Occupational Performance Coaching for parents of picky eaters: A mixed methods study.

BACKGROUND/AIM: Picky eating is a common childhood phenomenon that impacts many families' occupations surrounding mealtimes. Evidence of the effectiveness of Occupational Performance Coaching (OPC) for caregivers of children suggests it may represent a useful occupation-focused intervention for parents of picky eaters. Using an OPC-targeted intervention, this study aims to report preliminary effectiveness, explore the experience of parents' participation, and investigate factors that influence the OPC intervention. METHODS: This study used an explanatory mixed-method design. Parent participants (n = 8) were recruited via purposive sampling and engaged in three sessions of OPC delivered via an online platform between October and December 2022. Standardised assessments were completed before and after OPC and a qualitative semi-structured interview two weeks after the final OPC session. Variables were analysed descriptively, and independent t tests were performed to compare scores on each standardised assessment pre- and post-intervention. Pearson's correlation analyses were conducted to consider associations between resistance to change and the extent of change in each outcome measure. Reflexive thematic analysis was conducted on postintervention interview transcripts. CONSUMER AND COMMUNITY INVOLVEMENT: Consumer invovlement was limited to parents feedback on their experiences of the intervention. RESULTS: Improvements in occupational performance as measured by the COPM change score were statistically significant (p = <0.001). Child eating behaviours, as measured by the CEBQ Food Fussiness subscale change score (p = 0.01) and BPFAS change score (p = 0.02), demonstrated significant improvements. The extent to which parents viewed these behaviours as problematic as measured by the BPFAS problem change score, showed a significant reduction (p = <0.001). Three themes emerged from interviews with parents: small changes beyond nutrition, parents supported as the experts, and what parents value within an intervention. CONCLUSION: Targeted OPC intervention delivered online by an occupational therapist may be an effective intervention for parents of picky eaters. Future studies using randomised controls are required before OPC can be routinely recommended in a clinical setting for the management of picky eating in children.

A qualitative inquiry of parents of extremely picky eaters: Experiences, strategies and future directions.

BACKGROUND/AIM: Picky eating is a common childhood phenomenon in younger children, impacting family relationships and mealtimes. Limited qualitative studies have explored parents' experiences of parenting an extremely picky eater. This study aimed to address this gap. METHODS: This exploratory qualitative research design included participants who were Australian-based parents (n = 10) of children aged 2-6 years with a minimum picky eating score of 3.33, indicating extreme picky eating, on the Food Fussiness subscale of the Child Eating Behavior Questionnaire (CEBQ). Parents were interviewed online via Zoom using semi-structured interviews focused on their experiences of having a child who is a picky eater. Reflexive thematic analysis was used to analyze the data. RESULTS: Five themes were identified: 1: The picky eating journey for parents. 2: Picky eating impacts families and mealtimes. 3: Parents have attempted multiple strategies to manage picky eating. 4: Emotions associated with parenting an extremely picky eater. 5: Parents of extremely picky eaters have a positive outlook for the future. CONCLUSION: This qualitative study demonstrates that parents' experiences of parenting an extremely picky eater are varied. Parents desire health professionals who listen to their concerns and provide evidence-based knowledge around parent feeding practices to positively impact picky eating.

Women pregnant after previous perinatal loss: relationships between adult attachment, shame, and prenatal psychological outcomes.

