Jo Atkinson

This article describes an occupational therapy intervention for stroke that was provided as part of a randomised controlled trial in order to evaluate the effects of the intervention of an occupational therapist in a nursing and residential home setting. The intervention was developed and described to enable it to be reproduced in further evaluations, as recommended by the Medical Research Council's guidelines for clinical trials.

Initially, the published evidence was reviewed and advice was sought to identify the process, content and recording methods needed to treat clients in a care home setting. This resulted in a clearly defined, evidence-based treatment package and a predetermined recording system.

Sixty residents received occupational therapy: the mean number of visits was 8.5 and the mean total time per participant was 4.7 hours. During 508 visits, the majority of time was spent on activities of daily living training and mobility practice (40%), followed by assessment and goal setting (31%), communication with residents, staff, relatives and other agencies (15%), adaptive equipment (10%) and the treatment of impairments (4%).

It is possible to develop evidence-based targeted occupational therapy interventions to be used in the context of a controlled clinical trial. Further work is required to examine the validity of the recording methods and the reproducibility of the intervention.

Background A large proportion of children are not able to perform age-appropriate fundamental movement skills (FMS). Thus, it is important to assess FMS so that children needing additional support can be identified in a timely fashion. There is great potential for universal screening of FMS in schools, but research has established that current assessment tools are not fit for purpose. Objective To develop and validate the psychometric properties of a FMS assessment tool designed specifically to meet the demands of universal screening in schools. Methods A working group consisting of academics from developmental psychology, public health and behavioural epidemiology developed an assessment tool (FUNMOVES) based on theory and prior evidence. Over three studies, 814 children aged 4 to 11 years were assessed in school using FUNMOVES. Rasch analysis was used to evaluate structural validity and modifications were then made to FUNMOVES activities after each study based on Rasch results and implementation fidelity. Results The initial Rasch analysis found numerous psychometric problems including multidimensionality, disordered thresholds, local dependency, and misfitting items. Study 2 showed a unidimensional measure, with acceptable internal consistency and no local dependency, but that did not fit the Rasch model. Performance on a jumping task was misfitting, and there were issues with disordered thresholds (for jumping, hopping and balance tasks). Study 3 revealed a unidimensional assessment tool with good fit to the Rasch model, and no further issues, once jumping and hopping scoring were modified. Implications The finalised version of FUNMOVES (after three iterations) meets standards for accurate measurement, is free and able to assess a whole class in under an hour using resources available in schools. Thus FUNMOVES has the potential to allow schools to efficiently screen FMS to ensure that targeted support can be provided and disability barriers removed.

Background and Purpose— A pilot evaluation of an occupational therapy intervention to improve self-care independence for residents with stroke-related disability living in care homes was the basis of this study.

Methods— A cluster randomized controlled trial with care home as the unit of randomization was undertaken in Oxfordshire, UK. Twelve homes (118 residents) were randomly allocated to either intervention (6 homes, 63 residents) or control (6 homes, 55 residents). Occupational therapy was provided to individuals but included carer education. The control group received usual care. Assessments were made at baseline, postintervention (3 months) and at 6-months to estimate change using the Barthel Activity of Daily Living Index (BI) scores, “poor global outcome”, (defined as deterioration in BI score, or death) and the Rivermead Mobility Index.

Results— At 3 months BI score in survivors had increased by 0.6 (SD 3.9) in the intervention group and decreased by 0.9 (2.2) in the control group; a difference of 1.5 (95% CI allowing for cluster design, −0.5 to 3.5). At 6 months the difference was 1.9 (−0.7 to 4.4). Global poor outcome was less common in the intervention group. At 3 months, 20/63 (32%) were worse/dead in the intervention group compared with 31/55 (56%) in the control group, difference −25% (−51% to 1%). At 6 months the difference was similar, −26% (−48% to −3%). Between-group changes in Rivermead Mobility Index scores were not significantly different.

Conclusion— Residents who received an occupational therapy intervention were less likely to deteriorate in their ability to perform activities of daily living.

There can be role conflicts for allied health professionals working in health care research that involves direct contact with study participants, particularly in relation to maintaining a duty of care. This opinion piece, drawn from the experience of working on an observational study, highlights the need for researchers to clarify their intent and purpose; to be aware of ethical demands; to have an established protocol to deal with the needs of participants arising through the course of the research; and to consider how the process of the study may affect the findings. Ultimately, the individual welfare of study participants should prevail over the aims of the study.

We describe the development of an evidence-based motor intervention and an implementation pilot study in ten primary schools, involving 515 children (4–11 years). ‘Helping Handwriting SHINE’ (HHS) is a novel, school-led, group-based handwriting intervention. Teaching staff delivered HHS and provided feedback through a questionnaire, reporting that: (i) the children found the tasks enjoyable; (ii) the background and booklet instructions were easy to understand, (iii) there was a need for more comprehensive staff training. The teaching staff made recommendations about session duration, group size, resource availability, and age differentiation of tasks. These suggestions are applicable to the development of any school-based group-led motor intervention, and we used this feedback to refine the HHS intervention. This study shows that implementing school-led motor interventions at scale is possible. Moreover, the work provides insights into the factors to consider when developing school-based motor interventions prior to conducting randomized controlled trials (RCT). The process outlined in this manuscript has led to an RCT to test the effectiveness of HHS within primary schools.