Occupational therapists’ perceptions of habits based on their professional experiences

Background: Habits are building blocks for occupation. If they are not explicitly approached, a vital aspect of occupation may be left out. Knowledge is lacking about how habits are understood and approached in occupational therapy practice.

Aim: To explore occupational therapists’ perceptions of habits based on their professional experiences.

Material and methods: A qualitative design with a focus group methodology was used. The qualitative data analysis was based on five focus group discussions, including 34 occupational therapists.

Results: An overarching theme, ‘the complexity of habits,’ representing the occupational therapists’ perception of habits, covers the content of three categories: ‘reflecting contradictoriness,’ including different forms of ambiguity that characterize habits, ‘reflecting identity and security’, that emphasize the meaning of habits for identity and structure in everyday life, and ‘reflecting context and society’, comprising perceptions of habits related to the life situation, time and social patterns and environment.

Conclusions: The occupational therapists’ perceptions gave a picture of habits as complex systems. Based on the findings, the therapeutic modes used when approaching clients’ habits should involve more explicit attention to habits and the inclusion of the client’s entire context.     

The Conceptions of Pain and Rehabilitation Questionnaire (CPRQ): development and test of face validity and stability over time

The heterogeneity of diagnoses included in the concept of chronic pain, as well as differences in adaptation to the situation involving chronic illness, imply the need for a variety of rehabilitation forms. Despite evidence concerning the success of multidisciplinary behaviour-orientated rehabilitation programmes, not all participants experience the expected change. The aim of the present study was to develop and test the face validity and the stability over time of a Swedish self-administered questionnaire: the Conceptions of Pain and Rehabilitation Questionnaire (CPRQ) for persons with chronic pain. The questionnaire is to be used as a guiding tool in planning for rehabilitation. Its purpose is to distinguish between individuals with expectations of and motivation for active rehabilitation and those with expectations of more supportive forms of therapy. The face validity was mainly obtained by target-group discussions including persons with chronic pain and rehabilitation staff with experience in the rehabilitation of persons with chronic pain. The test–retest stability analysis was performed using a model for identifying occasional and systematic disagreement. The questionnaire in its final form showed face validity and reliability in terms of stability over time. Further steps in the development process will include laying down the guiding principles for the questionnaire, based on new focus-group discussions, and completing work on the manual by including information about the origin of the questionnaire and instructions for its administration. Thereafter, the next step in the development process will be a test of responsiveness, i.e. to examine the degree to which the questionnaire really serves its purpose.     

The impact of arthritis on daily life with the patient perspective in focus

BACKGROUND: Rheumatoid arthritis (RA) often has a major impact on many areas of an individuals' life. The unpredictability of the prognosis as well as the day-to-day symptoms make it impossible to plan ahead. The aim of this study was to identify the domains of concern in the early course of RA. METHODS: Interviews were carried out according to the focus group method. Twenty-three patients with RA, aged between 27 and 67 years and with a disease duration ranging from 1 to 5 years, were included. Four groups were established, the composition of which was based on age, gender and social situation. RESULTS: Arthritis had a major impact on daily life of the patients, especially on the way they performed activities. It also strongly influenced their mood and social life. The participants tried to cope by 'dosing their activities', 'using new strategies' or to 'stretching their limits'. Their sense of helplessness and uncertainty led to both 'anger' and 'depression'. When activities could no longer be maintained, the role positioning in the family also changed. CONCLUSION: The results of this study support the view that more psychosocial support is required to encourage the recently diagnosed RA patient in the new situation of having a chronic disease.     

Occupational therapists’ reflection on practice within psychiatric care: A Delphi study

Aim: The aim of this study was to describe the reflections on practice in a group of Swedish occupational therapists in psychiatric care in order to illuminate the present practice and ideas about the future using a Delphi survey of three rounds. Material and method: The sample consisted of 14 occupational therapists in psychiatric care. The answers from the first and second rounds illustrate the wide variation in their practice. The third round points out consensus and disagreements in the domains: professional role, theories in practice, domain of concern, occupational therapy assessment, goal setting/treatment, outcome/evaluation and thoughts about the future. A consensus was reached in all domains, but not regarding competence to treat functional reduction and symptoms, or on the importance of theories for documentation, the choice of a theoretical foundation, and the importance of an evidence-based treatment model, although the theories were seen as supporting practice. Disagreements were found as to the effectiveness of repeated assessments as a means of evaluation. The future for OTs within psychiatric care was looked upon as positive. Discussion: The results developed from providing a relatively unclear and shallow perspective on OT practice to indicating a depth that shows what occupational therapy within psychiatry can be. During the process it became more and more clear how OTs think and act.     

The Flanagan Quality of Life Scale: Evidence of Construct Validity

Background  

The Quality of Life Scale (QOLS), developed originally by John Flanagan in the 1970's, has been adapted for use in chronic illness groups. Evidence for reliability and validity has been published over the years for both English and translations. This paper presents further evidence of construct validity for persons with chronic conditions as well as across two languages, and gender.     

Lower level of education in young adults with arthritis starting in the early adulthood

An appropriate education may lead to less work disability in patients with arthritis. The aim of the study was to determine the educational level in two groups of young adults with arthritis. Patients with juvenile arthritis ( JA, n=32) and patients with early adult onset of arthritis (EA, n=47) were examined with the Quality of Life Scale (QOLS) and a questionnaire concerning education and profession counselling. Comparisons with a reference group (n=95) from the general population were made. The EA group had lower level of education (p<0.01), compared to the reference group. Among the EA patients, 62% had not discussed their choice of occupation with anybody, compared to 19% in the JA group. The educational level was lower in patients with rheumatic disease starting in early adulthood. Educational issues and counselling should be focused on the care of young adults with arthritis.