little schoolhouse

Lorimer Moseley throws the gauntlet down!


This week I’ve been at the NOI Conference 2012 – a real blast! A week of neuroscience-backed biopsychosocial practice, and nerdy passions. My brain is nourished, in fact, it’s replete. And now to digest.

Why the headline?

Well, throughout the conference, over and over again I heard about physiotherapy and psychology – and nary a murmer about occupational therapy’s contribution (from the profession’s inception) to the biopsychosocial model of practice.  It’s like the profession simply does not exist.

One very brave young occupational therapist voiced her concern that there is a disconnect between the occupational therapy profession and the consciousness of other clinicians.  In a profession that has always worked from a biopsychosocial model, how is it that there is so little mention of it in a conference where this is at the heart of an enormous change in practice? Lorimer Moseley’s response was to say that occupational therapists must research more and publish in non-occupational therapy journals.  I have to agree.

I know there will be a chorus of “yes but…” from people, and I recognise the challenges.  As a profession we struggle with our epistemological and ontological orientation because we argue that our interventions are so tailored to individual needs that we can’t measure their outcomes.  That every individual has unique needs so we can’t measure outcomes empirically. And after all, individuals say they like and need what we offer.  We can’t do large-scale research because we don’t get research funding, or we’re clinicians not researchers, or if we do a good research study we can’t publish because major journals won’t accept our publications – all yes but’s!

Before I get torn limb from limb, I haven’t published – yet. And as a clinician I know how difficult it can be to pull a research proposal together, particularly without good support from health administrators.  I know this – and yet, Lorimer has a very good point.

Occupational therapists need to become far more visible but the way to do this is not by claiming “oh but we do X” – or Y or Z.

The profession simply must begin collaborating with people who have leverage – like Lorimer Moseley and his collaborators.

The profession must begin to critically appraise what it does, how it does it, and then begin to do therapy better.

The profession needs to train both clinicians and researchers and clinician-researchers.  A scientist-practitioner model is not out of the question – in fact, I think it must happen or the little respect we are afforded will be lost, and the profession will be absorbed into other disciplines.

What are the interesting hypotheses that need to be explored in occupational therapy practice? How can we contribute to the greater awareness of the “person-in-context” that other professions have right now? How can we answer our own questions about whether we are effective, or simply “nice people” who help others through nonspecific effects rather than specific occupational therapy?

These, and other curious questions, must be explored and publicised.

As Dr Fiona Wood said at NOI 2012 – Blinkers off, game on!

For more info on NOI 2012 – go here for 80 pages of transcript via Twitter. A powerful medium.

10 comments

  1. Well said, Bronnie – thanks for your relentless passion and enthusiasm for occupational therapy in the 21st century!! Your blog is an inspiration.

    1. Thanks so much Dene! I’m not entirely supportive of the profession – time to get our gloves off and ask some hard questions about how much the profession really wants to be taken seriously. All I know is, what I heard at NOI 2012 was much of what I learned to do waaaaay back in the early 1980’s as an undergraduate occupational therapy student. It’s like a novelty to other professions, and THEY WANT IT! Let’s make sure we lead.

  2. Yes, thank you Bronnie.

    It was a tad scary that there was no mention of OT input in the NOIgroup workshop I attended… or for that matter are there any OTs as part of the NOIgroup team? I just can’t believe how any profession could beat us to this sort of quality biopsychosocial research! Should be a wake-up call for OT world I think!

    It’s great to know there are OTs out there like you. Really gives me hope for the future of our profession – there are plenty of inspiring OTs out there, maybe they just need inspiration? A push in the right direction.

    Bronnie If we can’t question our own profession’s direction… Who will?

