Decision-making In Occupation Choice Research Articles

Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial.

Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.

Changes in Satisfaction with Meaningful Activities and Onset of Depressive Symptoms among Community-Dwelling Japanese Older Adults: A Population-Based Study Before and During the COVID-19 Pandemic.

This study aimed to clarify the association between changes in satisfaction with meaningful activities and the occurrence of depressive symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic. A population-based prospective cohort study (Tarumizu Study). A total of 231 community-dwelling older adults aged ≥65years without depressive symptoms at baseline. The participants completed baseline (June to December 2018, before the COVID-19 pandemic) and follow-up (September to December 2021, during the COVID-19 pandemic) assessments. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, and their satisfaction levels were evaluated. Satisfaction with the most meaningful activities was assessed as to whether it was maintained/improved or decreased at follow-up. In the follow-up survey, 31 (14.3%) participants reported the occurrence of depressive symptoms. Compared with before the COVID-19 pandemic, the rates of meaningful activities during the COVID-19 pandemic decreased for interpersonal interaction and social life and increased for leisure, sports, self-care, and domestic life. Logistic regression analysis revealed that changes in satisfaction with meaningful activity were associated with the occurrence of depressive symptoms after adjusting for demographic variables, baseline GDS scores, cognitive and physical status, and instrumental activities of daily living (odds ratio, 2.78; 95% confidence interval, 1.17-6.59, P= .020). To avoid decreasing satisfaction with meaningful activities, supporting older adults may be protective against the occurrence of depressive symptoms. Our findings highlight the need for health care professionals to not only encourage older adults to participate in activities for their mental health but also consider whether the activities are meaningful or satisfying for them.

Effect of Upper Limb Function Training Combined with Goal Setting Using the Aid for Decision-Making in Occupation Choice for Hand Application in Patients with Acute Stroke

Background and Purpose: We introduced an intervention that aimed to improve upper limb use in daily life using Aid for Decision-making in Occupation Choice for Hand (ADOC-H), a monitoring and problem-solving technique, in addition to conventional occupational therapy for hospitalized patients with acute stroke. This pilot study examined the effectiveness of this intervention to improve paralyzed upper limb use in daily life and their motor function.

Aid for Decision Making in Occupation Choice (ADOC) as a Tool to Address Activities and Participation: A Scoping Review

Aid for Decision-Making in Occupation Choice (ADOC) was developed to encourage shared decision-making and collaborative goal-setting in daily living activities. This scoping review aimed to review and synthesize research literature regarding ADOC and to identify any existing knowledge gap related to ADOC. The PRISMA-Scoping review was used as a guide. A literature search was retrieved from January 2011 until December 2021 based on four databases; Scopus, Google Scholar, PubMed and CINAHL. A total of nine articles (N=9) were included in this review. The findings were arranged in five themes; i) clinical purpose, ii) validity and reliability, iii) target population, iv) utility of ADOC and v) domains and items of ADOC. ADOC provides a client-centred and collaborative approach, highlighting meaningful occupations in daily living and the use of technology in rehabilitation. This review suggests the need for cross-cultural translation and validation of ADOC into the native language before it can be used.

Association between satisfaction with meaningful activities and social frailty in community-dwelling Japanese older adults

ObjectivesThis cross-sectional study investigates the associations among satisfaction with meaningful activities, and social frailty in community-dwelling Japanese older adults. MethodsWe analyzed data from 596 older adults (mean age 74.2 ± 6.4 years, female 63.6%) who participated in the Tarumizu Study 2019, a community-based health survey. Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice (ADOC) tool. Satisfaction was evaluated from 1 to 5, and those who were assigned a rating of 4 or 5 were operationally classified as the high satisfaction group (n = 487), with others occupying the low satisfaction group (n = 109). Both groups were evaluated based on the ADOC, social frailty (Makizako's five items), physical function, depressive symptoms, cognitive function, and higher-level competence. ResultsOf the 596 participants, 18.7% showed prevalence of social frailty. The low satisfaction group had a significantly higher prevalence of social frailty (low satisfaction 28.4% vs. high satisfaction 16.4%, P = 0.004) and depressive symptoms (low satisfaction 30.3% vs. high satisfaction 17.9%, P<0.01), and poor higher-level competence (P = 0.026) than the high satisfaction group. Logistic regression analysis showed that social frailty (Odds Ratio 1.78, 95% Confidence Interval 1.068–2.990, P = 0.027) was significantly associated with satisfaction with meaningful activity after adjusting for covariates. We found no significant differences in categories of meaningful activities between the low and high satisfaction groups (P = 0.549). ConclusionsThis study suggested that social frailty was associated with satisfaction with meaningful activities, regardless of the degree or category of satisfaction.

