York St John University
   
 
The Bridge
 
     
 
18 March 2009
 
   
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Bridging the gap between research and practice

As we are all starting to feel the benefits of spring, the daffodils coming out and lighter evenings, it is really good to be able reflect on some exciting developments in the field of occupation and mental health research. I hope you are as excited as I am by the a pilot randomised controlled trial published recently in Clinical Rehabilitation (see spotlight on research below). We were very fortunate to have one of the authors, Sarah Cook, participate with us on our first RCOMH bid camp…

 
Bid Camp 2009

                  
Last week a group of ten people met at the Commonwork conference and study centre to work on research proposals/ bids relevant to occupation, mental health and well being. The venue was very conducive to group work and provided an excellent environment for taking time out from the usual run of the mill to really focus on research (see www.commonwork.org for more information).  The group was a mixed group including those early in their research careers to others with a lot of research experience and so we all had very different needs. This was managed by having a very informal programme that included gatherings, shared meals and lots of time to work on individual/group projects according to each person’s needs. During the gatherings we discussed bidding, the politics of research, research careers and the use of creative activities in data collection and data analysis. At the end of the bid camp everyone felt that they had gained a lot from participating in it. In their reflections the positive benefits of taking time out to focus on research, developing ideas, networking, working with like minded people, and developing a work plan for research bids were mentioned. It is early days in understanding what the benefits are of participating in a bid camp but it does look like bid camps might be a good way of building research capacity.

                             
   Can you guess how this sculpture explains research bidding?

Spotlight on research

In our first spotlight on research, which we hope will become a regular feature in The Bridge, we are focusing on a very exciting paper that has just been published in Clinical Rehabilitation by Sarah Cook and colleagues. Simon Hughes, a consultant occupational therapist who is currently conducting a research study on occupation and assertive outreach, reflects on this publication…

This paper has been eagerly anticipated since the publication of ‘Occupational therapy defined as a complex intervention’ (Creek 2003). Creek’s (2003) work laid the pathway for this trial based on a clear definition of occupational therapy. The paper reports the findings from a pilot randomized control trial conducted in two NHS community mental health adult services in a city in the north of England. The aim of the study was to investigate the feasibility of a randomized controlled trial design to inform a future fully powered study within a European health and cultural context.  The intervention was twelve months of occupational therapy delivered in a community setting and individualised to the service user as an adjunct to usual care, this was compared to treatment as usual. The results showed that there were no differences between the two groups on any of the outcome measures. For both groups there was statistically significant improvement over the twelve month period as rated by the Social Functioning Scale and the Scale for the Assessment of Negative Symptoms. Studying the subscales within the Social Functioning Scale the occupational therapy group demonstrated clinically significant change that was not apparent in the control group; this was in the areas of relationships, independence performance, independence competence, and recreation.

The authors concluded that individualised occupational therapy may contribute towards an individual’s recovery and that further research is necessary with an emphasis on individuals’ cognitive abilities and employment.

The importance of this study is the steps forward it takes in the lengthy process towards being able to routinely evaluate a complex intervention such as occupational therapy. The Medical Research Council (2008) guidelines to developing and evaluating complex interventions confirm this process. In terms of challenges to the feasibility of the study key issues included (a) the context of the investigation in that occupational therapy is an established, rather than a novel, intervention and (b) there was evidence from the parallel qualitative study that individuals in the treatment as usual group had also received occupational therapy. (The authors also generated other possible explanations of lack of difference between the two groups). This pilot study has laid the groundwork for future fully powered studies, for example the outcome measures that the trials should be powered against are discussed. The paper also questioned the utility of the chosen standardised outcome measures to sensitively detect clinically significant change in an individually tailored programme. A proposal is put forward that in future consideration may need to be given to goal attainment scales.
 

If you would like to read Sarah’s article the full reference is:

Cook S, Chambers E, Coleman JH (2009) Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial. Clinical Rehabilitation 23 40-52. Available online at http://cre.sagepub.com/cgi/content/abstract/23/1/40
(DOI: 10.1177/0269215508098898)

References

Creek J (2003) Occupational therapy defined as a complex intervention London: COT

The Medical Research Council (2008) Developing and evaluating complex interventions: new guidance. Available online at :-
http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC004871


Simon Hughes
Lead for Occupation and working with people with psychosis living in the community Research Programme (RCOMH)
Tees, Esk &Wear Valley NHS Trust

Thinking of doing a PhD?
Sarah Cook may be able to offer supervision to colleagues wishing to embark on a PhD on topics related to mental health, occupational therapy, the arts and health,  creativity, work and/or service user involvement.

Contact her on s.p.cook@shu.ac.uk.

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