OTalk

#OTalk – Tuesday 19th October 2021 -Assessing fatigue: capturing what counts?

This #OTalk is hosted by Dr Leisle Ezekiel

Fatigue is a common and distressing consequence of many neurological conditions and has long been an area of focus in occupational therapy, particularly for therapists working with people with progressive neurological conditions. But it is increasingly evident that fatigue is a significant problem for people living with acquired brain injury and is a distinct and direct consequence of brain injury. Estimates of prevalence vary from 21-77% and there is evidence that fatigue may last for many years (Wylie and Flashman 2017; Acciarresi, Bogousslavsky and Paciaroni, 2014; Headway, 2019).

Fatigue is a complex and subjective experience which is difficult to define as it overlaps with concepts of tiredness and with the symptoms of depression, sleep dysfunction and muscle weakness (Doncker et al 2018, Mollayeva et al 2014). It is therefore best thought of as multi- dimensional phenomenon that consists of different types of fatigue with varying signs and symptoms. Cantor et al (2014) conceptualise fatigue as encompassing “psychological, motivational, situational, physical, and activity-related components” and define it as a: 

“subjective awareness of a negative balance between available energy and the mental and physical requirements of activities” (Cantor et al 2014)pp491.

So to understand an individual’s experiences of fatigue, we need to consider fatigue in the context of people’s daily lives (including occupations and environments), the behaviour associated with fatigue (i.e. coping strategies) and their beliefs around fatigue and activity. However, it can be difficult to disentangle fatigue experiences from other consequences of brain injury. For example: is a lapse in concentration a sign of fatigue or do people tire more easily because they have difficulty with attention (Wylie and Flashman 2017)

There have been several attempts to develop a taxonomy or case definition of fatigue after stroke (Kluger et al 2013, Lynch et al 2007). Others suggest a need to consider in-the-moment experiences of fatigue (state fatigue) separately from the chronic experience of fatigue (trait fatigue) as state fatigue is more likely to be associated with fatigue-related behaviours, for example, the decision to do something or whether to stop and rest (GR. Wylie and Flashman 2017) State fatigue is measured using a numeric rating scale or visual analogue scale (e.g. 0-10, with 0 being no fatigue and 10 worst fatigue). 

This complexity of fatigue creates challenges when we start to assess and measure fatigue and is a challenge in the development of fatigue outcome measures. There is a myriad of fatigue scales and measures used within research but many of them were not developed for the ABI population and tend to conflate the consequences of ABI with fatigue symptoms.  They are also completed retrospectively and ask for a summation of experience and are less reliable for those with cognitive challenges. When using a fatigue scale we need to pay close attention to what the scale measures, is fatigue uni or multi-dimensional, does the scale capture severity, intensity or impact or a combination of these? 

As occupational therapists, we focus on enabling people to manage their fatigue effectively, so that they can participate in the daily activities that are most meaningful and necessary. To do that, we need to understand the individual’s triggers, patterns of, and responses to fatigue so we can support them in developing and applying effective strategies.  But our assessment of fatigue is shaped by our conceptualisation of fatigue and depends on the tools we use to gather accurate and meaningful information about fatigue.  A survey of physiotherapists and occupational therapists highlighted significant differences in therapist’s beliefs about fatigue, with potential for these differences to result in clients/patients receiving conflicting advice (Thomas et al 2019)

The questions for today are: 

  1. How do we as OTs conceptualise fatigue for people with neurological conditions?
  2. What tools are useful in gathering data about people’s fatigue?
  3. What challenges do we experience in practice when gathering information about fatigue?
  4. How do we know assess whether our intervention has made a positive impact? 

References

Cantor JB, Ashman T, Bushnik T, Cai X, Farrell-Carnahan L, Gumber S, Hart T, Rosenthal J and Dijkers MP (2014) Systematic review of interventions for fatigue after traumatic brain injury: A nidrr traumatic brain injury model systems study. Journal of Head Trauma Rehabilitation. Lippincott Williams and Wilkins, 490–497.

