Area Of Occupational Therapy Practice Research Articles

Challenges and Opportunities to Work and Industry Practice in Occupational Therapy: A Practitioner Survey.

Work and industry (W&I) is a vital yet underrepresented area of occupational therapy practice. Describing the current practice trends, challenges, and opportunities in W&I provides a foundation for future development and advancements. To describe the state of W&I occupational therapy practice and to identify challenges and opportunities in this specialty practice area. Cross-sectional survey conducted June 12 to July 17, 2020. Online survey distributed through direct email invitations and online platforms (i.e., CommunOT, LinkedIn). One hundred twenty occupational therapy practitioners who had worked in W&I within the most recent 5 yr. We used 30 multiple-choice, Likert-scale, and free-response questions across three topics: (1) training, resources, and research; (2) challenges and barriers; and (3) opportunities. Most respondents were occupational therapy practitioners working in clinical settings with >5 yr of experience; 29.2% identified as male. The most frequently provided services were ergonomic consultation and worksite evaluation; clinic-based W&I services were less frequently provided. Workplace injury prevention, management of psychosocial issues, and employee wellness programs were ranked as the top opportunities for occupational therapy in W&I. A shortage of accessible training and resources to support W&I practice was found, particularly mentoring and occupational therapy-focused research evidence. Maintaining referrals, competition from other professions, and limited support from professional organizations were key challenges. This study illustrates the evolution of W&I occupational therapy practice and highlights an urgent need for increased professional recognition and educational support to maintain occupational therapy's presence in this practice area. Plain-Language Summary: In this study, we describe the current practice trends in work and industry occupational therapy practice. We identify challenges related to resources and training in this practice area and provide insights into opportunities for future development. The study findings show the evolution of work and industry occupational therapy practice and highlight an urgent need for more professional recognition and educational support to maintain occupational therapy's presence in this practice area.

Percepção de barreiras para implementar intervenções baseadas em ocupação

Abstract Introduction Occupation-based intervention (OBI) is defined as an intervention using a clients’ occupation and purposeful activities as a treatment medium to achieve the client’s goals. Several barriers to practising OBI have been reported in previous studies. However, limited research has been done to identify these perceived barriers to applying OBI in Malaysia’s various occupational therapy practice areas. Objective This study aimed to identify perceived barriers to applying OBI in Malaysia’s three main occupational therapy practice areas including physical, psychiatry and paediatric. Method A cross-sectional study design was employed, and participants were recruited using a purposive sampling strategy. Data was collected using an online survey from a Delphi study. Results Two hundred ninety-eight Malaysian occupational therapists aged between 22 and 56 years old participated in this study. The study identified several perceived barriers from the client factors, the contextual factors, occupation as treatment modalities and logistical issues. A statistically significant difference was found in the perceived barriers of applying OBI between different areas of occupational therapy practice (p=.013), working experience (p=.003), and position of occupational therapists (p=.001). Conclusion This study suggests that perceived barriers to applying OBI were influenced by the area of practice, working experience and position of the occupational therapists. The results highlight the need to identify potential solutions to applying OBI through research and education.

The Issues of Applying Occupation-Based Intervention (OBI) Among Malaysian Occupational Therapists: A Mixed-Methods Study

Malaysian occupational therapists perceived occupation-based intervention (OBI) as the occupation as a means and an end. This study aimed to identify and explore perceived barriers to implementing OBI in Malaysia's diverse areas of occupational therapy practice context. A sequential explanatory mixed-method design with a cross-sectional survey and three focus group discussions (FGD) were performed sequentially. The results from the survey corresponded with the FGD findings, and new barriers emerged namely, occupational therapy personnels, bureaucratic system and economic challenge. These results may help in the discovery of solutions to enhance OBI implementation in Malaysia. Keywords: occupation-based intervention; barriers; area of occupational therapy practice; sequential explanatory mixed-method eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i17.2892

The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach.

Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice. A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors. Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants' views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%. The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

Assessing fitness to drive after stroke

Purpose The assessment of fitness to drive after stroke is an emerging area of occupational therapy practice in Ireland. Despite this, little is known about occupational therapists’ evaluation practices, and there are no internationally agreed clinical guidelines to inform best practice. The purpose of this paper is to investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland. Design/methodology/approach This is a cross-sectional study design targeting occupational therapists working with people after stroke using an online survey. Summary and descriptive statistics were used to analyse the returned surveys. Findings In total, 47 occupational therapists participated. Off-road driving assessment was completed by 68 per cent of respondents. Functional assessment and non-driving-specific assessments were most widely used and perceived to be the most useful in informing the off-road assessment. A total of 89 per cent referred clients for on-road assessments; however, some referred without first completing an off-road assessment. The therapists who completed formal post graduate education/training in driving assessment reported greater confidence and competence in their skills and ability to assess fitness to drive. A vast majority of participants agreed that clinical guidelines regarding best practice in this area would be beneficial. Research limitations/implications A majority of occupational therapists are assessing fitness to drive after stroke in Ireland with non-driving-specific assessments and functional observations; however, there are many gaps and wide variations between services. Education/training in evaluating fitness to drive after stroke is recommended. The development of clinical guidelines to inform practice would facilitate a consistent approach nationally. Originality/value This is the first study completed in Ireland to investigate occupational therapy evaluation practices for fitness to drive after stroke.

Primary Contact Occupational Therapy Hand Clinics: Thepull of an occupational perspective.

Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective. This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes. The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity. Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.

Student-led Special Interest Groups as a Model for Inclusion of Specialty Hand Content in OTD Curriculum

This article presents a student-led special interest group within a doctorate of occupational therapy (OTD) program as a model to supplement the core curriculum for inclusion of specialty content related to hand therapy. Consisting of advanced educational modules, research article review and discussion, as well as related service projects, the group provides ancillary benefits as well as networking opportunities for student participants. An initial program evaluation demonstrates efficacy as students reported a positive impact on various areas of professional and clinical skills to support specialization in hand therapy upon graduation. The student-driven nature of this experiential learning approach provides more robust content without taxing often limited financial and faculty resources of occupational therapy programs. This model may be generalizable to other areas of occupational therapy practice to provide specialty content for various student interest areas at the academic level, encouraging specialization for new graduates to continue to provide advanced care to diverse populations.

Apprehension and interest

Purpose Role-emerging placements have been used internationally within occupational therapy education but are relatively new to Ireland. At times, there has been a debate in the profession regarding the use of this placement model. This paper aims to generate views from both occupational therapists and occupational therapy students on the use of role-emerging placements in the Republic of Ireland. Design/methodology/approach Electronic surveys were administered to occupational therapy students and occupational therapists in Ireland. Quantitative data were analysed using the SPSS Statistics software package and the content of the open question responses were analysed into themes. Findings Occupational therapists (n = 60) and occupational therapy students (n = 45) indicated that there were inconsistent views surrounding role-emerging placements. It is deemed as an effective method for student learning, but apprehension exists around inclusion within occupational therapy programmes in the Republic of Ireland. Preference was indicated towards inclusion of role-emerging placements on a part-time basis within formal occupational therapy education. Originality/value Both respondent groups viewed that role-emerging placements can positively influence new areas of occupational therapy practice and concern over the use of the placement model requires further exploration and debate. This study is from an Irish context, although there are similarities with other countries’ use of the placement model. There is a need for research through an in-depth exploration of the learning experience of undertaking role-emerging placements from the students’ perspective and identification of supports required to promote an optimal learning experience.

The Challenge of Cultural Competency in the Multicultural 21st Century: A Conceptual Model to Guide Occupational Therapy Practice

Background: Occupational therapists increasingly encounter clients from diverse cultural backgrounds and need to meet their professional obligation of delivering culturally competent practice. Yet the process of cultural competency is poorly understood in occupational therapy practice. There is a need for a clear understanding of the meaning and process of cultural competency as it is enacted in practice with a wide range of individuals from culturally diverse backgrounds.Aim: To investigate the process, stages, characteristics, and requirements of cultural competency as practiced by experienced occupational therapists.Method: Semi-structured interviews were carried out with 13 community occupational therapists experienced in delivering occupational therapy services in clients’ homes in a culturally diverse area in London, England.Findings: Interview data were analyzed and ordered into the format of a conceptual process model where cultural competency formed the core concept. The model of cultural competency that emerged from this study comprised six stages: cultural awareness, cultural preparedness, a cultural picture of the person, cultural responsiveness, cultural readiness, and cultural competence.Conclusion: Cultural competency is a complex process that needs to be based on underpinning occupational theory and actualized at the level of practice. Further research is needed to test out the model and illuminate the process of cultural competency in different areas of occupational therapy practice. (Less)

Sharpening our critical edge: Occupational therapy in the context of marginalized populations.

