Virtual communities of practice for novice occupational therapists: a vehicle for learning, support and professional identity strengthening?

INTRODUCTION

Healthcare practitioners delivering services in rural and underserved areas need timely access to appropriate knowledge to optimise the care they deliver. Novice generalist occupational therapists in South Africa experience this need as they respond to a high demand for hand therapy. Embedded within a study aimed at identifying their support and development needs, this article describes participants' experience of a virtual community of practice.

METHODS

A qualitative case study design was employed. Nine occupational therapists participated in a virtual community of practice that met fortnightly for meetings and interacted on WhatsApp. Data were collected through photo elicitation, facilitated reflection, and case discussions. An online survey questionnaire was used to evaluate participants' experience of this virtual community. Thematic analysis was applied to the anonymous responses submitted by participants (n=7). A number of strategies were employed to ensure the trustworthiness of results including prolonged engagement, member checking, peer examination, reflexive reading and writing, triangulation, and a dense description of participants to enable readers to evaluate the transferability of results.

RESULTS

Three themes were generated from analysis. The first theme, versatile support, describes participants' experience of being helped and supported, appreciating the immediacy of support, and being able to share resources. A vehicle for learning captures participants' experience of mutual learning, opportunity to reflect, to acquire knowledge and skills, and develop their clinical reasoning. Finally, the community of practice was grounding: learning opportunities were contextually relevant and participants were able to consolidate their professional values and identity. Participants raised the importance of using online platforms that were accessible, recommended a group size of 5-10 members, and proposed 60-90-minute meetings held weekly or fortnightly.

CONCLUSION

A virtual community of practice provided both support and professional development opportunities for therapists delivering hand therapy. Careful planning and implementation to upscale this intervention are recommended for rehabilitation personnel delivering care to underserved communities in South Africa. The logistics of virtual communities need to mitigate for connectivity difficulties, and online platforms should enable real-time support. Participant satisfaction and the evaluation of implementation outcomes should be considered in the design of virtual communities of practice.

Medical device regulation: requirements for occupational therapists in The Netherlands who prescribe and manufacture custom-made devices

PURPOSE

To interpret the Medical Device Regulation for occupational therapists in the Netherlands involved in prescribing and manufacturing custom-made assistive devices and to develop a roadmap for implementation.

MATERIALS AND METHODS

Four online iterative co-design workshops were organized under supervision of a senior quality manager to assist in the interpretation of the MDR framework with a focus on custom-made assistive devices; and to assist the implementation by generating guidelines and forms. The workshops for seven participating occupational therapists had an interactive character with Q&A, small and homework assignments, and oral evaluations. Next to occupational therapists, participants with different backgrounds joined such as 3D printing experts, engineers, managers, and researchers.

RESULTS

The participants experienced the interpretation of the MDR as informative, but also as complex. Complying with the MDR requires considerable documentation activities that are currently not part of care professionals tasks. This initially raised concerns regarding implementation in daily practice. To facilitate the MDR implementation, forms were created and evaluated for a selected design case together with the participants for future reference. Additionally, instructions were given which forms should be filled out only once per organization, which forms could be reused for similar types of custom-made devices, and which forms should be filled out for each individual custom-made device.

CONCLUSIONS

This study provides practical guidelines and forms to support occupational therapists in the Netherlands to prescribe and manufacture custom-made medical devices complying with the MDR. It is recommended to involve engineers and/or quality managers in this process.

Pediatric Occupational Therapists' Perspectives on Sleep: A Qualitative Descriptive Study

IMPORTANCE

Insufficient sleep is common among children seeking occupational therapy services but is rarely a focus of therapy despite sleep's critical impact on health.

OBJECTIVE

To examine pediatric occupational therapists' experiences, views, and confidence in addressing sleep concerns in their practice as well as barriers to and supports for doing so.

DESIGN

A qualitative descriptive study with thematic analysis of data from 1-hr virtual interviews. Rapport building, multiple-coder analysis, and member checking were used to ensure reliability and validity.

SETTING

Interviews were conducted remotely at each participant's preferred time and location.

PARTICIPANTS

Pediatric occupational therapists (N = 20) practicing across multiple settings in the United States were recruited through emails directed to their place of work and social media posts. A goal of 20 participants was set a priori with the goal of thematic saturation.

OUTCOMES AND MEASURES

A semistructured interview guide.

RESULTS

Participants were predominately cisgender (95%), female (85%), and White, non-Hispanic (90%). Overall, they voiced the importance of sleep but reported almost never writing sleep-related goals. Reported barriers that affected the participants' ability to fully address sleep in practice included therapists' lack of confidence and knowledge and low caregiver buy-in.

CONCLUSIONS AND RELEVANCE

The findings identify themes on the basis of which actionable steps toward promoting occupational therapists as sleep champions can be developed. Future implications include increasing sleep education opportunities, enhancing awareness of sleep health's impact on goal areas, and facilitating discussions about occupational therapy's role within the medical system and family system in supporting sleep. Plain-Language Summary: This qualitative study identifies what helps and hinders occupational therapists in addressing the sleep health concerns of their clients. We give occupational therapy clinicians and educators key supports to seek out or barriers to address.

Spatial Neglect: An Exploration of Clinical Assessment Behaviour in Stroke Rehabilitation

OBJECTIVE

There is a large gap between evidence-based recommendations for spatial neglect assessment and clinical practice in stroke rehabilitation. We aimed to describe factors that may contribute to this gap, clinician perceptions of an ideal assessment tool, and potential implementation strategies to change clinical practice in this area.

DESIGN

Qualitative focus group investigation. Focus group questions were mapped to the Theoretical Domains Framework and asked participants to describe their experiences and perceptions of spatial neglect assessment.

SETTING

Online stroke rehabilitation educational bootcamp.

PARTICIPANTS

A sample of 23 occupational therapists, three physiotherapists, and one orthoptist that attended the bootcamp.

INTERVENTION

Prior to their focus group, participants watched an hour-long educational session about spatial neglect.

MAIN MEASURES

A deductive analysis with the Theoretical Domains Framework was used to describe perceived determinants of clinical spatial neglect assessment. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice-change strategies in this area.

RESULTS

Participants reported that their choice of spatial neglect assessment was influenced by a belief that it would positively impact the function of people with stroke. However, a lack of knowledge about spatial neglect assessment appeared to drive low clinical use of standardised functional assessments. Participants recommended open-source online education involving a multidisciplinary team, with live-skill practice for the implementation of spatial neglect assessment tools.

CONCLUSIONS

Our results suggest that clinicians prefer functional assessments of spatial neglect, but multiple factors such as knowledge, training, and policy change are required to enable their translation to clinical practice.

A Profile of Occupational Therapists Working in School-Based Practice in Australian Primary Schools

Inclusive education has increased the demand for school-based occupational therapy services and has reconceptualised the practice in mainstream schools. Therapists are now expected to work collaboratively with teachers within tiered intervention models to support access and participation of all students, including those with disabilities, within the natural classroom context. School-based occupational therapy has become a specialised area of practice, as therapists work within educational, rather than health, systems and processes. While the growth in demand and expanded scope of practice is positive for the profession, predicted workforce shortages and the necessity for specialised and enhanced practice present significant challenges. The ability of the profession to fully support the demands of an inclusive education system remains unclear. As accurate, up-to-date information on the school-based therapy workforce is the foundation for planning future personnel needs, knowledge of the current state of the workforce is critical. There is a paucity of national data regarding this growing area of practice. The aim of this study is to describe a current profile of school-based occupational therapists to better understand the workforce, practice patterns, and the funding landscape in Australia. A convenient and purposive sample of 108 Australian paediatric occupational therapists working in mainstream primary schools in New South Wales, Queensland, and Victoria was surveyed in this quantitative study, which was analysed using descriptive statistics. Results provide some insights into the workforce and practice of school-based therapy in Australia offering preliminary data for future planning in this important and growing area of paediatric practice. While specific to the local context, results invite cross-national and global comparison to reveal universal trends and localised nuances across diverse settings.

