Therapist Focus Research Articles

Are physiotherapists and occupational therapists following the guidelines for discharge summary?-An analysis of the content of physiotherapists' and occupational therapists' discharge summaries and their adherence to stroke guideline recommendations.

Discharge summaries are important tools for communication between health care levels and can ensure continuity of rehabilitation. This study aims to gain insight into the content of discharge summaries written by hospital physiotherapists and occupational therapists regarding patients with stroke, and their adherence to recommended criteria for discharge summaries. 31 physiotherapy and multidisciplinary discharge summaries, for stroke patients discharged home from hospital with need of follow-up, were included in the study. We employed qualitative content analysis and descriptive statistics to explore and describe the content. The physiotherapists and occupational therapists adhered to the recommended criteria for content in varying degree. The main focus for physiotherapists and occupational therapists were description of ADL, sensorimotor and general cognitive functions, they rarely report tolerance to exercise, and the specific cognitive abilities to follow instruction and learn were often omitted. Less focus was put on patients' experiences and needs during acute stroke, and description of goals were omitted in the physiotherapy discharge summaries. While the physiotherapists and occupational therapists complement each other in their assessment of patients and inform the reader about both sensorimotor and cognitive functions and abilities, they omit some of the specific criteria for rehabilitation. Despite the omissions, the information provided is specific to the patients' function and needs.

The Hidden Client: Understanding the Lived Experience of Occupational Engagement of Partners of Persons Diagnosed with Bipolar I Disorder

The immediate social microcosm surrounding diagnosed individuals are often neglected. Partners of persons with bipolar I disorder experience positive and challenging experiences of occupational engagement, informed by their partner role. Guided by Interpretive Phenomenological Analysis (IPA), in-depth interviews unearthed participants’ lived experiences to highlight challenging experiences of occupational engagement, including, unmet occupational needs, occupational disharmony, and imbalance. Protective factors enhancing occupational engagement included satisfactorily achieving occupational needs and the experience of autotelic meaning. This study consolidated that exploring, understanding, and addressing occupational needs for everyone, including secondarily affected populations, should be a focus of occupational therapists.

The Personal, the Political, And The Psychotherapeutic

It is unthinkable that the turbulence of recent global events will leave couple and family relationships unaffected. Yet the focus of therapists is unlikely to extend much beyond family relationships in understanding and working with the problems of those seeking their help. Is this limited focus justifiable? Can an understanding of psychological processes in couple relationships, especially those around oppression, inform an understanding of political conflict? What implications might there be for psychotherapists? These questions arise from considering intersections between private and public domains of life in four contexts: the decision of the United Kingdom to leave the European Union; the global pandemic of Covid-19; the war in Ukraine; and the climate emergency.

Predictors of Daily Activity Performance of Children with Autism and its Association to Autism Characteristics

Background: The daily activity performance of children with autism spectrum disorder (ASD) is a central focus of occupational therapists. Yet, the existing performance-based assessments of basic and instrumental daily activities in children are limited and their application on children with ASD is scarce. The purpose of this study is to examine if daily activity performance of children with ASD is impaired as compared to children with typical development (TD), and to examine possible predictors of daily activity performance in children with ASD.

Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol.

Difficulty using the upper extremity in everyday activities is common after stroke. Constraint-induced movement therapy (CIMT) has been shown to be effective in both sub-acute and chronic phases of stroke recovery and is recommended in clinical practice guidelines for stroke internationally. Despite reports of equivalence of outcome when stroke rehabilitation interventions are delivered using telehealth, there has been limited evaluation of CIMT when using this mode of delivery. ReCITE will (a) evaluate the feasibility and acceptability of CIMT when delivered via telehealth to stroke survivors (TeleCIMT) and (b) explore therapists' experiences and use of an online support package inclusive of training, mentoring and resources to support TeleCIMT delivery in clinical practice. A prospective single-group, single blinded, study design with embedded process evaluation will be conducted. The study will be conducted at three outpatient services in Sydney, Australia. A multi-faceted therapist support package, informed by the Capabilities, Opportunity, Motivation- Behaviour model (COM-B), will be used to support occupational therapists to implement TeleCIMT as part of routine care to stroke survivors. Each service will recruit 10 stroke survivor participants (n = 30) with mild to moderate upper extremity impairment. Upper extremity and quality of life outcomes of stroke survivor participants will be collected at baseline, post-intervention and at a 4 week follow-up appointment. Feasibility of TeleCIMT will be evaluated by assessing the number of stroke participants who complete 80% of intensive arm practice prescribed during their 3 week program (i.e., at least 24 h of intensive arm practice). Acceptability will be investigated through qualitative interviews and surveys with stroke survivors, supporter surveys and therapist focus groups. Qualitative interviews with therapists will provide additional data to explore their experiences and use of the online support package. The COVID-19 pandemic resulted in a rapid transition to delivering telehealth. The proposed study will investigate the feasibility and acceptability of delivering a complex intervention via telehealth to stroke survivors at home, and the support that therapists and patients require for delivery. The findings of the study will be used to inform whether a larger, randomized controlled trial is feasible.

