Virtual communities of practice for novice occupational therapists: a vehicle for learning, support and professional identity strengthening?

INTRODUCTION

Healthcare practitioners delivering services in rural and underserved areas need timely access to appropriate knowledge to optimise the care they deliver. Novice generalist occupational therapists in South Africa experience this need as they respond to a high demand for hand therapy. Embedded within a study aimed at identifying their support and development needs, this article describes participants' experience of a virtual community of practice.

METHODS

A qualitative case study design was employed. Nine occupational therapists participated in a virtual community of practice that met fortnightly for meetings and interacted on WhatsApp. Data were collected through photo elicitation, facilitated reflection, and case discussions. An online survey questionnaire was used to evaluate participants' experience of this virtual community. Thematic analysis was applied to the anonymous responses submitted by participants (n=7). A number of strategies were employed to ensure the trustworthiness of results including prolonged engagement, member checking, peer examination, reflexive reading and writing, triangulation, and a dense description of participants to enable readers to evaluate the transferability of results.

RESULTS

Three themes were generated from analysis. The first theme, versatile support, describes participants' experience of being helped and supported, appreciating the immediacy of support, and being able to share resources. A vehicle for learning captures participants' experience of mutual learning, opportunity to reflect, to acquire knowledge and skills, and develop their clinical reasoning. Finally, the community of practice was grounding: learning opportunities were contextually relevant and participants were able to consolidate their professional values and identity. Participants raised the importance of using online platforms that were accessible, recommended a group size of 5-10 members, and proposed 60-90-minute meetings held weekly or fortnightly.

CONCLUSION

A virtual community of practice provided both support and professional development opportunities for therapists delivering hand therapy. Careful planning and implementation to upscale this intervention are recommended for rehabilitation personnel delivering care to underserved communities in South Africa. The logistics of virtual communities need to mitigate for connectivity difficulties, and online platforms should enable real-time support. Participant satisfaction and the evaluation of implementation outcomes should be considered in the design of virtual communities of practice.

Medical device regulation: requirements for occupational therapists in The Netherlands who prescribe and manufacture custom-made devices

PURPOSE

To interpret the Medical Device Regulation for occupational therapists in the Netherlands involved in prescribing and manufacturing custom-made assistive devices and to develop a roadmap for implementation.

MATERIALS AND METHODS

Four online iterative co-design workshops were organized under supervision of a senior quality manager to assist in the interpretation of the MDR framework with a focus on custom-made assistive devices; and to assist the implementation by generating guidelines and forms. The workshops for seven participating occupational therapists had an interactive character with Q&A, small and homework assignments, and oral evaluations. Next to occupational therapists, participants with different backgrounds joined such as 3D printing experts, engineers, managers, and researchers.

RESULTS

The participants experienced the interpretation of the MDR as informative, but also as complex. Complying with the MDR requires considerable documentation activities that are currently not part of care professionals tasks. This initially raised concerns regarding implementation in daily practice. To facilitate the MDR implementation, forms were created and evaluated for a selected design case together with the participants for future reference. Additionally, instructions were given which forms should be filled out only once per organization, which forms could be reused for similar types of custom-made devices, and which forms should be filled out for each individual custom-made device.

CONCLUSIONS

This study provides practical guidelines and forms to support occupational therapists in the Netherlands to prescribe and manufacture custom-made medical devices complying with the MDR. It is recommended to involve engineers and/or quality managers in this process.

Pediatric Occupational Therapists' Perspectives on Sleep: A Qualitative Descriptive Study

IMPORTANCE

Insufficient sleep is common among children seeking occupational therapy services but is rarely a focus of therapy despite sleep's critical impact on health.

OBJECTIVE

To examine pediatric occupational therapists' experiences, views, and confidence in addressing sleep concerns in their practice as well as barriers to and supports for doing so.

DESIGN

A qualitative descriptive study with thematic analysis of data from 1-hr virtual interviews. Rapport building, multiple-coder analysis, and member checking were used to ensure reliability and validity.

SETTING

Interviews were conducted remotely at each participant's preferred time and location.

PARTICIPANTS

Pediatric occupational therapists (N = 20) practicing across multiple settings in the United States were recruited through emails directed to their place of work and social media posts. A goal of 20 participants was set a priori with the goal of thematic saturation.

