The role of occupational therapy in providing vocational rehabilitation for people living with inflammatory arthritis: A scoping review

INTRODUCTION

Inflammatory arthritis significantly impacts work participation resulting in cost to individuals, employers, and society. Vocational rehabilitation seeks to address this need, but its pathways, interventions, and efficacy continue to be under investigation. Contributing variables are complex, identifying the need for a conceptual framework to guide practice. Occupational therapy addresses this complexity, providing theoretical frameworks such as the Person-Environment-Occupation-Performance (PEOP) model to understand the occupation of work supporting well-being and design interventions. The aim of this scoping review is to map the role of occupational therapy in providing vocational rehabilitation for people living with inflammatory arthritis.

METHODS

A scoping review following Arksey and O'Malley's (2005) stages was completed. Major databases and grey literature were systematically searched, and hand-searches completed. Descriptive and thematic analysis mapped the findings to the PEOP model framework.

CONSUMER AND COMMUNITY INVOLVEMENT

There was no consumer or community involvement in this review.

RESULTS

Fourteen studies were included. Major themes aligned to the PEOP model with further analysis synthesised in subthemes. A majority of person-related interventions to support work performance was observed. This framework identifies the domains of focus in vocational rehabilitation and current gaps. Work instability, employment retention, and self-efficacy were used to measure effectiveness.

CONCLUSION

This scoping review presents the evidence regarding vocational rehabilitation for the inflammatory arthritis population in the context of occupational therapy theory to provide a framework for clinical practice. A current focus on person-focused interventions was identified. The PEOP model provides a clear framework to understand the complexity and nuances of vocational rehabilitation across the domains. Outcome measures for vocational rehabilitation are heterogenous and require further exploration as capturing the intricacy of achieving balance with work participation remains unclear. Further research into vocational rehabilitation programs incorporating all domains of the PEOP model is needed. Consideration of work performance measurements to inform effectiveness and the resulting impact on a person's well-being is required.

Occupations and balance during the transition to motherhood with a lifetime chronic illness: A scoping review examining cystic fibrosis, asthma, and Type-1 diabetes

INTRODUCTION

Throughout the transition to motherhood, changes are experienced across a woman's physical, mental, social, and occupational self. Maternal chronic illness adds the complexity of increased healthcare needs and navigating a high-risk, medicalised pregnancy, birth, and post-natal period. Literature concerning motherhood transitions in chronic illness generally focusses on the mother's medical health and pregnancy outcomes; little is known about the impacts on women's occupations, balance, and quality of life. Understanding these issues may help support women in a more tailored and holistic way.

OBJECTIVE

This scoping review aims to gather, analyse, and synthesise existing empirical research on occupational engagement and occupational balance as they impact on wellbeing and quality of life in women with a lifetime chronic illness before and during pregnancy and in early motherhood.

METHOD

The review follows the nine-stage framework described in the Joanna Briggs Institute Manual for Evidence Synthesis (2020). Five databases were searched: Embase, Medline, PsycINFO, CINAHL, Scopus, and OT Seeker. Data were extracted and examined via content analysis, described in narrative synthesis, summarised into a conceptual framework, and tabulated.

FINDINGS

A total of 8,655 papers were discovered on initial search. Following title and abstract screening, 220 full-text studies were assessed for eligibility, and 46 papers were finally included. Analysis generated four major themes: The Disrupted Transition Journey; Adaptation, Compromise and Choice; Outcomes; and Drawing on What's Available. The themes were conceptualised into a framework to explain how women sought to balance motherhood and illness-related occupations. Adequate access to information, social support, expert care, and financial resources improved both quality of life and healthcare compliance.

CONCLUSION

Findings of this scoping review deepen the understanding of occupational balance during the transition to motherhood in the context of lifetime chronic illness. Healthcare providers and supportive family and friends can use this knowledge to adapt their approach to assisting women with chronic illness on the motherhood journey. These findings may also inform further inquiry into the scope of occupational therapy practice with this population.

