The clinical challenges experienced by new graduate occupational therapists: A matrix review

BACKGROUND.

The transition from student to new graduate occupational therapist is recognized as stressful. Current literature has not specifically drawn together the challenges new graduates face when learning to work with clients.

PURPOSE.

This review aimed to synthesize common challenges that new graduate occupational therapists face when working with clients.

METHODS.

Searches of online scholarly databases located research articles. Content related to working with clients in practice was charted using the Matrix Method.

FINDINGS.

From 21 articles, four categories of challenges were identified: "reasoning and decision-making," "using knowledge and skills in practice with clients," "the context of service provision," and "managing caseload and priorities." "Having self-doubt" was a theme that pervaded the data.

IMPLICATIONS.

New graduates often do not feel fully prepared for all aspects of occupational therapy practice. As they may not have access to substantial workplace support, exploring personal resources and professional support may assist this challenging transition.

Occupational Therapy Services in School-Based Practice: A Pediatric Occupational Therapy Perspective from Ireland

PURPOSE

School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development.

METHODS

This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics.

RESULTS

The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice.

Does therapy always need touch? A cross-sectional study among Switzerland-based occupational therapists and midwives regarding their experience with health care at a distance during the COVID-19 pandemic in spring 2020

BACKGROUND

The COVID-19 pandemic impedes therapy and care activities. Tele-health, i.e., the provision of health care at a distance (HCD), is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD for occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1.

HYPOTHESIS

Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2.

HYPOTHESIS

Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD.

METHODS

In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD, and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified.

RESULTS

The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs (n = 431) and midwives (n = 501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age only had a significant influence on the use of videotelephony, SMS, and chat services. OTs experienced HCD significantly more positively than midwives (log odds = 1.3; p ≤ .01). Video-telephony (log odds = 1.1; p ≤ .01) and use of phone (log odds = 0.8; p = .01) were positive predictors for positive experience, while use of SMS (log odds = - 0.33; p = .02) was a negative predictor. Among OTs, 67.5% experienced HCD as positive or mostly positive, while 27.0% experienced it as negative or mostly negative. Among midwives, 39.5% experienced it as positive or mostly positive, while 57.5% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%).

CONCLUSIONS

HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.

What is Professionalism in Occupational Therapy? A Concept Analysis: Qu'est-ce que le professionnalisme en ergothérapie? Analyse de ce concept

BACKGROUND.

Professionalism has been given different definitions over time. These are, commonly theoretical and difficult to operationalize.

PURPOSE.

This study aimed to provide an operational definition of the concept of professionalism in occupational therapy.

METHOD.

Based on a concept analysis design, a meta-narrative review was conducted to extract information from 30 occupational therapy manuscripts.

FINDINGS.

Professionalism is a complex competence defined by the manifestation of distinct attitudes and behaviours that support excellence in the occupational therapy practice. In addition, professionalism is forged and evolves according to personal and environmental characteristics. The manifestation of professionalism can lead to positive consequences for occupational therapists, clients, and the discipline, notably contributing to a positive and strong professional identity. Moreover, professionalism is also subject to cultural influences, which leads to variations in its development, manifestations, and consequences.

IMPLICATIONS.

This study offers a contemporary operational definition of professionalism and levers to promote its development and maintenance.

Acting as Change Agents: Insight Into Québec Occupational Therapists' Current Practice: Actions menées à titre d'agents de changement : aperçu des pratiques actuelles parmi les ergothérapeutes du Québec

BACKGROUND.

Change agents' actions have been studied mainly from a theoretical perspective.

PURPOSE.

This study aimed to empirically identify occupational therapists' actual change agent actions.

METHOD.

As part of a research partnership with the Canadian Association of Occupational Therapists-Québec chapter, we conducted this cross-sectional pilot study using an online survey.

FINDINGS.

The change agent practices of our 103 participants involve many types of actions but show underinvestment in mass communication. Mass communication actions are more frequent when participants have greater experience, additional academic degrees, and training in change agency. Also, occupational therapists with additional academic degrees and change agency training tend to use a wider variety of actions. Finally, our participants' actions principally target actors in the clinical context, rarely political actors.

IMPLICATIONS.