The impact of mobility scooter on occupational participation among older adults in Singapore: an exploratory study

PURPOSE

With an ageing population, the use of mobility scooters by community-dwelling older adults with mobility limitations has been increasingly prevalent in Singapore. Their experiences in using mobility scooters remain unclear. This study aimed to explore the impact of mobility scooters on occupational performance and engagement among elderly Singaporeans.

MATERIALS AND METHODS

Mobility scooter users were recruited via purposive and snowballing sampling. Semi-structured interviews were conducted in English or Mandarin via phone call or face-to-face and audio-recorded with permission. Interviews were transcribed verbatim in their original language and translated to English (when applicable) for thematic analysis.

RESULTS

Twelve eligible participants (mean age: 75 years) completed the interviews. They were predominantly female Chinese with 7 receiving training from occupational therapists (OT). Four main themes emerged from the interviews describing their experiences of using mobility scooters: factors of decision-making in getting a mobility scooter, enhanced occupational participation with the use of the mobility scooter, enablers for community participation and barriers to community participation. Despite having barriers, older adults with mobility limitations generally still had positive experiences to continue using mobility scooters to perform occupations in the community.

CONCLUSIONS

This study highlights the benefits of mobility scooters in supporting users' occupational performance and engagement in the community. Continual efforts are required from all stakeholders to provide an accessible environment and improve societal attitudes to further support the mobility scooter users.IMPLICATIONS FOR REHABILITATIONMobility scooter users can be deterred from performing their preferred occupations if they had a prior negative encounter and they mainly rely on self-developed coping strategies to overcome possible barriers in the community.Occupational therapists should identify and address the potential barriers when prescribing mobility scooters to older adult users.Occupational therapists should work collaboratively with other key stakeholders, such as external vendors and government agencies, to co-create a universal guideline to support and safeguard mobility scooter users.

Current clinical practice patterns and perspectives of Australian hand therapists during the treatment of adults with distal radius fracture: A national survey

INTRODUCTION

Successful return to pre-injury occupational performance following distal radius fracture (DRF) may be influenced by person and environment factors such as pain, age, social support, and socioeconomic status. The primary aim of this study was to explore Australian hand therapists' current clinical practice and determine whether they consider these factors during the management of DRF.

METHODS

A mixed methods online survey was distributed to members of the Australian Hand Therapy Association. Descriptive statistics were used to examine the quantitative data, and the qualitative data were analysed by content analysis.

RESULTS

Of the 120 members who completed the survey, 68% were occupational therapists and 32% were physiotherapists with 74% in the private and 26% in the public health-care setting. Most factors perceived to influence recovery were consistent with person factors and a biomechanical approach. Other factors related to occupational performance, such as social and leisure skills, environment and culture were reported less often. When asked about defining occupational performance, the key categories identified through qualitative open responses were 'performing meaningful activities/occupations', 'performing work/employment', and 'completing activities/function'.

CONCLUSION

The data suggest that hand therapists in Australia primarily identify person factors as key to recovery after DRF. Context and environmental factors that influence occupational performance did not appear to be considered as often during treatment or when defining occupational performance. Further research is needed to explore the contextual and environmental factors that influence hand therapy intervention and determine whether they play a role in the successful return to pre-injury occupational performance following DRF.

CONSUMER AND COMMUNITY INVOLVEMENT

The survey was conceptualised by the research team, which included two experienced hand therapists and piloted with 10 consumers. Hand therapists (consumers) of various years of experience and discipline (i.e., occupational therapy and physiotherapy) provided feedback to improve the survey in terms of content, comprehensibility, and length. No clients/patients of hand therapists were involved in the development of the survey or the study, and the consumers of the study were considered hand therapists.

Inclusivity in Occupational Participation: Life Stories of Bangladeshi With Spinal Cord Injury

This research aimed to describe the process of occupational participation among persons with spinal cord injury (SCI) discharged from the only SCI rehabilitation hospital in Bangladesh. We analyzed seven participants' interview transcripts and observations using the trajectory equifinality model. Study participants demonstrated the following occupational participation trajectories: (a) employing a strategy or difficulty in occupational participation; (b) performing solidarity or experiencing deprivation; (c) creating identity or divergence; and (d) being included in or excluded from everyday life. There are four pathways: (I) discouraging conditions that minimized daily performance; (II) reinforcing obligatory connections to optimization of daily performance; (III) reciprocity to facilitate social activities; and (IV) manipulating mastery in occupational participation. Occupational therapists can consider the trajectory phases and pathways of occupational participation when facilitating the inclusion of service users after discharge from the hospital.

Factors influencing implementation of assistive technology services for older adults from the perspectives of Thai occupational therapists: a mixed methods study

PURPOSE

Occupational therapists are crucial in providing assistive technology (AT) services for older adults. However, evidence has shown limited provision of such services in Thailand. This study aimed to investigate the factors that influence the implementation of AT services for older adults from the perspectives of Thai occupational therapists.

METHODS

An explanatory sequential mixed-methods design was guided by the measurement instrument for determinants of innovations and literature review. This study was conducted in two phases: quantitative and qualitative. During the quantitative phase, an adapted version of the Measurement Instrument for Determinants of Innovations was administered to 96 occupational therapists (OTs). A subsample of 5 OTs completed a semi-structured interview during the qualitative phase to explain the findings in the quantitative one.

RESULTS

Factors were categorized into three sections: personal, organizational and socio-political context levels. At the personal level, integrating knowledge and experience could contribute to awareness and professional competency. Client satisfaction influenced OTs to utilize AT, based on a client centred manner. With coordinator and performance feedback within the organization, OTs indicated that consultants supported them in their decision-making. In contrast, availability of AT for older adults is determined by time and resources. Moreover, at the socio-political context level, legislation and regulations may permit or prohibit accessibility of assistive devices.

CONCLUSION

In order to address current challenges, education or training programmes are needed to increase the awareness and competence of OTs. In addition, collaboration with other professionals in community settings is necessary to improve access to AT services.IMPLICATIONS FOR REHABILITATIONAT service for older adults is limited by the availability of time and resources. To handle with these challenges, occupational therapists could advocate for village health volunteers to be a part of the AT services for older adults in the community to increase AT accessibility for older adults.Additional education or training programs should be developed to build competencies and increase occupational therapists' awareness of providing AT services to older adults, as well as to strengthen their roles in AT services.Future research and health policies should focus on access to sufficient funding, and resources for occupational therapists relative to their role in implementing AT services.

"It Doesn't Die Within You": Outdoor Recreation Participation Following Spinal Cord Injury

Although some people with spinal cord injury (SCI) return to outdoor recreation, many have low activity levels and encounter significant environmental barriers. The purpose of the study was to describe how people with SCI engage in outdoor recreation activities, what meaning they attribute to these, and to inform occupational therapists in promoting outdoor recreation post-SCI. The study used qualitative, descriptive phenomenology. Thirteen participants completed semi-structured interviews, and data were analyzed using thematic analysis. Outdoor recreation contributes to personal well-being. It is a way to share life with loved ones and other disabled people. Having the right equipment and using a trial-and-error approach facilitated participation, which was sometimes supported and frequently constrained by physical, built, and information environments. Findings suggest implications for occupational therapists in the areas of direct intervention, entrepreneurship, and advocacy. These are consistent with the American Occupational Therapy Association Vision 2025 to collaborate for inclusion and accessibility in occupational performance.

Occupation-Based Assessments in Pediatric Occupational Therapy Practice

In pediatric occupational therapy, there is insufficient evidence examining assessment tool selection by occupational therapists and how assessment tools contribute to occupation-based practice. To examine the perceptions of occupation-based assessment tool selection by pediatric occupational therapists, a phenomenological research study was conducted with six pediatric occupational therapy practitioners. Three themes emerged from participants' perspectives: the centrality of occupation, selecting the just right tool, and practice implications. Participants recognized the need to integrate occupation-based assessments into practice but reported decreased opportunities secondary to training, available supplies, lack of awareness of foundational constructs, and organizational expectations. The use of occupation-based assessments positively enhances pediatric occupational therapists' clinical practice by upholding the core occupational beliefs of the profession throughout all phases of service delivery.