Doncker W de, Dantzer R, Ormstad H and Kuppuswamy A (2018) Mechanisms of poststroke fatigue. Journal of Neurology, Neurosurgery & Psychiatry. BMJ Publishing Group Ltd 89(3): 287–293. Available at: https://jnnp.bmj.com/content/89/3/287 (accessed 06/08/21).

Kluger BM, Krupp LB and Enoka RM (2013) Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology. Neurology 80(4): 409–416. Available at: https://pubmed.ncbi.nlm.nih.gov/23339207/ (accessed 06/08/21).

Lynch J, Mead G, Greig C, Young A, Lewis S and Sharpe M (2007) Fatigue after stroke: the development and evaluation of a case definition. Journal of psychosomatic research 63(5): 539–44. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17980228 (accessed 19/06/14).

Mollayeva T, Kendzerska T, Mollayeva S, Shapiro CM, Colantonio A and Cassidy JD (2014) A systematic review of fatigue in patients with traumatic brain injury: The course, predictors and consequences. Neuroscience and Biobehavioral Reviews. Elsevier Ltd 47: 684–716. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25451201 (accessed 23/12/14).

Thomas K, Hjalmarsson C, Mullis R and Mant J (2019) Conceptualising post-stroke fatigue: a cross-sectional survey of UK-based physiotherapists and occupational therapists. BMJ Open. British Medical Journal Publishing Group 9(12): e033066. Available at: https://bmjopen.bmj.com/content/9/12/e033066 (accessed 06/08/21).

Wylie GR and Flashman LA (2017) Understanding the interplay between mild traumatic brain injury and cognitive fatigue: models and treatments. Concussion. Future Medicine Ltd 2(4): CNC50. Available at: http://www.futuremedicine.com (accessed 13/05/21).

Wylie GR and Flashman LA (2017) Understanding the interplay between mild traumatic brain injury and cognitive fatigue: models and treatments. Concussion (London, England). Concussion 2(4): CNC50. Available at: https://pubmed.ncbi.nlm.nih.gov/30202591/ (accessed 06/08/21).

POST CHAT 

Host:  Dr Leisle Ezekiel

Support on OTalk Account:  @helenotuk

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.
OTalk

#OTalk -Tuesday 12th October 2021-How do you use social media for learning?

This #OTalk is hosted by Kerry Edwards.

Social media has become part of our everyday occupations. Originally social networking sites such as Twitter, Facebook, Instagram were set up for people to connect socially with friends and families. This has now evolved and has transformed how we communicate with each other on both personal and professional levels. Communicating on social media as a health care professional can be daunting both for people new to social media or for health care students using social media for professional communication, particularly as they may be conscious about upholding professional values and behaviours (RCOT, 2021; HCPC, 2020) in a social, public and open space. However, the literature identifies that there are several motivators for engaging in learning through social media over more traditional learning/CPD environments (Gilbert 2016; Hughs 2021; Murray and Ward 2017)   Social media offers increased accessibility; learning opportunities can be accessed at a convenient time and place from a mobile device. For example, you may access tonight’s chat from the comfort of your armchair at home, or in the car whilst balancing other commitments such as family and work. Social media can also offer social and professional connectedness within the community of practice and/or opportunities to have informal conversations to gain national and international perspectives on topics of interest or opportunities to connect with other OTs or students that we may not normally connect with in our everyday lives. 

This tweet chat aims to discuss how this occupational therapy community of practice currently use social media for learning and continuing professional development.  When using the hashtag #OTalk this week you will be consenting that your tweet can be used as part of the data collection process for my research project. This is part of my studies towards a professional doctorate in education. Ethical Approval from the Cross-School Ethics Committee for Education, Language & Psychology at York St John University has been gained: the approval code is RECEDU00055. If you do not wish your tweets to be used, please contact me within 2 weeks of this OTalk chat, either by Twitter direct message or email me at k.edwards2@yorksj.ac.uk, and your tweets can be removed from the data set.  

