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Occupational therapy practice for clients with cognitive impairments following aquired brain injury: occupational therapists' perspective
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe occupational therapy practice for clients with cognitive impairment following acquired brain injury (CIABI) from the perspective of practicing occupational therapists (OTs).

To fulfill this aim, qualitative and quantitative approaches were used including interviews (Study I) and questionnaires (Studies II -IV). Based on the qualitative descriptions generated in Study I, a questionnaire was developed and evaluated for content validity and test-rest validity (Study II). The questionnaire was then used in a survey (Study III). The reactive Delphi technique was used to empirically define the aspects that OTs found to be consistent with the concept of therapeutic use of self (Study IV).

The results showed that a predominant practice pattern was the use of ADL activities for intervention regardless of whether limitations in occupational performance or cognitive function were assessed, or whether the approach to therapy was remedial or compensatory. General ADL-instruments were used more than instruments focused on impairment level. Therapies covering a wide range of cognitive impairments, and abilities important to organizing and executing occupational performance were commonly targeted. Therapies targeting clients’ activity limitations were prioritized before remediating impairment. Therapeutic use of self was regarded as being important and the results identified clientspecific aims not earlier described in relation to therapeutic use of self. Another prominent practice pattern was the collaborative approach toward clients, relatives, and other staff. Theories used to support practice were primarily general. Occupational therapy practice for clients with CIABI was found to be complex, and the practice patterns were affected by circumstances such as the ‘hidden’ nature of the cognitive impairments, perceived lack of knowledge, and organizational issues. The results of this thesis can be used as a foundation for further research on practice patterns or the specific therapies used. It can facilitate discussions on strengths and weaknesses witcurrent practice, the need for development, and research utilization.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2012. , 89 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 41
Keyword [en]
occupational therapy, cognition, rehabilitation, practice, acquired brain injury, stroke, TBI, assessment, intervention
National Category
Occupational Therapy Other Health Sciences
Research subject
Occupational therapy
Identifiers
URN: urn:nbn:se:oru:diva-26007ISBN: 978-91-7668-903-5OAI: oai:DiVA.org:oru-26007DiVA: diva2:556617
Public defence
2012-12-07, Örebro universitet, Prismahuset, hörsal HSP2, Fakultetsgatan 1, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-25 Created: 2012-09-25 Last updated: 2016-08-10Bibliographically approved
List of papers
1. Occupational therapists' descriptions of their work with persons suffering from cognitive impairment following acquired brain injury
Open this publication in new window or tab >>Occupational therapists' descriptions of their work with persons suffering from cognitive impairment following acquired brain injury
2009 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 16, no 1, 13-24 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate how Swedish occupational therapists’ describe their work with persons suffering from cognitive impairment following acquired brain injury. A qualitative descriptive approach was used and interviews were conducted with 12 occupational therapists working in community and county council care. Qualitative content analysis was used and revealed three main themes: 1) “To make the invisible visible”, 2) “To collaborate- a prerequisite for success” and 3) “Dilemmas to handle”. The findings showed a complex scenario where the occupational therapists worked to make the cognitive impairments visible to themselves, the clients, and persons close to the client. Collaboration was perceived as a key factor. The dilemmas concerned different aspects in the rehabilitation process, which affected the occupational therapists’ work with the clients. Identified areas in need of improvement are prioritisations and additional education regarding both intervention methods and theory. A reluctance to use standardised assessments was expressed and research that identifies and overcomes those hindrances in clinical practice is needed. Therapeutic use of self was described as important. To understand and illuminate the occupational therapists’ comprehension of the concept further research is required.  

Place, publisher, year, edition, pages
London, UK: Informa Healthcare, 2009
Keyword
brain injury, cognition, occupational therapy, qualitative content analysis, rehabilitation, stroke
National Category
Nursing Occupational Therapy
Research subject
Nursing Science; Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-7995 (URN)10.1080/11038120802123520 (DOI)000264692800002 ()18609240 (PubMedID)2-s2.0-61549101770 (ScopusID)
Available from: 2009-09-23 Created: 2009-09-23 Last updated: 2015-02-16Bibliographically approved
2. Occupational therapists' practice patterns for clients with cognitive impairment following acquired brain injury: development of a questionnaire
Open this publication in new window or tab >>Occupational therapists' practice patterns for clients with cognitive impairment following acquired brain injury: development of a questionnaire
2012 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, no 2, 150-163 p.Article in journal (Refereed) Published
Abstract [en]

Clients with cognitive impairment following acquired brain injury (CIABI) are a common group to receive occupational therapy services. Research has shown that occupational therapy has a positive effect on occupational performance for these clients, but the exact nature of the interventions is not clearly described and needs to be better understood and defined. The aim of this study was to develop and evaluate an empirically derived questionnaire for the purpose of surveying occupational therapists' (OTs') practice patterns in relation to CIABI. The questionnaire was developed from the results of a former qualitative study. It was evaluated for content validity by a group of six OT researchers with experience in CIABI, using the content validity index (CVI). Reliability was evaluated by a test-retest design with a group of 51 OTs. Data were analysed by non-parametric statistical methods. Initially the questionnaire consisted of 90 items dealing with OT practice and nine demographic questions. After the reliability and content validity process the OT practice items were reduced to 44. The revised questionnaire will be used to survey and explicitly describe occupational therapy practice for clients with CIABI.

