Psychometric properties of the second version of the Occupational Performance History Interview (OPHI-II)

'Occupational experience' in occupational therapy and occupational science literature: A scoping review

INTRODUCTION

'Occupational experience' (OE) is widely used within the occupational therapy profession. However, it lacks a clear and unified definition in the profession's consensus practice frameworks and seminal models. Therefore, this study aimed to examine how OE has been defined and described in both occupational therapy and occupational science literature.

METHODS

A scoping review was performed, with a search conducted in ProQuest, PsycINFO, EMBASE, PubMed, Academic Research Premier, Scopus and Web of Science. The search strategy included a combination of the terms 'occupational experience' and either 'occupational therapy' or 'occupational science'. Inclusion criteria consisted of research articles in English that included OE as one of the central foci. Articles were chosen by the research team in collaboration with a medical librarian.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumer and community involvement was included in this study.

RESULTS

Seventy-three articles were included, mostly investigating OE in a targeted group or a specific aspect of experience, primarily among Western high-income-countries. Only 14 articles provided definitions of OE, with the most frequent being 'subjective dimension of occupation/participation'. Six themes emerged: (1) OE as a subjective component of occupation, (2) OE consisting of interrelated experiential facets, (3) OE in relation to meaning, (4) OE in relation to self-identity, (5) OE in relation to context and environment and (6) OE in relation to health outcomes.

CONCLUSIONS

The results point to largely incongruous definitions and descriptions of OE in the literature.

PLAIN LANGUAGE SUMMARY

This study looked at how "occupational experience" (OE) is described in occupational therapy and occupational science. We reviewed 73 research articles. Most of these articles focused on OE in specific groups, like asylum seekers, or on types of experiences, like the feeling of "flow." Most of the research was done in Western countries. The most common definition of OE was "a person's experience of doing an activity." We also found six main ideas about OE. These show that OE is personal, can include several experiences at once, connects to a person's identity and environment, and affects health.

Young Adults' Daily Participation Scale: A measure of objective and subjective participation

INTRODUCTION

Participation in occupations is considered essential for individuals' health and wellbeing. Participation is a multidimensional construct that encompasses objective and subjective dimensions that transform over the course of life. Nonetheless, there is a lack of comprehensive measures that examine young adults' participation in age-appropriate activities. Therefore, we developed the Young Adults' Daily Participation Scale (YADAPS) and aimed to explore its psychometric properties.

METHODS

In Study 1, the content validity of the YADAPS was established based on nine experts. Its internal consistency, criterion, convergent, and construct validity were explored among 115 typical young adults (21-35 years). Using a different sample, Study 2 examined YADAPS discriminant validity among 33 young adults with developmental coordination disorder (DCD) and 52 typical peers.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumer and community involvement was included in these studies.

RESULTS

The relevance of YADAPS items was sufficient. Internal consistency was acceptable to excellent in most scales (.74 ≤ α ≤ .89). Criterion validity was supported by correlations between the subjective participation scales and a wellbeing measure. Convergent validity was found for all scales. No gender effect was observed (p ≥ .05). However, significant differences (p ≤ .05) were found between individuals with and without DCD.

CONCLUSIONS

The YADAPS appears to be a promising measure of objective and subjective dimensions of participation in young adults. The results support the importance of examining various participation dimensions, including occupational experience. Thus, it may be used for clinical purposes among young adults as well as for occupational science research, to broaden our understanding on the interplay between participation dimensions in various life situations in young adulthood. However, further research is needed on psychometric properties, the most suited scoring method, and to consolidate their robustness among diverse populations of young adults.

PLAIN LANGUAGE SUMMARY

Participation, or how one engages in daily life activities, greatly affects wellbeing. The activities in one's routine change over the lifespan, in accordance with one's developmental phase. Existing assessments of participation have limitations, like not considering young adults' concerns or only focussing on certain aspects of participation. By focussing on both the objective-observable and subjective-experiential aspects of participation, the Young Adults' Daily Participation Scale (YADAPS) strives to be a comprehensive assessment tool designed specifically for reflecting activities relevant in young adulthood. This manuscript provides preliminary validity and reliability for the YADAPS, a new questionnaire that assesses objective and subjective aspects of participation in activities relevant for individuals in young adulthood. Furthermore, the questionnaire is able to distinguish between young adults with and without participation difficulties; therefore, it is suitable for research and clinical use.

