A call for sustainable practice in occupational therapy

Climate Change and Occupational Therapy: Meeting the Urgent Need for Adaptation, Mitigation, and Resilience

Climate change may be the most pressing existential threat to human health and wellbeing in the twenty first century. In this paper, the authors provide context and critique on barriers to climate action in the United States and other high-income countries, including the profit-driven approach to health, consumerism, and the climate change countermovement. The reciprocal connections between occupational engagement and climate damage are examined from a lens of collective and irresponsible occupations and subsequent accountability. The authors propose the United Nations' Sustainable Development Goals as a basis for recommendations occupational therapy practitioners could implement within the priorities of adaptation, mitigation, and resilience.

Occupational therapy's contributions to combating climate change and lifestyle diseases

BACKGROUND

The interdependence between human occupations, lifestyle diseases and climate change provides an opportunity to address them simultaneously. Occupational therapists' training in lifestyle modification and knowledge about the impact of the physical environment on daily occupations puts them in a unique position to contribute to global efforts of combating climate change and lifestyle diseases through the promotion of sustainable occupations.

AIM

To illustrate how occupational therapists can contribute to global efforts of combating climate change and lifestyle diseases by framing climate change from a personal and public health perspective.

METHOD

In this discussion paper we argue that occupational therapists can use education and lifestyle modification to support individuals in the prevention and management of lifestyle diseases and that they can help design and advocate for environments that promote sustainable occupations.

RESULT

This discussion paper highlights the contributions that occupational therapists can make to how we understand and address climate change and lifestyle diseases.

CONCLUSIONS AND SIGNIFICANCE

We argue that by framing the climate change discourse from a health perspective, occupational therapists can contribute to global efforts of combating climate change and lifestyle diseases by supporting individuals to engage in sustainable occupations and communities to facilitate this engagement.

The environmental impact of health care for musculoskeletal conditions: A scoping review

BACKGROUND

Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions.

METHODS

We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed.

RESULTS

Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1).

CONCLUSION

Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.

The Opportunity for Occupational Therapy in Pediatric Disaster Recovery

As natural disasters increase in frequency throughout the world, more children and families are exposed to disaster-related stress and trauma. Many children with disaster exposure face occupational disruption, in which common activities, roles, and relationships are damaged or destroyed. In this descriptive column, we explore the impact that natural disasters have on children, the contribution of pediatric occupational therapy to disaster management, and the opportunity for occupational therapy practitioners to engage in collaborative psychosocial and activity interventions during disaster recovery. Through trauma-informed occupational therapy, children in traditional and community-based services will benefit from assistance in restoring normalcy. With this column, we aim to contribute to the continued exploration of roles in pediatric disaster prevention and recovery and a call for qualitative and quantitative scholarship in this setting.

Clinical Reasoning in Occupational Therapy Practice: A Scoping Review of Qualitative and Conceptual Peer-Reviewed Literature

IMPORTANCE

The occupational therapy clinical reasoning literature includes a large proportion of peer-reviewed qualitative and conceptual articles. Although these articles can contribute to the understanding of how clinical reasoning has been conceptualized in occupational therapy, they have not yet received in-depth analytic attention. To address this gap, we conducted a scoping review.

OBJECTIVE

To examine how qualitative and conceptual literature has addressed clinical reasoning in occupational therapy.

DATA SOURCES

Database searches were conducted in Scopus, Web of Science, PsycINFO, Embase, and MEDLINE.

STUDY SELECTION AND DATA COLLECTION

Included articles were published between 2010 and 2019, were peer reviewed, addressed clinical reasoning in occupational therapy, were qualitative or conceptual articles, focused on practitioners, and were in English. Twenty-six articles met the inclusion criteria. Data were extracted according to relevant categories and were analyzed numerically and thematically.

FINDINGS

Four themes were identified: clinical reasoning processes, factors influencing clinical reasoning, new models or frameworks to guide clinical reasoning, and emergent perspectives on clinical reasoning.