[Translation of the Occupational Balance Questionnaire in French and its Validation]

Background. Questionnaires measuring occupational balance have been created in recent years, but those available in French are limited. Purpose. This study aimed to translate and transculturally adapt the Occupational Balance Questionnaire and to examine the internal consistency, test-retest reliability and convergent validity of the French version. Methodology. A cross-cultural validation was conducted with adults in Quebec (n = 69) and in French-speaking Switzerland (n = 47). Results. Internal consistency was good in both regions (α > 0.85). Test-retest reliability was satisfactory in Quebec (ICC = 0.629; p < 0.001), but a significant difference was found between the two measurement times in French-speaking Switzerland. Significant associations were found between the results of the Occupational Balance Questionnaire and those of the Life Balance Inventory (Quebec, r = 0.47; French-speaking Switzerland, r = 0.52). Implications. These initial results support the use of the OBQ-French in the general population of two French-speaking regions.

Longitudinal Changes in Occupational Balance among Baby Boomers in Japan (1996-2016)

In Japan, the proportion of the older adult population-the post-war baby boomer generation-is increasing rapidly and presenting new problems, such as suicide among baby boomers and the burden of family care. The purpose of this study was to clarify how baby boomers changed their occupational balance between their 40s and 60s. This study used public statistical data from the Survey on Time Use and Leisure Activities published by the Statistics Bureau of Japan to analyze the longitudinal characteristics of the time allocation of baby boomers. The findings of this study showed gender differences in occupational balance among the study population. The occupational balance of men changed due to occupational transition after mandatory retirement, but that of women did not change significantly. Longitudinally examining the time allocation changes of one generation revealed that the readjustment of occupational balance is necessary during life role changes, such as retirement. Moreover, if this readjustment is not carried out properly, individuals will experience role overload and loss.

Translation, Psychometric and Concept Analysis of the Occupational Balance-Questionnaire Based on a Turkish Population

Occupational balance is a crucial concept in occupational therapy, accepted as a key component of health and well-being. The Occupational Balance-Questionnaire (OB-Quest) is designed as a standardized instrument to assess occupational balance. This study investigated the validity and reliability of the OB-Quest Turkish, which consisted of translation, cross-cultural adaptation, and analysis psychometric properties phases. The factor structure of the OB-Quest indicated a good model fit. The criterion-related validity showed a positive correlation with Beck Depression Inventory and a negative correlation with the 12-item Short Form Survey. The OB-Quest-Turkish showed questionable internal consistency and an excellent correlation between test-retest.Supplemental data for this article is available online at https://doi.org/10.1080/07380577.2021.2010160 .

A new tool to measure occupational balance: Adolescent Occupational Balance Scale (A-OBS)

BACKGROUND

The concept of occupational balance in adolescents is not clear enough.

AIM

The current study aims at developing a valid and reliable scale to measure occupational balance in adolescents.

METHOD

We conducted online interviews with the participant adolescents via semi-structured interview forms. We applied the Davis technique twice to 10 expert panellists and the test form to 600 individuals. Two weeks later, we re-tested 153 of the participants. We then carried out item analysis to evaluate the internal consistency of the scale. We also conducted explanatory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the construct validity of the scale.

FINDINGS

The content validity index of the scale was found to be 0.986. EFA showed that the scale consisting of 27 items had a six-factor structure explaining 56.7% of the total variance. Model fit indices about the structure created by factor combination technique in CFA were CMIN/df = 2.135; RMSEA = 0.06; GFI = 0.866; NFI = 0.81, CFI = 0.887, TLI = 0.868; IFI = 0.89. The analysis to test the reliability of the scale resulted in ICC: 0.993 and Cronbach's alpha: 0.997. Pre-test and post-test analyses showed very strong correlational coefficients (p < 0.005).

CONCLUSION

A-OBS is a valid and reliable scale consisting of 27 items and 4 sub-dimensions. It can be used in studies that will focus on occupational balance in healthy adolescents. It is the first occupational balance scale developed for adolescents in the occupational therapy literature. We recommend further studies to validate the scale and adapt it to different languages and cultures.