Factors That Influence Occupational Engagement of Young Adults Who Are Cancer Survivors: A Pilot Study

Cancer and its treatment can impact occupational engagement. However, occupational therapy-specific research studying young adult cancer survivors remains limited. The objective of this study to identify the type of occupations that young adult cancer survivors choose to engage in and to understand their decision-making process when choosing these occupations. A mixed-methods explanatory sequential design was used. Eleven participants, nine females and two males, between the ages of 18 and 35, were included. Several occupations were identified for engagement such as activities of daily living, leisure, work, sleep and rest, and health management. The predominant factor that influenced why occupations were chosen was that individuals purposefully selected occupations that allowed them to choose a path toward a more meaningful life. Information gained from this pilot study can be used to inform occupational therapy practitioners regarding services and interventions that promote occupational engagement for young adult cancer survivors.

Interventions to Improve Social Participation, Work, and Leisure Among Adults Poststroke: A Systematic Review

IMPORTANCE

Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address.

OBJECTIVE

To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases.

STUDY SELECTION AND DATA COLLECTION

Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

FINDINGS

Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low.

CONCLUSIONS AND RELEVANCE

Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation. What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.

Keeping Pace With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy

The use of telehealth to deliver occupational therapy services rapidly expanded during the COVID-19 pandemic. There are frameworks to evaluate services delivered through telehealth; however, none are specific to occupational therapy. Therefore, occupational therapy would benefit from a framework to systematically evaluate components of telehealth service delivery and build evidence to demonstrate the distinct value of occupational therapy. The PACE Framework outlines four priority domains to address areas of need: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. This article describes the development and expert reviewer evaluation of the PACE Framework. In addition, the PACE Framework's domains, subdomains, and outcome measure examples are described along with future directions for implementation in occupational therapy research, practice, and program evaluation.

An examination of the psychometric properties of the occupational identity questionnaire for community-living elderly who require care

INTRODUCTION

Authors created an Occupational Identity Questionnaire Provisional version (OIQ-P) to assess occupational identity for elderly individuals. The purpose of this study was to examine the psychometric properties of the OIQ-P.

METHODS

Participants included 135 (42 males) elderly who lived locally and required care or support. OIQ-P was evaluated in terms of structural validity, criterion validity and internal consistency.

RESULTS

Based on the results of an exploratory factor analysis and confirmatory factor analysis, an OIQ with a factor structure of 3 factors and 14 items was created. Rasch rating scale model revealed that 14 participants and 1 item did not fit the goodness of fit, nevertheless, the overall result was good. Spearman's rank correlation coefficient indicates that there was a law correlation between OIQ and the occupational identity scale of the Occupational Performance History Interview Version 2. In terms of internal consistency, the person separation index and person separation reliability coefficient were 2.30 and 0.84, respectively.

CONCLUSION

This study confirmed the structural validity, criterion validity and internal consistency for the OIQ. To enhance the clinical utility of the OIQ, it is necessary to examine the interpretability and conduct an intervention study using the OIQ.

Performance of Everyday Occupations and Perceived Health of Spouses of Men With Spinal Cord Injury at Discharge and 6 Months Later

STUDY DESIGN

An exploratory longitudinal study.

OBJECTIVES

(a) Compare the occupational performance, and life satisfaction of spouses of men with SCI with those of spouses of healthy men, (b) compare the occupational performance, perceived health, and life satisfaction of spouses of men with SCI at discharge from inpatient rehabilitation and 6 months postdischarge; and (c) assess whether the functioning levels of men with SCI and the perceived mental health of the spouse, correlate with her occupational performance.

SUMMARY OF BACKGROUND DATA

Spouses of men with spinal cord injury (SCI) report having symptoms of depression and anxiety. However, their ability to choose everyday occupations and perform them satisfactorily (occupational performance) was less studied.

METHODS

Fifteen women spouses of men with SCI and 15 women spouses of healthy men participated. Study measures included four self-report questionnaires and the Occupational Performance History Interview that was analyzed quantitatively and measured occupational performance by three components: occupational identity, competence, and settings.

