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

2020 vision: promoting participation, mental health and wellbeing through occupational therapy - what are we doing and where are we heading?

Knowledge translation in the context of the Asia Pacific region.

Rehabilitation Research

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

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.

Special Issue: Innovations in occupational therapy measurement.

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

Official documents and professional policies are approved by the AOTA Representative Assembly and undergo scheduled review and approval by the Representative Assembly Coordinating Committee (RACC). These documents are used by the Association and its membership to guide education, practice, advocacy, and policy on behalf of the profession. The documents are a valuable resource for occupational therapy practitioners and provide a solid grounding in the profession for students, consumers, and external stakeholders.Items in bold are new for 2022 and are available in this supplement to the American Journal of Occupational Therapy. Official documents are periodically reviewed, and documents may be superseded by newer versions or rescinded. A complete list of the most current documents is available at https://www.aota.org/practice/practice-essentials/aota-official-documents.Guidance documents provide comprehensive perspective and guidance on topics that shape advancement of the profession and its future direction. ▪ Guidelines for Documentation of Occupational Therapy (2018)▪ Guidelines for Occupational Therapy Services in Early Intervention and Schools (2017)▪ Guidelines for Reentry Into the Field of Occupational Therapy (2020)▪ Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2020)▪ Occupational Therapy Practice Framework: Domain and Process, 4th Edition (2020)▪ The Practice of Occupational Therapy in Feeding, Eating, and Swallowing (2017)▪ A Descriptive Review of Occupational Therapy Education (2016)▪ Scholarship in Occupational Therapy (2022)Position statements present an official stance on the provision of services, practice of occupational therapy, or role of occupational therapy. They are developed in response to a professional issue, concern, or need. ▪ COE Academic Terminal Degree (2022)▪ Assistive Technology and Occupational Performance (2016)▪ Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services (2022)▪ Cognition, Cognitive Rehabilitation, and Occupational Performance (2019)▪ Continuing Professional Development in Occupational Therapy (2016)▪ Driving and Community Mobility (2016)▪ Fieldwork Level II and Occupational Therapy Students (2018)▪ Importance of Collaborative Occupational Therapist-Occupational Therapy Assistant Intraprofessional Education in Occupational Therapy Curricula (2017)▪ Importance of Interprofessional Education for Occupational Therapy (2022)▪ Importance of Primary Care Education in Occupational Therapy Curricula (2017)▪ Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments (2022)▪ Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice (2017)▪ Occupational Therapy and Complementary Health Approaches and Integrative Health (2016)▪ Occupational Therapy Doctoral Capstone: Purpose and Value (2022)▪ Occupational Therapy Fieldwork Education: Value and Purpose (2022)▪ Occupational Therapy for Children and Youth Using Sensory Integration Theory and Methods in School-Based Practice (2015)▪ Occupational Therapy in the Promotion of Health and Well-Being (2019)▪ Occupational Therapy Scope of Practice (2021)▪ Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence (2017)▪ Occupational Therapy Services in Facilitating Work Participation and Performance (2017)▪ Occupational Therapy Services in the Promotion of Mental Health and Well-Being (2016)▪ Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion (2020)▪ Occupational Therapy’s Perspective on the Use of Environments and Contexts to Facilitate Health, Well-Being, and Participation in Occupations (2015)▪ Occupational Therapy’s Role in Case Management (2018)▪ Occupational Therapy’s Role in Medication Management (2017)▪ Occupational Therapy’s Role in the Neonatal Intensive Care Unit (2018)▪ Occupational Therapy’s Role With Chronic Conditions (2022)▪ Philosophical Base of Occupational Therapy (2017)▪ Philosophy of Occupational Therapy Education (2018)▪ Role of Occupational Therapy in End-of-Life Care (2016)▪ Role of Occupational Therapy in Pain Management (2021)▪ Physical Agents and Mechanical Modalities (2018)▪ Role of Occupational Therapy in Primary Care (2020)▪ Role of Occupational Therapy in Wound Management (2018)▪ Telehealth in Occupational Therapy (2018)▪ Value of Occupational Therapy Assistant Education to the Profession (2019)▪ Vestibular Impairment, Vestibular Rehabilitation, and Occupational Performance (2017)Professional standards describe and define minimal standards for practice, continued competence, and other professional behaviors. ▪ AOTA 2020 Code of Ethics▪ Standards for Continuing Competence (2021)▪ Standards of Practice for Occupational Therapy (2021)Societal statements are written in the form of public announcements and identify a societal issue of concern; state how the issue affects the participation of individuals, families, groups, or communities in society; and may offer action to be taken by individuals, families, groups, or communities. ▪ AOTA’s Societal Statement Denouncing Conversion “Therapy” (2022)▪ AOTA’s Societal Statement on Disaster Response and Risk Reduction (2017)▪ AOTA’s Societal Statement on Community Violence (2022)▪ AOTA’s Societal Statement on Gun Violence (2022)▪ AOTA’s Societal Statement on Health Disparities (2013)▪ AOTA’s Societal Statement on Health Literacy (2016)▪ AOTA’s Societal Statement on Livable Communities (2016)▪ AOTA’s Societal Statement on Stress, Trauma, and Posttraumatic Stress Disorder (2017)▪ AOTA’s Societal Statement on Youth Violence (2016)▪ Specialized Knowledge and Skills of Occupational Therapy Educators of the Future (2009)

