Promoting the implementation of occupational therapy home programmes for children with cerebral palsy based on evidence, theory and practice

Student thesis: Doctoral ThesisDoctor of Philosophy


Introduction Occupational therapists are expected to underpin and inform delivery of services and treatment with the best available evidence. However, the nature of ‘best evidence’ is much disputed, and difficulties in implementing best evidence, where it is available, are well documented. In addition, it is recognised that there are gaps in the evidence base for many therapy services delivered world-wide. Knowledge translation processes are designed to help move evidence, policy, and theory into practice to help close these gaps. A vital first step for knowledge translation interventions is to identify contextual changes required to adopt evidence, policy, and theory into practice.
Background Cerebral palsy affects a person’s whole body, to varying degrees, impacting everyday occupations. Occupational therapy home programmes (OTHPs) are important for children with cerebral palsy (CWCP) since they can increase the overall amount of therapy provided to the child, by involving family members in addition to therapists, potentially leading to better outcomes. These parent-implemented programmes, with oversight from an occupational therapist, involve individualised goal-directed interventions and the routine
application of measurement tools.
Aim In the absence of knowledge about the implementation of OTHPs, a need was identified for the creation of a body of evidence to identify how they are used within the context of evidence-based practice (EBP). The aim of this thesis is to draw together and discuss this evidence in relation to relevant theory and policy and highlight mechanisms of support needed to ensure the delivery of OTHP best practice.
Methodology The approach of subtle realism is adopted as the lens through which the analysis and discussion of the four-study collection of work is undertaken. This approach reflects the complexity of knowledge and of occupational therapy, within the realities of home programme delivery. Study designs include a cross-sectional survey, practice analysis, critical review, and qualitative interviews.
Findings The use and content of evidence-based OTHPs vary. Gaps in the evidence relate to standards of goal setting, evaluation, and uptake of effective interventions within a familycentred framework. Implementation barriers relate to lack of EBP knowledge, opportunity, and motivational processes. Support mechanisms include, use of profession-specific theories, mentorship, and collaborative partnership working between higher education and practice settings.
Conclusion This thesis provides a novel understanding of the factors influencing the delivery of OTHPs for CWCP. Change is warranted to value and implement EBP, capture outcomes, improve goal-setting and use occupational therapy theories to both enhance family-centred care and articulate the profession’s unique contribution.
Date of AwardAug 2022
Original languageEnglish
Awarding Institution
  • Coventry University

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