Specialist Therapists Research Articles

2049 Evaluating the rate, timeliness and accuracy of centralised Clinical Frailty Score documentation at a major NHS A&E department

Abstract Introduction Between 5-10% of patients attending the emergency department (ED) are elderly patients living with frailty. NHS England now recommends that all patents aged >65 presenting to acute care should have a Clinical Frailty Score documented within 30 minutes of arrival. We audited the CFS documentation from the Electronic Patient Record (EPR) for patients aged >65 presenting to our local E.D. Methods Our baseline audit looked at patients aged >65 presenting to our ED from 01/09/23-07/09/2023 (n=430). We extracted data for rate and timeliness of documentation from EPR. To calculate accuracy, we compared the documented scores from ED triage staff, with that of our therapist led Frailty Intervention Team (FIT). We excluded patients not assessed by the FIT. We then re-audited the data for 3 separate weeks after delivering a tailored teaching session for band 6 and 7 nurses, and introduction of an educational poster. Results We found exceptional baseline compliance and timeliness of CFS scoring with a 97% documentation rate with a median time of 31 mins from presentation. When assessing accuracy of triage nurse CFS documentation, we found that 42% of patients fell into a lower category of frailty when compared to scores allocated by the FIT. Following teaching sessions and poster education, we observed no improvement in this. Conclusion Our audit identified an overall excellent baseline compliance and timeliness in EPR documentation of CFS scores despite the department’s heavy workload. We noted a significant under-recognition of frailty at ED triage compared to specialist therapist scoring. Despite delivering education sessions and introduction of an educational poster there is still significant room for improvement in accurate identification of frailty with the CFS.

NATURAL GYNECOLOGY

Feminism plays an important role in the construction and deconstruction of gynecology. From the distance it brought for women to enter the job market more effectively, to the return to the search for self-knowledge, which includes their own body. The holistic nurse, or specialist therapist in the area, will check the exams, take an anamnesis with the patient to try to find out the reason for the consultation and seek treatment as a whole. Some activities can be prescribed such as phytotherapy with the use of flower remedies, Reiki, acupuncture, meditation, uterine vaporization. With this, a multidisciplinary team will be activated to accompany this woman and generate the greatest possible comfort.

The role of physical and occupational therapy in palliative and hospice medicine of neurodegenerative diseases

The aim of our research is to review modern literature regarding the relevance and frequency of physical and occupational therapy in palliative and hospice medicine of neurodegenerative diseases. Results. The role of physical therapy and occupational therapy in palliative-hospice medicine for such neurodegenerative diseases as Parkinson’s disease, cognitive impairment and/or dementia, Alzheimer’s disease, amyotrophic lateral sclerosis, multiple sclerosis has been studied. It has been found, a wide variety of physical and occupational therapy is widely used in palliative hospice medicine despite the disease’s severity. These methods significantly improve the quality of life of both palliative patients and their families ultimately. Physical and occupational therapist specialists are a very important link in the multidisciplinary team of palliative-hospice medicine. Conclusions. Physical and occupational therapy play a very important role in neurodegenerative diseases patients requiring palliative-hospice care in today’s world. Palliative physical and occupational therapy of patients with neurodegenerative diseases has many benefits that help maintain or improve various bodily functions. This contributes to the quality of life improving for not only patients but also for their family members who care for them.

205 DESIGN OF AN AMBULATORY CARE HUB IN AN OLDER PERSONS SETTING

Abstract Background The service was established to deliver rehabilitation based in a day care setting. The Multi-Disciplinary Team (MDT) allocated to cover the unit often had other clinical responsibilities. Therapy was delivered in silo with differing plans/goals for individual patients. There was often reduced with insufficient/no cover to the department. The department was closed during the pandemic. Upon reopening a decision was made to restructure service delivery. A pathway of change was decided on to move from a day care setting to an ambulatory hub model of care. Methods A Delphi method was undertaken and a review of processes conducted by the Clinical Nurse Manager 2 (CNM2). Consequently, all new referrals were screened and virtual telephone clinics held. Nursing Comprehensive Geriatric Assessments (CGA) were conducted on patients referred by their GP or who had not attended the Age-Related Healthcare Department within 6 months. This ensured clarity around patient needs. Individualised care plans were initiated before the patient’s medical appointment took place. Any urgent reviews were flagged to specific therapists by the CNM2. Results The service was restructured and is now interdisciplinary in approach. The Service moved from a day care setting reviewing approx. 60 patients weekly to an ambulatory care hub model with over 450 targeted interdisciplinary reviews weekly. A spreadsheet was developed and collated weekly by the CNM2 informing therapists of referrals received hence streamlining care- planning. This enabled MDT collaboration and merging of appointments to prevent multiple attendances. This development has been welcomed by patients and families. Conclusion The Ambulatory Care Hub operates at a maximum capacity with patient’s receiving targeted comprehensive interdisciplinary therapy input. There is a greater sense of teamwork within the department and patients benefit from this collaboration. This redesign has shown that a well-structured MDT provides essential support in many areas of disease management.

