#OTalk Research 3rd Dec 2019 – Inclusive research for people who lack capacity to consent

This month’s #OTalk Research will be hosted by Dr Naomi Gallant (@naomi_gallant) on the important topic of how we can include people who lack capacity to provide informed consent in our research. Here’s what Naomi has to say:


The Mental Capacity Act (2005) stipulates that in order for a person to be deemed to have the mental capacity to make a decision they must be able to:
understand the decision they are making and the information relevant to it
retain the information relevant to the decision
weigh up or use the information to inform the decision making
– and be able to communicate their decision (by any means)



One of the most important principles of the assessing mental capacity is that each assessment is decision and time specific. Somebody may have the capacity to understand, retain, weigh up and communicate what they would like to eat or drink in a set moment but may not be able to use the same thought processes to make the decision about a discharge plan home from hospital. The ability to make any decision can also fluctuate.

Understanding and retaining the information needed to make an informed decision to participate in research can be a complicated one! As a group, people who lack capacity to consent to participate in research are often excluded. As clinicians we may be familiar with the MCA principles and feel confident performing mental capacity assessments. Researchers on the other hand, may not all have the clinical experience and so assessing capacity becomes a cumbersome part of recruiting participants for research. Consequently, there is a huge gap of important people’s voices in important research projects.

I’d like to explore the following questions in the Twitter Chat:

1) Which groups of people may be excluded from research due to lack of capacity?
2) What are people’s experiences of including people who lack capacity to consent in research and what barriers did you experience?
3) How can we overcome the barriers to including people in our research who lack capacity to consent, particularly when inviting them to participate?
4) What research methods can be more inclusive for people who lack capacity to consent to participation?
5) What can we offer as researchers who are Occupational Therapists to include more people who lack capacity to consent?

Post Chat Updates:

The Numbers

747.494K Impressions
241 Tweets
49 Participants

Online transcript Health care Hashtags #OTalk 3rd December 2019

PDF of transcript: #OTalk 3 Dec 2019

#OTalk Participants


#OTalk 26th Nov 2019 – Driving After a Stroke

The RCOT Specialist Section Neurological Practice (SSNP) Stroke Forum welcomes you to the #OTalk on driving after stroke and invites you to participate in a tweet chat on driving following stroke. The chat will include the meaning of driving to us, the assessment of driving ability, methods of rehabilitation, and adjusting to life without returning to drive.

Driving is an occupation that, to many of us, represents a means of independence. This can include the independence to travel to work, to visit our family and friends, to support our everyday lives such as travelling to the supermarket, and to undertake our leisure activities. Much of our domestic and social lives are supported by us being able to drive and losing this ability would be highly likely to significantly impact on our lives.

In the UK, following a stroke, people are not permitted to drive for at least one month. After this time, people must not drive if there are enduring physical and cognitive limitations. Doctors may give the go-ahead for returning to driving if they consider that the person’s abilities are adequate. When there is uncertainty around a person’s abilities, a referral may be made to a driving assessment service where the person will be tested with a combination of physical and cognitive assessments and an on-road test.

As stroke is a condition where varying degrees of recovery is possible, rehabilitation may be a means to improve a person’s ability to increase the chance of returning to drive. Rehabilitation to improve independence in most occupations usually includes the practice of that occupation, but this is not possible with driving as people cannot legally drive before being assessed as competent. Thus, occupational therapy must depend on indirect methods of assessment and rehabilitation towards an outcome that is not guaranteed of returning to drive.

Please consider the following questions:

  1. What does the occupation of driving mean to you?
  2. How do you determine whether somebody can resume driving following the first month after stroke or whether testing at an official assessment service is required?
  3. How do you rehabilitate a person’s driving?
  4. How can occupational therapy help those who do not return to driving?

We hope the conversation resulting from the above questions will help us to understand different perspectives on driving after stroke and to discover methods which occupational therapists use to assess driving ability, to provide rehabilitation and to work towards developing alternatives to driving.



Online Transcript

The Numbers

326Avg Tweets/Hour
15Avg Tweets/Participant

#OTalk Participants

Data for #OTalk can be up to 15 minutes delayed


#OTalk 19th Nov 2019 Sex work and Occupational Therapy.

This week Rachel Rules ‪@_rachelOT and ‬ ‪ Rebecca Twinley‬ ‪@RebeccaTwinley‬ will be leading the chat,  here is what she had to say…

Sex work holds a ‘provocative place in the social psyche’(McCray, Wesely, & Rasche, 2011), yet sex work is a more commonplace role than society recognises. It is predicted that 40-42 million people engage in sex as work globally (Fondation Scelles, 2016), however, there are complications in making this estimate due to the covert nature of sex workand the actual amount is likely much higher. Sex workers are a diverse community from a range of socioeconomic backgrounds – this community encompasses women, men, transgender and gender-diverse individuals – and ways of engaging in sex as work are equally as varied.

In the search for Occupational Therapy literature related to this community of people, it was found that there is a dearth of research from an occupational perspective. Though, Ecklund, Arana, Henning, Lopez, Patel and Varnell’s (2018) phenomenological study explores the facilitators and barriers to occupational participation for six female exotic dancers leaving the sex industry and recognises the role of the Occupational Therapist in working with this population.

When considering the promotion of health through occupation, the stigma that sex workers face can greatly contribute to marginalisation and alienation in society (Open Society Foundations, 2019). This can affect access to health care services and if a person chooses to leave sex work, future working roles.