BACKGROUND: Insecure adult attachment, shame, self-blame, and isolation following perinatal loss place bereaved women at risk of adverse psychological outcomes, which can impact child and family outcomes. To date, no research has considered how these variables continue to influence women's psychological health in pregnancy subsequent to loss. OBJECTIVE: This study explored associations between prenatal psychological adjustment (less grief and distress) and adult attachment, shame, and social connectedness, in women pregnant after loss. METHOD: Twenty-nine pregnant Australian women accessing a Pregnancy After Loss Clinic (PALC) completed measures of attachment styles, shame, self-blame, social connectedness, perinatal grief, and psychological distress. RESULTS: Four 2-step hierarchical multiple regression analyses revealed adult attachment (secure/avoidant/anxious; Step 1), shame, self-blame, and social connectedness (Step 2) explained 74% difficulty coping, 74% total grief, 65% despair, and 57% active grief. Avoidant attachment predicted more difficulty coping and higher levels of despair. Self-blame predicted more active grief, difficulty coping, and despair. Social connectedness predicted lower active grief, and significantly mediated relationships between perinatal grief and all three attachment patterns (secure/avoidant/anxious). CONCLUSIONS: Although avoidant attachment and self-blame can heighten grief in pregnancy after loss, focusing on social connectedness may be a helpful way for prenatal clinicians to support pregnant women during their subsequent pregnancy - and in grief.

Planning for Change: Co-Designing Implementation Strategies to Improve the Use of Sensory Approaches in an Acute Psychiatric Unit.

Implementing sensory approaches in psychiatric units has proven challenging. This multi-staged study involved qualitative interviews (n = 7) with mental health care staff in an acute psychiatric ward to identify the local factors influencing use of sensory approaches, and co-design implementation strategies with key stakeholders to improve their use. Using framework analysis, results revealed that the use of sensory approaches were hindered by: inadequate access to sensory resources/equipment; lack of time; lack of staff knowledge; and belief that sensory approaches are not effective or part of staff's role. To address identified barriers a systematic theory-informed method was used to co-design implementation strategies to improve the use of sensory approaches.

Using the Theoretical Domain Framework to understand what helps and hinders the use of different sensory approaches in Australian psychiatric units: A survey of mental health clinicians.

BACKGROUND/AIM: Although sensory approaches are recommended to relieve distress and agitation and reduce the use of seclusion and restraint, many Australian psychiatric units have struggled to sustain their practice. The aim of this study was to investigate the barriers and enablers influencing the use of different sensory approaches across one health region in Australia and to obtain recommendations for strategies to improve their use. METHOD: This cross-sectional survey was informed by the Theoretical Domain Framework. Likert scale questions considered barriers and enablers to the use of non-weighted sensory interventions, weighted modalities, sensory rooms, and sensory assessments/plans. Open-ended questions explored participant concerns and recommendations to improve the use of sensory approaches. RESULTS: Participants (n = 211) were from nursing, allied health, medical, and peer support staff across inpatient psychiatric units. Factors most frequently identified as enablers for using sensory approaches were beliefs of positive benefits to consumers (e.g. decreasing distress and agitation); belief it was within the staff's role; and knowledge of the approaches. Limited time was the most common identified barrier. Factors statistically associated with more frequent use were knowledge, skills, confidence, availability, and easy access to sensory tools/equipment. Only 30% of participants were concerned about potential risks of sensory approaches, with this risk mitigated through adequate supervision and thorough risk assessment. Recommendations to improve practice included improved access to, and maintenance of, equipment, more training, and increased staffing. CONCLUSION: This study revealed how barriers and enablers vary for different sensory approaches and how these factors impact their frequency of use in psychiatric units. It provides insights into staff recommendations to improve the use of sensory approaches in one health region in Australia. This knowledge will lead to the development of implementation strategies to address identified barriers and improve the use of sensory approaches in psychiatric units.

Picky eating in children: Current clinical trends, practices, and observations within the Australian health-care context.