Our results suggest that occupational therapists can and will invest in the full range of change agent actions provided they can acquire the necessary knowledge and skills.

Goal setting practices of occupational therapists in spinal cord injury rehabilitation in Gauteng, South Africa

INTRODUCTION

Client-centered goal setting has multiple benefits in spinal rehabilitation. However, research has shown that many occupational therapists struggle to facilitate client-centered goal setting. South Africa presents unique challenges to client-centered goal setting, but no data is available on how it is applied.

STUDY DESIGN

A qualitative research design following an appreciative inquiry stance was used.

OBJECTIVE

To explore how occupational therapists implement and envision the goal setting practices in spinal rehabilitation.

SETTING

Rehabilitation facilities in Gauteng, South Africa.

METHODS

A focus group consisting of five occupational therapists working within spinal rehabilitation was held. An appreciative inquiry stance was used to determine current successes and future ideas on how to implement goal setting in a spinal rehabilitation setting.

RESULTS

Data was analysed thematically using Braun and Clark. Themes were developed under each phase of appreciative inquiry. Discovery phase: Participants felt that current effective goal setting is therapist-directed and that client insight facilitates effective goal setting. Dream phase: Participants agreed that client-centered goal setting is the ideal. In addition, effective collaboration within the team and adequate resources were identified during the dream phase as ideals to effective goal setting practices. Design and Destination phase: Participants generated ideas on how to improve on team collaboration during goal setting and how to ensure goal setting is client-centered for effective goal setting in spinal rehabilitation to take place.

CONCLUSIONS

The study emphasizes that for effective goal setting to occur, the process must remain client-centered. Essential to this process is collaboration between both the team and family members. Adequate resources and a low therapist-patient ratio supports effective goal setting.

Role Perception and Professional Identity of Occupational Therapists Working in Education Systems: Perception du rôle et identité professionnelle des ergothérapeutes qui travaillent dans les systèmes scolaires

BACKGROUND.

Occupational therapists, especially those in education systems, are challenged to define their professional roles and identities.

PURPOSE.

This research evaluated the Role-Perception Questionnaire for Occupational Therapists in the Education System's (RP-OT) psychometric properties, the Professional Identity Scale (PIS) internal consistency among occupational therapists, and relationships among role perception, professional identity, and demographic characteristics.

METHOD.

A sample of 147 occupational therapists in education systems completed the RP-OT and PIS. We conducted exploratory factor analysis and calculated Cronbach alpha to evaluate the RP-OT and PIS psychometric properties. Relationships were examined using Pearson correlation.

FINDINGS.

The RP-OT was found reliable and valid, with medium-to-strong correlations among role perception, professional identity, and demographics. Teamwork in the education system was the major predictor (82%) of professional identity.

IMPLICATIONS.

Teamwork is part of the professional role of occupational therapists in the education system and a significant component for developing their positive professional-identity perception.

Healthy ageing and occupational therapy in South Asian countries: a scoping review protocol

INTRODUCTION

The increasing population of older adults is one of the most significant challenges faced by various countries across the world. South Asian region is accommodating almost a quarter of the world's population, with nearly 6% of them being >65 years of age. There is a lack of awareness regarding the role of occupational therapists in community settings, the assessments and interventions used by occupational therapists to facilitate healthy ageing among community-dwelling older adults. This scoping review is planned to systematically identify the literature from the last two decades, related to various assessments and interventions provided by occupational therapists to promote healthy ageing among older adults in South Asia.

METHODS

This scoping review will be based on the methodological framework given by Arksey and O'Malley and Levac et al. and will include data from January 2000 onwards. The following databases will be included in the search-SCOPUS, MEDLINE (PubMed), Web of Science, CINAHL, EBSCO, Clinical key, Wiley Online, ProQuest and Cochrane library. Screening of titles and abstracts and full texts will be carried out by two reviewers independently in consultation with the third reviewer. Both quantitative and qualitative data will be analysed separately to identify the assessments carried out, interventions provided and factors that influence healthy ageing among community-dwelling older adults aged ≥60 years in South Asia. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be used for collating and reporting the results.