    1. Thanks so much for your kind words – if the profession has people like you coming up through the ranks, it will be moving in the right direction too! I don’t believe there are any occupational therapists in the NOI team, partly because it is so physiotherapy focused. And it does strike me as sad that physiotherapists want to learn all this biopsychosocial stuff as if they have to do it all themselves. I thoroughly support all clinicians becoming aware of, and skilled in, the biopsychosocial model – but at the same time, it’s good to know that there are others who specialize in working this way, and translating clinic-based treatments into what a person with pain needs to do in his or her own world. I see this era as an opportunity for people with pain to get the help they need to live well, and think its now a case of occupational therapy to step up and show leadership. As a profession, we are inclined to whine from the sidelines about how other people are taking our role so now it’s time to consider novel research paradigms and make Gordon the promise of our philosophical roots.
      **steps off soapbox so someone else can take over for a minute**

  3. HI Bronnie

    I think there is actually an OT attached to the NOI group, Laura von Bertouch, doing her PhD in pain research at the moment. although she didnt seem to be at the conference.

    I came away from the NOI conference with conflicting thoughts. Initially I had been soooo frustrated re lack of awareness of OT contribution to pain manamgement and what we have to offer. Mind you, I have thought that for the last 25 years. But in the end I thought that maybe if it is all part of other health professions moving towards a direction that we have always embraced, then maybe we should all be merging to become functional therapists, as certainly the brain science is informing us that the traditional hands on physio approach won’t work.

    And now after a few days reflection I am thinking that OT clincians in pain managment need to be talking more to researchers and educators to get some joint research projects going. Bronnie I like your question about what are the interesting hypotheses in occupational therapy that need to be explored? I think we could start with the basics, like whether the areas traditionally explored by OT’s in clinical practise in pain management make a difference. Does pacing really make a difference? Do graded actvity programs work? Does home based education differ from office based? Maybe we need to do some trans Tasman research.

    Just some ideas. By the way, great to meet you and some really great OT’s at NOI conference, even if we were in a minority.

  4. Actually, getting a tv show to include an OT in its cast of characters. What would Private Practice be like if there were a social worker, an OT, a PT a nurse midwife etc. in its cast? And who do we know who knows someone who knows someone who … knows a writer for one of the shows we’d like to include us?

    Publishing? What about an article about an OT as a parent or a strong female role model or someone who has created a new program being chosen?

    or Who would like to write a children’s series set on an island where a kid is the main character but there’s an OT who saves her life and teaches her important strategies?

    Where is there room to portray any of us that gets the word out to the people who will insist that they get to see us? How can we educate others and influence from the ground up?

    Where are there places in the telecast of the Olympics this summer that would highlight the work of the OTs who are likely in major places of renewal and rehabilitation for some of the world’s finest athletes?

    We have lots of power; it just is hard to use when everyone works so hard every day at their jobs. But some of this could be fun and not hard, social – as in the who do you know game!

    1. Wouldn’t that be awesome? I think it’s going to happen over time, but as a profession, occupational therapy has to be more confident in how it presents itself, and be more public in where it publishes. Allied health professions suffer from a profile problem, not an identity problem – and profile is about saying, publishing, quantifying and demonstrating what we do.

  5. As an infrequent visitor to the site I would like to say that this thread could be a bunch of Osteopaths talking. And I thought this when in attendance at the NOI conference. We have also worked with a biopsyhcosocial approach due to our guiding principles. We have also sat by not contributing to research, too scared to question our own profession. We might have some great aspects but a lot of what we do is useles and the explanations even worse! It seems such a big mountain to climb and I wonder if merging and creating an effective manual therapy for the patient isnt a more productive use of our time. Goodness me, I’ll be chucked out of the profession any minute!

    I left the conference almost in a state of despair but have turned it around by trying to become a better clinician patient by patient. It certainly won’t help the big picture for Osteopaths though.

    Thanks for all your wonderful work Bronnie. Kind Regards, Angie

    1. Thanks to you Angie! Yes, it’s a common feature of many professions – navel gazing and weeping, wailing and gnashing of teeth! But I agree also that working patient by patient to improve clinical skills is a great approach rather than get stuck in despair. And it’s those incremental steps that will do so much to improve the profile and expectations of the profession too. It might not be quick, but it’s thorough and do-able!

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