BACKGROUND/AIM: Childhood picky eating occurs when there is limited intake or variety of food and/or unwillingness to try new foods. Within research settings, standardised assessments are used to describe picky eating behaviours in children. However, little is known about assessment practices of occupational therapists. Similarly, occupational therapy interventions for picky eating in the literature focus on; providing strategies for parents, and working with the child on self-feeding skills. Despite this, interventions and strategies utilised by occupational therapists in clinical practice within an Australian health-care context are unknown. This study examines Australian health professionals' observations of picky eating behaviours, the use of childhood picky eating assessments and interventions, and differences between occupational therapists and other professionals. METHODS: Health professionals (n = 179) were recruited through professional organisations, such as Occupational Therapy Australia. Participants completed an online survey between March and May 2021. Independent variables were reported using descriptive statistics, with logistic regression used to consider differences between occupational therapists and other health professionals. Conventional content analysis was used to analyse responses to open-ended questions. RESULTS: The final sample included 109 eligible participants, with an average of 8.5 years working with picky eaters. Results indicated picky eating behaviours aligned with those reported in the literature. Participants relied on clinical observations and workplace designed assessments. The most common interventions were education, coaching, and the sequential oral sensory approach to feeding. Occupational therapy participants were significantly more likely than other health professional participants to report always using coaching and education. CONCLUSION: Although few health professionals used standardised or validated assessments, the use of education and coaching by occupational therapists aligned with the literature. Results highlight the need for more rigorous investigation to determine the sensitivity of current assessments to differentiate between clinical and typical picky eating, and the effectiveness of interventions for childhood picky eating.

Lived experiences of adolescents with fetal alcohol spectrum disorder.

AIM: To explore the lived experiences of adolescents with fetal alcohol spectrum disorder (FASD) to understand: the ways in which their challenges influence daily functioning; and the personal assets and external resources that facilitate participation. METHOD: Semi-structured interviews were conducted with four adolescents (one identified as non-binary, one male, and two female) with FASD aged 13 to 15 years. A photo elicitation approach facilitated participation, whereby adolescents first took photographs of their daily activities and environments. Photographs were subsequently used to generate discussion during the interviews. Data analysis involved using interpretative phenomenological analysis to generate themes. RESULTS: Two superordinate themes and three subthemes relating to participants' lived experiences emerged from the interviews: (1) 'anxiety challenges participation' (subthemes [i] 'need for external support'; [ii] 'the power of positive relationships'; and [iii] 'talents and interests facilitate participation') and (2) 'importance of a unique identity'. INTERPRETATION: Findings illustrated the barriers adolescents experienced regarding their daily functioning and independence. Additionally, incorporating strengths into daily activities appeared to reduce anxiety and improve participation, and adolescents desired for their unique characteristics to be recognized and appreciated. To support adolescents with FASD, service providers should consider incorporating strengths-based approaches and an explicit focus on facilitating the development of positive self-identities. WHAT THIS PAPER ADDS: Anxiety often prevented adolescents' independent participation in social activities, requiring caregiver assistance. Strengths (e.g. talents, positive relationships) facilitated adolescents' participation and reduced their anxiety. Clinicians and researchers should consider strengths-based approaches to interventions targeting participation. Interventions for adolescents with fetal alcohol spectrum disorder could focus on developing a positive self-identity.

Sensory approaches in psychiatric units: Patterns and influences of use in one Australian health region.

BACKGROUND/AIM: Australian guidelines and policies recommend the use of sensory approaches in mental health care. Nevertheless, many Australian psychiatric units report difficulty sustaining these approaches. To inform efforts to close the gap between recommendations and practice, the aim of this study was to understand the patterns of use of sensory approaches and what demographic and clinical factors influence their use, across one health region in Queensland, Australia. METHODS: Using a cross-sectional survey design, a custom-designed questionnaire was distributed via email and in paper form to health professionals and peer support workers working in acute, secure, and community care psychiatric units across one health region. Information on demographics and the use of various sensory interventions was gathered utilising both open-ended and Likert scale questions. RESULTS: Useable questionnaires were collected from 183 participants from various disciplines (77% nursing). The majority reported using sensory approaches with a limited number of consumers, and almost 9% never used the approach. Activity-based sensory interventions and sensory equipment were most often used, whereas sensory assessments, sensory plans, and sensory groups were least used. Sensory interventions were mainly used to reduce consumer anxiety and agitation and to assist with emotional regulation. Factors positively correlated with frequency of use for all interventions were discipline (occupational therapy); working in an acute inpatient unit; and training in sensory approaches. Age was negatively correlated with frequency of use only for weighted modalities. CONCLUSIONS: This study revealed that sensory approaches were used by most staff though with a limited proportion of consumers in psychiatric units in one large metropolitan health service. It provides insights into the factors influencing frequency of use, highlighting the importance of training in sensory approaches and access to occupational therapists. With this knowledge, we can work towards closing the gap between recommendations and the practice of sensory approaches.

