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

The role and effectiveness of occupational therapy in prison rehabilitation programs: systematic review

PURPOSE

The purpose of this study was to research studies in the literature regarding the role of the occupational therapist within penitentiary facilities.

DESIGN/METHODOLOGY/APPROACH

The study design is a systematic review using five different databases.

FINDINGS

Findings can therefore ascertain the potential role of occupational therapists in penitentiary institutions because they can contribute to the rehabilitation of prisoners both inside and outside prisons with a view to their reintegration into society.

RESEARCH LIMITATIONS/IMPLICATIONS

It is necessary for clinical practice, and especially to increase the health of people within prisons, to update the occupational therapist interventions in the literature that are effective within prisons.

PRACTICAL IMPLICATIONS

According to this study, the intervention of occupational therapists in the prison setting reduces recidivism and contributes to social and work reintegration. This has positive effects in terms of costs related to incarceration.

ORIGINALITY/VALUE

Findings can therefore ascertain the potential role of occupational therapists in penitentiary institutions because they can contribute to the rehabilitation of prisoners both inside and outside prisons with a view to their reintegration into society.

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions

BACKGROUND

Chronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory.

METHODS

Realist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory.

RESULTS

Four contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client's home, skilled occupational therapists, and clients feeling ready for making changes.

CONCLUSIONS

The ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings.

TRIAL REGISTRATION

The trial was prospectively registered on www.

CLINICALTRIALS

gov (registration date: 05/03/2020; identifier: NCT04295837 ) prior to data collection that occurred between August 2020 and October 2021.

The 'process of doing' in everyday occupations - a challenge for young adults with cerebral palsy

Background: There is a lack of knowledge about how persons with cerebral palsy (CP) perceive their 'process of doing' while performing everyday occupations. As described in the Model of the Process of Doing (MPoD), performing an occupation is a complex process consisting of six phases (generate idea, plan, initiate, enact, adjust, end) and time management.Aim: To collect the experiences of young adults with CP, classified at Manual Ability Classification System (MACS) level I or II, regarding how they perceive challenges in their occupational performance in relation to the different phases of the 'process of doing'.Method: Semi-structured interviews were performed with ten participants with CP aged 19-30 years, MACS level I or II. The interview material was related to the MPoD phases using directed content analysis.Results: The participants' descriptions of how they perceived their personal 'process of doing' showed problems in all MPoD phases. All participants experienced difficulties in one or more phases, but none had difficulties in all phases. Difficulties were more frequent in some phases than in others.Conclusion/Significance: To understand the complexity of doing everyday occupations in young adults with CP, there is a need to address all phases of the 'process of doing'.

Perspectives on content and delivery of the ABLE 1.0 intervention programme

BACKGROUND

The occupational therapy intervention programme ABLE 1.0 was designed to enhance the ability to perform activities of daily living in persons living with chronic conditions. There is a need to determine if content and delivery of the ABLE 1.0 are acceptable among occupational therapists (OTs) and clients after having delivered or received the programme, respectively.

OBJECTIVES

The paper reports on evaluation of content and delivery of the ABLE 1.0 among OTs and clients. This, in terms of acceptability of intervention in principle, and perceived value, benefits, harms, or unintended consequences of the intervention.

MATERIAL AND METHODS

Qualitative semi-structured interviews were conducted with OTs having delivered and clients having received ABLE 1.0 in a Danish municipality. Content analysis was performed.

FINDINGS

Two OTs and three clients participated. Analyses revealed six categories related to content and delivery; 'Overall perception of the programme'; 'Potential for implementation'; 'Evaluation, goal setting and clarification of reasons for ADL task performance problems'; 'Intervention: compensatory solutions'; 'Format and duration' and 'Preconditions for delivery'.

CONCLUSIONS AND SIGNIFICANCE

The findings provided valuable information used for further development of the ABLE programme.

Mismatch between actual and preferred extent of telework: cross-sectional and prospective associations with well-being and burnout

BACKGROUND

This study aimed to determine whether telework mismatch, i.e., lack of fit between actual and preferred extent of telework, is cross-sectionally and prospectively associated with well-being and burnout.

METHODS

A questionnaire was sent to employees in a Swedish manufacturing company in November 2020 (baseline) and September 2021 (follow-up). It contained questions about well-being (WHO-5 Well-Being Index) and burnout (Copenhagen Psychosocial Questionnaire III), as well as the preferred extent of telework and extent of telework performed. Telework mismatch was calculated as the difference between the actual and preferred extent of telework. Change in mismatch over time was categorized as 1) less mismatch at follow-up than at baseline, 2) more mismatch at follow-up, and 3) identical levels of mismatch at baseline and follow-up. Multivariate and univariate analyses of variance were used to determine the effects of mismatch and change in mismatch over time on baseline ratings and changes in ratings of well-being and burnout. All analyses were performed with and without adjustment for age, sex, marital status, children, type of employment, commuting time and extent of telework performed.

RESULTS

The response rate was 39% at baseline (n = 928, 67% men, mean(SD) age: 45(11) years) and 60% at follow-up (n = 556, 64% men, mean(SD) age: 46(11) years). A cross-sectional association was found between telework mismatch and well-being, showing that employees who teleworked more than they would like reported worse well-being than those who teleworked less than they would like. No statistically significant association was found between telework mismatch and burnout. The ability of telework mismatch at baseline to predict changes in well-being or burnout over 10 months was small and non-significant. No association was found between change in telework mismatch over the 10-month period and corresponding changes in well-being or burnout.

CONCLUSION

Our results suggest that telework should be thoughtfully practiced in companies/organizations to avoid negative consequences for employees who already telework more than they prefer. Studies are needed to determine how long-term changes in match between preferred and actual extent of telework is associated with employee well-being, including how the association is modified by the nature of the job and the work environment.

Achieving trust in health-behavior-change artificial intelligence apps (HBC-AIApp) development: a multi-perspective guide

OBJECTIVE

Trust determines the success of Health-Behavior-Change Artificial Intelligence Apps (HBC-AIApp). Developers of such apps need theory-based practical methods that can guide them in achieving such trust. Our study aimed to develop a comprehensive conceptual model and development process that can guide developers how to build HBC-AIApp in order to support trust creation among the app's users.