Occupational balance of Spanish occupational therapist – a challenge

BACKGROUND

Occupational balance is a central aspect in occupational therapy. Awareness of occupational balance/imbalance among occupational therapists could influence the orientation of their professional interventions.

OBJECTIVE

To describe and compare the occupational balance status of occupational therapists working in Spain.

MATERIAL AND METHODS

Cross-sectional descriptive study using an online questionnaire. Participants were occupational therapists working in Spain who answered a questionnaire including 22 questions on the sociodemographic and employment data and the Spanish version of the Occupational Balance Questionnaire (OBQ-E) ranging 0-65 where higher ratings equal better occupational balance.

RESULTS

A total of 648 currently working occupational therapists participated. Mostly women, with median age of 32 years, without partner, children, or dependents. The median OBQ-E was 37 (IQR = 27; 45). Statistically significant differences were found between the medians of participants varying in the categories 'hired as an occupational therapist', weekly work hours, and population working with children and adults.

CONCLUSIONS AND SIGNIFICANCE

Spanish occupational therapists presented a moderate occupational balance that varied between subgroups. Professional recognition, working hours, and the population they attend are aspects that influence their occupational balance. Knowledge of occupational therapists' occupational balance could contribute to the development of policies aimed at promoting it.

Associations Between Parental Occupational Balance, Subjective Health, and Clinical Characteristics of VLBW Infants

Objective

Very low birthweight (VLBW) infants have an increased risk of mortality and frequently suffer from complications, which affects parental occupational balance. Occupational balance is the satisfaction with one's meaningful activities, which include everyday activities that people need to, want to, and are expected to do. In contrast to work-life balance, the construct of occupational balance addresses different activities equally and it applies to all persons, regardless of whether they are working or not. Parental occupational balance might be related to parents' and VLBW infants' health. Therefore, the objective of this study was to investigate associations between parental occupational balance, subjective health, and clinical characteristics of VLBW infants.

Methods

A cross-sectional multicenter study was conducted in six Austrian neonatal intensive care units. Occupational balance and subjective health of parents of VLBW infants were assessed with six self-reported questionnaires. The following clinical characteristics of VLBW infants were extracted from medical records: gestational age, birthweight, Apgar scores, Clinical Risk for Babies II Score, and complications of prematurity. Spearman's rank coefficients were calculated.

Results

In total, 270 parents, 168 (62%) female and their VLBW infants, 120 (44%) female, were included in this study. Parents' mean age was 33.7 (±6.0) years, mean gestational age of VLBW infants was 27 + 3 (±2) weeks. Associations between parental occupational balance, subjective health, and clinical characteristics of VLBW infants were identified (r s = 0.13 - 0.56; p ≤ 0.05), such as the correlation between occupational areas (r s = 0.22, p ≤ 0.01), occupational characteristics (r s = 0.17, p = 0.01), and occupational resilience (r s = 0.18, p ≤ 0.01) with bronchopulmonary dysplasia of VLBW infants.

Conclusion

Occupational balance is associated with parents' and VLBW infants' health. Interventions to strengthen parental occupational balance might increase parental health and thereby also improve health and developmental outcomes of their VLBW infants.

Perceived challenges at work and need for professional support among people with inflammatory arthritis - a qualitative interview study

BACKGROUND

People with inflammatory arthritis (IA) often experience low work ability, and up to 38% lose their jobs during the initial years after the diagnosis of IA.

AIM

We explore the perceived challenges at work and identify the need for professional support among Danish people with IA.

MATERIALS/METHODS

Individual explorative interviews based on a hermeneutic approach. We used Graneheim and Lundman's qualitative content analysis.

RESULTS

Eleven women and four men with IA (aged 36-68 years) who worked full or part time, or were on short-term sick leave, participated. The analysis revealed one main theme, Balancing work as part of everyday life, and four sub-themes: 1) Working despite challenges, 2) Prioritising energy for work, 3) Fatigue leading to lack of control, and 4) Need for flexibility and recognition.

CONCLUSIONS

People with IA prioritise staying at work despite experiencing challenges with fatigue and balancing their work and energy in everyday life. They need recognition, support and flexibility at work to be able to continue in their jobs.

