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Occupational Therapy: An Evolving Profession

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This week is Occupational Therapy Week in the United Kingdom and World Occupational Therapy Day was celebrated on the 27th of October with the World Federation of Occupational Therapists celebrating the essence of the profession.

Occupational therapy students being trained in weaving. Used with permission of Oxford Brookes University.

Occupational therapy students being trained in weaving. Used with permission of Oxford Brookes University.

Occupational therapy is synonym with improving the quality of life of individuals through engagement in activities and has its humble origin in the First and Second World War, with occupational therapists providing rehabilitation services to wounded soldiers with the aim of re-establishing them in the workforce.

During World War I, vocational services were provided to injured soldiers in the military hospitals in Canada and vocational workshops were set up by the Invalid Soldier’s Commission, whilst “young suitable ladies” provided activities to patients who were bedbound. In 1917, the United States founded the Society for the Promotion of Occupational Therapy, which is now known as The American Occupational Therapy Association, whilst Canada established short courses for the training of occupational therapists, then referred to as “ward aids” or “occupation aids”.  The Canadian Association of Occupational Therapy (now known as the Canadian Association of Occupational Therapists) was established in 1926.

Basket-weaving also formed part of the occupational therapy training course.

Basket-weaving also formed part of the occupational therapy training course. Used with permission of Oxford Brookes University.

Dr Elizabeth Casson played a vital role in the development of the profession in the United Kingdom and set up the first school of Occupational Therapy at Dorset House in 1930. Dr Casson understood the value of occupation and engagement in activities:

Dr Casson, aged 21. Used with permission of Oxford Brookes University.

Dr Casson, aged 21. Used with permission of Oxford Brookes University.

“When I first qualified as a doctor …I found it very difficult to get used to the atmosphere of bored idleness in the day rooms of the hospital. Then, one Monday morning, when I arrived at the women’s wards, I found the atmosphere had completely changed and realised that preparations for Christmas decorations had begun. The ward sisters had produced coloured tissue paper and bare branches, and all the patients were working happily in groups making flowers and leaves and using all their artistic talents with real interest and pleasure. I knew from that moment that such occupation was an integral part of treatment and must be provided.”

Quoted in The story of Dorset House School of Occupational Therapy 1930 – 1986, [Oxford: Dorset House School of Occupational Therapy, 1987], p.1

The original location of the Dorset House in Clifton, Bristol.

The original location of the Dorset House in Clifton, Bristol. Used with permission of Oxford Brookes University.

The Scottish Association of Occupational Therapists (SAOT) was founded in 1932, with The Association of Occupational Therapists (AOT) for England, Wales and Northern Ireland following in 1936.  These two organisations merged in 1974, forming the British Association of Occupational Therapists.

Nissen huts located on the grounds of the Churchill Hospital (Oxford), used for occupational therapy training since 1946.

Nissen huts located on the grounds of the Churchill Hospital (Oxford), used for occupational therapy training since 1946. Used with permission of Oxford Brookes University.

During World War II, two occupational therapists travelled from Britain to set up the first Occupational Therapy department in Johannesburg, South Africa. Despite enduring wild storms at sea and losing all equipment on the way, these brave ladies established a training course in 1943, with occupational therapists providing services to injured men in the military hospitals across in the country. The South African Association of Occupational Therapists (now known as the Occupational Therapy Association of South Africa) was established in 1945 and was one of the founder members of the World Federation of Occupational Therapists in 1852, with Vona du Toit being the first Vice-President.

Occupational therapy as a profession has undergone many changes since the use of activities within a hospital setting, and has evolved to provide services within various sectors. However, to the core of occupational therapy remains the belief in the value of occupation, as emphasized by Dr Casson:

Dorset House celebrated 21 years in July 1951.

Dorset House celebrated 21 years in July 1951. Used with permission of Oxford Brookes University.

“…to form a community where every individual was encouraged to feel that she had a real object; for a patient the object was to get well and go out to a worth-while life; for a member of the staff it was to serve others with all the talents she possessed; for a student, to develop all her capacities for her life as an Occupational Therapist and to find the individual job that only she could do.”

– Quoted in The story of Dorset House School of Occupational Therapy 1930 – 1986, [Oxford: Dorset House School of Occupational Therapy, 1987], p.3

To find out more about vocational services offered by Obair, visit our stand at the Occupational Therapy Show, taking place in Birmingham on the 25th and 26th of November 2015.

