Occupation: purposefulness and meaningfulness as therapeutic mechanisms. 1995 Eleanor Clarke Slagle Lecture

Experiences of meaningful occupation among diverse populations - A qualitative meta-ethnography

BACKGROUND

Few studies synthesising knowledge about meaningful occupation are available. Meta-ethnography allows the synthesising of a variety of empirical findings and translational knowledge may be developed.

AIM

Investigate how individuals from diverse cultures and contexts experience meaningful occupation as described in qualitative research, applying meta-ethnographic approach.

MATERIAL AND METHODS

The study was based on 44 qualitative articles, selected by following a systematic procedure. Articles published between 2003-2021 were included. Studies on children, intervention and review articles were excluded. All authors conducted the analysis and synthesis, in several steps, and reached a consensus interpretation of the data.

RESULTS

Five categories explaining why and how people experienced meaning emerged. They were represented in all contextual settings. The main category was 1) Constructing identity and self-actualising throughout life. The other four categories were 2) Cultivating valued feelings 3) Spiritualising by being energised or disentangled 4) Connecting and belonging 5) Rhythmizing and stabilising by being occupied.

CONCLUSION AND SIGNIFICANCE

The synthesis provided novel insights into how people experience meaning in occupation in various contexts as part of their process of constructing identity and self-actualisation throughout life. This knowledge is valuable as expanding and nuancing the understanding of meaningful occupation.

Occupation as means and ends in paediatric occupational therapy - A systematic review

BACKGROUND

There is a lack of evidence-based knowledge in paediatric occupational therapy about the effectiveness of interventions using daily activities as a treatment modality in improving children's participation.

OBJECTIVE

This study aimed to evaluate the effectiveness of occupation-based and occupation-focused interventions in improving participation in everyday occupations for young children with a disability.

MATERIAL AND METHODS

A systematic review based on Joanna Briggs Institute methodology and critical appraisal tools was conducted. Six databases were searched for quantitative intervention studies aimed at improving participation in everyday occupations of young children with a disability through the use of everyday occupation.

RESULTS

The search yielded 3732 records, of which 13 studies met inclusion criteria. Ten studies met methodological quality criteria and were included in the synthesis, five randomised controlled trials and five quasi-experimental studies, involving a total of 424 children with a mean age of 6.5 years. The studies were classified into cognitive (n = 5), context-focussed (n = 2) and playgroup interventions (n = 3). Study quality ranged from low to moderate, only one study was rated high quality.

CONCLUSIONS AND SIGNIFICANCE

Occupation-based and occupation-focused interventions may have a positive effect on participation in everyday occupations for young children with a disability, but study design, risk of bias and insufficient reporting limit confidence in the body of evidence.

What are the views of musculoskeletal physiotherapists and patients on person-centred practice? A systematic review of qualitative studies

PURPOSE

There is a growing expectation of physiotherapists to adopt a person-centred approach to their practice. Person-centredness for musculoskeletal physiotherapy, however, remains an under-researched area. A synthesis of the findings from qualitative studies exploring perceptions of person-centredness in musculoskeletal physiotherapy was conducted to inform future clinical practice.

METHODS

ENTREQ and PRISMA guidelines were used to develop a protocol for a qualitative systematic review registered with PROSPERO (registration number: CRD42020170762). Five electronic databases were searched to identify relevant primary studies. Studies were assessed for quality and data extracted. Data were analysed using thematic synthesis.

RESULTS

A total of 3250 studies were identified and screened. Nine studies met the inclusion criteria. Four main themes emerged from the data: treating each patient as a unique person, the importance of communication for achieving a therapeutic alliance, necessary physiotherapist traits for person-centredness, and supporting patient empowerment.

CONCLUSION

Empowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment, with clinical bravery recognised as a specific person-centred physiotherapy trait able to facilitate this. Physiotherapists should also consider the meaningfulness of any treatment activities they provide to maximise the person-centredness of their approach.IMPLICATIONS FOR REHABILITATIONEmpowerment of patients in musculoskeletal physiotherapy contexts might be improved through a more narrative approach to assessment.Clinical bravery is a person-centred physiotherapy trait that facilitates certain conversational freedom to elicit the true patient narrative.Person-centred physiotherapists should reflect on how meaningful their treatment activities are for individual MSK outpatients.

Evaluation of an inpatient occupation-based group program using a process evaluation framework

INTRODUCTION

Occupation-based groups are used in inpatient rehabilitation to enhance delivery and intensity of intervention; however, little research is available to understand their effectiveness. The aim of this study was to examine the process of an occupation-based group to understand mechanisms and success factors.

METHODS

A mixed methods process evaluation using an evidence-based framework guided implementation and analysis. Participants were those involved in the 'LifeSkills' group run daily in an adult inpatient general rehabilitation ward. Quantitative administrative data, goal achievement outcome measures, group observations and qualitative semistructured interviews were conducted.

RESULTS

Thirty participants were recruited. Factors for success included consistency in group structure and support, using meaningful practise opportunities and facilitating a real-world experience. There was no significant relationship between patient outcomes and dose of training or patient demographics.

CONCLUSION

This evaluation contributes to a growing body of evidence for incorporating occupation-based approaches into rehabilitation and offers insights into practice implementation.

Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health

Background

Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks.

Objectives

The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength.

Methods

In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation.

Results

60 patients with a history of spinal cord injury (SCI) (n = 42; 59%), stroke (n = 25; 34%), traumatic brain injury (TBI) (n = 4; 6%), and reason unknown (n = 1; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care (n = 131; 41%), domestic life (n = 68; 21%), and mobility (n = 58; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown.

Conclusion

Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.

