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Background/Aims: Service users who have spent time in seclusion describe it as a negative experience, viewing it as punishment. Although occupational therapists work within these settings, there is limited research and documentation of interventions aimed at reducing occupational deprivation in seclusion. A service evaluation was conducted at a medium secure adult mental health unit to better understand the current practices of occupational therapists working in seclusion. Methods: A bespoke tool was developed to capture occupational therapy interventions within a 12-month timeline. Results: Data showed that there were 31 interventions provided across 300 days of seclusion for 16 patients. Therapy lasted between 5 and 45 minutes involving a range of adapted interventions and resources appropriate for positive risk taking. Conclusions: Despite creative and adaptive interventions identified, provision of occupational therapy appeared sporadic and restricted by a 5-day service. This illustrates the need for specialist training and guidelines to support an integrated and consistent approach. [ABSTRACT FROM AUTHOR]

Background: Little is known about which outcome domains characterise meaningful recovery following prosthetic rehabilitation and should be measured. Our previous qualitative work developed a conceptual model of outcome domains which are meaningful to patients. This qualitative synthesis aims to develop that model by exploring views and experiences of recovery captured in the limb loss literature, and use these to produce a second iteration of the model describing outcome domains of importance following prosthetic rehabilitation from the patient's perspective. Methods: Systematic searches were conducted using CINAHL, Psychinfo and Web of Science from 2011 to early 2023. Studies with a qualitative design focusing on views and experiences of lower limb prosthetic users were eligible for inclusion. Quality was assessed using the CASP tool. 'Best Fit' framework synthesis was used to synthesise the evidence and develop the conceptual model. Results: 40 studies were included, describing the experiences of 539 participants. Data supported the pre-existing conceptual model and led to development of four of the five domains. The newly named ECLIPSE model describes meaningful outcome domains as 1) Being able to participate in important activities and roles, 2) Participating in the way I want to, 3) My prosthesis works for me, 4) If I am in pain, I can manage it, and 5) I am able to accept my new normal. Studies came from 15 countries showing good coverage of high-income settings. Few participants from low-and-middle-income countries were included, it is unclear if the ECLIPSE model describes outcome domains of importance in these settings. Conclusions: This synthesis provides a rigorous foundation for understanding outcome domains of importance following lower limb prosthetic rehabilitation from the patient's perspective. The ECLIPSE model is an accessible representation of recovery which could direct rehabilitation programmes, as well as inform the evaluation of prosthetic care through the selection of outcome measures. [ABSTRACT FROM AUTHOR]

Rehabilitation outcomes are important for patients, professionals and policy makers. Most outcome measures (OMs) were developed for "Western" contexts and may be inadequate for low-resource and conflict settings, where the ability to demonstrate impact would be critical to strengthening the sector. This study aims to understand perspectives of physiotherapists from challenging environments regarding current practices, value, barriers, and facilitators of measuring rehabilitation outcomes. Focus group discussions were held in English with 35 physiotherapists from 18 countries. Audio recordings were transcribed verbatim, anonymised, and analysed using reflexive thematic analysis. Four themes emerged illustrating the levels at which outcomes and measures were discussed: User (patients, families), provider (physiotherapists, rehabilitation workers), application (OMs), and structure (management, health system). Participants discussed diversity in current practices and patient populations, utility of OMs and a neglected rehabilitation sector lacking investment. Barriers to progressing outcome measurement included lacking patient health literacy, rehabilitation provider training, valid OMs, and leadership. Participants suggested improved patient involvement, routine outcome measurement by using, developing, or adapting simple, context- and stakeholder-relevant OMs, and support from management. These insights illustrate the need of and provide robust recommendations for context-adapted development of rehabilitation outcome measurement in various challenging contexts. Rehabilitation outcomes are important to show impact in low-resource and conflict settings, but most outcome measures originate from "Western" contexts Experience of physiotherapists from low-resource and conflict settings reveals the barriers and facilitators to measuring rehabilitation outcomes in their workplaces Participants' suggest to use or develop simple scales that are contextualised and stakeholder-relevant for standard, routine measurement This study highlights the need to improve the measurement of rehabilitation outcomes in challenging contexts and provides guidance on how to do so [ABSTRACT FROM AUTHOR]

Despite guidance to minimize restrictive practice within the UK, seclusion and long-term segregation are necessary to maintain the safety of patients and clinicians. There is little evidence to guide the work of occupational therapists with secluded patients. A literature search identified seven papers that met the study inclusion criteria. A deductive approach to thematic analysis was conducted using the 'Model of Human Occupation' as a theoretical framework to identify issues related to occupational need during a period of seclusion. Findings indicate ways in which occupational therapists could engage with patients in seclusion and suggest a need for future research. [ABSTRACT FROM AUTHOR]

To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting. This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied. Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device. These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings. This research provides an understanding of lower-limb prosthesis users' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting. The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation. Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations. Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation. When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome. [ABSTRACT FROM AUTHOR]