RESULTS

Occupational performance and life satisfaction of caregivers were lower than those of spouses of healthy men and did not significantly change over 6 months. However, they had higher scores on physical, mental, and general health 6 months postdischarge than at discharge. Mental health of the spouse correlated with her occupational identity.

CONCLUSION

It is recommended that rehabilitation intervention focus not only on patients with SCI, but also on their healthy spouses to promote their occupational performance, health, and well-being.

LEVEL OF EVIDENCE

3.

Construct validity of the Persian version of the Child Occupational Self-Assessment in children with attention-deficit/hyperactivity disorder in Iran

Objective

This study aimed to assess the construct validity of the Child Occupational Self-Assessment, translated to Persian that could provide occupational therapists with a tool to evaluate occupational competence and values of children in Iran.

Methods

A total of 250 children (87 girls and 163 boys) with attention deficit hyperactivity disorder aged 7.5–11 years referred from two specialised children’s hospitals were included. The researchers read the questions to the children and they identified their own answers. The data were analysed based on the Rasch Rating Scale Model.

Results

Four of the items showed misfit and as a result of deleting these items the Persian version of the questionnaire has 21 items with an appropriate validity.

Conclusion

The Persian version of Child Occupational Self-Assessment can be used with new items format. It could be also useful to replace the missing question to develop the tool further.

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.

Psychosocial Characteristics of Women with a Delayed Diagnosis of Turner Syndrome

OBJECTIVES

To characterize the psychosocial profiles of adult women diagnosed with Turner syndrome before (early diagnosis) and at or after (late diagnosis) 13 years of age.

STUDY DESIGN

Women with Turner syndrome ages 22 and older at evaluation (n = 110) participated in a cross-sectional study at the National Institutes of Health. Researchers performed nonparametric and logistic regression analyses to assess early and late diagnosis cohorts on measures of depression, substance use, and perceptions of competence and identity.

RESULTS

Of study participants, 47% received a Turner syndrome diagnosis at or after age 13 years. Median age at diagnosis was 12.0 years (range, 0-43). Covariate-adjusted models revealed that women with late diagnoses had an increased likelihood of developing mild to severe depressive symptoms (OR,  7.36) and a decreased likelihood of being perceived as competent (OR, 0.26). Women with a late diagnosis also exhibited more frequent substance use compared with women with early diagnoses.

CONCLUSIONS

These data suggest that Turner syndrome diagnoses received at or after age 13 years may contribute to adverse outcomes related to depression, substance use, and perceptions of competence. Delayed Turner syndrome diagnoses may place women and girls at risk for negative psychosocial development extending into adulthood. These findings indicate it is important for pediatricians to evaluate psychosocial domains in girls with Turner syndrome regularly, particularly among those diagnosed at age 13 years or older.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00006334.

Managing Everyday Occupations as a Predictor of Health and Life Satisfaction Among Mothers of Children With ADHD

OBJECTIVE

Raising a child with special needs disturbs the balance of family life and affects mothers' everyday life. The purpose of this study was to assess the contribution of occupational competence, occupational settings, and role load to the health and life satisfaction of Arab mothers of children with and without ADHD.

METHOD

Participants included 40 Israeli Arab women aged 25 to 40 years. Half were mothers of children with ADHD and half were mothers of children without ADHD. Data were collected by using four self-report questionnaires.

RESULTS

Occupational competence and occupational settings predicted mothers' mental health and life satisfaction. Having or not having a child with ADHD only reflects a minor contribution.

CONCLUSION

Enhancing mothers' occupational competence and settings may increase their health and life satisfaction. This study highlights the need to focus on maternal occupational competence and settings as they affect mothers' health and well-being when providing intervention to children with ADHD.

Re-establishing an occupational identity after stroke – a theoretical model based on survivor experience

Introduction

Annually, approximately five million people worldwide are left with a permanent disability following a stroke, often with ongoing occupational issues. A deeper understanding of the emerging picture of occupational disruption and identity reconstruction after stroke is needed to inform client-centred practice.

Method

In-depth interviews using constructivist grounded theory methodology were conducted with six Queensland (Australia) adult stroke survivors. Data analysis identified themes which were woven into an overarching theory about the process of reintegration back into the community and living a meaningful life.