ETHICS AND DISSEMINATION

As this scoping review uses data from already available literature, it does not require ethics approval. Results will summarise and present the existing literature related to healthy ageing among community-dwelling older adults. We plan to disseminate the results through a peer-reviewed journal, targeting occupational therapists, other rehabilitation workers and researchers from South Asia.

Exploring physiotherapists' and occupational therapists' perceptions of the upper limb prediction algorithm PREP2 after stroke in a rehabilitation setting: a qualitative study

OBJECTIVE

To explore how physiotherapists (PTs) and occupational therapists (OTs) perceive upper limb (UL) prediction algorithms in a stroke rehabilitation setting and identify potential barriers to and facilitators of their implementation.

DESIGN

This was a qualitative study.

SETTING

The study took place at a neurorehabilitation centre.

PARTICIPANTS

Three to six PTs and OTs.

METHODS

We conducted four focus group interviews in order to explore therapists' perceptions of UL prediction algorithms, in particular the Predict Recovery Potential algorithm (PREP2). The Consolidated Framework for advancing Implementation Research was used to develop the interview guide. Data were analysed using a thematic content analysis. Meaning units were identified and subthemes formed. Information gained from all interviews was synthesised, and four main themes emerged.

RESULTS

The four main themes were current practice, perceived benefits, barriers and preconditions for implementation. The participants knew of UL prediction algorithms. However, only a few had a profound knowledge and few were using the Shoulder Abduction Finger Extension test, a core component of the PREP2 algorithm, in their current practice. PREP2 was considered a potentially helpful tool when planning treatment and setting goals. A main barrier was concern about the accuracy of the algorithm. Furthermore, participants dreaded potential dilemmas arising from having to confront the patients with their prognosis. Preconditions for implementation included tailoring the implementation to a specific unit, sufficient time for acquiring new skills and an organisation supporting implementation.

CONCLUSION

In the present study, experienced neurological therapists were sceptical towards prediction algorithms due to the lack of precision of the algorithms and concerns about ethical dilemmas. However, the PREP2 algorithm was regarded as potentially useful.

The Influencing Factors of Gender Differences on Mental Burdens in Young Physiotherapists and Occupational Therapist

Background: Gender differences in personal discrimination experience, burnout, and job stress among physiotherapists and occupational therapists are considered as associated factors of job loss, poor job quality, high turnover, and economic losses due to the outflow of medical personnel. Thus, the purpose of this study is to analyze the level of burnout, personal discrimination experience, and job stress according to gender differences for young physiotherapists and occupational therapists. Furthermore, we used regression analyses to determine the contribution of gender differences in personal discrimination experience and job stress to self-reported burnout, considering gender and two age groups (younger than 30 years old vs. 30 years old and over). Methods: A total of 325 professional physiotherapists and occupational therapists were part of this study (n = 325; male n = 131; female n = 194. Age: 20–29 years old, n = 178; ≥30 years old, n = 147). Data were collected using a questionnaire including our three study variables (scales: the Maslach Burnout Inventory (MBI), a modified version of the gender section of the Medical School Graduation Questionnaire from the Association of American Medical Colleges; and the Korean version of the Job Content Questionnaire (JCQ)). Further, data on socio-demographic factors, job-related factors, health-related factors, and subjective job satisfaction were also collected. Results: There were significant positive correlations between job stress and gender differences in personal discrimination experience and job stress and burnout in women 30 years old and over. Personal experience of gender discrimination (β = 0.179, p = 0.015) and job stress (β = 0.162, p = 0.028) explained a significant 42.4% of the variance in burnout in the case of younger female participants (20–29 years old). However, this model did not explain a significant amount of the variance in burnout in the case of younger male participants (R² = 0.156, p = 0.072). Regarding participants aged 30 years and over, our results showed that only job stress (but no personal experience of gender discrimination) was a relevant predictor for both males (β = 0.471, p < 0.001) and females (β = 0.373, p = 0.001). Conclusion: In this study, female therapists showed higher levels of burnout than male therapists. In particular, personal discrimination experience and job stress significantly contributed to burnout in younger female therapists while job stress was the most relevant predictor variable of burnout for both males (under 30 years old and 30 years old and over) and females in their thirties and beyond. For young female physiotherapists and occupational therapists, safe working environments should be created to reduce work-related mental burdens. It is also necessary to consider policies and regulations that can prevent job stress for therapists and measures that can positively resolve the unavoidable job stress.

Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation

Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.

A preliminary study to identify data needs for improving fit of hand and wrist orthosis using verbal protocol analysis

The delayed delivery, poor fitting and discomfort of customised orthoses are reported in rehabilitation clinics as resulting in more invasive interventions. The current practice of orthosis customisation relies heavily upon the experience and fabrication processes of therapists. In order to better understand the current practice, and thus identify data that is required for better comfort moving towards a data-driven customisation, this article describes a study generating working models of therapists. Customisations of hand and wrist orthoses for 18 patients were observed. Verbal protocol analysis was employed to extend the current understanding of fabrication processes. Working models of four therapists were established with quantitative evaluation on major phases, interactive activities and iterations of performing tasks during fabrication, revealing different working models between in- and out-patient departments (e.g. fabrication for in-patients was more complex and focussed on ergonomic fitting whereas fabrication for out-patients paid attention to durability) which were qualitatively explained. Practitioner summary: Fit and comfort are imperative for orthosis design and fabrication, however the current practice of customisation of an orthosis relies upon the experience of individual hand therapist. The article presents working models of hand therapists, and relevant data that would enable customisation of orthosis for better fit. Abbreviations: VPA: verbal protocol analysis; h&w: hand and wrist; LTT: low temperature thermoplastic; ANOVA: analysis of variance.

Mapping the occupational therapy workforce research worldwide: Study protocol for a scoping review

BACKGROUND

Human Resources for Health (HRH) research informs the development of evidence-based, population-centered HRH policies and practices. Occupational therapists are key human resources for meeting the health, rehabilitation, and occupational needs of the population worldwide. Yet, the global status of the occupational therapy workforce research remains unchartered.

OBJECTIVES

This study protocol depicts the methods to map out and synthesize the occupational therapy workforce research worldwide.

METHODS

Six scientific-literature databases and key international institutional websites will be systematically searched, complemented by snowballing searches and recommendations from key global, regional, or national representatives of the World Federation of Occupational Therapists. Two independent reviewers will screen titles-and-abstracts and then full-texts against the eligibility criteria, e.g., 10 categories of workforce research. Educational research, non-empirical papers, and papers (or their summaries) not available in English, Spanish or Portuguese are excluded. Data extraction (e.g., methods, geographies, aims, key findings) will be conducted by one author and fully verified by another. The extracted data will be computed as well as subject to content analysis to provide quantitative map of the literature and of the contents addressed, e.g., per inclusion category.

CONCLUSION

The results of this review can inform wide consultation processes and strategic, concerted local and global developments of the occupational therapy workforce.

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older

OBJECTIVE

To establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.

METHODS

Points to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated.

RESULTS

Two overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6.

CONCLUSION

These first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.

2020 EULAR points to consider for the prevention, screening, assessment and management of non-adherence to treatment in people with rheumatic and musculoskeletal diseases for use in clinical practice

BACKGROUND

Non-adherence to treatment could preclude reaching an optimal outcome. Thirty to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to the agreed treatment.

OBJECTIVES

The objective was to establish points to consider (PtCs) for the prevention, screening, assessment and management of non-adherence to (non-)pharmacological treatments in people with RMDs.

METHODS

An EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included healthcare providers (HCPs), comprising rheumatologists, nurses, pharmacists, psychologists, physiotherapists, occupational therapists and patient-representatives from 12 European countries. A review of systematic reviews was conducted in advance to support the TF in formulating the PtCs. The level of agreement among the TF was established by anonymous online voting.

RESULTS

Four overarching principles and nine PtCs were formulated. The PtCs reflect the phases of action on non-adherence. HCPs should assess and discuss adherence with patients on a regular basis and support patients to treatment adherence. As adherence is an agreed behaviour, the treatment has to be tailored to the patients' needs. The level of agreement ranged from 9.5 to 9.9 out of 10.