Functional electrical stimulation (FES) can be effective in assisting physical and psychosocial difficulties experienced by people with spinal cord injury. Perceived benefits and barriers of the current and future use of FES within the wider spinal cord injury community is currently unknown. The main objective of this research was to explore the spinal cord injury community's views of the use of FES to decrease disability in rehabilitation programmes. An online and paper questionnaire was distributed to people with spinal cord injury, health care professionals and researchers working in spinal cord injury settings in the United Kingdom. A total of 299 participants completed the survey (152 people with spinal cord injury, 141 health care professionals and 6 researchers). Common views between groups identified were: (1) FES can be beneficial in improving physical and psychosocial aspects and that (2) adequate support and training for FES application was provided to users. Barriers to FES use included a lack of staff time and training, financial cost and availability of the equipment. Sixty three percent of non-users felt they would use FES in the future if they had the opportunity. Users' views were important in identifying that FES application can be beneficial for people with spinal cord injury but also has some resourceful barriers. In order to increase use, future research should focus on reducing the cost of FES clinical service and also address implementation of awareness and training programmes within spinal units and community rehabilitation settings. Users of functional electrical stimulation think that it is beneficial for improving physical and psychosocial limitations after spinal cord injury Barriers to FES use include a lack of staff time and training, financial cost and availability of the equipment have been suggested by people with spinal cord injury and health care professionals Education and implementation programs for health care professionals and people with spinal cord injury are now necessary to increase the awareness about functional electrical stimulation application Reduction of FES cost could also increase its uptake in spinal cord injury clinical services [ABSTRACT FROM AUTHOR]

Limb salvage surgery is a surgical procedure for tumour resection in bone and soft-tissue cancers. Guidelines aim to preserve as much function and tissue of the limb as possible. Surgical outcome data is routinely available as part of surgical reporting processes. What is less known are important non-oncological outcomes throughout recovery from both clinical and patient perspectives. The objective of this review was to explore non-oncological outcomes in patients diagnosed with sarcoma around the knee following limb salvage surgery. A scoping review methodology was used, and results analysed using CASP checklists. Thirteen studies were included and following appraisal and synthesis, three themes emerged as providing important measures intrinsic to successful patient recovery: (1) physical function, (2) quality of life and, (3) gait and knee goniometry. Specifically, patients develop range of motion complications that alter gait patterns and patients often limit their post-operative participation in sport and leisure activities. This study has shown the importance of exploring confounding factors, adopting a holistic view of patient recovery beyond surgical outcomes, proposing evidence-based guidance to support and inform healthcare providers with clinical decision-making. This review highlights the paucity and lack of quality of research available, emphasising how under-represented this population is in the research literature. Patients having undergone LSS often have limited participation in sport and leisure activities. Patients can develop range of motion complications, such as flexion contracture or extension lag, which may affect the pattern of gait. Clinical consideration should be given to walking ability and gait patterns during the rehabilitation phase to prevent poor functional outcomes during recovery. Variation of treatment protocols, outcome measurement and rehabilitative care has been identified as important in predicting the outcomes in recovery from LSS procedures. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge); were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development and service provision planning, could have avoided many of the difficulties highlighted by this study.

Background: According to Slade's Personal Recovery Framework, mental health recovery involves developing a positive identity, reframing experiences, developing self-management and valued social roles. Aim: This study explored how developing a personal narrative can support mental health recovery through reframing and developing a more positive identity. This paper provides an overview of the study's three phases and the resultant Personal Narrative Workshop Programme. Method: Phase 1 involved developing and analysing my own recovery narrative using autoethnography. Phase 2 used Participatory Action Research (PAR) to explore the experience of other service users, with co-researchers recruited to two focus groups. Six co-researchers continued into Phase 3 (three cycles of PAR) to develop the workshop programme. Results: An eight-session workshop programme was co-produced and fully documented. Conclusions: Developing a narrative is not benign: it can involve reliving trauma; and dealing with the 'voice of others' in our narratives can be difficult. As a result, the workshop programme aimed to provide a supportive environment, promoting collaboration and validation. Methodological issues resulted from the complexities of using a PAR approach, and on the multiplicity of roles for the researcher. [ABSTRACT FROM AUTHOR]

Introduction: Prosthetic treatment is widely used for children and adolescents with upper limb difference, for functional benefit, cosmetic restoration or the performance of specific activities. Children and adolescents feel, however, that prostheses do not help function, are uncomfortable, are unreliable, are heavy and are not aesthetically acceptable. This research aims to develop an understanding of children's and adolescents' views on upper limb prostheses in relation to their daily occupations. Method: Eight children and adolescents with upper limb difference participated in a focus group (n =4) or an individual interview (n =4). Data was analysed using thematic analysis. Results: Participants described both positive and negative views of their prostheses. Participants described experiences where their prosthesis was helpful to them for social interactions, when playing and in self-care and productive activities. However, participants also described choosing not to use prostheses due to lack of functional benefit, causing a hindrance in certain activities and restriction of movement. Conclusion: Prostheses can be useful tools for occupational participation for children and adolescents. General purpose functional prostheses for children and adolescents can result in the prosthesis not being useful, becoming a hindrance and restricting movement. Task specific devices can overcome these issues to help children and adolescents in social interactions, when playing and in carrying out self-care and productive activities. [ABSTRACT FROM AUTHOR]

Objective: To explore athletes' perceptions of the factors that they feel may affect their adherence to a physiotherapy intervention. Design: A qualitative design using semistructured interviews. Setting: Participants were interviewed at home or their athletic club. Participants: 8 participants, 5 men and 3 women with a mean age of 30.4 y. Results: Thematic analysis revealed 2 main categories of themes. The first relates to the athlete's perceptions of factors affecting his or her own adherence, with themes including the impact of injury, justification of adherence, and strategies used by the patient. The second relates to perceptions of the physiotherapist's impact on adherence, with themes relating to characteristics of and strategies used by the physiotherapist. Conclusions: Findings demonstrate the importance of exploring patients' perceptions of adherence. A number of factors that affect adherence are identified, and strategies that may enhance adherence suggested. [ABSTRACT FROM AUTHOR]