METHODS

We apply a multi-disciplinary approach where medical informatics, human-centered design, and holistic health methods are integrated to address the trust challenge in HBC-AIApps. The integration extends a conceptual model of trust in AI developed by Jermutus et al., whose properties guide the extension of the IDEAS (integrate, design, assess, and share) HBC-App development process.

RESULTS

The HBC-AIApp framework consists of three main blocks: (1) system development methods that study the users' complex reality, hence, their perceptions, needs, goals and environment; (2) mediators and other stakeholders who are important for developing and operating the HBC-AIApp, boundary objects that examine users' activities via the HBC-AIApp; and (3) the HBC-AIApp's structural components, AI logic, and physical implementation. These blocks come together to provide the extended conceptual model of trust in HBC-AIApps and the extended IDEAS process.

DISCUSSION

The developed HBC-AIApp framework drew from our own experience in developing trust in HBC-AIApp. Further research will focus on studying the application of the proposed comprehensive HBC-AIApp development framework and whether applying it supports trust creation in such apps.

Facilitators and barriers to employment for persons with chronic spinal cord injury or disorder: A qualitative study framed by the person-environment-occupation model

CONTEXT/OBJECTIVE

Prolonged unemployment is common for people living with a spinal cord injury or disorder (SCI/D) and can impact negatively on quality of life. The present study examines stakeholder perspectives and experiences with the job search process in order to identify service gaps and return-to-work solutions.

DESIGN

In-depth semi-structured interviews were thematically analysed, with questions focused on factors that can help or hinder efforts to gain employment. Generated themes were then applied to the Person-Environment-Occupation (PEO) systems model of participation.

SETTING

Community-based disability service provider in South Australia.

PARTICIPANTS

Purposive sample of persons with SCI/D (n = 8) and rehabilitation professionals (n = 4).

RESULTS

Person-centred themes were strongly endorsed by both groups and focused on incentives of, and motivation for, employment. Equally important to the job search process were individual expectations and attitudes, particularly job readiness. Environmental facilitators included employers' positive attitude, although workplace discrimination remained a concern. Occupation-based barriers, rather than opportunities, were identified - namely, difficulties in SCI/D self-management, the need for timely functional assessments, and more opportunities for education, upskilling and retraining.

CONCLUSIONS

The PEO model provides a broad framework to better understand the complex return-to-work process for people with a SCI/D and, potentially, uncover tangible solutions. The suggestion is that vocational rehabilitation should go beyond skills training and include motivational support to enhance job readiness. This must be done on a case-by-case basis. There is also a need for active and covert discrimination to be addressed through employment policies. The findings will be used to develop intervention targets for a newly established vocational rehabilitation service.

Daily life coping-Helping stress-afflicted people manage everyday activities

BACKGROUND

Symptoms of stress are widespread in the working population and associated with long-term sickness absence and poor work functioning. Occupational therapy (OT)-based interventions are effective in improving return-to-work (RTW)-rates in stress-afflicted long-term sickness benefit beneficiaries (SBBs). No Danish standard on OT-RTW for stress-afflicted SSBs exists.

AIMS

To describe and evaluate the feasibility of a seven-week OT-RTW intervention for stress-afflicted SBBs.

MATERIALS AND METHODS

Daily Life Coping (DLC) utilizes peer-learning and salutogenetic perspectives to address occupational imbalances experienced by long-term SBBs. Stress-afflicted SBBs (n = 54) in the municipality of Hilleroed were enrolled. Self-efficacy and well-being were measured before and after intervention using the general self-efficacy (GSE) scale and WHO-5 Well-Being Index (WHO-5). RTW-rates were measured at one-year follow-up. Participant feedback was collected using standardized evaluation forms.

RESULTS

Following the intervention, WHO-5 improved by 13.7 ± 16.5 points and GSE improved by 4.3 ± 4.8 points. Participant feedback was positive. At one-year follow-up, employment status data were available for 51 SSBs of these 58.8% achieved employment. High post-test GSE and WHO-5 scores were associated with employment at follow-up.

CONCLUSION

DLC led to significant improvements in self-efficacy and well-being. Preliminary results indicate benefits on RTW-rates.

SIGNIFICANCE

This study provides evidence of the feasibility of DLC in a municipal setting.

Coaching-Based Teleoccupational Guidance for Home-Based Stroke Survivors and Their Family Caregivers: Study Protocol for a Superior Randomized Controlled Trial

Background

Home-based rehabilitation has been shown to be useful for stroke survivors to participate in daily life activities and return to their families. However, many home-based stroke survivors face challenges in the lack of professional guidance, rational training plans, and insufficient motivation, which will affect their rehabilitation outcomes to varying degrees. Though occupational therapy and coaching are widely recommended for stroke rehabilitation, studies that combine these two interventions via telerehabilitation in home-based rehabilitation are limited. Hence, this study will explore whether coaching-based teleoccupational guidance (CTG) will help stroke survivors and caregivers obtain satisfactory outcomes.

Methods

This single-blind (assessor), two-arm parallel superior randomised controlled trial will be conducted in the Hebei General Hospital, Shijiazhuang, China. Ninety-two participant dyads in home-based rehabilitation will be recruited and randomised to either CTG (intervention group) or a standard telerehabilitation group (control group). Participant dyads in the intervention group will follow a 6-step circle procedure and receive 12 teleoccupational coaching sessions over 3 months via WeChat. Data will be collected at baseline, after the intervention (3 months), and follow-up (6 months). The Reintegration to Normal Living Index will be the primary outcome to assess the participation of stroke survivors. Secondary outcomes will not only involve an observation of changes in activities of daily living, intrinsic motivation, motor function, and quality of life of stroke survivors but also will focus on the caregivers' perceived benefit and care burden. Discussion. This trial will assess the effects of CTG compared with standard telerehabilitation. We believe that the results of this study will add to the understanding of occupational therapy for stroke survivors in home-based rehabilitation and provide a reference for developing health policy and facilitating other chronic management. Trial Registration Number. The Chinese Clinical Trial Registry ChiCTR2200061107.