Effects of Meaningful Action Observation Therapy on Occupational Performance, Upper Limb Function, and Corticospinal Excitability Poststroke: A Double-Blind Randomized Control Trial

Introduction

Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes.

Method

A randomized control trial was designed to compare between experimental (n = 13) and control groups (n = 14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects.

Result

Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p ≤ 0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p = 0.03) and satisfaction (p = 0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p ≥ 0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p = 0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments.

Conclusion

Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.

Exploring Patient Outcomes After Participation in an Inpatient Occupation-Based Group: A Longitudinal Observational Cohort Study

IMPORTANCE

Occupation-based interventions are used during inpatient rehabilitation, and group models may enhance intervention delivery. However, little is known about the impact of occupation-based groups on patient outcomes.

OBJECTIVE

To examine the effect of an occupation-based group on patient outcome measures of instrumental activities of daily living (IADL) skills over time and explore demographic differences among patients.

DESIGN

Longitudinal observational cohort study with four time points: preintervention, postintervention, 30-day follow-up, and 90-day follow-up.

SETTING

Tertiary hospital general rehabilitation ward.

PARTICIPANTS

Inpatient adults age 18 or older recruited using consecutive sampling from those referred to the group.

INTERVENTION

The LifeSkills group, which focused on repetitive practice of meaningful occupation-based activities.

OUTCOMES AND MEASURES

Demographic data were obtained, and the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling, Lawton IADL scale, and a self-efficacy scale were administered at each data point.

RESULTS

Thirty people (21 women, 9 men; ages 35-91 yr) participated, with 5 lost to follow-up. A statistically significant increase in scores postintervention occurred on all measures and was also seen at 90-day follow-up for COPM occupational performance, satisfaction, and self-efficacy scores. Lawton IADL scale scores at follow-up were lower than those at preintervention and statistically significant. No significant differences were found for age and diagnosis.

CONCLUSIONS AND RELEVANCE

Positive patient outcomes of goal achievement, occupational performance, satisfaction, and self-efficacy were seen at discharge, with evidence of sustainability over time. This could be a resource alternative for addressing skill retraining because people with different diagnoses and in different age groups benefited equally. What This Article Adds: Occupation-based group programs have encouraging application in general inpatient rehabilitation for addressing patient outcomes.

Development and Validation of Occupation Based Practice Measure (OBPM)

Background. Occupation based practice (OBP) is the central core of occupational therapy. Therefore, measuring its usage and influencing factors seems necessary. Purpose. To develop and validate the occupation based practice measure (OBPM). Method. OBPM was developed in two phases: (I) following a qualitative study, a literature review was conducted. The item pool was revised by expert panel; (II) The face, content, construct validity, internal consistency, and test-retest reliability were assessed. Findings. The 142 items derived through the qualitative study were integrated with the 42 items derived from the literature review. The item pool was reduced by expert panel to 78 items and finalized to 37 items through face, content, and construct validity. Cronbach's alpha was greater than 0.70 and intra-class correlation coefficient showed good to excellent reliability. Implications. OBPM is a valid and reliable questionnaire that evaluates the occupational therapists' knowledge, attitudes, interest, usage, and contextual factors influencing the OBP.

Perspectives and Influences on Occupation-Based Hand Therapy

Background. Occupational therapists practicing hand therapy are challenged to implement occupation-based practices (OBPs) due to the strong influence of the medical model. Purpose. To explore hand therapists' perceptions of OBP and describe occupation-based interventions (OBIs) in hand therapy. Method. Qualitative content analysis (QCA) was used to analyze semi-structured interviews with seven hand therapists. Findings. Six themes emerged: (1) OBP denotes treatment that is customized to ensure individual meaningfulness to each client; (2) the client-therapist relationship is a foundational element central to OBP in hand therapy; (3) goal setting serves as an important link between biomechanics and occupation; (4) OBP in hand therapy encompasses a spectrum of both OB and non-OB interventions; (5) various contextual factors influence OBI; (6) advanced experience in hand therapy facilitates enactment of tailored OBI. Implications. Comprehension of multiple aspects of occupation-based methods in hand therapy exemplifies best practices for clinicians to benefit clients and the profession's identity.

Establishment of Reliability of the Occupation-Based Practice Assessment

The profession's foundational construct; occupation, is therapeutically effective, but there remains inconsistent use as a therapeutic medium. A psychometrically strong tool can measure and maximize the use of occupation. This study establishes preliminary psychometric properties of the Occupation-Based Practice Assessment (OBPA). This methodological study tested inter-rater reliability using simulated video cases to examine the OBPA. Overall reliability was acceptable with at .868. All subsections were acceptable including Meaning and Purposeful Occupation (.871), Therapeutic Intent (.819), and Engaged Participation (.807). Two items, Context (.946) and Actual Doing (.981), demonstrated excellent reliability; while three items, Meaning (.747), Adaptation (.799), and Participation (.735), fell slightly below the acceptable level. Preliminary investigation of the OBPA reveals acceptable inter-rater reliability and suggests potential for use following additional in-vivo testing to measure therapeutic interactions to enhance student learning, optimize clinical practice, facilitate professional development, evaluate programs, and quantify occupation-based practice in research.

