Professional expertise of occupational therapists in community practice: results of an Ontario survey

This paper presents findings of a study, The Community Practice Project, that examined the situation of occupational therapists practising in community based settings in the province of Ontario, Canada in 1992. In addition to providing a profile of the typical community based therapist, the study considered issues relating to: the principal roles in places of employment; specific job skills and areas of professional expertise utilized in the community; and how well occupational therapists; formal training prepared them for their community oriented roles and tasks. Results indicate that great opportunities exist and job satisfaction is high in community settings. Nonetheless, therapists feel inadequately prepared for the new role of consultant and its concomitant skills in a field that has re-oriented itself toward the client and is increasingly focused on health promotion and disability prevention.     

Factors influencing the education of occupational therapists in Ontario

This paper examines some of the factors which were involved in the December 1974, decision, of the Ontario's Minister of Colleges and Universities to Mohawk College of Applied Arts and Technology to establish an experimental program in occupational therapy. This program is being launched without the endorsement of the provincial and national association of occupational therapy which wish to maintain a baccalaureate level of education for occupational therapists in a university settings. Some questions which are explored in the examination of this case are: What is a College of Applied Arts and Technology? How is it different from a University? What is a profession? What is a paraprofession? Is occupational therapy a profession or a paraprofession? Why did Mohawk College propose an occupational therapy program? What factors contributed to the occupational therapists' inability to stop the proposal? What was the process of approval of the proposal? How important are status and prestige as factors in these issues? The following discussion will attempt to deal with these questions as they relate to the educational arrangements for occupational therapists in Ontario.     

Management of work-related low back pain: a population-based survey of physical therapists

BACKGROUND AND PURPOSE: Physical therapy often is used in the management of work-related low back pain (LBP). Little information, however, is known about the types of interventions used by physical therapists in the management of this condition. The objective of this study was to describe the interventions used by physical therapists in the treatment of workers with acute or subacute LBP, with or without radiating pain below the knee. SUBJECTS: Clinical management questionnaires for workers without and with radiating pain were returned by 190 and 139 physical therapists, respectively. METHODS: For each treatment session, therapists recorded treatment objectives, interventions, and education provided to 2 workers with LBP, 1 with radiating pain and 1 without radiating pain. RESULTS: The majority of physical therapists used stretching and strengthening exercises, spinal mobilization, soft tissue mobilization and massage, manual traction, posture correction, interferential current, ultrasound, heat, and functional activities education. With radiating pain, the majority of the therapists also used cold and the McKenzie approach. Treatment objectives pursued by the majority of the therapists were decrease of pain, increase of range of motion, increase of muscle strength (force-generating capacity of muscle), decrease of muscle tension, and worker education. DISCUSSION AND CONCLUSION: Physical therapists use an array of interventions with workers with LBP. The effectiveness of most interventions reported has not been well studied.     

School-based practice patterns: a survey of occupational therapists in Colorado.

OBJECTIVE: This purpose of this study was to describe school-based occupational therapy practice for kindergarten through twelfth-grade students in Colorado and to examine occupational therapy practice in light of current education policy and published views of best practice. METHOD: Study data were provided by 105 occupational therapists and occupational therapy assistants who completed a 24-item questionnaire. RESULTS: Occupational therapists carried an average caseload of 43.68 students; most frequently served kindergarten through third-grade students with perceptual or communicative disabilities; and delivered services most often in pullout treatment areas. Practitioners spent most of their work week providing direct services. Remedial or developmental approaches were used 62% of the time and compensatory and educational approaches 37% of the time. Individualized education program goals addressed by occupational therapists were most frequently developed by the occupational therapist and targeted students' sensory or motor impairments. Workshops on autism and sensorimotor intervention techniques were reported as the primary and preferred forms of professional development. CONCLUSION: The strong majority of reported occupational therapy services contrasted with emerging views of best practice. They were, however, consistent with the Colorado Department of Education's guidelines for "motor specialists" that address occupational therapy, physical therapy, and adaptive physical educators working in schools. Study findings are discussed.     

Therapeutic approaches to fibromyalgia syndrome in the United Kingdom: a survey of occupational therapists and physical therapists.

BACKGROUND AND PURPOSE: This study sought information from occupational therapists (OTs) and physical therapists (PTs) working in rheumatology in the UK on their usual methods of treatment and management of patients with fibromyalgia syndrome (FMS). METHODS. Data were gathered by self-completion questionnaire on: work setting; referrals of FMS patients; usual treatment objectives; assessment and treatment approaches; perceived responsiveness of patients; and other perceptions of the management of FMS. Most data were in the form of frequency counts, with some ordinal scales and open responses. RESULTS: Responses were obtained from 142 therapists (71% response rate), of whom 47 OTs and 39 PTs managed patients with FMS. The foremost therapeutic objective was increased functional ability for OTs, and increased exercise tolerance and general fitness for PTs. Pain reduction or management was rated as the second objective for both groups. An endurance-based exercise program and energy conservation techniques were the most frequently utilized interventions. Patients with FMS were thought to be 'moderately responsive' to physical management. Predictors of outcome were considered to be largely psychosocial, rather than physical, in nature. CONCLUSION: These data provide a preliminary profile of current practice in the management of FMS among UK therapists and indicate certain differences in approach between OTs and PTs.     

Secondary analysis of survey data: a research method with potential for occupational therapists

The secondary analysis of previously collected survey data can assist occupational therapists to focus research, make policy decisions and test theory. In this paper the authors outline the process of carrying out a secondary analysis using existing survey data. Steps include selecting the research question, and then locating, appraising, acquiring and analysing the data. To illustrate this process, the authors examined the relationships between accidents and mobility impairments among older adults using data previously collected in the National Population Health Survey. Finally, some further examples of occupational therapy research carried out using secondary analysis of survey data are considered.     