Occupational Justice: Staff Member's Understanding of the Role of Occupational Therapy within Organizations Serving Persons Experiencing Homelessness

The purpose of this descriptive study was to explore the understanding of occupational justice and occupational therapy's role among staff members working within organizations serving persons experiencing homelessness. A survey was developed to determine if staff (N = 43) understood what occupational therapists can do to help persons experiencing homelessness. Responses were split almost equally between agree/strongly agree and disagree/strongly disagree. Most or 95% (n = 38) of respondents stated their organization would be interested in increasing programming to support the ideas of occupational justice. This suggests that occupational therapy can fill a need in these organizations to promote occupational justice.

An international study of diversity in occupational therapy research- A bibliographic review of English research literature

BACKGROUND

The cornerstone of a strong profession is the research that supports its knowledge base and practice. However, little is known about the range of international occupational therapy research.

OBJECTIVE

To explore the range and diversity of the international occupational therapy research from published peer reviewed literature in English during the year 2018.

METHODOLOGY

Limited to 2018, a review was conducted of sources from i) health-related search engines using search terms associated with occupational therapy practice, and ii) content pages of occupational therapy publications. Articles were excluded if they i) had no occupational therapy author, ii) were not peer reviewed, iii) not in English, and iv) did not include primary data collection (e.g., opinion pieces, position statements, study protocols). Of articles selected for analysis, data were extracted and synthesized according to the study's origin country, publishing research journal, the characteristics of the represented research, and its alignment with World Federation of Occupational Therapists research priorities.

RESULTS

A total of 4,169 articles were retrieved from the search (i.e., 3,459 from health-related search engines and 710 through a manual search of occupational therapy journals). After exclusions, 2,345 articles were included for analysis.

CONCLUSION

The review identified English published research was predominantly conducted in economically privileged countries. In addition, it revealed several research priorities that need further development such as evaluating the effectiveness of occupational therapy interventions.

Assistive products to support daily time management of older persons with dementia in India: experiences and views of informal caregivers and occupational therapists

PURPOSE

The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs).

METHODS

The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed.

RESULTS

Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education).

CONCLUSIONS

The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Implications for rehabilitationAdoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders.Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India.It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products.Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions.

Occupational Therapy Observation Tool-Adjustment Support Details for autistic children: Investigation of content validity and clinical utility

INTRODUCTION

Standardised testing is crucial for autistic children to receive appropriate interventions, necessary services, and funding. Behaviours associated with autism can hinder children's test performance and participation. The 18-item, two-page Occupational Therapy Observation Tool-Adjustment Support Details (OTOT-ASD) is used in conjunction with standardised assessments. The OTOT-ASD enables the recording of autism-related behaviours and the reasonable assessment accommodations made to support participation in testing. The current study aims to investigate the content validity and clinical utility of the OTOT-ASD from occupational therapists' perspectives.

METHOD

A specifically designed online questionnaire was distributed Victoria-wide to occupational therapists with clinical experience with autistic children. The questionnaire was designed in line with the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN), including relevance, comprehensiveness, and comprehensibility of items evaluated for content validity. Applicability and clinical usefulness were also investigated. Quantitative data were analysed using descriptive statistics.

RESULTS

Seventy-one occupational therapists responded to the questionnaire and 46 provided a full dataset. Over 96% of the respondents considered documenting behaviours and testing accommodations as important, yet less than 45% reported having resources to record this information. Ninety-five percent of the respondents perceived the OTOT-ASD to be useful in clinical practice. Over 70% agreed that OTOT-ASD items were significantly relevant to practice and comprehensive. To improve comprehensibility, identified items were altered following feedback.

CONCLUSION

The findings suggest that the OTOT-ASD is clinically useful and content validity is sound. Further research on other psychometric properties of the OTOT-ASD and users' qualitative experiences in utilising the tool is recommended.

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy

INTRODUCTION

Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice.

METHODS

Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis.

FINDINGS

Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'.

CONCLUSION

Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

BACKGROUND

Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited.

OBJECTIVES

We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists.

METHODS

Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests.

RESULTS

79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention.

CONCLUSIONS

HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.

Bridging gaps in the design and implementation of socially assistive technologies for dementia care: the role of occupational therapy

Dementia is a global health challenge, and people living with dementia (PLWD) are especially susceptible to reduced engagement in meaningful occupations, including social participation. In the past few decades, socially assistive technologies continue to be developed amidst a rapidly evolving technological landscape to support the social health of PLWD and their caregivers. Examples include social robots, virtual reality, smart home technology, and various digital technologies, such as mobile applications for tablets and smartphones. Despite an increasing body of research and interest in this field, several gaps relating to the design and implementation process of socially assistive technologies continue to undermine their relevance for PLWD in daily life. In this paper, some of these gaps are highlighted and the role of occupational therapy in the design and implementation of socially assistive technology is presented. In the design process, occupational therapists are uniquely skilled to advise and advocate for the tailoring and personalisation of technology to address the occupational needs of PLWD. In the implementation of socially assistive technologies, occupational therapists are skilled to educate, train, and conduct ongoing evaluations with PLWD and their caregivers, to incorporate socially assistive technologies into their routine and daily lives. We recommend that occupational therapists should continue to be acquainted with such technologies through continuous professional development and educational curricula. Moreover, we highlight the necessary collaboration between occupational therapists, technology developers, and researchers to enhance the process of designing and implementing socially assistive technology, so that their relevance for PLWD and their caregivers can be maximised.Implications for rehabilitationDevelopers and designers of socially assistive technology should consider the disease trajectory of different types of dementia, as well as the different needs, abilities, preferences, occupations and routines of people living with dementia (PLWD) and/or their caregivers.Collaborations between technology developers, researchers, and occupational therapists should take place iteratively throughout the process of designing and implementing socially assistive technology to maximise their relevance and applicability for people living with dementia and their caregivers.To continue enhancing the current role of occupational therapy in socially assistive technology provision, occupational therapists should keep up to date with socially assistive technology that are being developed to support the social health of PLWD.

Developing Client Self-Advocacy in Occupational Therapy: Are We Practicing What We Preach?

Background

Developing client self-advocacy is in occupational therapy's (OT) scope of practice; however, there is limited understanding of if, or how, occupational therapists learn about self-advocacy interventions as well as implement self-advocacy into clinical practice.

Objective

This study sought to identify if and how therapists learn about self-advocacy intervention approaches and identify if and how therapists implement self-advocacy into their work with clients.

Method

A survey was distributed via email to academic and professional listservs in the United States, and data were collected using REDCap survey software. Descriptive statistics were analyzed data using REDCap/SPSS. Comparative statistics, Kruskal-Wallis's tests, Chi-square tests for independence, and Pearson's correlation tests analyzed differences across groups of respondents.

Results

Practicing and licensed occupational therapists (n = 138) across the United States completed the survey. Findings indicate a majority (59.5%) of occupational therapists not learning strategies for addressing or developing client self-advocacy. Of significance, 21.7% of participants had never been exposed to concepts of client self-advocacy in academic or clinical education. Practitioners who did address self-advocacy did so indirectly through teaching-related skills (76.6%).

Conclusion

Many clients of OT will need self-advocacy skills in order to address issues of exclusion and discrimination that prohibit full participation in society. Occupational therapists must prioritize incorporating client self-advocacy into curricula and clinical practice.