The role of the speech and language therapist in the rehabilitation of speech, swallowing, voice and trismus in people diagnosed with head and neck cancer.

Head and neck cancer (HNC) and its treatment can have a significant impact on physical and psychosocial wellbeing. A multidisciplinary team (MDT) approach is critical to reduce the potential acute, long-term and late effects of treatment by optimising function at baseline, supporting people during treatment and with rehabilitation post treatment. The key focus for speech and language therapists is to support the holistic needs of people with a focus on speech, swallowing, voice and mouth opening. Effective management is reliant on working with MDT members and interventions are implemented against the background of robust multidimensional baseline evaluation. There have been significant advances in treatment modalities for both primary and recurrent HNC. These include highly conformal radiotherapy modalities, including: image-guided radiotherapy; parotid-sparing and dysphagia-optimised intensity-modulated radiotherapy; and the introduction of intensity-modulated proton therapy, as well as immunotherapy, transoral robotic surgery and surgery with advanced reconstructive techniques. Such treatment advances coupled with a changing patient demographic means that people with HNC are now living longer. However, this is not always without consequences and late treatment effects are a new challenge facing MDTs, requiring high levels of support and rehabilitation.

Development of a Conversational Agent for Promoting Increased Activity in Users with Traumatic Brain Injury

<h3>Research Objectives</h3> To develop and test a conversational agent-i.e., a chatbot that users communicate via text messaging-designed to augment behavioral activation treatment for reducing depression and increasing participation in individuals with moderate to severe Traumatic Brain Injury (TBI) called RehaBot <h3>Design</h3> A prototype of RehaBot was developed based on feedback from therapist and consumer focus groups and then tested in three separate user demonstration trials. A usability and preliminary efficacy trial is underway. <h3>Setting</h3> Outpatient rehabilitation. <h3>Participants</h3> Rehabilitation providers and persons with moderate to severe TBI. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> System Usability Scale (SUS). <h3>Results</h3> Therapist focus group participants indicated that RehaBot could promote engagement with therapeutic plans and provide prompts that cue users to adhere to routines. Respondents with TBI indicated that they would be comfortable interacting with RehaBot, and most had prior experience with chatbots. They expressed a preference for a system accessible via smartphone (vs. computer/voice assistant). Goal reminders, progress updates, and encouragement were identified as beneficial features. Respondents conveyed that misunderstandings between users and chatbots would be frustrating. In demonstration trials, two of the three participants could complete 5 of 5 RehaBot tasks independently. One user completed three independently and a 4th with assistance. The average SUS rating was 4.3 (0.80) on a 5-point scale. <h3>Conclusions</h3> Preliminary evidence suggests that a chatbot augment to behavioral activation treatment-RehaBot-is acceptable and easy to use for persons with moderate to severe TBI. Further research is ongoing to establish usability in a larger sample and evaluate RehaBot's efficacy in improving therapeutic plan adherence. <h3>Author(s) Disclosures</h3> None.

Being a Naikan therapist—focus on roles and mindsets

Being a Naikan therapist—focus on roles and mindsets

Working with emotion predicts sudden gains during experiential therapy for depression

Objective: This study involves the first attempt to identify sudden gains in a sample of clients undergoing experiential therapy for depression while also investigating client and therapist change processes related to sudden gains. Method: Pre- and post-session Beck Depression Inventory, short form (BDI-SF) questionnaires were used to identify sudden gains and differentiate between in-session and between-session symptom changes in thirty-six client-therapist dyads. Archival videotape data of a sub-sample were coded using the Experiencing Scale, Classification of Affective Meaning States, and the Coding System for Therapist Focus. Results: The study revealed that 63.9% of clients experienced a sudden gain and the bulk of the total mean symptom decrease (74.9%) was found to occur within the session preceding the sudden gain. During this critical session, clients were more likely to display deepened experiencing (p < .01, η 2 = .34), clients were more likely to express “primary adaptive emotions” (p < .05, r = .38), and therapists were found to be more likely to focus on unmet client needs (p < .01, d = .75). Conclusion: The majority of the sudden gain change occurs within session in experiential therapy, and primary adaptive emotions as well as addressing unmet needs are possible processes of sudden gains.

