State of the Journal: Advancing and Promoting Frames of Reference for Occupational Therapy Practice

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

Background: The provision of assistive devices (ADs) to enable function is a well-established component of occupational therapy (OT) practice. However, multiple client and therapist factors prevent the utilization of ADs in practice. Objectives: This study aimed to explore the utilization of ADs in OT practice in Tamil Nadu (TN). Study Design: The survey research design was used to conduct this study. A ten-item electronic survey was developed based on the research question. Methods: The survey was E-mailed to 295 occupational therapists in TN identified through convenience sampling. The survey link was also shared on four WhatsApp Messenger groups (Tamil Nadu Branch of All India Occupational Therapists' Association Official Group, OTist Group, Clinic OT, and Santosh Alumni) with many occupational therapists belonging to TN (snowball sampling). Data were collected between August 29, 2019, and September 20, 2019. Results: Thirty-five occupational therapists responded to the survey. Writing and eating utensils were the commonly prescribed ADs in TN OT practice. Client factors, cultural factors, lack of availability, cost, and therapists' skill may contribute to the limited usage of ADs in Indian OT practice. Innovating low-cost culturally acceptable ADs, educating stakeholders, and training practitioners on how to prescribe/utilize ADs in practice may mitigate the barriers related to ADs use. Conclusion: The usage of ADs in TN OT practice is limited. Multiple factors affect the utilization of ADs in the Indian context of practice. A multipronged approach focusing on innovative device development, advocacy, and skill development is needed to promote the utilization of ADs in Indian OT practice.

Recently, home health services have been a topic of increasing interest. Occupational therapy practice and utilization patterns in home care have not been the subject of recent research. I examined 65 publications addressing current occupational therapy practice in U.S. home health. Articles were analyzed to uncover factors influencing occupational therapy utilization and practice. Results indicate that research has looked at a variety of typologies and efficacy measures for occupational therapy in home care. However, occupational therapy utilization and practice patterns in home health do not appear to be entirely consistent with research. I identify factors explaining this inconsistency and make research and practice recommendations. Results suggest that system challenges limit the utilization and practice of occupational therapy to deliver expected outcomes in home health practice.

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)

* Occupational Therapy in the Community: What, Why, and How * Community Practice: It's More than Geography * Educating for Community-Based Occupational Therapy Practice: A Demonstration Project * Helping Occupational Therapy Students and Faculty Develop Cultural Competence * Professional Expertise of Community-Based Occupational Therapists * The Pizzi Holistic Wellness Assessment * Gateway to Wellness: An Occupational Therapy Collaboration with the National Multiple Sclerosis Society * Facilitating Successful International Adoptions: An Occupational Therapy Community Practice Innovation * Using Chaos Theory to Understand a Community-Built Occupational Therapy Practice * Development of a Community-Based Return to Work Program for People with AIDS * Development of Occupational Therapy in a Homeless Shelter * Quality of Life Issues in Community Occupational Therapy Practice * Index * Reference Notes Included

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)

Background: Client-centred practice aims to involve the person in making decisions during the therapeutic intervention process, giving him or her a central and active role. Objectives: To analyze the effects of client-centred practice in occupational therapy on issues related to occupational performance and participation among people with stroke and traumatic brain injury. Material and methods: A systematic review of randomized clinical trials examining the effects of a client-centred practice carried out by occupational therapists in patients with stroke or traumatic brain injury aged over 18 years was conducted. PubMed, Web of Science, Scopus, OT Seeker, PsycINFO and EBSCO were used to retrieve potentially eligible publications. Results: Eight studies, from 294 identified, were included. The extracted data showed that the application of client-centred practice in occupational therapy improved satisfaction with occupational performance compared to conventional interventions. However, client-centred practice and conventional intervention had similar effects on functionality (Activities of Daily Living), life satisfaction and burden on caregivers. Conclusions and significance: Client-centred practice has the effect of achieving greater satisfaction with occupational performance. This suggests that client-centred practice in occupational therapy helps patients to accept the new limitations on their occupational performance. Further studies are needed to determine the effects of client-centred practice on other aspects.