Characteristics of meaningful activities in community-dwelling Japanese older adults with pre-frailty and frailty

ObjectivesThis cross-sectional study aimed to clarify the association between physical and social frailty, cognitive impairment, and meaningful activity in older adults. MethodsData were obtained from 747 older adults (mean age, 74.7 ± 6.2 years; women, 63.9%) who participated in a community-based health check survey (Tarumizu Study 2018). Physical frailty, cognitive impairment, and social frailty were evaluated using the Fried phenotype model (exhibiting one or more of the criteria, including having a pre-frailty status); computerized cognitive test including memory, attention, executive functions, and processing speed (having a score below an age-education adjusted reference threshold in one or more domains); and Makizako's 5 items (exhibiting one or more of the criteria, including having a pre-frailty status), respectively. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, after which their satisfaction and performance were evaluated. Meaningful activities were categorized into physical activity, cognitive activity, social activity, and other daily activity. ResultsThe physical frailty group was significantly less likely to choose physical activity over other activities (p < 0.05). The cognitive impairment group was significantly less likely to choose cognitive activity over other activities (p < 0.01). The multi-domain frailty group (including cognitive impairment) was significantly less likely to choose social activity over other activities (p < 0.05). No significant differences in satisfaction and performance were observed according to frailty status. ConclusionsOur findings indicated that physical and social frailty and cognitive impairment may affect participation in meaningful activities corresponding to these domains.

Effects of collaborative consultation using iPad application in school-based occupational therapy: A single-arm pre-post pilot study.

This pilot study examined the effect of collaborative consultation with teachers in school-based occupational therapy (SBOT) using iPad application for goal-setting-Aid for Decision-Making in Occupation Choice for School (ADOC-S). A single arm pre-post intervention design was conducted at four preschools in Japan. The participants were 10 preschool teachers (10.5±0.4years of teaching), and 10 children (3.8±0.4years old; five boys). The teachers received three collaborative consultations (1hr for each) from one occupational therapist. Firstly, the occupational therapist conducted an observational assessment of the child's school life, then the teacher and occupational therapist identified occupation-based goals for each child using the ADOC-S. Secondly, the teacher and the occupational therapist developed the graded goals using the Goal Attainment Scale (GAS) and discussed the daily intervention plan for the teachers to conduct. Thirdly, the occupational therapist followed up on the intervention process using GAS. The subjective outcome was measured at 10 point-satisfaction and performance score in each goal using Canadian Occupational Performance Measure (COPM). The observed outcome was measured using GAS and Strengths and Difficulties Questionnaire (SDQ). All the participants including teachers and children successfully underwent the intervention process. Significant improvement was found pre-post and effect size (ES) was large on the COPM (ES; r=.85-.94), GAS (ES; r=.98-.99) and SDQ (ES; r=.64). All goals (30/30) exceeded expectations of GAS from zero to +2. Although there are some limitations and considerations which need to be resolved for future studies, our results suggest that ADOC-S would help build a rapport with a teacher in SBOT settings, and this collaborative consultation would facilitate a positive outcome.

Self-Selection of Interesting Occupation Facilitates Cognitive Response to the Task: An Event-Related Potential Study.