An emerging and important area of occupational therapy practice involves engaging with various individuals and population groups who live in marginalizing conditions that result in health inequities. This paper calls for more critical and intersectional analyses of occupational therapy in the context of marginalized populations. Intersectionality has the potential to reveal important and complex interactions among social systems that create and sustain marginalization and to inform more nuanced, contextualized, and socially responsive forms of occupational therapy. Central to this process is the co-construction of knowledge with people who experience marginalization. Engaging in this work requires occupational therapists to undertake ongoing critical reflexivity to attend to our sociohistorical positioning of power and privilege in relation to marginalized populations. Complicating our discourse on marginalized populations is imperative to enacting our critical potential in working toward social justice and health equity.

A cognitive therapy conceptual framework for clinical supervision

Clinical supervision has been recognised as an effective strategy to facilitate and support practitioners to develop expertise, knowledge and clinical reasoning skills, with the selection of an appropriate framework deemed crucial to professional practice. However, there is an acknowledged paucity of evidence in relation to the efficacy of individual conceptual frameworks. The efficacy, suitability and applicability of a cognitive therapy clinical supervision framework for associated health professionals is considered, along with the implementation of this specific conceptual framework to an area of occupational therapy practice. Findings confirmed adopting such a highly structured and clinically focused framework was of benefit to supervisees, supervisors and healthcare delivery within a specific clinical setting.

Aging, occupation and mental health: the contribution of the Research Centre for Occupation and Mental Health

The Research Centre for Occupation and Mental Health (RCOMH) was set up to develop world class research in occupation and mental health to influence best practice. This paper focuses on RCOMH as an international centre by exploring the drivers and rationale for RCOMH, summarising RCOMH’s activity, explaining how RCOMH is developing research programmes and elucidating how it is a vehicle for achieving WFOT’s goal of increasing research within occupational therapy internationally. The “Occupation and older people’s mental health” research programme is used as an exemplar to illustrate how RCOMH is developing research programmes, share how research into aging, occupation and mental health is being progressed, and a current study is outlined. It is anticipated that this paper will encourage those working in mental health across the world to get involved in RCOMH’s endeavours or stimulate others to develop international collaborative research centres related to other areas of occupational therapy practice.

Assessing Occupation: The Importance of Using Valid Tests and Measures

The primary focus of occupational therapy is promoting the health and wellbeing of individuals who present with occupational performance dysfunction, activity limitations or participation restrictions (College of Occupational Therapists 2004). When therapists initially see a client, they take an occupational history and usually complete some type of assessment. The assessment component of service delivery can include informal clinical observations and formal standardised tests. Coster (2008, p743) stated: ‘In many areas of occupational therapy practice, quantitative measures are required to document need for services and, increasingly, quantitative measures are required to document the value of these services in terms of the outcomes achieved.’ Therapists must be confident that the tests and measures that they use to evaluate clients are assessing what they purport they do in a rigorous and robust manner. In other words, the tests and measures must exhibit a high degree of construct validity. Assessment tools have been classified as bottom-up and top-down (Weinstock-Zlotnick and Hinojosa 2004). Bottom-up assessments are the traditional instruments that look at isolated, decontextualised components of occupational performance (such as whether a child can shift pegs in a board or place coins inside a small container), whereas top-down assessments look at individuals in their day-to-day real life contexts (such as whether a child is able to access the neighbourhood playground if he or she is confined to a wheelchair). Top-down assessments often take into consideration the person, the environment and the occupation. How do we ensure the construct validity of both bottom-up and top-down assessments?

Embracing Ambiguity: Facing the Challenge of Measurement

Assigning numbers to variations in the behaviors, experiences, or beliefs of individuals and groups is a firmly established tradition in Western culture. In many areas of occupational therapy practice, quantitative measures are required to document need for services and, increasingly, quantitative measures are required to document the value of these services in terms of the outcomes achieved. In order to meet these expectations, occupational therapy frequently has adopted both methods and instruments from other disciplines including psychology, medicine, and education. However, the assumptions and modes of thinking about people that accompany these methods are not always compatible with the values and practice.of occupational therapy. This paper explores tensions inherent in the assessment process in a profession that is holistic and humanistic in its orientation. I propose that in order for assessment to serve our goal of supporting health and participation through engagement in occupation we must accept the uncertainty and be vigilant about the biases in thinking that are inherent in our measures.

Forensic Psychiatry and Vocational Rehabilitation: Where are We at?

Having a productive occupation is seen as fundamental to an individual's health and wellbeing. Employment provides structure, self-identity, a means to provide for oneself and social inclusion. The Government has made a commitment to invest in supporting people back into the workplace following illness. This opinion piece reflects the authors' interest in how this applies to service users with a forensic history, who face additional barriers to employment. It calls on occupational therapists to share research and practice accounts of vocational rehabilitation within forensic settings in order to contribute to the evidence base for this area of occupational therapy practice.

