Convergent validity of two adult self-report sensory scales: Comparing the Adolescent/Adult Sensory Profile and the Sensory Processing Measure 2-Adult Form.

INTRODUCTION: Occupational therapists use standardised scales and measures to assess an individual's sensory processing factors. To date, few studies have investigated the correlations between the Adolescent/Adult Sensory Profile (A/ASP) and the Sensory Processing Measure 2-Adult Form (SPM-2-Adult). The aim of the project is to investigate the association between the sensory processing factors measured by the A/ASP and SPM-2-Adult when completed by the same group of adult participants, with an additional research question investigating whether any significant differences existed between sensory processing scores based on participants' self-reported gender identity. METHODS: Forty-two adults aged 18-30 completed the A/ASP and the SPM-2-Adult. Associations between the A/ASP quadrant and the SPM-2-Adult subscales were examined using Spearman's rho correlation coefficients, and differences between participants based on their self-reported gender identity were investigated using Mann-Whitney U tests. RESULTS: Statistically significant correlations were obtained between the A/ASP Low Registration, Sensory Sensitivity, and Sensation Avoiding quadrant subscales and all nine of the SPM-2-Adult subscales ranging from weak (rho = 0.342, p < 0.027) to strong (rho = 0.790, p < 0.001) correlations. The A/ASP Sensation Seeking quadrant subscale was only significantly correlated with the SPM-2-Adult Social Participation subscale (rho = -0.416, p = 0.006). Three subscales had statistically significant differences based on gender identity: SPM-2-Adult Vision (p = 0.007), SPM-2-Adult Sensory Total (p = 0.048), and A/ASP Sensory Sensitivity (p = 0.043). CONSUMER AND COMMUNITY INVOLVEMENT: Consumers and community members were not involved in the design, execution, or write-up of the study results. CONCLUSION: The A/ASP and the SPM-2-Adult had several subscales that were significantly correlated with one another. Of note, significant associations were achieved between the A/ASP Low Registration, Sensory Sensitivity, and Sensation Avoiding quadrant subscales and all nine of the SPM-2-Adult subscales. These findings make a significant preliminary contribution to the psychometric body of evidence related to the sensory processing assessment of adults.

Supporting occupational therapists to initiate conversations about sexuality with people with intellectual disability: Co-design by deliberative dialogue.

INTRODUCTION: Occupational therapists routinely report low levels of confidence in addressing needs related to sexuality and intimacy. These issues are compounded when supporting clients with intellectual disability, due to prevailing assumptions about capacity and few practical support resources. At a disciplinary level, there is ongoing discourse around how to best conceptualise and support sexual and gender identities generally, within models of human occupation. Leveraging interdisciplinarity, where sexuality overlaps as a sphere of interest, can aid the development of practical support resources. Engagement with sociology (focussed on relationality) and disability studies (focussed on embodiment) offers a generative path forward. METHODS: The deliberative dialogues framework was used to develop a co-designed resource by occupational therapists for occupational therapists. Six Australian occupational therapists with experience working with clients with intellectual disability and/or sexuality were purposively recruited to participate in co-design groups. Using the eight features of deliberative dialogue, data was collected and analysed by an interdisciplinary research team to collaboratively produce a practical support resource. RESULTS: Participants agreed the greatest need was to develop a resource for clinicians, to support conversations with clients about sexuality. Five key themes emerged: (1) Theoretical explanations addressing why sexuality is important must be paired with practical advice; (2) make a conversational call to action from 'OTs' for 'OTs' by locating sexuality within the domain of occupational therapy; (3) make explicit that people with intellectual disability are sexual beings; (4) need for self-reflection; and (5) demonstrate how existing understandings of occupation apply to sexuality. CONCLUSION: A resource in the form of a brochure was developed, intended to be used as a conversation primer. The process used to develop the resource demonstrated the value of interdisciplinary collaboration and the utility of deliberative dialogue as a co-design method.

LGBTQ+ Loss and Grief in a Cis-Heteronormative Pandemic: A Qualitative Evidence Synthesis of the COVID-19 Literature.