Evaluation of Exposure Instructions to Pain: Should Therapist Focus on Fear Reduction or Expectation Violation?

Exposure elements are highly effective for the treatment of individuals with chronic pain and elevated fear-avoidance. However, different therapeutic instructions are justified by competing theories regarding underlying mechanisms. The habituation model suggests that therapists should focus on fear reduction. The inhibitory learning approach suggests that therapists should aim for maximal expectation violation. We employed a mixed 3 × 2 experimental design with the between-group factor instruction (habituation, expectation violation, control) and the within-group factor time (pretest, posttest) to provide a fine-grained analysis of both instructions. Nociceptive thermal pain was induced to female students (N = 112). Both instructions improved cognitive pain coping. Only the expectation violation instruction increased pain tolerance. Similarly, only the expectation violation instructions led to specific psychophysiological changes, characterized by a significantly higher initial increase and subsequent decrease in the skin conductance level. This study provides experimental evidence for the effectiveness of exposure-based interventions among individuals confronting acute thermal pain. Instructions addressing expectation violations appeared to produce the greatest effects. Testing concrete expectancies might further improve exposure effects. Future research needs to translate our findings into clinical practice.

Everyday Occupations and Other Factors in Relation to Mental Well-Being among Persons with Advanced Parkinson’s Disease

This cross-sectional study investigated performed activities and the level of satisfaction with everyday occupations among people (n = 67) with advanced Parkinson’s disease (PD), and how these factors and experiences of social relationships were related to mental well-being. Managing one’s hygiene and physical exercises were activities that the majority still performed, whereas few were engaged in work or other productive occupations. Perceived health problems and satisfaction with everyday occupations were important factors for mental well-being since satisfaction with everyday occupations may be an important focus for occupational therapists and other health professionals when supporting mental well-being among persons with advanced PD.

Progressive functional exercise versus best practice advice for adults aged 50 years or over after ankle fracture: protocol for a pilot randomised controlled trial in the UK - the Ankle Fracture Treatment: Enhancing Rehabilitation (AFTER) study

IntroductionAnkle fractures result in significant morbidity in adults, with prognosis worsening with increasing age. Previous trials have not found evidence supporting supervised physiotherapy sessions, but these studies have not focused...

Reducing Barriers to Mental Health Care: Bringing Evidence-Based Psychotherapy Home.

Barriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence-based psychotherapy program to reduce obstacles to care. A practice improvement initiative providing no-fee evidence-based mental health care at home in clients' primary languages. Independence at Home, a community service of SCAN Health Plan in Southern California. Diverse older adults and adult caregivers of older people with age-related disability (mainly dementia). Redesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety. We describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs. Insights successfully served demographically diverse clients experiencing a broad range of barriers to mental health care. A total of 211 clients completed therapy using one of three evidence-based approaches in the first 33 months of operation (2015-2018). Clinical efficacy was high and equivalent across demographic groups and therapy models. Depression, anxiety, quality of life, self-rated disability, and patient activation all improved significantly. We supported therapists' transition to the new model, modified workflows, and used clinical outcome data and therapist focus groups to improve referral, selection, and enrollment processes and simplify treatment assignment. With program maturation, treatment duration and direct costs both declined. The Insights model could add value to healthcare organizations seeking to provide effective, equitable mental health services for older adults and caregivers who have difficulty accessing care for depression, anxiety, or difficult life challenges. J Am Geriatr Soc 67:2174-2179, 2019.

The Structure of Competence: Evaluating the Factor Structure of the Cognitive Therapy Rating Scale

The Cognitive Therapy Rating Scale (CTRS) is an observer-rated measure of cognitive behavioral therapy (CBT) treatment fidelity. Although widely used, the factor structure and psychometric properties of the CTRS are not well established. Evaluating the factorial validity of the CTRS may increase its utility for training and fidelity monitoring in clinical practice and research. The current study used multilevel exploratory factor analysis to examine the factor structure of the CTRS in a large sample of therapists (n = 413) and observations (n = 1,264) from community-based CBT training. Examination of model fit and factor loadings suggested that three within-therapist factors and one between-therapist factor provided adequate fit and the most parsimonious and interpretable factor structure. The three within-therapist factors included items related to (a) session structure, (b) CBT-specific skills and techniques, and (c) therapeutic relationship skills, although three items showed some evidence of cross-loading. All items showed moderate to high loadings on the single between-therapist factor. Results support continued use of the CTRS and suggest factors that may be a relevant focus for therapists, trainers, and researchers.