Findings

The central process of adjustment for all participants was reconstruction of an occupational identity, facilitated through connections within and across three domains – self, others and reality. Connecting with self involved emotional management; motivation; confidence; occupational engagement; and seizing control. Connecting with others included being understood; belonging; receiving help; and interactions. Connecting with reality meant confronting the impact on daily life and one's unfolding life story according to three realities: past reality, the reality of the stroke and future reality.

Conclusion

Exploring how stroke survivors form and maintain connections across the domains of self, reality and others provides a framework to ground occupational therapy services in the reality of individual needs from an occupational perspective.

Mental health occupational therapy and supported employment

Purpose

The individual placement and support (IPS) model is an evidence-based approach to employment support for people with severe mental illness that functions by co-locating an employment consultant from the local disability employment service within a community mental health team to assist service users to find work. This paper aims to examine the unintended impacts of implementing IPS on occupational therapy practice and offer some suggestions.

Design/methodology/approach

The authors performed a narrative literature review on the IPS model, employment and occupational therapy. Authors then analysed and discussed impact on occupational therapy practice and concluded by making suggestions based on current evidence and practice.

Findings

The authors concluded that implementation of IPS has resulted in some unintended changes of practice in mental health with occupational therapists taking a less active role in enabling employment outcomes than previously. This paper concludes by calling upon occupational therapists to re-establish their role of enabling employment.

Originality/value

This paper offers an original viewpoint on employment and occupational therapy based on current evidence and authors’ expertise.

Exploring Occupational Adaptation through the Lives of Women with Multiple Sclerosis

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

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

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

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

Exploring the Impact of Sleep Apnoea on Daily Life and Occupational Engagement

Introduction:

Obstructive sleep apnoea (OSA) has significant implications for a person's health, wellbeing and occupational engagement, but has received almost no attention from occupational therapists.

Method:

This qualitative study used semi-structured interviews to explore nine people's experience of living with OSA. The Occupational Performance History Interview-II was used to collect data. Interviews were recorded and transcribed verbatim.

Findings:

Through thematic analysis, one core theme was identified: ‘OSA is a life-changing condition’. From this, five subthemes emerged: the impact of OSA on (i) occupational participation, (ii) psychological wellbeing, (iii) relationships, (iv) executive functioning and (v) treatment issues. These findings reveal a myriad of difficulties in daily life and occupational performance. In addition, they highlight the potentially serious implications for individuals living with sleep disorders.

Conclusion:

From this study, it is clear people with OSA face challenges with their daily life and occupational engagement. This suggests an important role for occupational therapy in empowering people to manage their condition. Further research is warranted examining sleep and occupational performance, and education on sleep and sleep hygiene for practice.

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

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

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

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

'Everything just seems much more right in nature': How veterans with post-traumatic stress disorder experience nature-based activities in a forest therapy garden

Available evidence shows that an increasing number of soldiers are seeking help for post-traumatic stress disorder. The post-traumatic stress disorder condition has big emotional and psychological consequences for the individual, his/her family and the society. Little research has been done to explore the impact of nature-based therapy for veterans with post-traumatic stress disorder although there is a growing amount of evidence pointing towards positive outcome. This qualitative study aims to achieve a deeper understanding of this relationship from the veteran’s perspective. Eight Danish veterans participated in a 10-week nature-based therapy. Qualitative interviews were conducted and analysed using the interpretative phenomenological method. The results indicated that the veterans have achieved tools to use in stressful situations and experienced an improvement in their post-traumatic stress disorder symptoms.

Male-to-female transitions: Implications for occupational performance, health, and life satisfaction

BACKGROUND

People who undergo a gender transition process experience changes in different everyday occupations. These changes may impact their health and life satisfaction.

PURPOSE

This study examined the difference in the occupational performance history scales (occupational identity, competence, and settings) between male-to-female transgender women and cisgender women and the relation of these scales to health and life satisfaction.

METHOD

Twenty-two transgender women and 22 matched cisgender women completed a demographic questionnaire and three reliable measures in this cross-sectional study. Data were analyzed using a two-way analysis of variance and multiple linear regressions.

FINDINGS

The results indicate lower performance scores for the transgender women. In addition, occupational settings and group membership (transgender and cisgender groups) were found to be predictors of life satisfaction.