CONCLUSIONS AND RELEVANCE

This review advances knowledge about how clinical reasoning has been conceptualized in occupational therapy and has been applied in a range of practice contexts. The review highlights discussions about types of reasoning, the dynamic and iterative nature of reasoning, contextual dimensions of reasoning, client-centered and occupation-based approaches, new frameworks and models, and emergent and innovative perspectives on clinical reasoning in occupational therapy. What This Article Adds: This scoping review represents an important contribution to knowledge about how clinical reasoning has been conceptualized in occupational therapy by mapping key themes and illuminating scholarly conversations in the qualitative and conceptual clinical reasoning literature.

Occupational Therapy in an Ecological Context: Ethics and Practice

Unsustainable lifestyles contribute to global greenhouse gas emissions and climate change. The growing recognition of this negative impact on the earth's ecosystems and human health and well-being compels occupational therapy practitioners to address environmental sustainability issues. Western contextual factors present obstacles to the adoption of ecologically beneficial practices in occupational therapy. Resolving these ethical challenges through the use of multiple epistemologies may yield novel solutions and usher in the adoption of ecologically sustainable occupational therapy in the United States. In this column, I explore some of the contextual factors that influence occupational therapy theory and practice as they relate to ecological sustainability. I also briefly discuss some non-Western cultural perspectives, challenges to integrating ecological ethics into occupational therapy practice in the United States, and ways individual occupational therapy practitioners and state and national organizations can begin to address this issue.

Occupational Therapy Practice Framework: Domain and Process—Fourth Edition

The fourth edition of the Occupational Therapy Practice Framework: Domain and Process (hereinafter referred to as the OTPF–4), is an official document of the American Occupational Therapy Association (AOTA). Intended for occupational therapy practitioners and students, other health care professionals, educators, researchers, payers, policymakers, and consumers, the OTPF–4 presents a summary of interrelated constructs that describe occupational therapy practice.

Household Waste Sorting and Engagement in Everyday Life Occupations After Migration—A Scoping Review

The aim of this scoping review was to gain an overview of the current state of the literature on the engagement in waste sorting post migration from an occupational perspective, in the light of two aspects sustainability efforts currently face: Increased human migration and environmental degradation. Both the resource recovery and occupational science literature were reviewed and analyzed. However, despite the current lack on studies on how migrants’ transition into waste sorting schemes at the household level, this scoping review was able to provide a broad picture of the engagement in daily activities that support sustainability, such as household waste sorting. Given the current initiatives to develop efficient resource recovery from waste, such knowledge contributes to efforts to engage households with different cultures and experiences in waste sorting. The results highlight the importance of future research to better understand how people who are new to waste management schemes experience these, and study the way that engagement in waste sorting shifts and transforms. This is because providing such knowledge can contribute to raising awareness of the environmental impact of waste sorting, and inform policies aimed at sustainable waste management.

Razonamiento clínico en terapia ocupacional. Una revisión narrativa

 Introducción. El razonamiento clínico ordena el procesamiento de la información obtenida durante la evaluación, facilitando tomar decisiones para implementar planes de tratamiento. Esta área es cada vez más relevante para la formación de estudiantes y profesionales de terapia ocupacional. Objetivo. Analizar la literatura sobre razonamiento clínico en terapia ocupacional publicada entre 2009 y 2018. Materiales y métodos. Se realizó una revisión de la literatura en bases de datos, repositorios institucionales, monografías y literatura gris de alcance. Se establecieron criterios de selección para la obtención de documentos que luego se analizaron estableciendo un conjunto de variables que permitieron el análisis de la literatura. Resultados. La literatura sobre razonamiento clínico en el período estudiado fue de 99 publicaciones, más de la mitad que en los 33 años anteriores. El razonamiento clínico en el ámbito docente es el de mayor impacto (41.4%); 52.5% son publicaciones que mejoran la práctica con sus aportes al reforzar el desarrollo de destrezas profesionales y la calidad de las intervenciones. Conclusión. El aumento de la investigación sobre razonamiento clínico en terapia ocupacional dota a esta área de conocimiento y rigor, mejorando así la eficacia de los terapeutas ocupacionales.