Commemorative Editorial: The Legacy of Franklin Stein, PhD, OTR/L, FAOTA.

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Knowledge translation in the context of the Asia Pacific region.

The Universal Declaration of Human Rights ratified by the UN in 1948 encompasses the concepts of creating and enabling occupational opportunities including work, leisure, education and community participation (United Nations, 1948). The UN Declaration supports occupational therapists to act on behalf of our clients and our communities as well as diverse populations of vulnerable people. The World Health Organization (WHO) defines vulnerable people as children, pregnant women, elderly people, malnourished people, and people who are ill or immune-compromised (WHO, 2013). People with disabilities are included in this group and tend to be among the poorest of the poor (WHO, 2011). Poverty – and its common consequences such as malnutrition, homelessness, poor housing and destitution – is a major contributor to vulnerability. Natural and manmade disasters are affecting more and more people around the world. People are displaced from their homes and their lives, making them vulnerable. They may lose everything or be able to take only the basics with them. Livelihood opportunities may be destroyed. With lost roles and changed circumstances, survivors live perhaps in temporary housing in tiny rooms which take little time to clean, where there is no work, nothing to do, no occupational opportunities, a loss of daily structure, leading to boredom and despair (Wilson, 2011). With their support systems removed, displaced people are often unable to access basic health, welfare and education services. They experience severe socio-economic loss and impoverishment. How is the global community responding to this global crisis of displacement and vulnerability? What can we do as communities of professionals and as individuals? As a profession concerned with promoting health and well being through occupation, occupational therapists should be addressing issues that truly affect people's lives. In translating international policy into local action, we can fulfill many of the goals set out by the UN in their seminal document The Millennium Development Goals (United Nations, n.d.). Why do I comment on the MDGs, which were established in 2000 with goals set for 2015? How does this relate to the subject of this editorial – vulnerable populations and human displacement? I feel it is important for occupational therapists to understand global policy development so that we can better apply international principles to our own health systems and direct practices in order to effect change for our clients and communities. Much has been written in the international literature (now online) that supports the ongoing thrust of the MDGs to achieve global health and reduce poverty, partly because national and international organisations have to report to the UN regularly on their actions related to the MDGs and future goals (United Nations, n.d.), but also because there is increased interest worldwide among the general population. With easy access to online media, we are made instantly aware of the aftermath of disasters. Huge strides have been made so far in meeting the MDGs (United Nations, 2013). For instance, according to the Millennium Development Goals Report 2013, there have been visible global improvements in all health areas as well as in primary education. This includes halving the number of people living in extreme poverty. Some of this has been accomplished through financial input from major development organisations to reduce country debt. With continual global monitoring and evaluation, positive accomplishments can be tracked and supported. Now, UN agencies are looking to post-2015 actions for sustainable development goals to support and continue the actions already started. With the realisation that there must be policy and financial support from higher levels of government to effect change at community level, better coordination, better methods of monitoring, and improved policy at all levels are required to achieve the sustainable development goals. Another thrust at global level has been in direct relation to disaster mitigation. Global agencies have moved from talking about disaster relief and response to realising that disasters will happen but humans can reduce their impact through preparedness and changed ways of thinking. Change of thinking can lead to change in actions. One agency, the UN-based Global Network for Disaster Reduction (GNDR), started an online discussion to gain a clearer perception of the actions for change required at all levels from global to local. I was fortunate to be part of these discussions. One action undertaken by the group was to go to communities and community leaders to find examples of effective actions (Global Network for Disaster Reduction, 2011). Twenty thousand people from 69 countries responded to a GNDR survey and the results were compiled into Views from the Frontline. From this material, 90 case studies were produced, called Action from the Frontline, which share ideas and spur creative thinking. These case studies can be viewed at www.globalnetwork-dr.org. The GNDR research team found that different communities have different perspectives on their own needs (Global Network for Disaster Reduction, 2011). These case studies promote ways for communities to realise possibilities for reducing the effects of disaster – famine, epidemics, flooding – and make change to mitigate disaster risk. Based on their research results, GNDR brought community leaders together in regional workshops to share their ideas. With the authority of this agency, these ideas were conveyed to national and international levels through regional and world conference and online sharing which include community leaders, national and international NGO's. The 2012 World Disasters Report (International Federation of Red Cross and Red Crescent Societies, 2012) focused on forced migration and displacement. The work of the international community on reducing disaster risk and mitigating the impact of disaster is built on the knowledge and experience developed by countries and other stakeholders over the past several decades. Milestones include: in 1987, the 1990s was declared the international decade for natural disaster reduction (A/RES/42/169) by the United Nations General Assembly; in 1989, the United Nations General Assembly adopted the International Framework for Action for the International Decade for Natural Disaster Reduction (A/RES/44/236); in 1994, the Yokohama Strategy and Plan of Action for a Safer World was adopted by the 1st World Conference on Natural Disaster Reduction; in 1999, the United Nations General Assembly endorsed the International