Written by Lezanne Fieuw

Why Matheson?

Occupational therapists use Functional Capacity Evaluations (FCE) to determine the current functional capability of an individual with regards to the ability to return to or being retained at work. Our expertise and experience in this area of practice is the reason why when Anne and Jain (Obair) wanted to develop a FCE training programme for the UK market. We approached Matheson and partnered with them to adapt their internationally renowned training to meet the unique needs of the UK market and have been offering training for the past 5 years+. No other FCE approach/system training has been specifically customised for the UK market.

UKFCE training underway.

UKFCE training underway.

In general terms, Matheson is an approach to FCE and is not an FCE system of which there are a number in use in the UK. Many of these FCE systems were developed by either a single practitioner or an organisation who developed their own tests, e.g. for lifting, for strength testing etc., or developed their own FCE equipment. These systems usually mean that you do their training and you have to use (and purchase) their tests or their equipment to do the FCE. The validity and reliability of many of these “own tests” have never been established and some, e.g. static strength testing used to measure manual handling capacity, is now well recognised as having no validity as a measure of manual handling capacity.

As an approach to FCE, the Matheson FCE differs from other FCE’s in: its ethos, its core elements, its core assessment tools, its evaluation protocols, in the evaluation training, in validity and reliability, in who can be trained etc.We thus decided to highlight some of the differences and the reasons for Obair endorsing the Matheson FCE.

Group discussing course material.

Group discussing course material.

The Matheson FCE:

Is an approach/ protocol and not a system: with Matheson, you learn how to do an FCE as well as how to administer and interpret the results of various standardised tests.

At its core it has a practice hierarchy: that places safety as its basis and includes: reliability, validity, practicality and utility and therefore the evaluator is assured that they keep the individual safe while still answering the referrer’s questions.

Is about training and producing thinking evaluators: and not practitioners who administer tests and use a computer to determine a score and thereby identify function, often in conjunction with producing a report with graphs and findings that can mean little to the referrer.

Has in excess of 19,000 trained Matheson FCE evaluators worldwide: so you are in very good company and there is a lot of international expertise available for new evaluators to tap into via Obair and the Matheson web site and resources.

Using a Jamar hand dynamometer.

Using a Jamar hand dynamometer.

Facilitates the evaluators’ continual professional development: once you have trained as a Matheson evaluator you have access to Matheson Evaluators’ group, which in turn allows you to access free Webinarsand current published research through the learning resources. Matheson also offers advanced training programmes.

Uses standardised tests whose validity and reliability has been determined and published in peer review journals: and there is no requirement to buy specific pieces of equipment or assessment tools as can be the case with FCE systems.

Offers an approach that can be customised: and Matheson evaluators, as thinking evaluators, can make use of any standardised test used in rehabilitation or medicine to determine function in all areas e.g. physical function, cognitive/perceptual function, mental health function.

Approach and software do not negate the clinical experience of the

evaluator: and cannot be carried out by a technician as it requires and relies on the expertise of the clinician.

Is the definitive FCE in a number of spheres in the US and Canada where Matheson FCE has been in use for 25 years+ and where the greatest number of evaluators are located.

Written by Anne Byrne (Clinical Director) & Jain Holmes (Training Director) September 2015

Obair’s Functional Capacity Evaluation (FCE) Credentials:

Anne: 37 years+ as an occupational therapist and 25 years working in vocational rehabilitation & occupational health in both

Demonstrating the use of FCE equipment.

Demonstrating the use of FCE equipment.

the UK and in Canada. Took her first FCE course in 1987 and has been using FCE in her practice since. Accredited in 2 FCE approaches/systems and has also completed post graduate training in 3 others.

Jain: 25 years+ as an occupational therapist and 15 years working in vocational rehabilitation and occupational health in the UK and the USA. Author of “Vocational Rehabilitation” and currently doing her PhD related to vocational rehabilitation. Accredited in 2 FCE approaches/systems and has also completed post graduate training in 3 others.

Between Anne & Jain, we are accredited in 4 different systems and have done post graduate training in 6 others. Therefore, at Obair we know a good FCE when we see one!

World Spine Day

October 16th marks the annual celebration of World Spine Day as part of The Bone and Joint Decade’s Action Week.  This year’s theme is “Your Back at Work”, which is fitting, considering the increasing socioeconomic burden of non-specific chronic low back pain.

