Background: Occupational therapists can support people with rheumatoid arthritis to self-manage their disease symptoms and engage in daily activities. This protocol reports a review to broaden understanding of what is known about the role of occupational therapy in the self-management of rheumatoid arthritis.Methods: Studies involving adults with rheumatoid arthritis, having participated in self-management involving occupational therapy, will be included. Patient involvement will help develop the search strategy by identifying patient-centred interventions and outcomes to complement those identified by researchers. An electronic search will be performed using several bibliographic databases, including grey literature from subject-specific, health-related, and social care databases.Searches will run from the database inception until the date that the search is conducted (December 2021-May 2022). Retrieved studies will be de-duplicated, and the remaining titles and abstracts will be screened by three reviewers. Full texts of all eligible studies will be independently reviewed by the reviewers to select papers for data extraction and quality assessment. Outcomes are function, pain, fatigue and lived experience. For quantitative studies, data will be synthesised using descriptive statistics in text and tables, whereas for qualitative studies, data will be synthesised using thematic synthesis.Discussion: This review will synthesise current evidence on how occupational therapy can help the self-management of rheumatoid arthritis. It will include evidence of best practice, including advice, education and training provided by occupational therapists. These findings can inform future research and the selection of strategies to promote quality of life for people with rheumatoid arthritis.
Background/Aims Occupational therapy (OT) can support people with rheumatoid arthritis (RA) to self-manage their symptoms and engage in meaningful daily activities. Previous evidence reviews are dated, limited to quantitative research designs, and lack a focus on self-management. The effectiveness of OT in supporting RA self-management is unclear when accounting for both measurable outcomes (e.g., function) and lived experience. This review aimed to assess the impact of OT on the self-management of RA by reviewing quantitative (pain, function and fatigue) outcomes and qualitative (narrative experience) evidence. Methods PROSPERO registration CRD42022302205. We systematically searched for studies involving adults with RA participating in self-management programmes incorporating OT. Searches were conducted via MEDLINE, CINAHL, AMED, PsycINFO, Web of Science (Core Collection) databases, and grey literature sources up to 1 April 2022, with a refresher search conducted on 30 June 2022. Three reviewers screened titles and abstracts. Two reviewers independently extracted and assessed full texts of eligible studies, using the Cochrane risk of bias (quantitative and mixed methods) and Critical Appraisal Skills Programme (CASP) (qualitative) tools to assess study quality. Studies were categorised as: educational-behavioural, comprehensive OT, community (home-based) OT, splints and assistive devices, and other programmes, including workplace interventions. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE-CERQual (qualitative) were used to assess the quality of evidence for each intervention category. Patients and occupational therapists (OTs) were consulted via online workshops to inform the search strategy (n = 4 patients) and interpret review findings (n = 6 patients; n = 4 OTs). Results Of the 36 papers meeting eligibility criteria, 27 were quantitative studies (n = 1802 participants), three qualitative (n = 31), and six mixed methods (n = 844). Strong evidence supports the use of educational-behavioural programmes for pain and function, particularly group sessions on joint protection education. Qualitative evidence was limited to three papers exploring personal transformations experienced during community-based (home) OT. Weak evidence supports the use of splints and assistive devices, whereas comprehensive OT intervention had mixed effectiveness. Across all intervention types, there was little evidence to support OT for self-managing fatigue. Conclusion Educational-behavioural programmes offer improvements in pain and function, but behaviour changes in self-management do not translate to improved long-term health benefits. For fatigue, the evidence to support OT self-management programmes is inconclusive, with the few qualitative insights on lived experience relating to illness, independence, (occupational) activity and altruism specific to home-based OT. Our findings extend current research that OT programmes targeting RA self-management behaviours are effective for short-term behaviour change and improving pain and function, but cannot demonstrate prevention of further physical deterioration for progressive RA. Timing programmes to match the individual’s disease stage (i.e. early or established RA) appeared to impact therapy outcomes and patient experience. Evidence on the patient experience and long-term effectiveness are lacking. Disclosure J.P. Gavin: None. L. Rossiter: None. J. Adams: None. V. Fenerty: None. J. Leese: None. A. Hammond: None. E. Davidson: None. C. Backman: None.