OUTCOMES AND MEASURES

A semistructured interview guide.

RESULTS

Participants were predominately cisgender (95%), female (85%), and White, non-Hispanic (90%). Overall, they voiced the importance of sleep but reported almost never writing sleep-related goals. Reported barriers that affected the participants' ability to fully address sleep in practice included therapists' lack of confidence and knowledge and low caregiver buy-in.

CONCLUSIONS AND RELEVANCE

The findings identify themes on the basis of which actionable steps toward promoting occupational therapists as sleep champions can be developed. Future implications include increasing sleep education opportunities, enhancing awareness of sleep health's impact on goal areas, and facilitating discussions about occupational therapy's role within the medical system and family system in supporting sleep. Plain-Language Summary: This qualitative study identifies what helps and hinders occupational therapists in addressing the sleep health concerns of their clients. We give occupational therapy clinicians and educators key supports to seek out or barriers to address.

Spatial Neglect: An Exploration of Clinical Assessment Behaviour in Stroke Rehabilitation

OBJECTIVE

There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area.

DESIGN

Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment.

SETTING

Online stroke rehabilitation educational bootcamp.

PARTICIPANTS

A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp.

INTERVENTION

Prior to their focus group, participants watched an hour-long educational session about spatial neglect.

MAIN MEASURES

A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area.

RESULTS

Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools.

CONCLUSIONS

Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice.

A Profile of Occupational Therapists Working in School-Based Practice in Australian Primary Schools

Inclusive education has increased the demand for school-based occupational therapy services and has reconceptualised the practice in mainstream schools. Therapists are now expected to work collaboratively with teachers within tiered intervention models to support access and participation of all students, including those with disabilities, within the natural classroom context. School-based occupational therapy has become a specialised area of practice, as therapists work within educational, rather than health, systems and processes. While the growth in demand and expanded scope of practice is positive for the profession, predicted workforce shortages and the necessity for specialised and enhanced practice present significant challenges. The ability of the profession to fully support the demands of an inclusive education system remains unclear. As accurate, up-to-date information on the school-based therapy workforce is the foundation for planning future personnel needs, knowledge of the current state of the workforce is critical. There is a paucity of national data regarding this growing area of practice. The aim of this study is to describe a current profile of school-based occupational therapists to better understand the workforce, practice patterns, and the funding landscape in Australia. A convenient and purposive sample of 108 Australian paediatric occupational therapists working in mainstream primary schools in New South Wales, Queensland, and Victoria was surveyed in this quantitative study, which was analysed using descriptive statistics. Results provide some insights into the workforce and practice of school-based therapy in Australia offering preliminary data for future planning in this important and growing area of paediatric practice. While specific to the local context, results invite cross-national and global comparison to reveal universal trends and localised nuances across diverse settings.

Current clinical practice patterns and perspectives of Australian hand therapists during the treatment of adults with distal radius fracture: A national survey

INTRODUCTION

Successful return to pre-injury occupational performance following distal radius fracture (DRF) may be influenced by person and environment factors such as pain, age, social support, and socioeconomic status. The primary aim of this study was to explore Australian hand therapists' current clinical practice and determine whether they consider these factors during the management of DRF.

METHODS

A mixed methods online survey was distributed to members of the Australian Hand Therapy Association. Descriptive statistics were used to examine the quantitative data, and the qualitative data were analysed by content analysis.

RESULTS

Of the 120 members who completed the survey, 68% were occupational therapists and 32% were physiotherapists with 74% in the private and 26% in the public health-care setting. Most factors perceived to influence recovery were consistent with person factors and a biomechanical approach. Other factors related to occupational performance, such as social and leisure skills, environment and culture were reported less often. When asked about defining occupational performance, the key categories identified through qualitative open responses were 'performing meaningful activities/occupations', 'performing work/employment', and 'completing activities/function'.

CONCLUSION

The data suggest that hand therapists in Australia primarily identify person factors as key to recovery after DRF. Context and environmental factors that influence occupational performance did not appear to be considered as often during treatment or when defining occupational performance. Further research is needed to explore the contextual and environmental factors that influence hand therapy intervention and determine whether they play a role in the successful return to pre-injury occupational performance following DRF.