Tailoring to support digital technology-mediated occupational engagement for older adults - a multiple case study

Background: With the evolution of contemporary occupations mediated by digital technologies (DTs), there is a need for occupational therapists to develop and structure knowledge on how to support older adults' engagement in occupations and social participation in a digitalised society.Objective: The objective of this study is to explore how tailoring to support older adults' engagement in DT-mediated occupations could be schematised.Material and methods: The study employed a multiple case study methodology. There were nine cases, with each case involving an older adult undergoing a collaborative process to support engagement in DT-mediated occupations. The collaborative process was initiated through questionnaires, observations, and dialogues. Meetings and tailoring strategies were documented in fieldnotes and memos on tailoring, respectively. Semi-structured interviews concluded data collection. Cross-case synthesis was used in data analysis.Results: The result is a proposed scheme for tailoring to support older adults' engagement in digital technology-mediated occupations, wherein strategies undertaken in the collaborative processes were synthesised and described.Conclusion and significance: The proposed scheme for tailoring could contribute to occupational therapists' knowledge on how to support older adults' engagement in contemporary occupations. Testing the model in various practice settings is recommended in order to enhance occupational therapy practice.

Occupation-based group programs in the inpatient hospital rehabilitation setting: a scoping review

PURPOSE

Occupation-based practice involves the inclusion of meaningful occupations in the therapeutic process and is promoted within hospital-based general rehabilitation contexts for individual clients or within a group setting. The purpose of this paper is to summarise the current literature regarding the types of occupation-based group programs used within general inpatient rehabilitation and the reported outcomes.

METHODS

A scoping review was conducted and included papers if they described an occupation-based intervention, delivered in a group setting, conducted in an inpatient rehabilitation hospital context, with an adult population. Studies were collated, summarized and key findings are presented.

RESULTS

Ten articles met inclusion criteria. The results indicate that occupation-based groups are used in inpatient rehabilitation across a variety of settings, the approach is valued by the occupational therapy profession and it appears to have an influence on patient satisfaction and experience. However, the impact on a patient's confidence and occupational performance outcomes post-inpatient rehabilitation remains unclear.

CONCLUSIONS

There is a dearth of evidence on the impact of occupation-based group service focus in the inpatient rehabilitation setting. Considering the importance of occupation to the profession, further investigation into the use of this approach in a group setting is required.Implications for rehabilitationOccupation-based groups are used in inpatient rehabilitation to achieve more therapy time but there is variability in group processes and outcomes measured.Patient centred occupation-based groups appear to have an influence on patient satisfaction and experience.For the occupation-based groups reviewed, providing explicit links between patient goals, therapeutic activity and real life was important for improving outcomes.There is a growing focus for the use of occupation-based groups in occupational therapy and more research is needed to establish effectiveness.

Occupational Therapy Practice Framework: Domain and Process—Fourth Edition

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

The use of augmented reality for rehabilitation after stroke: a narrative review

PURPOSE

To explore research relating to the use of Augmented Reality (AR) technology for rehabilitation after stroke in order to better understand the current, and potential future application of this technology to enhance stroke rehabilitation.

METHODS

Database searches and reference list screening were conducted to identify studies relating to the use of AR for stroke rehabilitation. These studies were then reviewed and summarised.

RESULTS

Eighteen studies were identified where AR was used for upper or lower limb rehabilitation following stroke. The findings of these studies indicate the technology is in the early stages of development and application. No clear definition of AR was established, with some confusion between virtual and augmented reality identified. Most AR systems engaged users in rote exercises which lacked an occupational focus and contextual relevance. User experience was mostly positive, however the poor quality of the studies limits generalisability of these findings to the greater stroke survivor population.

CONCLUSION

AR systems are currently being used for stroke rehabilitation in a variety of ways however the technology is in its infancy and warrants further investigation. A consistent definition of AR must be developed and further research is required to determine the possibilities of using AR to promote practice of occupations in a more contextually relevant environment to enhance motor learning and generalisation to other tasks. This could include using AR to bring the home environment into the hospital setting to enhance practice of prioritised occupations before returning home.IMPLICATIONS FOR REHABILITATIONThere is a developing body of evidence evaluating the use of various forms of AR technology for stroke rehabilitation.User motivation and engagement in rehabilitation may improve with the use of AR.A clear and consistent definition for AR must be developed.Ongoing work could explore how AR systems support engagement in, and promote motor learning that links to, meaningful occupations.

ICT-Based Health Care Services for Individuals with Spinal Cord Injuries: A Feasibility Study

In the Republic of Korea, 90.5% of those living with spinal cord injury (SCI) are faced with medical complications that require chronic care. Some of the more common ones include urinary tract infections, pressure sores, and pain symptomatology. These and other morbidities have been recognized to deteriorate the individual's health, eventually restricting their community participation. Telerehabilitation, using information and communication technology, has propelled a modern-day movement in providing comprehensive medical services to patients who have difficulty in mobilizing themselves to medical care facilities. This study aims to verify the effectiveness of health care and management in the SCI population by providing ICT-based health care services. We visited eight individuals living with chronic SCI in the community, and provided ICT-based health management services. After using respiratory and urinary care devices with the provision of home visit occupational therapy, data acquisition was achieved and subsequently entered into a smart device. The entered information was readily accessible to the necessary clinicians and researchers. The clients were notified if there were any concerning results from the acquired data. Subsequently, they were advised to follow up with their providers for any immediate medical care requirements. Digital hand-bike ergometers and specialized seating system cushions are currently in development. The ICT-based health care management service for individuals with SCI resulted in a favorable expected level of outcome. Based on the results of this study, we have proposed and are now in preparation for a randomized clinical trial.

Occupational therapists’ experiences and perspectives towards occupation-based practice in Thailand: A mixed-methods study

Introduction

Occupation-based practice is a core tenet of occupational therapy. This study explores perspectives and experiences with occupation-based practice among Thai occupational therapists.

Method

Using mixed methods, a focus group was conducted with eight occupational therapists, and the results were interpreted using thematic analysis. A questionnaire survey was also completed concerning practitioner perspectives ( n = 216).