SIGNIFICANCE

The study highlights the need to be aware of occupational balance and, thus, to include other aspects in life apart from just work. It points at occupational therapists as relevant partners in vocational rehabilitation.

Exploring the associations among occupational balance and health of adults with and without inflammatory arthritis

OBJECTIVE

Occupational balance is a person's subjective perception of the amount and variation of their everyday activities. Evidence suggests an association between occupational balance and health. However, the impact of arthritis on occupational balance and its association with health is unclear. This exploratory study examined associations between occupational balance and measures of health, and between-group differences, in adults with and without inflammatory arthritis (IA).

METHODS

In a cross-sectional study, participants completed the Occupational Balance Questionnaire (OBQ11), SF-36 Health Survey (Physical and Mental Component Scores) and provided demographic information. Telomere lengths were analyzed from dried blood spots.

RESULTS

143 adults participated (67 with IA, 76 healthy comparison (HC) group). Occupational balance was higher in the HC group than the IA group (mean difference = 3.5, 95% CI = 1.0, 5.9, p = 0.01), but this difference was not statistically significant when adjusted for physical health. The association between occupational balance and physical health was stronger in the IA group (R² = .17, p = .001) than in the HC group (R² = .05, p = .05). Occupational balance was associated with mental health (R² = .26, p < .001) but not associated with telomere length (R² = .02, p = .24).

CONCLUSION

Occupational balance is associated with mental health for all participants and associated with physical health and disease activity in participants with IA. Attention to assessment of and strategies for improving occupational balance in rehabilitation practice and arthritis self-management programs may contribute to sustaining physical and mental health.

Rasch Analysis of the Norwegian Version of the Occupational Balance Questionnaire in a Sample of Occupational Therapy Students

Background

Recently, the Occupational Balance Questionnaire developed in Sweden was translated into Norwegian. No studies to date have examined the measurement properties of the Norwegian version of this questionnaire.

Aim

The study is aimed at examining the psychometric properties of the Norwegian version of the Occupational Balance Questionnaire, the OBQ11-N.

Methods

Along with sociodemographic data, 180 occupational therapy students enrolled at two Norwegian universities completed the OBQ11-N as well as one question each related to health and quality of life and some sociodemographic variables. Rasch analysis was employed for examining rating scale functioning, item and person validity, dimensionality, and differential item functioning.

Results

Item categories were ordered, but there were potential gaps in the measurement of the construct. Person reliability was fair, whereas item reliability was low. Point biserial correlations were positive, indicating that all items contributed to the construct. Factor loadings were low for two items, and there were indices of a second underlying dimension and item redundancy. Many people were not aligned with the items, and some items functioned differently across various demographic variables. Conclusion and Significance. The OBQ11-N did not function as an adequate measure of occupational balance in a sample of students. Potentially, the detected measurement problems may be solved by adding more relevant items to a larger item pool, from which the best fitting items should be selected.

Exploring perceived occupational balance in women with fibromyalgia. A descriptive study

BACKGROUND

People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation.

OBJECTIVE

To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms.

METHODS

A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure.

RESULTS

One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance.

CONCLUSION

Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance.

SIGNIFICANCE

Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.

Cross-Cultural Adaptation, Validation and Reliability of the Spanish Satisfaction with Daily Occupations-Occupational Balance (SDO-OB): An Evaluation Tool for People with Mental Disorders

Occupation can be defined as all activities that occupy a person's time. The Satisfaction with Daily Occupations and Occupational Balance instrument evaluates the perceived satisfaction with performance and the balance in time dedicated to different occupations. The main aim was to translate the original instrument to Spanish and examine and establish the psychometric properties. This is a quantitative, cross-sectional study conducted in two stages: translation and cultural adaptation (forward translation, expert panel, back-translation, second expert panel and pre-testing and cognitive interviewing) and collecting data to evaluate psychometric properties (homogeneity, construct validity, known-groups validity, and floor/ceiling effects). One hundred participants took part in the study, adults with a diagnosis of a mental health disorder and adults without any known health problems. The Spanish version showed known-groups validity, acceptable internal consistency, and construct validity, although the relationships with some of the indicators of discriminant validity were somewhat higher than expected. The instrument shows promise as a useful screening tool for assessing activity level and satisfaction with daily occupations among a Spanish speaking population.