Official documents and professional policies are approved by the AOTA Representative Assembly and undergo scheduled review and approval by the Representative Assembly Coordinating Committee (RACC). These documents are used by the Association and its membership to guide education, practice, advocacy, and policy on behalf of the profession. The documents are a valuable resource for occupational therapy practitioners and provide a solid grounding in the profession for students, consumers, and external stakeholders.The Representative Assembly adopted the RACC Standard Operating Procedures, Attachment A, at the fall online meeting in November 2020. As a result of this motion, the types of official documents have been renamed and are categorized and described below.Items in bold are new for 2021 and are available in this supplement to the American Journal of Occupational Therapy. Official documents are periodically reviewed, and documents may be superseded by newer versions or rescinded. A complete list of the most current documents is available at https://www.aota.org.Guidance documents provide comprehensive perspective and guidance on topics that shape advancement of the profession and its future direction. Guidelines for Documentation of Occupational Therapy (2018)Guidelines for Occupational Therapy Services in Early Intervention and Schools (2017)Guidelines for Reentry Into the Field of Occupational Therapy (2020)Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services (2020)Occupational Therapy Practice Framework: Domain and Process, 4th Edition (2020)The Practice of Occupational Therapy in Feeding, Eating, and Swallowing (2017)A Descriptive Review of Occupational Therapy Education (2016)Scholarship in Occupational Therapy (2016)Position statements present an official stance on the provision of services, practice of occupational therapy, or role of occupational therapy. They are developed in response to a professional issue, concern, or need. Academic Terminal Degree (2017)Assistive Technology and Occupational PerformanceCognition, Cognitive Rehabilitation, and Occupational Performance (2019)Complex Environmental Modifications (2015)Continuing Professional Development in Occupational Therapy (2016)Driving and Community Mobility (2016)Fieldwork Level II and Occupational Therapy Students (2018)Importance of Collaborative Occupational Therapist-Occupational Therapy Assistant Intraprofessional Education in Occupational Therapy Curricula (2017)Importance of Interprofessional Education in Occupational Therapy Curricula (2015)Importance of Primary Care Education in Occupational Therapy Curricula (2017)Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice (2017)Obesity and Occupational Therapy (2013)Occupational Therapy and Complementary Health Approaches and Integrative Health (2016)Occupational Therapy Fieldwork Education: Value and Purpose (2016)Occupational Therapy for Children and Youth Using Sensory Integration Theory and Methods in School-Based Practice (2015)Occupational Therapy in the Promotion of Health and Well-Being (2019)Occupational Therapy Scope of Practice (2021)Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence (2017)Occupational Therapy Services in Facilitating Work Participation and Performance (2017)Occupational Therapy Services in the Promotion of Mental Health and Well-Being (2016)Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion (2020)Occupational Therapy’s Perspective on the Use of Environments and Contexts to Facilitate Health, Well-Being, and Participation in Occupations (2015)Occupational Therapy’s Role in Case Management (2018)Occupational Therapy’s Role in Medication Management (2017)Occupational Therapy’s Role in the Neonatal Intensive Care Unit (2018)Philosophical Base of Occupational Therapy (2017)Philosophy of Occupational Therapy Education (2018)Role of Occupational Therapy in End-of-Life Care (2016)Role of Occupational Therapy in Pain Management (2021)Physical Agents and Mechanical Modalities (2018)Role of Occupational Therapy in Primary Care (2020)Role of Occupational Therapy in Wound Management (2018)Scope of Occupational Therapy Services for Individuals With An Autism Spectrum Disorder Across The Life Course (2015)Telehealth in Occupational Therapy (2018)Value of Occupational Therapy Assistant Education to the Profession (2019)Vestibular Impairment, Vestibular Rehabilitation, and Occupational Performance (2017)Professional standards describe and define minimal standards for practice, continued competence, and other professional behaviors. AOTA 2020 Code of EthicsStandards for Continuing Competence (2021)Standards of Practice for Occupational Therapy (2021)Societal statements are written in the form of public announcements and identify a societal issue of concern; state how the issue affects the participation of individuals, families, groups, or communities in society; and may offer action to be taken by individuals, families, groups, or communities. AOTA’s Societal Statement on Disaster Response and Risk Reduction (2017)AOTA’s Societal Statement on Health Disparities (2013)AOTA’s Societal Statement on Health Literacy (2016)AOTA’s Societal Statement on Livable Communities (2016)AOTA’s Societal Statement on Stress, Trauma, and Posttraumatic Stress Disorder (2017)AOTA’s Societal Statement on Youth Violence (2016)

