Therapy Literature Research Articles

Identifying Occupational Therapy Research Priorities in Trinidad and Tobago: A Group Concept Mapping Study.

In Trinidad and Tobago, occupational therapy is an emerging profession with limitations in the number of practitioners and the scope of practice. With the development of a new Master of Science Occupational Therapy programme in the country, the profession is continuously growing. There has been an increased demand for culturally relevant research to build the occupational therapy evidence base locally. However, the narrow range of occupational therapy literature in the country makes it difficult to highlight research gaps and decipher what research areas should be prioritised to best impact occupational therapy practice at present. This group concept mapping study is aimed at identifying priority areas for occupational therapy research in Trinidad and Tobago from the perspectives of occupational therapy students and practitioners. Participants brainstormed and contributed specific research ideas they would like to see developed in the country. Individually, participants sorted these ideas into themes and rated each idea based on perceived importance and feasibility. Using the GroupWisdom™ software, multidimensional scaling and hierarchical cluster analyses were applied to the sort data to create idea clusters within a concept map. Rating values were analysed to determine priority research themes within the concept map. The resulting concept map illustrated seven research priorities: Contextualising Practitioner Development, The Realities of Emerging OT Practice, Localising Mental Health OT, Occupation and Participation of Children and Youth, School-based OT in the Local Context, OT with Special Populations, and OT Contributions to the Public Health Sector. These findings represent the research needs of the occupational therapy profession in Trinidad and Tobago and will help to focus future researchers' efforts to expand the local evidence base.

Art therapy in pediatric burn care: A conceptual framework for clinical practice

Burn injuries are an unexpected traumatic event and can be physically and emotionally devastating for a child and their families. This article presents a conceptual framework for art therapy practice with pediatric burns, founded on the three stages of burn treatment- critical, acute, and rehabilitation. The framework is based on narrative synthesis of research on the psychosocial needs of children with burn injuries, art therapy literature on pediatric burn patients, as well as in medical settings. Based on the stages of burn recovery, and the role of other relevant stakeholders, the framework provides recommendations for clinical practice of art therapy with children sustaining burn injuries, their caregivers and siblings, and healthcare providers. Robust studies including art therapy as interventions are recommended to determine their effectiveness in addressing the specific psychosocial needs in different stages of pediatric burn care.

26.3 “WE'RE ALL WALKING ON EGGSHELLS!” FAMILY THERAPY INTERVENTIONS TO RESOLVE MEDIA-RELATED CONFLICTS

Objectives: Child and adolescent psychiatrists often hear parents lament that their child is on a screen too much. This can be disruptive to the family and can displace other important activities for the child, such as schoolwork, sleep, or exercise. The lines are blurred now more than ever, in the context of COVID-19, when screens are necessary for remote learning and for peer socialization. For some families, navigating screen limits becomes an ongoing and recurrent conflict leading to everyone feeling like they are “walking on eggshells.” This presentation will focus on the application of family therapy concepts to working with families around negotiating media rules. Methods: Key concepts, largely from narrative and attachment-focused family therapy theories, will be described. These will include the importance of joining with each member of the family and defining the problem in systemic terms such that all members recognize their contribution to sustaining and maintaining the problem and their role in improving it. Ensuring that all parties, including the child, have buy-in to work on the problem is important. Recognizing problematic patterns in families (such as the parent nagging/child withdrawing, parent overfunctioning/child underfunctioning) will be described. Language to externalize the problem, or to look at the problem as located within the system and not within the child, will be offered. Focusing on improving attachment relationships within the family, which are often frayed in the context of these recurrent conflicts around media, will be reviewed. Results: Concepts from the family therapy literature and practice will be highlighted. These concepts can be easily incorporated into the practice of child and adolescent psychiatrists. Conclusions: Child and adolescent psychiatrists are well poised to help families navigate conflicts and negotiate limits around screen use. Collaborative ways to engage the child and family in shifting problematic patterns can improve family relationships and communications. FT, FAM, MED

Early use of cytokine adsorption in treatment of COVID-19 associated respiratory distress syndrome

