Charmi Shah

Books render knowledge and good reads inspire as well as create professionals. Call it a curiosity thing, I want to know which OT book is your favourite or inspired you in choosing your current OT path. I request you to please spare some time and drop your favourite OT book's or an OT related book's name ,no matter which area of OT it represents.

Facilitator for the Month | Charmi Shah, Mumbai, India (Community Forum Lead) The following article is an open access article, published in BMC- Psychiatry Journal in 2017. Link to the complete article at the end of the post. The Article is level Ib of the level of evidence AIM and Issues addressed by the article- What is the research question/ aim and objective of the article? The study aim was to evaluate the effectiveness of the 16-week Balancing Everyday Life (BEL) program, compared to care as usual (CAU), for people with mental illness in specialized and community-based psychiatric services. Why does it matter? How it fits to what already is know? Interventions that address everyday life in general, and that are aimed at assisting people with mental illness in shaping a satisfying and balanced lifestyle, are less well developed. Such interventions have shown to be effective for other target groups, however, such as the Lifestyle Redesign™ to prevent ill-health among independently living older people and the Redesigning Daily Occupations (ReDO)™ for people with stress related disorders. The Balancing Everyday Life (BEL) program, which was based on the same principles, was developed for people using specialized and community-based psychiatric services. The BEL program has a strong focus on accomplishing activity balance for the participants, defined as having a satisfying amount of and variation between activities Design of the study- It is RCT study based on cluster randomization Study methods- All settings in both specialized psychiatry (outpatient units within general psychiatry and psychosis care) and community-based psychiatry (activity-based day centers) in three regions in southern and western Sweden were invited to enter the project Inclusion of settings admitting patients with a broad spectrum of disorders, such as psychoses, mood disorders and neuropsychiatric disorders. In settings that agreed to participate, a gatekeeper (an occupational therapist employed at the unit) identified clients according to the following criteria: a) self-reported imbalance between everyday activities (assessed in an interview with the gatekeeper), b) age of 18–65 years, c) substance abuse not the main diagnosis (according to team conference), d) no comorbidity of dementia or developmental disorder (according to team conference) and e) sufficient command of Swedish to participate in the data collection (assessed in an interview with the gatekeeper). A total of 226 participants entered the study; 133 from BEL settings and 93 from comparison settings. Intervention - 1. BEL is a group-based program (5–8 participants) consisting of 12 sessions, one session a week, and 2 booster sessions with two-week intervals. The themes for the group sessions are, e.g., activity balance, meaning and motivation, healthy living, work-related activities, leisure and relaxation, and social activities. Each session contains a brief educational section, a main group activity and a home assignment to be completed between sessions. The main group activity starts with analyzing the past and (foremost) the present situation and proceeds with identifying desired activity goals and finding strategies for how to reach them. This mapping and planning step is followed by a home assignment that means performing the desired activity in a real-life context. The home assignment is aimed at testing one of the proposed strategies. During the next group meeting, the real-life experience is evaluated and group members discuss and give each other feedback. 2. The CAU occupational therapy sometimes included some form of group intervention, addressing for example daily living skills, social skills or creative activities, while some occupational therapists offered individual therapy only. Primary outcomes- The Swedish self-rating version of the Profiles of Occupational Engagement among people with Severe mental illness (POES), the Swedish version of Satisfaction with Daily Occupations and Occupational Balance (SDO-OB), Occupational Value with predefined items (OValpd), Swedish version Secondary outcomes- Manchester Short Assessment of Quality of Life (MANSA), Rosenberg self-esteem scale, first item of the MOS SF-36 , Global Assessment of Functioning (GAF) scale The participants responded to the questionnaires at the start of the BEL intervention, and after 16 weeks of intervention (including the booster sessions) the measurements were repeated. A follow-up was then made after another six months. The same data collection (instruments and procedures) was made at corresponding time points with the participants who received CAU Main findings Results- The BEL group improved more than the CAU group from baseline to 16 weeks on primary outcomes in terms of activity engagement (p < 0.001), activity level (p = 0.036) and activity balance (p < 0.042). The BEL group also improved more on the secondary outcomes of symptom severity (p < 0.018) and level of functioning (p < 0.046) from baseline to 16 weeks, but not on well-being. The group differences on activity engagement (p = 0.001) and activity level (p = 0.007) remained at the follow-up. The BEL group also improved their well-being (quality of life) more than the CAU group from baseline to the follow-up (p = 0.049). Implications- 1.The impact of care context, together with other potentially influential factors such as psychotropic medication, diagnosis, sex and socio-demographic factors, were to be investigated in their forthcoming study to see if these factors play a role for the possibility for benefitting from the BEL intervention. 2.The care context might influence the outcome of the BEL intervention, which could be another possible implication. Limitations - 1. The exact participation rate couldn’t be calculated, however, due to use of gatekeepers and dissatisfactory administrative routines with respect to registration of non-participants. This is a limitation of this study and weakens its external validity. 2. The design did also not allow for blinding. Conclusion- The BEL program was effective compared to CAU in terms of activity engagement. The BEL appeared to be important in shortening the time required for participants to develop their engagement in activity and in attaining improved quality of life in a follow-up perspective. Generalizability- Not mentioned in the article Facilitator’s Comments – The BEL program although was developed for community based psychiatric services. It still holds implications on other areas of occupational therapy where group interventions are given for developing activity engagements or quality of life and also where holistic approach to treatment is used such as in palliative Care centers or residential homes for seniors. However, the details about the intervention has been superficially mentioned in the article. Hence it becomes less likely to use it for clinical or future research purpose. The article is now open for discussion. Don’t forget to share your thoughts and views on it in the comment section below. Link for full article - https://doi.org/10.1186/s12888-017-1524-7 Reminder- The discussion will be open for 3 weeks and summary would be posted at the end of the month. If you wish to facilitate for any particular month get in touch with The OT Hub Team or simply place a comment below.