LGBTQ+ people are no stranger to loss and grief, particularly during times of pandemic such as the 1980s-90s HIV/AIDS pandemic and now, the COVID-19 pandemic. Current COVID-19 loss and grief research remains relatively silent on LGBTQ+ peoples' loss and grief experiences. The aim of this research was to conduct a qualitative evidence synthesis of LGBTQ+ people's COVID-19 loss and grief experiences reported in the literature. A systematic search and inclusion strategy identified 22 relevant articles for review. Inductive thematic synthesis resulted in five loss-focused themes across the articles: (1) loss of work and livelihood, (2) loss of social and kinship connection, (3) loss of LGBTQ+ community connection, (4) loss of physical and mental health supports and (5) loss of LGBTQ+ identity authenticity, affirmation and visibility. Discussion of these themes highlights the many layered and often disenfranchised nature of LGBTQ+ people's loss during the COVID-19 pandemic.

The contribution of occupation to children's experience of resilience: A qualitative descriptive study.

BACKGROUND: This qualitative descriptive study explored what occupations children aged 10-13 years participate in and how participation in occupation contributes to resilience from their perspective. Little is known about how occupations contribute to resilience, and less is known from children's perspectives. Exploring how participation in occupation contributes to resilience is important as children continue to face adverse situations; resilience may help protect their development against uncertainty. METHODS: Following ethics approval eight participants were recruited through schools in a large New Zealand city. Data were collected through semi-structured interviews and one focus group, these were audio recorded and transcribed. The six-phase process of thematic analysis, developed by Braun and Clarke (), was utilised to analyse the data. FINDINGS: Three main themes emerged from the data: what resilience is, occupations children do and how those occupations contribute to resilience and thirdly; building participation and resilience. The study revealed sophisticated descriptions of what resilience meant to the participants from their experience, which included the ideas of bouncing back and staying strong. The participants described what occupations they participate in and how these occupations connect to resilience. The participants also described their experience of how participation in their occupations helped build resilience by fostering support, letting go, experiencing distraction, and experiencing fun and happiness. CONCLUSION: The findings suggest that health professionals, policy makers and educators have much to learn from children. Specifically, the need for children to participate in occupations as a way to build resilience. This indicates that a child-focussed approach is needed to incorporate children's perspectives in practice and policy development. The findings suggest that practitioners working with children should incorporate participation in occupation in social, health and education intervention plans with children, as well as use occupation based coping strategies when teaching children skills to manage challenges in life.

Re-visioning practice through action research.

BACKGROUND/AIM: Ongoing knowledge development calls on health professionals to explore strategies to disseminate new or updated theoretical frameworks to practitioners. To date few researchers have explored effective means to do this or how the dissemination of professional ideas impacts on effective service delivery. The study described in this article aimed to identify strategies senior occupational therapists adopted to disseminate new concepts that have the potential to re-vision and transform practice. METHODS: Six occupational therapists were recruited as co-researchers to become part of a collaborative community of practice. Over a 9-month period they engaged in a project based on action research cycles where they had access to a newly revised theoretical framework. During each cycle the co-researchers participated in a teleconference which was audio-recorded where they reflected on concepts in relation to their own practice. FINDINGS: As understanding of the theoretical framework increased, they discussed which aspects of their practice could change, particularly in relation to processes they used to disseminate knowledge to the staff they supervised or managed. CONCLUSION/SIGNIFICANCE: The co-researchers described a range of ideas for dissemination which included individual and group strategies. In addition, they became aware of the transformative potential of their new knowledge as a way to better understand and create change within their organisations. The co-researchers also described a sense of increased confidence, not only in terms of conceptualising practice but in terms of supervising staff and challenging service delivery.

A pilot cluster randomized controlled trial of structured goal-setting following stroke.

OBJECTIVE: To determine the feasibility, the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal-setting. DESIGN: A cluster randomized controlled trial. SETTING: Inpatient rehabilitation facilities. SUBJECTS: People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal-setting and complete the primary outcome measure. INTERVENTIONS: Structured goal elicitation using the Canadian Occupational Performance Measure. MAIN MEASURES: Quality of life at 12 weeks using the Schedule for Individualised Quality of Life (SEIQOL-DW), Functional Independence Measure, Short Form 36 and Patient Perception of Rehabilitation (measuring satisfaction with rehabilitation). Assessors were blinded to the intervention. RESULTS: Four rehabilitation services and 41 patients were randomized. We found high values of the intraclass correlation for the outcome measures (ranging from 0.03 to 0.40) and high variance of the SEIQOL-DW (SD 19.6) in relation to the minimally importance difference of 2.1, leading to impractically large sample size requirements for a cluster randomized design. CONCLUSIONS: A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary.