CONSUMER AND COMMUNITY INVOLVEMENT

The survey was conceptualised by the research team, which included two experienced hand therapists and piloted with 10 consumers. Hand therapists (consumers) of various years of experience and discipline (i.e., occupational therapy and physiotherapy) provided feedback to improve the survey in terms of content, comprehensibility, and length. No clients/patients of hand therapists were involved in the development of the survey or the study, and the consumers of the study were considered hand therapists.

The impact of mobility scooter on occupational participation among older adults in Singapore: an exploratory study

PURPOSE

With an ageing population, the use of mobility scooters by community-dwelling older adults with mobility limitations has been increasingly prevalent in Singapore. Their experiences in using mobility scooters remain unclear. This study aimed to explore the impact of mobility scooters on occupational performance and engagement among elderly Singaporeans.

MATERIALS AND METHODS

Mobility scooter users were recruited via purposive and snowballing sampling. Semi-structured interviews were conducted in English or Mandarin via phone call or face-to-face and audio-recorded with permission. Interviews were transcribed verbatim in their original language and translated to English (when applicable) for thematic analysis.

RESULTS

Twelve eligible participants (mean age: 75 years) completed the interviews. They were predominantly female Chinese with 7 receiving training from occupational therapists (OT). Four main themes emerged from the interviews describing their experiences of using mobility scooters: factors of decision-making in getting a mobility scooter, enhanced occupational participation with the use of the mobility scooter, enablers for community participation and barriers to community participation. Despite having barriers, older adults with mobility limitations generally still had positive experiences to continue using mobility scooters to perform occupations in the community.

CONCLUSIONS

This study highlights the benefits of mobility scooters in supporting users' occupational performance and engagement in the community. Continual efforts are required from all stakeholders to provide an accessible environment and improve societal attitudes to further support the mobility scooter users.IMPLICATIONS FOR REHABILITATIONMobility scooter users can be deterred from performing their preferred occupations if they had a prior negative encounter and they mainly rely on self-developed coping strategies to overcome possible barriers in the community.Occupational therapists should identify and address the potential barriers when prescribing mobility scooters to older adult users.Occupational therapists should work collaboratively with other key stakeholders, such as external vendors and government agencies, to co-create a universal guideline to support and safeguard mobility scooter users.

Factors influencing implementation of assistive technology services for older adults from the perspectives of Thai occupational therapists: a mixed methods study

PURPOSE

Occupational therapists are crucial in providing assistive technology (AT) services for older adults. However, evidence has shown limited provision of such services in Thailand. This study aimed to investigate the factors that influence the implementation of AT services for older adults from the perspectives of Thai occupational therapists.

METHODS

An explanatory sequential mixed-methods design was guided by the measurement instrument for determinants of innovations and literature review. This study was conducted in two phases: quantitative and qualitative. During the quantitative phase, an adapted version of the Measurement Instrument for Determinants of Innovations was administered to 96 occupational therapists (OTs). A subsample of 5 OTs completed a semi-structured interview during the qualitative phase to explain the findings in the quantitative one.

RESULTS

Factors were categorized into three sections: personal, organizational and socio-political context levels. At the personal level, integrating knowledge and experience could contribute to awareness and professional competency. Client satisfaction influenced OTs to utilize AT, based on a client centred manner. With coordinator and performance feedback within the organization, OTs indicated that consultants supported them in their decision-making. In contrast, availability of AT for older adults is determined by time and resources. Moreover, at the socio-political context level, legislation and regulations may permit or prohibit accessibility of assistive devices.

CONCLUSION

In order to address current challenges, education or training programmes are needed to increase the awareness and competence of OTs. In addition, collaboration with other professionals in community settings is necessary to improve access to AT services.IMPLICATIONS FOR REHABILITATIONAT service for older adults is limited by the availability of time and resources. To handle with these challenges, occupational therapists could advocate for village health volunteers to be a part of the AT services for older adults in the community to increase AT accessibility for older adults.Additional education or training programs should be developed to build competencies and increase occupational therapists' awareness of providing AT services to older adults, as well as to strengthen their roles in AT services.Future research and health policies should focus on access to sufficient funding, and resources for occupational therapists relative to their role in implementing AT services.