Strategy for Disaster Reduction (A/RES/54/219); and in 2005, in Kobe, Japan, the 2nd World Conference on Disaster Reduction adopted the Hyogo Framework for Action 2005–2015: Building the Resilience of Nations and Communities to Disasters (HFA) (International Federation of Red Cross and Red Crescent Societies, 2012). The Hyogo Framework for Action (HFA), a 10-year plan to make the world safer from natural hazards, will end its term in 2015. Thinking forward to post-2015 action has generated much discussion among stakeholders. Since the adoption of the HFA, the promotion of resilience has gained significant attention and investment, but there is disagreement about what resilience means and how it should be incorporated into the post-2015 development framework. Is the promotion of resilience a new approach that will bridge the divide between providing relief and promoting development, or is it a concept developed in the international aid arena to cover the real need for humanitarian response? Measuring resilience may be a way to determine its influence (Levine, Pain, Bailey & Fan, 2012). The proposed elements of a post-2015 disaster risk reduction framework include ways of fostering accountability so that responses are practical, specific and focused, measurable in progress, conform to agreed standards and certification and stimulate commitment by stakeholders. According to the United Nations Office for Disaster Risk Reduction (2013), the framework should enhance risk governance with public-private partnerships and support scientifically informed decision making. It should address the underlying cause of increasing loss from disaster and reduce vulnerability through the development of insurance schemes, training and information, social protection schemes and safety nets. Thus, disaster risk management would become a part of sustainable development. In these Frameworks for Action to reduce disaster risk, there should be particular note of the needs of people with disabilities as it has been found that, in developing countries, people with disabilities tend to be among the most vulnerable. People with disability account for between 15% and 20% of the global community and this figure is higher in a developing country context (WHO, 2011). The circumstances that people with disability consistently face include lower educational enrolment and attainment; limited employment opportunities; limited access to information, services and resources, and an increased likelihood of a life in poverty (Robinson, Scherrer & Gormally, 2013). People with disability may be placed at increased disaster risk due to cognitive, intellectual or physical impairments. These factors may limit the ability of a person to access information and/or to act on that information. For example, information on disaster preparedness may not be available in accessible formats so people with disabilities are less aware and less prepared for a disaster. Including people with disabilities into disaster planning and decision making processes should help to protect the dignity and rights of the most vulnerable members of the community. It will ensure that the skills and capacities of all community members are utilised in relief, recovery and reconstruction. It will also contribute to meeting the need created by increased numbers of people with disability in the community as a result of disaster. The World Federation of Occupational Therapists (WFOT) is the international representative of occupational therapists worldwide. Its objectives are to promote health, occupation and participation within a worldwide perspective; to increase and maintain the awareness, understanding and use of services of occupational therapists by government, employers and the wider community through collaborative action; to develop and promote a standard of excellence in occupational therapy practice; to ensure the ongoing development and accessibility of high quality education and research for occupational therapists worldwide; and to present the diversity of international or cross-cultural issues. WFOT is collaborating with multiple international organisations and contributing to the international discussion on areas of direct relevance to its objectives. The partnership with WHO's Disability and Rehabilitation Team (DAR), for example, provides an avenue for contribution, involvement, and forward planning on specific issues of disability, vulnerable groups, and disaster management. These issues have been noted in a number of occupational therapy papers. The WFOT Position Paper on Human Displacement, the WFOT Position Paper on Human Rights, the WFOT Position Paper on Cultural Diversity all refer to the problems which ensue from forced migration and consequent vulnerabilities. WFOT, through its position papers, offers support for occupational therapists to inform governments and strategic organisations of the role of occupational therapy in working with vulnerable and culturally diverse groups. The WFOT Guiding Principles on Diversity and Culture (Kinebanian & Stomph, 2009) offers suggestions and approaches to understanding cultural needs and human rights. The WFOT Position Paper on Human Displacement (2012) notes that occupational therapists respect occupational strengths by valuing previous life roles, occupational adaptation, and existing occupational participation. It affirms “reciprocity with displaced persons, partners, and host communities as normal means of reducing the impact of displacement for people and host communities affected.” The WFOT Position Paper on Human Rights (2006a) also supports occupational justice. The WFOT Position Paper on Community Based Rehabilitation (2004) notes, “Occupational therapists are committed to advance certain core principles, one of which is the right of all people – including people with disabilities – to develop their capacity and power to construct their own destiny through occupation”. The WFOT Minimum Standards for the Education of Occupational Therapists (2002) emphasise client-centered occupation-based practice. They offer an occupation-centred framework for students to work in novel practice areas, with diverse and vulnerable populations. The WFOT Disaster Preparedness and Response (DP&R) Information Package (2006b) is available to occupational therapists in countries affected by disaster or where DP&R training is taking place. This package was updated in 2012 with revised website and databases and a second edition is being considered. Regional and national workshops have been conducted by WFOT, or by national OT associations with the support of WFOT, to raise awareness and build capacity to work with vulnerable groups affected by disaster. These workshops have addressed prevention and risk reduction issues incorporating occupation-based principles. Workshops