Uniting practice and theory in an occupational framework. 1998 Eleanor Clarke Slagle Lecture

Achieving best practice: a review of evidence linked to occupation-focused practice models

ABSTRACT The aim of this paper is to identify and synthesize evidence concerning the most widely used contemporary occupation-focused models including Ecology of human performance; Model of human occupation; Occupational adaptation; and Person-environment-occupational performance. The paper characterizes the amount and type of evidence. Evidence found includes illustrations of how the models can be applied to understand and address a particular problem or population, basic studies that test or expand theoretical concepts, psychometric studies, studies that document therapy outcomes, and studies that examine clinical reasoning and/or practice based on the models. The four models differed widely in the amount and type of evidence available.

Service learning can make occupation-based practice a reality: a single case study

ABSTRACT Service learning is philosophically congruent with the objectives of progressive occupational therapy curricula. This article presents a case-based research study that examined the attributes and outcomes of a service-learning course that included Level I fieldwork. Analysis of the case study identified three themes: (a) the translation of theory to practice, (b) the value of contextual learning, and (c) the gestalt of occupational awareness. Service learning can be considered a pedagogical [2] model that promotes the synthesis of conceptual models to clinical practice. Furthermore, it enables students to develop a professional and personal philosophy of occupation earlier in their careers.

Convergent Validity of the Engagement in Meaningful Activities Survey in a College Sample

The Engagement in Meaningful Activities Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002) demonstrated sufficient psychometric properties in a sample of 122 adults. The EMAS was found to have adequate test—retest (r = .71) and internal consistency (α = .88) reliability; significant positive correlations between the EMAS and the subscales of the Basic Psychological Needs Scale and the Sources of Meaning Profile and negative zero-order correlations were found with short form versions of the Boredom Proneness Scale and the Depression, Anxiety, and Stress Scales. Step-wise multiple regression analysis results showed the Sources of Meaning Profile, Boredom Proneness Scale, and Competence subscale of the Basic Psychological Needs scale best predicted the EMAS. These results lend additional construct validity evidence in support of the EMAS as a brief measure of meaningful activity participation.

The Meaning of Occupational Gaps in Everyday Life in the First Year after Stroke

This longitudinal study identified how occupational gaps were characterized in people's lived experiences of performing everyday occupations during the first year after stroke. Four participants were interviewed four times during the year after stroke. The data were collected and analyzed using the Empirical, Phenomenological, Psychological method. Five main characteristics were identified: (1) encountering occupational gaps in formerly taken-for-granted activities, (2) striving to narrow gaps in desired occupations, (3) recognizing oneself in doing, (4) searching for a new sense of self through doing, and (5) creating strategies to enable doing. The findings show the importance of being able to preserve some sense of self in everyday doings after a life course disruption caused by stroke. Important implications for clinical practice include sensitivity to clients' experiences during this process, enablement of experiences in occupations promoting recognition, and support of clients in recapturing desired occupations.

From Practice to Praxis: Reconnecting Moral Vision with Philosophical Underpinnings

In this article, it is argued that in order to meet the profession's ethical and moral obligations, occupational therapists need to ensure that they are connected to the philosophical foundations of occupational therapy. By making occupational therapy practice occupation-focused, therapists guarantee that they provide a unique and valuable contribution to multidisciplinary teams and that they help to meet all the needs of patients. The findings from an action research study of 15 occupational therapists' practice in an urban Australian acute hospital setting are used to illustrate that occupational therapy practice can and should be occupation-focused.

Research data were gathered through audio-recording and transcribing individual interviews and research group meetings. The data were analysed qualitatively using non-linear formal and informal processes. The findings were as follows: having a clear professional vision increased the confidence of co-researchers; attending to patients' occupational needs increased the therapists' motivation to engage in more occupation-focused practice; and therapists felt increased satisfaction when their practice was occupation-focused. The article concludes by advocating that occupational therapists can be wiser and more ethical practitioners by engaging in praxis, a form of moral, reflective practice scholarship, particularly through participating in communities of practice that focus on understanding and developing ways of enabling occupation.

Assessments used in occupational therapy practice: an exploratory study

ABSTRACT The purpose of this study was to explore the assessments used in occupational therapy practice through identifying most commonly used assessments and the rationale for their use in different occupational therapy practice areas. The study utilized a nonprobability convenience sample of 260 occupational therapy practitioners attending the American Occupational Therapy Association's annual conference. A descriptive survey research design was used for conducting this study. The survey instrument addressed three major questions related to (a) the area of practice, (b) the specific assessments used, and (c) reasons for using the specific assessments. Descriptive statistics were utilized to analyze the results. Results indicated most of the assessments used in occupational therapy clinics target body structure and function. Assessments were used due to their convenient availability in clinics, clinical utility and standardization, client-centeredness, development by occupational therapists, being taught in school/fieldwork, and being satisfying to insurance companies. Implications for occupational therapy education, practice, and research are presented.

