I know Journal Clubs get a bad rap. They can be time-consuming to prepare for. They can be overwhelming or boring if the facilitator doesn’t get the balance just right. And you can leave not having a clear idea of how you can actually use that information to improve your practice.

But the Your OT Tutor Journal Club (a.k.a. YOTT JC) tries to address these barriers, and so far, the feedback has been great. Attendees are having loads of ‘a-ha’ moments and leaving with practical, actionable strategies they can use in their practice every day to feel confident that they are delivering their services in an evidence-based way.

Here are just some of the clinical pearls that YOTT JC members have learnt from attending the sessions or watching the recordings.

If you’d like to find out more yourself, jump to the info page here, or keep reading and find out more at the end.

1. How can we provide effective client education? – From “The OT role in Pressure Care management”

Guidelines recommend the importance of facilitating a self-management approach – as most clients at risk of pressure injuries have chronic conditions and will be at risk long-term, it is very important that they are shown how to self-manage their pressure injury risk (appropriate to their ability). It’s important to evaluate the effectiveness of education provided; don’t just keep telling the client information – ask them questions and get them to show/tell you what they know so you can instead focus on filling in the gaps in their knowledge.

2. Should you prescribe AT for people with FND? – From “OT role with Functional Neurological Disorder”

This was often one of the most challenging decisions for OTs! Many were still prescribing AT but overall felt unsure if they were doing the right thing, due to potential adverse outcomes (e.g. becoming dependent on AT, slowing potential recovery). We should avoid AT where possible, especially in the early stages of the diagnosis, and investigate all other options first. Carefully consider the pros and cons of equipment prescription, undertake risk assessments and explore mitigation strategies other than AT, aim to wean use if possible if it is prescribed, and don’t provide AT “just in case”, only when it is needed.

3. Effective ways to address pain in MS – From “Working with people with Multiple Sclerosis”

OTs should undertake a comprehensive, holistic assessment for people with MS who report pain. When there is no simple modifiable cause (e.g. adjusting pressure cushion or bed position), consider referrals to specialised pain clinics for a comprehensive multidisciplinary approach. New research is also exploring the benefits of addressing the impact of differences in sensory integration (e.g. people with MS being under or over aroused to sensory input). Some clinicians are utilising weighted blankets, forest bathing and other mindfulness-based strategies to manage MS impairments linked to pain.

4. Should we be stopping stimming and masking? – From “Neurodiversity-affirming practice”

The approach we take needs to be reflective of the individual client’s preferences, rather than that there is a set right/wrong approach. It’s important to recognise that stimming activities serve a function and shouldn’t be eliminated, but they may be modified or replaced with alternatives or OTs may need to adapt the environment to assist clients to self-regulate. Masking and social skills training are not generally neurodiversity-affirming, but may be appropriate to support in certain circumstances, depending on the client’s goals and preferences.

5. Is any energy conservation education appropriate? – From “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome”

Ensure the content is tailored to the individual – a generic handout is unlikely to cover everything it needs to. Be wary of using resources that have been written for other diagnoses – e.g. some diagnoses may talk about energy conservation while also building someone’s capacity for more activity (e.g. cardiac rehab) but this is not the approach to use for ME/CFS. Encourage recognition of energy demands of different activities and an understanding of rest (vs watching tv etc) for accurate pacing as part of fatigue management. 

6. How can we identify older people at risk of falls? – From “Falls Prevention”

Older people may not spontaneously report falls, so they should be routinely asked during all encounters with health professionals. Rather than just asking the question “have you had any falls?” it is recommended that 3 key questions be asked: (i) Have you fallen in the past year, (ii) Do you feel unsteady when standing or walking? (iii) Do you have worries about falling? These will help open conversations to fully explore someone’s risk of falling.

7. The forgotten benefits of power seat elevation – From “Wheelchair Power Seat Elevation”

Power seat elevation increases independence through maximising functional reach, but there are other benefits. Don’t forget about things like pedestrian safety (crossing the road while elevated made it easier for drivers to see them), improving line of sight (they can see events and over distances the same way as people who are standing) and not having to be on the same level as everyone else’s bottom! Also don’t underestimate the importance of being independent with small tasks (e.g. turning on a light switch) for improving freedom in choice/timing of activities and quality of life.

8. Do clients have to be ‘tech-savvy’ to use telehealth for home assessments? – From “Telehealth Home Assessments”

It was easier to complete home assessments via telehealth when the client was tech savvy, had good internet connection, had a support person who could be present during the session, and who didn’t have any significant communication or cognitive impairments that couldn’t be overcome with AAC or assistance from a support person. But, it is not necessary for the client to be ‘tech savvy’ at all, as long as the support person who is present is and is willing to assist. It was also noted that sometimes two support people were required, as the person needed someone to provide physical assistance with their mobility, and another to manage the camera.

9. Predicting when self-directed therapy will actually work – From “Self-directed Therapy”

We need to allocate time at the start of the therapeutic relationship to establish the client’s motivation for change. We may need to use motivational interviewing to help them reach a point where they can successfully complete a self-directed program, but depending on the setting, there may not be time to do this. In these instances, we may need to be accept that self-directed programs won’t work, and explore other ways for clients to achieve their goals.

