Exploring occupational therapists’ perspectives on the clinical utility of the Assessment of Client’s Enablement (ACE): A qualitative study

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

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

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.

Rural Early Intervention Therapists’ Perceptions of Emergency Remote Telehealth Use

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.

Climate change and the unsustainable exploitation of Earth's natural environment pose threats to health and wellbeing. There is growing evidence outlining the potential of occupational therapy to address issues of environmental sustainability and climate change. Research investigating the perspectives and experiences of occupational therapists, particularly those practicing within Australia, is in its infancy. The aim of this research was to explore such perspectives and lived experiences, with a focus on climate change and environmental sustainability. This exploratory, qualitative descriptive study involved a total of 13 occupational therapy clinicians and academics who were conveniently recruited via an online advertisement. Data were gathered through three online focus groups guided by a semi-structured schedule. Braun and Clarke's six-step method for thematic analysis was used to guide data analysis. There was no consumer or community involvement. Four main themes were identified: conflicting values: personal versus professional; the value of an occupational therapy lens; small steps towards a bigger picture of environmental sustainability; and the challenges for occupational therapy in a material world. This study provides a comprehensive exploration of the potential and reality of environmental sustainability in Australian occupational therapy practice. The findings highlight that although occupational therapists perceive environmental sustainability as a pertinent and important matter, knowledge about existing resources, how to implement environmental sustainability into practice, and the profession's role in relation to climate change remains low. Despite occupational therapists' intention to have an impact and influence in their workplaces, the findings highlight that a broader, future-focused, and profession-wide examination of the part occupational therapy could play in addressing environmental sustainability and contributing to further reducing the impact of climate change is required. Future research could build upon and investigate the effectiveness of specific strategies for incorporating environmental sustainability explored within this research.

The effectiveness of robotic therapy in stroke rehabilitation has been established by many studies, and occupational therapists should consider using robotics in their clinical practice. However, little is known about occupational therapy practitioners' experience using robotics. To explore occupational therapists' perceptions of the mechanisms and outcomes of occupational therapy using robotics with chronic stroke patients. Qualitative study with semistructured focus group interviews. Data were analyzed using thematic analysis. Hospitals and institutions in Japan in which occupational therapists used robotics in their clinical practice. Twenty-seven occupational therapists with experience in using robotics with chronic stroke patients as a self-training method that involved repetitive movements of a paralyzed upper extremity. Participants were interviewed in nine focus groups. Five themes-(1) body function, (2) values, (3) performance skills, (4) occupational performance, and (5) participation-and 12 subthemes were identified on the basis of the Occupational Therapy Practice Framework: Domain and Process (3rd ed.). Participants indicated that robotics improved patients' body function and promoted a desire for independence, which resulted in improved occupational performance and participation in their desired occupations. Occupational therapists regarded robotics as an adjunct to other therapy, which improved patients' body function and promoted their desire for independence. What This Article Adds: Findings from this research provide insights into using robotics to enhance occupational therapy practice.

Literature points out that not always the intervention priorities considered by clients meet with those outlined by Occupational Therapists (OT). The intervention of OT in Mental Health aims to understand how occupations are amended in accordance with client expectations. The research here described seeks to understand the perception of clients and OT on intervention priorities, trying to determine whether there is compliance between the views. Within a qualitative approach was carried out a descriptive and exploratory case study with data triangulation from different sources. Software aided content analysis technique was used for the interpretation of data obtained through semi-structured interviews. OT and clients have differing views regarding intervention and its priorities. While the OT prioritize habits and routines, especially related to the ADL and IADL, customers give special focus to problem solving. It was found that clients are not fully satisfied for not being allowed to work for individual goals.

INTRODUCTION: Major depressive disorders (MDD) cause work disability and work loss, often resulting in unemployment. Employees with MDD are often referred to occupational therapists (OTs) to assist with functional capacity evaluation (FCE). Functional Capacity Evaluation forms a part of the return-to-work decision making process. This study describes the views and perceptions of occupational therapists regarding the requirements needed to conduct reliable FCEs of employees suffering from MDD. METHODS: This study employed a descriptive, qualitative study design. Data were collected in three phases using open-ended questions, focus groups and member checking groups. Thematic content data analysis was used. FINDINGS: In total, 78 occupational therapists were recruited and 39 participated, with response rates of (28) 47%, (11) 61% and (9) 82% respectively across the three phases. Nine participants took part in the focus groups and member checking groups. Three themes emerged, namely: (1) occupational therapists' competencies in performing functional capacity evaluations (2) the process of functional capacity evaluation and (3) comprehensive functional capacity evaluation. CONCLUSION: The views and perceptions of occupational therapists of performing FCEs is to formulate return-to-work decisions. Occupational therapists should be competent in the use of standardised measurement tools, non-standardised assessment and clinical reasoning. Key words: Major Depressive Disorder, Functional Capacity Evaluation, occupational therapy, return-to-work, vocational rehabilitation