Online journal clubs in medical field have been active for quite some time now (medicine, radiology and nursing to name a few). However, only a couple of regional online Occupational therapy journal clubs have been active. We at The OT hub with the privilege of having a global community , are pleased to introduce an Open Access Online Journal Club . For those who don’t know what a Journal club is or how it functions, here is a short description about it. The WHAT, HOW and WHY A traditional journal club is a group of individuals who meet regularly to discuss critically the clinical applicability of articles in current medical journals . They were usually facilitated by a leader who selects a relevant article, prepares some learning points for discussions ahead of the meeting and guided face to face discussions with the participants There is an over hundred years of unrecorded history for journal clubs in medical education. With a history of over a century, Journal clubs have acted as a powerful education tool. Traditional journal clubs evolved in healthcare to encourage scholarly activity and research awareness through reading and discussion of journal articles. Traditional Journal clubs however face challenges of scheduling participants and facilitators, recruiting local experts and having a limited local impact. As Occupational therapist or perhaps this applies to any healthcare professionals, we are faced with the problem of keeping abreast with the rapidly enlarging volume of contemporary medical literature. With the advent of modern digital technologies, online education and learning is proving a boon for us as we are constantly pressed against time. Also not to forget, the need of the hour for our profession right know is incorporating Evidence Based Practices. Research has proven that Journal clubs are an effective method for improving the evidence based practice knowledge and skills. HOW ARE WE GOING TO DO IT An open access article will be selected once every two months. The topic and article would be of the host's/facilitator's choice, details about the reviewed article will be posted in the Journal club section of our community forum’s page. The club will then be open for discussions , learning and participation. If you are interested in becoming a facilitator,reviewing an article and leading discussions in the club feel free to contact us. Also if you wish for us for include your research papers/articles in the club. Send us a link /pdf ( It should be an open access article if published in any journals). Or simply leave a comment below and we will get back to you. Stay tuned and Namaste for now. Charmi Shah Community forum lead from Mumbai ,India The OT Hub team