have been held at regional occupational therapy congresses, including the Asia Pacific OT Congress 2012, as well as World Congresses. Out of a workshop held after the WFOT World Congress in Chile in 2010, a regional group called TO en alert (Occupational therapists on Alert) was formed in South America. Members have shared information, research and actions for improved response to disaster related situations. Disaster Preparedness, Response and Recovery is one themes of the coming WFOT World Congress in Japan in June 2014. There will be a great deal of sharing related to the occupational therapy role in disaster management and risk reduction. Discussions will include concerns for human displacement and occupational justice issues. These exchanges will further inform the global occupational therapy community about working in this important field of practice. Occupational therapists are working with survivors of disaster, refugees and migrants around the world at the initial stages of natural disaster as well as at the stage when people become migrants and must adjust to new and sometimes frightening circumstances. In many situations OTs are supporting people and communities to help each other. OT intervention may include life skills training on an individual level or in groups, or provide train the trainer situations where skills can be passed on. As noted in this journal, OT students and practitioners work with diverse populations with multicultural backgrounds and needs. Examples of good practice in this area abound although they are not often written up in journals. It is often only at conferences – and now more often in online social media and blogs – that we learn of innovative practice. Seeking out opportunities to observe innovative practice in different countries, I have found excellent examples of approaches to mitigating vulnerabilities through ‘self-help’ and community practice. After the OTARG Congress two years ago in Zambia, I had the privilege of visiting a remote village to observe a feedback meeting of a local NGO self-help group. The discussion centred on abuse of women and girls. The meeting started with a drama put up by the local school children. It carried through the day with small group discussion and feedback. Some 40 villagers had come from a 10 mile radius to attend the meeting. They live in arid farmland and eke out a subsistence living. The Response Network in Zambia is an excellent example of local action. Though it does not have an occupational therapist directly involved in their activities, it embodies many of the principles of occupational therapists working in community development and is based on international policy. It is a rights-based organisation which is involved in helping people to know their rights with regards to education and living with dignity. Focused on facilitating village self-help programs, they use a structured method of encouragement and information delivered by skilled facilitators to motivate villagers to start and run self-help activities to improve their life situation. Locally developed manuals provide information on how to start and run self-help clubs within a variety of thematic areas, including community schools, adult literacy, skills training, know your rights, women's rights, health and nutrition, organic growing, HIV/AIDS, children with special needs and sports. By helping villagers to understand that they have many skills and resources themselves, facilitators help villages realise that they can solve most of their own problems without depending on outside donors. From 2005 to 2012, the Response Network has facilitated village programs in more than 600 villages. These villages have started over 3000 self-help clubs with over 60,000 members, building confidence, knowledge and skills and improving their life situation (Response Network, http://responsenetwork.org/). This self-help approach could easily be translated into other situations working with vulnerable groups. This year, after another very successful OTARG Congress, this time in Zimbawe, I had the opportunity to stay in Cape Town in South Africa and visit the Grandmothers Against Poverty and AIDS (GAPA), an NGO started by occupational therapist Kathleen Brodrick (2004). GAPA is a community-based support programme for grandmothers of small children and teenagers who have lost their parents to the long-term epidemic AIDS. The project, in a township near Cape Town, brought together depressed, distressed and frustrated women through a familiar occupation – patchwork quilting. Today all over South Africa there are grandmothers holding together families affected by HIV/AIDS and poverty. Often these women are the sole bread winners in a household. They may also be nursing the dying and bringing up orphaned grandchildren on their own. Research shows that these grandmothers suffer from a lack of information, stigmatisation and overriding poverty (GAPA, http://www.gapa.org.za/). Four-day workshops are held each month for grandmothers who are new to the project where they learn about HIV infection and AIDS. Practical skills to overcome effects of the pandemic on households are taught. The workshops cover topics such as HIV/AIDS and cancer awareness, vegetable gardening, human rights, elder abuse, death and bereavement, drawing up a will and business skills. Grandmothers are also invited to attend support groups held in the homes of area representatives once a week. GAPA's motto is ‘together we are stronger’ and the aim is to draw on the inherent strength of the grandmothers in the community to bring lasting change and hope. This NGO, which started with a small group of women and a vision, has now grown to become international. The UN is assertively addressing global issues of poverty and inequity while identifying specific goals and monitoring progress toward meeting those goals at an international and national level. Using the documents and reports of international policy already established in high level meetings, occupational therapists can translate these principles into local action. Occupational therapists need to be aware of global issues and documented strategies in order to devise better approaches to increasing individual occupations and removing societal barriers that inhibit participation. Occupational therapists must work collaboratively with vulnerable people, whether they are migrants, survivors of natural disasters or epidemics, or living at subsistence level in difficult situations. Occupational therapists need to have an understanding of their needs and cultural perspectives to assist in promoting occupational engagement and participation. WFOT documents are useful to support such actions. The articles in this journal offer further examples of local action incorporating international policy.