Relationship of Forced Social Distancing and Home Confinement Derived from the COVID-19 Pandemic with the Occupational Balance of the Spanish Population

Abrupt interruption in the performance of everyday occupations as a consequence of forced social distancing and home confinement, coupled with a lack of regulatory capacities and skills, can trigger harmful effects on people's health and well-being. This study aimed to determine the factors related to the occupational balance in the Spanish population during home confinement as a consequence of the coronavirus disease 19 (COVID-19) pandemic. A total of 3261 subjects completed an online survey, which was disseminated through the mainstream social media platforms in Spain and included the Occupational Balance Questionnaire (OBQ), sociodemographic variables, and factors related to COVID-19 infection. The mean age of the participants (81.69% women) was 40.53 years (SD ± 14.05). Sociodemographic variables were related to a greater occupational balance, and the multivariate analysis showed that age (β = 0.071; p = 0.001), the perception of having received enough information (β = 0.071; p ≤ 0.001), not telecommuting (β = -0.047; p = 0.022), and not being infected by COVID-19 (β = 0.055; p = 0.007) contributed to a better occupational balance. There were profiles of people less likely to suffer disturbances in occupational balance during home confinement, but more studies are needed to help understand and analyze the effects of the COVID-19 pandemic on people's occupational and mental health.

Danish translation and validation of the Occupational Balance Questionnaire

BACKGROUND

Occupational balance is a key concept in occupational science and occupational therapy. However, it is not well operationalized and instruments to evaluate occupational balance are scarce.

AIM

To translate and validate a Danish version of the 10-item Occupational Balance Questionnaire (OB-Quest).

MATERIAL AND METHODS

Translation was conducted using the dual-panel approach. Thereafter, data from 262 healthy Danish students were analyzed regarding fit to the Rasch model.

RESULTS

The translation of the questionnaire to Danish required only minor cultural adaptations. Ninety percent of the participants were female. The mean age (±SD) was 26.10 (7.05) years. The reliability (person separation index) was questionable (0.63), and the scale showed multidimensionality. Two items (1 and 9) showed misfit to the Rasch model. Differential item function by gender was detected in one item (item 4). After deleting items 1 and 9 and splitting item 4 into two gender-specific items, the new 9-item scale showed good overall and individual item fit. However, reliability remained low (0.59) and some elements of the latent variable (occupational balance) were not sufficiently represented.

CONCLUSIONS AND SIGNIFICANCE

Further development and testing of the Danish OB-Quest is needed before implementation in clinical practice or research involving healthy subjects.

Activity repertoires and time use in people living with chronic obstructive pulmonary disease

BACKGROUND

Understanding the dynamics and aspects of how activity choices impact health and well-being in people living with chronic obstructive pulmonary disease (COPD) is important to inform rehabilitation.

AIM

To describe, firstly, how much time people living with COPD spend on work, daily living tasks, recreation and rest; secondly, how this population perceived competence, importance and enjoyment related to these activities; thirdly, if differences in such perceptions and time use were associated with the living situation and COPD severity.

MATERIAL AND METHODS

This cross-sectional study involved 76 participants (+45 years, COPD, living in ordinary homes), who completed the Occupational Questionnaire (OQ). Descriptive statistics and group comparisons were performed.

RESULTS

Most of the participants' time were spent on daily living activities and recreational activities. Participants spent approx. 80% of their recorded time in OQ on activities they valued, enjoyed and in which they felt competent. Participants living alone scored significantly lower on enjoyment in restful activities than those living in couples (p < 0.05). No statistically significant difference in perceived competence, importance or enjoyment was found in relation to COPD severity.

CONCLUSIONS AND SIGNIFICANCE

Findings underscore the importance of targeting overall daily activity repertoires including compositions of activity types, time use and perceived competence, importance and enjoyment.