Occupational therapy is a client-centred profession seeking to enable people to attain/maintain good health and well-being through their participation in daily life activities. Recent developments in the profession have heightened the need for the inclusion of ethics from an African perspective and also the importance of the involvement of all stakeholders namely, occupational therapy students, educators, clinicians, regulatory bodies and the population being served. The first section focusses on the current gaps and challenges in ethics within the practice of occupational therapy in Africa. A synthesis of African literature is provided on how ethical issues are addressed in occupational therapy education and practices. Contextualised examples of ethical issues encountered by students, educators and therapists are presented. The second section of this chapter discusses the socialised model which promotes the principle of respect for patient autonomy and protection of patients’ rights and the mutual relationship model which promotes the cultural belief, bio-psychosocial and patient-centred approaches. Furthermore, the integration of the ethical principles, legal expectations, policies and Acts that govern the occupational therapy profession are highlighted. Furthermore, the unique ethical dilemmas faced by occupational therapists practising in Africa are emphasised. In the third section, the relevance of ethics in material principles of distributive justice in occupational therapy practice in Africa is presented, specifically given the resource-poor nature of many African countries. The concept of occupational justice is evolving and gaining recognition among occupational therapists and occupational scientists in Africa and its implications in ethics are further explored in this section. In the last section, recommendations are provided for maintaining ethical standards in line with the ambit and ethos of the profession. In the conclusion, areas that require further research in ethical practice of occupational therapy with individuals, groups and communities in the African context are elucidated.

Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary. To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy. PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science. We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis. Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups). We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.

To understand the current status of knowledge, attitude and practice (KAP) of occupational therapy (OT) among healthcare professionals in intensive care unit (ICU) and analyze the influencing factors, to provide reference for nursing managers in developing targeted measures to promote the adoption of OT. From January to March 2025, we conducted a cross-sectional survey using convenience sampling among 511 ICU healthcare professionals across 13 cities in Jiangsu Province. Participants completed anonymous online questionnaires, including a general information form and a validated, self-developed Knowledge, Attitudes, and Practices (KAP) questionnaire to OT for ICU healthcare professionals. The KAP instrument comprised three dimensions: knowledge (12 items), attitude (16 items), and practice (14 items). We performed univariate analysis and multivariable logistic regression using SPSS 25.0 to identify associated factors. A total of 464 valid questionnaires was received (90.8% response rate). The overall KAP performance showed an average score of 156.58 ± 31.16. Attitudes achieved the highest average score (67.54 ± 10.99), while knowledge showed the lowest (37.88 ± 13.56). Knowledge correlated positively with attitude and practice. Multivariate logistic regression identified age, professional title, ICU experience, hospital level, and OT-related knowledge training as factors influencing ICU healthcare professionals ' KAP levels. This KAP survey provides a diagnostic foundation for OT implementation, it indicates that educational training is a necessary, high-impact strategy. However, the negative association with seniority and hospital level indicates that a simple educational strategy may be insufficient; tailored strategies addressing organizational culture, workload, and professional role expectations in those specific contexts will be required. Not applicable (This study did not require registration in a clinical trials registry because it is an observational cross-sectional study).

The focus of occupational therapy is often on personal care, life skills, and daily living. Sport, as a type of leisure activity, can also provide benefits to health and well-being. Occupational therapy practitioners should therefore promote the role of sport in the lives of clients. To investigate the extent, range, and nature of peer-reviewed occupational therapy literature investigating sport as a leisure occupation. The following databases were searched: Embase, MEDLINE, OTseeker, PsycINFO, PubMed, and SPORTDiscus. We identified published studies investigating competitive sport in occupational therapy research or practice. Included studies investigated adult participants (age ≥18 yr) participating in sport, had a clear occupational therapy input, and were written in the English language. Six studies met the inclusion criteria. Only 2 of the 6 studies identified through the search strategy were conducted after 2004, diagnosis and outcome measures varied widely, and sport as a leisure occupation was found to have positive individual outcomes. Opportunities exist to investigate sport as a leisure occupation and its involvement in occupational therapy practice. Future research may contribute to positive outcomes and experiences for clients who receive occupational therapy. This scoping review describes literature about sport as an occupation and highlights the opportunities for practitioners and researchers to incorporate sport as a leisure occupation.

The lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other dissident gender and sexuality (LGBTQIA+) population is prone to experiencing violence and social deprivation. Although occupational therapy research and practice has addressed populations experiencing various forms of discrimination, few studies have focused on the LGBTQIA+ population as an area of concern. To map, characterize, and analyze peer-reviewed journal articles related to the LGBTQIA+ population in the occupational therapy literature. We searched for journal articles published up to December 2021 indexed in the Virtual Health Library, CINAHL, SciELO Citation Index, SCOPUS, and Web of Science. We used Arksey and O'Malley's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension for scoping reviews. Included articles articulated occupational therapy practice, education, research, and theoretical analysis in relation to LGBTQIA+. Forty-three articles published from 1987 to 2021 met the inclusion criteria. They included 28 research articles, 9 reflection articles, 3 experience reports, and 3 literature reviews. Articles primarily offered general recommendations and possible professional contributions. More studies that seek to ascertain the effectiveness and limitations of occupational therapy practice with the LGBTQIA+ population are needed. With its diverse theoretical and methodological assumptions, occupational therapy can offer support so that professionals can alleviate these people's suffering in oppressive conditions and contribute to a more just society. What This Article Adds: This scoping review provides an overview of academic publications in occupational therapy on the LGBTQIA+ population, identifies dominant topics and gaps in this context, and points to ways to advance occupational therapy's contributions and actions that consider the needs and demands of people of dissident genders and sexualities.

Introduction: Independence is a core concept in occupational therapy, but there is little consensus within the profession upon a universal definition. The present study employed a critical interpretive synthesis to examine two fundamental research questions: ‘How is independence conceptualised in quantitative and qualitative research within occupational therapy?’ and ‘How does the term “independence”, in its present use, critically impact occupational therapy policy and practice?’ Method: Articles pertaining to occupational therapy and contributing to the definition of independence within the profession were examined. Three successive levels of coding — open, axial and selective — were used to analyse 19 final articles. Findings: From the literature, nine definition themes emerged: function, autonomy and competence, control, context, culture, environment, personal attributes and safety. These themes were then organised into three categories: personal factors, environmental factors and continuum, which were synthesised together to create a model that addresses all factors critical to the composition of independence. In addition, four clinical themes developed: goal of occupational therapy, client-therapist relationship, variable definitions in occupational therapy practice and limitations of present practice. Conclusion: Through the formalisation of the integral components of independence, this study enables a standardised foundation for the examination of this core concept across the profession.

A frame of reference is the mechanism for linking theory to practice. It may be the most practical and important tool a professional uses. As the practice of occupational therapy has evolved, so has the basis of information, or theories, on which it is grounded. From the theories, models have been developed that typically view occupational performance as a transaction between the person, occupation and environment. Occupational therapy practitioners use many frames of reference. Not all of them address all areas of occupational performance identified within this overarching model. Often the area of the environment does not receive attention. To do their jobs thoroughly, occupational therapy practitioners need frames of reference for thinking about the environment. The purpose of this paper is to identify and explore frames of reference that may be useful to occupational therapy practitioners when they are taking into consideration the physical environment. Included are the following frames of reference: ergonomics, industrial hygiene, environmental psychology, accessibility and feng shui. A case study is presented to illustrate the unique perspective of each frame of reference.

Background: Occupational therapy (OT) practice in India is yet to be regulated at the national level. This presents a significant challenge to the OT community in India as it would be difficult for them to defend themselves if other professionals violate the scope of practice (SOP) boundaries. Objectives: The aim is to explore the views of occupational therapists (OTs) related to the issue of SOP boundary violation in OT practice in India. Study Design: An online survey research design was chosen to conduct this study. A 10-item electronic survey (9 with response options and one open ended) was developed based on the research question. Methods: An online survey link generated through SurveyMonkey was E-mailed to 760 OTs in India, identified through convenient sampling. The survey link was also shared on four WhatsApp Messenger groups (TNAIOTA Official Group, OTist Group, Clinic OT, and IPOTPDG1) with many Indian OTs (snowball sampling). Data were collected from January 29, to February 29, 2020. Results: The number of responses received was 126. One hundred and nine (87%) respondents believed that other professionals encroach OT's SOP boundaries knowingly or unknowingly. This belief is strong among all OTs across the nation, regardless of gender and practice experience. Conclusions: Many OTs in India believe that individuals belonging to other professions step into the domain of OT knowingly or unknowingly. Enacting an OT practice legislation, establishing a regulatory body at the national level and increasing them at state levels, endorsing an official SOP document, educating stakeholders, and engaging in awareness promotion initiatives would help mitigate the issue to a great extent. Ongoing and strategic efforts by the OT community in India are warranted.