Occupational adaptation - analyzing the maturity and understanding of the concept through concept analysis

Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement.Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation.Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred.Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility.Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.

The Use of Occupational Adaptation in Research: A Scoping Review

The aim of this scoping review was to identify and describe how occupational adaptation has been used in different research studies published from 1992 to 2015 and to identify possible gaps in study design. Four categories of studies were identified: those focused on understanding how occupational adaptation occurs in different life situations and different health conditions, those focused on the use of occupational adaptation as a guide or model in organizing the occupational therapy process, and those using occupational adaptation as a part of instrument development. Several gaps in research are evident including updating the theory development on occupational adaptation, types of maladaptation, studies conducted in less affluent countries, quantitative studies with robust designs, inclusion of men and younger persons as subjects, vulnerable groups, health promotion, and community settings.

Being in a Secure Forensic Psychiatric Unit: Every Day is the Same, Killing Time or Making the Most of It

Institutional environments are challenging settings in which to provide rehabilitation. This study describes the time use of a group of inpatients, the majority diagnosed with schizophrenia, in a secure forensic psychiatric unit in Australia. Time diaries, interviews and fieldnotes were collected over 5 weeks. Eight participants completed time diaries for two consecutive days, of whom five were also interviewed using the Occupational Performance History Interview II.

The participants' time use was dominated by personal care and leisure occupations. In general, the participants were dissatisfied with their time use, describing themselves as ‘bored’ or ‘killing time’. Many perceived that the environment created barriers to their participation in valued occupations, yet some also found occupations that provided solace, challenge or a connection with the outside world.

The findings indicate the importance of understanding individuals' unique occupational histories, interests and skills in order to create opportunities to engage them in relevant occupations that use personal resources, as part of forensic rehabilitation programmes, and the utility of the Occupational Performance History Interview II in this context. Further research exploring patient and staff perspectives on the challenges of occupational programming in forensic settings and the longitudinal impact of such programming on inpatients' occupational functioning, health and wellbeing is recommended.

Exploring Occupational Adaptation through the Lives of Women with Multiple Sclerosis

Multiple sclerosis (MS) affects people's physical capabilities and the lives of people with MS are constantly changing (Finlayson et al 2005), yet how people adapt to the disease from an occupational perspective has received little attention. This study explored the occupational adaptation of women with MS.

Seven women with MS were recruited from the Multiple Sclerosis Society of Ireland. Each participant completed the Modified Interest Checklist (Kielhofner and Neville 1983), the Role Checklist (Oakley et al 1985) and the Occupational Questionnaire (Smith et al 1986). Qualitative data were also collected, using the Occupational Performance History Interview – II (Kielhofner et al 2004).

The findings from all four tools were amalgamated and analysed. Three main themes emerged: the impact of MS on (i) performance capacity, (ii) roles and (iii) interests. The participants adapted by performing interests and roles differently and developing new meaningful interests and roles that were congruent with their performance capacity.

The findings highlight the importance of having an understanding of the impact of different types of MS on the occupational adaptation process. A greater understanding will facilitate occupational therapists in enabling people with MS to adapt to their condition by engaging in meaningful occupations throughout the lifespan.

Engagement in Play Activities as a Means for Youth in Detention to Acquire Life Skills

This study describes how occupational therapists in a community-based programme, Occupational Therapy Training Program (OTTP), use play activities to facilitate the acquisition of life skills by youth in detention. This pilot study explored the extent of engagement of male and female inmates aged 14 to 18 years old in structured play activities on topics such as interpersonal relationships, self-awareness, cultural celebrations and the transition to community. Retrospective analysis of data collected from surveys using the Engagement in OTTP Activities Questionnaire (EOAQ), completed by youth participants at the end of each group session, was used to measure the extent of occupational engagement. Worksheets and artworks produced by OTTP participants during those group sessions were also analysed. The participants reported very high engagement in OTTP. Engagement scores for male participants were higher than those for female participants, and male and female participants had higher engagement scores for different activities. Over 90% of the worksheets and artworks were found to be complete and relevant to the topic of the session. Play activities could be an appropriate way for occupational therapists to encourage youth in detention to acquire life skills. Demographic information and the actual number of participants are unknown because of how the existing data were collected. Future studies examining the potential gender-related preferences for specific topics deserve further investigation as well as research comparing the youth's engagement in OTTP interventions using play activities to other group interventions. Copyright © 2016 John Wiley & Sons, Ltd.

Content Validity of the Relative Mastery Measurement Scale: A Measure of Occupational Adaptation

This research addressed the need for a clinically practical and psychometrically sound measure of a central construct of Occupational Adaptation theory. As an indicator of Occupational Adaptation, the Relative Mastery Measurement Scale (RMMS) was developed and evaluated for content and construct validity. The RMMS assesses individuals' perceptions of their effectiveness, efficiency, and satisfaction regarding their responses to occupational challenges. In the first phase, the content validity of the RMMS was statistically evaluated using the ratings of five experts in Occupational Adaptation. Lu's Coefficient of Agreement among the experts for the final 12-item RMMS was an acceptable .95. In phase two, construct validity and reliability were examined using a combination of Rasch analysis and traditional measurement statistics. Participants were 150 rehabilitation clients. Reliability and validity was supported through the unidimensionality of 11 of 12 RMMS items by the ordering of item difficulty, goodness-of-fit statistics, factor analysis, and point-biserial correlations.