Here are the questions that will be used to structure this week’s #OTalk 

  1. OTalk is celebrating its’ 10th anniversary this month. How long have you been joining in with the chat?
  2. What is your motivation for joining in with the OTalk chat? 
  3. What other activities on social media have you personally (and professionally) found useful to support your learning and development? – e.g., sharing of written articles and blogs, connecting with others. 
  4. How has the pandemic effected the way that you have engaged with your learning/CPD on social media over the past 18 months?
  5. Do you record your learning/CPD activities from social media? If so, how? 
  6. How would you like your learning on social media to be recognised in the future?  

References 

Gilbert S (2016) Learning in a Twitter-based community of practice: an exploration of knowledge exchange as a motivation for participation in #hcsmca. Information, Communication & Society, 19:9, 1214-1232,

HCPC (2020) Guidance on the use of social media. Available from https://www.hcpc-uk.org/standards/meeting-our-standards/communication-and-using-social-media/guidance-on-use-of-social-media/. Accessed 01/10/21 

Hughs K (2020) The use of Twitter for continuing professional development within occupational therapy, Journal of Further and Higher Education, 44:1, 113-125,

Murray, K., Ward K (2017). Attitudes to Social Media Use as a Platform for Continuing Professional Development(CPD) within Occupational Therapy. Journal of Further and Higher Education. 43:4 545-559 

Royal College of Occupational Therapists (2021) Professional standards for occupational therapy practice, conduct and ethics. London, RCOT 

POST CHAT 

Host:  Kerry Edwards

Support on OTalk Account: Kirstie @kirstieot
Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.
OTalk

#OTalk Research – Tuesday 5th October 2021 – How can we use new research to address the unmet need for rehabilitation in people with long-term conditions?

This week’s chat will be co-hosted by @NIHRevidence and @lindsaybearne a Senior Research Fellow in Knowledge Mobilisation at the  NIHR Centre for Engagement and Dissemination, . 

In 2017, WHO launched the Rehabilitation 2030 initiative, which laid out the increased need for rehabilitation due to an ageing population and increasing incidence of people with multiple long term conditions. They urged governments to improve their rehabilitation offerings. 

However, since the COVID pandemic,  rehabilitation services have decreased. This has affected people with long-term conditions, diminishing their health and wellbeing.  A group of charities and professional bodies have teamed up (called the Community Rehabilitation Alliance) and, together, they have called for a new national strategy for rehabilitation

We, at NIHR Evidence, have  collated some of the evidence on innovative approaches to rehabilitation for people with long-term conditions that have been published as NIHR Alerts. Our Collection, authored by Professor Lindsay Bearne, explores some new ways  to deliver rehabilitation effectively and cost-effectively. It  includes studies exploring telerehabilitation, workforce innovations by involving other staff members, and novel training for professionals. The Collection argues that implementing new research will enable us to ‘Move forward stronger’ to address the unmet need for rehabilitation. 

Why not join this week’s #OTalk to share your thoughts on how we can draw on new research to optimise rehabilitation delivery for people with long-term conditions. And discuss how innovative approaches could meet the needs of individuals in an effective and cost-effective way. 

The questions

In the #OTalk discussion we will use the following questions to structure the discussion but please feel free to join in with other questions and perspectives:

  • What are the key challenges to delivering person-centred rehabilitation? 
  • How can new ways of working, such as training non-specialist staff or telerehabilitation, help address the unmet need? 
  • What research is needed to help improve rehabilitation services? 
  • What do you think governments and policy makers need to do to address the unmet need for rehabilitation?
  • How do you access rehabilitation research evidence? 

