Nicholson Clare, Francis Jill, Nielsen Glenn, Lorencatto Fabiana
Department of Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
Faculty of Medicine Dentistry and Health Science, Clinical Epidemiology Program, University of Melbourne, Ottawa Hospital Research Institute, Melbourne, Australia.
Br J Occup Ther. 2022 Apr;85(4):262-273. doi: 10.1177/03080226211020658. Epub 2021 May 27.
Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom.
Community-based neurological occupational therapists ( = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach.
Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists' dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations.
Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings.
职业治疗师在功能性神经障碍患者的治疗中发挥着不可或缺的作用，但有证据表明，在社区环境中职业治疗的实施情况存在差异。本研究探讨了在英国为功能性神经障碍患者提供社区职业治疗的障碍和促进因素。
邀请10名有功能性神经障碍治疗经验的社区神经职业治疗师完成半结构化定性访谈。访谈提纲和分析基于理论领域框架，这是一种用于调查临床实践障碍和促进因素的行为科学工具。采用内容分析与框架分析相结合的方法对数据进行分析。
治疗的重要障碍包括指导实践的已发表信息有限、专业角色不明确以及多学科团队协作受限。促进因素包括职业治疗师在身心健康方面的双重培训以及对活动参与的关注。不同地理位置的服务提供、质量和可及性各不相同。
职业治疗师在帮助功能性神经障碍患者方面具有独特优势；然而，研究结果表明，英国许多地区现有的社区服务结构不完善，限制了所能提供的治疗质量。需要额外的资源来支持社区环境中的职业治疗服务提供。