Photo by Bethany Legg; www.unsplash.com

Photo by Bethany Legg; www.unsplash.com

Globally, back and neck disorders are on the rise, with jobs becoming more desk bound and computer based. At Obair, we perform display screen evaluations (DSE) and ergonomic assessments with the focus on improving sitting posture and the ergonomic layout of workstations. Having a workstation that matches your body’s characteristics can aid in preventing musculoskeletal discomfort and pain and in turn, improve work performance.

Photo by Benjamin Child; www.unsplash.com

Photo by Benjamin Child; www.unsplash.com

Obair offers advice on appropriate workstation ergonomics and self-management strategies at work. There are some basic factors to be considered when choosing an appropriate chair. First, you should be able to sit back comfortably with your back touching the backrest. The chair should be height adjustable to ensure that your forearms are parallel to the desk when typing. If your feet do not rest on the ground, a footrest should be considered. Armrests can be useful, but should not hinder you from moving as close to the desk as needed.

Photo by Rayi Christian Wicaksono; www.unsplash.com

Photo by Rayi Christian Wicaksono; www.unsplash.com

Attention should be paid to the height of your desktop or laptop screen monitor. Prolonged neck flexion places a lot of tension on the neck and back muscles and can lead to muscle spasms and discomfort. Make use of an adjustable screen monitor or laptop stand to ensure working at eye level. In addition, being able to touch type (i.e. type without looking at the keyboard) will also ensure that you keep your neck in a neutral position.

Although having a workstation fit to suit your needs is beneficial, having regular rest and stretch breaks cannot be underestimated. Our bodies are made to move and so, it is advised to stand up at least every hour to grab a drink of water or walk around the office. A good way of achieving this is to have routines in place, such as only filling your cup half way or setting your phone to vibrate.

In this way, we are being mindful of the way that we work and use our bodies. As part of #WorldSpineDay, you are invited to share a #spineselfie of #YourBackAtWork, demonstrating a healthy spine habit at work.

Low Back Pain and Return to Work

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The annual Health and Wellbeing at Work conference took place in Birmingham in March this year. Anne Byrne presented a College of Occupational Therapists’ sponsored presentation on “Functional Limitation of Back Pain and the Impact on Return to Work”, focusing on factors pertaining to the functional outcome of rehabilitation.

Photo by Victor Hanacek; www.picjumbo.com

Photo by Victor Hanacek; www.picjumbo.com

Low back pain (LBP) is characterised by a range of signs and symptoms, ranging from subjective findings such as pain and stiffness, to objective findings relating to decreased range of movement and psychological distress. Research indicates that 90% of LBP is non-specific and 28% of the population will experience a significantly disabling episode of LBP in their lifetime. In the majority of cases, rapid resolution is expected within four weeks and full recovery by six weeks. The question remains as to why some individuals fail to recover and experience persisting symptoms.

Causes of LBP range from heavy and light lifting, to materials manipulation and computer use such as keyboarding. Occupations with the highest prevalence include health care professionals, skilled trades, service sector, construction and agriculture. LBP accounted for 2.8 million days lost in Great Britain in 2014.

Research has shown that psychological stress and fear avoidance beliefs correlate better with measures of functional limitation than clinical severity and clinically relevant pain. It appears that psychosocial factors, such as anxiety, lack of understanding and fear, impact on an individual’s functional outcome following an onset of LBP. Identifying and addressing these obstacles are key to facilitating recovery and participation.

Photo by Lotto Löhr; www.unsplash.com

Photo by Lotto Löhr; www.unsplash.com

Although traditional clinical evaluation methods can be helpful, the focus is often only on the physical impairment and performance components are not assessed. A biopsychosocial approach is put as an alternative method, making use of the core set for LBP as outlined by the International Classification of Function. A robust FCE should incorporate the assessment of both physical and psychological function, making use of multiple methods and triangulation of findings.

A multidimensional task analysis profile (MTAP) is then used to compare the client’s objective report to the subjective work capacity, and thereby matching capacity to demands.

Part of the FCE would be to identify obstacles (physical, psychological and social) that can delay RTW. This could include the claimant’s attitude and beliefs regarding his or her own condition and return to work. Social obstacles can also hinder the RTW process, e.g. loss of contact with employer, lack of modified duties and poor social support. The evaluator should pay attention to language used, so as not to feed into fear avoidance beliefs and catastrophic thinking patterns.

