Application of the Person-Environment-Occupation Model: a practical tool

Expanding client-centred thinking to include social determinants: a practical scenario based on the occupation of breastfeeding

BACKGROUND

Client-centred thinking in occupational therapy underemphasizes the influence of social determinants and societal-level factors on occupation across the life course. When client-centred thinking focuses solely on the local or immediate contexts of individuals, therapists may not fully recognize or understand how social determinants can create barriers to occupational participation and performance.

AIM/OBJECTIVES

This article critically examines gaps in traditional thinking concerning client-centredness and demonstrates how the complex interplay between social determinants and societal-level factors may lead to occupational injustices.

MATERIAL AND METHODS

A practical example from a recent study on breastfeeding and accompanying scenario is used to examine limitations in current client-centred reasoning. The Life Course Health Development framework, a theoretical framework examining contexts of health disparities, is applied to illustrate the opportunity to expand thinking about client-centredness.

RESULTS

The Life Course Health Development framework may be a useful addition to client-centred thinking about social determinants of occupation.

CONCLUSION AND SIGNIFICANCE

Expanding client-centred thinking to include awareness, understanding, and respect for social determinants of occupation may enhance therapist-client interactions and outcomes of the occupational therapy process, and address gaps in current thinking that may contribute to occupational injustices.

Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes

This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage I intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline.

Enabling occupation at the end of life: A literature review

OBJECTIVE

Occupation, or meaningful activity, can contribute to the well-being and quality of life of all individuals. It is thus a logical tautology that occupation should be enabled for those at the end of life. Our present review examines current provision of these processes by Occupational Therapist, who can be much-valued members of multidisciplinary palliative care teams.

METHOD

Following a literature search and critical selection, 10 global papers were identified examining occupation and occupational therapy at the end of life in the acute, hospice, and community environments.

RESULTS

Universally, there appeared to be a dearth of therapists working in end-of-life care. Provision of palliative care in hospitals was found to be compensatory or rehabilitative. Hospice therapy emerged as pleasingly occupational, though the number of hospice places was disappointingly few. Community literature was sparse, so it proved challenging to draw definitive conclusions. Promising research refracted light on occupation at home; however, it also revealed stretched domiciliary services, where clients are not well informed about the potential scope of occupational therapy.

SIGNIFICANCE OF RESULTS

A "good death" involving a quality end-of-life experience is the foundational goal overarching all therapy and medicine in the provision of palliative care. Arguably, an occupation-focused approach provided by therapists meets client needs to enable meaningful experiences in the limited time left to them. Current occupational therapy practice environments are not necessarily achieving these goals in commensurate fashion. There is a need to promote the role of occupational therapy and circumscribe what therapists can offer. Further research is necessitated across all environments and future funding for therapist positions in palliative teams. End-of-life care can be complex and challenging; however, therapists can facilitate fulfillment of client-centered occupational goals. In engaging with personally constructed nuances of meaning, quality of life can be improved in those deserving of a significant and emotionally rich daily existence during their final days.

Occupations and personal projects: A comparison of the concepts

Introduction

The concept of personal projects has been used in occupational therapy research to understand occupation better. However, no clear distinction has been made between personal projects and occupations. An argumentative review was carried out to determine if the concepts of occupation, as outlined in the Canadian Model of Occupational Performance and Engagement and the Person Environment Occupation Model and personal projects are interchangeable.

Method

Definitions of each concept and seven points of comparison were identified through reading and discussion of key material related to: framework and origins; association with health and well-being; consideration of the environment; individualized and self-directed nature; consideration of aspects of the person; categories; and balance.

Findings

Occupation and personal projects represent similar concepts when they refer to concrete and time-limited activities. More abstract and extended personal projects may be broken down into more concrete, shorter-term occupations. Differences were noted with respect to consideration of the environment, aspects of the person, categories and balance.

Conclusion

Differences in the way the environment, aspects of the person, categories and balance are considered in personal projects may provide helpful insights for occupational therapists as they attempt to practice in a client-centered, strengths-based manner with a focus on occupation.