Knowing the people planning: measuring change in mental health services.

This article describes the underlying philosophy of knowing the people planning (KPP) and gives an example of a practical approach to measure people's recovery in terms of consumer identified outcomes leading to the improvement in the effectiveness of mental health and addiction services in Hawke's Bay. KPP provided a valuable approach to planning service delivery by measuring key variables of service delivery based on consumer determined key features and a means to describe the quality improvements implemented in services in Hawke's Bay. Practitioners were directly involved; the key was to identify gaps and work with stakeholders to create solutions to facilitate better and improved recovery outcomes.

Living with a long-term health condition and seeking paid work: qualitative systematic review and thematic synthesis.

PURPOSE: An interplay of complex issues influence opportunities to gain paid work for people living with long-term conditions, but there are patterns that traverse the various contexts. Synthesising findings across qualitative studies can inform vocational rehabilitation approaches. METHODS: Public consultation and PRISMA guidelines were used to develop a protocol and comprehensive search strategy. Seven databases were searched and results screened against inclusion criteria. Included studies investigated either lived experiences of gaining paid work while living with a long-term condition or the socio-cultural factors affecting opportunities for paid work. Findings were extracted from included studies and then analysed using thematic synthesis. RESULTS: Sixty-two studies met inclusion criteria. Identified themes demonstrate that people living with long-term conditions need access to support through the different stages of gaining paid work. This can include considering the benefits and risks of having paid work and negotiating needs in the workplace prior to and during employment. Positive experiences for workers and employers were influential in changing attitudes about the work-ability of people living with long-term conditions. CONCLUSION: Findings emphasise the interplay between socio-cultural norms and the constraints experienced in trying to gain work. Appropriately targeted support can unlock possibilities that are otherwise hindered by these norms.IMPLICATIONS FOR REHABILITATIONPositive experiences of paid work for people living with long-term conditions and those who employ them are important for stimulating future opportunities."Informal" or alternative routes into paid work are experienced as more successful in contending with discrimination.Job seekers living with long-term conditions need access to pre-placement advocacy, support to negotiate work-related needs, and support to negotiate difficulties that arise in the job.Vocational rehabilitation initiatives need to have good collaboration with other health services to ensure consistent messages about seeking and managing work.

Experiences of vocational rehabilitation and support services for people living with a long term condition: qualitative systematic review.

PURPOSE: Identify and synthesise qualitative research evidence on activities and processes within formal vocational service provision that contribute to experiences of effective support to gain employment for people living with long term conditions. METHODS: A pre-published protocol was developed using PRISMA guidelines. Seven databases were searched to identify qualitative research. Results of the search were screened against inclusion criteria and for methodological quality. Findings from included studies were extracted and then analysed using thematic synthesis methods. RESULTS: Twenty two studies met the inclusion criteria. Six themes were identified that elucidated factors that contribute to experiences of supportive and effective vocational rehabilitation service delivery: a personalised service with service user preferences at the core; sustainable, timely and ongoing support; proactive collaboration with the employing organisation; peer support, the essential and necessary skills for gaining employment; and critical vocational worker skills, knowledge and attitudes. CONCLUSION: This study demonstrates the utility of synthesising qualitative research to provide insight into the factors that contribute to experiences of supportive and effective vocational rehabilitation services that traverse various contexts. Future high quality qualitative research is required to probe a broader range of long term conditions to better identify the similarities and differences across services and groups.IMPLICATIONS FOR REHABILITATIONAcross qualitative studies, common aspects of "good" vocational services can be identified that contribute to experiences of effective support to gain paid work for people living with long term conditions.Services are experienced positively when they are personalised, flexible, collaborative and take into account both lived experience and knowledge of the person's condition.Vocational rehabilitation services should proactively build collaborative relationships between the job seeker, employing organisation and other agencies and services.Specific skills and services that people living with long-term conditions find particularly helpful include peer support, work-focused skill development and workplace adjustment and accommodations.