Having returned from the 13th World Congress of Occupational Therapists in Sweden, we reflect on the development of our international connections and collaborations in our profession. In the past, Australia was isolated by distance. This was highlighted during the celebrations of 50 years of the World Federation of Occupational Therapists at the Congress, when it was pointed out that in its beginning sea mail was the main form of communication! Since then, technological advances have greatly expanded our opportunities to travel, meet and share our ideas with international colleagues. Growth in electronic communication is enabling us to develop and maintain international professional contacts on a daily basis. It is also facilitating the accessibility of our Journal to international colleagues and their publications to us. Consequently, the readership of the Australian Occupational Therapy Journal, like other occupational therapy journals, now includes occupational therapists around the globe, as well as to Australian occupational therapists. To build international collaboration between occupational therapy journals, 11 occupational therapy journal editors met at the Congress. One outcome from this meeting was to establish a discussion database for international editors to enable exchange of ideas and to maintain contact. Our Journal is currently one of the few occupational therapy journals internationally with electronic publication, and the only journal to have established processes for publication of critically appraised papers. In addition, a report from Blackwell Publishing (UK) indicated that the Australian Occupational Therapy Journal was one of the most popular on the Wisepress stand at the Congress. To foster a more international outlook, the Editorial Board has made the decision to expand the Editorial Advisory Board to include recognised international occupational therapists, as well as Australian experts. Their roles will include promotion of the Australian Occupational Therapy Journal internationally, as well as advice to the Board, preparation of guest editorials and refereeing of manuscripts. Our first two international Advisory Board members are Dr Doris Pierce and Dr Michael Iwama. Doris is the Endowed Chair in Occupational Therapy at Eastern Kentucky University, USA, where her role includes facilitating faculty scholarship and research in infant and toddler development and disability. Michael has recently been appointed as an associate professor at Dalhousie University, Halifax, Nova Scotia, Canada, after seven years at Kibi International University, Okayama, Japan. Michael's research focuses on occupational therapy in Asia, particularly issues of culture and constructions of occupational therapy theory and knowledge. We believe both will offer us a wide range of expertise, and we welcome them to our Editorial Advisory Board. We also welcome our first international Editorial Board member, Dr M. Clare Taylor, who has been appointed the inaugural editor for Critically Appraised Papers. Clare is an international expert in the area of evidence-based practice. She is currently a lecturer in occupational therapy at Coventry University in the United Kingdom and author of Evidence-based practice for occupational therapists[ Taylor, M. C. (2000). Evidence-based practice for occupational therapists. London: Blackwell Science]. We thank Annie McCluskey (University of Western Sydney), Sally Bennett (University of Queensland), and Margaret Wallen (current Journal Editorial Advisory Board member) for their valuable contribution in preparing the guidelines for this new department. We believe these are exciting developments and enhance the Journal's capacity to bring you, the readers, clinically important research and practice knowledge of a high quality, and to enable you to share your work within the global occupational therapy community.

