Dementia and occupation: a review of the literature

BACKGROUND: Recent evidence supports the usefulness of occupational therapy models, particularly the Occupational Performance Process, in structuring research evidence to inform practice. PURPOSE: In this paper we report the results of our work to identify and summarize quantitative and qualitative research evidence about occupational therapy intervention for individuals with Alzheimer's disease and their caregiver, relevant to the first stage of the Occupational Performance Process, which is to identify, validate and prioritize occupational performance issues. RESULTS: Review of literature from diverse sources deemed to be relevant was summarized under three themes: the experience of occupation among persons with dementia, the experience of occupation among caregivers of persons with dementia, and discussion of occupational performance issues. PRACTICE IMPLICATIONS: Best practice recommendations are made based on this review.     

Introducing OTseeker (Occupational Therapy Systematic Evaluation of Evidence): a new evidence database for occupational therapists.

This clinical scenario illustrates how OTseeker can be used by occupational therapists to locate research that may inform clinical decisions. Beyond the clinical arena, this database also has potential to greatly enhance the ability of researchers to perform systematic reviews of RCTs and eventually, development of clinical guidelines. In conclusion, OTseeker is a new Web-based database that provides fast access to evidence of therapeutic effectiveness for clinicians, academics, and students, as well as consumers and providers of occupational therapy services. OTseeker will be able to be used by clinicians to guide dinical practice, by researchers to perform systematic reviews of RCTs, by students, and by consortiums of stakeholders to develop evidence-based guidelines for occupational therapy practice.     

Occupational therapy research on assistive technology and physical environmental issues: a literature review

BACKGROUND: To determine future directions for research in the area of assistive technology and physical environmental issues, it is important to have an understanding of prior research. PURPOSE: This literature review examined how assistive technology and physical environmental issues have been studied in the research published in international peer-reviewed occupational therapy journals. METHOD: Five recent volumes of nine journals were manually searched utilizing specific criteria. The publications were classified according to their perspective, application of the Person-Environment-Occupation (PEO) model, and the research design. RESULTS: Both research fields demonstrated use of different research methods and they displayed equal needs with regard to improved research methodologies. PRACTICE IMPLICATIONS: There are a lack of studies involving all three PEO components indicating a lack of research in occupational performance issues. Further research on occupational performance is important for developing occupational therapy practice in the area of assistive technology and physical environmental issues. Furthermore, study designs reflecting the societal level in all three PEO components are required. Finally, there is a strong need for conceptual and theoretical development in both fields.     

Some issues related to research utilization in occupational therapy

The importance of research in the rehabilitation fields, including occupational therapy, has been widely recognized in the past decade. The production of credible research literature has received high priority as occupational therapy strives to achieve professional status within the hierarchy of rehabilitation service providers. To accomplish this goal, research that establishes a scientific basis for therapy must be produced, and this research must be integrated with clinical practice. Occupational therapy appears to be making progress in producing research literature related to clinical practice; however, the issue of research utilization has remained largely unexplored. This paper discusses methods of applying research findings and procedures in practice environments and explores some issues related to research utilization. Research utilization is viewed as a complex process involving multiple components related to individual decision making, theory development, and the documentation of clinical practice.     

Occupational therapy sequential client care recording system: a comparative study.

The client care record is a key document for determining standards of care in occupational therapy. The purpose of this study was to determine the effectiveness of a client care recording system for occupational therapy that combined the theoretical framework of the Developmental Analysis, Evaluation and Intervention Schedule, and the scientific method of the Problem Oriented Medical Record. The research form of the client care record was compared to a traditional client care record in current use in an occupational therapy clinic. An interdisciplinary panel of health professionals rated both the original and proposed form of the record on the variables of completeness, organization, understandability, and usefulness. The findings show statistically significant differences between the client care record based on the combined Developmental Analysis, Evaluation and Intervention Schedule and the Problem Oriented Medical Record and the currently used record system.     

A program for improving energy conservation behaviors in adults with rheumatoid arthritis

This paper presents the design and evaluation of an occupational therapy program developed at the National Institutes of Health for teaching energy conservation and joint protection to adults with rheumatoid arthritis. An existing model for educational diagnosis in health education was used to identify program, behavioral, and educational objectives for the new program. The use of this model resulted in measurable objectives, which were used as outcome measures in the randomized research evaluation of the new program. The dependent variables measured were activity-of-daily-living status, psychosocial adjustment to illness, knowledge, disease activity, pain, and fatigue. None were significantly different after the intervention. The independent variables measured included components of balancing rest and physical activity. After 3 months, a greater percentage of the subjects receiving the workbook-based occupational therapy program than those receiving traditional occupational therapy demonstrated an application of the behaviors the intervention was designed to change.     