When considering the lives of sex workers as occupational beings, it is useful to consider the concept of the ‘dark side of occupation’ (Twinley, 2013), in exploring the unexplored and ensuring that people and their occupations are not ‘censored’ or ‘condemned’.

The aim of this #OTalk is simply to encourage thinking about Occupational Therapists’ knowledge, pre-conceptions andabilities in working holistically with sex workers.

This #Otalk differs, in that I have invited the sex workers of twitter to engage in the latter part of the talk, in the hope of capturing their experiences of accessing mainstream healthand social care services and to learn how we can improve our services and approach.

1. What is your current knowledge and understanding of sex as work?

2. Do you believe that discussing sex work is within your remit as an Occupational Therapist?

3. Are you aware of any non-mainstream or sex worker specific services in your community that you could signpost sex workers to, if they wished to access them?

4. What do you perceive the Occupational Therapy role to be in working with sex workers in your community?

5. The following two questions are directed at people who engage in sex as work – Do you have any experiences to share in accessing ‘mainstream’ health and social careservices (for both physical and mental health)? Do you disclose your work?

6. Is there anything that you think could be improved? What would you like health and social care professionals to know?

Post Chat Updates:

Online Transcript: #OTalk Transcript from www.symplur.com/healthcare-hashtags/OTalk

PDF of transcript: #OTalk 19 Nov 2019

The Numbers

1.579M Impressions
472 Tweets
76 Participants

#OTalk Participants


Eckland, E., Arana, J., Henning, L., Lopez, J., Patel., R. & Varnell, J. (2018) Exploring the role of occupational therapy with women leaving the sex industry. American Journal of Occupational Therapy, 72, 1.

Fondation Scelles (2016) Prostitution. Exploitation, persecution, repression. Retrieved from https://www.fondationscelles.org/pdf/RM4/1_Book_Prostitution_Exploitation_Persecution_Repression_Fondation_Scelles_ENG.pdf

McCray, K., Wesely, J. K., & Rasche, C. E. (2011). Rehab retrospect: Former prostitutes and the (re)construction of deviance. Deviant Behavior, 32(8), 743–768.

Open Society Foundations (2019). Understanding Sex Work in an Open Society. Retrieved from https://www.opensocietyfoundations.org/explainers/understanding-sex-work-open-society

Twinley, R. (2013) The dark side of occupation: a concept for consideration. Australian Occupational Therapy Journal, 60(4), 301-303.



#OTalk 12 November 2019 – How can occupational therapists use digital technology and apps to enhance practice?

This week’s chat will be hosted by #OTalk team member Clarissa (@geekyOT), who works as an occupational therapist on a personality disorder ward in a medium secure forensic unit. After more than 10 years of working in mental health, Clarissa has recently started a new role with the secure messaging app for healthcare professionals, Forward

A few weeks ago, my GP phoned me and asked me to go to Accident & Emergency (A&E). She said that she wanted me to be seen by a specialist, who she had tried to contact via switchboard a few times without success. She assured me that she had written a letter that should help me get seen quicker, and asked me to come to the surgery to pick it up. I explained that the detour would add an hour to my journey, and asked whether she could e-mail me the letter so I could print it out. That wasn’t an option. I asked her to e-mail it to A&E, and, keen to avoid a long journey when I was already feeling unwell, I even offered to phone A&E and ask for their e-mail address. 

Long story short: that didn’t work, and I ended up jumping in an Uber to pick up the printed letter from my GP after all. 

The A&E doctor assessed me and paged a specialist. No response. He tried again. Nothing. 

“This could take a while,” he said, glancing back at the phone on his desk. 

Wishing time away, I scrolled through the apps on my phone. Apps for communication. Apps for productivity. Apps to track all aspects of my health and lifestyle. Make life easier. Save time. And I imagined how much time could have been saved had my GP been able to contact the specialist directly. (As it happens, it would have completely saved me a trip, saved valuable A&E time, and saved me cancelling half a day of sessions with my own patients)

Frustrated with the series of delays, I told the doctor that I’d been for an interview with Forward Health earlier that week. I said that the secure messaging app could have saved us all a lot of time, and explained that he could have sent a detailed message to his colleague (confidential information and all), rather than waiting around for the phone to ring. He asked if it’s secure (it is) and free (yup), and expressed his surprise that he had never heard of it before.

Click here to download the Forward app

This led me to think about how much more efficient and effective I, as an occupational therapist, could be if I had the right technology at my fingertips. The NHS Long Term Plan sets out a vision of digital transformation for the NHS. But, even with my interest in technology, I get so bogged down with the pressures of clinical work that I don’t keep up with new developments. And I’m sure I’m not alone in that. 

So, following on from last week’s research #OTalk about innovation, let’s spend some time this week thinking about practical ways we can use digital technology and apps in our work.

I’d like this to be a space where we can vent about very real frustrations, and also think freely and creatively about future possibilities. Technology is rapidly changing, so let’s not restrict ourselves to what we already know. 

Chat Questions

  • Which apps/digital technology do you already use to support you in your work?
  • What frustrations do you have in practice that could be improved if you had technology that’s fit-for-purpose?
  • What barriers limit the use of technology in your setting?
  • Do you use any apps for your own health/wellbeing/occupational balance?  
  • If you could instantly create any app to improve your work life, what features would it have?

Post Chat Update

The Numbers*

1.411m Impressions
341 Tweets
49 Participants

*Twitter data from the #OTalk hashtag from Tue, November 12th 2019, 8:00PM to Tue, November 12th 2019, 9:00PM (Europe/London) – Symplur