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

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.

Cultural humility may improve the quality of occupational therapy services, but how occupational therapy practitioners apply this approach in their practice contexts has not been clearly described in the literature. To describe peer-reviewed rehabilitation literature on the practice of cultural humility and align the findings with occupational therapy practice using the Canadian Practice Process Framework (CPPF). Nine databases were searched, using the term cultural humility to identify relevant peer-reviewed rehabilitation literature. Google Scholar and six journals were hand-searched to identify additional studies. This substudy of a larger knowledge synthesis was guided by Arksey and O'Malley's (2005) scoping review methodology. Titles, abstracts, and full texts of studies were screened using Covidence. Study descriptors, context, population, and cultural humility elements defined by Tervalon and Murray-García (1998), and recommendations were extracted, analyzed, and mapped onto the CPPF. In total, 11 studies were included. Cultural humility elements of self-reflection and critique (n = 7; 63.6%), self-awareness and egolessness (n = 8; 72.7%), and supportive interaction (n = 5; 45.4%) were identified. Most cultural humility elements aligned with the societal (n = 11; 100%) and practice (n = 10; 90.9%) contexts of the CPPF. Findings highlight how occupational therapists could integrate cultural humility at each stage and in each context of their practice. Additionally, these insights can inform occupational therapy education on integrating cultural humility into training programs and guiding practitioners in applying cultural humility principles to enhance their practice. Plain-Language Summary: Cultural humility may improve the quality of occupational therapy services. How occupational therapy practitioners apply cultural humility has not been clearly described in the literature. This review describes literature on the practice of cultural humility. The findings were aligned with occupational therapy practice using the Canadian Practice Process Framework. The findings highlight how occupational therapists could integrate a cultural humility approach at each stage, in each practice process and context, and into training programs. The findings also provide a foundation for future research on how to apply cultural humility principles to improve occupational therapy services.

‘We make our world significant by the courage of our questions and by the depth of our answers’ . . . Carl Sagan (1973, p. 193). Over the past two decades, occupational therapy has grown and developed rapidly. Changes include expansion in practice focus and location, increased emphasis on occupation and occupational performance, and a greater importance of accountability and measurement of therapy outcomes. Worldwide, there is substantial agreement that client-centredness, use of evidence, and occupation-based practices embody the fundamental principles of reflective occupational therapy. There are, however, significant challenges to meet such expectations. As practitioners, students, educators, researchers, and managers, how can we address these challenges? I believe that such change is grounded as much in the way we approach practice as in what we actually do. I wish to share with you some thoughts about characteristics that our profession can apply as we move forward — the ideas of depth, innovation and courage. The depth of the occupational therapy discipline reflects our ability to appreciate and understand the complexity of daily living. In times of turmoil, cultural change, globalisation, societal ageing, and increasing disability, our comprehension of the nature of people doing occupations within varied environments is fundamentally important (McColl, 2002). For effective occupational therapy, it is necessary to guide education, practice and research by broad, conceptual models. Examples include currently developed and contemporary occupational therapy models (Dunn, Brown & McGuigan, 1994; Law et al., 1996; Canadian Association of Occupational Therapists, 1997; Gibson & Strong, 2003; Strong, 2003) as well as interdisciplinary models such as the International Classification of Functioning, Disability and Health (World Health Organization, 2001). While conceptual models are not enough, they provide the foundation for occupational therapists to understand the complex relationships between persons, occupation and environment. Such models form the basis for the development of a deep appreciation of the ways in which people find meaning in their lives through occupation. As occupational therapists develop ‘best’ practice, we would be wise to seek inventive methods of assessment and intervention strategies. We are leaders in client-centred practice and forming effective partnerships with clients, families, colleagues, service providers, agencies, and government. Expanding the range of interventions and populations with whom we work will enable occupational therapy to truly explore the relationship between occupation, health and well-being for individuals and populations. In doing so, occupational therapists can bring hope to those who suffer through lack of satisfactory occupations. We also have the potential to forge a new understanding of evidence-based practice. Our profession will move forward in this way if we recognise that evidence-based practice, in its most innovative way, represents a confluence between research evidence, practice wisdom, and client values and preferences. Australian occupational therapy is one of the leaders in the world in moving evidence into practice. Resources such as OT Seeker, and Critically Appraised Papers in the Australian Occupational Therapy Journal are models for other countries to follow. Courage is not typically considered in a discussion centred on the development of a profession. However, think about the definition of courage, as ‘the state or quality of mind or spirit that enables one to face danger, fear, or vicissitudes with self-possession, confidence, and resolution’ (American Heritage Dictionary, 2000). How better to describe an occupational therapy practice centred on the needs, values and wishes of those we serve? Facing the future in developing effective practice inevitably leads us to concentrate on how we can enable change in occupation and environments rather than simply change people. In this way, we define occupational therapy in ways that are not limiting, but which are potentially more effective. We must have the courage to measure the outcomes of what we do, and to stop carrying out interventions that we learn are not effective. Occupational Therapy, whether practised in Australia, in Canada, or elsewhere, will be known by what we do to make a difference in the world. Some years ago, a parent said to me during an interview: ‘You spend their young lives trying to get them ready for the world and when the time comes, the world isn't ready for them. So we have to find a way to do it.’ Depth, innovation, and courage — these values can help us in this journey. My thanks to Linsey Howie from La Trobe University for her helpful review of this editorial.