10. Use PEO elements to consider all the factors impacting sleep – From “The OT role in Sleep Management”

When people experience difficulty with sleep, it is rarely one thing causing the issue; using a model like the PEO can help ensure a range of factors have been considered and addressed. Environmental changes could be adding air conditioning, lighting changes, or the use of white noise.  Person factors to address could be referring for a GP review to consider whether medication regimes are optimally managing symptoms like muscle spasms and incontinence. Occupation factors include exploring the impact and timing of exercise and naps for optimising sleep.

11. Home automation gives more than dollar savings – From “The value of Home Automation”

While home automation has proven cost-saving benefits (and we should be crunching the numbers and giving actual figures in our applications), we shouldn’t forget to highlight the subjective benefits too. This includes reduced reliance on carers, increased independence, improved wellbeing, increased social connections, physical safety, psychological safety, increased dignity and improved energy and comfort.

12. Do ‘brain-training’ games work? – From “Cognitive Rehabilitation”

When exploring the benefits of cognitive skills training (e.g. brain training games) for people with TBI, they will be most beneficial when their use is strategy-focused and conducted by a TBI-experienced therapist who can facilitate the transfer of skills across to functional activities. There is no strong evidence that these sorts of activities are effective for improving memory when used in isolation.

13. How can non-driver trained OTs help with driving? – From “Chronic pain and driving”

Driver-trained OTs can assist someone to drive through prescribing assistive technology and modifications like spinner knobs and hand/feet control adjustments, and they can also teach driving skills in a graded way that accommodates the person’s disability-specific needs. But remember even non-driver trained OTs can help with the basics, such as addressing ergonomics (e.g. seat and steering wheel position, back supports) and planning (e.g. helping to identify the best time and routes to drive to simplify the task demands).

14. When clients don’t want the recommended AT – From “End-of-life AT prescription”

It is important to take a holistic view of the situation and consider all the different factors that could be impacting their decision to not use equipment. Use models to consider the client’s motivation, roles and relationships, as often the social dynamic with the carer and issues of dependency were deciding factors. Also consider where the person is at psychologically – have they accepted their prognosis or are they seeing equipment as a reminder of something they are not ready for yet.

15. How can we quantify ‘Value for Money?’ – From “Value for money in Home Modifications”

There are three approaches to take; these are discussing the costs related to formal care, informal care, and ‘cheapest options’ as the metrics. The most common (and usually successful) approach is when cost savings in other areas of the client’s funding plan can be demonstrated. For example, if a bathroom modification meant that a funded support worker no longer needed to be present for showering, the cost savings of this per year were compared to the cost of the bathroom modifications.

16. Every OT can make an impact – From “Working with people with Long COVID”

Even if you’re not an expert in Long COVID, using common OT approaches and interventions can still make an impact. Start with goal setting and prioritisation of which functional difficulties to address first, as high fatigue levels are significant barriers to progressing therapy (e.g. can only work on one difficulty at a time). While we are building our evidence-base for working with this population, draw on existing evidence related to energy conservation, sleep hygiene, equipment/AT prescription, cognitive strategies, relaxation/breathing techniques, and more.

17. Create a psychologically safe space to ensure success – From “OT student clinical placements”

To increase the chances an OT student will do well on their clinical placement, we need to provide a psychologically safe space where students feel they are able to ‘have a go’ and make mistakes. Providing opportunities for peer learning and ensuring we don’t give ‘surprise’ negative feedback in formal evaluations (we should be discussing this throughout informal check-ins) is also important.

18. Becoming a YOTT JC member is worth it! – From our members

OK, well this technically isn’t a clinical pearl, but it was still an ‘a-ha’ moment for many of our members. Many had attended Journal Club sessions before, but never found them that beneficial. But YOTT JC is different – I streamline the prep and focus on how we can translate the research evidence into everyday practice so you can use your new knowledge straight away.

Here are a couple of quotes from our members:

“Amazing, well prepared, materials made life easy to be able to listen and absorb information - well summarised.”

“Thank you Clare. I always learn a lot from these journal club sessions.”

“I found the journal club session a motivating and interesting way to keep up with the latest evidence...”

“I have recommended that my workplace get on it! Thank you Clare - makes a journal review palatable....”

So are you curious enough to give it a go yourself? Find out more here: https://yott.au/journalclub

Or jump to my YouTube channel and get a sneak peek at how it all works.

P.S. If you’re looking for more OT CPD but want something more than a Journal Club, go and check out my other membership options - the Your OT Tutor Alliance or Your OT Tutor Connector CPD memberships. You’ll learn practical tips on core OT knowledge and skills that will help you become a better OT who loves what you do.

If you found this newsletter helpful, make sure you subscribe and ring the bell on my profile so you’ll be notified whenever I put up a new post. Also check out the Your OT Tutor website and subscribe to the mailing list or sign-up for the Learning Library – there are heaps of resources, courses, and CPD opportunities, with more being added regularly.

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