Academic journal article British Journal of Occupational Therapy

To Provide or Not to Provide Treatment? That Is the Question

Academic journal article British Journal of Occupational Therapy

To Provide or Not to Provide Treatment? That Is the Question

Article excerpt

Background

There is a shift towards ensuring that occupational therapy provision is based on a client's needs and is equitable among clients. It follows that occupational therapists need to be able to discriminate between individual clients' needs and that treatment provision should be consistent between therapists for clients with similar needs (Weiss and Shanteau 2003). Paediatric occupational therapists in Scotland have been reported to 'lack a common rationale' for practice (Scottish Executive 2003b), but there is little evidence about the possible issues underlying this. Previous research has been limited to descriptions of current practice (Howard 2002, Kelly 2003) and there has been little research about the rationale for and consistency of practice, particularly regarding whether treatment is provided. At the level of the individual clinician, this research investigated paediatric occupational therapists' beliefs about and intentions to provide treatment for children with coordination difficulties.

Use of knowledge as a basis for a common rationale

Research about occupational therapists' practice has been dominated by the identification of clinical reasoning styles (Fleming 1991a, 1991b, Mattingly 1991a, 1991b, Schell and Cervero 1993). Much of this has been criticised for limited scientific rationale, the dismissal of existing literature and the use of invalid methods (Roberts 1996, Harries and Harries 2001). It has been proposed that instead of clinical reasoning styles, the focus should be on the content of reasoning (Roberts 1996). For this study, the authors classified the content of reasoning as described in the clinical reasoning literature into four categories: research evidence, professional wisdom, client experience and context, and resources and practical issues. These were viewed as different types of knowledge that therapists may use to guide practice.

There is little evidence about how different types of knowledge relate to occupational therapists' practice. Therapists' use of research evidence has been found to be limited (Cameron et al 2005), possibly due to a lack of time and skills in assessing and implementing evidence (Humphris et al 2000, Metcalfe et al 2001) or the scarcity of research evidence (Scottish Executive 2002, Blair and Robertson 2005). The evidence used (Bennett et al 2003) and the training courses attended (Howard 2002) are reported to be based largely on professionally accumulated wisdom (for example, experience and information from colleagues). Although therapists are expected to use knowledge about the client's experiences and context (College of Occupational Therapists 2004), evidence about whether they actually do this is limited. In addition, occupational therapists have been found to consider pragmatic issues (for example, resources) regarding their own and the client's context (Munroe 1996, Unsworth 2004).

In another field of clinical practice, recent research (Bonetti et al 2006) found that general dental practitioners' behaviour was predicted not by their knowledge about whether particular actions are clinically effective, but by the practitioners' beliefs about the behaviour (for example, whether respondents perceived that taking action was under their control). This suggests that theories of human behaviour (that is, behavioural theories) could be useful in investigating clinicians' practice.

Beliefs about behaviour as a basis for a common rationale

Rassafiani et al (2006, 2008) used Social Judgement Theory (Sherif and Hovland 1961, Cooksey 1996) to investigate occupational therapists' beliefs about factors related to management decisions regarding children with cerebral palsy. Therapists' perceptions about selected factors were weighted by their judgements about the importance of each factor (or belief) in shaping the decisions. Perceptions that are weighted in this way correspond to the 'expectancy-value' models of attitude (Fishbein 1963). …

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