Introduction. It is the recommendations for treatment of sepsis and septic shock combined with rheumatologists’ recommendations for monoclonal antibodies therapy that guide severe COVID-19 management in ICU. However, those recommendations may not be fully applied to patients with acute respiratory distress-syndrome associated with SARS-CoV-2, as there exists a difference in pathogenesis between sepsis and virus-associated pneumonias. Monoclonal antibodies therapy may contribute to cytokine cascade severity and promote lung injury. Cytokine storm aggravates the course of the disease. At present, there are two groups of methods described in literature for cytokine storm control and therapy: pharmacological and extracorporeal approaches.Materials and methods. We have performed a retrospective analysis of five COVID-19 patients with acute respiratory syndrome. Cytokine adsorption start criteria were respiratory insufficiency and IL-6 levels greater than 500 pg/ml. Adsorption therapy was initiated within 24 hours of ICU admission and continued for 48–120 hours in hemoperfusion mode on Multifiltrate machine (Fresenius Medical Care). The length of a single session of CytoSorb (Cytosorbents Inc.) therapy was 24 hours.Results. All patients demonstrated SpO2/FiO2 ratio growth and IL-6 concentration decrease by the end of hemoadsorption. We noted lymphocyte count rise as well as IgM и IgG SARS-CoV-2 antibodies titer substantial increase.Conclusions. Our observations suggest that the early start of hemoadsorption associates with gas-exchange stabilization and hinders respiratory distress progression. Hemoadsorption allows for pro-inflammatory cytokines concentrations decrease and prevents secondary lung injury. According to our data, hemoadsorption is beneficial to form a coronavirus infection specific immune response. Further research is needed for a detailed study of the results we here describe.

Clinical and imaging selection criteria treating lumbar disc herniations by oxygen-ozone therapy, corticosteroid and local anaesthetic.

Radicular lumbar back pain is an important public health problem not already provided with a unequivocal treatment approach. Medical and physical therapies represent the first solution, however when these are not successful, the second therapeutic step is still controversial and mini-invasive treatment may play an important role. In these cases oxygen-ozone therapy has been proved to be a very safe and effective option that is widely used with different modalities. 
 This paper, by reviewing oxygen-ozone therapy literature data, aims to propose an effective procedural technique and to clarify patient’s selection criteria; furthermore complications and follow-up management are also considered.

The politics of vulnerable masculinity in couple therapy.

Couple therapy and related literature has problematized men's emotional inexpressiveness as constraining for men and as contributing to men's privileged and dominating position vis-à-vis women. Fostering men's emotionality in and outside of therapy has been proposed as a way to improve men's well-being and relationships and promote gender equality. Critical masculinity scholars have noted that many men now enact vulnerable ("softer") and emotional forms of masculinity. Yet, there is lack of insight into how such enactment may intersect with gender inequality. This article presents a critical thematic analysis of 30 transcribed videotaped couple therapy sessions focusing on the performance of men's affective masculinities and the political dimensions of men's increasing emotionality within couple therapy. The study shows that vulnerable masculinities, although argued as bearing the potential to foster relational and social change, may also obscure continuing commitment to dominant masculinity norms. Implications for practice are discussed.

The Conundrum of Kappa and Why Some Musculoskeletal Tests Appear Unreliable Despite High Agreement: A Comparison of Cohen Kappa and Gwet AC to Assess Observer Agreement When Using Nominal and Ordinal Data.

In clinical practice, physical therapists often use different kinds of tests and measures in the assessment of their patients. For therapists to have confidence when using their tests and measures, an important attribute is having intratester and intertester reliability. Studies that assess reliability are cases of observer agreement. Many studies have been performed assessing observer agreement in the physical therapy literature. The most commonly used method to assess observer agreement studies that use nominal or ordinal data is the statistical method suggested by Cohen and the corresponding reliability coefficient, Cohen kappa. Recently, Cohen kappa has undergone scrutiny because of what is called kappa paradox, which occurs when observer agreement is high but the resulting kappa value is low. Another paradox also occurs when asymmetries exist between raters on their disagreements, resulting in a higher kappa value. In the physical therapy literature, there are numerous examples of this problem, which can often lead to misunderstanding the meaning of the data. This Perspective examines how and why these problems occur and suggests an alternative method for assessing observer agreement.