Inclusivity in Occupational Participation: Life Stories of Bangladeshi With Spinal Cord Injury

This research aimed to describe the process of occupational participation among persons with spinal cord injury (SCI) discharged from the only SCI rehabilitation hospital in Bangladesh. We analyzed seven participants' interview transcripts and observations using the trajectory equifinality model. Study participants demonstrated the following occupational participation trajectories: (a) employing a strategy or difficulty in occupational participation; (b) performing solidarity or experiencing deprivation; (c) creating identity or divergence; and (d) being included in or excluded from everyday life. There are four pathways: (I) discouraging conditions that minimized daily performance; (II) reinforcing obligatory connections to optimization of daily performance; (III) reciprocity to facilitate social activities; and (IV) manipulating mastery in occupational participation. Occupational therapists can consider the trajectory phases and pathways of occupational participation when facilitating the inclusion of service users after discharge from the hospital.

"It Doesn't Die Within You": Outdoor Recreation Participation Following Spinal Cord Injury

Although some people with spinal cord injury (SCI) return to outdoor recreation, many have low activity levels and encounter significant environmental barriers. The purpose of the study was to describe how people with SCI engage in outdoor recreation activities, what meaning they attribute to these, and to inform occupational therapists in promoting outdoor recreation post-SCI. The study used qualitative, descriptive phenomenology. Thirteen participants completed semi-structured interviews, and data were analyzed using thematic analysis. Outdoor recreation contributes to personal well-being. It is a way to share life with loved ones and other disabled people. Having the right equipment and using a trial-and-error approach facilitated participation, which was sometimes supported and frequently constrained by physical, built, and information environments. Findings suggest implications for occupational therapists in the areas of direct intervention, entrepreneurship, and advocacy. These are consistent with the American Occupational Therapy Association Vision 2025 to collaborate for inclusion and accessibility in occupational performance.

Occupation-Based Assessments in Pediatric Occupational Therapy Practice

In pediatric occupational therapy, there is insufficient evidence examining assessment tool selection by occupational therapists and how assessment tools contribute to occupation-based practice. To examine the perceptions of occupation-based assessment tool selection by pediatric occupational therapists, a phenomenological research study was conducted with six pediatric occupational therapy practitioners. Three themes emerged from participants' perspectives: the centrality of occupation, selecting the just right tool, and practice implications. Participants recognized the need to integrate occupation-based assessments into practice but reported decreased opportunities secondary to training, available supplies, lack of awareness of foundational constructs, and organizational expectations. The use of occupation-based assessments positively enhances pediatric occupational therapists' clinical practice by upholding the core occupational beliefs of the profession throughout all phases of service delivery.

Occupational Justice: Staff Member's Understanding of the Role of Occupational Therapy within Organizations Serving Persons Experiencing Homelessness

The purpose of this descriptive study was to explore the understanding of occupational justice and occupational therapy's role among staff members working within organizations serving persons experiencing homelessness. A survey was developed to determine if staff (N = 43) understood what occupational therapists can do to help persons experiencing homelessness. Responses were split almost equally between agree/strongly agree and disagree/strongly disagree. Most or 95% (n = 38) of respondents stated their organization would be interested in increasing programming to support the ideas of occupational justice. This suggests that occupational therapy can fill a need in these organizations to promote occupational justice.

An international study of diversity in occupational therapy research- A bibliographic review of English research literature

BACKGROUND

The cornerstone of a strong profession is the research that supports its knowledge base and practice. However, little is known about the range of international occupational therapy research.

OBJECTIVE

To explore the range and diversity of the international occupational therapy research from published peer reviewed literature in English during the year 2018.

METHODOLOGY

Limited to 2018, a review was conducted of sources from i) health-related search engines using search terms associated with occupational therapy practice, and ii) content pages of occupational therapy publications. Articles were excluded if they i) had no occupational therapy author, ii) were not peer reviewed, iii) not in English, and iv) did not include primary data collection (e.g., opinion pieces, position statements, study protocols). Of articles selected for analysis, data were extracted and synthesized according to the study's origin country, publishing research journal, the characteristics of the represented research, and its alignment with World Federation of Occupational Therapists research priorities.