IMPLICATIONS

The present study supports the role of occupational therapy in promoting occupational identity and competence of transgender women and giving special attention to their social and physical environment.

The Effect of Engagement in Everyday Occupations, Role Overload and Social Support on Health and Life Satisfaction among Mothers

One of the founding assumptions underlying the health professions is the belief that there is a strong relationship between engagement in occupations, health, and wellbeing. The ability to perform everyday occupations (occupational performance) has a positive effect on health and wellbeing. However, there is also conflicting evidence indicating that participation in multiple roles or in certain occupations may lead to poorer health. Therefore, there is a need to better understand this relationship. The purpose of the present study was to examine three possible theoretical models to explain mothers' health and life satisfaction from the perspective of their occupational performance, their role load, and their social support. 150 married mothers, ages of 25-45, who had at least one child between the ages of one to ten years, participated in the study. Data were collected by using seven self-report questionnaires. The models were analyzed using Structural Equation Modeling. The results show that social support has a direct effect on mothers' physical health and life satisfaction and an indirect effect, mediated through the occupational performance variables, on mothers' mental health and life satisfaction. Role overload does not affect mothers' health and life satisfaction. These results suggest that mothers could benefit from health programs that help them manage their occupational routines. Such programs should focus on improving the mother's occupational performance and adapting her social environment to fit her occupational needs.

Improved occupational performance of young adults with a physical disability after a vocational rehabilitation intervention

PURPOSE

The purpose of this study was to investigate into more detail how occupational performance of participants of a 1-year multidisciplinary vocational rehabilitation intervention changed over time, using a broad focus on three areas of occupational performance, addressing work, as well as self-care and leisure. In addition, we explored differences between employed and unemployed persons.

METHODS

In a pre-post-intervention design, changes in occupational performance, addressing work, self-care and leisure, were evaluated using the Canadian Occupational Performance Measure (COPM) and the Occupational Performance History Interview (OPHI-II).

RESULTS

Eleven young adults (median 22 years) with physical disabilities participated. Post-intervention, participants experienced fewer problems and showed improved occupational performance in work, as well as self-care and leisure, and improved satisfaction with performance. Participants also showed improved occupational identity and occupational competence, and total scores on OPHI-II. Participants who did not achieve employment did not differ in demographic characteristics. They experienced problems in all three areas of occupational performance at pre-intervention, and more difficulty in interacting in occupational settings (environment). Post-intervention, their levels of occupational identity, competence and settings were similar to those of employed persons.

CONCLUSIONS

Participants showed improved occupational performance after the intervention. The goal of employment and the broad integrated approach of the intervention seemed to motivate participants to resolve problems in work, as well as self-care and leisure. Unemployed persons faced problems in all three areas of occupational performance at start. Although they seemed to catch up during the intervention, they did not achieve employment within 1 year.

Construct Validity and Factor Structure of the Persian Occupational Self-Assessment (OSA) With Iranian Students

This study aimed to investigate construct validity and factor structure of the Persian Occupational Self-Assessment (OSA; Baron, Kielhofner, Iyenger, Goldhammer, & Wolenski, 2003 ) based on the model of human occupation (MOHO). Three hundred and thirty-six (179 male and 157 female) Iranian junior high students were measured using the OSA. The data were analyzed using a Confirmatory Factor Analysis (CFA) and the Rasch Rating Scale Model (RSM). In combination, the CFA and RSM results provided strong evidence for the construct validity of the Persian version. The CFA indicated that the hypothesized second-order model could explain the relationship of the OSA items to the latent variables of occupational competence and value for occupations. However, RSM item hierarchies did not replicate those found in previous international studies.

A new intervention to improve work participation of young adults with physical disabilities: a feasibility study

AIM

The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness.

METHOD

Twelve young adults with physical disabilities (six males, six females; age 19-28 y, median age 21 y 6 mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years.

RESULTS

The intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was €3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years follow-up, a significantly higher proportion of participants were employed (8/12 post vs 2/12 pre-intervention; p<0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure.

INTERPRETATION

Feasibility and preliminary effectiveness of the intervention are promising. Employed participants seemed to have achieved suitable and continuous employment.