The Theory and Practice of Group Psychotherapy, Sixth Edition

The Theory and Practice of Group Psychotherapy, Sixth Edition

Surgeon-Therapist Communication Must Be Improved in Rotator Cuff Repair Rehabilitation: An Electronic Survey of Physical Therapists on Postoperative Rehabilitation Protocols and Communication with Treating Surgeons.

There is no consensus on postoperative rotator cuff repair protocols in orthopedic or physical therapy literature. Despite surgical management, the frequency of rotator cuff retears continues to be high. This study is designed to investigate the current concepts of postoperative rehabilitation and to evaluate the state of communication between referring surgeons and treating physical therapists. A survey was conducted over a 2-year period, performed by an online survey company. Six hundred responses were obtained from physical therapists. Most rehab protocols were based on size of tear, tissue quality, and open versus arthroscopic repair. Current intervention concepts and professional experience guided protocol development. Thirty-three percent of therapists receive operative notes ≤ 25% of the time. Sixteen percent reported not receiving operative notes and not having access to the physician >50% of the time. Most patients were seen within 2 weeks, with passive range of motion started in 83% of cases. Sixty percent started active-assist range of motion at ≤ 4 weeks. Sixty-four percent of therapy was continued for 12 to 16 weeks. Patient compliance, poor tissue quality, and rapid rehab progression were reported as common causes of failure. Most rehabilitation programs follow protocols developed by surgeons and physical therapists. Tissue quality, size of tear, and repair type are usually documented in the operative report, and are rarely conveyed to the therapist. This study highlights the lack of communication between the physician and the therapist. Improving communication regarding the findings at surgery, opening lines of communication, and making alterations to the protocol may improve patient outcomes.

Conserving dignity and facilitating adaptation to dependency with intimate hygiene for people with advanced disease: A qualitative study

Background: People at the end of life experience increased dependence with self-care as disease progresses, including care with intimate hygiene. Dependence with intimate hygiene has been identified as a factor that may compromise dignity at the end of life. However, adaption to increased dependency and subsequent impact on dignity with intimate hygiene is an under-researched area. Aim: This study sought to understand how people at the end of life experience dignity with intimate hygiene when function declines and how people adapt to increased dependence with intimate hygiene needs. Design: A qualitative design was employed using a hermeneutic phenomenological perspective which privileges participant perspectives. Findings were mapped against occupational therapy and dignity literature. Setting/participants: Participants were people with advanced disease receiving inpatient or community palliative care. Results: Eighteen interviews were conducted with people about their experiences and perspectives of dignity with intimate hygiene. The following themes were constructed from the data: (1) There’s a way of doing and a way of asking, (2) Putting each other at ease, (3) It’s just how it is, (4) Regaining and retaining control. How people adjust to dependence with intimate hygiene is individually mediated. Patterns of occupational adaptation to increased dependence with intimate hygiene and practical implications for care are discussed. Conclusion: Adaptation to increased dependence with intimate hygiene is facilitated by enabling moments of micro-competence and agency over how care is received. Carers play a pivotal role in compromising or conserving the dignity with intimate hygiene at the end of life.

Meditation in the age of its technological mimicry.

In recent years, mindfulness meditation has become a popular technique to reduce stress or anxiety related problems and to enhance happiness and wellbeing. Apart from specific real-life mindfulness programs in schools, hospitals, military, and business environments, there is a strongly expanding field of digitally mediated mindfulness. From a critical psychological, ‘Foucauldian’ perspective, we analyse popular mindfulness apps as dispositifs of power that contribute to aligning the selfgovernance of individuals with the requirements of neo-liberal governance. Our analysis exposes them as sociocultural artefacts fostering exactly such forms of subjectification that fit the neoliberal state of affairs. By freely amalgamating and interweaving psychological, Buddhist, and economic ‘knowledge’ (their ‘meditations’ being inspired, apart from alleged Buddhist sources, from cognitive behavioral therapy, positive psychology, and management literature), such apps orient self-government towards competition, optimization, enhancement, and acceleration, i.e., towards a happiness conflated with productivity – probably not quite what the Buddha had in mind.