Influencing discussions and use of Neuroadvancements: Perspectives of Canadian occupational therapists

BACKGROUND: The early involvement of many actors including health professionals is identified in neuroethics and neurogovernance discussions as crucial in constructing conversations around awareness, reaction, and knowledge development pertaining to the ethical, legal, and societal consequences of neuroscientific or neurotechnological advancements (NA). Occupational Therapists (OTs) have a stake in NA; however, OTs are rarely mentioned within this context. Lifelong learning (LL) could be used to increase OTs knowledge on NA and its consequences. However, LL is rarely mentioned within neuroethics and neurogovernance discussions. OBJECTIVE: The study’s purpose is to understand the role of OTs as professionals and citizens in neuroethics and neurogovernance discussions and to examine the utility of LL processes put in place for OTs to empower OTs to contribute in a meaningful way to NA discussions. METHODS: 8 semi-structured interviews with OTs were conducted and analyzed using a directed content analysis. RESULTS: Although participants believed OTs can provide a holistic perspective to neurogovernance discussions, their knowledge on NA and its consequences is limited, and LL is not used as a tool to remain informed about such consequences. CONCLUSION: More education on NA and its consequences throughout their OT degree and through LL opportunities is warranted to facilitate their involvement.

A Study of Environmental Factors in Low Vision Rehabilitation

Healthcare has the past decades shifted from a narrow medical perspective to a more holistic, biopsychosocial perspective. Disability understood as a contextual condition constituted by the relation of the individual to their social and physical context. The disability model of the International Classification of Functions (ICF) contextualizes activity, participation, body functions and structure by including environmental and personal factors. However, illustrated by the consideration of the environmental factors as a neutral dimension, the dynamic interrelation of the individual parts of the system is rather unchartered. In 2017-2019, a lighting assessment was developed and tested on 60 participants in low vision rehabilitation. An action research project accompanied the pilot study from 2018. Ethnographic participatory observations of the low vision consultants in 15 consultations, semi-structured interviews, and a document analysis of the project material of the pilot project has been analyzed using the theoretical framework of science and technology studies. Mapping the physical environment showed a range of factors from spatial organization to luminaires and light bulbs. Moreover, in relation to specific activities, relevant factors were identified and assessed, and in the intervention adjusted to relevant personal and social factors. Identifying overlapping personal, environmental, and professional spheres illustrates the complexity of practicing rehabilitation in people's everyday lives. Acknowledging and coordinating different versions of lighting enabled low vision consultants to work across these spheres relationally. ICF was embedded in the practice of low vision consultants as a frame of reference, however, implementing this framework occurred through an assemblage of tools from different fields. The focus on lighting as an active element in low vision rehabilitation demonstrated a way to work across the personal and environmental to reduce the gap that caused disability. In everyday life, the physical environment was pivotal in the person-environment relationship and in enabling or disabling the individual. However, the physical environment was also key to the rehabilitation process, facilitating the individual's learning and change processes and reconfiguring their understanding and use of the environment. Consequently, the physical environment was not a neutral background to the other factors but rather enabling the rehabilitation and recovery processes.

Efficacy of a technology-based client-centred training system in neurological rehabilitation: a randomised controlled trial

Background

A client-centred task-oriented approach has advantages towards motivation and adherence to therapy in neurorehabilitation, but it is costly to integrate in practice. An intelligent Activity-based Client-centred Training (i-ACT), a low-cost Kinect-based system, was developed which integrates a client-centred and task-oriented approach. The objectives were (1) to investigate the effect of additional i-ACT training on functioning. And (2) to assess whether training with i-ACT resulted in more goal oriented training.

Methods

A single-blind randomised controlled trial was performed in 4 Belgian rehabilitation centres with persons with central nervous system deficits. Participants were randomly allocated through an independent website-based code generator using blocked randomisation (n = 4) to an intervention or control group. The intervention group received conventional care and additional training with i-ACT for 3 × 45 min/week during 6 weeks. The control group received solely conventional care. Functional ability and performance, quality of life (QoL), fatigue, trunk movement, and shoulder active range of motion (AROM) were assessed at baseline, after 3 weeks and 6 weeks of training, and 6 weeks after cessation of training. Data were analysed using non-parametric within and between group analysis.

Results

47 persons were randomised and 45 analysed. Both intervention (n = 25) and control (n = 22) group improved over time on functional ability and performance as measured by the Wolf Motor Function Test, Manual Ability Measure-36, and Canadian Occupational Performance Measure, but no major differences were found between the groups on these primary outcome measures. Regarding QoL, fatigue, trunk movement, and shoulder AROM, no significant between group differences were found. High adherence for i-ACT training was found (i.e. 97.92%) and no adverse events, linked to i-ACT, were reported. In the intervention group the amount of trained personal goals (88%) was much higher than in the control group (46%).

Conclusions

Although additional use of i-ACT did not have a statistically significant added value regarding functional outcome over conventional therapy, additional i-ACT training provides more individualised client-centred therapy, and adherence towards i-ACT training is high. A higher intensity of i-ACT training may increase therapy effects, and should be investigated in future research.

Trial registration: ClinicalTrials.gov Identifier NCT02982811. Registered 29 November 2016.

Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE)

INTRODUCTION

The need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council's guidance on how to develop and evaluate complex interventions, the occupational therapy programme (A Better everyday LifE (ABLE)) was developed and feasibility tested. The aim of this protocol is to report the planned design and methods for evaluating effectiveness, process and cost-effectiveness of the programme.

METHODS AND ANALYSIS

The evaluation is designed as a randomised controlled trial with blinded assessors and investigators. Eighty participants with chronic conditions and ADL problems are randomly allocated to ABLE or usual occupational therapy. Data for effectiveness and cost-effectiveness evaluations are collected at baseline (week 0), post intervention (week 10) and follow-up (week 26). Coprimary outcomes are self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)). Secondary outcomes are perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS). Explorative outcomes are occupational balance (Occupational Balance Questionnaire); perceived change (Client-Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument). The process evaluation is based on quantitative data from registration forms and qualitative interview data, collected during and after the intervention period. A realist evaluation approach is applied. A programme theory expresses how context (C) and mechanisms (M) in the programme may lead to certain outcomes (O), in so-called CMO configurations. Outcomes in the cost-effectiveness evaluation are quality-adjusted life years (EuroQool 5-dimension) and changes in ADL ability (AMPS, ADL-I). Costs are estimated from microcosting and national registers.

