Why do some people who had a stroke not receive the recommended 45 min of occupational therapy and physiotherapy? A Delphi study.

OBJECTIVES: To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians' recommended minimum of 45 min of daily therapy. DESIGN: Three-round remote e-Delphi study. SETTING: National study, based in the UK. PARTICIPANTS: Occupational therapists and physiotherapists with experience of delivering therapy after stroke and awareness of the 45 min guideline. RESULTS: Forty-five therapists consented to participate in the study. Thirty-five (78%) completed round one, 29 of 35 (83%) completed round 2 and 26 of 29 (90%) completed round three. A consensus (75%) was reached for 32 statements. Reasons why a person may not receive 45 min were related to the suitability of the guideline for the individual (based on factors like therapy tolerance or medical status) or the capability of the service to provide the intervention. In addition to the statements for which there was a consensus, 32 concepts did not reach a consensus. Specifically, there was a lack of consensus concerning the suitability of the guideline for people receiving Early Supported Discharge (ESD) services and a lack of agreement about whether people who need more than 45 min of therapy actually receive it. CONCLUSION: Some people do not receive 45 min of therapy as they are considered unsuitable for it and some do not receive it due to services' inability to provide it. It is unclear which reasons for guideline non-achievement are most common. Future research should focus on why the guideline is not achieved in ESD, and why people who require more than 45 min may not receive it. This could contribute to practical guidance for therapists to optimise therapy delivery for people after stroke.

Why do some people with stroke not receive the recommended 45 min of occupational therapy and physiotherapy after stroke? A qualitative study using focus groups.

OBJECTIVES: To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians' recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study. DESIGN: Focus group study. SETTING: Stroke services in the South of England. PARTICIPANTS: A total of nine participants, in two groups, including therapists covering inpatient and Early Supported Discharge (ESD) services with awareness of the 45 min guideline. RESULTS: Thematic analysis of focus group data identified five factors that influence the amount of therapy a person receives: The Person (with stroke), Individual Therapist, Stroke Multidisciplinary Team, the Organisation and the Guideline. Study findings suggest that the reasons why a person does not receive the therapy recommendation in inpatient and ESD services relate to either the suitability of the guideline for the person with stroke, or the ability of the service to deliver the guideline. CONCLUSION: This study provides evidence for possible reasons why some people do not receive a minimum of 45 minutes of therapy, 5 days per week, related to (1) the suitability of the guideline for people with stroke and (2) services' ability to deliver this amount of intervention. These two factors are related; therapists decide who should receive therapy and how much in the context of (a) resource availability and (b) people's need and the benefit they will experience. The study findings, combined with the findings from other studies, will be used to initiate a Delphi study, which will establish consensus among therapists regarding the reasons why some people do not receive the guideline amount of therapy.

Parents' understanding of play for children with cerebral palsy.

OBJECTIVE: To present the findings of an exploratory study regarding the experience of play as an everyday occupation for children with severe cerebral palsy from their parents' perspective. METHOD: We took a qualitative methodology and interpretive descriptive approach. After ethical approval, 7 participants were recruited and completed an interview and contextual information sheet. RESULTS: The interview data led to the exploration of four themes: typical play, burden of play, expanding the concept of play, and therapy and play. These components were interlinked and contributed to parents' understanding of play. CONCLUSION: Occupational therapy practitioners can aim to further understand the importance of affirming typical play, recognizing the burden of play, explaining expanded play, and explaining the importance of play for play's sake.

Physiotherapists' experiences of activity pacing with people with chronic musculoskeletal pain: an interpretative phenomenological analysis.

PURPOSE: Activity pacing is a strategy used by physiotherapists treating people with chronic pain. Questions as to the usefulness of activity pacing with people with chronic pain have been raised clinically and in research. This study explores physiotherapists' experiences of using activity pacing with people with chronic musculoskeletal pain. METHOD: We interviewed six physiotherapists and used the methods of Interpretative Phenomenological Analysis (IPA) to explore the meaning of pacing. RESULTS: We identified three master themes. First, activity pacing was perceived as part of a process whereby patients came to realize that change is possible, and that life could be different. Second, in order to use activity pacing effectively the physiotherapist needs to shift from a "fix it" to a "sit with" approach to the treatment. Third physiotherapists described how they used many combined therapeutic approaches in managing chronic pain. CONCLUSIONS: This study increases our understanding of activity pacing and will help to make the best use of activity pacing in clinical practice, and optimize outcomes for the patients. These findings suggest that physiotherapists need to develop reflective listening skills, and use an experiential learning approach to facilitate activity pacing.

Exploring the multi-sensory environment as a leisure resource for people with complex neurological disabilities.

The problems experienced by people with neurological disabilities create barriers to participation in leisure activities. Particular common features include cognitive deficits (attention, executive functioning, language and memory), functional difficulties (in activities of daily living), psychomotor impairment (dyspraxia and poor co-ordination), and behavioural difficulties (aggression, agitation, and wandering). The Multi-sensory environment (MSE) has the potential to accommodate some of these problems experienced by people with neurological disabilities and, as such, is a valuable leisure resource. Multi-sensory activity can address individual sensory needs, such as offering a stronger stimulus if initial attempts are unnoticed, and be offered alongside familiar activities and routines to enhance sensory awareness. If the complexity of the activity, individual needs, and MSE demands are matched, engagement in this activity may be achieved. The Pool Activity Level Occupational Profiling Tool can provide a protocol from which MSE activity may be facilitated. By using this tool the MSE fits well within the World Health Organisation International Classification of functioning, Disability and Health by facilitating participation and reducing environmental barriers.