A Q-method approach to perceptions of professional reasoning in occupational therapy undergraduates

BackgroundProfessional reasoning provides a firm basis for the development of teaching and assessment strategies to support the acquisition of skills by healthcare students. Nevertheless, occupational therapy educators should use diverse methods of learning assessment to examine student learning outcomes more fully with an evaluation that supports the overall complexity of the process, particularly learners’ subjective experience. The aim of this article is to identify the range of perspectives among occupational therapy undergraduates regarding terms or concepts that are key for improving their professional reasoning.MethodsQ-methodology was used to address the aim of the study. A concourse relating to a series of ideas, phrases, terminology, and concepts associated with various studies on professional reasoning in occupational therapy, specifically on students in this field, was generated. The terms that had the clearest evidence, the most relevance or the greatest number of citations in the literature were collected (n = 37). The P-set was assembled by non-probabilistic sampling for convenience. It comprised undergraduate university students in occupational therapy. Factor analysis was conducted using Ken-Q Analysis v.1.0.6, reducing the number of Q-sets to smaller groups of factors representing a common perspective.ResultsThrough statistical analysis of the Q-sorts of 37 occupational therapy students, 8 default factors were identified. The four factors in accordance with the selection criteria were rotated by varimax rotation to identify variables that could be grouped together. Each viewpoint was interpreted, discussed and liked to different aspects of professional reasoning in occupational therapy.ConclusionsThe observed perceptions were linked to the various aspects of professional reasoning that have been widely discussed in the occupational therapy literature. For most of the students, there was a strong correspondence between the narrative, interactive and conditional aspects of the various components.

Humor in Couple Relationships: An Opportunity for Therapeutic Inquiry

Humor has been a focus of therapy literature for over a century and is considered an essential communication tool and important component of therapeutic relationships. Yet couple therapy literature does not feature humor as a relational practice or strategy for couples’ relationship development. When humor presents in a therapy conversation it offers opportunities for therapists to explore the implications and meanings for the couple relationship, potentially contributing to new and enhanced relationship experience. This article provides vignettes from one couple therapy conversation to illustrate therapeutic possibilities for exploration of couples’ humor. Therapists are encouraged to pay attention to humor as a complex, dynamic, discursive practice with therapeutic benefits for couples’ therapy.

An Integrative Review of Contemporary Perspectives on Videoconference-Based Therapy-Prioritising Indigenous and Ethnic Minority Populations in the Global South.

An integrative literature review was undertaken as a means of drawing together contemporary perspectives on the outcomes and affordances of videoconference-based therapy. This review was conducted in a way which placed emphasis on the need for mental healthcare strategies which are mindful of the cultural and social needs of indigenous and ethnic minority populations, particularly those situated in the Global South. The review was undertaken using an inverse funnelling approach which sought to prioritise literature on videoconference-based therapy literature which specifically focused on indigenous and ethnic minority populations. A series of general and population specific searches across relevant health databases were supplemented by a simultaneous search of Google Scholar. The PICOS search tool was used in developing the search terms, and data was processed using an inductive approach to thematic analysis. A final dataset of 43 articles were included in the review. This body of literature encompassed an international range of studies and included perspectives informed by quantitative, qualitative and mixed methods research. Four key themes were identified across the reviewed literature: indigenous and ethnic minority populations, therapeutic relationships, clinical outcomes and technical and logistical considerations. Based on our findings, there is reason to believe that videoconference-based therapy can be made to be just as effective as offline, face-to-face modes of delivery. However, research into the efficacy, impact and cultural implications of this technology in relation to indigenous and ethnic minority populations represents a significant gap within contemporary literature.

Occupational Justice-Colonial Business as Usual? Indigenous Observations From Aotearoa New Zealand: La justice occupationnelle : sous régime colonial comme d'habitude? Observations d'autochtones d'Aotearoa en Nouvelle-Zélande.