Strategies for inclusion in play among children with physical disabilities in childcare centers: an integrative review

The purpose of this integrative review was to examine strategies that facilitate inclusion in play among children with physical disabilities in childcare centers. Nine databases were systematically searched for peer reviewed empirical studies investigating inclusion strategies for play in childcare settings among preschoolers with physical disabilities. Nine studies met the inclusion criteria and were appraised using the McMaster Critical Review Forms. The inclusion approaches identified were grouped into relevant strategies during analysis. Two main strategies were identified: role of the adult facilitator and environmental factors. substrategies within the role of the adult facilitator included: customize approach for specific child's needs; adult facilitator self-awareness of presence; prompting and praise; and promote fairness, equity, and play interaction. Substrategies within the environmental factors included: physical setting; type of toys; and type of play activity. The findings suggest play inclusion strategies in the childcare environment. Therapists are encouraged to apply inclusion strategies to improve play opportunities for children with disabilities, but future research is necessary to confirm the effectiveness of these strategies using higher quality study designs.

Barriers and facilitators related to participation in aquafitness programs for people with multiple sclerosis: a pilot study

Exercise and leisure activities provide physical and psychosocial benefits to people with multiple sclerosis (MS) and can enhance their quality of life. In Winnipeg, Manitoba, Canada, people with MS have reported barriers to their participation in local MS-specific aquafitness (AF) programs. Therefore, a formal exploration of the accessibility of local AF programs for people with MS was undertaken. The purpose of this phenomenological study was to identify factors that facilitate or impede participation in AF programs by individuals with MS living in Winnipeg. Qualitative data were collected from a total of eight participants through one focus group (n = 7) and one in-depth interview (n = 1). The sample consisted of individuals with MS who were currently participating in AF programming as well as those who were not. Data were audio-recorded and transcribed verbatim, and thematic analysis was completed. Seven themes emerged regarding factors affecting participation in local AF programs. Barriers to participation included inadequate transportation, lack of one-on-one support, environmental inaccessibility, and fears associated with participation in the programs. Facilitators of participation included a knowledgeable instructor and experiencing physical and psychosocial benefits from the program. Information from this study was used locally to advocate for people with MS in order to increase participation in local AF programming.

The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting

Background:

Limited evidence is available to illustrate the use of theory to underpin occupational therapy practice in acute physical health care settings in the United Kingdom.

Method:

A generic qualitative method investigated the views, knowledge and perceptions of seven Scottish occupational therapists about the potential usefulness of the Person-Environment-Occupation Model (PEO Model) in acute care. This convenience sample participated in two focus groups: the first to examine and understand the PEO Model and the second to explore further reflections of the strengths and limitations of its use in practice.

Findings:

The PEO Model has the potential to provide a meaningful framework in which to conceptualise patients in an acute physical health care setting.

Conclusion:

The PEO Model offers flexibility regarding the extent to which occupational performance is addressed, in a setting characterised by short hospital admission stays. Also, a range of occupation-focused models was valued to practise effectively in this setting.

The Patterns of Activity, and Transport to Activities among Older Adults in Singapore

Background

Engagement in occupations is important, and appropriate transportation modes are necessary for continued activity participation in the community. The aim of this study was to explore the patterns of activity and transportation methods used by older adults and the links between their transport use and activity engagement in Singapore.

Methods

Fifty-six participants aged 50 years and older recorded in a time diary (in English or Mandarin) their activity participation over 24 hours on a weekday or weekday and weekend day. Data on the participants' out-of-home activities were analyzed using parametric statistics, including Student t-tests and analyses of variance, along with visual inspection of the data.

Results

No significant difference was found between time spent out of the house on weekdays and weekends on the variables of sex, age, and self-reported health status, and between living situation and time spent out of the house for drivers and nondrivers. The participants undertook a wide variety of activities including work, singing with friends, and shopping, and most frequently left their house to shop, exercise, or meet family/friends or participate in leisure activities. The participants were found to be able to use several transportation methods to access these activities, and they were satisfied with how they traveled to them.

Conclusion

This study contributes to the understanding of the activity engagement of older adults in Singapore. It has highlighted participants' engagement in neighborhood activities and the importance and preference to walk or use public transportation to access activities. Additionally, this study has highlighted the need to consider the issues surrounding occupational performance in older adults.