Driving and Community Mobility

Attention to driving and community mobility is a growing area of concern due to the implications across the life span, association to occupational engagement, and relevance to other organizational entities (see Appendix B). The skills, knowledge base, and scope of practice of occupational therapy enhanced by additional training in driver rehabilitation place the profession of occupational therapy in the forefront of driving and community mobility services. The focus on injury prevention, engagement in occupation, and the intervention strategies used in driver rehabilitation and community mobility services are consistent with the Philosophical Base of Occupational Therapy (AOTA, 1995) and, therefore, warrant attention in all areas of occupational therapy practice.

Survey of Occupational Therapy Practice in Hong Kong in 2004

Background In order to meet the future challenges of the new healthcare-services system in Hong Kong, there is a rising need to understand the scope of occupational therapy (OT) practice within the local context. Therefore, a cross-sectional survey of 518 occupational therapists (OTs) in Hong Kong was conducted in 2004. Objective To describe the profile and scope of OT practice in Hong Kong. Methods A standardised questionnaire was sent to all OTs registered under the Occupational Therapists Board, as defined by the Special Supplement No.4 to Gazette No. 42/2003, published by the Government of the Hong Kong Special Administrative Region. The OTs were requested to submit the completed questionnaires to the research team. Descriptive data were then collected for analysis. Results Of the 1,018 questionnaires that were sent out, 518 OTs responded (50.9%). Results indicated that 412 (81.6%) OTs had more than 5 years of clinical experience, 246 (47.5%) OTs had a Master's degree, and 178 (34.4%) reported that stroke was the most common type of treated condition. Other areas of OT practice were also described. Conclusions This survey provided the most recent and clear profile and scope of OT practice in Hong Kong. Four areas of OT practice which require extra attention were identified, and four strategic plans to ensure a sustainable development of OT in future are proposed.

The influence of fieldwork on the preferred future practice areas of final year occupational therapy students

The student fieldwork experience has been recognised as an important influence on the areas of occupational therapy practice pursued by clinicians after graduation. The recruitment patterns of graduate occupational therapists is a key issue, especially in clinical areas such as rural practice and mental health. This study aimed to investigate the future practice preferences of 50 final year occupational therapy students from two occupational therapy schools in New South Wales, in relationship to their fieldwork experience, using a focus group and a survey. General physical dysfunction was the most popular area of future practice for this group. Results suggested that fieldwork influenced students through the programme content, the timing of placements, supervision, and students’ personal responses to their experiences. The study also demonstrated that students use the fieldwork experience to guide their decision to enter an area of practice.

Factors affecting the establishment of occupational therapy services in retail pharmacy: The pharmacist’s perspective

The establishment of occupational therapy services in retail pharmacy is a relatively new development in New South Wales (NSW). Hence there is a lack of literature addressing this innovative area of occupational therapy practice. The aims of this study were to determine if retail pharmacists identify a role for occupational therapy services in retail pharmacy, to ascertain what occupational therapy services retail pharmacists identify as being appropriate for establishment in retail pharmacy, and to find out what factors retail pharmacists identify as affecting the establishment of those services. A questionnaire was developed and mailed to 207 retail pharmacists in NSW. The response rate was 32% (n = 67). The findings indicated that 59% of respondents identified a role for occupational therapy services, the most common role being the provision of home health‐care services. Factors that support or limit the establishment of occupational therapy services in retail pharmacy were also identified. The importance of the results for occupational therapy practice are discussed, and future research directions are proposed.

Inappropriate client sexual behaviour in occupational therapy

AbstractThe purpose of this study is to identify the prevalence and nature of inappropriate client sexual behaviour (ICSB) in occupational therapy practice in New South Wales, Australia. The effects of ICSB on therapists, and the perception of it as sexual harassment, as well as responses to ICSB were also explored. A self‐administered questionnaire was mailed to a random stratified sample of occupational therapists. Results indicate that ICSB, although often not perceived as sexual harassment, does occur in occupational therapy practice. About half of the therapists exposed to ICSB reported negative consequences, primarily negative effects on work performance and psychological stress. Commonly, therapists responded to an incident of ICSB by discussing it with the client, although many chose to ignore it. Most respondents attribute the behaviour to pathological disease‐oriented factors. This area of occupational therapy practice requires further research, particularly in terms of factors that influence the prevalence and perception of the behaviour. Copyright © 1999 Whurr Publishers Ltd.