RESULTS

A total of 4,169 articles were retrieved from the search (i.e., 3,459 from health-related search engines and 710 through a manual search of occupational therapy journals). After exclusions, 2,345 articles were included for analysis.

CONCLUSION

The review identified English published research was predominantly conducted in economically privileged countries. In addition, it revealed several research priorities that need further development such as evaluating the effectiveness of occupational therapy interventions.

Assistive products to support daily time management of older persons with dementia in India: experiences and views of informal caregivers and occupational therapists

PURPOSE

The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs).

METHODS

The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed.

RESULTS

Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education).

CONCLUSIONS

The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Implications for rehabilitationAdoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders.Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India.It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products.Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions.

Occupational Therapy Observation Tool-Adjustment Support Details for autistic children: Investigation of content validity and clinical utility

INTRODUCTION

Standardised testing is crucial for autistic children to receive appropriate interventions, necessary services, and funding. Behaviours associated with autism can hinder children's test performance and participation. The 18-item, two-page Occupational Therapy Observation Tool-Adjustment Support Details (OTOT-ASD) is used in conjunction with standardised assessments. The OTOT-ASD enables the recording of autism-related behaviours and the reasonable assessment accommodations made to support participation in testing. The current study aims to investigate the content validity and clinical utility of the OTOT-ASD from occupational therapists' perspectives.

METHOD

A specifically designed online questionnaire was distributed Victoria-wide to occupational therapists with clinical experience with autistic children. The questionnaire was designed in line with the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN), including relevance, comprehensiveness, and comprehensibility of items evaluated for content validity. Applicability and clinical usefulness were also investigated. Quantitative data were analysed using descriptive statistics.

RESULTS

Seventy-one occupational therapists responded to the questionnaire and 46 provided a full dataset. Over 96% of the respondents considered documenting behaviours and testing accommodations as important, yet less than 45% reported having resources to record this information. Ninety-five percent of the respondents perceived the OTOT-ASD to be useful in clinical practice. Over 70% agreed that OTOT-ASD items were significantly relevant to practice and comprehensive. To improve comprehensibility, identified items were altered following feedback.

CONCLUSION

The findings suggest that the OTOT-ASD is clinically useful and content validity is sound. Further research on other psychometric properties of the OTOT-ASD and users' qualitative experiences in utilising the tool is recommended.

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy

INTRODUCTION

Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice.

METHODS

Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis.

FINDINGS

Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'.

CONCLUSION

Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

BACKGROUND

Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited.

OBJECTIVES

We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists.

METHODS

Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests.

RESULTS

79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention.

CONCLUSIONS

HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.

Bridging gaps in the design and implementation of socially assistive technologies for dementia care: the role of occupational therapy

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.Implications for rehabilitationDevelopers and designers of socially assistive technology should consider the disease trajectory of different types of dementia, as well as the different needs, abilities, preferences, occupations and routines of people living with dementia (PLWD) and/or their caregivers.Collaborations between technology developers, researchers, and occupational therapists should take place iteratively throughout the process of designing and implementing socially assistive technology to maximise their relevance and applicability for people living with dementia and their caregivers.To continue enhancing the current role of occupational therapy in socially assistive technology provision, occupational therapists should keep up to date with socially assistive technology that are being developed to support the social health of PLWD.

Developing Client Self-Advocacy in Occupational Therapy: Are We Practicing What We Preach?

Background

Developing client self-advocacy is in occupational therapy's (OT) scope of practice; however, there is limited understanding of if, or how, occupational therapists learn about self-advocacy interventions as well as implement self-advocacy into clinical practice.

Objective

This study sought to identify if and how therapists learn about self-advocacy intervention approaches and identify if and how therapists implement self-advocacy into their work with clients.

Method

A survey was distributed via email to academic and professional listservs in the United States, and data were collected using REDCap survey software. Descriptive statistics were analyzed data using REDCap/SPSS. Comparative statistics, Kruskal-Wallis's tests, Chi-square tests for independence, and Pearson's correlation tests analyzed differences across groups of respondents.

Results

Practicing and licensed occupational therapists (n = 138) across the United States completed the survey. Findings indicate a majority (59.5%) of occupational therapists not learning strategies for addressing or developing client self-advocacy. Of significance, 21.7% of participants had never been exposed to concepts of client self-advocacy in academic or clinical education. Practitioners who did address self-advocacy did so indirectly through teaching-related skills (76.6%).

