BackgroundPeople with intellectual disability are at risk of poor hospital experiences and outcomes. The aims were to conduct a content and quality review of research into the acute hospital experiences of both people with intellectual disabilities and their carers, and to identify research gaps.MethodA systematic search was conducted of primary research between 2009 and 2013 that addressed the experiences of the target group in general acute care hospitals. Quality appraisal tools yielded scores for quantitative and qualitative studies, and overarching themes across studies were sought.ResultsSixteen studies met inclusion criteria. Quality scores were 6/8 for a survey, and 2/11-9/11 (mean =5.25) for qualitative studies/components. Content analysis revealed seven over-arching themes covering individuals’ fear of hospital encounters, carer responsibilities, and problems with delivery of care in hospitals including staff knowledge, skills and attitudes.ConclusionsOur review of eligible papers revealed that despite 20 years of research and government initiatives, people with intellectual disability continue to have poor hospital experiences. The need for research to identify and investigate care at specific points of encounter across a hospital journey (such as admission, diagnostic testing, placement on a ward, and discharge) as well as to include people with a diversity of disabilities is discussed in terms of potential to influence policy and practice across health and disability sectors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0505-5) contains supplementary material, which is available to authorized users.

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Occupational therapists regard play as the primary occupation of childhood. However, many authors of play assessments have viewed play either as a functional outcome of other skills or as an indication of the child's developmental level. While such views of play are valid, these approaches to play are broad and do not fully consider the cognitive value of play. A study was undertaken with 82 preschoolers to see if a new play assessment which considers cognitive play skills, called the Child-Initiated Pretend Play Assessment, (ChIPPA), possessed acceptable inter-rater reliability, and could discriminate between the play of typically developing preschoolers and preschoolers with pre-academic problems. This assessment evaluates preschoolers’ elaborate imaginative actions, number of imitative actions, and number of object substitutions. The ChIPPA was found to have excellent inter-rater reliability and did discriminate between children who were typically developing and children who experienced pre-academic problems. In particular, the elaborateness of a child's play actions and the child's ability to substitute objects were strong discriminators of preschoolers with and without pre-academic problems. Three play profiles which emerged from the research are discussed.

Very little is known about the differences between novice and expert clinical reasoning in community health practice. This article presents the findings of a study of the clinical reasoning of five expert and five novice community health occupational therapists (CHOTs) during the conducting of home visits. A head-mounted video camera was used to record the visits, followed by the participants reporting their clinical reasoning verbally using a video-assisted debriefing method. The transcripts from these verbal reports were analysed quantitatively and qualitatively. The quantitative results demonstrated many differences between experts and novices in terms of the amounts and types of clinical reasoning used. For example, the novices used more procedural reasoning whereas the experts used more conditional reasoning and mixes of different reasoning types. The qualitative results demonstrated that the experts used a free-flowing conversational approach when reasoning during home visits whereas the novices depended on external structures such as assessment forms to guide the process. Given their experience and familiarity with the process, the experts were confident and clear in their reasoning whereas the novices were more awkward and self-conscious. The experts handled sensitive issues whereas the novices seemed to avoid them. The study findings may provide insights for student and novice therapists concerning expert CHOTs' practice and promote reflection in general on the attainment of expertise in clinical practice.

Using both clinical reasoning data and literature from the past 20 years, this paper sought to examine the relationship between client-centred practice and clinical reasoning, to explore the concept of pragmatic reasoning and to present a diagrammatic conceptualisation of our knowledge of clinical reasoning in occupational therapy. The clinical reasoning literature published between 1982 and 2001 was reviewed and this information was combined with the findings from a study which used a head-mounted video camera to collect data and then explore the clinical reasoning of 13 experienced occupational therapists. The data were collected and analysed within a focused ethnographic framework. The findings showed that clinical reasoning occurred in the context of client-centred practice, but that a reciprocal relationship appeared to exist between client-centred practice and interactive reasoning. It also appeared that pragmatic reasoning was related only to the therapist's practice context and that all forms of reasoning were influenced by the therapist's worldview. A diagram was developed to depict this current understanding of the modes of clinical reasoning. While clinical reasoning has been described as the guiding force in a therapeutic practice, we are only just beginning to understand the nature of reasoning and reflection and how clinicians think. Further research is required to build and test the emerging theory of clinical reasoning in occupational therapy.