Knowledge Gaps Regarding Indigenous Health in Occupational Therapy: A National Survey

Background. There is a need for the occupational therapy profession to respond to the Truth and Reconciliation Commission of Canada Calls to Action and work towards supporting the health and well-being of Indigenous Peoples. Purpose. (1) To determine the knowledge gaps of occupational therapists about Indigenous health and (2) to create recommendations to address identified gaps and inform responses from the profession. Method. A national needs survey was created and distributed to occupational therapists across Canada to determine the knowledge of occupational therapists about Indigenous health. Survey results were analyzed using thematic analysis and descriptive statistics. Findings. Data collected from 364 survey responses informed six distinct themes representing knowledge gaps of occupational therapists related to Indigenous health as follows: lack of foundational knowledge, power relations, lifelong learner, need for appropriate tools/approaches, respectful collaboration, and environmental influences. Implications. The project offers insight into the role of the occupational therapy profession in the process of reconciliation. Insights are focused on decolonizing occupational therapy practice, building trusting relationships with Indigenous Peoples, and the provision of appropriate training for occupational therapists to engage in culturally safer practices.

Addressing Driving in Acute Care: Perceived Relevance and Competence

Background. Recent legislation has expanded the responsibilities of occupational therapists regarding fitness to drive in the Canadian province of Ontario. To date, little is known about the practice of acute care occupational therapy with addressing driving, or how such responsibilities have affected clinical practice. Purpose. The objective of this study was to understand the relevance of driving-related knowledge areas to acute care occupational therapists and examine their self-reported competency for these areas. Method. Anonymous online surveys were administered to 41 occupational therapists working in acute care hospitals in Ontario. Findings. Therapists reported many driving-related knowledge areas are relevant to acute care practice yet consistently reported lower levels of competence for addressing such areas. Implications. Findings support the need for further competency development regarding driving-related practice in acute care. Occupational therapy curriculum and continuing education initiatives are avenues for capacity-building. Future research to identify effective competency development strategies is warranted.

Exploring Therapeutic Relationships in Pediatric Occupational Therapy: A Meta-Ethnography

Background. Developing strong therapeutic relationships with families is a crucial aspect of pediatric occupational therapy. However, building such relationships is complex as they involve multiple directions of interaction. Purpose. To provide a thorough interpretation of children's, caregivers', and occupational therapists' experience of the therapeutic relationship. Method. A meta-ethnography was realized to synthesize qualitative studies. A systematic search was carried out using five databases from 2005 to 2022. The CAPS checklist was used to appraise included studies' quality. The analysis was completed using a constant comparison of findings. Findings. Three themes emerged from the 14 studies synthesized. The first theme illustrates that the therapeutic relationship can have different meanings depending on the perspective of children, caregivers, or occupational therapists. The second theme explores the components impacting the experience of the relationship. These include the power dynamics, the communication, and respect for diversity. Finally, the third theme illustrates how the relationship can empower positive change. Implications. Children, caregivers, and occupational therapists each have a perspective that ought to be heard. Occupational therapists should actively ask for children's and caregivers' perspectives to encourage power sharing and effective communication. By doing so, occupational therapists can strengthen the therapeutic relationship, which, in turn, promotes positive change.

Implementing Telehealth Among Occupational Therapists Working in the Health Care System: A Survey on the Current Practice and Experiences

Background: Occupational therapy services implemented via telehealth (Tele-OT) have declined since COVID-19, despite their well-known benefits. This study aimed to (1) compare the demographic and the clinical characteristics, attitudes, perceived usability, self-efficacy toward Tele-OT, and the factors affecting technology use for occupational therapists with and without Tele-OT experience; (2) describe the current practice and examine the factors associated with Tele-OT implementation; and (3) better understand the barriers and facilitators for implementing Tele-OT. Methods: An online survey invited ocupational therapists working in the health care system. The following measures were used: the Technical affinity-attitude (TA-EG) measured attitudes toward Tele-OT, the System Usability Scale measured perceived Tele-OT usability, and the Unified Theory of Acceptance and Use of Technology measured factors related to Tele-OT use and self-efficacy. An open-ended question requested ocupational therapists to describe one Tele-OT session. Results: We included 309 occupational therapists (mean [SD] age = 39.1 [9.9]): 181 with and 128 without Tele-OT experience. The groups significantly (p < 0.001) differed in age and years of OT experience. No between-group differences were found regarding attitudes, perspectives, and self-efficacy for Tele-OT. Occupational therapists used video platforms, apps, and phones to conduct the Tele-OT sessions. Descriptions of the Tele-OT sessions were qualitatively sorted into "perceived experience" (i.e., satisfaction and challenges) and "factors related to Tele-OT implementation" (e.g., infrastructure and technology). Conclusions: Occupational therapists with and without Tele-OT experience have similar attitudes and self-efficacy regarding Tele-OT. Thus, Tele-OT implementation may be affected by other personal and environmental factors. Health care organizations can possibly use these findings to promote Tele-OT and bridge the implementation gap.

Accommodating Students with Disabilities: Fieldwork Educators' Experiences

Background. Fieldwork is an essential part of experiential learning in occupational therapy education. Fieldwork educators identify limits on reasonable accommodation and difficulty implementing disability-related accommodations. Student occupational therapists with disabilities report discrimination from within the profession, including inflexible fieldwork environments. Purpose. To understand the experiences of occupational therapy fieldwork educators in Canada in accommodating students with disabilities and to develop action-oriented practice recommendations. Method. In this interpretive description study, we interviewed 11 fieldwork educators about their experiences accommodating students with disabilities. Interviews were recorded, transcribed, and analyzed using a constant comparative approach. Findings. Educators emphasized a meta-theme of "Learning" when asked about disability-related accommodations. Three subthemes about student learning emerged: 1. Educators focused on "Student Learning in Preparation for Professional Practice" rather than their fieldwork setting only; 2. Educators were "Using Occupational Therapy Skills for Student Learning" in fieldwork; and 3. Educators recognized that their professional and personal "Context Influences Student Learning." Conclusion. Fieldwork educators can work with students to align their accommodations with required learning outcomes for professional practice and use their occupational therapy skills to assist with implementation. Fieldwork educators require time and other supports to work effectively with all students.

Understanding Occupational Therapists' Knowledge and Confidence When Assessing for Spatial Neglect: A Special Issue Review

IMPORTANCE

Spatial neglect (SN)-failure to respond to stimuli on the side of the body contralateral to a poststroke lesion-is one of the most disabling impairments for stroke survivors, and 80% of stroke survivors may have undetected SN. Occupational therapists' evaluations should include determining the impact of poststroke SN.

OBJECTIVE

To investigate occupational therapists' confidence, knowledge, current practices, barriers, and facilitators when assessing for SN in adult stroke survivors.

DESIGN

A 30-item survey was created with guidance from stroke rehabilitation occupational therapists who reviewed the survey for face and content validity.

SETTING

Online survey.

PARTICIPANTS

Occupational therapist survey responders (N = 76).

OUTCOMES AND MEASURES

Self-report assessments were used to measure occupational therapists' confidence in identifying SN, SN assessment practices, and barriers to and facilitators of SN assessment. Knowledge of SN signs and symptoms, neuroanatomy, and clinical presentation were measured with a three-question quiz.

RESULTS

Eighty-one percent of the respondents reported a high level of confidence in identifying SN, and 70% reported routinely assessing for SN, with 81% using clinical observation rather than standardized tools as the primary assessment method. Barriers to SN assessment included time and resources.

CONCLUSIONS AND RELEVANCE

Most respondents, despite reporting high levels of confidence with routine SN assessments, did not use standardized SN measures and demonstrated suboptimal knowledge of SN. These results emphasize the need to increase clinical education about SN and its assessments. Plain-Language Summary: This study gathered baseline information on an underinvestigated topic-occupational therapists' education, confidence, current practices, barriers, and facilitators when assessing for spatial neglect in adult stroke survivors. The study results also contribute to future research on occupational therapists' current confidence and knowledge when assessing for spatial neglect.

