or quasi-randomised controlled trials (RCT), non-randomised controlled trials, and cohort studies of interventions or programs for CYP with complex psychological and/or behavioural issues, and/or a disability in foster care were included. Data extraction Details of study characteristics, population demographics and intervention content were tabulated. Qualitative analysis was performed by two independent raters using the Physiotherapy Evidence Database (PEDro) scale for RCTs and an adapted version of The Downs and Black Checklist for Measuring Study Quality (DB Scale) for non-randomised control trials. Data synthesis Four studies met inclusion criteria (two RCTs and two non-randomised control trials). The two RCTS were of moderate methodological quality, each scoring five points (out of a maximum of 10) on the PEDro Scale. The two non-randomised control trials were of similar methodological quality, scoring 14–17 points (out of a maximum of 28) on the adapted Downs and Black Checklist. Content The included studies evaluated a variety of interventions which differed considerably with respect to services offered, approach/philosophy, service delivery models and intensity/duration. Two of the four studies were of behaviourally based parent training interventions. Whilst the other two studies also involved parent training, the primary focus of intervention was the implementation of individualised case management plans by key stakeholders in the CYP's life. The frequency of intervention and length of follow-up in the included studies varied greatly. Three of the reviewed studies reported positive outcomes for children and young people, as well as their caregivers/parents, whilst the fourth found no significant change. Conclusions Studies generally demonstrated gains from the interventions provided, however the nature and extent of these benefits differed greatly across the various outcomes measured. Further, studies often did not take into account other factors which may have contributed towards the observed outcomes. In light of the complexity of providing services to CYP with behavioural issues and/or disability who are in out-of-home care, the costs associated with these services, and the risks if these are not effective, this review highlights the need the need for further research of the efficacy of support services for this group.

Although people with life-limiting conditions report a desire to have spiritual concerns addressed, there is evidence that these issues are often avoided by health care professionals in palliative care. This study reports on the longitudinal outcomes of four workshops purpose-designed to improve the spiritual knowledge and confidence of 120 palliative care staff in Australia. Findings revealed significant increases in Spirituality, Spiritual Care, Personalised Care, and Confidence in this field immediately following the workshops. Improvements in Spiritual Care and Confidence were maintained 3 month later, with Confidence continuing to grow. These findings suggest that attendance at a custom-designed workshop can significantly improve knowledge and confidence to provide spiritual care.

Background: It has been argued that the unique nature of the occupational therapy role in palliative care (PC) warrants dedicated attention in undergraduate programmes to improve the confidence of occupational therapy graduates to work in this setting. Nevertheless, little is known about either the present PC education or the preparedness of graduates to work in this field. In addressing each of these issues, this study also sought information to guide the development of occupational therapy-specific undergraduate teaching resources. Methods: Survey information was gathered from two participant groups: (i) six occupational therapy schools from Australia and New Zealand and (ii) 24 occupational therapists employed in PC in Australia and New Zealand. Two different surveys were used, targeting issues specific to each of these two groups. Where possible, data were analysed quantitatively, whereas open-ended questions were interpreted thematically. Results: Occupational therapy schools reported 2–10 hours of PC-specific content and requested teaching resources specific to the occupational therapy role. Less than half of the clinicians (45.8%) recalled receiving undergraduate content in PC, and 75% reported having felt unprepared to work in this field. Clinicians who had received PC-specific content at university felt more prepared to work in this field than those who had not. Several recommendations for teaching PC were made. Conclusions: The link between the extent of PC education received and perceived readiness to work in this field, together with the relatively small amount of dedicated undergraduate PC-specific content, supports the need to optimise teaching in this unique field.