In focusing on capacity and the claimant’s strengths rather than limitations, the occupational therapist is opening the door of possibility and instilling hope. The focus should be on using a pro-active method of identifying appropriate interventions than can assist the claimant in returning to independence in activities of daily living and work.

An FCE is an effective method of identifying barriers and maximising participation. Early identification of obstacles is crucial in order to plan the way forward.

National School of Occupational Health Study Day


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Scottish whisky titleAnne presented at the first conference of the newly formed National School of Occupational Health on the 26th September 2014. There were over a hundred participants from various areas of occupational health (OH) practise.
The remit for the presentation was to inform participants of the role of occupational therapy in occupational health. As the overall theme of the study day was the Food Industry, Anne chose to focus her presentation on 8 years’ experience of providing occupational therapy (OT) within the Scotch Whisky Industry.
The introduction of the session presented facts and figures to the audience, including:

  • Exports of Scotch Whisky are worth £4.3 billion to the UK and it accounts for ¼ of the UK’s food and drink exportsScottish whisky distillery
  • 10,000 are directly employed in the industry, mainly in economically deprived areas, and over 35,000 jobs across the UK are supported by the industry

Hence why it is important that the industry continue to be productive, and that the skilled www.resume-for-you.com workers in this industry are kept healthy!
Anne introduced participants to the manufacturing process from malting to aging to bottling in order to illustrate the demands of various roles and how in some areas, traditional methods continue to be used, which can be very difficult to adapt or to accommodate for impaired functional ability.
OT in OHAnne discussed the 3 main areas of occupational health in which occupational therapy provides services:

  • Functional Capacity Evaluation (FCE) – focussed on job specific FCE and the importance of Job Demands Analysis (JDA) in matching capacity to demands in order to facilitate return to work and maintenance at work.  Also discussed, how the FCE can be used to evaluate workers with limitation in physical, cognitive or mental health function and that it is the clinical expertise of the occupational therapist that is important.
  • Ergonomics Evaluation – slides that illustrated real work demands were used to engage the audience in the workshop by encouraging them to identify concerns and then solutions based on principles and strategies to minimise risk and facilitate performance.  The principles and strategies can be used in any industry
  • Education and Training – briefly discussed a participatory ergonomics programme and the use of education and training in ergonomics to identify and up-skill suitable staff to engage in the programmes.

The feedback form the presentation was very positive with a number of OH colleagues voicing they did not realise what OT had to offer in OH; however, now they did!

Obair’s Directors share how Occupational Therapy can add value to Occupational Health


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Jain Holmes, Training Director and Anne Byrne, Clinical Director with Obair wrote an article for the Occupational Health Magazine that was published online on 3 May 2014 part of the Personnel Today essential HR news and guidance from the Xpert HR team.

Here is an excerpt of our article – if you want to read the whole thing then go straight to the article here.

Occupational therapists (OTs) and occupational health professionals are frequently mistaken for each other. OTs Jain Holmes and Anne Byrne aim to demystify what their profession does, and identify what they contribute to the workings of occupational health.
OT training centralises around understanding how a human being functions in everyday life (home, school, work and leisure) and we are medically dual-trained in physical and mental health and can therefore work with individuals who have problems in either or both areas.

Our approach is holistic, which means we look at the person, the tasks they want or need to accomplish and the environments in which they want or need to perform the tasks. Therefore, we spend a great deal of time during our training learning about how humans might function differently in various built (physical) and social environments, and how tasks and environments can be adapted to fit the person’s needs or their functional impairment in order to facilitate performance.

How does occupational therapy apply to OH?
OTs focus on where a health issue impacts on the individual’s capacity to do their job or remain in their job, and we can potentially be used to determine if the issue preventing return to work or remaining at work relates to work capability, the job tasks or the work environment.

We identify and translate the employee’s physical or mental health symptoms in such a way that describes the impact they have on that employee’s job, and employees and employers advise that this is often one of the most useful aspects of an OT evaluation.

Following an evaluation and analysis (dependant on the referral request), the findings allow OTs to recommend a variety of methods that will help an employee to stay at or return to work (RTW) in a safe and sustainable manner.

Ideally, together with the larger workplace team (OH, HR and line managers), we will chart an employee’s progress and solve issues if and when they arise to the point where functioning in the job role remains stable and the RTW is sustained.

Our core skills lie in evaluating human functioning – i.e. the whole person in the specific environment doing a particular task – and then improving function by building an individualised, goal oriented rehabilitation programme with the aim in OH of progressing a case-to-case resolution. Inevitably there is some overlap with other professionals in a broader OH team, and OTs view this positively as it allows us to understand roles and participate in the multidisciplinary team with greater effectiveness.