Speech-language pathologist, physical therapist, and occupational therapist experiences of interprofessional collaborations

Interprofessional collaboration among speech-language pathology, physical therapy, and occupational therapy is considered to promote best practice in rehabilitation as it can enhance efficiency, patient outcomes, and clinician and patient satisfaction. Although clinician experiences with interprofessional collaboration have been studied in each of the rehabilitation professions separately, limited research has been conducted on the shared attitudes or experiences across speech-language pathology, physical therapy, and occupational therapy. The purpose of this study was to understand speech-language pathologist, physical therapist, and occupational therapist experiences of interprofessional collaborations. We conducted an exploratory cross-sectional online survey study. The survey included Likert-scale questions and open-ended questions that probed clinicians' general experiences with interprofessional practice and views and beliefs regarding barriers and facilitators to interprofessional collaboration. Responses from 213 clinician respondents were analyzed using descriptive quantitative methods and a qualitative content analysis. The results revealed overlap in attitudes and experiences across speech-language pathology, physical therapy, and occupational therapy about barriers and benefits to interprofessional collaboration. Perceived respect differed among the professions, with speech-language pathologists more frequently reporting that their role is often misunderstood or undervalued by other rehabilitation professionals. These results may guide future research focused upon the predictors of successful interprofessional collaborations and interactions.

Physical and occupational therapists' perceptions of sustainability of a knowledge translation intervention to improve the use of outcome measures in inpatient rehabilitation: a qualitative study

PURPOSE

To assess the perceptions, barriers, and facilitators of sustaining the use of outcome measures of physical and occupational therapists following a three-year knowledge translation intervention.

METHODS

A phenomenological qualitative study was conducted at an inpatient rehabilitation hospital on 13 clinicians (6 physical therapists and 7 occupational therapists) participating in the knowledge translation intervention. Data collection used semi-structured interviewing during three focus groups to understand the lived experience of clinicians participating in the knowledge translation project. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) codebook.

RESULTS

Two investigators coded twelve CFIR constructs into barriers and facilitators for outcome measure use. Four key themes emerged as determinants for outcome measures use: (1) Organizational support and clinician engagement; (2) the knowledge translation intervention; (3) the outcome measures themselves; and (4) the patients. Clinicians reported using outcome measures for patient education, treatment planning, and goal setting, while they found other outcome measures lacked functional significance. Facilitators included organizational support, access to knowledge, ongoing training, and clinician engagement. Ongoing barriers included the need for more training and the need to select different tests.

CONCLUSIONS

This study found proper selection of outcomes measures is important and attributed the sustainability of the knowledge translation intervention to organizational support, clinician engagement and ongoing training. The clinicians wanted continued training to overcome new barriers. Barriers identified in this study were unique to the typical barriers identified for outcome measure use. Ongoing barrier assessments are needed for continued refinement of knowledge translation interventions to enhance sustainability.

Preparing occupational therapy students for practice in rural areas: a scoping review protocol

INTRODUCTION

Despite greater needs in rural areas, occupational therapists are maldistributed to urban spaces which limits service access and health outcomes for rural people and communities. Preparation of students for rural practice may improve rural workforce recruitment and retention; however, the range and scope of preparation strategies employed by education providers are unclear. This scoping review aims to understand and describe the range of strategies education services use to prepare occupational therapy students for rural practice across the globe.

METHODS AND ANALYSIS

The study will include all publications about strategies used to prepare occupational therapy students for future rural practice, prior to enrolment, during the programme or on graduation. MEDLINE (Ovid), Emcare (Ovid), APA PsychInfo (Ovid), CINAHL (EBSCOhost), Health Source: Nursing/Academic (EBSCOHost), Educational Resources Information Centre (ERIC), Open Access Theses and Dissertations (OATD), and Scientific Electronic Library Online (SciELO) databases will be systematically searched in English, Spanish, French and Portuguese languages. Citations will be screened by two or more independent researchers against inclusion criteria and data extracted from included publications using a customised extraction tool. Frequency counts will be provided for study type, student location and sociodemographics, and the timing/educational strategy. The extracted data will be analysed using a matrix framework and presented in diagrammatic/tabular form and accompanied by a narrative summary which will describe how the results relate to the reviews' questions.

ETHICS AND DISSEMINATION

This study will not involve human/animal subjects and does not require ethics approval. Results will be disseminated to relevant groups in peer-reviewed journal(s) and at relevant occupational therapy, higher education and/or rural health conferences. Results will also be translated and shared in blogs/social media to support access for non-research audiences and shared with other regional universities to influence curriculum design.

Enhancing evidence-based practice into healthcare: Exploring the role of scientific skills in occupational therapists

BACKGROUND

Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application.

OBJECTIVES

To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists.

MATERIAL AND METHODS

We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries.

RESULTS

Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research.

CONCLUSIONS

Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists.

SIGNIFICANCE

Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

Worldwide Survey on Digital Assistive Technology (DAT) Provision

Occupational therapists have long been involved in assistive technology (AT) provision worldwide. AT is recognized by the World Health Organization (WHO) to enhance functioning, independence, and autonomy and ultimately promote well-being for people living with disabilities. With the digitalisation of societies, the everyday lives and occupations of individuals are changing, becoming more reliant on digital solutions. The development of digital assistive technology (DAT) also offers opportunities for people with disabilities to access, interact, and pilot the digital world. However, we do not know how occupational therapists are involved in DAT provision worldwide. A survey was conducted in the global occupational therapist's community in June 2022 to describe DAT provision and the factors influencing it. Occupational therapy practitioners were included (n = 660) in the analysis. In DAT provision, occupational therapists mostly provide advice to people, assess their needs, provide instruction or training, prescribe DAT, and fit DAT to people and their environment. The clients served through DAT provision are most frequently people with neurological impairments, chronic illnesses, sensory impairments, and older people. The reasons for providing DAT focus on education, work, school, and leisure. It is expected that DAT provision will enhance independence, self-esteem, occupational participation, and social relationships. Issues faced by occupational therapists when providing DAT are costs of product and funding schemes, sufficient knowledge, and access to knowledge sources. Survey respondents are mostly from Western countries with access to the Internet and the digital world, including having digital literacy, highlighting the digital divide that exists between world regions and countries, but also within countries worldwide. There is a need to continue research to better understand the issues related to digitalisation and the digital participation of people living with disabilities.

Occupational adaptation for adults living with advanced cancer: A phenomenological longitudinal study

INTRODUCTION

People living with advanced cancer want to continue participating in their valued occupations amid cancer progression. However, increasing dependence and bodily deterioration challenge a person's ability to do so, thus requiring adaptation to how they engage in their occupations. Theoretical frameworks on the process of occupational adaptation often do not address the implications of progressive functional decline.

METHODS

A longitudinal phenomenological design was used to understand the lived experience of occupational engagement for working-aged adults living with advanced cancer. A semi-structured interview series explored participants' experience of occupational engagement and how this changed over time. Data were analysed thematically and mapped against the Model of Human Occupation (MOHO).

FINDINGS

Eight adults (40-64 years old) participated in 33 interviews over 19 months. Three themes were constructed from the data: ongoing adaptation through doing, the significance of volition in adaptation, and everyday life is contingent on my environment. Study findings demonstrate that the process of adaptation occurs through occupational engagement, is motivated by volition, and is affected by the environment. Volition and the environment play a more central role in occupational adaptation than occupational competency for the advanced cancer cohort.

CONCLUSION

Study findings further MOHO's theoretical conceptualisation of occupational adaptation by identifying the centrality of volition and the environment in the process of adaptation. For people living with advanced cancer, disease progression results in unremitting functional decline, thus rendering competency an unstable and untenable construct. Rather, this paper argues that occupational adaptation is facilitated by volition (i.e., the motivation behind the doing) and the environment, thus fostering a sense of identity and meaning at the end of life. Occupational therapists' awareness of the significance of volition and the environment can thus foster continued occupational engagement and meaning at the end of life for people living with advanced cancer.