Attachment theory has been acclaimed as ‘the best supported theory of socioemotional development yet available’ (Bowlby, 1988, p. 28) and, more recently, as the most widely accepted and validated approach in developmental psychology (Thomas, 2005). The ongoing extension of the original childhood focus of attachment theory to include research into adolescence and adulthood highlights the applicability of this theory ‘from the cradle to the grave’ (Woodward, 2004, p. 53). In more recent years attachment theory has impacted, both theoretically and clinically, in fields as diverse as infant mental health (Teti, 2005), chronic pain (Meredith, Ownsworth, & Strong, 2008) and ageing (Woodward). Although this expansion of the theory suggests its relevance to clinical and academic occupational therapists, a search of the occupational therapy literature suggests that this powerful theory has had little identifiable impact on the literature of our profession. In this paper, attachment theory is briefly described, and the small amount of evidence linking attachment theory specifically to the field of occupational therapy is considered. Attention is then transferred to the broader attachment literature (non-occupational therapy specific) which highlights the potential of attachment theory to inform occupational therapy practice and research. In particular, it is the goal of this paper to promote awareness of the importance of understanding and utilising the tenets of attachment theory within our profession, including its potential to: (i) improve our understanding of clinical phenomena and support clinical reasoning across all fields of occupational therapy practice (including mental health, physical and paediatric practice); (ii) improve our understanding of individual health behaviours, emotions and beliefs; (iii) guide early intervention/prevention; (iv) guide specific areas of practice, such as work rehabilitation; (v) support understanding of key practices and processes relevant to our profession; (vi) inform professional issues; (vii) gain personal insights; and (viii) promote and refine research, with implications for the provision of optimal occupational therapy services and education.

Adult attachment theory has been portrayed as a framework from which to conceptualise career choice, with evidence that occupational therapy students report both a high rate of secure attachment and high levels of satisfaction with their career choice (Roney et al 2004). These findings appear to support the notion that those with secure attachment styles are drawn to the people-oriented, care-giving nature of occupational therapy. The present study was undertaken to test this assumption further by comparing students from first-year occupational therapy and commerce courses: two courses perceived to differ in their focus on care giving. One hundred and fifty-three university students (n = 53 occupational therapy, n = 100 commerce) completed a questionnaire encompassing demographic information, adult attachment styles, factors influencing career choice and the level of satisfaction with this choice. A significant difference in the attachment styles between the two groups (p

Objectives:To examine: (1) the relationships between habitual approach to activity engagement and specific aspects of physical functioning in chronic pain; and (2) whether or not these relationships differ according to pain duration.Materials and Methods:Outpatients (N=169) with generalized chronic pain completed a set of written questionnaires. Categories of approach to activity engagement were created using the confronting and avoidance subscales of the Pain and Activity Relations Questionnaire. An interaction term between approach to activity engagement categories and pain duration was entered into analysis with age, sex, pain intensity, the categorical approach to activity engagement variable, and pain duration, in 9 ordinal regression models investigating functioning in a variety of daily activities.Results:The approach to activity engagement category predicted the personal care, lifting, sleeping, social life, and traveling aspects of physical functioning but, interestingly, not the performance skills used during these activities, that is, walking, sitting, and standing. The interaction term was significant in 2 models; however, the effect of pain duration on associations was the inverse of that theorized, with the relationship between variables becoming less pronounced with increasing duration of pain.Discussion:The results of this study do not support the commonly held notion that avoidance and/or overactivity behavior leads to deconditioning and reduced physical capacity over time. Findings do, however, suggest that a relationship exists between avoidance and/or overactivity behavior and reduced participation in activities. Implications for the clinical management of chronic pain and directions for further research are discussed.

BACKGROUND: The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication ofPain Curricula for Occupational Therapy and Physiotherapyby the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the 'People in Pain' course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement.OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain.METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study.RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance.CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

edited by C. Long & J. Cronin‐Davis, 2006, Oxford, Blackwell Publishing, 186 pp. + index, £26.90 (paperback), ISBN 1‐4051‐4666‐4 Based on the title of this book alone, readers might expect a presen...