Managing diverse occupational therapy resources in a creative, corporate model

Two occupational therapy departments were amalgamated into a corporate whole and charged with the development of a workable, corporate structure. The departmental model which was developed served to enhance the concepts of quality of working life, employee autonomy, management team and quality circle theory. This paper provides a background from business and organizational literature, and outlines the development of the departmental model, in concert with the adoption of the client-centred model of occupational performance as a department basis for practice. This development was taking place concurrently with larger, institutional changes into a decentralized clinical programme management model. Discussion highlights the level of staff satisfaction with the changes, areas of concern during the development of the system and plans for the future growth. During this period of massive and critical change in the delivery of health care services, there has been a trend in restructuring health care institutions towards decentralized models. This paper will describe the experience of one occupational therapy department in developing an innovative departmental structure involving participatory management amalgamation. It is believed that the experience of the past occupational therapy work units with one viable option for a renewed management model. Staff skill sets can be maximized and optimal potential realized while faced with inevitable resource shrinkage and service reorganization.     

Participatory action research: integrating community occupational therapy practice and research

Participatory action research (PAR) is a form of collaborative research particularly concerned with power inequities of marginalized communities. With this approach, occupational therapists can work with clients and communities to address issues of access, inclusion, equity and collaboration in practice and research. This paper begins with a summary of key concepts and controversies related to participatory action research. Two examples from occupational therapy experience are used to demonstrate the initial steps and key principles of PAR projects and to highlight the conceptual links between PAR and community-based, client-centred occupational therapy. One project involved a group of mental health consumers, the other a community group of older adults. Several challenges and potential outcomes in PAR projects are highlighted in this examination of the complexity of PAR processes. The paper concludes by identifying possibilities and obstacles to the further use of PAR in occupational therapy.     

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

Occupational therapy focuses on complex dynamic relationships between people, occupations and environments. Therapists must clearly communicate their practices and how their practice influences outcomes. This paper explores applications of the Person-Environment-Occupation Model (Law et al., 1996) in occupational therapy practice, and delineates how this particular model helps therapists to conceptualize, plan, communicate and evaluate occupational performance interventions. Three case studies illustrate how the model can be used by occupational therapists to systematically approach analysis of occupational performance issues while considering the complexities of human functioning and experience. The ways in which the model facilitates communication within and outside occupational therapy are explained. The Person-Environment-Occupation Model is offered as a tool for therapists to use in client(s)-therapist alliances to enable clients to successfully engage in meaningful occupations in chosen environments.     

Selection of occupational therapy students.

A research study on the selection of students for entrance into the basic professional four-year occupational therapy curriculum at Elizabethtown College is presented in this paper. The study has tow primary objectives: the determination of factors that could serve to discriminate between prospective students who would remain in the program from those would withdraw; and the development of a mathematical model that could be used in future years for student selection to the occupational therapy program. It is suggested that the model can be applied to any educational setting, can effectively streamline the usual admissions process, and can ensure that qualified students enter occupational therapy programs and thus be an additional indicator for the success and continuation of the profession.     

New Single-Subject and Small-n Design in Occupational Therapy: Application to Weight Loss in Obesity

Ottenbacher (1986) showed the usefulness of single-subject design (SSD) in occupational therapy. However, SSD methodology is not regarded by the wider research community as providing statistically reliable and valid evidence of effectiveness of treatment partly because of its observational nature. Although statistical estimations can also be made from least squares regression or by a trend line, a new methodology has great potential to influence research in occupational therapy. The new model enables the use of initial client data from the beginning of treatment (for single subjects or small groups) to determine a point in the linear regression at which predictions can be made for the number of treatments needed for stability or improvement. This model is invaluable for third-party payment as well as for client motivation. The purpose of this article is to present this new methodology, the semiparametric ratio estimator (SPRE), illustrated by case application to treatment of obesity.     

Cultural relativism: occupation and independence reconsidered

In this article, findings from a qualitative study of a cohort of occupational therapy students in Auckland, New Zealand are presented. The study focussed on the experiences of students as they learned to work with people from different social and cultural backgrounds over a 3-year period. As well as identifying curriculum and teaching/learning processes that enhance intercultural competence development, the data that emerged from the study also highlight important issues about how occupation and independence are conceptualised across cultures. A review of the trans-disciplinary and occupational therapy literature dealing with theoretical, conceptual and educational issues relating to cross-cultural practice is followed by a presentation of narrative extracts that address the key concepts of occupation and independence. These are then discussed with reference to relevant occupational therapy literature. In conclusion, implications for future research and practice are explored focussing on a need for occupation and independence to be reconsidered as culturally relative constructions.     

Children's work: the less-considered childhood occupation.

Children's work has largely been overlooked by researchers of many disciplines due to sociohistorical trends that fostered the notion that childhood should be a time free of work. Likewise, it has received little attention in occupational therapy most likely due to the influence of these historical developments on occupational therapy rhetoric and values. This paper begins by describing the influence of child labor laws and reformation on children's participation in work. Next, using a comprehensive review of the literature gathered from social sciences, a critical examination of the historical and current research on children's work is provided. This synthesis is framed in concepts of occupational science analyzing the evidence that describes the nature, form, function, and meaning of children's work. For occupational therapists working with children with disabilities, this research provides beginning guidelines for occupation-based work interventions and typical expectations for nondisabled children that may be applied using clinical reasoning to populations with disabilities.     