Findings

Three major themes were identified: (a) perspectives on occupation-based practice were related to practice areas and felt to strengthen the identity of occupational therapy (52% strongly agree), leading to improved services and better outcomes for clients (44% strongly agree); (b) approaches focused on activities of daily living were appropriate for cross-practice areas; and (c) occupation-based practice is consistent with integrated medical sciences and occupations for clients (52% strongly agree).

Conclusion

Implementing occupation-based practice will be of value to clients, provide benefits as a compass to direct processes, and enhance clinical reasoning and outcomes.

Determining whether occupational therapy goals match between pairs of occupational therapists and their clients: a cross-sectional study

PURPOSE

This study examined the degree to which goals perceived by occupational therapists (OTs) matched those perceived by their clients.

METHODS

A total of 100 clients and 79 OTs were recruited from seven subacute rehabilitation wards in Japan. Matched pairs of OTs and their clients were independently asked for their perception about the clients' occupational therapy goals through semi-structured interviews.

RESULTS

Collectively, the OTs reported 239 goals, while the clients reported 161 goals. While both the OTs and the clients reported a high level of client engagement in the goal setting process, 79% of the goal statements were mismatched between pairs of OTs and their clients. Goal matching was slightly better for goals about activities of daily living or participation than for goals about body structure or body function.

CONCLUSIONS

Although most OTs and their clients perceived that they engaged in goal-setting together, only 21% of reported goals actually matched between OTs and clients. It would also be worth investigating whether there is any correlation between the content of goals, patient engagement in goal setting, degree of goal matching, and health outcomes achieved by clients following discharge from rehabilitation services.Implications for rehabilitationAlthough most occupational therapists (OTs) and their clients perceived that they engaged in goal-setting together, 79% of the goals independently reported by OTs and their clients did not match in seven post-acute rehabilitation wards across Japan.Goals were slightly more likely to match if the topic of the goals related to instrumental activities of daily living or participation (30.3%) or basic activities of daily living (24.7%) than if the topic of the goals were about body structure or body function (11.2%); however, the overall rate of goal matching was low.Japanese OTs need to develop more effective methods for recording or communicating goals in ways that clients can understand; this may be the same for other countries.

Thinking While Moving or Moving While Thinking - Concepts of Motor-Cognitive Training for Cognitive Performance Enhancement

The demographic change in industrial countries, with increasingly sedentary lifestyles, has a negative impact on mental health. Normal and pathological aging leads to cognitive deficits. This development poses major challenges on national health systems. Therefore, it is necessary to develop efficient cognitive enhancement strategies. The combination of regular physical exercise with cognitive stimulation seems especially suited to increase an individual's cognitive reserve, i.e., his/her resistance to degenerative processes of the brain. Here, we outline insufficiently explored fields in exercise-cognition research and provide a classification approach for different motor-cognitive training regimens. We suggest to classify motor-cognitive training in two categories, (I) sequential motor-cognitive training (the motor and cognitive training are conducted time separated) and (II) simultaneous motor-cognitive training (motor and cognitive training are conducted sequentially). In addition, simultaneous motor-cognitive training may be distinguished based on the specific characteristics of the cognitive task. If successfully solving the cognitive task is not a relevant prerequisite to complete the motor-cognitive task, we would consider this type of training as (IIa) motor-cognitive training with additional cognitive task. In contrast, in ecologically more valid (IIb) motor cognitive training with incorporated cognitive task, the cognitive tasks are a relevant prerequisite to solve the motor-cognitive task. We speculate that incorporating cognitive tasks into motor tasks, rather than separate training of mental and physical functions, is the most promising approach to efficiently enhance cognitive reserve. Further research investigating the influence of motor(-cognitive) exercises with different quantitative and qualitative characteristics on cognitive performance is urgently needed.

A Bibliometric Analysis of Highly Cited and High Impact Occupational Therapy Publications by American Authors

A bibliometric analysis was completed of peer-reviewed literature from 1991-2015, written by American occupational therapists, to examine US high impact scholarship with "occupational therapy" and "occupational therapist(s)" used as keywords to search journal articles' publication title, abstract, author details, and keywords. Results included 1,889 journal articles from 1991-2015 published by American occupational therapists as first or corresponding author. Sixty-nine articles attained a TotalCitation₂₀₁₅ ≥ 50 and 151 attained a Citation₂₀₁₅ ≥ 5 indicating that they were the most highly cited literature produced in this period. Although the majority (58%) of this literature was published in occupational therapy-specific journals, 41% was published in interdisciplinary journals. Results illustrate that the volume of highly cited American occupational therapy peer-reviewed literature has grown over the last two decades. There is need for the profession to strategize methods to enhance the publication metrics of occupational therapy-specific journals to reduce the loss of high quality publications to external periodicals.

The effect of an equine assisted therapy (EAT) programme on children’s occupational performance – a pilot study

Purpose

Equine-assisted therapy (EAT) uses the horse and its environment to achieve therapeutic goals as designed by an allied health professional (Taylor, 2010). The benefits of these interventions affect areas such as motor skills (Bass et al., 2009; Silkwood-Sherer et al., 2012), sensory processing (Ward et al., 2013), learning, social interaction and socioemotional development (Bracher, 2000). It was felt that occupational therapists could offer valuable input in this area. This paper aims to investigate the impact of a specific six-week EAT programme on six participants’ occupational performance.

Design/methodology/approach

Mixed methods were used in this pilot study, consisting of a pre- and post-design with two follow-up periods. Participants were aged between 5 and10 years with a diagnosis of a visual impairment, and some had additional diagnoses. The Canadian Occupational Performance Measure (COPM) was administered to parents pre-programme, post-programme and approximately six week after the programme ceased. Additional information from notes that contained children’s and parents’ reports was analysed thematically.