This thesis presents empirical evidence supporting the relevance of adult attachment theory in understanding the chronic pain experience. The thesis arose from the recognition that, although pain-related psychosocial variables have been used to differentiate subgroups of individuals in chronic pain, little is known about the developmental origins or cognitive, behavioural, or affective correlates of these subgroups. Attachment theory offers a development framework, which is of potential value in guiding early pain intervention and prevention efforts, as well as tailoring interventions to suit specific patient needs. In order to investigate the value of applying adult attachment theory to the chronic pain field, five central research questions were identified: 1) Does insecure attachment contribute to a more negative experience of acute pain for those not diagnosed with a chronic pain condition? That is, does the association between insecure attachment and maladaptive pain-related variables precede the onset of chronic pain)? 2) How do the subgroups of adult attachment, identified in a chronic pain sample, compare to the clusters identified by pain-related psychosocial measures in the same sample? 3) Are the documented associations between attachment and psychosocial variables (i.e., cognitive appraisals, self-efficacy, coping, social support) evident in the context of chronic pain? 4) Do attachment variables moderate the associations between these psychosocial variables and painrelated variables?, and 5) What is the association between adult attachment variables and outcomes from chronic pain rehabilitation programs? To address the first question, an experimental study was designed to explore the perceptions, emotions and coping patterns of 58 pain-free individuals exposed to an acute (coldpressor) pain experience. Findings revealed that higher levels of anxiety over relationships were associated with lower pain thresholds, more stress, depression and anxiety, diminished perceptions of control over pain, and diminished ability to decrease pain. More secure attachment, on the other hand, was associated with greater perceptions of control over pain, and lower levels of depression and catastrophizing. In order to explore research questions 2-5, data from two clinical samples were collected on the first and last days of participation in one of two chronic pain rehabilitation programs (program length varied from two to three weeks). A total of 152 participants completed questionnaires before treatment, with 100 of these participants also completing questionnaires after treatment. Participants were aged between 18 and 82 years (M = 38.8, SD = 12.4), and had been in pain for an average of 3.7 years (SD = 6.9). Approximately 41% of participants were women, and 58% were men (gender for one participant was unknown). In order to address question two regarding the similarity between adult attachment subgroups and pain clusters based on a psychosocial pain measure (Multidimensional Pain Inventory, MPI), pre-treatment data were analyzed. The clustering approach using the MPI, known as Multiaxial Assessment of Pain (MAP), identifies three subgroups of individuals, labeled interpersonally distressed, dysfunctional, and adaptive copers. These clusters were compared with the four subgroups and two dimensions obtained with adult attachment measures. Results revealed that the interpersonally distressed MAP subgroup was associated with fearful attachment, while the dysfunctional MAP subgroup was linked with avoidant (low comfort) attachment. The comfort attachment dimension was associated with more adaptive MPI variables, while the anxious attachment dimension was linked with more maladaptive MPI variables. Consideration of research questions three to five prompted development of an integrative model, the Attachment-Diathesis Model of Chronic Pain (ADMCP), which provided a framework for exploring the psychosocial mechanisms linking attachment security with the outcome variables of perceived pain intensity, disability, and treatment outcomes. Based on predictions emerging from this model, a set of five studies explored pre-treatment associations between adult attachment variables, six psychosocial mechanisms (pain appraisal, depression, pain self-efficacy, anxiety, perceptions of social support, and coping), and outcome variables pre-treatment. One further paper was devoted to implications of adult attachment for treatment outcome. In general, findings from these studies revealed that variables representing attachment insecurity were significantly associated with more maladaptive coping, cognitive, affective and interpersonal characteristics, both before and after treatment, compared to variables reflecting secure attachment. Overall, both securely and insecurely attached individuals made progress in response to pain rehabilitation. Finally, a summary of the evidence of associations between attachment variables, psychosocial mechanisms, and treatment outcomes revealed by this research is presented, permitting discussion regarding the explanatory value of the ADMCP and clinical implications. Limitations to the present research, including family-wise error, the use of self-report measures, and the self-selecting nature of the sample, are discussed, and directions for further research are proposed. The evidence presented in this thesis advances our understanding of the developmental origins of chronic pain conditions, and provides a lens through which to view the heterogeneity of people with chronic pain. Overall, this project highlights the value of applying adult attachment principles to this field. It is anticipated that findings will assist in the development of a more differentiated range of treatment approaches for the individuals who experience chronic pain. In addition, the findings of this project may have important implications for prevention and early intervention of these conditions.

Purpose It is difficult to replicate evidence-informed models of psychosocial and assertive care interventions in non-research settings, and means to determine workforce capability for psychosocial therapies have not been readily available. The purpose of this paper is to describe and provide a rationale for the Therapy Capability Framework (TCF) which aims to enhance access to, and quality of, evidence-informed practice for consumers of mental health services (MHSs) by strengthening workforce capabilities and leadership for psychosocial therapies. Design/methodology/approach Guided by literature regarding the inadequacies and inconsistencies of evidence-informed practice provided by publicly-funded MHSs, this descriptive paper details the TCF and its application to enhance leadership and provision of evidence-informed psychosocial therapies within multi-disciplinary teams. Findings The TCF affords both individual and strategic workforce development opportunities. Applying the TCF as a service-wide workforce strategy may assist publicly-funded mental health leaders, and other speciality health services, establish a culture that values leadership, efficiency, and evidence-informed practice. Originality/value This paper introduces the TCF as an innovation to assist publicly-funded mental health leaders to transform standard case management roles to provide more evidence-informed psychosocial therapies. This may have clinical and cost-effective outcomes for public MHSs, the consumers, carers, and family members.