Changing occupational roles for the young adult with cancer: A longitudinal case study.

INTRODUCTION: Young adulthood is a period of rapid occupational role development. While the impact of a cancer diagnosis at this time is likely to be substantial, little research has addressed this topic. The aims of this study were to gain insights into the impact of cancer on occupational roles throughout the cancer disease trajectory, from diagnosis to the palliative stage, for one young person. METHODS: A longitudinal case study design was used. Five semi-structured interviews, layered with photo elicitation, were conducted over 3 years. Qualitative data were analysed thematically. RESULTS: Three themes emerged: the adjusted plan, establishing rules, and damage control and self-preservation. Challenges impacting participation in, and meaning of, and the occupational roles themselves shifted over time. CONCLUSION: Findings provide knowledge of occupational adaptation, and the reconstruction of occupational role identity and participation, of the young adult living with cancer along the disease trajectory.

Occupational therapy in oncology palliative care for adolescents and young adults: Perspectives of Australian occupational therapists.

INTRODUCTION: Palliative Care Australia suggests current needs (emotional wellbeing, understanding of cancers impact on relationships, everyday activities, and life milestones) for adolescent and young adults in palliative care are unmet due to a lack of age-specific palliative care facilities in Australia. This includes the provision of occupational therapy that can impact these unmet needs. Although the occupational therapy role in palliative care has been documented, little is known about existing occupational therapy services or occupational needs for young people with palliative care needs. The aims of this study were to obtain occupational therapists insights of working with this population in Australia regarding (1) gaps in palliative care services for this population; (2) facilitators and challenges to providing occupational therapy for this group; and (3) perceived occupational needs of young people living with a life-limiting cancer diagnosis. METHODS: Using snowball sampling, an online survey was distributed to occupational therapists with experience working in palliative cancer care with adolescents and young adults. Available for 6 weeks, the survey included demographic, work history, and service delivery questions. Forced-choice questions were summarised descriptively, and content analysis was used to analyse free-text data. RESULTS: Eleven completed surveys were returned. Overall, therapists perceived current palliative care services for this population within Australia to be lacking. Two gaps emerged: age-appropriate facilities and gaps in provision of psycho-social and occupational therapy services. Funding, lack of knowledge of the occupational therapy role, and professional confidence were highlighted as challenges to practice. Main occupational needs related to maintenance of as "normal" a life as possible: maintaining occupational role engagement, continuing connection with others, and being heard regarding their occupational needs. CONCLUSION: Findings suggest a need for service changes, including custom-designed facilities, improved funding, training and mentoring, to support age-appropriate and occupation-focussed care for the young person in cancer-specific palliative care.

Substances and your senses: The sensory patterns of young people within an alcohol and drug treatment service.

Background: Substance use disorders (SUD) and trauma histories in adults have been linked with sensory processing patterns that are significantly different from the general population. Nevertheless, no studies have investigated sensory patterns, or the variables with which they are related, in youth with SUD. This study aimed to compare sensory patterns of this sample with normative data and consider associations between sensory patterns and: substance use, trauma, quality-of-life, mental and physical health. Methods: A cross-sectional quantitative research design was employed with a sample of 87 young people (mean age = 20.8 years) with SUD voluntarily attending a specialist youth outpatient alcohol and other drug (AOD) service. For participants, the Adolescent Adult Sensory Profile was added to measures routinely collected at the service. Results: Participants' sensory processing patterns for low registration, sensory sensitivity, and sensation avoiding were significantly higher than the normative population, while sensation seeking was both lower and higher. Ninety-one percent reported atypical scores on one or more sensory patterns. High rates of probable Post-Traumatic-Stress-Disorder (PTSD), psychological distress, and low quality-of-life were also reported, which were meaningfully related with sensory patterns. Conclusion: Young people reported complex combinations of sensory processing patterns, with comorbid probable PTSD, psychological distress, and low quality-of-life. Findings reflect studies with adult AOD, trauma, and other clinical conditions, and highlight the potential value of screening for sensory patterns and applying transdiagnostic approaches which simultaneously address substance use, mental health, trauma and sensory needs to optimize outcomes for young people with SUD.