"The final piece of the puzzle to fit in": an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury

PURPOSE

Little is known about employment experience after spinal cord injury (SCI) because most research to date concentrates on employment predictors. We explored the experiences of people with SCI, and vocational rehabilitation (VR) professionals working for a VR programme, in pursuing a return to employment in New Zealand (NZ) post-SCI.

METHODS

Twelve people with SCI (four employed, three job-seeking, five unemployed) and six VR professionals were interviewed, and the transcripts subjected to an Interpretative Phenomenological Analysis.

RESULTS

The core meaning of employment post-SCI was to live a normal life. Work advantages were social connectedness, a sense of self-worth, earning a living, and being occupied. Employment was the zenith of rehabilitation but not the first priority post-SCI. Employment barriers and facilitators were congruent with those found in similar studies. The role of VR was to sow the seeds of return to employment and to partner with the SCI client.

CONCLUSIONS

For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity.

Occupational identity disruption after traumatic brain injury: an approach to occupational therapy evaluation and treatment

People with traumatic brain injury (TBI) represent a significant population for occupational therapy practitioners. The long-term physical, cognitive, behavioral, and psychosocial symptoms of TBI can contribute to the experience of occupational identity disruption and affect participation outcomes in community living. Although occupational therapy scholars have studied the topic of identity, there appears to be a gap in the education and research literature regarding the topic of post-TBI occupational identity disruption. This article describes theoretical perspectives on identity, summarizes evidence regarding post-TBI identity disruption and the transition process, and examines the role of occupational therapy in evaluating and treating identity disruption.

Utilization of the iPad application: Aid for Decision-making in Occupation Choice

The purpose of the study was to develop and evaluate an iPad (Apple) application, Aid for Decision-making in Occupation Choice (ADOC), so as to promote shared decision-making in an occupation-based goal setting. This application involves the client choosing from 94 illustrations describing daily activities related to the category of "activities and participation". One hundred occupational therapy clients evaluated the ADOC for goal setting; the clients and 37 occupational therapists underwent a survey to determine their perceptions of decision-making in the goal setting. More than 90% of the clients felt that they could give their opinions using the ADOC regarding goal setting. The majority of the occupational therapists (>90%) felt that ADOC would be useful in their clinical practice for setting client goals. The results indicated that ADOC is a useful and acceptable tool for both clients and occupational therapists in shared decision-making in occupation-based goal setting.

Creating a clinically useful data collection form for the DASH questionnaire

PURPOSE

We generated a clinically useful data collection form for the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. This data collection form is designed to aid in measuring change and goal setting.

METHOD

Rasch analysis was used to generate three data collection forms for constructs on the DASH (gross motor, fine motor, and symptoms; N = 960). A form was completed to represent the findings from 1 study participant. Admission and discharge data were illustrated for one of the three sections (gross motor activity). Possible goals were indicated on the admission form. The discharge form illustrates whether these goals have been achieved.

RESULTS

Figures illustrate the utility of the forms in observing functional change from admission to discharge and how the forms aid in goal setting.

CONCLUSION

Use of the data collection form has many positive implications. This type of form could aid in goal setting and treatment planning.

Worker Role Interview: Testing the psychometric properties of the Icelandic version

In Iceland, the worker role is one of the most enacted and valued roles, but the national disability rate is increasing and is often associated with the loss of the worker role. Resources in work rehabilitation in Iceland are disjointed, and the Ministry of Health and Social Security is calling for more focused and effective services in the field of work rehabilitation. One step towards reaching the goal of more effective services is having a reliable and theory-based assessment tool available to clinicians. The Worker Role Interview (WRI) is a psychometrically sound assessment tool based on the Model of Human Occupation. WRI assesses the psychosocial and environmental factors influencing injured and disabled workers' ability to return to work. This article examines the psychometric properties of the Icelandic version of the WRI (WRI-IS) in order to determine whether therapists can use the instrument in a consistent and dependable manner. Fourteen Icelandic occupational therapists completed the WRI-IS with 146 clients who intended to return to work. Eleven of the interviewed clients were videotaped and rated by more than one therapist. Total ratings were 249. A many-faceted Rasch measurement (MFRM) approach was used to analyze the WRI-IS. Fifteen of the 17 WRI-IS items showed acceptable fit to the measurement model, and the items represented a meaningful continuum of psychosocial ability to return to work. The 14 therapists and over 95% of the clients showed acceptable fit to the model. The results indicate that the WRI-IS can generate reliable and valid measures of a client's psychosocial ability to return to work.