Introduction: Globally, over-crowding within Emergency Departments is becoming a serious concern (Walker et al 2016) impacting on patient safety (Pines et al 2011) and work-related stress (The College of Emergency Medicine 2013; Lavoie et al 2011). One reason for over-crowding is that, in addition to treating urgent medical and surgical conditions, Emergency Departments act as the ‘front doors’ of hospitals, and people wait for admission to acute-care (Walker et al 2016), a process known as unscheduled care (The Royal College of General Practitioners 2011). Occupational therapists are well-placed to address some of the issues around unscheduled care (Mearns et al 2008). This is because they assess and treat people directly in the Emergency Department and determine whether a discharge directly home is feasible (Mearns et al 2008). The College of Occupational Therapists recently claimed that 70% of patients referred to occupational therapy in this way were discharged directly (College of Occupational Therapists 2016). This presentation claims a role for occupational therapists in Emergency Departments in terms of their potential to reduce over-crowding. It will report on the findings from two linked studies: - a critical review of the literature (James et al 2016) and a qualitative study (James et al 2016a). Methods: A systematic search was performed for occupational therapy in the Emergency Department using database platforms, internet search engines and grey sources. Critical analysis of each record was undertaken and synthesised. An Interpretative Phenomenological Analysis framework was applied to the qualitative study. Nine occupational therapists with experience of working in the Emergency Departments were recruited from across Scotland. Individual, semi-structured interviews were audio-recorded and transcribed verbatim. Interview transcripts were analysed line-by-line and interpreted using Interpretative Phenomenological Analysis methods. Results: The systematic search returned 23 potentially relevant papers of which 16 met the criteria for further inclusion and seven were critically analysed. Not all study sample sizes were small, but variable methodological quality meant current evidence can only be taken into professional practice with caution. Findings from the qualitative study led to two over-arching themes. Theme one captured the experience of occupational therapists working in Emergency Departments. Theme two encapsulated what it was like to enter and establish a new role. Discussion: There are good reasons why occupational therapists are well-placed to address issues of over crowding in the Emergency Department. However, based on current evidence, there can only be a limited understanding of its role and efficacy. There is a need for large-scale, well designed research studies of occupational therapy within emergency care.

Introduction and aim: LGBTQIA+ people constitute a minority group that navigate their occupational engagement within a historically entrenched system of oppression. This opinion piece addresses a subject matter that is increasingly garnering attention from the international health science community, yet it remains insufficiently explored in South African occupational therapy dialogues. The aim of this paper is to stimulate critical reflection among occupational therapists on the discourses that underpin our daily practice. By utilising the person- environment-occupation model, we seek to demonstrate the unique and essential role of occupational therapy in serving LGBTQIA+ people within the South African context. Conclusion: Although occupational therapists are trained to consider all aspects of a person, discussions around gender are rarely emphasised in undergraduate training or clinical practice. This opinion piece demonstrates the roles that occupational therapists may play when working with LGBTQIA+ people to provide services that are holistic and relevant to their needs and contexts. Recognizing the impact of everyday occupational therapy practices on LGBTQIA+ individuals is crucial, requiring a commitment to inclusivity and continuous reflection within the field of occupational therapy. Implications for practice Occupational therapists can play an important role in serving LGBTQIA+ individuals when they are committed to recognizing how dominant discourses about this group can be sustained through the everyday practices of delivering occupational therapy.

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

Occupation-based practice (OBP) is central to the practice of occupational therapists where occupations or meaningful activities become the focus of the assessment, intervention, and outcomes measurement process. Although occupational therapists practising in Thailand claim that they engage in OBP, this claim warrants empirical investigation. This study aimed to investigate the experiences and perceptions of hospital-based occupational therapists of OBP within stroke rehabilitation. Utilizing a qualitative design, fourteen occupational therapists were recruited through purposive sampling. Data were collected through semi-structured interviews until data saturation was reached. Each interview was recorded and transcribed verbatim, and data were analyzed using thematic analysis. Five themes were identified (1) Perspective towards OBP, (2) OBP as professional value and cultural identity, (3) Implementing OBP for stroke rehabilitation in hospital settings, (4) Environmental factors of using OBP in stroke rehabilitation, and (5) OBP in the service management. Occupational therapists perceived that OBP is important for professional identity. Using OBP provides positive changes in stroke clients. This study provides evidence that will help implement OBP into occupational therapy in Thailand.