The Construction of Keyforms for Obtaining Instantaneous Measures from the Occupational Performance History Interview Rating Scales

Occupational therapists routinely use rating scales to indicate a client's level of functioning, monitor progress, and evaluate intervention success. Rating scales yield ordinal data, whereas true measurement requires interval level data. Rasch analysis can convert rating scale data into true interval measures, but the use of measures derived from this method is limited in everyday occupational therapy practice because raw data must be computer scored. The keyform is an alternative to computer scoring. It is a paper-and-pencil form with which the therapist can record and convert ratings to interval measures while exercising intuitive quality control of the data. This article illustrates the application of this methodology to the Occupational Performance History Interview-2nd Version (OPHI-II). The authors discuss the OPHI-II scales, describe the methodology for developing the keyforms, and demonstrate how they are used.

Construct Validity of the Three Motor-Reduced Subscales of the Developmental Test of Visual Perception — Adolescent and Adult (DTVP-A): A Rasch Analysis Model Evaluation

Background:

The Developmental Test of Visual Perception — Adolescent and Adult (DTVP-A) is a test used by therapists even though its construct validity has not been thoroughly assessed.

Purpose:

This study evaluated the scalability/interval level measurement, unidimensionality, lack of differential item functioning (DIF) and hierarchical ordering of the items of the three motor-free subscales (Figure-Ground, Form Constancy and Visual Closure) of the DTVP-A.

Method:

The motor-free visual perceptual performance scores from a sample of 221 participants aged 20+ years (49 adults with and 172 adults without neurological impairment) were used to complete a Rasch analysis of the DTVP-A's three motor-free subscales.

Results:

On the DTVP-A Figure-Ground (FG) subscale, items FG2 and FG6 demonstrated Rasch model misfit, while no item exhibited DIF. On the Form Constancy (FC) subscale, items FC1, FC2, FC4 and FC6 were misfitting, while items FC3 and FC11 exhibited DIF based on gender. Visual Closure (VC) subscale items VC2, VC3, VC13 and VC15 exhibited misfit with the Rasch model requirements, while VC1 and VC5 demonstrated DIF. When all three subscales were analysed together as one Total Motor-Reduced Visual Perception Scale, items FC2, FC1, FC4, VC12, VC15, FC17 and FG6 demonstrated Rasch model misfit, while items VC1, VC2, VC5 and FC11 exhibited DIF based on gender.

Conclusion:

The construct validity, scalability, hierarchical ordering and lack of DIF requirements were met by the majority of the motor-free DTVP-A items. However, items FG6, FC1, FC2, FC4 and FC11 appeared to be particularly problematic. Given the fact that a number of items exhibited Rasch analysis model misfit or DIF, clinicians need to take this into consideration when using the three motor-free DTVP-A subscales individually or collectively to assess clients.

An evaluation of the construct validity of the Developmental Test of Visual-Motor Integration using the Rasch Measurement Model

BACKGROUND

One method of evaluating the construct validity of instruments is the Rasch Measurement Model (RMM), an increasingly popular method used for test construction and validation.

AIM

The aim was to examine the construct validity of the Developmental Test of Visual-Motor Integration 5th Edition (VMI) by applying the RMM to evaluate its scalability, dimensionality, differential item functioning and hierarchical ordering.

METHOD

The participants were 400 children aged 5 to 12 years, recruited from six schools in Melbourne, Victoria, who completed the VMI under the supervision of an occupational therapist. VMI items 1, 2 and 3 were excluded from the Rasch analysis since all of the children achieved a perfect score on these items.

RESULTS

None of the items exhibited RMM misfit due to goodness-of-fit mean square (MnSq) infit statistics and standardised z (ZStd) scores being outside the specified acceptable range. VMI item 9 (copied circle) exhibited differential item functioning based on gender. In relation to hierarchical ordering of items, several were found to have similar logit difficulty values. For example, VMI items 26, 27 and 29; items 18, 22 and 24; and items 4, 5 and 11 were found to have the same level of challenge. As well, the VMI scale item logit measure order did not match that presented in the VMI test manual.

CONCLUSION

Theoretically, the VMI items are developmentally ordered; however, this ordering was not mirrored by the item logit difficulty scores obtained. This has scoring implications, where scoring a respondent's VMI test booklet is terminated after three consecutive items are not passed. Clinicians should also be aware that item 9 may exhibit bias related to gender.