The value that qualitative research brings to the occupational therapy body of evidence is widely accepted. Including evidence relating to individuals’ lived experiences through qualitative studies parallels occupational therapy's practice focus and theoretical underpinnings of the person in context. Engaging with consumers of occupational therapy services, for example, ensures that our practices, clinical and academic, remain current and reflective of the experience of people we work with. Qualitative research, where participants provided rich and in-depth description of their personal experience, is thus akin to client centred practice which is our modus operandi (World Federation of Occupational Therapists, 2016). Qualitative research can be considered a natural extension of occupational therapy practice experience and expertise. After all, occupational therapists who are guided by a person-centred approach, will inevitably explore and consider their client's unique values and experiences in order to understand the context and meanings underlying occupational participation. We are comfortable interacting with clients and, consequently, occupational therapists should have prerequisite skills necessary for meaningful data collection with research participants using qualitative approaches. There is, however, a difference as the primary purpose of interaction is different – one aims to assist the other to enquire. Different techniques are used in these interactions reflecting the different methodological traditions from which they emerge. Clinicians know that ‘one size does not fit all’ in therapy. We thus interpret findings of reliable, standardised and valid assessments in the context of unique occupational performance needs, goals, roles and environments of the client, in order to collaboratively develop and intervention plan with our client. So it is with qualitative research data and methodology. The information collected will only ‘make sense’ if the assessment/enquiry methods used are rigorous, take account of the unique context and experiences of people involved, and ‘make sense’ from a range of perspectives. How do we know if qualitative research methodologies are rigorous? Can something that is so unique even incorporate attributes comparable across study questions and contexts? Just as therapy uses guidelines and methodological research to enhance the consistency and quality of practice processes, what tools can qualitative researchers in occupational therapy use to develop and implement robust research questions and procedures? Do we apply the same level of precision used to generate qualitative evidence in practice to the data collection, analysis and interpretation that we do in qualitative research? Is there a risk that qualitative findings from research is less rigorous than what we would use in practice? Are we taking the appropriate measures to ensure qualitative research produce findings that will have the potential to advance occupational therapy practice, research, and education? When it comes to the ‘quality’ of qualitative research, evidence suggests that ‘sample size’ is both a matter of contention and a meaningful guide to issues that need consideration. In the first instance, while sample size has been identified as a factor in study design, and it can be difficult to determine with precision, the size of the sample should be guided by ‘data saturation’ rather than sampling of people per se (Creswell, 2013). At the same time, the concept of data saturation has been challenged as a means to determine the quality of qualitative studies (O'Reiley & Parker, 2013). Other authors have proposed sample size can be determined on the number of participants rather than ‘data’, depending on the qualitative methodologies. For example, phenomenological studies may use between five and 20 participants (Creswell, 2013; Green & Thorogood, 2014) while three to 15 participants is acceptable in studies using interpretative phenomenological analysis (Smith, Flowers & Larkin, 2009). Still further, some qualitative researchers avoid suggestion of any particular approach, instead providing resources to researchers to help align their study design, procedures and sample size as best as possible with the question they are seeking to answer (for example, the Rosalind Franklin-Qualitative Research Appraisal Instrument and the Consolidated criteria for reporting qualitative research.) These resources have been developed precisely to help qualitative researchers design, conduct, and report comprehensive research that is credible, dependable and transferable to other contexts. The Australian Occupational Therapy Journal through its Editorial Board and Reviewers, stays abreast of discussions and developments in qualitative methodologies and approaches. Authors need to remember that, the journal will publish ‘papers that have a sound theoretical basis, methodological rigour with sufficient scope and scale to make important new contributions to the occupational therapy body of knowledge’ (Wiley & Sons, 2018). It will maintain its commitment to ‘disseminate scholarship and evidence to substantiate, influence and shape policy and occupational therapy practice locally and globally’ (Wiley & Sons). To achieve this commitment, authors of qualitative research studies must provide strong justification to support their methodological choices and clearly describe data collection, analysis and interpretation steps that will demonstrate trustworthiness of findings and design rigour.