ETHICS AND DISSEMINATION

Danish Data Protection Service Agency approval: Journal-nr.: P-2020-203. The Ethical Committee confirmed no approval needed: Journal-nr.: 19 045 758. Dissemination for study participants, in peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

NCT04295837.

Factors Associated with Quality of Life among Caregivers of People with Spinal Cord Injury

Purpose

Often people with spinal cord injury (SCI) require help from their caregivers to carry out activities of daily living. Such assistance may affect caregiver quality of life (QoL). This study investigates the QoL and its associated risk factors among caregivers of people with SCI to find possible ways to increase their QoL. Material and Method. A convenience sample of 135 Iranian caregivers of people with SCI participated in a cross-sectional study from the Brain and Spinal Injury Repair Research Center of Tehran (BASIR), Iran, from June 2018 to October 2019. The World Health Organization's Quality of Life Questionnaire (WHOQoL-BREF), the Beck Depression Inventory-II (BDI-II), the Caregiver Burden Scale (CBS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was then applied to identify risk factors associated with caregiver QoL.

Results

Moderate to highly significant negative correlations were observed between all domains of the WHOQoL scale and subscales of the CBS and the BDI-II. After controlling for demographic and clinical variables, depression, burden, and level of injury were found to predict caregiver QoL significantly. Furthermore, QoL was lower in caregivers of people with quadriplegia than paraplegia (p < 0.05).

Conclusions

The level of injury, self-perceived caregiver burden, and depression are associated with QoL for the caregivers of people with SCI. A holistic approach incorporating caregiver training, psychological interventions, and adequate support may enable better QoL for these caregivers.

Elizabeth Casson Memorial Lecture 2020: Re-engineering truth and certainty in occupational therapy

The Elizabeth Casson Memorial Lecture is awarded on an annual basis to a member of high standing within the occupational therapy profession. The 2020 lecture was delivered by Dr Jenny Preston MBE who contested the underlying assumptions of truth and certainty by considering how we generate, create and understand knowledge within the occupational therapy profession. Through the principles of process re-engineering, Dr Preston sought to define, analyse and identify how we interpret and apply that knowledge within our broad understanding of truth to capture the impact of occupational therapy. Finally, Dr Preston attempted to design and develop a future state in which evidence and practice are entwined to create the best possible outcomes.

Occupational Therapy Management of a Moderate COVID-19 Disease Process in a Skilled Nursing Facility: A Case Report

Older adults living in skilled nursing facilities (SNFs) and long-term care facilities are particularly susceptible to the coronavirus disease 2019 virus and face unique challenges during their rehabilitation process. This case report highlights the disease and rehabilitation course of an older adult who received all of his medical and rehabilitative treatment while residing in a SNF. The occupational therapy evaluation and intervention processes, as well as the client's response to intervention, are described. The client's positive outcomes are linked directly to occupational therapy's ability to incorporate medical, physical, and psychosocial aspects into part of the interdisciplinary model of care in a SNF.

Self-determined Occupational Performance Model for Children From Economically Disadvantaged Backgrounds : Modèle de performance occupationnelle autodéterminée pour les enfants issus de milieux économiquement défavorisés

Background. Children from low-income backgrounds have a higher incidence of handwriting challenges due to the unique social and environmental stressors associated with poverty. Additionally, children from economically disadvantaged households are at risk for motor, cognitive, and social deficits, which further impact their handwriting performance. Purpose. The purpose of this paper is to propose a theoretical model that provides a holistic perspective for addressing the handwriting needs of children from low-socioeconomic backgrounds. Key Issues. The presented conceptual model is derived from the person-environment-occupation model for occupational performance and self-determination theory. These theories reciprocally complement and enhance each other, providing a foundation from which clinicians can guide evaluation and intervention. Implications. Through the use of the proposed model, evaluation and intervention focus on intrinsic motivation while considering the physical, social, and cultural impacts on a child's occupational performance. The provider connects with the child's basic psychological needs, thus improving handwriting outcomes and facilitating improved academic performance.

Personal narratives of learning self-management: Lessons for practice based on experiences of people with serious mental illness

INTRODUCTION

Clinicians are challenged to deliver self-management interventions in recovery-oriented services for individuals living with serious mental illnesses. Little is known about how people learn self-management skills and questions remain about how best to deliver support. To offer insights for delivery, this research describes the lived experiences of learning self-management and the meaning of those experiences within recovery journeys and the context of health-care delivery.

METHODS

Design followed van Manen's approach of phenomenology through an occupational therapist's lens. Using purposeful criterion sampling until saturation, 25 adults with psychosis experiences (8-40 years) from six community-based specialised mental health programs were interviewed. Conceptual maps were cocreated depicting key learning experiences, intersections with services, and recommendations. Data reduction, reconstruction and explication of meaning occurred concurrently, and multiple strategies were used to transparently support an open, iterative, reflexive process.

FINDINGS

Participants described eight essential tasks to live well, learned often serendipitously, taking up to 15-30 years to find the right combination of supports and self-management strategies to achieve what they felt was a life of quality. Self-management needs were not routinely addressed by services and extended beyond illness or crisis management while participants grappled with emotions, self-concept, relationships, and occupational issues. Participants asked providers to "teach us to teach ourselves"; "invite clients" to the decision table; and deal directly with emotions of fear, shame, and trust with respect to self and relationships. Findings challenge conventional conceptualisations of self-management to consider clients living interdependent lives with tasks performed in context, dynamically influenced by complex personal, socio-ecological relationships.

CONCLUSIONS

Participants' narratives compel increasing access to strategic personalised self-management learning opportunities as an effort to shorten the prolonged recovery paths. Findings offer ways providers can understand and address eight self-management learning tasks from the perspective of lived experiences. Self-management was enmeshed with recovery, health, and building a life.

