Designing a trial of early electrical stimulation to the stroke-affected arm: Qualitative findings on the barriers and facilitators

Introduction: This study aimed to explore the barriers and facilitators to implementing early therapeutic electrical stimulation (ES) treatment from both the patient and therapist perspectives as part of a feasibility study. Methods Design: Interviews were conducted with patients and their carers and focus groups with the therapists post-intervention period. Setting: Interviews were in the patient’s homes and for the focus groups in a specialist stroke unit in Nottinghamshire. Subjects: Fifteen patient participants (34% of sample) were interviewed (intervention n = 9; control group n = 3; carers n = 3). Sixteen therapists (9 occupational therapists; 7 physiotherapists) took part in the three focus groups. Intervention: Participants were randomized to receive usual care or usual care and ES to wrist flexors and extensors for 30 min, twice a day, 5 days a week for 3 months. Findings: The barriers to ES treatment cited by the therapists outweighed the barriers mentioned by patients. Therapists’ barriers included lack of confidence and staff knowledge regarding ES and time pressures of delivering the ES. No patients mentioned time as a barrier and considered the treatment regime to be acceptable; however, lack of staff support was mentioned 14 times by them. Conclusion: Although initially the perceived barrier for therapists was time restrictions, after analysing the data, it appears that confidence/knowledge is the real barrier, and time is the manifestation of this underlying self-doubt. Patients were able to confidently self-manage treatment, and although efficacy was not measured, patients volunteered information regarding its perceived benefit, and no adverse effects were reported.

Therapeutic Alliance in Web-based Treatment for Eating Disorders: Patient and Therapist perspectives (Preprint)

BACKGROUND In face-to-face therapy for eating disorders, the therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. Current, however, not much is known about the TA during web-CBT and its associations with symptom reduction, treatment completion and the perspectives of patients versus therapists. OBJECTIVE The present study aimed to investigate (1) differences between TA-ratings measured at interim and post-treatment, separately for patients and therapists, (2) the degree of agreement between therapists and patients (treatment completers and non-completers) for TA-ratings, and (3) associations between patient and therapist TA-ratings and both eating disorder pathology and treatment completion. METHODS A secondary analysis was performed on the RCT data of a web-CBT intervention for eating disorders. TA-ratings (HAQ) were measured at interim and post-treatment, focusing on treatment completers, non-completers and therapists. Paired t-tests were conducted to assess the change from interim to post-treatment. Intraclass correlations were calculated to determine cross-informant agreement with regards to HAQ-scores between patients and therapists. Through two stepwise regressive procedures (at interim and post-treatment), it was examined which HAQ-scores predicted (1) eating disorder pathology and (2) therapy completion. RESULTS Participants were 170 females with BN (n=33), BED (n=68), or EDNOS (n=69); mean age 39.6 (SD=11.5) years. For completers, HAQ-total scores and HAQ-Helpfulness scores improved significantly from interim to post-treatment. For non-completers, all HAQ-scores decreased significantly. For all HAQ-scales, agreement between patients and therapists was poor. However, agreement was slightly better post-treatment than at interim. The helpfulness subscale of the HAQ was negatively associated with eating disorder psychopathology at interim and post-treatment. A positive association was found between HAQ-total patient scores at interim and treatment completion. Lastly, post-treatment HAQ-total patient scores and post-treatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. CONCLUSIONS The results showed that for web-CBT for eating disorders, in particular the confidence to improve one’s situation (HAQ-Helpfulness) is important for predicting eating disorder pathology and treatment completion. Furthermore, in the current web-CBT, the TA increased for completers and decreased for non-completers, according to both patients and therapists.

Barriers to Community Integration for Older People in Malaysia: A Qualitative Study from Occupational Therapist Perspectives

Introduction Existing research has addressed the importance of community integration (CI) and its benefits of dwelling in a community but has yet to address the methods and efficiency of improving these activities among older people. Thus, it is vital to understand how healthcare workers can integrate the benefits of CI among older people, especially with the use of occupational therapists (OTs). The latter are actively working to improve ageing individuals mobility within the community. Objective This study aims to identify Malaysian OTs’ perspectives on CI’s and its implication on older people. Method Occupational therapist from different states of Malaysia participated in a semi-structured interview, through a virtual medium (Zoom Cloud Meetings). The interview guide encapsulated the theory of critical incident technique (CIT). Results Thematic content analysis, over fourteen participants from 13 states of Malaysia, provided insights into CI’s barriers for older people in Malaysia. The findings revealed that multifaceted factors from an individual, organisational and socio-environmental perspective limit older people’s active CI engagement. Conclusion South-East Asia hierarchal and collectivist culture play a significant role in influencing all factors of CI. OTs must understand and incorporate appropriate cultural norms during CI practice development for the older population in Malaysia.

Gaps Between Parent and Therapist Perspectives on Family-Centered Care as a Factor of Service Setting

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of this study was to evaluate gaps between parent and provider perceptions of the family-centeredness of services and the contribution of the service setting (outpatient versus schools) to these gaps. Findings indicated significant gaps between parents and providers, and between practice settings, in all assessed domains. These gaps suggest areas of opportunity for OTs to enhance their practice in order to foster more effective partnerships with parents. Primary Author and Speaker: Liat Gafni-Lachter Additional Authors and Speakers: Ayelet Ben-Sasson, Shaimaa Alsaaed

Patient and Therapist Perspectives on Treatment for Adults with PTSD from Childhood Trauma

This study aimed to explore patients’ and therapists’ experiences with trauma-focused treatments in patients with posttraumatic stress disorder from childhood trauma (Ch-PTSD). Semi-structured interviews were conducted with patients (n = 44) and therapists (n = 16) from an international multicentre randomised clinical trial comparing two trauma-focused treatments (IREM), imagery rescripting and eye movement and desensitisation (EMDR). Thematic analysis was used to identify key themes within the data. Patients and therapists commented about the process of therapy. The themes that emerged from these comments included the importance of the patients’ willingness to engage and commit to the treatment process; the importance and difficulty of the trauma work, observations of how the trauma focused therapy produced changes in insight, and sense of self and empowerment for the future. In addition, therapists made suggestions for optimising the therapist role in the trauma-focused treatment. This included the importance of having confidence in their own ability, confronting their own and their client’s avoidance and the necessity and difficulties of adhering to the treatment protocols. These reported experiences add further support to the idea that trauma-focused treatments, without a stabilisation phase, can be tolerated and deepens our understanding of how to make this palatable for individuals with Ch-PTSD.