Occupational balance and its association with life satisfaction in men and women with rheumatoid arthritis

INTRODUCTION

Despite improved treatments and reduced disability, people with rheumatoid arthritis (RA) experience difficulties in daily life, which may negatively affect their balance of everyday life activities (occupational balance). The aim of this study was to describe occupational balance and its association with self-rated life satisfaction in men and women with RA.

METHODS

A survey, including demographic and health-related questions, was sent to 1,277 people who met the following criteria: with RA >4 years, aged 18-80 years, included in the Swedish Rheumatology Quality Register (SRQ), and had at least one registered visit to the participating rheumatology units in the year before inclusion. The 682 who answered all items in the Occupational Balance Questionnaire (OBQ) were included in the study. Their answers were analysed with descriptive statistics, and logistic regression analyses were conducted on men and women separately.

RESULTS

Significantly higher occupational balance was identified in those participants who were >65 years, had no children at home, had a lower disease activity score, were not continuously stressed and reported low pain intensity. The results of the logistic regression analyses of both genders showed that higher occupational balance was significantly associated with a higher probability for rating themselves as being satisfied with life as a whole.

CONCLUSION

Occupational balance was identified as related to satisfaction with life as a whole, which is valuable information for health professionals. Enhanced occupational balance may be achieved in people with RA by working towards reducing their stress and pain.

Measuring occupational balance and its relationship to perceived stress and health: Mesurer l'équilibre occupationnel et sa relation avec le stress perçus et la santé

BACKGROUND

There is an assumption that occupational balance is integrally related to health and well-being.

PURPOSE

This study aimed to investigate test-retest reliability of the English-translated Occupational Balance Questionnaire (OBQ), its relationship to measures of health (Short Form Health Survey-36 Version 2.0 [SF-36v2]) and stress (Perceived Stress Scale-10; PSS-10), and demographic differences in OBQ scores in Canadian adults.

METHOD

Test-retest reliability (2 weeks) was assessed using intraclass correlation (ICC) coefficients. Online surveys from 86 adults were analyzed using descriptive, correlational, and t test statistics.

FINDINGS

OBQ test-retest reliability was ICC = 0.74 (95% CI [0.34, 0.90]; p = .003) when excluding an influential case ( n = 20). OBQ correlations with PSS-10 were r = -.72; with SF-36v2 Mental Component Score, r = .65; and with Physical Component Score, r = .31; all p < .001. Age and gender had no impact on OBQ scores.

IMPLICATIONS

Findings help elucidate relationships among health, stress, and occupational balance; however, further psychometric testing is warranted before using OBQ for clinical purposes.

Occupational imbalance and the role of perceived stress in predicting stress-related disorders

BACKGROUND

Stress-related disorders are the main reason for sick leave in many European countries. The aim of the present study was to explore whether perceived occupational imbalance predicts stress-related disorders, potential gender differences, and to explore the mediating role of perceived stress.

METHOD

Longitudinal data on 2223 employees in a public organization in Sweden were collected by surveys, and analyzed by logistic regression.

RESULTS

Occupational imbalance predicted stress-related disorders among both women and men. However, what aspects of occupational imbalance which predicted stress-related disorders differ by gender. Perceived stress was not a mediator in these associations.

CONCLUSION AND SIGNIFICANCE

How women and men perceived their occupational balance affected the risk of stress-related disorders. The results may be used to develop effective strategies to decrease stress-related disorders.

Occupational balance in health professionals in Sweden

BACKGROUND

Health care employees are often women, a group that has high degrees of sick leave and perhaps problems attaining occupational balance. However, people think differently about their everyday activities and it is therefore important to take their perceptions into account but occupational balance has not yet been measured in health professionals. The aim was to describe occupational balance in three different samples of health professionals in Sweden. A further aim was to investigate whether occupational therapists (OTs) rate their occupational balance differently from other health professionals.

MATERIAL AND METHOD

Four hundred and eighty-two health professionals, employees in public dentistry, mental health care and OTs, aged 21-70 years participated. The participants' occupational balance was measured using the occupational balance questionnaire (OBQ).