Introduction: In this study, we examined whether the self-selection of occupations of interest affects reaction times (RTs) and cognitive processing by using the Aid for Decision-making in Occupation Choice (ADOC) and event-related potentials (ERP). We also assessed the relationship of these with psychological indicators.Method: We extracted 78 occupations from the ADOC in consideration of the subjects’ age, and three conditions were set: (1) self-selection of an interesting occupation; (2) self-selection of a disliked occupation; and (3) forced selection. The RT task was executed under their conditions during which ERP was measured. We compared the P300 component of ERP in these conditions. Moreover, we examined the association of cognitive processing and degree of satisfaction and performance concerning occupation, with psychological indicators.Results: P300 amplitude at Fz significantly increased in the self-selection of an interesting occupation. P300 amplitude at Pz was significantly positively correlated with the occupational satisfaction score.Conclusion: Self-selection of interesting occupations in the ADOC resulted in increased attention resource allocation by increasing motivation. Further, there was a positive correlation between satisfaction concerning the occupation and attention of resource allocation. Therefore, occupational therapists should know which occupations the patients consider interesting and help them to select by themselves, thus enhancing their satisfaction after consultation. These interventions may contribute to promoting motivation and cognitive processing.

The clinical utility of a decision-aid to facilitate the use of the hand in real-life activities of patients with distal radius fractures: A case study

BackgroundOccupation-based intervention (OBI) in hand therapy has shown superior benefits in patient-reported performance and physical measures; however, only a few studies have used OBI. We developed a decision-aid to promote the use of an injured hand in the real world (Aid for Decision-making in Occupation Choice for hand; ADOC-H) PurposeTo investigate the clinical utility of the ADOC-H (paper version) in patients with distal radius fractures. Study DesignA prospective case series and a clinical survey for occupational therapists. MethodsThis study comprised a prospective patient case series of 8 patients with distal radius fractures, treated using Volar locking plates, and a clinical survey of 4 experienced occupational therapists. ResultsNo patient or therapist complaints or drop-outs were reported. Active range of motion (wrist), Grip strength, and Disabilities of the Arm, Shoulder, and Hand scores improved for all patients. The ADOC-H induced 158 activities using the injured hand, with activities of daily living (69.8%) selected earlier in the treatment period, and instrumental activities of daily living (63.3%) selected later. The feedback and case studies suggested that the ADOC-H was useful for patients who were afraid of using the hand and, interestingly, patients who were able to use their hand without pain or other problems. The clinical survey showed that most therapists found the ADOC-H effective in facilitating real-life use of an injured hand. ConclusionsThe ADOC-H paper version is an useful tool that can be applied to facilitate patients with distal radius fractures to use their injured hands in real-life settings.

Associations between Depressive Symptoms and Satisfaction with Meaningful Activities in Community-Dwelling Japanese Older Adults.

The aim of this cross-sectional study was to investigate relationships between individuals’ ratings of satisfaction and performance of activities that they found meaningful and depressive symptoms. Data was obtained from 806 older adults (mean age 74.9 ± 6.3 years, women = 63.0%) who participated in a community-based health check survey (Tarumizu Study 2018). Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Non-linear logistic regression analyses were used separately by gender to examine the association between satisfaction and performance of meaningful activities and depressive symptoms. The prevalence of depressive symptoms was 15.8%. We found no significant difference between meaningful activity choice between older adults with depressive symptoms and those without, in both men and women. After adjusting for potential covariates, satisfaction was associated with depressive symptoms in both men (OR 0.52, 95% CI 0.35–0.77) and women (OR 0.67, 95% CI 0.49–0.91), but performance was limited in women (OR 0.87, 95% CI 0.77–0.99). Our findings suggest that depressive symptoms are associated with satisfaction in meaningful activities regardless of activity categories.

Development of a Tablet Application for Collaborative Goal-setting in School-based Occupational Therapy: The Aid for Decision-Making in Occupation Choice for Schools (ADOC-S)

ABSTRACTIntroduction: This study aimed to develop a new tablet application named the Aid for Decision-making in Occupation Choice for School (ADOC-S). It aims to assist with conducting collaborative occupation-based goal-setting by sharing decision-making with a team member (child, parent, teacher, and occupational therapist) using a consultation model of school-based occupational therapy (SBOT). Method: This developmental study involved two phases: (1) using a focus group technique to develop the concept and prototype of the ADOC-S, and (2) using a Delphi-style method to reach a consensus among eight experienced occupational therapists regarding the ADOC-S items, text, and images. Then, we reported its use in SBOT practice with a single case example of a school-aged child in Japan. Results: First, the concept and the prototype application of ADOC-S was created. Then, after two Delphi rounds, the eight occupational therapists reached a consensus that 68 items in four categories were included in the ADOC-S: Self-care (17 items); Communication (9 items); School life (22 items); and Play (20 items). The case study illustrated how to use the ADOC-S and its efficacy for collaborative goal-setting in SBOT. Conclusion: The ADOC-S appears to promote collaborative goal-setting in SBOT. This application now needs to be clinically tested.