Conclusion

Many clients of OT will need self-advocacy skills in order to address issues of exclusion and discrimination that prohibit full participation in society. Occupational therapists must prioritize incorporating client self-advocacy into curricula and clinical practice.

Knowledge Gaps Regarding Indigenous Health in Occupational Therapy: A National Survey

Background. There is a need for the occupational therapy profession to respond to the Truth and Reconciliation Commission of Canada Calls to Action and work towards supporting the health and well-being of Indigenous Peoples. Purpose. (1) To determine the knowledge gaps of occupational therapists about Indigenous health and (2) to create recommendations to address identified gaps and inform responses from the profession. Method. A national needs survey was created and distributed to occupational therapists across Canada to determine the knowledge of occupational therapists about Indigenous health. Survey results were analyzed using thematic analysis and descriptive statistics. Findings. Data collected from 364 survey responses informed six distinct themes representing knowledge gaps of occupational therapists related to Indigenous health as follows: lack of foundational knowledge, power relations, lifelong learner, need for appropriate tools/approaches, respectful collaboration, and environmental influences. Implications. The project offers insight into the role of the occupational therapy profession in the process of reconciliation. Insights are focused on decolonizing occupational therapy practice, building trusting relationships with Indigenous Peoples, and the provision of appropriate training for occupational therapists to engage in culturally safer practices.

Addressing Driving in Acute Care: Perceived Relevance and Competence

Background. Recent legislation has expanded the responsibilities of occupational therapists regarding fitness to drive in the Canadian province of Ontario. To date, little is known about the practice of acute care occupational therapy with addressing driving, or how such responsibilities have affected clinical practice. Purpose. The objective of this study was to understand the relevance of driving-related knowledge areas to acute care occupational therapists and examine their self-reported competency for these areas. Method. Anonymous online surveys were administered to 41 occupational therapists working in acute care hospitals in Ontario. Findings. Therapists reported many driving-related knowledge areas are relevant to acute care practice yet consistently reported lower levels of competence for addressing such areas. Implications. Findings support the need for further competency development regarding driving-related practice in acute care. Occupational therapy curriculum and continuing education initiatives are avenues for capacity-building. Future research to identify effective competency development strategies is warranted.

Exploring Therapeutic Relationships in Pediatric Occupational Therapy: A Meta-Ethnography

Background. Developing strong therapeutic relationships with families is a crucial aspect of pediatric occupational therapy. However, building such relationships is complex as they involve multiple directions of interaction. Purpose. To provide a thorough interpretation of children's, caregivers', and occupational therapists' experience of the therapeutic relationship. Method. A meta-ethnography was realized to synthesize qualitative studies. A systematic search was carried out using five databases from 2005 to 2022. The CAPS checklist was used to appraise included studies' quality. The analysis was completed using a constant comparison of findings. Findings. Three themes emerged from the 14 studies synthesized. The first theme illustrates that the therapeutic relationship can have different meanings depending on the perspective of children, caregivers, or occupational therapists. The second theme explores the components impacting the experience of the relationship. These include the power dynamics, the communication, and respect for diversity. Finally, the third theme illustrates how the relationship can empower positive change. Implications. Children, caregivers, and occupational therapists each have a perspective that ought to be heard. Occupational therapists should actively ask for children's and caregivers' perspectives to encourage power sharing and effective communication. By doing so, occupational therapists can strengthen the therapeutic relationship, which, in turn, promotes positive change.

Implementing Telehealth Among Occupational Therapists Working in the Health Care System: A Survey on the Current Practice and Experiences