Occupational therapy addressing the ability to perform activities of daily living among persons living with chronic conditions: a randomised controlled pilot study of ABLE 2.0

BACKGROUND

The ABLE intervention was developed to enhance the ability to perform activities of daily living (ADL) tasks among persons living with chronic conditions. ABLE is a generic, home-based, individualised, 8-week occupational therapy intervention program, developed to be delivered in Danish municipalities. In a previous study, the feasibility of ABLE was evaluated in terms of content and delivery. In this pilot study, the remaining feasibility aspects of a randomised controlled trial including (i) trial procedures (recruitment and retention), (ii) randomisation, (iii) adherence to program, (iv) feasibility of additional outcome measurements, and (iv) access to information on usual occupational therapy were evaluated.

METHODS

The study was conducted in a Danish municipality, using a two-armed parallel randomised controlled design, planning a recruitment strategy including 20 persons living with one/more chronic conditions and experiencing problems performing ADL. The following progression criteria were used to determine if a future full-scale randomised controlled trial was feasible: (i) recruitment (50% met the eligibility criteria) and retention (80%), (ii) randomisation (80% accepted randomisation, procedure was executed as planned), (iii) adherence to program (100% followed the treatment protocol), (iv) outcome measurements (80% of the participants delivered relevantly and fully answered questionnaires), and (v) usual occupational therapy (extraction of needed information was successful).

RESULTS

Due to the COVID-19 pandemic, the study was truncated resulting in limited but sufficient data to answer most of the study questions. (i) Eighteen of 37 eligible persons (48.6%) were recruited; of those treated (n = 6), all remained (100%); (ii) 18 accepted randomisation (100%), and procedure was effective; (iii) ABLE was delivered with adherence (100%); (iv) 92.3-100% of the participants gave relevant and complete answers in two of three questionnaires; and (v) needed information on usual occupational therapy was extractable in seven of nine aspects.

CONCLUSIONS

Proceeding to full-scale trial is recommendable; however, a few adjustments on outcome measurements, inclusion criteria and extraction of information on usual occupational therapy are needed.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov (Identifier: NCT04295837 ) on December 5th, 2019. Retrospectively registered.

Living with myalgic encephalomyelitis/chronic fatigue syndrome: Experiences of occupational disruption for adults in Australia

Introduction

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a poorly understood, highly stigmatised health condition that has widespread impacts on the individual. Currently, there is limited understanding of the ME/CFS experience from an occupational perspective within Australia. This study aimed to explore the lived experience of ME/CFS and subsequent disruption to occupational participation for adults living in Australia.

Methods

Using descriptive case study design, five participants with ME/CFS in Australia completed semi-structured interviews. Reflexive thematic analysis was used to analyse the qualitative data.

Findings

Themes identified were organised using the Person-Environment-Occupation model. Participants reported systemic changes to previous levels of physical, cognitive and affective functioning, resulting in significant occupational disruption and poor well-being. Occupational prioritisation was followed by a loss of occupations starting with leisure, then productivity and eventually self-care. Environmental barriers to participation included stigma and misunderstanding of ME/CFS, financial hardship, lack of appropriate health services and strains on personal support networks and relationships.

Conclusion

Changes to occupational performance following the onset of ME/CFS caused significant occupational disruption and resulted in limited participation which narrowed over time. There is a clear role for occupational therapy to intervene early to prevent significant negative impacts on occupational participation for people with ME/CFS.

Functional, work-related rehabilitative programming for cancer survivors experiencing cancer-related fatigue

Introduction

Cancer-related fatigue negatively impacts 50–90% of cancer survivors. In North America, approximately 50% of return-to-work interventions initially fail for survivors, with cancer-related fatigue often cited as a barrier to workability. Occupational therapy-driven cancer-related fatigue work-related programming for survivors is sparse, despite many published reviews calling for interdisciplinary interventions; to address work-related performance, specific functional interventions are likely to be needed. Further exploration and a broader understanding of survivors’ cancer-related fatigue management, participation in rehabilitative programmes, and plans for return to work are necessary to target survivor needs better.

Method

Drawing on social theory, this exploratory descriptive study utilised content and thematic analysis of interviews from 12 survivors to explore and describe the perspectives of survivors experiencing cancer-related fatigue yet desiring to work.

Results

Content analysis reflected distinct differences in fatigue-related terminology. Thematic analysis identified three themes specific to cancer-related fatigue and workability: valuing physical wellness, perceived cognitive impacts of cancer-related fatigue on function and workability, and the lack of transition from physical exercise to functional work-related activities.

Conclusion

Survivors identified gaps in care related to managing cognitive symptoms and the need for functional, work-related interventions to manage cancer-related fatigue. With their expertise in function, occupational therapists are well positioned to facilitate work-specific interventions, within cancer-specific exercise programming.

Feasibility of ABLE 1.0-a program aiming at enhancing the ability to perform activities of daily living in persons with chronic conditions

Background

The “A Better everyday LifE” (ABLE) intervention was developed to accommodate the need of a program addressing ability to perform activities of daily living (ADL) in persons with chronic conditions living at home. During intervention development, it is necessary to evaluate relevant aspects of the feasibility of a program. Thus, the aim was to evaluate the feasibility of content and delivery of ABLE version 1.0.

Methods

A one group pre- and post-test design was applied. Thirty persons with chronic conditions, two occupational therapists (OTs), and five occupational therapy students (OTSs) participated. ABLE 1.0 is an 8-week program consisting of ADL evaluation (session 1); goal setting and reasons for ADL problems (session 2); intervention (sessions 3–7); and re-evaluation (final session), conducted in the clients’ home-setting and local area. Sessions 1–4 and the final session was mandatory.

To evaluate the feasibility of content and delivery, the OTs, after each session, reported on applied intervention component(s), time-use, needed equipment, adjustments, meaningfulness, confidence, progress toward goal attainment, and side effects using registration forms. The clients reported on progress toward goal attainment, meaningfulness, and satisfaction. Clinically relevant improvements in ADL ability were identified using the ADL-Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS). Goal attainment was evaluated using the Goal Attainment Scaling (GAS).