RESULTS

The ratings of occupational balance were similar to earlier studies and did not differ significantly between the samples. The OTs' occupational balance was also similar to that of the other health professionals.

CONCLUSION

The similarities in occupational balance indicate the same difficulties in attaining it.

SIGNIFICANCE

The result highlights the possibility that working people face similar difficulties in achieving occupational balance. Further research is warranted about how to attain it.

Life Balance and Stress in Adults With Medical Conditions or Obesity

This cross-sectional research examined differences in life balance and perceived stress by body mass index (BMI) levels and self-reported medical conditions that limited physical activity. The sample consisted of 2,338 participants between the ages of 18 and 49 years who took the Life Balance Inventory, the Perceived Stress Scale, and provided demographic information including height and weight. Findings showed that individuals who were obese (BMI > 30.0) reported significantly lower life balance scores and higher stress scores than participants without obesity (p < .001). Also, individuals who had medical conditions that resulted in activity limitations reported significantly less life balance and more stress than individuals without medical conditions (p < .001). These findings highlight the importance of addressing activity participation as a means to promote health and wellness.

Personal Life Approach: An Interactive Way of Understanding Older Adults' Participation in Activities Following Hospitalization

PURPOSE

To explore factors that support or inhibit participation in daily activities amongst older adults who have returned home following hospitalization.

DESIGN AND METHODS

An exploratory qualitative design was used to gather information from a sample of older adults. Participants were recruited during their hospital stay from acute and rehabilitation wards in Victoria, Australia. Semistructured interviews were carried out in the participants' home within 6 weeks of discharge. Data were analyzed through thematic analysis.

RESULTS

Participants (n = 21) were aged ≥65 years (mean 82 years [SD 8.5]), 57% were female (n = 11) and 76% with English as their first language (n = 16). Thematic analysis identified one primary theme (personal life approach) moderated by spirituality and two subthemes; interpretation of physical and mental abilities, and social interactions. The life approach acted as a filter through which participants interpreted their abilities and social interactions that either supported or inhibited their return to participation after a stay in hospital.

IMPLICATIONS

The findings suggest that clinicians need to consider the individual's approach to life in their recovery following hospitalization. This approach can influence their return to participation in activities and potentially be supported (towards higher levels of optimism) by health professionals to enhance participation in activities postdischarge.

Definitions of occupational balance and their coverage by instruments

Introduction

Occupational balance is an important and widely used concept in occupational therapy and occupational science. There is, however, not one unified definition in use, but several different ones, and thus instruments that measure the concept in research studies are diverse as well. Consequently, it is unclear how instruments and definitions correspond. The purpose of this study was to examine the coverage of occupational balance definitions by occupational balance instruments.

Method

Within a mixed-methods design we conducted a qualitative and quantitative content analysis of definitions and items of existing instruments. Definitions and items were extracted from articles identified in a systematic literature search. The extent of congruence and coverage between definitions and instruments was examined.

Results

The definitions used in 47 articles were structured into 19 categories. The categories which were found in most definitions were a balance of ‘various occupational patterns and areas’ (42; 89%) and ‘occupational accomplishment, performance, roles and responsibilities’ (35; 75%); 20 instruments were explored. Together they covered 16 (84%) of the 19 categories.

Conclusion

Knowing which instruments cover which dimensions of occupational balance can support occupational therapists, other health professionals and health researchers in their selection of an instrument to measure occupational balance.

“Do-Live-Well”: A Canadian framework for promoting occupation, health, and well-being

Background.

Occupational therapists can bring a unique and valuable perspective to the national dialogue on health promotion. Current approaches have a narrow focus on diet and exercise; a broader focus on occupation has the potential to enrich understanding regarding forces that contribute to health and well-being.

Purpose.

A new “Do-Live-Well” framework will be presented that is grounded in evidence regarding the links between what people do every day and their health and well-being.

Key Issues.

Elements of the framework include eight different dimensions of experience and five key activity patterns that impact health and well-being outcomes. Personal and social forces that shape activity engagement also affect the links to health and well-being.