Narrative slope as a predictor of work and other occupational participation

This study aims to determine the utility of the narrative slope in predicting the vocational/productive outcomes of participants. For 65 participants living in supportive facilities for adults with HIV/AIDS in the United States, narrative slopes, based on the Occupational Performance History Interview II, were constructed and classified as progressive, stable, or regressive. Information regarding participants' productive activities was collected at discharge from intervention programming, and at 3-month intervals, up to 9 months. Data were analyzed to examine the relationship between narrative slope and engagement in employment and other productive activity post-intervention. Demographic variables were also analyzed. None of the demographic factors significantly correlated to outcomes. It was found that a more positive narrative slope was predictive of a higher likelihood of being employed or engaged in other productive activity.

Occupation and meaning in the lives of women with chronic pain

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

Examining Rater Behavior on a Revised Version of the Short Child Occupational Profile (SCOPE)

A previous study of the Short Child Occupational Profile (SCOPE), an assessment of occupational participation, supported the psychometric soundness of the instrument overall, but pointed to some potential problems in practitioners' use of the SCOPE in practice. Specific revisions were made to the SCOPE to address the rating behaviors of leniency/severity, halo effect, and restriction of range. A many-faceted Rasch model analysis was conducted after 39 practitioners working in eight practice sites learned to administer the SCOPE using a variety of methods and rated 168 clients using the SCOPE (version 2.1). Practitioners exhibited three significantly different levels of leniency/severity, 35 practitioners did not exhibit any halo effects, and the top three rating categories were used 91% of the time. Findings suggest that a variety of methods can be used to learn to administer and rate the SCOPE in an appropriate manner to assess the personal and environmental factors affecting the occupational participation of children.

Occupational Performance, Self-Esteem, and Quality of Life in Substance Addictions Recovery

A non-randomized pretest—posttest design was used to evaluate changes in occupational performance, self-esteem, and quality of life among clients completing a substance abuse recovery program that included occupational therapy services addressing life skills. Seventy-five clients participated in intake and discharge assessment (4- to 6-month interval) that used the Occupational Performance History Interview (Version 2.0), the Rosenberg Self-Esteem Scale, and the Quality of Life Rating scale. A limited number of follow-up interviews at 3 and 6 months were also conducted. Marked improvement with significant differences and large effect sizes were found between intake and discharge scores for all measures. Most clients scored in the range of moderate occupational dysfunction at discharge, when their highest performance level was seen. Follow-up data revealed that occupational performance declined at 3 months and improved again at 6 months. Change in occupational performance is clearly reflected in the recovery process, but recovery is challenged when clients leave the supportive halfway house environment.

Measurement qualities of a self-report and therapist-scored functional capacity instrument based on the Dictionary of Occupational Titles

Studies provide convincing arguments to support the development of functional capacity instruments based on the Dictionary of Occupational Titles (DOT). The purpose of this study is to investigate the item-level measurement qualities of a newly developed DOT-based functional capacity instrument for clients undergoing rehabilitation treatment for back pain. Client and therapist ratings were collected on 124 clients from 27 rehabilitation sites using the newly developed Occupational Rehabilitation Data Base (ORDB) functional capacity instrument. Rasch analysis was used to investigate: (1) unidimensionality, (2) hierarchical item difficulty continuum, (3) rater severity, and 4) person-item match. Overall, the functional capacity scale of the ORDB showed good measurement qualities. All items, except the Handling item fit the Rasch measurement model. Because of high fit statistics and loading on factors independent from the remainder of the items, the "handling" item was removed, from further analyses. Separate client-rated and therapist-rated instruments retained good item-level psychometrics. While client and therapist items showed similar item-difficulty hierarchical structures, clients had a tendency to be more severe in their rating and the correlation between client and therapist ratings was relatively low, 0.32. These findings suggest that Handling items should not be included as a DOT measure for clients with back pain. While the above psychometric study supports using client or therapist ratings as independent instruments, the lack of concordance between these ratings requires further investigation.

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

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