CONCLUSIONS

These PtCs can help HCPs to support people with RMDs to be more adherent to the agreed treatment plan. The basic scheme being prevent non-adherence by bonding with the patient and building trust, overcoming structural barriers, assessing in a blame-free environment and tailoring the solution to the problem.

Maximizing Telerehabilitation for Patients With Visual Loss After Stroke: Interview and Focus Group Study With Stroke Survivors, Carers, and Occupational Therapists

BACKGROUND

Visual field defects are a common consequence of stroke, and compensatory eye movement strategies have been identified as the most promising rehabilitation option. There has been a move toward compensatory telerehabilitation options, such as the Durham Reading and Exploration (DREX) training app, which significantly improves visual exploration, reading, and self-reported quality of life.

OBJECTIVE

This study details an iterative process of liaising with stroke survivors, carers, and health care professionals to identify barriers and facilitators to using rehabilitation tools, as well as elements of good practice in telerehabilitation, with a focus on how the DREX package can be maximized.

METHODS

Survey data from 75 stroke survivors informed 12 semistructured engagement activities (7 focus groups and 5 interviews) with 32 stroke survivors, 10 carers, and 24 occupational therapists.

RESULTS

Thematic analysis identified key themes within the data. Themes identified problems associated with poststroke health care from both patients' and occupational therapists' perspectives that need to be addressed to improve uptake of this rehabilitation tool and telerehabilitation options generally. This included identifying additional materials or assistance that were required to boost the impact of training packages. The acute rehabilitation setting was an identified barrier, and perceptions of technology were considered a barrier by some but a facilitator by others. In addition, 4 key features of telerehabilitation were identified: additional materials, the importance of goal setting, repetition, and feedback.

CONCLUSIONS

The data were used to try to overcome some barriers to the DREX training and are further discussed as considerations for telerehabilitation in general moving forward.

Home-modification interventions addressing falls and participation in activities of daily living among older adults: a scoping review protocol

INTRODUCTION

Falls are the second leading reason for incidental or unexpected deaths worldwide. Many older adults who fall, regardless of whether they are injured or not, tend to experience fear of fall and this can lead to decreased participation in activities of daily living (ADLs). Subsequent falls lead to weakness, a decline in physical functioning, increased chances of falling and a negative impact on the instrumental ADLs. Here, we present our scoping review protocol to appraise the literature to describe and explain the home-modification interventions used by occupational therapists to address falls and participation in ADLs among community-dwelling older adults. We are aiming to review the available home-modification intervention protocols, facilitators and barriers to such interventions, and the experiences of occupational therapists and clients after receiving these interventions.

METHODS AND ANALYSIS

This scoping review protocol follows existing guidelines for scoping reviews with a particular attention on Arksey and O'Malley (2005) and Colquhoun et al (2014). We will include the following databases: Scopus, Web of Science, PubMed, ProQuest, Cumulative Index to Nursing and Allied Health Literature and Google Scholar. We plan to conduct the literature search from August 16, 2020 to September 15, 2020. Two reviewers will independently screen eligible studies for inclusion. We will extract the bibliographic data, study design, details of the intervention provided, outcomes and experiences of occupational therapists and clients, and further organise them for better understanding.

ETHICS AND DISSEMINATION

As secondary data analysis, this scoping review does not require ethics approval. Results will summarise and disseminate the existing literature related to home-modification interventions provided by occupational therapists addressing falls and participation in ADLs among community-dwelling older adults. We plan to disseminate the results through peer-reviewed journals and conferences, targeting occupational therapists, other rehabilitation workers, researchers and policy makers.

Occupational Therapy in the Promotion of Health and Well-Being

A balanced pattern of occupations enhances the health and fulfills the needs of individuals, families, communities, and populations (American Occupational Therapy Association [AOTA], 2014b; Hocking, 2019; Meyer, 1922). Occupations are personalized "everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life" (World Federation of Occupational Therapists, 2012, para. 2). The purpose of this statement is to describe occupational therapy's role and contribution in the areas of health promotion and prevention for internal and external audiences. AOTA supports and promotes the involvement of occupational therapy practitioners¹ in the development and delivery of programs and services that promote health, well-being, and social participation of all people.