An Examination of the Construct Validity of the Motor-Free Visual Perceptual Test—Third Edition (MVPT-3) Using Rasch Analysis with Adult Participants

Visual perceptual skills of adults are often assessed by occupational therapists using standardized tests. The Motor-Free Visual Perception Test—Third Edition (MVPT-3) is a frequently used test, although its construct validity has not been thoroughly evaluated. The purpose of the study was to consider the construct validity of the MVPT-3 by evaluating its scalability/interval level measurement, unidimensionality, lack of differential item functioning (DIF), and hierarchical ordering of its items when completed by a group of adult participants. The visual perceptual performance scores from a sample of 221 participants 20 years or older (49 adults with neurological impairment and 172 adults without) were used to complete a Rasch analysis (RA) of the MVPT-3. When analyzed using RA, the MVPT-3 exhibited adequate measurement properties. However, several MVPT-3 scales exhibited RA misfit (items 40, 45, 54, 56, 61, 64) or DIF (items 57, 60, 61). The construct validity, scalability, unidimensionality, hierarchical ordering, and lack of DIF requirements were met by most (87.7%; 8 of 65 items) of the MVPT-3 scale items. When using the MVPT-3 to assess adult clients, clinicians should consider the items that exhibited RA misfit or DIF when interpreting scores.

Occupation and meaning in the lives of women with chronic pain

The aim of this study was to examine how women experience occupations as they live with chronic pain and more specifically to gain detailed knowledge regarding the meaning of important occupations in their life. The article is based on an analysis of 17 narratives based on an Occupational Performance History Interview. Participants were interviewed as part of their occupational therapy assessment at Orton Rehabilitation. The narratives were analysed in order to identify the experiences of doing occupations in everyday life. When interpreting their problems in and solution for doing occupations women in this study used four basic metaphors: (1) moving forward, (2) slowing down, (3) fighting and (4) standing still. The tone of the narratives varied from hopeful to hopeless and from fearful to frustrated. Each of these four types of narratives differed in: (a) the tone of the narrative, (b) the meaning ascribed to occupation, (c) how others are viewed in relation to one's doing, and (d) how the future is envisioned. The experience of occupation in the lives of women with chronic pain is heterogeneous and depends on the underlying meaning of the narrative used to experience and interpret occupational life.

Construct Validity of the Test of Visual-Motor Integration: An Evaluation Using Rasch Analysis

Background

Rasch analysis can be used as a method of evaluating construct validity during test construction, validation, or evaluation.

Objective

The aim of this study was to examine the construct validity of the Test of Visual-Motor Integration (TVMI) by applying Rasch analysis to evaluate its scalability, dimensionality, differential item functioning (DIF), hierarchical ordering, and scoring category structure.

Methods

The participants included 400 children aged 5–12 years, recruited from six schools in the Melbourne metropolitan area, Victoria, Australia. The children completed the TVMI under the supervision of an occupational therapist.

Results

Overall, 3 of 30 of the TVMI scale items were problematic: Items 1 and 2 exhibited a Rasch model misfit and Item 5 exhibited DIF based on gender. In addition, the TVMI items were not found to be hierarchically ordered as reported in its manual. The TVMI scoring category structure was satisfactory.

Conclusion

Because only three TVMI items were found to be problematic, the construct validity of the TVMI appears satisfactory. However, given that the items are not hierarchically ordered, it is recommended that clinicians use the TVMI with caution when calculating participants' performance scores. This is particularly relevant if testing is ceased if a participant reaches the TVMI ceiling point by drawing three items incorrectly in a row.

Validity of the Developmental Test of Visual-Motor Integration Supplemental Developmental Test of Visual Perception

Visual perceptual skills of school-age children are often assessed using the Supplemental Developmental Test of Visual Perception of the Developmental Test of Visual-Motor Integration. The study purpose was to consider the construct validity of this test by evaluating its scalability (interval level measurement), unidimensionality, differential item functioning, and hierarchical ordering of its items. Visual perceptual performance scores from a sample of 356 typically developing children (171 boys and 185 girls ages 5 to 11 years) were used to complete a Rasch analysis of the test. Seven items were discarded for poor fit, while none of the items exhibited differential item functioning by sex. The construct validity, scalability, hierarchical ordering, and lack of differential item functioning requirements were met by the final test version. Since 7 test items did not fit the Rasch analysis specifications, the clinical value of the test is questionable and limited.

Therapists' and clients' perceptions of the occupational performance history interview

SUMMARY The Occupational Performance History Interview-Second Version (OPHI-II) is a semi-structured interview that gathers life history information. The interview data is used to score three rating scales and complete a narrative slope. Previous research has primarily examined the validity of the scales. This qualitative study sought to understand from the perspectives of therapists and clients how they experienced the interview process and narrative slope of the OPHI-II. Clients and therapists agreed that the OPHI-II interview built rapport, generated insights into the client's life experiences, and was helpful in planning goals and services and both groups generally found the narrative slope valuable. Both therapists and clients indicated the importance of tailoring the interview process and the narrative slope to each client's unique perspective and needs. Study findings both support the usefulness of the OPHI-II and provide suggestions for how it can be used most effectively.