Resources

POST CHAT 

Host:  @NIHRevidence and @lindsaybearne  Support on OTalk Account: @Preston_jenny
Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.
OTalk

#OTalk 28th September 2021 – Thermoregulation for wheelchair users: preventing problems with heat and moisture

This #OTalk is hosted by @WheelAir_

Overheating, over-sweating and excessive moisture build-up are common complaints among wheelchair users. Either due to a medical condition or restrictive seating configurations, many wheelchair users struggle to control heat and moisture levels in the seat contact areas.

At WheelAir, we feel that there is a general lack of understanding and awareness of how heat and moisture complications manifest and how serious an issue thermoregulation can be for wheelchair users.

Overheating

The body uses four mechanisms to maintain thermoregulation: conduction, convection, radiation and evaporation. However, for people with sweating dysfunction, caused by a spinal cord injury for example, no evaporation heat loss can take place. Such overheating drastically heightens the risk of developing heat stress or fatigue, as well as other issues such as heat-induced seizures and muscle spasms. Having to “just deal with” overheating and warm environments can, therefore, be very dangerous for wheelchair users if precautions aren’t taken.

Over-sweating and moisture build-up

Similarly, over-sweating or excessive moisture build-up can have serious consequences for wheelchair users. This is because the skin microclimate – that is, the temperature, humidity and airflow next to the skin surface – is an indirect pressure ulcer risk factor. Temperature and humidity affects the structure and function of the skin, lowering possible damage thresholds for the skin and underlying soft tissues. Even for people who are unable to sweat, such as those with a complete SCI, excessive moisture build-up is a problem. Even when not sweating, the skin releases moisture automatically through a much more passive process called transepidermal water loss (TWL). This is an unavoidable process and, of course, TWL increases when someone is sitting all day.

Research on heat and moisture

The team at WheelAir has spent the past 5 years researching heat and moisture to better understand how to recognise symptoms. We have now created a clinical assessment toolkit to improve the efficiency of evaluating heat and moisture risks for wheelchair users. The toolkit is designed to better inform and educate those involved in the decision-making and reimbursement processes, such as OTs, about the prevention or treatment of heat and moisture related complaints, such as pressure injuries or skin rash.

We want to facilitate OTalk to discuss these newly devised clinical tools and hear from OTs about their experiences of handling heat and moisture issues for wheelchair users.

About WheelAir

The WheelAir system is the first temperature control system designed to fit any wheelchair. All of our products are designed to disperse air evenly across the wheelchair contact area to lower the user’s core temperature and keep the skin dry and clean.

The very first WheelAir was brought to life in 2015 by our Managing Director, Corien Staels, as her final university project during her textiles degree after her university tutor, who was a wheelchair user, told Corien of the problems associated with overheating. Intrigued, Corien wanted to know more and discovered that overheating in a wheelchair is not only very uncomfortable, but also potentially dangerous. She learned that people were using ice-packs and water sprays to keep cool and it seemed ridiculous to her that in this day and age, there wasn’t a technological solution. And so she came up with the WheelAir concept – a simple idea that has already made a lot of impact. Ultimately, WheelAir’s vision is to create a world where every wheelchair user feels comfortable and in control of their temperature.

QUESTIONS:

1. We have had a very hot summer, what symptoms have you seen for wheelchair user clients in the past few months? How have they been managing staying cool and avoiding overheating?

2. Similarly, have moisture related issues been more of a challenge during the hot summer months? Are people struggling with sweating too much, skin issues like rashes, and finding it difficult to stay cool and dry?

3. In general, what types of symptoms do you see with heat and moisture related issues for wheelchair users? How often do you see these as issues for wheelchair users?

4. If a client has heat and/or moisture related symptoms, what do you usually suggest for solutions?

5. How can training about overheating, sweat, and microclimate management improve for Occupational Therapists that work with wheelchair users?

POST CHAT 

Host:  @WheelAir_

Support on OTalk Account:  @colourfulot

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.
OTalk

#OTalk Tuesday 22nd Sep 2021 -The Role of Occupational Therapy in Primary Care Mental Health Teams

This #OTalk is hosted by Helen Parmenter and Cheryl Carr who are both occupational therapists working in primary care teams.