Results

Twenty clients (67%) completed ABLE 1.0 and received four sessions (median = 4, range 4–7) each lasting between 30 and 94 min. Most frequently applied component was “Changing habits related to task performance”. Generally, OTs reported having the needed equipment. Deviations from the manual were made by omission of GAS and AMPS and less than mandatory number of sessions per client. The OTs reported confidence in delivering the program and the clients perceived the program as meaningful and satisfying, and experienced progress toward goal attainment. Goal attainment was found in 52% of the goals. Sixteen (80%) clients obtained clinically relevant improvements in self-reported or observed ADL ability.

Conclusions

The content and delivery of ABLE 1.0 was feasible. However, the study revealed a need to adjust the recruitment procedure and make minor changes in the intervention manual. A pilot randomized controlled trial (RCT) study is recommended.

Trial registration

The study was registered at ClinicalTrials.gov with registration no. NCT03335709 on November 8, 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00790-7.

Frailty and Life-Space Mobility: Implications for Clinical Practice and Research

Frailty is an important medical syndrome that can be prevented or treated with specific interventions. However, there is limited research evidence on multifactorial perspectives of frailty management and its impact on daily function including mobility declines and changes in life-space mobility. Using the person-environment-occupation (PEO) model we aim to describe the relationship between frailty and life-space mobility in older adults. This manuscript provides a new framework for clinical practice and research implications of frailty and life-space mobility in older adults including: (1) overview of key concepts, (2) application of the PEO model to describe how frailty (personal) and life-space (environmental) can influence occupational performance, and (3) clinical practice implications to improve frailty-related immobility. This new framework provides a starting point to extend the focus of frailty beyond the individual to encompass the environmental context within which people live and move.

Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review

Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children's functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children's perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.

Improving vocational recovery among people with psychosis: a two-pronged approach

Purpose

This paper aims to investigate the feasibility of conducting research on a two-pronged vocational intervention for people with first episode psychosis. The paper also aims to empirically examine the impact of a two-pronged vocational intervention for people with first episode psychosis by determining what effect, if any, introducing a two-pronged vocational intervention to an early intervention for psychosis service (EIPS) has on vocational outcomes using a prospective follow-up design. The approach consisted of supported employment (individual placement and support, IPS) for participants without a productive role and a job retention programme for those employed or studying.

Design/methodology/approach

Between 2010 and 2013, a supported employment specialist joined an EIPS where occupational therapy was available to all attenders. The appropriate intervention was determined by the occupational therapist on the team. Participants were interviewed at baseline and one follow-up. Ethical approval was attained. The Individual Placement and Support Fidelity Scale was used to ensure the quality of IPS implementation.

Findings

In total, 39 (20 men, 19 women) consented; 21 (54 per cent) of these participants were unoccupied; 18 (46 per cent) had a productive role; 87 per cent (n= 34) were followed up. The mean length of follow-up was 18 months. At follow-up, 50 per cent (n= 10) of unoccupied participants had attained a productive role, and 17 of the 18 participants had retained their productive role. Overall, participants were found to have spent an average of 62 per cent of the follow-up period in a productive role.

Research limitations/implications

Rates of vocational recovery among people affected by psychosis may be enhanced by a two-pronged approach that allows for the persons individual work circumstances to be taken into account.

Originality/value

This study highlights the impact of a two-progroned vocational intervention for people with first episode psychosis in Ireland. It is the first study of its kind to be published in the Republic of Ireland and the first world-wide to include a job retention element in its design.

Financial Management Activity Process: Qualitative inquiry of adults with acquired brain injury

Background.

Little is known about the financial management occupations of people living with brain injury, despite the importance of these to adult autonomy.

Purpose.

This work aims to develop a conceptual framework for financial management after adulthood acquired brain injury.

Method.

This qualitative study used grounded theory methods. Data included semistructured interviews of 10 adults living with brain injury and two close others who assist with financial management occupations. Analysis included initial and focused coding, memo writing, constant comparison, theoretical sampling of questions, and member checking.

Findings.

The Financial Management Activity Process conceptual framework describes a complex action process. This includes accounting for factors influencing financial choices and actions, and identifying and using a trusted personalized process, including using financial management strategies aligned with the constraints of factors.

Implications.

This conceptual framework may be useful to assessment and intervention development. It highlights the between-person and between-activity variability in financial management processes and strategy use.

An integrated literature review of the current discourse around universal design in the built environment - is occupation the missing link?

PURPOSE

To synthesise current literature regarding applications of universal design (UD) to built environments that promote social participation, identify areas of agreement and areas requiring further attention and development. Occupations refer to personally meaningful activities, which people need, want or must do as part of their daily life.

MATERIALS AND METHODS

Recently published literature (January 2011-December 2017) relevant to UD and built environments, and pertaining to any discipline or professional area, were identified via a systematic search of databases in the EbscoHOST platform. The person-environment-occupation (PEO) model was chosen as a theoretical framework for the review, which included a sample of 33 peer reviewed journal articles.

RESULTS

The current discourse is driven more by description, discussion, and commentary than empirical approaches; although, a combination of quantitative, qualitative, and mixed methods approaches was employed. Much of the current discourse on UD and the built environment focuses on the person and the environment, with the occupations carried out in built environments and the interaction between these domains not referred to in much detail.

CONCLUSIONS

Including occupations, social participation, multi- and trans-disciplinary collaboration, and multicultural perspectives in the ongoing discourse around UD would enable the concept to reach its full potential as a medium for social justice. Implications for Rehabilitation The universal design (UD) process must account for the occupations that people perform in the built environment. Multi-disciplinary research and development, using multiple methods, is the most appropriate approach to investigate the application of UD to the built environment. Key areas of contention within the current discourse include meaningful inclusion of non-professional stakeholders, tensions between embracing and eliminating diversity and how professional education should be delivered.

