Online occupational therapy in the caregivers of people with Multiple sclerosis: a randomized control trial

PURPOSE

Caregivers of people with Multiple sclerosis (MS) face various challenges in the occupations of daily lives. We investigated the effect of an online occupational therapy program on the mastery and performance in caregivers of people with MS.

METHOD

In a single-blind randomized controlled trial twenty-four eligible caregivers of people with MS participated in the control and an occupational therapy group program. Caregivers completed The Canadian Occupational Performance Measure (COPM) and the Relative Mastery Scale (RMS) before and after the intervention and one-month later.

FINDINGS

The level of performance, satisfaction and mastery were significantly improved in the intervention group after the intervention (p<.001) and there were significant differences in performance and satisfaction scores between the groups (p<.001).

IMPLICATIONS

Online Occupational therapy shows promising results in facilitating the adaptation process and improving caregivers' performance and satisfaction levels.IMPLICATIONS FOR REHABILITATIONCaregivers of people with multiple sclerosis face various challenges when engaging in their daily occupations.Managing the challenges faced by caregivers as essential members of the treatment team contributes to improving their performance level in daily occupations and can finally enhance the quality of treatment interventions for patients.Online delivery can overcome caregivers' time constraints for attendance in the treatment centers for training.Online occupational therapy can enhance mastery, occupational performance level, and satisfaction, and is recommended for caregivers of people with multiple sclerosis.

Psychometric evaluation of the Relative Mastery Scale: An Occupational Adaptation instrument

This study evaluated the psychometric properties of the Relative Mastery Scale (RMS). Valid and reliable client-centered instruments support practice in value-based health care and community-based settings. Participants were 368 community-dwelling adults aged 18 to 95 years. Researchers conducted validity and reliability examinations of the RMS using classical test theory and Rasch measurement model. A partial credit model allowed exploration of individual scale properties. Spearman's correlation coefficients between items were statistically significant at the .01 level. Cronbach's alpha coefficient was .94 showing strong internal consistency. In exploratory factor analysis, Factor 1 accounted for 71% of variance with an eigenvalue of 4.26. In Rasch analysis, the 5-point rating scale demonstrated adequate functioning, confirmed unidimensionality, and person/item separation. The RMS instrument demonstrates sound psychometric characteristics. A valid and reliable measure of internal occupational adaptation supports application to monitor progress of internal occupational adaptation across a variety of individuals.

Outcomes of Team-Centered, Occupational Adaptation-Based Versus Traditional Dementia Workforce Training : Résultats comparés d'une formation axée sur l'équipe et l'adaptation occupationnelle et de l'approche de formation traditionnelle pour le personnel travaillant auprès des personnes atteintes de démence

Background. Dementia workforce training aligned with Occupational Adaptation (OA) theory may facilitate teams resolving challenges in the care environment more than traditional skills-based (SB) training, although comparisons are needed. Purpose. This pilot study compared effectiveness of an OA and SB program on relative mastery and team development for dementia care teams at a continuing care retirement community. Method. In a quasi-experimental study, employees underwent nine sessions in an OA or SB program. Relative Mastery Measurement Scale and Team Development Measure results were collected pre-, mid-, post-intervention. A 3 × 2 ANOVA determined differences in group score changes across time. Findings. Data from 28 employees (14/group) showed group-by-time interaction reached statistical significance for both relative mastery (F = 3.17, df = 2, p = .05) and team development (F = 8.38, df = 2, p = .001). Implications. OA-based training may improve dementia care teams' collaborative mastery over real-world challenges. While preliminary findings inform program developers, further research must explore clinical effectiveness.

Occupational Adaptation as a Model for Intervention in Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) often presents with chronic symptoms and impacts a wide variety of areas of occupation, including activities of daily living, sleep, work, school, leisure, play, and social participation. The Occupational Adaptation theory supports practitioners in offering clients opportunities to develop internal adaptive processes to achieve relative mastery in desired occupations. The present manuscript provides a foundation for Occupational Adaptation theory as an appropriate model for intervention in POTS with specific assessments and interventions to guide occupational therapy practitioners in implementing this approach. A case study describes the use of Occupational Adaptation in the clinical intervention of a college student with POTS.

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.

Feasibility testing of the Occupational Adaptation Practice Guide

Introduction

The theory of occupational adaptation was articulated with an emphasis on client-centered and occupation-based practice. The Occupational Adaptation Practice Guide is an instrument designed to facilitate therapists’ application of this theory in evaluation and treatment planning to influence clients’ internal occupational adaptation and participation in daily life.

Method

The purpose of this study was to trial the instrument and to assess percentage of agreement and perceived feasibility of the Occupational Adaptation Practice Guide in an inpatient rehabilitation setting. Eight therapists completed the Occupational Adaptation Practice Guide according to a videoed case study for evaluation of percentage of agreement. Each therapist then administered the guide to separate clients and subsequently completed an open-ended questionnaire to assess acceptability and practicality feasibility.

Results

Percentage of agreement was 100% for motor control, perception and environmental ratings, with the cognition and psychosocial ratings each at 75%. Themes gathered from qualitative data revealed perceptions of the instrument as comprehensive and efficient.

Conclusion

The instrument was reported to be an efficient, thorough tool that facilitated the use of the theory of occupational adaptation.

The Influence of Environment on Clinical Practice: Unspoken Rules

Purpose:

The purpose of this study was to explore organisational social processes as an environmental contributor to the professional culture of practice. Occupational therapy practitioners are expected to be adaptable, responding to ever-changing demands of health care organisations. Occupational therapy students are expected to integrate into multiple settings during their practice education; however, the distinctive culture of organisations is often unspoken, making acculturation difficult.

Method:

This study examined four representative practice settings in the United States through institutional ethnography.

Findings:

Analysis revealed complex, interlaced, poorly documented social processes at immediate, local and external organisational levels. Occupational therapy practitioners revealed that these social processes influenced the ways in which they provide health services, perceive change and respond to change. They also revealed that newcomers, including practitioners and students, must learn to fit in by the sink-or-swim method.

Conclusion:

The findings of the study suggest possible changes in didactic, practical and continuing education to facilitate adaptation to increasingly complex health care systems. Further research is recommended to determine practitioner and student perceptions of hierarchical social processes, commonalities and differences of practice environments, the influence of different environments on practice, and strategies of adaptation.

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

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