The role of occupational
therapists in reablement
services: a realist synthesis
Lisa Dibsdall
Today..
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Overview of my realist synthesis
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Definitions
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Mapping the territory
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Literature search strategy
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Identifying context mechanism outcome
configurations
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Second search of the literature
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Findings and conclusions
Reflections on the process
Where I’m coming from
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PhD Student – part time
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An occupational therapist
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Interested in my topic
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Self funded
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New to realist approaches
Starting point
Reablement
➢‘services for people
with poor physical or
mental health to help
them accommodate
their illness by learning
or re-learning the skills
necessary for daily living’
➢Developed following
government focus on
personalisation and
preventative services
Occupational
Therapists
➢Support people to
complete the occupations
that are important to them
➢Educated in how physical
and psychological
disabilities affect
engagement in
occupations.
➢Trained in rehabilitation
techniques
Reablement and Occupational Therapists
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No blueprint for the delivery of
reablement services
Service embedded in a complex social
system
Little research on occupational
therapists in reablement services.
How occupational therapists work in
reablement and what influences their
effectiveness
‘what works for whom in what
circumstances and why?’
Mapping the territory

Who are my stakeholders?
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Using experts in the field

Professional networks

Publications from College of
Occupational Therapists
Identifying possible programme theories
Identifying possible programme theories
Research Question
How do configurations of occupational therapy
practice in reablement and their underlying
mechanisms influence best outcomes for service
users and reablement teams?
Initial literature search
 Terms for reablement
 enablement, restorative care,
rehabilitation
 Terms for adult social care
 147,000 results
 Searched for adult social care and
occupational therap*
 Exclusion criteria - iterative process
Identifying contexts
mechanisms and outcomes
 Screened 2297 articles
 appraised full text of 190 articles
 Individual appraisal sheets
context mechanism outcome configurations
If...then statements
 If occupational therapists are available for
informal and formal supervision and training
of support workers [context] and support
workers have confidence in the ethos of
reablement [mechanism] and are open to
changes in their practice [mechanism] then
support workers are effective enablers
[outcome]
If...then statements
 If service users have quick access to
occupational therapists to assess for and
provide equipment and/or adaptations
[context] and service users accept using
equipment or adaptations [mechanism] then
service users are able to complete daily living
tasks more easily [outcome] and quality of life
improves [outcome]
Second review of the literature
 Search for evidence of theory.
 Broadened search out from reablement
 Focus on occupational therapists working
with service users in the community
 Training support workers
 Provision of equipment and adaptations
 Goal setting
Second review of the literature
- another table
Training and supervision of
support workers
 Need for a change in culture from ‘doing to’ a
person
 Staff retraining is ‘crucial’ particularly for those
from traditional home care settings.
 Greater training and supervision leads to
increased job satisfaction
 Occupational therapists have knowledge and
experience to train support workers.
 Occupational therapists currently have a greater
role in informal training and support leading to
increased skills for support workers.
Provision of equipment and adaptations
 Provision of equipment and adaptations can
increase independence for service users and
prevent or delay admission to care homes.
 Equipment is acceptable to most people and
still used over a period of time
 Quick access to an occupational therapist is
more important that having an occupational
therapist within the team
 Delayed access to occupational therapists leads
to bed dependency and prevents new service
users joining the reablement service.
 Delays in provision of equipment is frustrating
for service users.
Goal setting and
reablement planning
 Occupational therapists complete assessments,
identify goals and write reablement plans with
service users.
 Occupational therapists assert that their
knowledge of medical conditions enables them
to take more risk in designing reablement plans
 Some managers assert that occupational
therapists can work with a medical model
approach and be risk averse.
Conclusions
 Some evidence to confirm and refute the
programme theories of the conceptual
framework
 Few studies contain significant information on
the role of occupational therapists in
reablement services.
 Few occupational therapists were participants
in studies of reablement services.
 Need for further research on the occupational
therapists working in reablement services from
the perspective of occupational therapists, their
managers and reablement support workers.
My Research
 Multiple case study design
 Three Local Authorities
 Observation of occupational therapists
 Interviews with occupational therapists and
managers.
 Focus groups with support workers.
Reflections
 New terminology
 Realist synthesis helped to identify contexts,
mechanisms and outcomes relevant to my topic.
 This information has guided my case study
research.
 Director of studies has not used realist approaches.
 It is an iterative process to be presented in a linear
format for my thesis
 Benefit from connection with RAMESES network.