Background: Occupational therapy services implemented via telehealth (Tele-OT) have declined since COVID-19, despite their well-known benefits. This study aimed to (1) compare the demographic and the clinical characteristics, attitudes, perceived usability, self-efficacy toward Tele-OT, and the factors affecting technology use for occupational therapists with and without Tele-OT experience; (2) describe the current practice and examine the factors associated with Tele-OT implementation; and (3) better understand the barriers and facilitators for implementing Tele-OT. Methods: An online survey invited ocupational therapists working in the health care system. The following measures were used: the Technical affinity-attitude (TA-EG) measured attitudes toward Tele-OT, the System Usability Scale measured perceived Tele-OT usability, and the Unified Theory of Acceptance and Use of Technology measured factors related to Tele-OT use and self-efficacy. An open-ended question requested ocupational therapists to describe one Tele-OT session. Results: We included 309 occupational therapists (mean [SD] age = 39.1 [9.9]): 181 with and 128 without Tele-OT experience. The groups significantly (p < 0.001) differed in age and years of OT experience. No between-group differences were found regarding attitudes, perspectives, and self-efficacy for Tele-OT. Occupational therapists used video platforms, apps, and phones to conduct the Tele-OT sessions. Descriptions of the Tele-OT sessions were qualitatively sorted into "perceived experience" (i.e., satisfaction and challenges) and "factors related to Tele-OT implementation" (e.g., infrastructure and technology). Conclusions: Occupational therapists with and without Tele-OT experience have similar attitudes and self-efficacy regarding Tele-OT. Thus, Tele-OT implementation may be affected by other personal and environmental factors. Health care organizations can possibly use these findings to promote Tele-OT and bridge the implementation gap.

Accommodating Students with Disabilities: Fieldwork Educators' Experiences

Background. Fieldwork is an essential part of experiential learning in occupational therapy education. Fieldwork educators identify limits on reasonable accommodation and difficulty implementing disability-related accommodations. Student occupational therapists with disabilities report discrimination from within the profession, including inflexible fieldwork environments. Purpose. To understand the experiences of occupational therapy fieldwork educators in Canada in accommodating students with disabilities and to develop action-oriented practice recommendations. Method. In this interpretive description study, we interviewed 11 fieldwork educators about their experiences accommodating students with disabilities. Interviews were recorded, transcribed, and analyzed using a constant comparative approach. Findings. Educators emphasized a meta-theme of "Learning" when asked about disability-related accommodations. Three subthemes about student learning emerged: 1. Educators focused on "Student Learning in Preparation for Professional Practice" rather than their fieldwork setting only; 2. Educators were "Using Occupational Therapy Skills for Student Learning" in fieldwork; and 3. Educators recognized that their professional and personal "Context Influences Student Learning." Conclusion. Fieldwork educators can work with students to align their accommodations with required learning outcomes for professional practice and use their occupational therapy skills to assist with implementation. Fieldwork educators require time and other supports to work effectively with all students.

Understanding Occupational Therapists' Knowledge and Confidence When Assessing for Spatial Neglect: A Special Issue Review

IMPORTANCE

Spatial neglect (SN)-failure to respond to stimuli on the side of the body contralateral to a poststroke lesion-is one of the most disabling impairments for stroke survivors, and 80% of stroke survivors may have undetected SN. Occupational therapists' evaluations should include determining the impact of poststroke SN.

OBJECTIVE

To investigate occupational therapists' confidence, knowledge, current practices, barriers, and facilitators when assessing for SN in adult stroke survivors.

DESIGN

A 30-item survey was created with guidance from stroke rehabilitation occupational therapists who reviewed the survey for face and content validity.

SETTING

Online survey.

PARTICIPANTS

Occupational therapist survey responders (N = 76).

OUTCOMES AND MEASURES

Self-report assessments were used to measure occupational therapists' confidence in identifying SN, SN assessment practices, and barriers to and facilitators of SN assessment. Knowledge of SN signs and symptoms, neuroanatomy, and clinical presentation were measured with a three-question quiz.

RESULTS

Eighty-one percent of the respondents reported a high level of confidence in identifying SN, and 70% reported routinely assessing for SN, with 81% using clinical observation rather than standardized tools as the primary assessment method. Barriers to SN assessment included time and resources.

CONCLUSIONS AND RELEVANCE

Most respondents, despite reporting high levels of confidence with routine SN assessments, did not use standardized SN measures and demonstrated suboptimal knowledge of SN. These results emphasize the need to increase clinical education about SN and its assessments. Plain-Language Summary: This study gathered baseline information on an underinvestigated topic-occupational therapists' education, confidence, current practices, barriers, and facilitators when assessing for spatial neglect in adult stroke survivors. The study results also contribute to future research on occupational therapists' current confidence and knowledge when assessing for spatial neglect.