Exploring the meaning of occupation: the case for phenomenology.

BACKGROUND: Some authors are beginning to challenge current categorisations of occupation as self-care, productivity, and leisure in favour of categories that address meaning. However, the meaning of occupation receives relatively little attention in the literature. PURPOSE: To provide a synthesis of the contemporary literature that considers the meaning of occupation and to argue that phenomenological insights into the meaning of occupation might usefully inform occupational therapy research, theory, and practice. KEY ISSUES: Meaning is a key aspect of occupation. Three phenomenological meanings of occupation uncovered by a study conducted in New Zealand-the call, Being-with and possibilities-provide a starting point for practice, research, and theory informed by understandings of the lived experience of occupation. IMPLICATIONS: Occupational therapy's theories would benefit from an evidence base that includes meaning, which in turn would lead to authentic occupational therapy practice.

Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: systematic review and meta-analysis.

OBJECTIVES: To evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work. METHODS: Systematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool. RESULTS: Eleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions. DISCUSSION: The meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with 'usual care' control groups in populations with mild to moderate mental health conditions.

Focusing on employment in primary mental health care: A scoping review.

BACKGROUND: People with mental health issues usually access primary health care services but employment status and/or return to work is not typically an explicit focus of a general practice consultation. OBJECTIVE: This scoping review aims to investigate the broad range of interventions used in primary health care to effectively support people with mental health issues to choose, get, or keep employment. METHODS: A literature search was conducted using five electronic databases. Peer reviewed research articles published between 1996 and February 2016 were included in the review. RESULTS: Twelve studies explored work related interventions for people with mental health issues in the primary health care context. The most commonly used intervention was sickness certification, other interventions that show promise were identified but there is limited empirical evidence to show their effectiveness in relation to improving employment outcomes. General practitioners identified a range of barriers in terms of focusing on employment outcomes for patients including knowledge and confidence in understanding the impact of work on symptoms and limited access to advice or services to refer patients to. CONCLUSIONS: This review suggests that work focused interventions situated in primary health care settings appear to be a promising approach for people with mental health issues. However, various barriers impact the implementation of an employment approach, with limited comparisons between different effective interventions. In the context of increasing numbers of people presenting with mental health issues, future research should address the implementation and effectiveness of work-focused interventions based in primary health care.

Survival, momentum, and things that make me "me": patients' perceptions of goal setting after stroke.

PURPOSE: Goal setting and patient-centredness are considered fundamental concepts in rehabilitation. However, the best way to involve patients in setting goals remains unclear. The purpose of this study was to explore patient experiences of goal setting in post-acute stroke rehabilitation to further understanding of its application to practice. METHOD: Thematic analysis was used to analyse interview transcripts from 10 stroke survivors, recruited from 4 rehabilitation units as part of a pilot study investigating the effects of a structured means of eliciting patient-centred goals in post-acute stroke rehabilitation. RESULTS: Three key themes emerged: (1) "A Day by Day Momentum", comprising subordinate themes of "Unpredictability" and "Natural Progression" in which daily progress forwards was seen as an integral part of rehabilitation; (2) "Battle versus Alliance" in which issues of struggle versus support influenced participants' advancement; and (3) "The Special Things", consisting of subordinate themes of "What Makes Me 'Me'" and "Symbolic Achievements" concerning issues defining individuals and their rehabilitation experiences. CONCLUSIONS: Patients' discourse around goal setting can differ from the discourse conventionally used by clinicians when describing "best practice" in rehabilitation goal setting. Understanding patients' non-conventional views of goals may assist in supporting and motivating them, thus providing drive for their rehabilitation. IMPLICATIONS FOR REHABILITATION: Stroke patients think about goals very differently from health professionals. Individual patients have diverse ideas about goals within the context of the uncertainty of stroke, their life as a whole and recovery after formal rehabilitation is completed. To meet these diverse needs, health professionals need to communicate fully with patients to gain an understanding of their experiences of stroke and wider views on goals.