A survey to determine how occupational therapists in Ontario rehabilitation units are using microcomputers for patient treatment in clinical programs

Thirty four Ontario Rehabilitation units were surveyed to determine how occupational therapists use microcomputers for patient treatment. Twelve rehabilitation units (35.3% of the sample) presently have microcomputers and 11 of these units have recently purchased the microcomputer for clinical use. Stroke, head injury and spinal cord injury patients were identified as the population that use the microcomputer. The APPLE 11 microcomputer was the most popular type chosen by rehabilitation units. Commercially available software programs are used for cognitive, perceptual, educational and recreational purposes. Satisfaction level with the quality of the software, however, was only 42.8%. Finally, it was noted that the speech therapist was the primary professional who liaised with the occupational therapist.     

Burnout in occupational therapists

Burnout is a job-related condition involving feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment. The Maslach Burnout Inventory (Maslach & Jackson, 1981a) is the instrument most widely used to measure job-related stress in human service professions, such as occupational therapy. This study explored the application of the Maslach Burnout Inventory for use with occupational therapists. The subjects were 99 registered occupational therapists residing in the southeastern United States. Mean scores lower than the aggregate occupational norms provided by the test's authors on the Emotional Exhaustion and Depersonalization subscales supported the need to develop specific norms for occupational therapists. Results of this study indicate that use of the aggregate norms would underestimate the level of experienced burnout. Correlational analyses delineated significant relationships between age and Emotional Exhaustion and Depersonalization, education and Emotional Exhaustion and Depersonalization, years of work as an occupational therapist and Depersonalization and Personal Accomplishment, years in the present position and Personal Accomplishment (intensity only), hours of direct patient contact and Emotional Exhaustion (intensity only), and hours of direct patient contact and Depersonalization (frequency only). These correlates of burnout furnish clues for understanding the development of work-related stress in occupational therapists.     

Retention strategy: a clinical ladder for occupational therapists

This article explores the issue of retention of occupational therapists and its impact on the facility, client, department and the profession. It also describes the use of a clinical ladder as a retention tool and presents the experience of one clinical facility in developing a clinical ladder. The literature, in association with the experience of the aforementioned clinical facility in the development of a clinical ladder in an occupational therapy department, does not provide conclusive evidence of the efficacy of a clinical ladder as a retention tool. However, it does lend enough support for the concept to encourage its further use in occupational therapy departments. There is a need to be creative in the design of retention methodologies which will decrease turn over and attrition from the profession in order to provide a stable pool of personnel to agencies that employ occupational therapists.     

Networking: a successful linkage for community occupational therapists

The networking process involves the linkage of people, agencies, and community resources. This paper describes an application of networking and community involvement. The four authors, all occupational therapists, used their knowledge and skills to provide and extend health promotion services for disabled persons within their community. During this process, they extended the role of occupational therapy into nontraditional settings.     

Understanding 'independence': perspectives of occupational therapists

Purpose. The purpose of this study was to understand how the term independence is used in rehabilitation. In particular, we asked occupational therapists in Canada and Japan to interpret the term independence in terms of people with disabilities. In rehabilitation, independence has long been a key concept. A review of the literature shows that the term's meaning has shifted throughout the past century. However, despite its significance, the word's meaning has never been deeply analysed, and it is left to the interpretation of the individual practitioner; consequently, there is a conceptual confusion surrounding the term. Furthermore, no studies have been conducted from an inter-cultural viewpoint that included non-Western societies.

Method. A qualitative interpretive study was conducted, based on semi-structured interviews with 18 occupational therapists. Nine Canadian and nine Japanese therapists were interviewed in depth and their perspectives analysed for themes and categories corresponding to their working definition of independence.

Results. Therapists' interpretation of the term independence consisted of three perspectives: “Independence as competence,”“Independence as autonomy,” and “Independence as psychological qualities”. These perspectives were typically combined into two patterns of dealing with independence in practice. Differences between Canadian and Japanese perspectives were explored.

Conclusions. The study's findings confirm some ideas about independence that have been pointed out in the professional literature, but they also add several important ideas - the idea of psychological characteristics as key to independence, and the notion of a cultural overlay on the definition and application of the concept independence. This study's findings should contribute to the ongoing discussion in the professional literature about the virtues and limitations of pursuing independence as the ultimate goal in rehabilitation.     

Cognitive rehabilitation: a pilot survey of therapeutic modalities used by Canadian occupational therapists with survivors of traumatic brain injury

This pilot study used survey methodology to gather initial information from Canadian occupational therapists on 1) the delivery of cognitive rehabilitation services for survivors of traumatic brain injury and 2) the therapeutic approaches and modalities used currently to manage residual cognitive impairments. A questionnaire was developed, field-tested and mailed to 27 sample sites across Canada, selected non-randomly. Twenty returned questionnaires (74%) were included in the data pool. The findings revealed that a wide range of cognitive impairments were seen very often, with impairments in memory being most common. Respondents used both a cognitive remediation and compensatory approach and a combination of therapeutic modalities to address impairments of orientation, attention, and memory. There was an interesting and overlapping range of specific modalities identified. Inpatient and outpatient services were offered to survivors, primarily within the first year post-injury. These occupational therapists used various resources to develop expertise in cognitive rehabilitation. Possible implications of the pilot study findings for Canadian occupational therapists are high-lighted and discussed.     

Employment of occupational therapists in nontraditional settings

From my personal experience as a therapist employed in a nontraditional setting, I have identified the skills and abilities of experienced occupational therapists that are germane to work in nontraditional settings or beyond the clinic walls. Our profession can benefit from therapists working in nontraditional settings by gaining recognition and influencing decision makers in ways that will benefit the clientele that occupational therapists serve.