Care-givers’ perspectives of occupational engagement of persons with dementia

Meaningful engagement in activity is associated with the maintenance of health and wellbeing, but reduced activity participation is common among persons with dementia. Family care-givers play an important role in engaging their relatives with dementia in activities but little is known about their perception of occupational engagement. This study aimed to examine care-givers’ perception of occupational performance of their relatives from three aspects: person, occupation and environment. Adopting a qualitative methodology, semi-structured and in-depth interviews were conducted with 14 family care-givers. Care-givers were also asked to document the activity patterns of their relative, using the Activity Card Sort Hong Kong version (ACS-HK). The ACS-HK findings suggested that high-demand leisure activities were mostly retained (61%) while instrumental activities of daily living were the least retained (37%). Qualitative analysis revealed that care-givers’ perception of activity participation was intertwined with their motives and behaviours to get their relatives engaged in activities. Care-givers acknowledged occupational engagement as a means of maintaining wellness and used various strategies to encourage their relative's activity participation. Apathy and passivity, however, are difficult to deal with. Also, activity decisions appear to depend on the availability of support resources and a balance between safety concern and risk-taking. Clinical practitioners could assist care-givers by suggesting activity strategies and providing support resources for continued engagement of their relative in activities.

Understanding Parenting Occupations in Neonatal Intensive Care: Application of the Person-Environment-Occupation Model

The adoption of family-centred care principles within neonatal intensive care, including support for the development of the parental role, has been increasing in profile over the past decade. During this period, occupational therapy has also had an emerging role in the provision of services within neonatal intensive care. However, there has been limited exploration of the concept of parenting as an occupation as a means of supporting parental role development within the neonatal intensive care unit (NICU). In accordance with the philosophy of family-centred care, opportunities exist to determine how the occupational efforts of parents and preterm infants can best be supported.

This paper provides a review of the current literature and its application to the Person-Environment-Occupation (PEO) Model as a framework for illuminating the acquisition of parenting occupations in the NICU. Illustration is provided of how the application of the PEO Model can be used to direct occupational therapy practice to incorporate a focus on family-centred care and the development of an occupation-based approach through which practice can be enhanced, ensuring that both the infant's and the family's needs are recognised and addressed.

A reflection on motor learning theory in pediatric occupational therapy practice

BACKGROUND

Theory provides a guide to clinical practice. To date, the most prevalent theories in pediatric occupational therapy practice are sensory integration and neurodevelopmental treatment.

PURPOSE

The purpose of this paper is to present a brief overview and reflection on motor learning theories as well as a summary of motor learning principles that can be used in pediatric practice.

KEY ISSUES

Over the past two decades, motor learning theory has been applied in adult occupational therapy practice, but it has been slow to gain popularity in pediatrics.

IMPLICATIONS

Although therapists may be tacitly applying motor learning principles in practice, conscious and deliberate application of these principles to a variety of pediatric populations is required to determine if motor learning theory provides a viable and effective contribution to evidence-based, occupational therapy pediatric practice. Further research comparing motor learning interventions to other dominant interventions in pediatric occupational therapy is warranted.

Influence of adapted environment on the anxiety of medically treated children with developmental disability

OBJECTIVES

To examine the influence of a sensory adapted environment (SAE) on the behavior and arousal levels of children with developmental disability in comparison with typical children, during a stress-provoking medical situation.

STUDY DESIGN

Sixteen children (6-11 years old) with developmental disability and 19 age-matched typical children participated in a cross-over trial measuring behavioral and psychophysiological variables, performed during a dental intervention.

RESULTS

Both groups performed better in the SAE compared with the regular environment (RE), by comparing: the mean duration of anxious behaviors in the SAE and RE (5.26 and 13.56 minutes; P <or= .001); the mean electrodermal activity for arousal levels, before commencement of treatment in the SAE and RE (784 and 349 Kohms; P= .002); and the mean electrodermal activity during treatment in the SAE and RE (830 and 588 Kohms; P= .001). A significant group by environment interaction was revealed, indicating that the difference in the 2 environments was greater in children with developmental disability than typical children in all 3 measures.

CONCLUSIONS

These findings indicate the importance of environment in determining the comfort level of all children. The greater difference in the 2 environments observed in children with developmental disability suggests that this group benefits more from sensory adapted environments.