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a neuroimmune condition that significantly affects children's occupational performance across multiple domains. However, occupational performance is often overlooked in current PANS clinical frameworks, despite its critical role in daily functioning and well-being. To synthesize evidence on the occupational performance challenges experienced by children with PANS, the tools used to assess these challenges, and occupational therapy interventions used with these children. MEDLINE, CINAHL, Cochrane Library, PsycINFO, SCOPUS, ERIC, and EMBASE were searched from their inception through May 17, 2024. Peer-reviewed studies addressing PANS and occupational performance were included, with data categorized using the Occupational Therapy Practice Framework, 4th Edition. Of 3,431 records, 40 studies met inclusion criteria. Occupational performance challenges centered on communication, nutrition, education, rest/sleep, social participation, and toileting, with limited data on bathing, dressing, personal hygiene, and play and leisure. Assessments emphasized client factors, rarely using occupation-based tools. Only 2 studies mentioned occupational therapy interventions. PANS has a pervasive impact on children's occupational performance, highlighting the urgent need to prioritize it within clinical frameworks. Future research should focus on occupation-based intervention studies and assessments to enhance outcomes for children with PANS. Plain-Language Summary: Pediatric acute-onset neuropsychiatric syndrome (PANS) causes sudden, severe symptoms, such as obsessive-compulsive behaviors, eating difficulties, sensory and motor changes, and developmental regression, which significantly disrupt children's ability to perform daily activities. This study included 40 research articles addressing what is known about the impact of PANS on children's daily functioning and the role of occupational therapy in managing challenges. Results showed that most studies focused on communication, nutrition, education, sleep, social, and toileting challenges, but few addressed other daily tasks like bathing, dressing, personal hygiene, and play or leisure. Despite identified challenges, only two studies mentioned occupational therapy interventions, highlighting a major gap in the evidence. Assessments focused mainly on a child's skills and challenges, rather than looking at how the child participates in everyday activities. The findings highlight the need to better understand the challenges children with PANS face in their everyday activities and to provide practical strategies to help them succeed. Positionality Statement: Newby is a pediatric occupational therapist and researcher with both professional and personal experience of PANS. Her clinical work with children diagnosed with PANS, along with personal experience supporting a family member with this condition, has deepened her interest in the episodic fluctuations in occupational performance that occur during periods of exacerbation and remission. Haracz is an occupational therapist, academic, and researcher with a focus on mental health and the intersection between physical and psychological well-being. Lane is an occupational therapist, academic, and researcher who specializes in the neuroscience of developmental conditions and how sensory processing differences affect children's engagement in daily occupations. Tona is an occupational therapist and educational psychologist whose interest in neuroinflammatory disorders emerged following a family member's diagnosis with PANS. Her research explores the characteristics of PANS, treatment access, caregiver burden, and the role of occupational therapy in improving participation in both PANS and long-COVID populations.

Special Issue on Productive Aging: Evidence and Opportunities for Occupational Therapy Practitioners