Musculoskeletal Complaints in Occupational Therapists Compared to the General Population: A Cross-Sectional Study in Germany

Occupational therapists (OTs) are exposed to physical factors at work, which can lead to an increased risk of musculoskeletal disorders. Most studies examining musculoskeletal complaints in OT report that the neck, shoulders, and lower back are most often afflicted. The aim of the present study was to examine the impact of work as an OT (focusing on specific work tasks) on specific musculoskeletal complaints compared to the general working population. A cross-sectional study involving a self-administered standardized questionnaire was conducted from January until October 2015 in Germany. In OT and the comparison group, the highest 12-month prevalence of musculoskeletal disorders were observed for the lower back, the neck, and the shoulders. In contrast, elevated prevalence ratios (PR) were found for OT in the thumbs (PR = 2.7; 95% CI = 1.9-3.8), the wrists (PR = 1.4; 95% CI = 1.1-1.8), and the elbows (PR = 1.5; 95% CI = 1.0-2.2). OTs were particularly exposed to high exertion hand activity and several stressful postures at work. In conclusion, OTs seem to be at risk of developing work-related musculoskeletal complaints in the thumbs, wrists, and elbows. Preventive measures should help to reduce the exposures caused by highly repetitive and forceful hand activities.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

Occupational therapist-led mindfulness-based stress reduction for older adults living with subjective cognitive decline or mild cognitive impairment in primary care: a feasibility randomised control trial protocol

INTRODUCTION

Community-dwelling older adults living with subjective cognitive decline or mild cognitive impairment may experience decreased efficiency in their overall functional performance. This decreased cognitive efficiency may result in anxiety, low mood, perceived stress and decreased emotional well-being and quality-of-life. These psychological symptoms may further exacerbate cognitive decline.Exploring non-pharmacological interventions such as mindfulness within primary care is vital in enabling individuals to develop strategies to manage cognitive impairment or psychological symptoms. Mindfulness-based stress reduction (MBSR) is an 8-week programme that is beneficial in alleviating psychological symptoms; however, its impact on perceived satisfaction on overall functional performance with this population has not been evaluated. The primary objective of this study is to explore the feasibility of conducting a randomised controlled trial of an occupational therapist-led MBSR programme within primary care.

METHODS

Convergent mixed-methods, randomised control feasibility trial with 40 participants from an interprofessional primary care team in Toronto, Ontario. Participants are randomised into the 8-week MBSR group or wait-list control will be compared at baseline, postintervention and 4weeks follow-up. The primary aim is to determine the feasibility of the intervention with this population and setting. The secondary aim is to examine perceived satisfaction with functional performance as measured by the Canadian Occupational Performance Measure. Secondary clinical outcomes include psychological symptoms.

ANALYSIS

Investigators will analyse the quantitative and qualitative data strands separately. Descriptive statistics, focus group and interviews will then be merged and further analysed to best understand the feasibility and preliminary clinical outcomes from the study.

ETHICS AND DISSEMINATION

The study is approved by Women's College Hospital (2017-0056-E), and Queen's University, Kingston, Ontario (6026418). The study will follow Standard Protocol Items: Recommendations for Interventional Trials. The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.Trial registration numberNCT03867474; Pre-results.

Current U.S. splinting practices for individuals with cervical spinal cord injury

STUDY DESIGN

Survey research design.

OBJECTIVE

To understand current splinting practices of occupational therapists working with individuals with spinal cord injury.

SETTING

The United States.

METHODS

An online survey was emailed to occupational therapists working in U.S. inpatient spinal cord rehabilitation facilities. The survey included questions about hand splinting practices in their patients with cervical spinal cord injury.

RESULTS

Sixty-five occupational therapists in 21 different states completed the survey. They reported that current and predicted hand function was the primary principle guiding splint decision making. Across all levels of cervical SCI, resting hand splints are commonly prescribed for night use, and 64.6% of respondents stated they typically recommend them for individuals without active arm movement. Most respondents (73.8%) also report prescribing wrist splints for day use for individuals without active wrist movement. Survey results indicate that therapists are using splints less frequently overall for all levels of injury. The long-opponens splint is no longer being used regularly in SCI and the MCP block splint is being used more frequently.