MANAGEMENT OF CLEFT LIP AND PALATE IN PAKISTAN

Knowledge about the effective management of cleft lip and palate, the common birth defect is gaining prominence worldwide. The superintendence of a child with a cleft lip or cleft lip and palate begins from the day the infant is born. Cleft lip and palate management necessitates active participation and coordination among professionals such as clinical nurse specialist, feeding specialist, maxillofacial surgeon, craniofacial surgeon, pediatric anesthetist, orthodontist, dentist, otolaryngologist, consultant pediatrician, consultant ENT, audiologist, speech and language therapist, clinical psychologist, and consultant clinical geneticist. In Pakistan, limited involvement of speech and language therapists in the neonatal and primary care unit engenders complications. Role of speech and language therapist is significant in creating awareness about specific feeding techniques to prevent primary and secondary complications including malnutrition4. Feeding guidelines provided by American Speech and Hearing Association can be provided to clinical nursing specialists enabling them to manage children in NICU or primary care units. Communication difficulties can be addressed by counseling and training of parents and caretakers5.

International experience in organizing medical care for the population of Italy and Serbia by military medical specialists during the COVID-19 pandemic

Based on the decision of the President of the Russian Federation, interservice teams of the Armed Forces of the Russian Federation were formed to combat a new coronavirus infection (COVID-19) in Italy and Serbia. Eight medical and nursing teams were formed from the medical personnel in each detachment, led by epidemiologists, each consisting of an anaesthesiologist (resuscitator), an infectious disease specialist (therapist), and an anesthesiologist nurse. Their main task was to provide medical care for patients with new coronavirus infection in the medical and preventive organizations of these countries. In order to accomplish their tasks and to provide high-quality medical care (protection of personnel from contamination by biological agents), each group was equipped with personal protective equipment. The work of the medical teams on the territory of Italy and Serbia consisted in sanitary and epidemiological reconnaissance, epidemiological examination of the outbreaks of the new coronavirus infection, organization of anti-epidemic measures and treatment of patients with COVID-19 in the medical and preventive organizations of these countries. Calculations of mobile aerosol disinfection complexes and auto-filling stations of the radiation, chemical and biological protection troops were involved in carrying out anti-epidemic measures on a daily basis. As a result of the measures taken, experience was gained in using the forces and resources of the Ministry of Defense of the Russian Federation to localize the outbreaks of the new coronavirus infection in the territory of foreign countries. The joint work of the group of the Armed Forces of the Russian Federation and local authorities has reduced the incidence of a new coronavirus infection among the local population of Italy and Serbia.

Orthotic intervention following stroke: a survey of physiotherapist, occupational therapist and orthotist practice and views in the UK

Background/Aims Orthoses are often used to promote mobility and rehabilitation for patients in the UK after a stroke. The perspective of stroke therapists in the UK is an important factor determining current practice and orthotic provision. The purpose of this study was to investigate the views of orthotists, physiotherapists and occupational therapists on the delivery mechanisms and relationships that influence orthoses intervention and provision for patients with stroke in the UK. Methods A UK-based online survey was conducted. Participants were stroke therapy clinicians within acute and community settings, recruited through their membership of the British Association of Prosthetists and Orthotists, the Association of Chartered Physiotherapists Interested in Neurology, and the Royal Collage of Occupational Therapists—Specialist Section for Neurological Practice. Data were analysed using descriptive statistics and content analysis. Results A total of 305 questionnaires were completed (64 orthotists, 131 physiotherapists, 110 occupational therapists). Some 67% (n=190) of respondents identified the optimal timing for initial orthotic assessment as within the first days following a stroke or before discharge from hospital. Waiting times and operational barriers to orthoses provision were perceived to have a negative impact on patients’ rehabilitation. A closer working relationship between orthotists and the stroke rehabilitation team is desirable. Conclusions The survey found that the use of orthoses and orthotic specialist input are perceived to play an important role within the stroke rehabilitation pathway. Further evaluative research is warranted to explore the optimal timing and benefits, and the orthotist's role within the stroke rehabilitation team.