Having recently returned from the most successful 21st National Conference of Occupational Therapists in Brisbane, we feel stimulated by the launch of the Accredited Occupational Therapist Program (AccOT) and by the theme of evidence-based practice (EBP), which emerged during the scientific program and in Anne Cusick’s Sylvia Docker lecture. These developments have been in train for several years, as indicated by the long-term planning for the AccOT Program and by the recent issue of the Australian Occupational Therapy Journal featuring EBP (December 2000). The AccOT Program has been developed to assist and encourage occupational therapists to maintain currency of knowledge and skills. It also aims to promote occupational therapy skills to consumers, employers, government agencies and authorities; these groups will now have a means for identifying those practitioners who are continually working to update their professional skills. This program is comprehensive, covering standards of practice, occupational therapy training programs, appropriate mechanisms for handling of any concerns or complaints, and guidelines for mentoring and supervision. The core theme of the AccOT Program is continuing professional development, which links effectively with EBP. The International Symposium on Evidence-Based Occupational Therapy, organised by the Department of Occupational Therapy at the University of Queensland and held prior to the Conference, provided an exciting forum for Australian and international occupational therapists to participate in identifying issues, themes and future directions for EBP. We were fortunate to have leading Australian and New Zealand representatives and eminent international occupational therapy speakers. The links between Australia, New Zealand, Canada, the UK and the USA, and the World Federation of Occupational Therapists, which were strengthened at the symposium, will provide a valuable base for future collaboration. A further recommendation from the symposium related to the publication in our Journal of critically appraised papers (CAP) relevant to occupational therapy. This would involve location of suitable papers, preparation of a structured abstract, and a written commentary on the paper by an expert from the relevant field. Publishing a variety of CAP in a journal enables the subscribers to access a wider range of scientific papers relevant to their professional interests. This proposal will be discussed at our next Editorial Board meeting. It is important to understand that EBP is the combination and integration of best available research evidence, clinical experience and patient values (Sackett et al., 1996), with Taylor (2000) stressing that EBP should be seen as ‘just one of the tools of clinical reasoning and reflective practice’ (p. 3). Best evidence can range from expert discussion to systematic reviews and meta-analysis of randomised controlled trials, with qualitative research now being seen as acceptable and appropriate evidence (Taylor). Evidence-based practice in the health sector is a universal concept, which according to Sackett et al. (1996), will be integral to all practice by the year 2005. The AccOT Program will provide an effective tool for occupational therapists to achieve this goal. The continuing professional development tool of the AccOT Program will provide an effective framework for occupational therapists to develop their practice through access to the latest research, developing skills in understanding and interpreting the research literature, and by accessing systematic reviews and critically appraised papers from journals and the Internet. These themes from the Conference can be interpreted as demonstrating the continuing growth of our profession, and signify the strength of the foundations of our practice.

Occupational Therapy Is a Vital Member of the Interprofessional Team-Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

The occupational therapy community has been receptive to the World Health Organisation's International Classification of Functioning, Disability and Health (ICF) published in 2001. Building upon results of a survey (2008–2009) and subsequent workshop (2010) conducted by the World Federation of Occupational Therapists on the use and utility of the ICF for occupational therapists, this paper addresses some of the opportunities and challenges to strengthening the use of the ICF in occupational therapy practice. Attaining further clarity on the relationship of occupational therapy concepts and the ICF and developing crosswalk tables to exemplify linkages between occupational therapy terminology and the ICF will strengthen utility of the ICF for occupational therapy. Enhanced clarity about the concepts within occupational therapy that correspond to the ICF will ultimately assist other professions and disciplines in their understanding about occupational therapy and occupational therapists’ roles in health and related systems.

Background: The role of occupational therapy is to provide management for various conditions including neurological, musculoskeletal, and psychological disorders, with the aim of maximizing function and independency in daily occupations. According to the World Federation of Occupational Therapists (WFOT), occupational therapy is a client-centered health profession concerned with promoting health and well-being through occupation. In Saudi Arabia, there are escalating rates of chronic conditions, which create an increasing demand for occupational therapy services. Yet, occupational therapy practice frameworks, as well as areas of assessment and intervention, are not well explored within the context of Saudi Arabia.Purpose: The aim of this research is to identify the most common disorders that occupational therapists work with within Saudi Arabia and the approaches used for managing these disorders.Methods: This was a cross-sectional study. An electronic survey was distributed to 230 occupational therapists working in Saudi Arabia. The survey consisted of two sections; the first was on educational backgrounds, and the second section was about the common conditions encountered in a clinical setting and the treatment approaches applied. The interventions nominated by participants were mapped to the person–environment–occupation model and to the occupational therapy practice framework.Results: The overall response rate was 57%. Analysis of data of 131 participants revealed that neurological diseases (e.g., stroke, multiple sclerosis, and Parkinson's disease) were the most common conditions managed by occupational therapists (64.3%), while respiratory diseases had the lowest percentage (4.7%). With regard to intervention approaches, “therapeutic exercise” was the most commonly applied approach as was reported by 77.1% of the therapists, while “functional electrical stimulation” was the lowest chosen approach as it was applied by 19.8% of the therapists.Conclusion: Occupational therapists in Saudi Arabia manage a variety of conditions and apply a wide range of rehabilitation approaches, yet gaps still exist in providing a holistic approach. The study emphasizes the importance of redirecting the focus of occupational therapists to core concepts of maximizing functioning and occupational performance and using occupation as a mean and as an outcome of rehabilitation.