CONCLUSION

Survey responses indicated that splinting is standard care for individuals with cervical spinal cord injury and that the level of SCI dictates specific recommendations. Splint practice guidelines are a framework for intervention mediated by case-specific clinical reasoning and client input.

What occupational therapists' say about their competencies' enactment, maintenance and development in practice? A two-phase mixed methods study

BACKGROUND

Understanding how professional competencies are actually enacted in clinical practice can help university programs better prepare their graduates. The study aimed to describe 1) the perceived competency level of occupational therapists holding an entry-to-practice master's degree 2) the factors perceived as impacting the enactment of competencies; and 3) the strategies used to maintain and further develop level of competency in the seven practice roles: expert in enabling occupation, communicator, collaborator, practice manager, change agent, scholarly practitioner and professional.

METHODS

Descriptive two-phase mixed methods sequential design. The quantitative phase consisted of an online survey sent to all occupational therapists holding an entry-to-practice master's degree in Quebec, Canada (n = 1196), followed by focus group discussions with a subset of participants. Analysis used descriptive statistics and the Framework Approach for content analysis of focus group data. Competencies were theoretically anchored into the Profile of Occupational Therapist Practice in Canada (an equivalent to CanMEDS framework) and we used the Theoretical Domain Framework to collect and describe perceived factors and strategies.

RESULTS

Response rate to Phase 1 was 26.5% (n = 317/1196). The communicator, collaborator and professional roles were perceived as highly solicited in practice, valued and were rated more frequently at a higher competency level as compared to the other four roles (expert, manager, change agent and scholar roles). Focus group participants (n = 16) mentioned that both individual and organisational factors influence enactment of competencies. Consulting colleagues was the preferred strategy to support the scholar role, often described as foundational for the development of expertise.

CONCLUSION

This descriptive study provides valuable information as to how the seven roles are enacted in practice. Though the scholar role is highly valued by clinicians and organizations, insufficient time is allotted to searching for evidence and reflection in practice. Strategies emerging from the results are mainly directed toward this role with an emphasis on using of peers as a source of evidence. Future studies could explore how contextual factors influence the enactment of competencies across different professions as well as how these evolve over time.

Occupational Health among Swedish Occupational Therapists: A Cross-Sectional Study

The Swedish public sector is facing great challenges in recruiting and retaining healthcare professionals, due to increasing sick leave numbers. The aim of this study was to describe Swedish occupational therapists’ occupational health in terms of risk factors in the social and organizational work environment, occupational balance, and work-related mental health problems. A web survey was emailed to all working members of the Swedish Association of Occupational Therapists (n = 7600) and 3658 answered the survey. The web survey included questions on sociodemographic characteristics, social and organizational environment, occupational balance, and work-related health. The occupational therapists in general rated their workload as high, which was described as leading to increased stress, difficulties doing a good job, and increased job turnover. They also reported having difficulties maintaining occupational balance. Almost a fifth reported having symptoms related to mild incipient exhaustion or a pronounced exhaustion disorder. Almost 60 percent reported having, during the last year, seriously considered seeking new employment as an occupational therapist and 35 percent had seriously intended to leave their profession. In conclusion, there is an urgent need to improve the work situation of occupational therapists. If not, increases in mental health problems, sick leave and job turnover rates may seriously jeopardize the welfare system by eroding healthcare.

Computer Vision-Based Approach for Quantifying Occupational Therapists' Qualitative Evaluations of Postural Control

This study aimed to leverage computer vision (CV) technology to develop a technique for quantifying postural control. A conventional quantitative index, occupational therapists' qualitative clinical evaluations, and CV-based quantitative indices using an image analysis algorithm were applied to evaluate the postural control of 34 typically developed preschoolers. The effectiveness of the CV-based indices was investigated relative to current methods to explore the clinical applicability of the proposed method. The capacity of the CV-based indices to reflect therapists' qualitative evaluations was confirmed. Furthermore, compared to the conventional quantitative index, the CV-based indices provided more detailed quantitative information with lower costs. CV-based evaluations enable therapists to quantify details of motor performance that are currently observed qualitatively. The development of such precise quantification methods will improve the science and practice of occupational therapy and allow therapists to perform to their full potential.