Findings

Five of the six children were rated as having clinically significant changes in their occupational performance. Analysis of parents’ and children’s reports on their experience of the programme showed the main themes to be: peer interaction, taking on new challenges, feelings towards EAT and change.

Originality/value

Although there are many practitioners of EAT in Ireland, there is little research, and none was found in relation to the role of occupational therapists within this context. These results indicate that EAT may be effective in assisting some children to reach a variety of goals. This pilot study not only suggests that EAT is worth further research but also begins to explore the role of occupational therapy in this form of intervention.

Application of Nonlinear Dynamics Theory to Neuro-Occupation: A Case Study of Alcoholism

Nonlinear dynamics systems theory, also referred to as chaos theory, is infiltrating the biomedical and social sciences, including the practice of occupational therapy. Consequently, the Neuro-occupation model has emerged for the treatment of different illnesses, in which a therapist strives to apply the benefits of this theory. This model provides occupational therapists with a method of anticipating the natural flux between underlying or hidden order and chaos in occupations, which allows individuals to function at their highest level. These occupations typically involve the interaction of numerous variables over time. By considering a nonlinear dynamics approach in illnesses such as alcoholism, occupational therapists may understand how meaningful occupations serve as a catalyst to facilitate change, which may assist in better understanding the effect of the therapeutic relationship with the clients they serve. This paper explains the nonlinear dynamics of the interventions in a single case study on alcoholism using the Neuro-occupation model.

Some Factors influencing Occupational Engagement for People with Schizophrenia Living in the Community

With the emergence of occupational science, there has been renewed interest in the health benefits of occupational engagement and a call for more research into the occupational nature of humans. Engaging in occupations is known to have a positive effect on an individual's health and sense of wellbeing. A common feature of people with schizophrenia, however, is a decrease in volition and a reduction in the occupations performed. This study explored some of the influences on occupational engagement for people with schizophrenia living in the community.

A qualitative approach was chosen, using semi-structured interviews. Four male and four female participants, aged 23 to 49 years, described the influences on their occupational engagement. Content analysis, primarily using coding and memoing, was employed to categorise the data. Four main themes emerged: health, routine, external factors and internal factors. Some specific factors identified within these themes were medication, daily schedules, staff, family, work, self-concept and challenges. The implications of the results are discussed, with particular reference to assisting occupational therapists to enable clients with schizophrenia to engage more successfully in occupations.

The Impact of an Allotment Group on Mental Health Clients' Health, Wellbeing and Social Networking

The needs of people with serious mental health problems are frequently not met by services and service users' difficulties are further compounded by social isolation and exclusion. Clients attending a community mental health team horticultural allotment group described the importance that they attached to social contact in the group. This study aimed to develop an understanding of how this experience came about so that it could be harnessed more effectively.

A qualitative approach was used to explore the subjective experience of meaning that had underpinned regular attendance by nine group members. Qualitative interviews and a focus group generated data, which were examined in the light of concepts drawn from the literature on therapeutic horticulture, social networking and meaning in occupation. The participants described the restorativeness of the allotment setting, a resurgent destigmatised identity and attachment to a highly valued social network. The study concludes that there are particular qualities of the plant-person relationship that promote people's interaction with their environment and hence their health, functional level and subjective wellbeing. The embeddedness of allotments within communities means that they have great potential as media for occupational therapy and as mechanisms for social inclusion.

Sexuality and Disability: A Case of Occupational Injustice

Sexuality is an integral part of human life; however, people with disabilities often report an unsatisfying sexual life. The aim of this study was both to explore the reasons for the reported unsatisfying life and to reframe it in terms of occupational injustice and denial of participation in meaningful occupation.

In-depth interviews were carried out with six men with a spinal cord injury. Thematic analysis was applied to the data and formed the basis for the textural description of the participants' experiences.

The study participants generally found that certain societal beliefs and attitudes had an impact on their participation in sexuality-related occupations. They were experiencing occupational injustice as a result of the restriction of engagement in meaningful occupation. Impairment per se was usually not perceived as a barrier to a fulfilling sexual life.

The study concluded that occupational therapists should embrace occupational justice as the main purpose of the profession and include issues of sexuality in their agenda.

‘Baking Gives You Confidence’: Users' Views of Engaging in the Occupation of Baking

The quality of care in acute inpatient areas has been identified as unacceptable and, in some areas, as counter-therapeutic (Sainsbury Centre for Mental Health 1998). Occupational therapy continues to make a significant contribution within this practice area. However, specific research that has addressed the acute service user's perspective of engagement in occupation is limited.

This qualitative study explored 12 mental health service users' perspectives of engagement in the occupation of baking through a semi-structured interview. The findings identified that the opportunity to acquire new skills and, importantly, confidence while producing an end product stimulated the participants to attend the treatment session. The engagement in baking was also influenced by the participants' desire to add structure to their daily routine.

The study concludes that the physical and social environment in which the therapy takes place is a powerful motivating factor in facilitating individuals to participate in an occupation. The findings emphasise the importance of engagement in occupations, in conducive settings that meet the individual's needs. The study highlights that baking has many recognisable benefits for service users, offering a flexible and valued occupation.

The Importance of Maintaining a Focus on Performance Components in Occupational Therapy Practice

Some authors have promoted the need for occupational therapists to prioritise occupation over performance components in their clinical work (Fisher 1992, Mathiowetz 1993, Trombly 1995, Baum and Law 1997, Fortune 2000, Molineux 2004). Nevertheless, there is a strong case to be made for maintaining concurrently a focus on performance components. This case is based on a review of relevant literature, which yielded three ways in which performance component functioning could be used to enhance a person's experience of occupational therapy. It is concluded that there is a sound rationale for maintaining a dual focus on occupational performance and performance components in occupational therapy practice.