ABSTRACTThe theme of the first World Federation of Occupational Therapists’ Congress held on African soil – Connected in Diversity; Positioned for Impact – informs this lecture, which challenges the dominance within the international occupational therapy profession of theories and models formulated by a privileged English-speaking minority. It contends that occupational therapists perpetuate colonialism when theories, assessments, interventions, outcome measures and models of practice that are informed by culturally-specific, Western neoliberal assumptions about what is valuable and desirable are promoted and applied in contexts that are politically, culturally, economically and socially dissimilar; and argues that occupational therapy practices informed by these assumptions may be inadequate, inappropriate, irrelevant and oppressive. It asserts that because theorists formulate their ideas within specific socio-cultural, political, economic and geographic contexts, cross-cultural perspectives are necessary to reveal gaps in existing knowledge and identify what has been overlooked, obscured, omitted and assumed. It proposes that knowledge derived from our profession’s diverse perspectives might be triangulated to generate inclusive theoretical models, inform culturally-safe practices and be more responsive to the structural factors that inequitably constrain people’s opportunities to use their abilities. Surely, the occupational therapy profession can be positioned to have a relevant and significant global impact if we build from the strength of our diversity, and work together towards ensuring that all people, regardless of difference, have the capabilities (i.e. both the abilities and the opportunities) to engage in occupations that contribute to their own well-being and the well-being of their communities, as is their right (World Federation of Occupational Therapists (WFOT). (2006). Position statement: Human rights. Retrieved from www.wfot.org)!

Occupational therapists demonstrate diversity in the many ways in which they practise, and responding to calls to embrace health promotion is one such example. The articles in this issue were selected on this topic, from those either recently accepted or already available online through BJOT’s Online First publish ahead of print. They share a focus on prevention and early intervention that is the theme for this year’s Occupational Therapy Week, which runs in the United Kingdom (UK) from 2 November, coming shortly after World Occupational Therapy Day on 27 October. Inaugurated by the World Federation of Occupational Therapists (WFOT) in 2010, World OT Day is an opportunity for occupational therapists around the world in WFOT’s 80 international occupational therapy professional associations to promote and celebrate the profession locally, nationally and internationally (WFOT, 2015). The articles collected here are international in both origin and relevance. Two are concerned with prevention – helping people stay well by enabling them to make healthy choices – and indicate how participation in occupation can be health promoting for the general population. Genter et al. (2015) undertook a systematic review of the literature on the contribution of allotment gardening to health and wellbeing while Taylor (2015) interviewed 17 serious enthusiasts about their chosen leisure pursuit. Her engaging account of how they experienced meaning and caring both for others and themselves through their occupation is worth reading, whether you are bridge player or a canoeist – perhaps your favourite leisure occupation is among those included. Five articles are concerned with targeting ‘at risk’ groups to prevent the development of health problems, and three of these tackle the importance of engaging in occupation for vulnerable groups of people. Smith (2015) concluded that people who seek asylum in the UK found meaning in occupation, wanted to keep busy and acknowledged the importance of altruistic occupations to benefit others. Gallagher et al. (2015) found that disadvantaged young people in Ireland had limited occupational choice and that this risked their wellbeing. Mackenzie and White (2015) explored the social networks of older women with intellectual disability living in the community in Australia and their study provides a useful summary of strategies that the women found helpful. The remaining two articles focus on the importance of early intervention for at risk children. Barfoot et al. (2015) described relationshipfocused occupational therapy for a child with cerebral palsy and her mother. Wilkes-Gillan et al. (2015) evaluated parents’ perspectives of a parent-delivered play-based intervention to improve the social play skills of children with attention deficit hyperactivity disorder. The final article in this collection demonstrates occupational therapy for people with a chronic condition to maintain quality of life. Schmid et al. (2015) examined a fall risk management programme for people with chronic stroke, who are at more risk of falling than those without and for whom the consequence of falling could cause additional problems. A special issue of BJOT calling for papers on health promotion or another person choosing articles at another time would have created a different issue. I hope you enjoy this selection and that the articles encourage you to consider how you can incorporate health promotion in your practice.