Increasing complexity is one of the major factors responsible for the rising workload in general practice (Baird et al 2016) and involves patients presenting with two or more health conditions which also interact with other social difficulties such as poverty, trauma, isolation etc.
Often these difficulties are considered in isolation when people try and access services meaning patients often fall through the gaps between specialist mental health services, social care and Improving Access to Psychological therapies with their management being held by their local GP.

As part of the NHS long term plan, which NHS England published in 2019, local areas are being asked to realign community mental health services with primary care networks, creating ‘new and integrated models of primary and community mental health care’ by 2023/24 (NHS England 2019, p 69) resulting in the establishment of primary care networks (PCNs).

A diverse range of mental health needs are seen in primary care, with general practices supporting people with a wide range of diagnoses and complexities, including people with psychosis, bipolar disorder, personality disorders and other needs. (The Kings fund, 2020 )

Examples of population needs may include:

  • People with complex needs that do not fulfil criteria for specialist mental health services
  • Child and adolescent mental health needs that do not fulfil criteria for secondary care services
  • Mental health needs among older people
  • People with long-term mental health conditions discharged from secondary care
  • People with persistent physical symptoms which impact on their mental wellbeing
  • Psychological needs of people with long-term physical health conditions
  • People at risk of suicide, but not in contact with specialist mental health services

With the establishment of the PCNs, an increasing number of roles are emerging for occupational therapists to work within these newly established teams which often comprise of a mix of GPs, social prescribers, peers support workers, coaches, counsellors and psychological practitioners.

Within primary care mental health services occupational therapists are involved in activities such as
-Risks assessments for acute distress
-Personalised care planning for self-management
-Patient activation to achieve personal goals
-Social prescribing, and signposting or referral onto recovery support and services
(RCOT)

With services in their infancy and roles being developed in practice with opportunities to shape our own unique contribution, we look forward to hearing form the wider community about their thoughts about how occupational therapists can develop this opportunity to promote their skills to others, identify gaps, develop new ways of working and become imbedded as partners in their local communities.

Questions that will be discussed during this #OTalk are:

  1.  What help or support do you wish patients had in primary care mental health services?
  2.  What key skills can OTs utilise to be most effective in their roles?
  3.  How can OT’s be effective and timely with complex presentations?
  4.  What might be the best ways for OTs to demonstrate their outcomes to others both within the GP surgeries and beyond?

References;

Baird B, Charles A, Honeyman M, Maguire D, Das P (2016). Understanding pressures in general practice [online]. The King’s Fund website. Available at: http://www.kingsfund.org.uk/publications/ pressures-in-general-practice (accessed on 21st July 2021).
The Kings Fund (2020). Mental Health and primary care networks: understanding the opportunities. The Kings Fund website. Available at: https://www.kingsfund.org.uk/publications/mental-health-primary-care-networks (accessed 26th July 2021)

NHS England (2019). The NHS long term plan [online]. NHS England website. Available at: http://www.longtermplan.nhs.uk/publication/nhs-long-term-plan (accessed on 20 July 2021).

RCOT. Occupational therapy in primary care. RCOT website Available at: https://www.rcot.co.uk/occupational-therapy-primary-care (accessed 20 July 2021)

POST CHAT

Host:  Helen Parmenter and Cheryl Carr

Support on OTalk Account: @helenotuk

Evidence your CPD. If you joined in this chat you can download the below transcript as evidence for your CPD, but remember the HCPC are interested in what you have learnt.  So why not complete one of our reflection logs to evidence your learning?

HCPC Standards for CPD.

  • Maintain a continuous, up-to-date and accurate record of their CPD activities.
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice.
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery.
  • Seek to ensure that their CPD benefits the service user.
  • Upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the Standards for CPD.

The Stats