2023 Sylvia Docker lecture: Ignite your passion, and connect, to make a difference

Together, we grow our profession of occupational therapy as we engage in understanding and addressing the issues that challenge the people we work with. In this Sylvia Docker Lecture, I will share the collective journeys of myself and other occupational therapists and health professionals who have undertaken (or are currently undertaking) their PhDs and are actively involved in research, to address these challenges. Together, we will explore three themes: understanding the WHY that ignites one's passion; living the journey-the EXPERIENCE; and making a difference-the IMPACT. Stories will be told through the lived experience of those engaged in research as currently enrolled PhD students, emerging researchers, and experienced researchers. These stories will capture the lived experience across individuals, and at different times in the research journey. Stories are summarised and captured using natural language processing. Topics are identified, concept maps visualised, and outputs interpreted in context of related theoretical models. Key topics identified include: the clinical and personal motivators that have ignited the passion in individuals; the value of connecting with others and growing networks; and how one's research has made a difference. The impact of discoveries and outcomes are highlighted, together with the importance of people and networks. Analysis of connections and synthesis over time revealed frequent and strong connections across themes, concepts and topics; with synthesising concepts of passion, networks, knowledge translation, opportunities, supervision and communication emerging and being shaped over time. These collective journeys provide inspiration and pathways to creative careers that have future potential in the growth of the profession of occupational therapy. It is recommended that each occupational therapist take the time to reflect on the 'why' that ignites your passion, your journey and how you can make a difference!

Dental desensitization by dentists and occupational therapists for autistic adults: A pilot study

LAY ABSTRACT

Managing patients with autism in the dental clinic often requires resorting to pharmacological behavioral control techniques, including general anesthesia. References in the literature to desensitization programs are scarce and focus on training children with autism to undergo oral examinations and preventive procedures. This study shows that a dental desensitization program implemented by dentists and occupational therapists could help in performing not only oral examinations but also simple dental therapeutic procedures for a considerable percentage of adults with autism, without using a pharmacological intervention (sedation or general anesthesia).

The Occupational Therapy Profession in Saudi Arabia

Objective

To provide an evidence-based description of how the occupational therapy profession operates in Saudi Arabia.

Methods

A case study methodology set out an evidence-based description of occupational therapy in Saudi Arabia. Three procedures were used: (1) a structured narrative review of publications on occupational therapy in Saudi Arabia based on searches of seven healthcare databases; (2) an audit of "grey literature" about or referring to occupational therapy education, practice, research, or the profession in Saudi Arabia using Google Scholar, Google search, official documents and websites, and relevant global organisation such as the WFOT website and documents; and (3) consultation with occupational therapists to further discuss emerging evidence from peer-reviewed articles and grey literature about occupational therapy in Saudi Arabia. Data were collected in Arabic and English. Findings. Occupational therapy in Saudi Arabia is a rapidly growing and emerging profession primarily focused on rehabilitation practice. Between 2010 and 2019, seven academic organisations commenced bachelor's degree programmes. Occupational therapy services in Saudi Arabia are concentrated in city-based secondary and tertiary healthcare services targeting rehabilitation and disability support. The practice aims to promote the reduction in impairment and increase activity performance and participation in valued life roles. Despite the increasing demand for occupational therapy services, there needs to be more access to and availability of their services. Enhancement of the awareness of occupational therapy among the public and other healthcare professionals is needed. A consistent definition of occupational therapy in Saudi Arabia would strengthen the profession, along with a national scope of practice, practice guidelines, increased workforce and development, and professional education information.

Conclusion

Occupational therapy in Saudi Arabia is growing regarding the size of the workforce and the number of programmes and services provided, thus contributing to the health and well-being of the population primarily through rehabilitation. Further development of the profession is necessary.

Identifying Facilitators of and Barriers to Referrals to Occupational Therapy Services by Israeli Cancer Health Care Professionals: A Qualitative Study

IMPORTANCE

Persons living with and beyond cancer (PLWBC) are rarely referred to occupational therapy services despite their functional difficulties. An understanding of the barriers to and facilitators of occupational therapy referrals from the perspective of cancer health care professionals could help minimize referral gaps.

OBJECTIVE

To explore cancer health care professionals' perspectives on and knowledge of occupational therapy's role in cancer care, identify the barriers, and explore solutions to optimize referrals.

DESIGN

Multiexplanatory qualitative case study.

SETTING

Community and hospital cancer clinics in Israel.

PARTICIPANTS

Six in-person focus groups of cancer care Israeli nurses and social workers, totaling 28 participants.

RESULTS

Two main themes were identified: (1) barriers to occupational therapy referrals and (2) partial facilitators of occupational therapy referrals. The four barriers subthemes were (1) gaps in knowledge about symptoms' effects on daily functioning, (2) gaps in knowledge regarding occupational therapy's role in cancer care, (3) bureaucratic and organizational barriers, and (4) unavailability of occupational therapy services. The two facilitators subthemes were (1) collaborations and communication with occupational therapists and (2) awareness of occupational therapy services. Participants suggested practical solutions for improving occupational therapy referrals, interdisciplinary collaboration and communication, and integrating occupational therapy into cancer care.

CONCLUSIONS AND RELEVANCE

Barriers to referrals included gaps in participants' knowledge that link side effects to functional difficulties indicating a need for referral to occupational therapy. Participants' suggestions to bolster referrals can be implemented by occupational therapists to reduce patients' unmet needs and bridge existing gaps in cancer care. Plain-Language Summary: This research helped to identify barriers and facilitators regarding insufficient knowledge about occupational therapy's role in cancer care and adds a better understanding of gaps in referrals to occupational therapy. In addition, cancer health care professionals who participated in the study suggested practical solutions for reducing barriers and maximizing support for referral. With these nuances, occupational therapy practitioners can work with medical cancer care units (i.e., acute care hospitals, medical cancer centers, and community health care clinics) to target the use of strategies that work for their units to ensure that persons living with and beyond cancer receive needed occupational therapy services.

Implementation of Evidence-Based Practice and Burnout Among Occupational Therapists: The Role of Self-Efficacy

IMPORTANCE

Implementing evidence-based practice (EBP) is essential for ensuring optimal quality care and obtaining positive outcome in treatment. Occupational therapists generally hold positive attitudes toward EBP; however, EBP is not always fully implemented.

OBJECTIVE

To explore the mediating role of self-efficacy on the relationship between implementing EBP and burnout among occupational therapists.

DESIGN

A cross sectional study.

SETTING

Data were collected through social media and WhatsApp groups using an online survey accessible through Qualtrics, a secured web-based data collection system; responses were anonymous.

PARTICIPANTS

The final sample consisted of 261 female Israeli occupational therapists (ages 24-65 yr, with 1-40 yr of clinical experience).

OUTCOMES AND MEASURES

The following questionnaires assessed EBP implementation, burnout, and self-efficacy, respectively: the EBP Implementation Scale, the Maslach Burnout Inventory, and the Occupational Therapy Self-Efficacy Questionnaire. Demographic data were also collected.

RESULTS

EBP implementation was low (0-43 points out of a maximum 72 points), moderate levels of burnout and high levels of self-efficacy were reported. Significant associations with medium effect sizes were found between EBP implementation and burnout: the higher the levels of EBP implementation, the lower the levels of burnout frequency and intensity. Moreover, self-efficacy mediated these relationships. EBP implementation was related to elevated self-efficacy, which, in turn, was associated with lower burnout.

CONCLUSIONS AND RELEVANCE

EBP implementation may serve as an important tool to limit burnout among occupational therapists by fostering their trust in their ability to handle clinical challenges. Further research is needed. Plain-Language Summary: This study explored implementing evidence-based practice (EBP) and its relationships to burnout and work-related self-efficacy among occupational therapists. The study found that self-efficacy mediated the relationships between implementing EBP and burnout. Implementing EBP was associated with higher self-efficacy, which, in turn, was associated with lower burnout among occupational therapists.