Randomised controlled trial of unsolicited occupational therapy in community-dwelling elderly people: the LOTIS trial

Objective:

The objective of this trial, the Leiden 85-Plus Occupational Therapy Intervention Study (LOTIS), was to assess whether unsolicited occupational therapy, as compared to no therapy, can decelerate the increase in disability in high-risk elderly people.

Design:

This was a randomised controlled trial with 2-y follow-up.

Setting:

The study took place in the municipality of Leiden in the Netherlands.

Participants:

The participants were 402 community-dwelling 85-y-old people, with a Mini-Mental State Examination score of >18 points at baseline.

Interventions:

Participants in the intervention group were visited by an occupational therapist who provided training and education about assistive devices that were already present and who gave recommendations and information about procedures, possibilities, and costs of assistive devices and community-based services. Control participants were not visited by an occupational therapist.

Outcome Measures:

The primary outcome measure was the score achieved on the Groningen Activity Restriction Scale. Secondary outcome measures included self-evaluations of well-being and feelings of loneliness.

Results:

The participants were evenly divided between the two groups: 202 participants were allocated to the intervention group and 200 participants to the control group. Of the 202 participants randomised to occupational therapy, 55 participants declined the proposed intervention. An occupational therapist indicated that of the remaining 147 participants, 66 (45%) needed an occupational therapy intervention. A total of 44 new assistive devices and five community-based services were implemented. During follow-up there was a progressive increase in disability in the intervention group (mean annual increase, 2.0 points; SE 0.2; p < 0.001) and control group (mean annual increase, 2.1 points; SE 0.2; p < 0.001). The increase in disability was not significantly different between study groups (0.08 points; 95% CI, −1.1–1.2; p = 0.75). There was also no difference between study groups for any of the secondary outcome measures.

Conclusion:

Unsolicited occupational therapy in high-risk elderly participants does not decelerate the increase in disability over time.

Background: Community-based services, such as occupational therapy, are widely used for elderly people to help them maintain independence. However, few studies have examined whether unsolicited offering of such services are effective in reducing disability, especially in the “oldest old”, that is, people 85 y or older.

What this trial shows: In this population of 85-y-olds, the effect of unsolicited occupational therapy was studied. The study consisted of therapists proactively making visits to elderly people in the trial, in order to provide additional services in addition to routine care. The researchers found no change in the reduction in disability over time in participants receiving unsolicited occupational therapy.

Strengths and limitations: The study is notable in that it provides good evidence, previously lacking, on the effects of unsolicited occupational therapy. The design was appropriate and randomisation was done correctly. Limitations include the fact that take-up of occupational therapy in the trial was not uniformly high.

Contribution to the evidence: Other evidence has shown that occupational therapy has beneficial effects in elderly people living at home. However, there has been little evidence about the effects of unsolicited occupational therapy in very elderly people, who are at particularly high risk of disability. This trial adds information from such a population and also indicates that making unsolicited visits, with the aim of finding people who have not already been provided with the services they need, is not likely to be of overall benefit.

Fueling the engines: a role for occupational therapy in promoting healthy life transitions

This article explores the potential role of occupational therapy in promoting healthy life transitions among people without illness or disease, The story of Roxana, a woman who moved with her family from Mexico to the United States, is described. The many transitions Roxana experienced are examined using the Person-Environment-Occupation Model. Implications for practice focus on assessment and intervention strategies that can help practitioners and individuals experiencing transitions use occupation to prevent illness and promote health.

Perceptions of power mobility use and safety within residential facilities

BACKGROUND

Power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities.

PURPOSE

As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use.

METHOD

In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members.

RESULTS

A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions.

PRACTICE IMPLICATIONS

Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.

Recent advances in physical and occupational therapy for children with cerebral palsy

Recent research and conceptual frameworks that emphasize family centered care and participation in family, school, and community life have contributed to advances in provision of health care by physical therapists and occupational therapists to children with cerebral palsy (CP) and their families. This article provides a contemporary perspective on physical and occupational therapy for children with CP. Topics include conceptual frameworks, early identification, prognosis for gross motor function, implications of impairment in motor control and muscle performance, and physical fitness and secondary prevention. Case scenarios and examples illustrate how current knowledge and research is applied to decision making within the context of the individual child and family.