Standardised Tests: An Appropriate Way to Measure the Outcome of Paediatric Occupational Therapy?

The advent of clinical governance has refocused clinicians on the need to use evidence-based practice, one aspect of which is the identification and measurement of intervention outcomes. Paediatric occupational therapists have traditionally used a variety of standardised tests in their practice and these are often cited as the means by which treatment outcomes are evaluated. However, the tests most frequently used may not be the most appropriate measures of the outcome of occupational therapy.

This paper explores some of the issues surrounding outcome measurement in the field of paediatrics and highlights aspects of outcome measurement requiring further clinical and research consideration. It is suggested that there is a need to develop a conceptual framework for outcome evaluation which is both consistent with the occupational focus of practice and uses outcome tools that are objective, useful and appropriate.

Neuro-Occupation: The Nonlinear Dynamics of Intention, Meaning and Perception

This paper suggests revisiting and re-exploring the concepts of intention, meaning and perception through neuro-occupation, which theoretically operationalises nonlinear brain dynamics and occupation. A review of theory and research suggests that intention, meaning and perception are instrumental in understanding the client's unfolding life experiences through a self-organised process.

In describing the organisation of the nonlinear dynamics of brain activity, it becomes apparent how intention, meaning and perception are the fundamental components of how human beings create meaning by engaging in self-directed and self-determined actions; hence, occupations. Through a fresh point of view and an improved understanding of the concepts of intention, meaning and perception, occupational therapy and occupational science may find common ground to integrate many diverse approaches into a more unified field.

Distinguishing between Occupation, Purposeful Activity and Activity, Part 1: Review and Explanation

Part 1 of this article explores how occupational therapists use the terms occupation, purposeful activity and activity. A literature review of the topic is presented, followed by a personal reflection and definition. It is hoped that this will provide an illustrative example of how the terms could be used and may assist occupational therapy students and occupational therapists to appreciate the potential differences. It is suggested that the terms occupation and purposeful activity should be used to reflect more accurately what occupational therapists do in their professional practice.

Sexuality and Occupational Therapy: Exploring the Link

Holism is perceived to be one of the major tenets of occupational therapy. This article discusses the relevance of sexuality to holistic health care and contributes to the continuing discussion regarding the legitimacy of sexuality as an area of concern for occupational therapists. Sexuality is an important part of the human experience and is linked closely with spirituality. However, it is often neglected by occupational therapists.

The article explores the occupational nature of sexuality and demonstrates its connection with the core concept of occupation. Moreover, considering the importance of spirituality in holistic care, the article also presents an overview of the relationship between sexuality and spirituality and illustrates sexuality as a dynamic identity component. It is proposed that occupational therapists should recognise sexuality and its importance in the individual's life and incorporate it into therapy.

An Evaluation of the Clinical Use of the Assessment of Motor and Process Skills with Children

This article reports on the use of the Assessment of Motor and Process Skills (AMPS) within a community paediatric occupational therapy service. The AMPS is a widely used observational assessment of functional ability for people from 3 years of age. There is extensive evidence of its validity and reliability, but there has been little published on its clinical use with children. This article describes the application of the AMPS as the first part of an audit in a service to children over a period of 15 months. The clinical utility of the AMPS is discussed.

Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial

STUDY DESIGN

Randomized Controlled Trial (RCT).

INTRODUCTION

Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations.

PURPOSE

The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries.

METHOD

A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group.

RESULTS

Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group.

CONCLUSION

This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.

Text messages reduce memory failures in adults with brain injury: A single-case experimental design

Introduction

This study evaluated the efficacy of a low-cost reminder system to support prospective memory after traumatic brain injury and identified factors that contributed to the outcome.

Method

Two single-case experimental designs with multiple baselines across activities are described. Participants presented moderate-to-severe cognitive impairments in one case and post-concussion syndrome in the other. Both reported memory problems in everyday activities. Target activities were selected using the Canadian Occupational Performance Measure. Participants were taught how to send reminders through Google Calendar to their mobile phones.

Results

The Canadian Occupational Performance Measure showed improved self-perception of performance and satisfaction levels. Using non-overlap of all pairs statistical analysis, most, but not all, target activities showed statistically significant improvement, with non-overlap ranging from 47% to 98%. Adjustments in the use of the reminders based on each participant’s activities and cognitive abilities were required in order to maximise the benefits.

Conclusion

The reminder system was effective in increasing the frequency of completion of routine activities of daily living. To increase the effectiveness of ubiquitous technology in supporting cognition after brain injury, several factors co-existing with cognitive problems should be taken into account.

The Extent Dynamic Standing Endurance is Effected When CVA Subjects Perform Personally Meaningful Activities Rather Than Nonmeaningful Tasks

This study addressed the question of whether personally meaningful goal-directed therapeutic activities for post-CVA subjects would facilitate greater improvements in their dynamic standing endurance as opposed to the use of activities that are not personally meaningful. The study involved six elderly subjects residing in a nursing home who were diagnosed with post CVA and consented to participate in the study. The subjects were given therapy three times a week for four weeks. Their time in standing was recorded for each meaningful and nonmeaningful task performed. Results of the study indicated that the subjects showed a statistically significant increase in standing time with personally meaningful activities versus nonmeaningful tasks.

Enhancing Occupational Performance through Occupationally Embedded Exercise: A Meta-Analytic Review

Occupation or purposeful activity is the unique historical root of occupational therapy and is thought to enhance health and prevent disability. Nelson's (1988) recent conceptual framework of occupation consolidates the beliefs of occupational therapy. One focus for empirical research and theoretical inquiry is the relationship between occupational form and occupational performance. This article critically analyzes this important part of the Nelson model and meta-analytically summarizes findings of the empirical studies that have examined this relationship. Results of the meta-analysis showed a substantial relationship of occupational form to occupational performance (weighted mean effect size r=0.50) in support of the proposition of the Nelson model that occupation can be analyzed in terms of the relationship between occupational form and occupational performance. The impact of potential moderators on the study findings is explored. Implications for occupational therapy theory and practice are discussed.