Background This research study emerged from the on-going quest of a team of occupational therapists to demonstrate that a local occupational therapy practice: was meeting the needs of adults with learning disabilities; was effective and achieving the objectives of the employing organisation; and was complying with the expectations of the College of Occupational Therapists regarding evidence based practice. Purpose The purpose of this study was to seek and to generate evidence on which to evaluate and improve a local community based occupational therapy practice with adults with learning disabilities. Methods Action research methodology was used in which the local occupational therapists were engaged as co-researchers over three stages. Stage one: essential criteria for occupational therapy assessments for adults with learning disabilities were developed. No standardised assessments were identified that could meet all of these criteria. Stage two: perceptions of occupational therapy assessment were gathered from a sample group of adults with learning disabilities, their carers and other stakeholders. Stage three: changes were made to occupational therapy practice in response to the findings of stage two and in order to meet referral to treatment targets imposed by the employing organisation. Data were collected on the changes made to occupational therapy practice, and how they were implemented, through the use of action learning sets and questionnaires. The perceptions of a new sample of participants with learning disabilities and other relevant people involved, about the occupational therapy practice that they had received, were ascertained. Throughout the whole study, data were collected from multiple sources using interviews, questionnaires and co-researcher discussions and reflections. The primary method of data analysis was thematic, with some descriptive analysis. Data from different sources were triangulated to develop key findings. Findings The participants with learning disabilities were able to provide valuable insights about their perceptions of occupational therapy practice. There was evidence that occupational therapists provided occupation focussed assessments and interventions which had a positive effect on the occupational performance of adults with learning disabilities. The occupational therapists used professional reasoning in their assessments and interventions with adults with learning disabilities rather than a standardised, formulaic approach. This ensured a flexible, holistic and person-centred approach which worked in a dynamic community context. Occupational therapists, as a service, creatively adapted their practice in response to organisational demands whilst maintaining occupational therapy principles. Conclusions The practice-based evidence generated from this research study could be relevant and transferable for other occupational therapy services working with adults with learning disabilities and contributes to the occupational therapy body of evidence within this speciality.

The onset of the pandemic highlighted the need for a review of rehabilitation practices to ensure coordinated, effective, and efficient services for people affected by COVID-19. This paper reports on a global survey highlighting the delivery of occupational therapy services to people with COVID-19/post-COVID-19 condition (PCC) and makes recommendations to facilitate quality service delivery for this population. An online cross-sectional descriptive survey was developed and distributed to the global occupational therapy community via member organisations and communication channels of the World Federation of Occupational Therapists to collect information for this study. The survey obtained qualitative and quantitative data from respondents who were occupational therapists or occupational therapy assistants regarding (i) demographic characteristics, (ii) work experience with persons with COVID-19 and PCC, (iii) modes of working, (iv) education and training, (iv) occupational therapy intervention provided to persons with COVID-19 and PCC, and (v) the perceived quality of the occupational therapy services provided. Findings indicate that respondents provided a range of occupational therapy interventions for people affected by COVID-19/PCC aligned with evidence-based practice guidelines. While respondents identified a strong role for occupational therapy and generally rated their services as effective, issues related to the accessibility of their services impacted quality and user satisfaction. The study highlighted the need to advocate for access to occupational therapy to facilitate engagement in desired and needed occupations for COVID-19 survivors. Other recommendations emerging from the findings include the need to develop, disseminate, and use research evidence for guiding services for people with COVID-19/PCC, create quality service standards, and ensure the availability of necessary resources and supports such as referral pathways and screening criteria, availability of staff, training, personal protective equipment, and assistive devices and technology.

The purposes of this study are to investigate perceptions of occupational therapy (OT) among medical, nursing, and OT undergraduates and to survey their collaborative status with occupational therapists in the fieldwork. Three groups of participants were surveyed: medical students (N=60), nursing students (N=67), and OT students (N=87). The students completed a questionnaire examining (1) knowledge about the profession of OT; (2) appraisal of OT; (3) service needs from occupational therapists; and (4) the current status of teamwork practices. All students indicated that academic education was their main source of knowledge about the profession of OT. Thirty-five percent of medical students and 40% of nursing students reported that they could not distinguish between the professions of OT and physical therapy (PT). Both medical and nursing students appreciated OT for improving patients’ function in activities of daily living (ADL). They also reported that the most service needed from occupational therapists is ”ADL evaluation and training.” Most medical students (77%) and nursing students (84%) reported that they rarely collaborated with OT staff in teamwork training for patient care. Ninety-five percent of medical students and 76% of nursing students agreed that working with occupational therapists during fieldwork could enhance their understanding of the OT profession. The findings indicated that a large proportion of medical and nursing students have inadequate knowledge about the role and function of occupational therapists and few opportunities to collaborate with occupational therapists. However, they also showed specific needs for OT in patient care. Therefore, the development of a clinical collaborative education program to facilitate teamwork between occupational therapists and other medical professionals is necessary.