Q is for Questions..

Questions I have been asked since my study visit to learn about the Lifestyle Redesign® occupational therapy approach. I wanted to investigate how it could be used to improve the hospital/home interface for older people.

Q- So what is the difference between Lifestyle Redesign® and Occupational Therapy?

A- I heard several different OTs, lecturers, researchers and clinicians give their view on this during my visit- “Lifestyle Redesign® is occupational therapy!”

Q- Why the trademark?

A-   The Division of Occupational Science and Occupational Therapy at University of Southern California (USC) developed the approach. Only OTs who have completed certification at USC can use interventions called Lifestyle Redesign®. The Division wanted to protect the quality of any research (and therefore evidence base) that used an approach calling itself Lifestyle Redesign®. The methodology has been widely publicised and use of it its welcomed, however programmes need to be entitled something different e.g. the Lifestyle Matters programme developed in the UK (Craig & Mountain 2007- see books tab at top of page).

Q- But how are things like weight management groups relevant to OTs working in hospital settings? Most OTs don’t work in that sort of way?

A-   While I was on my study visit I experienced the approach being used in many different settings and with many very different client groups. This demonstrates it’s versatility and adaptability to many different areas of work. Lifestyle Redesign® is a conceptual approach that can be used to develop programmes for individuals or groups, but it is not an instruction manual. There are complex issues to be understood and incorporated into interventions.

The approach takes an occupational view of individuals functioning and emphasises the health promoting aspect of redesigning an individuals occupations in a way that is meaningful for them.

Preventative work is an area where OT has a lot to offer (see my P post yesterday) and is a key area of current UK health care policy.

Q- But we haven’t got time to do this sort of thing!

A-   This approach provides a person centred, evidence based, health promoting approach using core OT skills. If used with older people at the hospital/home interface, it has the potential to improve outcomes and reduce readmission rates, thereby reducing costs. Changing practice is always difficult, especially in fast moving acute services, but we need to consider the old question of whether we are ‘doing the job right- or doing the right job’!

N is for Nutrition...

Nutrition seemed to come into everything during my recent study visit to the University of Southern California.

As a UK based Occupational Therapist (OT), this was unexpected. I found the Lifestyle Redesign® approach being used in areas of work such as weight management where, of course the emphasis was explicit. In other areas of work, such as the group I spent a session with who had had a stroke and were working on lifestyle issues to help prevent another, it formed an important aspect of the intervention. I attended the first 8 weeks of the Masters programme course on Lifestyle Redesign® where learning about nutrition, and about the factors that drive ‘conditioned hypereating” (David Kessler 2009- see the books tab at the top of this page).

Initially I wondered if it would be more appropriate for a dietician to be involved, but I came to understand that using this approach takes an occupational view of the issue and individuals were enabled to develop strategies that allow them to develop new routines and habits in their daily lives that are health promoting and sustainable, and that is the definition of Lifestyle Redesign®.

It might be too big a step for OTs to work in exactly that model in the UK, but there is certainly scope to reflect on whether and how we should be bringing more focus onto nutrition for many of our clients. I think about some of the older people I work with who are reliant on visits from carers to provide all their meals. Time constraints mean that they are often eating ready microwave meals daily and sometimes at almost every meal. Poor nutrition has an impact on function and on quality of life. So is it an issue for OTs to address? I’d love to know what people think...

I is for Individual

 

Individualisation of the information and new insights gained during Lifestyle Redesign® programmes enables positive changes to be made in people’s lives. Some programmes are delivered individually, such as the pressure ulcer prevention studies I learned about during my study visit, others are delivered as group sessions, such as the weight management programme I followed. All are based on an overall pre-prepared programme

The skill of the therapist enables the content to be individualised in either setting. The methods used include didactic presentation of information e.g. about occupational self analysis, peer exchange (in an individual session this might take the form of discussion), direct experience or doing something- perhaps the short term goal for that week, and lastly personal exploration or reflection about the experience and it’s relevance to one’s self.

The therapists were skilled in guiding individuals through a process that incorporated all these factors, but still allowed individuals to follow the process in a way that was relevant to them. For example, in the weight management group, individuals set a short term goal each week, these were very varied, from becoming involved in the family’s grocery shopping, to walking 5000 steps each day using a pedometer, they were relevant to the overall goal and most importantly were relevant to the individual’s daily routine at that point in time. In the pressure ulcer prevention study, the programme was delivered individually and although the therapists aimed to deliver the prepared programme, there had to be a great del of flexibility in this due to the changing and often challenging circumstances of clients lives.

Where occupational therapists are not providing an actual pre-prepared programme, it is still possible to use many of the methods used in explicit Lifestyle Redesign® programmes for the benefit of clients, this might include using a process of occupational self analysis, or being open to including and using a more ‘narrative’ approach. Once the underlying concepts are understood, they can be brought into many situations and interventions.

Emotional Eating and Balance

The last two Weight Management group sessions have covered emotional eating and life balance.

Chantelle gave the group a choice of which they wanted to do first and emotional eating was a clear favourite. From people's reactions it obviously struck a cord.

Emotional eating- any time you eat without being physically hungry.

A couple of questionnaires were handed round and everyone spent a few minutes filling them in. This helped to get people thinking before we discussed it. One was related to eating and behaviour- a sample question:

Q- You eat dessert or leftovers, even if you feel full after a meal-

a) rarely

b) sometimes, especially when you feel like you have to for social reasons

c) most of the time, just because you like the taste

d) usually, all the time, it is a habit

Another had questions about reasons for eating- a sample question:
 Q- I munch when I get bored         Tick Frequently/Occasionally/Rarely

These were not scored but used to get a discussion started, most people were happy to share some of their answers. Several commented that how they would answer now, 6 weeks into the programme, is different to how they would have answered before starting. This helped to demonstrate the changes they are making and was a source of encouragement- so reinforcing self-efficacy.
The discussion moved on to looking at the 'pay-off' for habits. These could be irrational rewards- telling yourself 'I deserve this', there could be social acceptance 'pay offs'- eating for social reasons or concern for what others might think; there are many other examples. The group worked individually on identifying a few of their own reasons for eating and the 'pay off', then we began looking at what other occupations or other non-food related activities could serve these 'pay offs'. For example, one group member reported eating to relax in the evening and planned to watch a DVD instead (without the popcorn!). This is an exercise that can be carried on and thought about over time.

The Balance session led on from this. We began the session by colouring in our own Balance Wheel- a simplified version of the one above- we included:

• Productivity
• Rest
• Play
• Self-Care

 

The results were discussed and people looked at which activities they felt they needed more or less of. Next we considered what activities and times of day we associate with eating. What times are easiest to make healthy choices and when are we most vulnerable to poor eating habits? We looked at the resources, whether financial, time, control or more personal resources such as physical or psychological aspects that can help or hinder the process of changing routines to incorporate health promoting activities.

The topics covered aim to help and support the group members in being able to look realistically and in depth at their usual routine and occupational choices and to make habit changes that will allow them to succeed in their goal to lose weight. Once again, this is part of the process of developing a sense of self-efficacy, one of the key outcomes of all Lifestyle Redesign programmes and essential to sustained success.