Changing face of stroke: implications for occupational therapy practice

Stroke is one of the most life-altering syndromes affecting the world population. Rehabilitation for people experiencing stroke is focused almost exclusively on self-care activities and being able to return home and has little to no focus on work rehabilitation or community reintegration. The Cognitive Rehabilitation Research Group (CRRG) at the Washington University School of Medicine in St. Louis was formed with the vision of improving everyday life for people after stroke by translating knowledge from neuroscience into treatment programs for productive living. Descriptive analysis of the intake assessment from the CRRG Clinical Core (N = 7,740) revealed three important findings: The age at stroke is decreasing, most strokes are neurologically mild to moderate in nature, and discharge placement decisions are being made largely on the basis of measures of impairment. The changes in the stroke population require occupational therapy to expand rehabilitation beyond the acute management of stroke to address full participation in work, family, and community life.

Development and Rasch analysis of the Assessment of Computer-Related Skills

The purpose of this study is to evaluate the internal scale validity, person response validity, and reliability of the newly developed Assessment of Computer-Related Skills (ACRS). Data from 32 healthy adult participants who performed two to three computer tasks were analysed to determine how well the participants fitted the many-faceted Rasch (MFR) model of the ACRS, as well as how well the ACRS skill items and tasks (a) fitted the MFR model of the ACRS, (b) matched the expectations for hierarchical ordering of their difficulties, and (c) differentiated persons into different levels of ability. Results indicated that with three skill items removed, the remaining 34 skill items, 8 computer tasks, and 30 participants demonstrated goodness-of-fit to the MFR model of the ACRS. The skills and tasks appeared to have logical hierarchical ordering and differentiated participants into at least three levels of ability. The findings affirmed the internal scale validity, person response validity and reliability of the ACRS for assessing persons' computer abilities. Future studies using a larger sample that includes individuals with disabilities and with difficulties with computer use are needed to further evaluate the validity and reliability of the ACRS.

Spinal cord injured persons’ conceptions of hospital care, rehabilitation, and a new life situation

BACKGROUND

The basic aim of spinal cord injury (SCI) rehabilitation is to help patients return to a life worth living. It is therefore important that the staff at spinal units and rehabilitation centres understand how the patients experience their rehabilitation and their adjustment process to the new situation.

AIM

To describe SCI persons' experiences of their rehabilitation process.

METHOD

Nineteen SCI persons were interviewed. Data from the tape-recorded interviews were analysed according to a modified descriptive version of the phenomenographic analysis process.

RESULTS

Six categories that describe the informants' conceptions of their rehabilitation process emerged: access to information, participation in planning rehabilitation, emotional support, feelings of vulnerability, adjustment to a new life situation, and emotional consequences of the injury.

CONCLUSION

Straightforward information, participation in the planning of the rehabilitation programme and emotional support were important factors influencing the rehabilitation process after the SCI. Professionals working with SCI rehabilitation should make use of patients' experiences in order to develop better rehabilitation programmes that focus on the individual needs of the patient. People are individuals and failure to take this into account can impact negatively on quality of life and the effectiveness of the rehabilitation.

Influences of the social environment on engagement in occupations: The experience of persons with rheumatoid arthritis

The aim of this explorative study was to describe and enhance the understanding of how persons with rheumatoid arthritis (RA) experience the influence of the social environment on their engagement in occupations. Nine persons were interviewed and the data obtained were analysed using a comparative method. The findings revealed that other persons in the social environment influenced informants' experiences of engaging in occupations in two ways, which formed the categories: "Constructive collaboration" and "Insufficient collaboration". These categories had certain properties related to the actions the others undertook to assist the informants during their collaboration. These assisting actions influenced the informants' possibilities to engage in occupations, and also their experience of engagement. The findings also showed that the "Conditions for collaboration" varied and influenced their collaboration, which thereby constituted a third category. The findings may contribute to a deeper understanding of how other persons can facilitate and restrict meaningful occupational experiences. This provides knowledge that can be used by occupational therapists when empowering their clients and those close to them to reflect on their actions and the consequences of these actions to enhance occupational engagement.

How can we get access to the experiences of people with dementia?