In a previous editorial on 2 April 2014, Julia Skelton, Director of professional operations at the College of Occupational Therapists echoed Jain and Anne’s sentiments about the value that OTs brings to OH, “Occupational therapists do, of course, work within OH already – but the numbers at the moment are still quite small. I think things will begin to change over the next five to 10 years and allied health professionals, including occupational therapists, will be more self-evident within these services. I do think the relationship will evolve”. The College, for example, is working with the Council for Work and Health and Anne Byrne is the representative for the College and has been discussing new innovations such as the Health at Work Service.
Anne Byrne is attending this week’s annual conference of the National School of Occupational Health in London and providing a workshop to look at how OTs and OH can work successfully together. Her workshop is entitled:

The Scotch Whisky Industry: The Role for Occupational Therapy

The Scotch Whisky industry employs 45,000 workers directly and indirectly and a large majority of these workers are engaged in manual work using traditional methods that can be difficult to adapt. It is therefore vitally important that the skilled workforce engaged in this industry, which accounts for £4.3 billion in UK exports, remain at work and the risk of injury and absence is minimised.

As an occupational therapist providing services to occupational health at a large manufacturer of Scotch Whisky there are a number of services aimed at reducing absence and the risk of injury that can be provided in order to add value to existing OH services.  This workshop will give participants an overview of the Scotch Whisky industry and the services Occupational Therapy provides within Occupational Health and will use examples from manufacturing process to focus the workshop on job demands analysis and ergonomics. Through an interactive session we will review a number of principles and strategies to minimise the risk and facilitate performance that can be applied in any industry where manual work is carried out.

We will provide an update on Anne’s workshop in the coming weeks.

EcoVadis award for Obair


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EcoVadis aims at improving environmental and social practices of companies by leveraging the influence of global supply chains. EcoVadis operates the 1st collaborative platform enabling companies to monitor the Sustainability performance of their suppliers, across 150 sectors and 95 countries.   Sustainable Supply Chain Management is the process which brings together the principles of supply chain management and corporate social responsibility (CSR) to make suppliers a sustainable source of value, anticipating environmental issues rather than reacting to them, and improving the labour standards throughout the supply chain.

Obair undertook the sustainable supply chain management exercise to demonstrate our company’s CSR commitment to key stakeholders:

  • Customers: Customers are increasingly evaluating their suppliers on their capability to protect themselves from environmental or labour issues, several tiers down the supply chain.
  • Employees: A company’s vision and values are a major contributing factor in attracting and retaining talented people, and procurement executives are increasingly sensitive to the commitment of their organization to sustainable procurement practices.

On completion of this exercise Obair was awarded the EcoVadis Silver rating.

The descriptor for this level of award for Obair is:Ecovadis silver

  • Structured and proactive CSR approach
  • Engagements/policies and tangible actions on major issues
  • Reporting on actions and performance indicators

Obair will continuing to make improvement with our business based on the feedback from Ecovadis and seek to move towards the gold award over 2014.


Obair’s new Clinical Manager


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May 2014 saw Obair welcoming a new member of staff – Ann Shearer, who has taken up the new role of Clinical Manager. Ann is based in Obair’s head Office at Trident House in Paisley and her role will include leading on the support and supervision of Obair’s Vocational Rehabilitation Evaluators who deliver the range of Obair products and to work with the Clinical Director to continue to maintain the quality of services to our customers. Ann will also retain her practitioner role providing high quality, innovative and evidence based Vocational Rehabilitation evaluations, services and interventions.

Ann2Ann, who is an occupational therapist who qualified in 2000, comes to Obair with considerable experience in Vocational Rehabilitation and Occupational Health. Her skills and knowledge extend to working in both the private and public sectors within the UK in the clinical specialties of musculoskeletal conditions, mental health and neurological conditions. Ann’s clinical skills include assessments in the work setting covering work site assessment, job demands analysis and ergonomics. Ann also has experience undertaking past and future care Medico-Legal assessments and is an accredited Matheson functional capacity evaluator.

Ann is committed to supporting the Obair Evaluators to further build a world class team using evidenced-based assessments and interventions with individuals, who due to injury, health condition or disability, are demonstrating restrictions in their functional or vocational capacity for work, enabling them to successfully retrain or return to work.