Modified motor vehicles: the experiences of drivers with disabilities

Purpose: Driving is often a rehabilitation goal of people with acquired disability, and vehicle modifications are typically required to facilitate this outcome. Though there have been several survey studies on vehicle modifications for people with disability, there has been no qualitative work on understanding people with disabilities' experiences of being a modified vehicle driver.Method: An interpretative phenomenological approach was used to understand the lived experiences of drivers with disability. Semi-structured interviews were conducted (n = 8) with drivers who used a variety of vehicle modifications from simple to highly complex. Using NVivo, Stage 1 of the coding involved case by case analysis and Stage 2 cross case analysis to identify themes that best captured drivers' experiences.Results: Four core themes were identified: knowing vs. challenging limitations, making complex driving considerations, considering undesired alternative transportation options, and responding emotionally to temporary vehicle loss. The Person-Environment-Occupation model was used as an orientating framework to discuss findings.Conclusions: This explorative small scale study highlights that less than full utilisation of modified vehicles is not a result of driver choice, but rather a complex interface between drivers' physical and psychological limitations, and physical environments that do not support the needs of drivers with disability.Implications for RehabilitationThe development of resources that identify environmental factors in public spaces (e.g., number and location of parking for people with disability, steps, slopes, ticket machines and their height and location) could support the driving choices of people with disabilities.It is important to assess psychological limitations of driving as well as physical limitations.Driving goals and driving capacity across different locations requires periodic review post-rehabilitation.More advocacy for improving community accessibility is required.

Evaluation of an intervention programme addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a feasibility trial (ABLE)

INTRODUCTION

The number of persons living with a chronic condition is increasing worldwide. Conditions are considered chronic when lasting 1 year or more and requiring ongoing medical attention and/or limiting activities of daily living (ADL). Besides medical treatment, physical exercise to improve body functions is recommended and prescribed. However, improvements in body functions do not necessarily improve ability to perform ADL. Thus, it is necessary to develop interventions aiming directly at enhancing ADL ability. As a part of the research programme 'A Better Everyday Life', the first version of the ABLE intervention programme was developed.

METHODS AND ANALYSIS

This feasibility study examine the perceived value and acceptability of the ABLE programme by evaluating the fidelity, reach, dose and potential outcomes using a pretest and post-test design involving 30 persons living with chronic conditions. Qualitative interviews among occupational therapists delivering and participants receiving the ABLE programme will be conducted to explore aspects affecting the intervention.

ETHICS AND DISSEMINATION

The results will form the base for refinement of the ABLE programme and planning of a large-scale randomised controlled trial investigating the effect of the programme on self-reported and observed ADL ability. Dissemination will include peer-reviewed publications and presentations at national and international conferences.

PROTOCOL VERSION

7 November 2017: v ersion 1.0. 19 February 2018: v ersion 2.0.

TRIAL REGISTRATION NUMBER

NCT03335709; Pre-results.

The State of the Science on Sensory Factors and Their Impact on Daily Life for Children: A Scoping Review

The objective of this study was to identify and synthesize research about how sensory factors affect daily life of children. We designed a conceptual model to guide a scoping review of research published from 2005 to October 2014 (10 years). We searched MEDLINE, CINAHL, and PsycINFO and included studies about sensory perception/processing; children, adolescents/young adults; and participation. We excluded studies about animals, adults, and review articles. Our process resulted in 261 articles meeting criteria. Research shows that children with conditions process sensory input differently than peers. Neuroscience evidence supports the relationship between sensory-related behaviors and brain activity. Studies suggest that sensory processing is linked to social participation, cognition, temperament, and participation. Intervention research illustrates the importance of contextually relevant practices. Future work can examine the developmental course of sensory processing aspects of behavior across the general population and focus on interventions that support children's sensory processing as they participate in their daily lives.

Comparing activity engagement of people aged 18 to 64 years with and without Parkinson’s disease

Introduction

Measuring activity engagement using the Activity Card Sort Australia (18–64) supports occupational therapists and clients to identify goals for therapeutic interventions. The aim of this study was to investigate activity engagement for people aged 18 to 64 years with and without Parkinson’s disease.

Method

Thirty-two participants, 16 people with Parkinson’s disease (mean age 57.8) and 16 healthy adults (mean age 53.1), were required to sort 85 visual activity cards into one of five categories: ‘never done’, ‘do not do now’, ‘do now’, ‘do less now’ and ‘given up’. The retained activity values were calculated and compared using the Mann–Whitney U Test.

Results

The overall retained activity scores were not significantly different ( p = .81); however, the group with Parkinson’s disease had higher retained scores in the physical activities domain ( p = .04)

Conclusion

The preventative exercise regimes of people with Parkinson’s disease seems to influence activity engagement patterns. A more detailed understanding of activity engagement may further help form the basis of meaningful interventions.

The caregivers' perspectives of burden before and after an internet-based intervention of young persons with ADHD or autism spectrum disorder

BACKGROUND

Everyday life in a family with a young person with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD), is multifaceted and may be a burden to the caregivers. The aim was to explore experiences of the caregiver situation, and how they were affected when the young persons received Internet-Based Support and Coaching (IBSC).

METHOD

A multiple descriptive case design was used. Ten caregivers of 10 young persons with ADHD and/or ASD participated, and completed a questionnaire, measuring caregiver burden. Three analysis methods were used; statistical analysis of the caregivers' scores, case reports and qualitative content analysis of an open question.

RESULTS

Most of the caregivers never had to provide hands-on help with primary ADL, and were able to cope with the young person's problems. The caregivers' role required patience. They had major worries about the future, when they would no longer be around to provide support. After the intervention, there was no common trajectory for all caregivers; their situation either remained unchanged, improved or deteriorated.

CONCLUSIONS

The caregiver's burden is more or less complex when the young person undergoes the transition into adulthood. The caregiver burden decreased in some families following the young person's participation in IBSC.

Development of a driving readiness program for adolescents and young adults with cerebral palsy and spina bifida

Introduction

Occupational therapists are amongst the certified driving rehabilitation specialists providing driving rehabilitation and training. This study aimed at gathering information on driving readiness in adolescents and young adults with physical and/or cognitive impairments related to cerebral palsy and spina bifida to guide the development of a driving readiness program for this clientele.

Method

A review of the scientific literature was performed. Seventy-four driving rehabilitation specialists across North America were surveyed, of whom eight were subsequently interviewed.

Results

Learner drivers with cerebral palsy and spina bifida lack the basic skills (such as information processing, visual memory, attention span) for and familiarity with community mobility and self-efficacy, often resulting in a lengthy and difficult learning process for automobile driving. The literature findings were corroborated by a survey and interview of specialized driving rehabilitation therapists. There is a therapist-driven desire to improve pre-requisite skills for driving through a driving readiness program tailored to this population’s specific needs. An outline of such a program was developed based on the person–environment–occupation model.

