British Journal of Occupational Therapy

Occupational therapists in many countries routinely perform predischarge home visits. Although there have been repeated calls to ascertain whether predischarge home visits are clinically and cost effective, there has been a tendency to neglect users' perceptions and experiences of this intervention.

The objective was to conduct a systematic thematic synthesis of older adults' perceptions and experiences of predischarge home visits.

The search strategy was an electronic database search. Conference proceedings were hand searched and universities and occupational therapy professional bodies within Europe, Australia and North America were contacted.

Forty-four studies were initially identified, of which 13 studies (7 published, 6 unpublished) were selected for detailed screening. Only three qualitative studies met the inclusion criteria and, from this synthesis, two main themes emerged from the data. The first theme was older adults' perceptions of home visits and the second theme was acceptance of occupational therapy.

Only a limited body of research has been conducted. This is surprising given the number of predischarge home visits that are performed. This thematic synthesis of qualitative research has highlighted that insufficient attention has been paid to older adults' perceptions of predischarge home visits.

The personalisation of adult social care, as confirmed in Putting People First (Department of Health 2007), will see a fundamental change in social care services, including occupational therapy. This study aimed to capture occupational therapists' perceptions of personalisation.

A qualitative study involving interviews with six practising occupational therapists was undertaken. The interviews were transcribed and the data studied for emerging themes, using thematic analysis to code and analyse the data.

Four main themes were identified: similarities to occupational therapy; a lack of understanding of occupational therapy; threats and concerns; and opportunities and action needed. All participants felt that they understood the components of personalisation and identified similarities to occupational therapy. All were able to highlight opportunities and actions for occupational therapists with regard to personalisation. However, all raised concerns about the future role of the occupational therapist and highlighted a general lack of understanding of occupational therapy.

Occupational therapists consider themselves to be well placed to support the implementation of personalisation. They feel that it is the right direction for adult social care, and that its goals are in parallel with those of occupational therapy. However, there are concerns that the possible contribution of occupational therapists could be overlooked.

The objective of the study was to investigate the convergent validity of the Developmental Test of Visual Perception — Adolescent and Adult (DTVP-A), the Motor-Free Visual Perception Test — third edition (MVPT-3) and the Test of Visual Perceptual Skills (non-motor) — third edition (TVPS-3) when used with adults.

Two hundred and twenty-one participants aged 20+ years (49 with and 172 without neurological impairment) completed the DTVP-A, MVPT-3 and TVPS-3. Spearman rho correlation coefficients were used to analyse the convergent validity of the three tests.

The DTVP-A (non-motor) total score was significantly correlated (p<0.01) with the MVPT-3 and the TVPS-3 total scores (rho = 0.73 and rho = 0.75 respectively). The MVPT-3 total score was also significantly correlated (p<0.01) with the TVPS-3 total score (rho = 0.79). The DTVP-A figure-ground subscale was found to be significantly correlated (p<0.01) with TVPS-3 subscales 1 to 7 with rho coefficients ranging from 0.36 to 0.56, as was the DTVP-A visual closure subscale (rho coefficients ranging from 0.43 to 0.64) and the DTVP-A form constancy subscale (rho coefficients ranging from 0.51 to 0.64). The DTVP-A total score was also significantly correlated (p<0.01) with subscales 1 to 7 of the TVPS-3 (rho coefficients ranging from 0.48 to 0.68). Moreover, the TVPS-3 total score was significantly correlated (p<0.01) with the figure-ground, visual closure and form constancy subscales of the DTVP-A (rho = 0.62, rho = 0.65 and rho = 0.68). Furthermore, the MVPT-3 total score was significantly correlated (p<0.01) with the figure-ground, visual closure and form constancy subscales of DTVP-A (rho = 0.59, rho = 0.68 and rho = 0.65 respectively) and with subscales 1 to 7 of the TVPS-3 (rho coefficients ranging from 0.53 to 0.70).

The DTVP-A, MVPT-3 and TVPS-3 exhibited moderate to high levels of convergent validity. The clinical implications of the findings of the study are that the DTVP-A, MVPT-3 and TVPS-3 appear to be measuring similar visual perceptual skills, but it is also important to note that the three tests all assess the visual perceptual skills in different ways.

Literature in occupational therapy, although paying increased attention to cultural differences and diversity, has largely ignored the situation of therapists who are themselves members of social and cultural minority groups. ‘Difference’ is assumed to be exclusively an attribute of the client.

This qualitative study explored the professional experiences of 12 occupational therapists in Ireland who self-identified as disabled or ethnic minority group members.

Participants reported challenges with colleagues and managers, which revolved primarily around cultural differences in the norms and expectations guiding social interactions, communications and practice styles. Overt discrimination was reported only by disabled therapists. With clients, again there were clashes of cultural values, but participants also experienced overt and covert prejudice and intolerance. This was particularly difficult to respond to in the context of client-centred practice.

Cultural competence, as the prevailing approach to diversity, emphasises suspending one's own values to facilitate those of clients. This demand may be inappropriate for minority therapists who may face prejudice and discrimination. In contrast, cultural humility and critical reflexivity emphasise negotiating values in the context of social power relations, an approach that may better position occupational therapy to benefit from a diverse workforce.