A survey of research involvement and priorities among occupational therapists in Norway

BACKGROUND

Involvement in research and shared priorities among occupational therapists (OTs) can enhance the quality of occupational therapy practice.

AIMS

To explore the research involvement and research priorities of OTs in Norway.

MATERIALS AND METHODS

An online survey comprising 14 open-ended and closed questions was made available to participants at the Seventh Norwegian Congress in Occupational Therapy to fill out.

RESULTS

Out of 633 congress participants, 307 (49%) OTs completed the survey. Among the respondents, ∼40% were involved in research. The most commonly reported area of research was rehabilitation. Research involvement was associated with employment in education or specialist healthcare services and with greater work experience and post-bachelor's degree education. The most frequently prioritized research question addressed the effect of occupational therapy. Unmet needs and factors conducive to increasing OT's involvement in research were identified.

CONCLUSIONS AND SIGNIFICANCE

The survey revealed that a considerable, but uneven, distribution of OTs were involved in research. To encourage greater participation in research, researchers, decision-makers, and employee associations should take steps to make research more appealing to OTs. The research priorities highlighted by Norwegian OTs align with those stated by OTs in other countries.

Occupational therapists' perceptions of the feasibility of using tele-assessment for remote prescription of assistive devices in Singapore: A qualitative study

BACKGROUND

Occupational therapists (OT) assess and prescribe assistive devices to older adults with limitations in performing daily living activities. Timely prescription of assistive devices to accommodate the rising demand has been affected by the COVID-19 pandemic. Tele-assessment allows for continuity of care, but its success depends on therapists' acceptance.

OBJECTIVE

This study examined OTs' perceptions of the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices for older adults in Singapore.

METHODS

Eligible OTs were recruited from purposive sampling. Semi-structured interviews were conducted via a virtual platform (Zoom). Audio recordings were transcribed verbatim. Inductive thematic analysis using a line-by-line coding method was used to identify common trends.

RESULTS

Interviews with 10 participants revealed three main themes: (1) therapists' perceptions of the feasibility of tele-assessment, (2) criteria for safe and appropriate prescription of assistive devices via tele-assessment, and (3) practical considerations for the implementation of tele-assessment. Participants felt that tele-assessment increases efficiency with more older adults being more receptive towards technology. They also raised suggestions to address OTs' concerns regarding the safety and accuracy prescription of assistive devices following tele-assessment. This included establishing the client's suitability for assistive device prescription, characteristics of assistive devices, resources required, and considering the preferences of stakeholders involved.

CONCLUSION

Tele-assessment for assistive device prescription by OTs appears feasible in Singapore. OTs should consider collaborating with other stakeholders to develop a tele-assessment clinical practice guideline for assistive device prescription. Further studies testing its clinical effectiveness during and/or post-pandemic are warranted.

Association between parent-proxy-reported and child-self-reported perceptions of children's motor competence and children's performance-based motor skill abilities

BACKGROUND

When assessing motor skills, occupational therapists are encouraged to seek the perspectives of children and their parents to promote the delivery of client-centered care.

AIM

To investigate whether 9-12-year-old children's views and their parents' proxy views of the children's motor skill competence and their performance on a standardized, performance-based assessment are associated.

MATERIALS AND METHODS

Thirty 9-12-year-old children completed the Perceived Motor Competence Questionnaire in Childhood (PMC-C) and the Pictorial Scale of Perceived Movement Skill Competence - version 2 (PMSC-2), while their parents completed the Movement Assessment Battery for Children-2nd Edition Checklist (MABC-2 Checklist). Children's objective motor skills were measured by the Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition (BOT-2). Spearman's rho correlations were used to analyze the data.

RESULTS

Significant associations were found between the BOT-2 total motor composite and the PMC-C. A significant association was found between the MABC-2 Checklist and the BOT-2 Strength and Agility composite, as well as the PMC-C total score.

SIGNIFICANCE AND CONCLUSIONS

Occupational therapists are encouraged to include children and their parents in the therapeutic process to capture individual perspectives and deliver client-centered care.

Occupational Therapists' Beliefs and Experiences Managing Chronic Pain, Wellness, and Occupational Performance

Chronic disease prevention, health, and wellness have become primary practice areas for occupational therapy. Occupational therapists (OTs) in pain rehabilitation are established as essential members of comprehensive and multidisciplinary pain management teams, focusing on increasing occupational performance through participation. This study's purpose was to investigate OTs' experiences managing chronic pain and to explore OTs' effectiveness in supporting clients' wellness and occupational performance through interventions. Eleven OTs (n = 11) participated with three themes emerging on chronic pain, interventions, and holistic teams. Findings suggest that OTs are successful at treating chronic pain, supporting wellness and occupational performance when their interventions are health-promoting, and clients are enabled to take an active role in their chronic pain management. This study demonstrates the critical impact OTs can have in multidisciplinary teams on clients' outcomes, such as increased occupational performance, wellness, and quality of life (QOL) through engagement in meaningful occupations.

Content Validity Testing of a Novel Cognitive Screen, the Gaylord Occupational Therapy Cognitive (GOT-Cog), to Improve Inpatient Occupational Therapy Treatment Planning

IMPORTANCE

No single cognitive screen adequately captures all cognitive domains that are important for inpatient occupational therapy treatment planning.

OBJECTIVE

To quantify the content validity of a novel 22-item cognitive screen, the Gaylord Occupational Therapy Cognitive (GOT-Cog) screen, developed to better inform inpatient occupational therapy treatment planning.

DESIGN

Delphi-style expert panel review.

SETTING

Long-term acute care hospital.

PARTICIPANTS

The first panel was attended by four occupational therapists, two speech-language pathologists, one physician assistant, and two neuropsychologists; the second, by four occupational therapists, one speech-language pathologist, and one physician assistant.

INTERVENTION

Each Delphi panel discussed the relevance, essentiality, and clarity of each item. After each discussion, panelists completed a content validity survey to summarize their evaluation of each item.

OUTCOMES AND MEASURES

On the basis of panelists' survey responses, item- and scale-level relevance, essentiality, and clarity were quantified by calculating the respective content validity index (CVI), content validity ratio (CVR), and content clarity index (CCI). Universal agreement (UA) and κ statistics were also calculated, as appropriate.

RESULTS

Upon presenting the initial 23-item instrument covering 10 cognitive domains to the first Delphi panel, several questions were added, removed, or rewritten, resulting in a 22-item instrument representing nine domains. After the second panel, several questions were again rewritten, and the domains reorganized. All scale-level metrics improved, including CVI (from 0.87 to 1.0), UA (0.52 to 1.0), CVR (0.43 to 0.94), and CCI (2.26 to 2.92).

CONCLUSIONS AND RELEVANCE

GOT-Cog displays overall excellent content validity and can proceed to construct validity testing. Plain-Language Summary: By reporting on the content validity of the Gaylord Occupational Therapy Cognitive screen, this brief report begins the necessary process of evaluating the measure's overall validity and reliability.

Profile of paediatric occupational therapy practice in Eastern Mediterranean countries

BACKGROUND

Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries.

AIMS/OBJECTIVES

This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists' usage of evidence-based practice in their practice.

MATERIAL AND METHODS

We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children.

RESULTS

The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice.

CONCLUSION

Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist.

SIGNIFICANCE

Within the EM region, knowledge regarding therapists' practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

The shadow side of occupational therapy: Necropower, state racism and colonialism

BACKGROUND

In the Global North, advances in occupational therapy benefitted unduly from the oppression, disablement and suffering of thousands of people in the South (and beyond). To prevent the recurrence of these injustices, history must be unveiled and occupational therapists urged to come to terms with their own involvement and responsibility.

OBJECTIVE AND METHOD

Utilising Achille Mbembe's concept of necropolitics, this academic essay blends select historical and philosophical perspectives to explore occupational therapy's concealed role in manifestations of institutionalised violence.

