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Occupation-based practice (OBP) is central to the practice of occupational therapists where occupations or meaningful activities become the focus of the assessment, intervention, and outcomes measurement process. Although occupational therapists practising in Thailand claim that they engage in OBP, this claim warrants empirical investigation. This study aimed to investigate the experiences and perceptions of hospital-based occupational therapists of OBP within stroke rehabilitation. Utilizing a qualitative design, fourteen occupational therapists were recruited through purposive sampling. Data were collected through semi-structured interviews until data saturation was reached. Each interview was recorded and transcribed verbatim, and data were analyzed using thematic analysis. Five themes were identified (1) Perspective towards OBP, (2) OBP as professional value and cultural identity, (3) Implementing OBP for stroke rehabilitation in hospital settings, (4) Environmental factors of using OBP in stroke rehabilitation, and (5) OBP in the service management. Occupational therapists perceived that OBP is important for professional identity. Using OBP provides positive changes in stroke clients. This study provides evidence that will help implement OBP into occupational therapy in Thailand.

PURPOSE:\ud Despite growth in rehabilitation research, implementing research findings into rehabilitation practice has been slow. This creates inequities for patients and is an ethical issue. However, methods to investigate and facilitate evidence implementation are being developed. This paper aims to make these methods relevant and accessible for rehabilitation researchers and practitioners.\ud \ud METHODS:\ud Rehabilitation practice is varied and complex and occurs within multilevel healthcare systems. Using a "road map" analogy, we describe how implementation concepts and theories can inform implementation strategies in rehabilitation. The roadmap involves a staged journey that considers: the nature of evidence; context for implementation; navigation tools for implementation; strategies to facilitate implementation; evaluation of implementation outcomes; and sustainability of implementation. We have developed a model to illustrate the journey, and four case studies exemplify implementation stages in rehabilitation settings.\ud \ud RESULTS AND CONCLUSIONS:\ud Effective implementation strategies for the complex world of rehabilitation are urgently required. The journey we describe unpacks that complexity to provide a template for effective implementation, to facilitate translation of the growing evidence base in rehabilitation into improved patient outcomes. It emphasizes the importance of understanding context and application of relevant theory, and highlights areas which should be targeted in new implementation research in rehabilitation. Implications for rehabilitation Effective implementation of research evidence into rehabilitation practice has many interconnected steps and a roadmap analogy is helpful in defining them. Understanding context for implementation is critically important and using theory can facilitate development of understanding. Research methods for implementation in rehabilitation should be carefully selected and outcomes should evaluate implementation success as well as clinical change. Sustainability requires regular revisiting of the interconnected steps.

This article describes findings from a qualitative study of the experiences of female student veterans in the military and in college. Twelve women were interviewed from two public research universities. Findings revealed individuals “betwixt and between” the complex intersection of identities: in the military, grappling with a sense of self as soldiers and as women, and trying to figure it out; and in college, as undeserving veterans struggling with the social and cognitive dissonance experienced as students. Under implications, we discuss how the complexity of identity complicates our understanding and support of this population in college.

Communication and teamworking skills are essential healthcare professional skills, yet undergraduates exhibit reluctance to engage with group work, especially in interprofessional groups. The aim of the study was to investigate whether a virtual reality bomb-defusing simulator would enable students to gain these skills through an enjoyable and challenging scenario without profession-specific knowledge. Students took it in turns to play the role of the ‘Defuser’ immersed in a headset, while the rest of the group were ‘Experts’ with a printed manual, but no sight of the bomb. The task challenged students to relay obscure symbols and instructions to each other rapidly and effectively. A subsequent focus group explored the impact of the simulation on students’ perceived learning, engagement and communication skills. The focus group of five multiprofessional healthcare students reported high levels of engagement and satisfaction while highlighting value in developing communication and teamwork. The simulator nurtured initial group dynamics and team bonding. Evaluation data indicated that the intervention facilitated cooperation, team bonding and the development of good communication skills. This method of encouraging communication would fit well into an interprofessional learning session as a useful tool ahead of more technical and clinically based group work.The focus group of five multiprofessional healthcare students reported high levels of engagement and satisfaction while highlighting value in developing communication and teamwork. The simulator nurtured initial group dynamics and team bonding.