Western ideologies and systems of occupation and justice are implicated in the colonization of indigenous peoples worldwide. Yet, colonialism, racism, and privilege are minimally acknowledged and examined within occupational therapy and occupational science literature, as evidenced in uncritical development of notions of "occupational justice." First, to open a discussion of how and why theories and approaches to justice have developed as they have in Aotearoa New Zealand. Second, to further a burgeoning field of Indigenous perspectives and critiques of colonial theorizing within the profession, while highlighting local Indigenous justice frameworks including Te Tiriti o Waitangi and Matike Mai Aotearoa. Colonialism is minimally examined in occupational justice approaches and promotion. Honest examination of colonialism alongside Indigenous justice frameworks can advance critical praxes of decolonising occupation and re-connect occupation with justice and equity.

Addressing Puberty Challenges for Adolescents With Autism Spectrum Disorder: A Survey of Occupational Therapy Practice Trends.

Understanding occupational therapy practice patterns for adolescents who have autism spectrum disorder (ASD) provides a baseline to determine areas of need and effective interventions. To identify puberty-related challenges addressed and interventions used by occupational therapy practitioners with adolescents ages 8-16 yr with ASD. A nonexperimental survey design with a stratified random sample was used. The Occupational Therapy-Autism and Puberty Survey was distributed in the United States online through the Qualtrics platform (available October 2017-January 2018). Occupational therapists (89%) or occupational therapy assistants with experience with adolescents who have ASD were included. The 71 eligible respondents were primarily White women with an average 16 yr of experience. Outcomes and Measures: Nine key challenges and 11 interventions regarding puberty and ASD were identified. Hypotheses were generated before data collection. More practitioners (>47%) addressed emotional regulation and personal hygiene, and fewer (<26%) addressed menstruation, safety, and masturbation. Nearly all practitioners (>92%) reported using social learning approaches and behavioral strategies, and most (>80%) reporting having received education in these interventions. Significant differences were found between reported education and use of behavioral skills training incorporating applied behavioral analysis (p < .001), parent training (p = .002), and technology (p = .003). Practitioners are neglecting to address puberty-specific challenges with adolescents who have ASD. Opportunities exist to expand the interventions used and challenges addressed by occupational therapy practitioners for adolescents with ASD. What This Article Adds: This article expands occupational therapy literature by giving a baseline understanding of the puberty-related challenges that practitioners are addressing with adolescents who have ASD. This information can assist the profession in developing effective interventions and educational opportunities to allow practitioners to successfully address puberty-specific challenges.

Video Modeling Use in Work Occupations for People With Autism: A Systematic Review.

Occupational therapy practitioners should use evidence-based practices, such as video modeling, to address work occupations supporting people with autism spectrum disorder, including those with co-occurring intellectual and developmental disabilities. To examine the evidence and relevance of video modeling supporting engagement in work occupations for people with autism and to translate these findings to occupational therapy practice. Cochrane Collection Plus, CINAHL, PubMed, ERIC, ProQuest, and peer-reviewed occupational therapy literature from 2008 to 2018. Study Selection and Data Collection: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study selection and data collection focused on occupational therapy scope of practice, autism spectrum disorder, co-occurring intellectual and developmental disabilities, video modeling, and work occupations for people age 16 yr and older. A total of 464 articles were screened. Six articles met inclusion criteria. Results indicated moderate evidence for video modeling to support work occupations for people with autism, specifically employment seeking and acquisition and specific job-performance skills. Samples were limited to people younger than age 28 yr and represented varied intellectual abilities, indicating potential for benefits across the spectrum of cognitive functioning. This systematic review highlights the promising potential of video modeling to address work occupations for people with autism. However, more rigorous effectiveness research is needed, including studies by occupational therapy practitioners. What This Article Adds: Occupational therapy expertise paired with video modeling, as a strengths-based, client-centered, customizable, socially acceptable intervention, can provide meaningful support for work occupations.