805 UPPER LIMB FRACTURE PATHWAYS IN FRAILTY ENABLE EARLIER RETURN TO FUNCTION WITH ASSOCIATED REDUCED LENGTH OF HOSPITAL STAY

Abstract Introduction Upper limb fractures are the second most common fracture requiring admission to hospital after hip fracture [Jennison, 2019]. At 1-year 20.5% have died, compared to 29.5% in hip fracture [Wiedl, 2021]. Local Problems: At North Bristol Trust most patients with upper limb fractures and a Clinical Frailty Score ≥ 5 are managed non-operatively on medical wards. Local service evaluation identified a long length of stay of 23 days. Case note review revealed: • Delayed transfers of care (DTOCs) had been managed non-weight bearing in slings for 4–6 weeks. • Non-weight bearing status resulted in DTOC due to declined access to social care and rehabilitation due to perceived health needs. • A high rate of hospital-acquired complications and failure to rehabilitate. • Breakdown in interdisciplinary communication and ownership across the pathway. Methods A multidisciplinary QI project was commenced. Using local data through business analytics, clinician and patient feedback, a new Trust guideline was developed for older people with frailty and upper limb fractures. Data collected determined average length of stay before and after implementation of the service change. A standard process control chart was created monitoring the effect of the changes in the pathway. The multidisciplinary team met regularly to make alterations during implementation. The resulting intervention included: • Removal of functional restrictions; allow free use of limb as comfort permits. • Simplified slings and minimised light weight casts. • Proactive integration of orthopaedic plan into CGA documentation. • Proactive interdisciplinary communication across pathways. • Patient information leaflets. Results Pre-intervention average length of stay was 23 days. Post-intervention was 14 days. Conclusion Proactive, structured management of upper limb fractures in people with frailty is associated with significant reduction in acute hospital length of stay. Next steps include a business case for a frailty trauma specialist therapist embedded into medicine.

Utility and Professional Attitudes toward Assistive Technology in UAE Special Needs Centers

The attitude of teachers about the use of technology is critical. As a result, when teachers have a constructive outlook toward a new type of assistive technology, they are more likely to make meaningful efforts to successfully integrate it into the teaching-learning process. The way assistive technology is used in the teaching and learning environment is heavily influenced by a special education teacher’s attitude. Therefore, the study explored the availability of assistive technology and explored the attitudes of professional of special education towards the use of assistive technologies in special needs centers of United Arab Emirates (UAE). Questionnaires were distributed and 100 responses were received from special education professionals. No statistically significant differences were observed in the attitudes of special education teachers and therapists with respect to their experiences, profession, gender, academic qualification, or locality. Assistive technologies were mostly used in different areas of special education including computer access, spelling, learning, recreation, environmental control, vision and hearing, writing, communication, mathematics, mobility, and positioning and seating. There is a constructive impact on the learning process of the children with special needs considering the expertise of specialist teachers and therapists on assistive technology linked to positive educational outcomes of students with special needs.

The effectiveness of physical activity interventions on communication and social functioning in autistic children and adolescents: A meta-analysis of controlled trials.

Difficulty with communication and social functioning are two outstanding core symptoms of autism spectrum disorder, while there is no efficacious pharmacologic treatment available to deal with them. Traditional behavioral therapies usually require specialist therapist and be conducted in specific settings, increasing burdens on families and individuals with autism. Physical activity has long been found to promote physical and mental well-beings, and it is more affordable and versatile than traditional therapies. There is preliminary support for the use of physical activity interventions to improve communication and social functioning in individuals with autism. In this study, we quantitatively aggregate data from existing controlled trials to provide an up-to-date inquiry into the effectiveness of physical activity interventions on communication and social functioning in autistic children and adolescents. We included 12 trials involving 350 participants (8 trials reported communication outcomes and 11 trials reported social functioning outcomes) and found small to moderate benefits on communication and social functioning. Further analyses showed that the benefit of physical activity interventions is greater in younger participants. Results of this study suggest that physical activity interventions are effective to improve communication and social functioning in autistic children and adolescents, and early participation in the interventions can be more beneficial. Given their affordability, versatility, and efficacy, physical activity interventions could be considered a cost-effective option for autism spectrum disorder management in the future.

Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology.

BackgroundFacial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients’ and clinicians’ views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways.ObjectiveThis study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology.MethodsSeparate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis.ResultsA total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9% (8/93) of adults reported traveling ≥115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology.ConclusionsThe study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated.