Background Acquired brain injury can cause eye movement disorders which may include: strabismus, gaze deficits and nystagmus, causing visual symptoms of double, blurred or 'juddery' vision and reading difficulties. A wide range of interventions exist that have potential to alleviate or ameliorate these symptoms. There is a need to evaluate the effectiveness of these interventions and the timing of their implementation. Objectives We aimed to assess the effectiveness of any intervention and determine the effect of timing of intervention in the treatment of strabismus, gaze deficits and nystagmus due to acquired brain injury. We considered restitutive, substitutive, compensatory or pharmacological interventions separately and compared them to control, placebo, alternative treatment or no treatment for improving ocular alignment or motility (or both). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (containing the Cochrane Eyes and Vision Trials Register) (2017, Issue 5), MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, AMED Ovid, PsycINFO Ovid, Dissertations & Theses (PQDT) database, PsycBITE (Psychological Database for Brain Impairment Treatment Efficacy), ISRCTN registry, ClinicalTrials.gov, Health Services Research Projects in Progress (HSRProj), National Eye Institute Clinical Studies Database and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The databases were last searched on 26 June 2017. No date or language restrictions were used in the electronic searches for trials. We manually searched the Australian Orthoptic Journal, British and Irish Orthoptic Journal, and ESA, ISA and IOA conference proceedings. We contacted researchers active in this field for information about further published or unpublished studies. Selection criteria We included randomised controlled trials (RCTs) of any intervention for ocular alignment or motility deficits (or both) due to acquired brain injury. Data collection and analysis Two review authors independently selected studies and extracted data. We used standard methods expected by Cochrane. We employed the GRADE approach to interpret findings and assess the quality of the evidence. Main results We found five RCTs (116 participants) that were eligible for inclusion. These trials included conditions of acquired nystagmus, sixth cranial nerve palsy and traumatic brain injury-induced ocular motility defects. We did not identify any relevant studies of restitutive interventions. We identified one UK-based trial of a substitutive intervention, in which botulinum toxin was compared with observation in 47 people with acute sixth nerve palsy. At four months after entry into the trial, people given botulinum toxin were more likely to make a full recovery (reduction in angle of deviation within 10 prism dioptres), compared with observation (risk ratio 1.19, 95% CI 0.96 to 1.48; low-certainty evidence). These same participants also achieved binocular single vision. In the injection group only, there were 2 cases of transient ptosis out of 22 participants (9%), and 4 participants out of 22 (18%) with transient vertical deviation; a total complication rate of 24% per injection and 27% per participant. All adverse events recovered. We judged the certainty of evidence as low, downgrading for risk of bias and imprecision. It was not possible to mask investigators or participants to allocation, and the follow-up between groups varied. We identified one USA-based cross-over trial of a compensatory intervention. Oculomotor rehabilitation was compared with sham training in 12 people with mild traumatic brain injury, at least one year after the injury. We judged the evidence from this study to be very low-certainty. The study was small, data for the sham training group were not fully reported, and it was unclear if a cross-over study design was appropriate as this is an intervention with potential to have a permanent effect. We identified three cross-over studies of pharmacological interventions for acquired nystagmus, which took place in Germany and the USA. These studies investigated two classes of pharmacological interventions: GABAergic drugs (gabapentin, baclofen) and aminopyridines (4-aminopyridines (AP), 3,4-diaminopyridine (DAP)). We judged the evidence from all three studies as very low-certainty because of small numbers of participants (which led to imprecision) and risk of bias (they were cross-over studies which did not report data in a way that permitted estimation of effect size). One study compared gabapentin (up to 900 mg/day) with baclofen (up to 30 mg/day) in 21 people with pendular and jerk nystagmus. The follow-up period was two weeks. This study provides very low-certainty evidence that gabapentin may work better than baclofen in improving ocular motility and reducing participant-reported symptoms (oscillopsia). These effects may be different in pendular and jerk nystagmus, but without formal subgroup analysis it is unclear if the difference between the two types of nystagmus was chance finding. Quality of life was not reported. Ten participants with pendular nystagmus chose to continue treatment with gabapentin, and one with baclofen. Two participants with jerk nystagmus chose to continue treatment with gabapentin, and one with baclofen. Drug intolerance was reported in one person receiving gabapentin and in four participants receiving baclofen. Increased ataxia was reported in three participants receiving gabapentin and two participants receiving baclofen. One study compared a single dose of 3,4-DAP (20 mg) with placebo in 17 people with downbeat nystagmus. Assessments were made 30 minutes after taking the drug. This study provides very low-certainty evidence that 3,4-DAP may reduce the mean peak slow-phase velocity, with less oscillopsia, in people with downbeat nystagmus. Three participants reported transient side effects of minor perioral/distal paraesthesia. One study compared a single dose of 4-AP with a single dose of 3,4-DAP (both 10 mg doses) in eight people with downbeat nystagmus. Assessments were made 45 and 90 minutes after drug administration. This study provides very low-certainty evidence that both 3,4-DAP and 4-AP may reduce the mean slow-phase velocity in people with downbeat nystagmus. This effect may be stronger with 4-AP. Authors' conclusions The included studies provide insufficient evidence to inform decisions about treatments specifically for eye movement disorders that occur following acquired brain injury. No information was obtained on the cost of treatment or measures of participant satisfaction relating to treatment options and effectiveness. It was possible to describe the outcome of treatment in each trial and ascertain the occurrence of adverse events.