This paper suggests and discusses a methodological approach that aims to facilitate the inclusion of people with dementia in research where the ambition is to better understand their experiences. People with dementia have commonly not been included as informants in research as their cognitive deficits have been regarded as a hindrance. Moreover, in the qualitative research tradition, most inquiries rely on data obtained from interviews, thereby requiring communication and verbal skills, which are skills that are affected early in the cause of dementia. Consequently, the considerably under-researched area of how dementia is experienced and managed from the perspective of those afflicted has long been put aside. This paper suggests that a combination of qualitative observations and adapted interviews may make it possible for people with dementia to participate as research informants. Issues concerned with creating a relationship with informants with dementia and helping them to elicit their experiences are elaborated and discussed. Some suggestions are made concerning how the context can be used for this intent, and how the observations and interviews can be adapted to the informants with dementia.

An integrative review combined with a semantic review to explore the meaning of Swedish terms compatible with occupation, activity, doing and task

The aims of this study were to explore the intended meaning of the terms "occupation", "activity", "doing", and "task" used in international occupational therapy literature and from this perspective explore which Swedish terms best capture these meanings. A literature review of occupational therapy-related journals was performed to gain a basic understanding of the term occupation and related terms. In addition, a semantic review was used: English and Swedish dictionaries were reviewed to explore the semantic meaning of the English terms "occupation", "activity", "doing", and "task", and the Swedish terms "aktivitet", "syssla/sysselsättning", "görande", and "uppgift". A comparison was also performed by searching for parallels between the results of the literature review, the semantic definitions of the English and Swedish terms and the comprehensive meaning of the Swedish terms aktivitet and syssla/sysselsättning. An overarching idea of the concept of occupation was found in the literature review and for the purposes of this study we have identified this as Occupation for survival. From this overarching idea, three themes were identified: The feature of occupation, Impact of occupation and Occupation an occupational therapy concept. Each theme could be subdivided into sub-themes. The Swedish term aktivitet was found to have more power, strength, and spirit connected to the synonyms found in the semantic analysis than to those connected with the Swedish term syssla/sysselsättning. According to the findings in this study we found that the term "aktivitet" is the best comparable term in Swedish to the English term "occupation".

Portrait of occupational therapy

The profession of occupational therapy promotes individuals to achieve health and wellness through engagement in meaningful occupations of daily living. This occupation-focused profession plays a critical role in health care in a multitude of settings with a wide range of clients. The paper highlights a global overview of the philosophies of occupational therapy, the current international practices in occupational therapy, the education of therapists, and the roles of law and professional societies that govern the practice of occupational therapy.

Using Theory to Underpin an Integrated Occupational Therapy Service through the Canadian Model of Occupational Performance

The aim of this action research study was to embed the theoretical tenets of the Canadian Model of Occupational Performance and its structures in a way that was appropriate to, and would be used by, all staff within an integrated health and social care setting. The action research involved 10 phases of reflection and action, with data analysis occurring between the cycles.

The findings showed the importance of taking time to embed theory before implementing model structures in order to prevent those structures, and particularly the paperwork, becoming superficial. In addition, the importance of using theoretical structures (models) flexibly and adapting them to particular services was identified.

A more generally applicable finding was that occupational therapists can and should demonstrate their theory through their practice and that this can be done by using a model to illustrate their clinical and, more specifically, their conditional clinical reasoning (Mattingly and Fleming 1994). In addition, the demonstration of clinical reasoning proved vital in making the client-centred and occupational beliefs of the model overt.

It was concluded that implementing theory and using occupation-based literature (Williams and Bannigan 2008) in this way can take a long time but is worthwhile because it provides a sound and strong base for the profession's identity.

Sleep, Occupation and the Passage of Time

This article explores the extent to which sleep has been considered in occupational therapy and occupational science and finds that the coverage of the subject is patchy: many authors do not mention it whereas some provide comprehensive and useful information. One reason for this variability could be that it is unclear whether sleep is an occupation and this question is debated. Although it is widely acknowledged that sleep is essential to the performance of daytime activity, most definitions of occupation and activity exclude sleep unless occupation is defined in the context of time use.

A brief review of the social history of sleep and the timing of occupations suggests that modern life and the natural sleep-wake cycle might be out of synchrony. The science of sleep is explored and the factors necessary for initiating sleep are examined, with aspects of daily occupation being found to influence sleep. It is suggested that, given the range of conditions affecting sleep that are seen by occupational therapists, it may be helpful to have a better understanding of sleep and the measures that might improve it. Because sleep occupies so much time, research in occupational science is recommended.

Relevance and focal view point in occupational therapists' documentation in patient case records

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where "Activity" and "Health" are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on "activity" and holistic health notions.