Implications.

The framework is designed to facilitate individual reflection, community advocacy, and system-level dialogue about the impact of day-to-day occupations on the health and well-being of Canadians.

Life Balance and Perceived Stress: Predictors and Demographic Profile

This article explored differences in life balance scores between demographic groups and whether life balance predicted perceived stress. This research used secondary analysis of 1,048 subjects from a database for the Life Balance Inventory (LBI). Analysis of variance showed that the profile of people with the highest total life balance scores was: white, 61 years or older, earned a master's degree, had incomes between $81,000 and $100,000, lived in the suburbs, had two children (but the children were not at home), were not working (if working, they were self-employed), owned a home, and lived in the United States. Other demographic groups differed in their LBI subscale scores. Regression analysis showed that life balance scores predicted lower perceived stress scores. This research provides additional construct validity evidence for the LBI and its associated Life Balance Model.

Associations between women's subjective perceptions of daily occupations and life satisfaction, and the role of perceived control

BACKGROUND/AIM

More knowledge is needed about the role of perceived control in the associations between different perceptions of daily occupations and positive health outcomes. The aim was to explore the associations between different subjective perceptions of daily occupations, in terms of occupational balance, occupational meaning, occupational value and satisfaction with occupations, and life satisfaction, and the role of perceived control in those associations.

METHODS

A questionnaire including questions about perceptions of daily occupations, perceived control and life satisfaction were answered by a random sample of 488 middle-aged Swedish women. Multiple logistic regression analysis was used to test the associations between perceptions of daily occupations and life satisfaction, and the role of perceived control.

RESULTS

After adjustments for perceived control women who perceived a high level of satisfaction with work and leisure, occupational balance, occupational meaning and occupational value perceived greater life satisfaction than the other women. Perceived control was not significant in the model.

CONCLUSIONS

It seems that occupational balance and occupational meaning were pivotal for the women's life satisfaction, but satisfaction with work and leisure, as well as perceived occupational value, was also of importance. The assumption that perceived control would have a role in the association between perceptions of occupations and life satisfaction was not confirmed.

SIGNIFICANCE OF THE STUDY

The results indicate that occupational therapists need to focus on occupational balance, occupational meaning, occupational value and satisfaction with work and leisure to promote positive health outcomes, in terms of life satisfaction, when working with middle-aged female clients.

Description and Development of the Life Balance Inventory

This article describes the development and psychometric testing of the Life Balance Inventory (LBI), an instrument created to measure the construct of life balance as conceptualized in the Life Balance Model. After initial item development based on theory, expert opinion, and feedback from 52 adults, rating and scoring mechanisms were established and two phases of pilot testing were completed. The first ( N = 282 adults) and second ( N = 458 adults) pilot testing phases used Rasch analysis that showed the items were capturing a range of balance traits and that the items fit intuitively with the model of life balance. The internal consistency of the LBI for both tests was good (Cronbach's alpha = 0.89 to 0.97). Confirmatory factor analysis for the four subscales of the LBI was inconclusive. The LBI has demonstrated acceptable internal consistency and content validity as a measure for life balance.

Participation Profile of Adults with Class III Obesity

The purpose of this study was to describe the time use and associated perceptions of performance, importance, and enjoyment for adults in treatment for obesity classified as severe. Adults ( n = 128) from obesity treatment programs in Ontario, Canada, completed a survey that included the Occupational Questionnaire, a measure of the distribution and meaning of time use across occupations. Descriptive analysis and differences between groups based on obesity severity, age, and being limited by obesity were completed. Participants spent the most time in daily living activities and less time in work, recreation, and rest activities. Participants reported doing activities that they enjoy and perform well is important. The distribution of time across occupations for participants in this study is similar to that of adults living with chronic health conditions. No significant differences in time use and associated meaning were found between groups based on body mass index or being limited by obesity. More time was spent in work activities for participants aged 25 to 54 years. Obesity interventions that support participation in existing occupations and enable participation in recreation and rest occupations should be considered.