Role of Occupational Therapy in Facilitating Participation Among Caregivers of People With Parkinson's Disease: A Systematic Review.

Caregivers play a critical role in facilitating the performance of people with Parkinson's disease (PD). Knowledge on how occupational therapy practitioners can mitigate the negative effects of caregiving is needed to enable caregiver participation. To explore the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people with PD to facilitate or maintain their participation in the caregiver role. We conducted a systematic review of the literature published in CINAHL, MEDLINE, PsycINFO, and OTseeker between 2011 and 2019. Article reference lists were also hand searched for additional articles. Study Selection and Data Collection: Articles were screened and evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The review was conducted in accordance with steps outlined by the American Occupational Therapy Association's Evidence-Based Practice Project. Six articles met the inclusion criteria. Interventions in each article were distinct, prohibiting theme development. Overall, the strength of evidence was low, and the risk of bias was high. None of the studies included in this review were obtained from the occupational therapy literature. Little evidence is available to support interventions within the scope of occupational therapy practice for caregivers of people with PD. Existing evidence suggests that interventions need to be flexible (e.g., in terms of time, cost, and delivery method) and tailored to the unique needs of this population. What This Article Adds: There is a continued need to develop occupational therapy interventions that support participation in the caregiving role for caregivers of people with PD.

Therapist art making as a means of helping service users with anxiety problems

ABSTRACT Background Therapist art making in individual sessions with adult service users has received little attention in the art therapy literature. Similarly, art therapy’s efficacy with anxiety problems has not been established. Context NHS Criminal Justice Community Mental Health Team, long term weekly individual art therapy. Outcomes Service User reported marked reduction in anxiety, CJCMHT observed significant reduction in anxiety and increased social functioning leading to discharge from forensic services. Conclusions Therapist art making helped reduce anxiety by increasing trust. The ambiguity of the artwork challenged black and white ways of relating to self and others. Therapist artmaking functioned as a non-verbal form of psychoeducation. Three styles of therapist art making can be described, all of which are characterised by improvisation: Alongside the Service User; Jointly with the Service User; Under the gaze of the Service User. Implications for research Art making can be helpful in 1:1 therapy with adult service users because it magnifies the art therapist’s ostensive (i.e. non-verbal) communications and increases trust. Making art alongside service users provides a unique way to engage with complex psychological and interpersonal material. It is the ambiguity of therapist artwork that seems particularly helpful, and it should be considered as a promising way to address black and white thinking in common mental health problems like anxiety and depression. Plain-language summary This paper describes the benefits of therapist art making in individual sessions with an adult user of mental health services. Lived Experience feedback is used to show how therapist art making helped reduce severe anxiety and improve social functioning. The paper describes the clinical reasoning for three art-based interventions; how they built and maintained trust, meaning and hope for both therapist and Lived Experience Author. The paper suggests that the ambiguity of therapist artwork can be thought about in terms of the presenting problem, particularly to reframe black and white ways of relating to self and others.

Trends of differentiation and integration in UK music therapy and the spectrum of music-centredness

A long-standing trend to differentiate and even oppose psychodynamic and ecological approaches to practice can be identified in the UK music therapy literature. This is complicated by the way in which ecologically oriented thinking is associated with practice identified to be music-centred. While the trend to differentiate and separate approaches is most apparent in the literature, it is also evident that in practice, therapists have long integrated different perspectives and ways of working, this integral trend having its roots in the work of the UK music therapy pioneers. This article explores how the ecologically oriented thinking associated with the Community Music Therapy movement, and introduced soon after the turn of the 21st century, served in part to broaden the scope of UK practice in a progressive, integrally oriented way. However, the article also discusses the rejection of psychotherapeutically oriented thinking made by some ecologically oriented authors to make space for the new way of thinking. It is suggested that this rejection has been less helpful for the development of the profession as a whole, as the different ways of working in music therapy can be understood to address different types and levels of need. This means that psychodynamic, developmental, ecological, neurological and other perspectives are all potentially important. Case vignettes are used to illustrate this and an integral approach to working, with music-centredness discussed in a way that embraces the full spectrum of UK practice.