Factors related to the intensity of occupational therapy utilization in a geriatric chronic care setting

BACKGROUND: There is very little known about the intensity of occupational therapy service provision in relation to client characteristics of a geriatric chronic care population. A model was utilized to study demographic and clinical factors associated with the intensity of occupational therapy utilization. METHOD: A retrospective correlational design was carried out using secondary analysis of occupational therapy workload data merged with selected variables from the Minimum Data Set (MDS) at Baycrest Centre for Geriatric Care, Toronto, Ontario and included a sample of 168 clients receiving occupational therapy. The outcome measure used was the total number of minutes of occupational therapy service provided. RESULTS: Having a pressure relieving device for the chair and being active more than one third of waking hours were significantly associated with the intensity of occupational therapy utilization. The clients received a greater amount of time in indirect therapy compared with the amount of time which they received in direct care. PRACTICE IMPLICATIONS: The method used to examine occupational therapy service utilization developed in this research facilitates the understanding of occupational therapy resource use based on client characteristics.     

Interwoven threads: occupational therapy, feminism, and holistic health.

Occupational therapy is a predominantly female profession; 93% to 95% of occupational therapists are women. The implications and ramifications of this reality have seldom been directly addressed. In this article, beliefs about balance, activity, environment, and autonomy are explored from the perspectives of occupational therapy, feminism, holistic health, and medicine. The assertion that occupational therapy has more in common philosophically with feminism and holistic health than it does with medicine is supported. This awareness provides a new framework for examining current issues of concern to the profession, such as support for purposeful activity, existence outside the mainstream of power holders, and problems and powers inherent in being seen as a women's profession. Recommendations are made that occupational therapists commit more money and energy to encourage, facilitate, and support female leadership; develop innovative strategies for keeping members who take time out to raise families informed; support more holistic and feminist reorganization of work settings; instill awareness of these issues in our students; and address our strengths as a women's profession. All occupational therapists must also confront their own anti-women prejudice.     

Implementing a health promotion strategy in occupational therapy education and practice.

In response to the growing emphasis on health promotion, this article addresses four major questions: 1) How is occupational therapy's client-centered philosophy reflected in the principles outlined by the World Health Organization (1984)? 2) What are the roles of occupational therapy in health promotion? 3) How will occupational therapy education foster this development? 4) How will the practice of occupational therapy respond to the challenges and implement the strategies outlined in "Achieving Health for All: A Framework for Health Promotion"? Despite similarities between occupational therapy's client-centered approach and the health promotion framework, the need for occupational therapy education to reflect the developments in health promotion and prevention is very evident. A four part model is proposed, and the implications for graduate education as well as continuing professional education are outlined. Recommendations for practice, education, research and development are discussed.     

Statement: occupational therapy provision for children with learning disabilities and/or mild to moderate perceptual and motor deficits.

This paper discusses three major issues in the provision of occupational therapy services to persons with learning disabilities and/or mild to moderate perceptual and motor deficits. The issues are (a) the historical influence of federal legislation on the scope and content of occupational therapy services to persons with these disabilities; (b) the provision of occupational therapy services for this population from infancy to adulthood; and (c) the context of service provision and efficacy of occupational therapy models.     

Issues in bidding for contracts for occupational therapy services.

There is an increasing number of occupational therapists in Canada who are involved in bidding for contracts to deliver occupational therapy services. Occupational therapists working in an institutional or community-based setting may not have had the responsibility of developing a proposal or a marketing plan for bidding purposes. However, the responsibility of developing a bid to compete for a service delivery contract often rests on occupational therapists who are sole practitioners in a private practice setting. The purpose of this paper is to highlight issues in the literature such as service delivery plans, marketing strategies and costing of services that can assist the occupational therapist in the development of a contractual bid. A specific clinical example, school therapy services, has been used to illustrate how these strategies can be applied to practice. Success in contractual bids appears to be primarily influenced by cost of the service, the expertise of the service provider, ability to provide coordinated care, ease of access for clients, and inclusion of methods to measure client outcome.     

Human development through occupation: theoretical frameworks in contemporary occupational therapy practice, part 1.

In 1968, the report of a conference sponsored by the American Occupational Therapy Association called for the development of an integrated theory of occupational therapy. A review of the practical problems faced by therapists today, contrasted with major developments in the art and science of the field during the past decade, suggests that this goal has not been attained. However, three major theoretical frameworks for therapy have evolved through the work of Fidler and Mosey, Wilbarger, and Llorens, who participated in the conference on theory. Reilly and associates developed a fourth framework of significance. Through analysis of theoretical constructs, generic concepts that characterize occupational therapy can be identified. Theoretical constructs and research validation of the four approaches to occupational therapy are discussed in this article. A second article to appear in a subsequent issue of AJOT illustrates the use of the four theoretical frameworks to derive a philosophical basis for practice and a model of the practice process called "human development through occupation."