Place, publisher, year, edition, pages
London, United Kingdom: Informa Healthcare, 2012
Keyword
Content validity, instrument development, psychometrics, reliability
National Category
Occupational Therapy Other Health Sciences
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-22123 (URN)10.3109/11038128.2011.576428 (DOI)000300557000005 ()21631175 (PubMedID)2-s2.0-84907043606 (ScopusID)
Note

Funding Agencies:

Örebro University, School of Health and Medical Sciences 

Swedish Association of Occupational Therapists 

Available from: 2012-03-16 Created: 2012-03-16 Last updated: 2016-11-17Bibliographically approved
3. Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury
Open this publication in new window or tab >>Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury
2014 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 28, no 11, 1365-1373 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

Primary objective: To describe Swedish occupational therapist practice patterns for clients with cognitive impairment following acquired brain injury.

Research design: A cross-sectional stratified random sample of 462 occupational therapists.

Methods: An online questionnaire was used to collect data.

Main results: The predominant practice pattern was the use of ADL-activities for assessment and therapy regardless of whether limitations in occupational performance or cognitive function were assessed or whether the approach was remedial or compensatory. For assessment, general ADL-instruments were used more often than instruments that assessed cognitive function. Instruments were used less often within municipal rehabilitation facilities compared to regional, county and primary care facilities. The most common focus of the therapies was in regard to abilities related to executive functioning. Another prominent practice pattern was a collaborative approach involving clients, relatives and other staff. The theories used in practice were, to a large extent, general in nature and did not focus specifically on cognitive functioning.

Conclusions: Swedish occupational therapy practice for clients with cognitive impairments following acquired brain injury focuses highly on occupational performance. Therapies targeting executive functioning seem particularly important in practice and a collaborative approach involving clients, relatives and other staff is a prominent feature in practice.

Keyword
assessment, intervention, occupational therapy cognition
National Category
Neurosciences
Research subject
Occupational therapy
Identifiers
urn:nbn:se:oru:diva-26099 (URN)10.3109/02699052.2014.919529 (DOI)24911987 (PubMedID)2-s2.0-84907043606 (ScopusID)
Note

Funding Agencies:

Örebro University

Swedish Association of Occupational Therapists

Available from: 2012-10-04 Created: 2012-10-04 Last updated: 2016-08-10Bibliographically approved
4. Therapeutic use of self as defined by Swedish occupational therapists working with clients with cognitive impairment following acquired brain injury: a Delphi study
Open this publication in new window or tab >>Therapeutic use of self as defined by Swedish occupational therapists working with clients with cognitive impairment following acquired brain injury: a Delphi study
2013 (English)In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 60, no 1, 48-55 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/AIM: The concept therapeutic use of self has mainly been described theoretically. Empirical descriptions are few and empirical validation is needed to make the concept more useful for informing practice and explaining what occupational therapists do in the interaction with their clients to facilitate successful outcomes. The aim of this study was to empirically define the aspects that occupational therapists working with clients with cognitive impairments following acquired brain injury find are consistent with the concept of therapeutic use of self.

METHOD: Thirteen expert occupational therapists participated. Reactive Delphi technique in three rounds was used where each round built on the results of the previous one. A questionnaire based on current literature was developed for the first round.

RESULTS: Twenty of 33 statements reached a consensus level of 75% or more. These statements reflected the therapists' consciousness, self-awareness and use of personal characteristics. The statements also concerned the intentions of therapeutic use of self, including client group-specific intentions such as enhancing self-awareness. The results indicate that the content of the concept may be defined differently depending on the client group.

CONCLUSIONS: The empirical descriptions generated from this study may help occupational therapists working with clients with cognitive impairments following acquired brain injury to describe how and with what intention they use themselves therapeutically in the rehabilitation process. In occupational therapy education, the results may be used to highlight how the concept may be understood in practice and to discuss it in relation to different client groups.

Keyword
Concept, development, occupational therapy
National Category
Medical and Health Sciences
Research subject
Occupational therapy
Identifiers
urn:nbn:se:oru:diva-26098 (URN)10.1111/1440-1630.12001 (DOI)23414189 (PubMedID)
Available from: 2012-10-04 Created: 2012-10-04 Last updated: 2016-08-10Bibliographically approved

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Lidström Holmqvist, Kajsa
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