Effectiveness of occupational therapy with frail community living older adults

This study examined the effectiveness of short-term, home-based occupational therapy guided by the Occupational Therapy Intervention Process Model for improving activities of daily living [ADL] with eight frail, older adults living in assistive living. A multi-method research approach was utilized to collect both quantitative and descriptive, qualitative data in the form of a retrospective examination of the participants' clinical records. The quantitative component was a within-subjects, repeated-measures analysis of participants' Assessment of Motor and Process Skills [AMPS] ADL motor and ADL process ability measures that revealed statistically significant improvement in ADL motor, but not ADL process abilities. The qualitative component was a content analysis of the clinical records. ADL baselines, goals, interventions and outcomes documented were analyzed. Improvement was noted in 77% of the written ADL goals. Results are discussed and recommendations were given for future research and documentation to improve the profession's ability to support evidence-based practice.

Cardiovascular and Electroencephalographic Response to Purposeful vs. Nonpurposeful Activity in Adults (†)

eEffects of purposefulness on heart rate, blood pressure, and electroencephalographic recordings were examined in 32 adults performing purposeful and nonpurposeful activities of equal cardiopulmonary workload. Blood pressure increased from resting during purposeful and nonpurposeful activity (all p < .02); the level of increase was similar for purposeful and nonpurposeful activity [systolic (p = .44); diastolic (p = .25)]. No significant differences in heart rate (p = .42) or electroencephalographic beta wave activity (p = .39) were noted between purposeful and nonpurposeful activities. These findings suggest that the degree of purposefulness of the activity did not influence the cardiovascular response.

Cardiovascular and electroencephalographic responses to purposeful versus nonpurposeful activities in children

To discern effects of purposefulness on cardiovascular and neural responses, heart rate and electroencephalographic recordings were taken in 31 children performing purposeful and nonpurposeful activities of equal duration and cardiopulmonary workload. Heart rate increased from resting levels during both purposeful (p = .001) and nonpurposeful (p = .01) activities, but the level of increase was the same for both (p = .30). Similarities in heart rate during purposeful and nonpurposeful activities suggest that purposefulness might not influence heart rate response in children. Encephalographic recordings did not show a higher beta-wave activity quotient during purposeful activity (p = .33).

Occupation as described by novice occupational therapy students in Sweden: the first step in a theory generative process grounded in empirical data

A core assumption in occupational therapy is that occupation enhances health. This study is one of a series of planned studies carried out in Sweden, with the overall aim to develop a theory, based on empirical grounds, concerning the dimensions of occupation that may be useful in occupational therapy. The specific aim for this study is to examine the dimensions of occupation as generally understood among novice occupational therapy students. Grounded Theory was the chosen method. Data were collected among occupational therapy students. The students wrote down spontaneously what they considered to be included in activity. A preliminary core category "The what, why, and how of occupation" and five other categories emerged from the analysis: (1) The doing and context of occupation; (2) Motive for occupation; (3) Time and place for occupation; (4) Type of participation; and (5) Outcome of occupation. Relationships between the categories were established between the Motive for occupation and Outcome of occupation, which constitute a kind of prerequisite for occupation. The three remaining categories: The doing and context of occupation, Time and place for occupation, and Type of participation established a form for occupation. In conclusion, the study results illuminated the richness of the concept of occupation and support the core assumption in occupational therapy that occupation enhances health.

Goal-directed training: linking theories of treatment to clinical practice for improved functional activities in daily life

BACKGROUND

Goal-directed training is an activity-based approach to therapy. Meaningful, client-selected goals are used to provide opportunities for problem solving and to indirectly drive the movements required to successfully meet the task demands. This is in contrast to interventions that focus on changing body functions. Here, the principles of goal-directed training will be studied through two case studies with the aim of linking theories of treatment to clinical practice.

PRINCIPLES ILLUSTRATED

The approach is based on the dynamic systems motor control theory and occupation-based therapy models, which suggest that movement patterns emerge from the interaction between the person's abilities, environment and the goal. Motor learning principles are applied to structure and schedule practice.

THEORY IN PRACTICE

Four components provide the basis for goal-directed training: (1) selection of a meaningful goal; (2) analysis of baseline performance; (3) intervention/ practice regime; and (4) evaluation of outcome. Two individuals with acquired brain injury practised self-care tasks: eating and tying hair into a ponytail. Intensive training was undertaken over four weeks and the intervention outcome measured using the Goal Attainment Scale.

CONCLUSIONS

The positive achievements in the self-care tasks illustrated that theories of motor control and motor learning can be applied to goal-directed training. The examples demonstrated that the approach could be applied to individuals with a range of abilities.