An occupational therapy intervention for residents with stroke living in care homes in the United Kingdom: A content analysis of occupational therapy records from the OTCH trial

Abstract

Key findings: Residents' goals focused on leisure activities whereas intervention time was mostly spent on improving function  There are conflicts between carer time constraints and supporting residents' independence to achieve therapy goals What the study has added:This study contributes further understanding about the content of an occupational therapy intervention delivered in UK care homes, including distribution of therapists' time and the goals most important to residents.

Process evaluation within pragmatic randomised controlled trials: what is it, why is it done, and can we find it?—a systematic review

“…Also explored healthcare professional perceptions of feasibility and which patients’ intervention most suited to. Qualitative Interviews Intervention Participant responses How delivery is achieved Reach Causal mechanisms in context Contextual moderators Unintended consequences Contextual factors shaping intervention theory Yes Littlewood 2015 [ 34 ] Nichols 2017 [ 35 ] Explored experiences of patients about intervention, with focus on patient adherence, and how changed over time Qualitative Interviews (longitudinal) Intervention Participant responses Causal mechanisms in context Contextual moderators How delivery is achieved No Williams 2015 [ 36 ] Novak 2015 [ 37 ] Investigated whether and how trial sites supplied thawed plasma in a timely manner Quantitative Detailed author description Observation, reports from sites Intervention and trial Fidelity How delivery is achieved No Sands 2016 [ 38 ] Explored how the flexible complex intervention was delivered in real-world complex settings Qualitative Trial dataset Intervention How delivery is achieved Adaptations Contextual moderators Participant responses Unintended consequences Contextual factors shaping intervention theory Fidelity No Saville 2016 [ 39 ] Explored preferences and experiences of intervention deliverers about various aspects of intervention Quantitative Questionnaire Intervention How delivery is achieved No Tjia 2017 [ 40 ] Investigated patients’ perceptions of benefits and drawbacks of intervention Quantitative Questionnaire Intervention Participant responses No Vennik 2019 [ 41 ] Explored views and experiences of parents and practice nurses of intervention and usual care Qualitative Interviews …”

“…Of the 17 process evaluation studies identified, nine were quantitative [ 22 , 24 – 28 , 32 , 37 , 39 , 40 ] and eight qualitative [ 23 , 29 – 31 , 34 – 36 , 38 , 41 , 42 ]. The three labelled as process evaluations were all qualitative [ 30 , 31 , 33 , 34 ].…”

“…Twelve process evaluations evaluated only intervention processes [ 22 , 24 , 28 – 31 , 33 – 36 , 38 – 42 ], and five evaluated both trial and intervention processes [ 23 , 25 – 27 , 32 , 37 ]. Of the latter, one explored patients’ experiences of trial participation qualitatively [ 23 ] and two described in detail the trial processes undertaken to ensure fidelity [ 27 , 37 ].…”

“…No other reports explicitly discussed the pragmatic nature of the RCT. However, one process evaluation [ 38 ] used a qualitative content analysis to ‘describe the pragmatic reality’ of intervention delivery, and its authors emphasise that this was important to allow post-trial replication of a flexible intervention with a large potential variability of delivery in a complex setting. In the report of a qualitative interview study with intervention recipients and providers [ 42 ], the authors highlight that these process evaluation data provide real-life insights to aid post-trial implementation.…”

“…Thirteen of the 17 process evaluation studies [ 22 , 24 , 28 – 32 , 35 – 38 , 40 – 42 ] had no mention in their corresponding index trial results papers.…”