Shame and guilt in the postnatal period: a systematic review.

Objective: The aim of this review was to explore the unique contribution of shame (negative evaluation of the self) and guilt (negative evaluation of behaviour) to postnatal psychological symptoms. Background: Although shame and guilt are related to psychological symptoms, the separate effect of each in postnatal psychological symptoms are not yet known. Methods: Seven electronic databases were systematically reviewed for articles on: (1) quantitative measures of shame, guilt, and psychological symptoms (2) in the postnatal period for infants under two years of age (3) published in English. Results: Of the 1,615 articles retrieved using PRISMA guidelines, five met criteria and were analysed independently by two reviewers using the STROBE criteria. In mothers, shame was significantly related to stress and postnatal depression. Shame significantly predicted postnatal depression. Guilt was significantly related to postnatal depression; however, the relationship was substantially reduced when included with shame. In fathers, shame, but not guilt, was significantly related to stress, anxiety, and depression. Conclusion: Shame and guilt are trans-diagnostic phenomena, negatively impacting on postnatal psychological health, and potentially the parent-child relationship. More research is needed to develop awareness of the unique effects of shame and guilt to optimise perinatal intervention.

Bringing sexuality out of the closet: What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?

INTRODUCTION: Sex has been recognised as an activity of daily living, and sexuality as an important part of our identity, with implications for our self-esteem and quality of life. Although this brings sex and sexuality within the scope of occupational therapy practice, empirical and anecdotal information suggests that neither are routinely included in therapy. The aim of this study was to investigate the experiences of therapists who are comfortable addressing sex and sexuality in practice, with a view to influencing future research and practice. The research question posed was as follows: "What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?" METHODS: Interpretative Phenomenological Analysis (IPA) was used to explore the research question. Semi-structured interviews were conducted with 11 Australian occupational therapists who were purposively recruited. Interviews were audio-recorded, transcribed verbatim, and analysed following the guidelines for IPA data analysis. RESULTS: Four master themes and five sub-themes emerged from the analysis and are discussed under the following headings: sexuality matters; know your boundaries; just do it; and seek support and mentoring. The themes provide insight into how occupational therapists successfully integrate sexuality into everyday practice. CONCLUSION: According to the participants in this study, addressing sex and sexuality during therapy is part of providing holistic client-centred care. With clear personal and professional boundaries, occupational therapists can address sexuality within routine practice utilising core occupational therapy skills, such as communication, collaborative problem solving, pacing, positioning, and adaptive equipment. Furthermore, participants demonstrated that this can be done within a range of settings. It starts with a commitment and the motivation to find a way.

Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review.

Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children's functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children's perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.

Substance Use: Links with Sensory Sensitivity, Attachment Insecurity, and Distress in Young Adults.

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 attachment with sensory sensitivity, and evidence that both are linked with higher levels of distress, there is a need to consider these variables in relation to substance use in a sample of young adults. Methods: A convenience sample of 223 young adults (18-24 years) completed self-report measures of attachment, sensory sensitivity, use of various substances (e.g. alcohol, legal and illegal drugs, cigarettes, energy drinks), and distress. Correlation, t-test, and regression/mediation analyses were conducted. Results: Sensory sensitivity was positively correlated with insecure attachment. Anxious attachment was related to problematic substance use, frequent cigarette use, and misuse of prescribed medications. Avoidant attachment was associated with frequent use of cigarettes and energy drinks. Sensory sensitivity, attachment anxiety, and attachment avoidance each had significant indirect effects on problematic substance use, mediated by increased levels of distress. Conclusions: Sensory sensitivity and attachment insecurity both appear to impact problematic substance use in young adults through elevated levels of distress. Findings support consideration of sensory- and attachment-informed interventions with this population.

Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life.

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.

Cancer care and occupational therapy: A scoping review.

INTRODUCTION: Cancer can disrupt participation in everyday activities, suggesting a place for occupational therapy; however, there is a need to articulate the nature, scope and available evidence supporting the occupational therapy role within cancer care. In this scoping review, we identify the breadth of practice and evidence for occupational therapy in cancer care, across all stages of the disease trajectory (diagnosis to palliation/survivorship) throughout the lifespan. METHODS: Five electronic databases were searched in June 2018, for English language articles. Key words were: cancer care, OR oncolog*, OR oncologic care, OR neoplasms, OR cancer survivors, OR terminal cancer, OR cancer rehabilitation, AND occupational therap*. No date restrictions were imposed. Included were: all styles of literature including grey literature, all types of cancers and all age brackets. There were no restrictions on place of origin of papers. Following the Arksey and O'Malley (2006; International Journal of Social Research Methodology, 8: 19-32) framework for scoping reviews, the first author screened titles and abstracts, and all three authors reviewed sets of the included articles. Conflicts were discussed until consensus was reached. RESULTS: After evaluating 305 titles and abstracts and 111 full-text articles, 89 papers were retained. Articles included research studies (n = 43), reviews (n = 15), grey literature (n = 16), practice analyses (n = 14) and an editorial (n = 1). The occupational therapy roles described were diverse, but largely descriptive in nature, with little evidence of outcomes from treatment. Furthermore, the majority of papers addressed adult populations, with few considering children, adolescents or young adults. Most papers focused on specific stages of the disease, and none addressed the disease along its full trajectory. CONCLUSION: Despite identifying a diverse range of occupational therapy roles in cancer care throughout the disease trajectory and across the lifespan, the need for professional discourse and research within our profession was highlighted. This was particularly evident for adolescents and young adults with cancer.

The experience of persistent pain and quality of life among women following treatment for breast cancer: An attachment perspective.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Approach to activity engagement and differences in activity participation in chronic pain: A five-day observational study.

BACKGROUND/AIM: Activity pacing is one of the most widely endorsed interventions used by occupational therapists to assist clients to manage chronic pain conditions. It targets two behaviours that are thought to be maladaptive: activity avoidance and overactivity (activity engagement that severely aggravates pain). However, in more recent years, the potential for activity pacing to negatively impact activity participation has been recognised which deters habitually overactive individuals from adopting the self-management strategy. The main aim of this study was to evaluate if variances in activity participation can be explained by how individuals approach activity engagement when in pain. METHODS: Sixty-eight adults with chronic pain completed a demographic questionnaire, the Pain and Activity Relations Questionnaire (PARQ), and recorded their participation in activities for five days using a paper diary. Two of the authors independently coded the recorded activities into one of three time-use categories: rest, productivity or leisure/social. A MANCOVA model was produced to examine differences in time use across four 'approach to activity engagement' categories which were determined by scores on the PARQ. RESULTS: A significant multivariate effect was found. Univariate comparisons revealed that 'overactives' (high overactivity, low avoidance) and 'pacers' (low overactivity, low avoidance) spent a similar amount of time resting over the five-day period. 'Overactives' spent the most amount of time on productive tasks and the least amount of time on social/leisure activities out of the four subgroups. CONCLUSION: Results suggest that activity pacing does not negatively impact on activity participation in chronic pain populations. 'Pacers' spent a similar amount of time resting, and had a slightly better balance between productive tasks and leisure/social activities, when compared to 'overactives'. The results of this study can be incorporated into patient education and highlight potential treatment avenues for individuals with chronic pain who are habitually overactive.

"Not just a normal mum": a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss.

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.