Introducing purposeful activity kits in a hand rehabilitation practice: Effects on clinical practice patterns and job satisfaction among occupational therapy practitioners

Introduction

Facilitating function through occupation and purposeful activity is the basic tenet of occupational therapy. However, the majority of research in hand rehabilitation clinics continues to focus on biomechanical interventions. The purpose of this research was to study practice patterns and personal opinions of occupational therapy practitioners before and after providing purposeful activity kits to an outpatient occupational therapy hand clinic.

Methods

Mixed-method design to evaluate an 8-week intervention of providing purposeful activity kits to a busy, military outpatient hand clinic. A paper survey was administered to nine occupational therapy practitioners before and after the intervention. Qualitative data were gathered through semi-structured interviews.

Results

A descriptive analysis indicated an increase in the use of activities, crafts, and occupation after the introduction of the purposeful activity kits. Practitioners consistently reported time as the top factor in their inability to incorporate more purposeful activities. Qualitative results support use of the new activities during both intervention and evaluation due to the focus on function and ease of use of the kits.

Conclusion

Purposeful activities can enhance any rehabilitation clinic in an organized, cost-effective manner. Practitioners responded positively toward the added equipment; however, it will take time and effort to adjust the theoretical decision making of practitioners. Additional participants and length of intervention is needed.

The effect of an occupation-based intervention in patients with hand-related disorders grouped using the sense of coherence scale: Study protocol

Introduction

High-quality rehabilitation is required if patients with hand-related disorders are to achieve high levels of functioning. Occupation-based interventions are effective in stroke, hip fractures, and for elderly people, but there is limited knowledge of their effect in hand therapy. Sense of coherence may affect rehabilitation outcome, since patients with weak sense of coherence experience lower functioning, are less satisfied with their occupational performance, have inferior quality of life and more pain compared to patients with stronger sense of coherence .

Method

Following SPIRIT guidelines, we present a randomized, controlled, parallel-grouped trial. It investigates the effect of an occupation-based intervention for outpatients with hand-related disorders and whether sense of coherence influences the outcomes. Patients are stratified into three groups (weak, medium and strong sense of coherence) and randomized to occupation-based or exercise-based hand therapy. Sample size calculation indicates that 70 patients are required in each intervention in each separate sense of coherence group. With an expected drop-out of 20%, a total of 504 participants will be randomized. Primary analysis is score change in functioning measured by the Disabilities of the Arm, Shoulder and Hand from start of rehabilitation to three months’ follow-up. Secondary outcomes are self-evaluated occupational performance and satisfaction with occupational performance.

Conclusion

This study will add valuable knowledge to the field of hand therapy regarding the therapeutic use of occupations that patients find meaningful. Moreover, it may show which patients will benefit the most from an occupation-based intervention in relation to their sense of coherence.

Effects of an Occupation-Based Intervention on Mobility Problems Following a Cerebral Vascular Accident

The usefulness of a new occupational therapy approach to intervention was explored with three individuals who had sustained a cerebral vascular accident (CVA). This new approach, the Occupational Adaptation Frame of Reference (OA), was used to guide the occupational therapist in the treatment of mobility problems associated with the CVA. Participants were assessed and treated by an occupational therapist in their home environment. Three case studies were compiled from qualitative and quantitative data. Data were gathered through observation, videotaping, narrative stories, and the Movement Rating Scale. Results revealed that intervention based on OA was associated with improved mobility skills.

Activity Participation and Well-Being of People with Dementia in Long-Term—Care Settings

This study examines the activities engaged in by nursing home residents with dementia and their states of well-being. Dementia Care Mapping was used to record the activities engaged in by, and the well-being of, 43 participants during a 6-hour period. The average age of the group was 81 years and length of stay at the nursing home was 27 months. Fourteen percent of participants had received a Clinical Dementia Rating (CDR) score of 1 (mild level of cognitive impairment), 35% had a CDR score of 2 (moderate impairment), and 51% had a CDR score of 3 (severe impairment). Results indicated that the three CDR groups engaged differently in activities. The CDR1 group participated significantly more in therapeutic/leisure activities and activities of daily living than did the CDR2 group ( p < .001 and p < .05) and CDR3 group ( p < .001). Conversely, the CDR3 group engaged in significantly more passive activities than did the CDR1 group ( p < .001), and had fewer social interactions and displayed more negative behavior than the other two groups ( p < .05). Moreover, their well-being was significantly worse than that of the other two groups (p < .001). A majority of participants (82%) demonstrated poor to very poor well-being. Because better well-being was associated with positive and enjoyable engagement in activities (τ = +0.67, p < .001), the low level of activity participation demonstrated by low-functioning individuals with dementia needs to be addressed. Moreover, further studies are indicated to explore the possible factors influencing their limited activity participation.

Epistemological Transformation in Occupational Therapy: Educational Implications and Challenges

An epistemological analysis of occupational therapy's history opens a novel perspective on the field's evolution and on important changes facing education and practice. Kegan's theory of epistemological transformation (e.g., how ways of knowing evolve) was used as an analytic tool to reexamine mostly secondary and some primary historical sources. Although the profession's history is often portrayed in terms of large and sweeping changes, this analysis suggests that little change occurred in occupational therapy's epistemology, making it difficult for the profession to become self-defined or easily adopt occupation, participation, and health as a focus for practice, education, and research. It is also suggested that recent developments in the field are at their core epistemological developments and serve as indicators that a new way of knowing has emerged in occupational therapy that is making new demands of practitioners and educators. Further, epistemological developments can help evaluate common educational assumptions and frame new educational approaches.