Purpose The aim of this review was to identify patient reported outcome measures (PROMs) for use in research and clinical practice involving individuals with visual impairment following stroke and to evaluate their content validity against quality assessment criteria. Method A systematic review of the literature was conducted to identify articles related to the development and/or validation of PROMS. We searched scholarly online resources and hand searched journals. Search terms included MESH terms and alternatives relating to PROMs, visual impairments and quality of life. Data were extracted relating to the development and validation of the included instruments. The quality of the development process was assessed using a modified version of a PROM quality assessment tool. Results A total of 142 PROMs were identified, 34 vision-specific PROMs were relevant and available to be analysed in this review. Quality appraisal identified four highly rated instruments: the National Eye Institute Visual Functional Questionnaire (NEI-VFQ), Activity Inventory (AI), Daily Living Tasks Dependant on Vision (DLTV) and Veterans Affairs Low Visual Function Questionnaire (VA LV VFQ). The four instruments have only been used with either a limited number of stroke survivors or a sub-population within visual impairment following stroke. Conclusion No instruments were identified which specifically targeted individuals with visual impairment following stroke. Further research is required to identify the items which a population of stroke survivors with visual impairment consider to be of most importance. The validation of a combination of instruments or a new instrument for use with this population is required. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0338-x) contains supplementary material, which is available to authorized users.

Introduction:This study aimed to develop a comprehensive occupational therapy treatment schedule of upper limb interventions for stroke survivors with reduced upper limb function.Method:In a three-phased qualitative consensus study, 12 occupational therapists from acute and community settings in North West England contributed to interviews and subsequently group discussions to design and pilot a treatment schedule. Interview data were analysed using thematic analysis; the themes were used to develop a framework for the schedule that was supported by and reflected the International Classification of Functioning, Disability and Health framework. A draft schedule was the subject of a focus group and the resultant schedule was piloted in clinical practice by eight local occupational therapists working in neurological rehabilitation.Findings:Consensus was reached on three themes summarizing aspects of function: interventions that address preparation for activity, functional skills (that is, an aspect of function), and function. Three additional themes summarized other aspects of therapy: advice and education, practice outside therapy sessions, and psychosocial interventions. These themes became the main headings of the treatment schedule. The Occupational Therapy Stroke Arm and Hand Record treatment schedule was piloted and found to be comprehensive and potentially beneficial to clinical practice.Conclusion:The Occupational Therapy Stroke Arm and Hand Record treatment schedule provides a tool for use in stroke research and clinical practice.

Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.

Aim: To determine whether providing therapy staff with objective information regarding the nature of visual impairment enhances functional recovery of stroke survivors. Methods: A mixed methodology incorporated a pilot randomized controlled trial (RCT) and qualitative study. Patients presenting acutely with functional disability and suspected visual deficit, underwent visual assessment. Patients with visual impairment were recruited; all subjects received rehabilitation. The sample was randomized to group A (control) where details of visual assessment were withheld from therapy staff and group B (experimental) where details of visual assessment were disclosed. Functional measures (Functional Independent Measure, timed walk) were recorded at baseline and 6-week follow-up. Health professionals participated in a focus group to discuss the perceived influence of the additional visual assessment service on functional outcome. Findings: 64 patients were recruited over 18 months (group A=31; group B=33). Drop out resulted in 19 subjects in group A and 20 in group B for full analysis. Significant functional improvement was noted in both groups, no significant difference was found between groups. Health professionals reported a perceived positive impact from the vision assessment service. Conclusions: Provision of visual assessment information did not influence functional recovery. Qualitative findings indicated perceived benefits from the provision of the vision assessment service.