TAHMİN PERFORMANSINI ARTTIRMAK İÇİN KOLEKTİF ÖĞRENME YAKLAŞIMI: ENGELLİ BİREYLERE YÖNELİK DENEYSEL ÇALIŞMA

In the case of too many variables, manual classification becomes a time- and labor-intensive process. For instance, classifying people with disabilities according to the problems they experience in self-care activities is a time-consuming process for specialist therapists. The aim of this study is to develop a model that can predict the problems experienced by physically and motor disabled individuals in self-care activities in order to reduce time spent by specialist therapist. Seven different data mining algorithms (support vector machines, artificial neural networks, C5.0, CART, QUEST, CHAID, bayesian networks) have been used in the estimation process. These algorithms have been applied individually and by forming different ensemble models. When experimental results of single and ensemble models were compared, it was seen that ensemble learning technique combined with two or more algorithms increased predictive performance.

Approach to patients with cleft lip and palate in orthodontics

Cleft lip and palate (CLP) are the most commonly observed congenital anomaly in the craniofacial region, which are observed in one in every one thousand children and caused by multifactorial factors. CLP occur due to the inability of embryonic protrusions, which forms the roof of the mouth with the maxillary bone, to integrate completely. Due to the scar tissue formed as a result of the operation conducted for dental problems, such as missing teeth or extra teeth, location anomalies, enamel defects, and anomalies of size, formation, and eruption, CLP can cause developmental problems, problems in speech due to difficulties in phonation, and hearing problems due to frequently experienced otitis media. CLP treatment requires a multidisciplinary approach. For the CLP treatment to succeed, it is very important for a team that consists of an orthodontic specialist, ENT specialist, audiologist, psychologist, dentist, and speech therapist to work in harmony. The treatment process of CLP starts as soon as the infant is born. The period of the first 6 months is the preoperative period. In this period, a feeding plaque implementation is conducted by an orthodontic specialist. Operations for lips are usually conducted between the 3rd and 6th months, whereas operations for palates are usually conducted between the 12th and 18th months. In mixed dentition, maxillary expansion and protraction, tooth location correction, and bone grafting are conducted. In continuous dentition, if constant orthodontic treatment is necessary, orthognathic surgical operations and prosthetic dentistry treatments are conducted. In CLP anomalies, the main aim is to educate future mothers and fathers about the factors that can be eliminated. For infants who are born with CLP, the treatment should be initiated without losing any time. The fact that the treatment of these patients is conducted at an esthetically and functionally satisfactory level will also improve the quality of life for both the patients and their families. Furthermore, in patients with CLP, esthetics, phonation, and speech, briefly, the external appearance should be emphasized with recurring operations and follow-ups and their mental states should not be ignored in addition to supporting them with psychological rehabilitation and a constant boost of morale.

Staffing level: Survey among psychosomatic-psychotherapeutic institutions in Germany

Using a standardized written hospital survey from the Deutsches Krankenhausinstitut (DKI), we invited a total of 218 psychosomatic-psychotherapeutic hospitals and specialist departments to participate. The participation rate of the institutions was 35%. In the overall sample, one psychotherapist (physician/clinical psychologist) was responsible for treating a median of 3.9 beds/patients (interquartile range 3.1-5.1) and one nurse a median of 2.9 beds/patients (interquartile range 2.3-3.9). There were significant differences for the nurse-patient ratio depending on the organizational size of the institution. To ensure quality treatment, professional experts saw increased staffing needs of about 12-17% across both professions. For the professional groups of specialist therapists and social workers, broad variances were observed for the therapist-patient ratio in the overall sample. The study provides an important and relevant data basis for the further discussion to determine mandatory minimal staffing levels in German psychosomatic-psychotherapeutic institutions.

Current Therapeutic Management of Perinatal Stroke with a Focus on the Upper Limb: A Cross-Sectional Survey of UK Physiotherapists and Occupational Therapists

Aim: To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. Design: Web-based cross-sectional survey. Methods: Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. Results: 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. Conclusions: Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.

Gynecological Issues for Cancer Survivors

Abstract The development of sexual morbidity in survivors of female cancers is a multifactorial problem encompassing psychological, physiological, and sociological elements. Often patients are embarrassed to discuss sexual function, and it is rarely addressed in clinical practice. Cancer treatments, such as surgery, chemotherapy, radiation, and endocrine therapies, greatly influence sexual health. Of import, pelvic floor dysfunction plays a significant role in women's ability to enjoy sexual intercourse and to tolerate the medical pelvic examination. Nurse practitioners and physical therapist specialists can offer a thoughtful, comprehensive assessment of the pelvic floor with a structured treatment program to significantly affect sexual satisfaction.