Contexts of the Flow Experience of Women with HIV/AIDS

This descriptive within-subjects design examined differences in frequency of the Flow experience in the lives of women with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) based on social contexts or categories of “who one is with” during daily occupations. Flow experiences during daily occupations of 19 women with HIV/AIDS were studied using the Experience Sampling Method (ESM). The ESM has a unique value for studying occupation because it captures the experience of occupation in real time. Chi-square tests of independence showed statistically significant differences in frequency of Flow across various social contexts as seen in previous studies of nonclinical populations. Participants in this study experienced Flow most often when alone and least often when in public; mothers experienced Flow most often when with children and least often when with adult companions.

Participation in Occupational Performance: Reliability and Validity of the Activity Card Sort

The Activity Card Sort (ACS) is a comprehensive instrument for assessing participation in occupational performance of instrumental, social-cultural, and leisure activities. The purpose of the study was to determine the reliability and validity of the ACS within different adult and older adult groups. The study included 263 participants comprising 5 groups of 61 healthy adults, 61 healthy older adults, 40 spouses or caregivers of individuals with Alzheimer's, 45 individuals with multiple sclerosis, and 56 individuals 1 year after having a stroke. The ACS was adapted to the Israeli culture in a previous study with the author's permission. The final version that was used in this analysis included 88 picture cards of adults performing instrumental, social-cultural, and low and high physical leisure activities that the clients sort into five categories. The ACS provides a “retained activity level” score that is the percentage of activities in which a person is currently engaged divided by those with whom he or she was involved in the past. In addition, comparisons between all groups of current activity levels were analyzed. The ACS had high internal consistency (Cronbach alpha in each area) for instrumental activities of daily living (IADL) and social-cultural activities (.82, .80), and lower for low and high physical leisure activities (.66, .61). A one-way analysis of variance (ANOVA) that compared groups of participants on total retained activity level and individual activity areas showed a significant group effect on all comparisons (p<.000) that support construct validity. Post hoc Scheffe tests revealed significant differences between most groups. The same results were found for current activity level. The results support the reliability and validity of the ACS and provide a basis for its clinical use.

A Practice Analysis of Occupational Therapy and Impact on Certification Examination

In 2003, the National Board for Certification in Occupational Therapy, Inc. (NBCOT®) conducted a practice analysis study of entry-level occupational therapy practice in the United States. Domains and tasks performed by the OCCUPATIONAL THERAPIST REGISTERED (OTR®) or CERTIFIED OCCUPATIONAL THERAPY ASSISTANT (COTA®) practitioner and the knowledge required to perform them were identified and validated via a large-scale survey of practice. Professional background and demographics of OTR and COTA respondents were reviewed and determined to be representative of practice, providing a basis for generalizability of results from the sample to the population of entry-level certified occupational therapy practitioners in the United States. The main findings were summarized to reflect what is happening in current practice for individuals who have recently obtained the OTR and COTA certification. Critical and frequently performed tasks were identified, as was critical and frequently used knowledge. The validated tasks and knowledge statements serve as the basis for item classification activities related to the OTR and COTA examinations. The revised blueprint specifications were used to guide examination construction for the NBCOT OTR or COTA examinations beginning in 2005.

A Methodology for Developing Evidence about Meaning in Occupation: Exploring the Meaning of Working

Using research-based evidence to support practice is becoming a standard of care. Although occupational therapists believe that occupation can be used as a therapeutic agent to promote health and well-being in their clients, there is only limited research to support this. One reason for this is the difficulty in quantitatively constructing “occupation” for research. This article describes one method that can be used to quantitatively measure meaning, an important indicator of occupation. This study explicates the “meaning” of working as examined through three interconnected constructs of work meaning (work centrality, societal norms about working, and valued work outcomes) and provides an exemplar study in which these three constructs were used to examine the meaning of working in a group of telecommunication workers. The Meaning of Working Survey was used to gather information from 170 telecommunication workers. Data from the survey were analyzed using both descriptive methods and cluster analysis. By evaluating these three constructs, it was possible to identify trends and patterns of the meaning of working for this group of workers. They did not view work as a central life role and viewed working as a constraint or a reciprocal arrangement. They valued benefits and wages over intrinsic outcomes. The cluster analysis revealed that meaning was generally related to external outcomes. The discussion focuses on how this methodology for measuring meaning could be used to develop research on the meaning of occupation and its effect on health outcomes. This study provides occupational therapy researchers with one quantitative methodology for examining the meaning of working and an exemplar on how that methodology has been used in research on meaning and occupation.

The Occupational Performance History Interview: Evidence for Three Underlying Constructs of Occupational Adaptation

The Occupational Performance History Interview (OPHI) was developed to gather data on a person's past and current occupational functioning. The OPHI includes both a life history narrative component designed to render the life history from the client's perspective and a rating scale designed to measure the client's past and present occupational adaptation. Previous research documented the reliability of the OPHI, but there has been limited study of its construct validity. This study used Rasch analysis to determine the construct validity of a modified version of OPHI scale (OPHI-R).

Data previously gathered on 20 clients in a psychiatric setting were analyzed. The results indicate that the items of the OPHI-R do not effectively measure a single construct of occupational adaptation as originally thought. Rather, the OPHI-R items appear to measure three underlying constructs reflecting occupational competence, identity and environment. These findings suggest that revision of the OPHI scale should seek to capture these three underlying constructs for the measurement of occupational adaptation.