Clients' emotional instability and therapists' inferential flexibility predict therapists' session-by-session empathic accuracy.

Clients' emotions often serve as a major focus for therapists' attention. Interestingly, little is known about the factors that facilitate or hinder therapists' accurate assessment of these emotions. We hypothesized that therapists' accuracy would be negatively tied to their clients' emotional fluctuation (i.e., instability) and positively tied to the therapists' own inferential fluctuation (i.e., flexibility) as well as to the clients' emotional intensity. Clients (N = 98/N = 76) received weekly psychodynamic psychotherapy at a university-based clinic. Following each session, clients reported their within-session emotions, and therapists provided their own assessment of their clients' emotions. As expected, when clients' emotions were more unstable, therapists were less accurate in tracking these emotions. Additionally, when therapists' assessments of their clients' emotions were more flexible, they were more accurate in tracking them. Our results help identify factors that predict accurate emotion perception within psychotherapy and may translate into actionable ideas for enhancing this accuracy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Contact Interruptions (2003)

Contact Interruptions (2003)

Years of Clinical Experience and Therapist Professional Development: A Literature Review

The purpose of this article is to review the effect of years of clinical experience on aspects of therapist professional development. Themes within this specific literature were determined inductively as part of an all-inclusive review. Years of clinical experience were found to be positively associated with increased confidence and perceived mastery in clinical ability, increased flexibility in professional identity and therapeutic orientation, reduced stress and anxiety in clinical practice, and improvements in clinical judgment and decision-making. Although years of experience were found to relate to increased therapist focus on the therapeutic relationship, evidence does not suggest that it is associated with improved ability to increase its quality. It is unclear how years of clinical experience affect therapist usage of and attitude towards evidence supported treatments and evidence based practice given the interference of age cohort effects. This literature is limited by overly-proportionate psychodynamic samples and the use of primarily cross-sectional designs.

Gold Award: Providing Accessible, Affordable, and Stigma-Free Behavioral Health Care for Older New Yorkers.

Gold Award: Providing Accessible, Affordable, and Stigma-Free Behavioral Health Care for Older New Yorkers.

Shape of change in internet based behavioral activation treatment for depression

Shape of change, sudden gains and depression spikes were examined in an online 12-session Behavioral Activation (BA) treatment for depression. Client and therapist factors related to sudden gains were examined to investigate processes associated with outcome. Methods: Participants were postpartum Women with Major Depressive Disorder (n=42) who received online BA supported in 30-minute telephone sessions by a mental health worker. Depression symptoms were assessed at each session and number of sessions completed were recorded by the online program. Therapist records were rated for client stressful life event and therapist concrete focus. A quadratic pattern provided the best fit with the data; a cubic pattern was a poor fit. Sudden gains, but not depression spikes, predicted lower depression scores at 17-week outcome. Women who had higher baseline social functioning, did not experience a stressful life event during therapy, and completed more online modules, but not more telephone sessions, were more likely to have a sudden gain. A concrete therapist focus was associated with sudden gains. These results extend research on trajectories of change and sudden gains to an online BA treatment and to postpartum depression, and suggest important client and therapist factors associated with sudden gains.

Prevention of Ventilator-Associated Pneumonia in the Intensive Care Unit: Beyond the Basics.

Ventilated-associated pneumonia (VAP) is a major concern for hospitals and a major problem for ventilated patients in the intensive care unit. Included in the basics are hand hygiene, wearing gloves, endotracheal tube suctioning, head of bed at 30°, stress ulcer prophylaxis, turning patient side to side at least every two hours, and giving the patient a sedation vacation each morning. Beyond the basics included here are oral hygiene, oral suctioning, endotracheal tube cuff pressure, artificial humidification, the difference in practice between registered nurses and respiratory therapists, using the beach chair position and early mobilization, and the VAP bundle. The prevention of VAP becomes the focus for both nurses and respiratory therapists working with patients who are ventilated.