Picky eating is a complex phenomenon, impacting family routines and relationships. Occupational therapists often work with picky eaters and their families, yet little is understood about the occupational therapy process and reasoning in this context. This study was guided by the following research question: How do Australian occupational therapists choose and deliver interventions for children with picky eating and their families? This qualitative interpretive descriptive study used in-depth semi-structured online interviews with 10 Australian-based occupational therapists working with children who are picky eaters. Data was analysed inductively following a thematic analysis process, and emergent themes were identified. Participants indicated that they used a complex reasoning process, with 'Tailoring Occupational Therapy for Picky Eating' emerging as the central finding. Key factors underpinning these tailored interventions were finding the why; addressing the why; and practising within context. To our knowledge, this is the first qualitative study to investigate occupational therapists' reasoning processes when working with families impacted by picky eating. Occupational therapists described the complexity of picky eating, and the subsequent reasoning to find suitable interventions. Findings may guide occupational therapists' clinical practice when working with children with picky eating and their families.

Background Stroke survivors form the largest client group seen by occupational therapists and a large proportion of these stroke survivors experience upper limb post-stroke sensory impairments (ULPSSI) which impact upper limb function and participation. This thesis addresses the clinical decision-making (CDM) of occupational therapists when managing ULPSSI. No appraised and synthesised summary of the research evidence related to the effectiveness of interventions for ULPSSI is available to support therapists’ CDM. Information on occupational therapists’ practice choices and decisions about managing ULPSSI and the survivors’ perspective on ULPSSI is scant. This information could support occupational therapists CDM when addressing ULPSSI and potentially improve stroke survivors’ outcomes. Thesis Aims This thesis aims to: 1. Synthesise the effectiveness of interventions for ULPSSI; 2. Explore how occupational therapists make and manage decisions regarding ULPSSI management; 3. Describe practice choices occupational therapists commonly make when managing ULPSSI and the sources of information they use to make these decisions; 4. Compare current assessment choices and intervention practices with recommendations from the research evidence and clinical practice guidelines; 5. Describe the stroke survivors’ perspective with regard to ULPSSI; and 6. Design and pilot an evidence-based, theory-driven educational intervention to support occupational therapists’ CDM when addressing ULPSSI. Thesis Methods Five distinct studies addressed the above aims. • A Cochrane systematic review evaluated the evidence for the effectiveness of ULPSSI interventions. • Twelve occupational therapists participated in a qualitative descriptive study exploring therapists’ practice choices and CDM related to ULPSSI. • Based on the qualitative study, a survey of 187 occupational therapists described therapists’ current practice choices regarding ULPSSI management and factors impacting CDM. • A qualitative descriptive study using semi-structured interviews with 15 stroke survivors explored their experience of ULPSSI and the associated rehabilitation encounter. • Finally, based on the need for training expressed by the survey participants, a one group pre- and post-test design, feasibility study evaluated the effect of a one day, theory-based educational intervention on 19 occupational therapists’ knowledge, perceived behavioural control, attitudes and intended behaviour regarding ULPSSI management, research utilisation, and shared decision-making. Workshop content incorporated information from the prior research studies forming this thesis. Results A Cochrane systematic review located 13 randomised controlled trials (RCTs) addressing ULPSSI interventions, with benefit shown from individual RCTs evaluating mirror therapy, a graded thermal stimulation, and intermittent pneumatic compression. Other single RCTs reporting statistically significant results for repetitive peripheral magnetic stimulation, early intensive task-orientated training and graded sensory rehabilitation were found but lacked sufficient data to determine effects sizes. Therapists in the qualitative study expressed considerable uncertainty when managing ULPSSI and focused on searching for knowledge especially from peers, reasoning by analogy, and trialling interventions to manage this uncertainty. Therapists described clinical and contextual factors influencing their CDM. The majority of survey respondents reported frequently assessing sensation but failed to use standardised measures. Just over half of the respondents frequently provided ULPSSI interventions, primarily providing non-specific sensory stimulation followed by compensatory strategies differing from those in recent research. Most therapists provided patient/caregiver safety education. Therapists cited lack of knowledge and skills, patients’ short length of stay, and lack of time as barriers to utilising ULPSSI interventions. Most therapists reported not being up-to-date with current research requesting continuing education to support practice. Survey respondents’ lack of awareness of interventions, believing that interventions for motor impairments addressed ULPSSI, and lack of time most commonly led to the decision not to use ULPSSI interventions. Clients’ cognitive status, ULPSSI severity, and time since stroke impacted therapists’ choice between compensatory or remedial approaches. Prior personal experience, trialling interventions, and consulting other therapists most commonly influenced specific intervention choice. Stroke survivors clearly articulated how ULPSSI impacted upper limb functional use. Survivors saw the recovery process extending years beyond current rehabilitation time frames and necessitating considerable work, though many survivors felt they were left on their own to address upper limb impairments. They reported little involvement in decision-making regarding their rehabilitation. A feasibility study of a theory-driven educational intervention demonstrated potential to significantly change therapists knowledge, attitudes and perceived behavioural control, and changes from current behaviour to intended behaviour regarding ULPSSI management, using research, and shared decision-making.