RESULTS

By examining its roles in World War II and France's colonisation of Algeria, we make visible the development of occupational therapy's distinct 'shadow side'. In Nazi Germany's Euthanasia Programme, it became a tool for identifying which lives were deemed 'worthy of living' and which were not, which indirectly contributed to the killing of 200,000 disabled persons. Under France's colonial medical system, occupational therapy imposed Western standards that alienated and completely depersonalised Algerian patients.

CONCLUSION AND SIGNIFICANCE

Entrenched in a (bio)economy that has endured beyond these events, occupational therapists must exercise vigilance, remaining mindful of the potential to unintentionally overlook individuals labelled as 'unproductive'. This requires confronting the profession's assumptions of inherent 'goodness' and acknowledging and addressing its shadow side.

Occupational Therapists in Patient Navigation: A Scoping Review of the Literature

This review seeks to understand the literature on patient navigator programs (PNPs) that employ occupational therapists (OTs), including the role (conceptualization), functions (operationalization) of OTs who work as patient navigators (PNs) and the settings and populations they serve. This review also mapped the role of PNs to the 2021 Competencies for Occupational Therapists in Canada. Scoping review methodology by Arksey and O'Malley (2005) was employed. Data were analyzed thematically and numerically to identify frequent patterns. Ten articles were included. Within PNPs, OTs worked in hospitals and communities, but their role was rarely well-defined. Five competency domains (i.e., communication and collaboration, culture, equity and justice, excellence in practice, professional responsibility, and engagement with the profession) were evident in existing PNPs that included OTs. This review supports the increasing interest in OTs as PNs by demonstrating the alignment between the OT competencies and roles and functions of OTs working within PNPs.

Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians

BACKGROUND AND PURPOSE

Somatosensory impairments are common after stroke, but receive limited evaluation and intervention during neurorehabilitation, despite negatively impacting functional movement and recovery.

OBJECTIVES

Our objective was to understand the scope of somatosensory assessments used by clinicians in stroke rehabilitation, and barriers to increasing use in clinical practice.

METHODS

An electronic survey was distributed to clinicians (physical therapists, occupational therapists, physicians, and nurses) who assessed at least one individual with stroke in the past 6 months. The survey included questions on evaluation procedures, type, and use of somatosensory assessments, as well as barriers and facilitators in clinical practice.

RESULTS

Clinicians (N = 431) indicated greater familiarity with non-standardized assessments, and greater utilization compared to standardized assessments (p < 0.0001). Components of tactile sensation were the most commonly assessed modality of somatosensation (25%), while proprioception was rarely assessed (1%). Overall, assessments of motor function were prioritized over assessments of somatosensory function (p < 0.0001).

DISCUSSION

Respondents reported assessing somatosensation less frequently than motor function and demonstrated a reliance on rapid and coarse non-standardized assessments that ineffectively capture multi-modal somatosensory impairments, particularly for proprioceptive deficits common post-stroke. In general, clinicians were not familiar with standardized somatosensory assessments, and this knowledge gap likely contributes to lack of translation of these assessments into practice.

CONCLUSIONS

Clinicians utilize somatosensory assessments that inadequately capture the multi-modal nature of somatosensory impairments in stroke survivors. Addressing barriers to clinical translation has the potential to increase utilization of standardized assessments to improve the characterization of somatosensory deficits that inform clinical decision-making toward enhancing stroke rehabilitation outcomes.

Wheelchair service provision content in professional rehabilitation organisations' standards documents and contemporary initiatives: a rapid review

PURPOSE

We sought to identify opportunities, challenges, contemporary initiatives and strategies for preparing entry-level practitioners who are competent at the basic level of wheelchair service provision across four key international professional rehabilitation organisations as revealed by their educational standards, relevant guidelines and policy statements, and other publicly available information.

METHOD

A rapid review was conducted in 2021 from the International Society of Physical and Rehabilitation Medicine (ISPRM), the International Society for Prosthetics and Orthotics (ISPO), World Physiotherapy, and the World Federation of Occupational Therapists (WFOT). Additional grey-literature and grey-data searches were conducted to identify contemporary initiatives that may support competency development in wheelchair service provision.

RESULTS

A total of 17 standards, guidelines, and policy statement documents were selected for detailed review. Each of the four organisations published at least one document containing language relating to wheelchair service provision. Twelve contemporary initiatives relating to wheelchair service provision were identified from the grey literature across the four organisations. Six additional initiatives were identified from the organisations' social media accounts. Themes emerged in the areas of contemporary content, opportunities, and challenges.

CONCLUSION

Global standardisation could help harmonise professional societies' approach to training wheelchair service providers.IMPLICATIONS FOR REHABILITATIONThere is a need to provide more descriptive content on wheelchair service provision in education and service standards and related documents to influence what is taught in professional rehabilitation programs that are accredited or approved by professional rehabilitation organisations.The organisations' networks are vast and may also help to promote additional continuing education in this area.

Occupational therapists' experiences of working with people with dementia: a qualitative study

BACKGROUND

Dementia is an age-related disease associated with complex health and care needs. Due to demographical shifts, the number of older people with dementia is forecasted to increase. Occupational therapists encounter people with dementia in their daily work, yet little is known about their experience of working with people with dementia.

AIM/OBJECTIVES

To explore occupational therapist's experiences of working with people with dementia.

MATERIAL AND METHODS

Ten occupational therapists were interviewed using semi-structured interviews. Data were analysed using reflexive thematic analysis.

RESULTS

The results are presented in five different themes: Working with persons who do not recognise decline in their abilities; Saving-face of the person in assessment situations; Facilitating continued engagement in everyday activities; Utilising information provided by care staff; Balancing different preferences on how to proceed.

CONCLUSION

Occupational therapists perceive a need in their work to employ various face-saving strategies and facilitate engagement in everyday activities. The results are exploratory and additionally research is needed to understand the therapists' experiences of working with persons with dementia.

SIGNIFICANCE

Everyday activities should be tailored to the person's abilities, with an emphasis on facilitating the person in carrying them out rather than the social environment taking them over.

Occupational therapists' experiences of using a new internet-based intervention - a focus group study

BACKGROUND

Research is limited about how the introduction of new ways of delivering and conducting occupational therapy, in accordance with expected changes in health care, is experienced by occupational therapists (OTs).

AIM

To explore how OTs experienced use of a new internet-based intervention, 'Strategies for Empowering activities in Everyday life' (SEE), focusing on supporting client resources to manage an active everyday life after stroke.

MATERIAL AND METHODS

A focus group study with periodical repeated discussion was designed. Four sessions during a period of 22 months were conducted with a total of four OTs.

RESULT

Overall, the results reflected that the OTs experienced that the use of SEE for persons with stroke was a valuable complement to existing rehabilitation. The process of introducing SEE included a multifaceted transition involving context, intervention process and delivery that renewed occupational therapy.

CONCLUSION

These results indicate how the use of new internet-based interventions such as SEE can influence and support renewal of occupational therapy that extends beyond the particular intervention. Continued research is needed to explore more aspects of SEE feasibility.

Understanding Health Professionals' Experiences of Interprofessional Mentored Research During Clinical Training: A Qualitative Descriptive Study

BACKGROUND

Interprofessional education is recognized as an important part of the training of future health professionals. Limited investigation has been done on the experiences of students who have completed interprofessional mentored research during their clinical training.

PURPOSE

To explore if this experience provided meaningful training in key areas of interprofessional education.

METHOD

Using a qualitative descriptive framework, one-on-one interviews were conducted with eight healthcare providers (three occupational therapists and five speech language pathologists) who engaged in interprofessional research during their clinical training. Qualitative content analysis was completed with triangulation by analyst and member checking.

CONCLUSION

Three main themes were identified: 1) interprofessional research project collaboration, 2) professional development, and 3) recommendations for student-oriented interprofessional research collaborations. The results illustrated that the health practitioners found their student experiences valuable to their current interprofessional practice and provided salient training on roles and responsibilities, teamwork, and communication.