Conclusion

A driving readiness program may act as an important clinical tool intended to optimize pre-driving skills in adolescents with cerebral palsy or spina bifida in order to facilitate the driving training process and ensure greater community independence in this population.

Perspectives of key stakeholders about vocational training and rehabilitation in Trinidad and Tobago

Introduction

Vocational training and rehabilitation programs are effective in increasing employability and community participation of individuals with intellectual disabilities. Much of the research on effective programming has been conducted in high-income countries with resources targeted at individuals with intellectual disabilities. Although Trinidad and Tobago is a high-income country, there is a dearth of services and resources available to individuals with intellectual disabilities. This article explores stakeholder perspectives on the current status of vocational training and rehabilitation programs for individuals with intellectual disabilities in Trinidad and Tobago.

Method

Participants from diverse groups were identified through snowball sampling. Data were collected in the form of semi-structured interviews conducted in person in Trinidad and Tobago and ranging from 45 to 75 minutes in duration. Interviews followed a loose structure of open-ended questions and the person–environment–occupation model helped inform the questions.

Results

Thirty participants completed the interviews including clients, parents, teachers, principals, non-governmental organization representatives and occupational therapists. Several themes and subthemes emerged including balancing the need for inclusion and segregation, stigma, social policy, issues in current vocational services and independence and expectations.

Conclusion

Vocational services in Trinidad and Tobago face many challenges including resource shortages and meeting the varying needs of clients. They also provide important safe spaces for socialization and acceptance. Resources are needed to improve the level of current services and to help address the competing and at times contradictory goals of differing stakeholders.

Mothers of Children with Disabilities: Occupational Concerns and Solutions

Mothers of children with disabilities have identified multiple challenges associated with achieving occupational balance in their lives. Occupational therapists are just beginning to explore the occupational and time use strategies that mothers use to successfully care for their children and get through the day in a positive manner. The Person—Environment—Occupation model was used to guide an occupational therapy intervention program called “Project Bien Estar,” which was designed to increase the satisfaction, time use, and occupational performance of mothers of school-aged children with disabilities. This article focuses on the rich content of the group discussions and individual reflections, providing insight into the world of women caring for children with disabilities. Thematic analysis was used to identify person, environment, and occupation factors that contribute positively and negatively to the mothers' well-being, and the effects of the occupational therapy intervention are discussed.

Quality of Life for Individuals with Schizophrenia: Validating an Assessment That Addresses Client Concerns and Occupational Issues

This article describes the initial validation study of the Quality of Life Measure for Persons With Schizophrenia (QOLM-S). This new assessment is grounded in a holistic conceptual framework, addresses occupational issues, and was developed on the basis of qualitative data collected from individuals with schizophrenia. Data were collected from 91 individuals with schizophrenia to examine aspects of reliability and validity. Results support both the internal consistency of the QOLM-S, with a Cronbach's alpha reliability coefficient of 0.97 for the overall scale, and concurrent validity. Correlations between the domain and total scores of the QOLM-S provide initial support for construct validity. This study supports the use of the QOLM-S as a descriptive tool. Future research to enhance the clinical utility and further examine the psychometric properties of the QOLM-S are suggested.

Living with Parkinson's and the Emerging Role of Occupational Therapy

Parkinson's disease is a chronic and increasingly complex condition, demanding multidisciplinary management. Over the last twenty years or so, alongside the growth of specialist services and healthcare teams specifically developed for people with Parkinson's, occupational therapy has grown in recognition as a treatment option, especially since evidence of its efficacy is now slowly emerging. The purpose of this work is to outline the role of occupational therapy clinical practice in the management of people living with Parkinson's disease and its emergent evidence base, combined with details of current occupational therapy philosophy and process, as applicable to occupational therapy practice for people with Parkinson's. The Canadian Practice Process Framework is used to structure this overview and was selected because it is a well-recognized, evidence-based tool used by occupational therapists and encompasses the core concepts of human occupation and person-centred practice. The framework employed allows the flexibility to reflect the pragmatic occupational therapy intervention process and so enables the illustration of the individually tailored approach required to accommodate to the complex pathology and personal, domestic, and social impacts, affecting the functioning of Parkinson's disease patients on a daily basis.

Physical activity and exercise training in multiple sclerosis: a review and content analysis of qualitative research identifying perceived determinants and consequences

PURPOSE

This systematic review was conducted to provide rich and deep evidence of the perceived determinants and consequences of physical activity and exercise based on qualitative research in multiple sclerosis (MS).

METHOD

Electronic databases and article reference lists were searched to identify qualitative studies of physical activity and exercise in MS. Studies were included if they were written in English and examined consequences/determinants of physical activity in persons with MS. Content analysis of perceived determinants and consequences of physical activity and exercise was undertaken using an inductive analysis guided by the Physical Activity for people with Disabilities framework and Social Cognitive Theory, respectively.

RESULTS

Nineteen articles were reviewed. The most commonly identified perceived barriers of physical activity and exercise were related to the environmental (i.e. minimal or no disabled facilities, and minimal or conflicting advice from healthcare professionals) and related to personal barriers (i.e. fatigue, and fear and apprehension). The most commonly identified perceived facilitators of physical activity were related to the environment (i.e. the type of exercise modality and peer support) and related to personal facilitators (i.e. appropriate exercise and feelings of accomplishment). The most commonly identified perceived beneficial consequences of physical activity and exercise were maintaining physical functions, increased social participation and feelings of self-management and control. The most commonly identified perceived adverse consequences were increased fatigue and feelings of frustration and lost control.

CONCLUSIONS

Results will inform future research on the perceived determinants and consequences of physical activity and exercise in those with MS and can be adopted for developing professional education and interventions for physical activity and exercise in MS.

IMPLICATIONS FOR REHABILITATION

Physical activity and exercise behaviour in people with multiple sclerosis (MS) is subject to a number of modifiable determinants. Healthcare professionals working to promote physical activity and exercise in those with MS should choose to endorse the positive benefits of participation. Future physical activity interventions for those with MS may be improved by incorporating behavioural management strategies.