Background With increasing pressure on placement capacity for allied health students, a need for novel and creative means through which students can develop foundational skills and prepare for practice-based learning opportunities has arisen. This study aimed to explore the experiences of domestic and international first-year students completing pre-clinical preparation programs, contrasting between in-person simulation and online options to contribute to best practice evidence for program design and delivery. Methods First-year students from physiotherapy, podiatry and occupational therapy self-selected to either a one-weeklong in-person simulation program or an online preparation for placement program. An integrative mixed-methods approach was employed. Qualitative findings from student focus groups were analyzed by reflexive thematic analysis and complemented by quantitative pre-post questionnaires which were examined for patterns of findings. Results There were 53 student participants in the study (simulation n = 29; online n = 24). Self-selecting, international students disproportionately opted for the simulation program while older students disproportionately selected the online program. Students appeared to benefit more from the simulation program than the online program, with alignment of focus group findings to the quantitative questionnaire data. The in-person simulation allowed students to apply their learning and practice patient communication. All simulation students reported asubsequent increase in confidence, although this seemed particularly marked for the international students. By contrast, the online program was most effective at developing students’ clinical reasoning and proficiency with documentation. Both programs faced minor challenges to student perceived relevance and skill development. Conclusion Both online and in-person simulation preparation programs were perceived to enhance readiness and foundational skills development for novice allied health students, with the practical nature of simulation generating more advantageous findings. This study provides useful information on the benefits and challenges of both types of delivery for foundational skills development and/or clinical preparation of allied health students.
The COVID-19 pandemic has led to an increased demand for clinical placements for Allied Health Professional (AHP) students. Consequently, we have needed to be creative to explore other ways to ensure students complete their 1,000 hours of clinical experience across the programme. A potential option is to use simulation to replace a portion of clinical hours. Evidence confirms that up to 25% of authentic physical practice with standardized simulated patients results in comparable student competency as assessed by an educator and that a 1-week period of simulation is effective in building students’ confidence before continuing with a placement in the clinical setting Our aim was to design, develop, implement and evaluate a multi-disciplinary simulation programme to prepare students with foundational placement skills. We sought to therefore reduce the burden on NHS staff. We also sought to determine the effect of the programme on student readiness for placement, student confidence, investigate stakeholder perceptions of the programme and determine the suitability of simulation in contributing to clinical hours.Simulation-based educational (SBE) pedagogy and principles guided the programme design and included: pre-brief, simulation with regular time outs to enable rehearsal of an activity and debriefing for reflection. We employed actor role players to act as the patient, relative or carer and clinical educators to guide the students as they would on a traditional placement. We developed three generic patient case studies designed specifically to focus on the development of the key programme learning outcomes: developing patient-centred communication skills and professional behaviours. We adopted a mixed-methods approach in our research design, collecting quantitative data from student self-report pre–post questionnaires, clinical educator questionnaires and qualitative data from focus groups to address our research questions and aims.A total of 29 Allied Health Professional students (from physiotherapy, occupational therapy and podiatry) completed a 5-day intensive simulation programme. The programme included an inter-professional ‘fishbowl simulation’ followed by 3 days of profession-specific clinical scenarios with profession-specific learning outcomes ending on the final day in six simulated multi-disciplinary team meetings. The sessions were interactive with simulated patients and their relative/carers giving authentic patient feedback from a patient perspective. We observed rich transformational learning observing students improve their communication skills and becoming more patient-centred in their approach. Preliminary student feedback indicates that they found the simulation programme challenging but extremely rewarding. Formal data analysis is continuing.
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