A development study and randomised feasibility trial of a tailored intervention to improve activity and reduce falls in older adults with mild cognitive impairment and mild dementia

BackgroundPeople with dementia progressively lose abilities and are prone to falling. Exercise- and activity-based interventions hold the prospect of increasing abilities, reducing falls, and slowing decline in cognition. Current falls prevention approaches are poorly suited to people with dementia, however, and are of uncertain effectiveness. We used multiple sources, and a co-production approach, to develop a new intervention, which we will evaluate in a feasibility randomised controlled trial (RCT), with embedded adherence, process and economic analyses.MethodsWe will recruit people with mild cognitive impairment or mild dementia from memory assessment clinics, and a family member or carer. We will randomise participants between a therapy programme with high intensity supervision over 12 months, a therapy programme with moderate intensity supervision over 3 months, and brief falls assessment and advice as a control intervention. The therapy programmes will be delivered at home by mental health specialist therapists and therapy assistants. We will measure activities of daily living, falls and a battery of intermediate and distal health status outcomes, including activity, balance, cognition, mood and quality of life. The main aim is to test recruitment and retention, intervention delivery, data collection and other trial processes in advance of a planned definitive RCT. We will also study motivation and adherence, and conduct a process evaluation to help understand why results occurred using mixed methods, including a qualitative interview study and scales measuring psychological, motivation and communication variables. We will undertake an economic study, including modelling of future impact and cost to end-of-life, and a social return on investment analysis.DiscussionIn this study, we aim to better understand the practicalities of both intervention and research delivery, and to generate substantial new knowledge on motivation, adherence and the approach to economic analysis. This will enable us to refine a novel intervention to promote activity and safety after a diagnosis of dementia, which will be evaluated in a definitive randomised controlled trial.Trial registrationClinicalTrials.gov: NCT02874300; ISRCTN 10550694.

Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness.

BackgroundObsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD.Methods and findingsThis study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = −1.91, 95% CI −3.27 to −0.55). These effects did not reach a prespecified level of “clinically significant benefit.” cCBT did not demonstrate significant benefit (adjusted mean difference = −0.71, 95% CI −2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment.ConclusionsWe have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN73535163.

Eating Disorders and Therapist Emotional Responses.

The aims of this study were to identify (a) patterns of clinicians' emotional responses to patients with eating disorders (ED); (b) patient, clinician, and treatment variables associated with therapist emotional responses; and (c) the influence of patient personality on therapist emotional responses. A random national sample of psychodynamic and cognitive-behavioral psychotherapists (N = 149) was asked to examine one patient (>18 years old) with an ED. Clinicians completed the SWAP-200, the Therapist Response Questionnaire, and the Clinical Questionnaire-Eating Disorder Form to provide general information about themselves, patients, and therapies. Results suggested a therapist pattern of emotional response in relation to different ED diagnosis and indicated meaningful influence of therapist experience and patient variables (such as sexual abuse, dissociative symptoms, and self-harm) on therapist emotional reactions. Finally, regression analysis suggested that therapist responses are more related to patient personality than ED symptoms. This study confirms the importance of patient personality in evoking specific therapists' reactions.

The identification of research priorities for UK occupational therapists in work rehabilitation

Background/Aims: UK occupational therapists are recognised as having key skills in work rehabilitation, but there is limited evidence to underpin this. In order to use research resources to best effect, it is vital to identify the research priorities of occupational therapists in work rehabilitation. This study aims to gather the views of those with a special interest in the field in order to identify their research priorities. Methods: An online survey was developed and administered electronically to members (n=173) of the College of Occupational Therapists Specialist Section–Work (COTSS–Work). Respondents were asked to: i) prioritise and comment on research areas; ii) propose research questions. A final sample of 42 surveys was collected and analysed thematically. Results: Responses reflected the diversity and complexity of work rehabilitation. Identifying a rank order of research priorities proved challenging as the majority (≥62%) of respondents considered all of the topic areas listed a high priority. Research into the following areas were included in the survey: interventions; outcome measurements; assessments; management and/or service delivery; planning and/or commissioning; and education. However, ‘interventions’ was rated highest overall. Conclusions: Occupational therapists in the UK need more evidence to justify their role in the work and health arena. Greater opportunities are required for occupational therapists in clinical practice, as well as those involved in research, to address areas in which evidence-based practice is lacking and the mechanisms to disseminate this knowledge base.