Effect of occupation-based interventions in patients with haematopoietic malignancies undergoing chemotherapy: A pilot randomised controlled trial.

Background/objectiveChemotherapy for cancer negatively affects activities of daily living and quality of life. This study aimed to validate and compare the efficacy of two different interventions in patients with haematopoietic malignancies undergoing chemotherapy: (1) occupation-based interventions, designed using the Aid for Decision-making in Occupation Choice (ADOC) (an iPAD application) and (2) impairment-based interventions. ADOC helps promote decision-making during activities and participation in occupation-based goal setting. The impairment-based intervention group served as the comparison group and underwent impairment-based interventions focusing on dysfunction.MethodsIn this single-blinded pilot randomised controlled trial, 19 participants received an occupation-based intervention (n = 9) or an impairment-based intervention (n = 10). The treatment period comprised two sessions. Recruitment, compliance and outcome completion rates were calculated for the study. Effect sizes were examined for outcomes regarding physical performance, instrumental activities of daily living and quality of life as evaluated by a blinded assessor.ResultsIn this study, 24.8% (28/113) of the eligible patients with haematopoietic malignancies were enrolled, and 67.9% (19/28) of these were retained up to the post-assessment stage. Recruitment (25%) and compliance (68%) rates were satisfactory. The Functional Assessment of Cancer Therapy-General emotional well-being and total scores were significantly higher for the occupation-based intervention group than for the impairment-based intervention group (both p < 0.05; d = 0.54, d = 0.51, respectively). Other outcomes showed no significant differences.ConclusionOccupation-based interventions designed using the ADOC application were useful for patients with haematopoietic malignancies.

Development of a tool to facilitate real life activity retraining in hand and arm therapy

Introduction Successful recovery of upper extremity function after stroke is more likely when the affected limb is used regularly in daily life. We developed an iPad (Apple) application called the ‘Aid for Decision-Making in Occupation Choice for Hand’ to facilitate daily upper extremity use. This study examined the suitability of items and pictures in the Aid for Decision-Making in Occupation Choice for Hand, and tested a paper prototype of the application (which has since been produced). Method We used a Delphi method with 10 expert occupational therapists to refine the items in the aid. Next, we prepared pictures of items in the aid and confirmed their suitability by testing them with 10 patients (seven stroke, three cervical spondylotic myelopathy). Nine occupational therapists conducted field tests with a paper prototype of the aid in clinical practice to examine its utility. Results After four Delphi rounds, we selected 130 items representing activities of daily living, organized into 16 categories. Of 130 pictures, 128 were recognizable to patients as representing the intended activities. Based on testing of the paper prototype, we found the Aid for Decision-Making in Occupation Choice for Hand process was suitable for clinical practice, and could be organized into six steps. Conclusion The Aid for Decision-Making in Occupation Choice for Hand process may promote daily upper extremity use. This application, since developed, now needs to be clinically tested in its digital form.

Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial

Background and purpose: The cost effectiveness of occupational therapy for subacute stroke patients is unclear in the extant literature. Consequently, this study determined the cost effectiveness of the occupation-based approach using Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke patients compared with an impairment-based approach.Methods: We conducted an economic evaluation from a societal perspective alongside a pilot randomized controlled trial, with a single blind assessor for participants in 10 subacute rehabilitation units in Japan. The intervention group received occupation-based goal setting using ADOC, with interventions focused on meaningful occupations. The control group received an impairment-based approach focused on restoring capacities. For both groups, occupational-therapy intervention was administered more than five times per week, for over 40 min each time, and they received physical and speech therapy prior to discharge. The main outcomes were quality-adjusted life years (QALYs) and total costs. Further, sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results.Results: The final number of participants was 24 in each of the two groups. In terms of QALYs, the intervention group is significantly higher than the control group (p = 0.001, difference 95% CI: 0.002–0.008) and total costs are not statistically significant. Applying a willingness-to-pay threshold of JPY 5 million/QALY, the probability of the occupation-based approach using ADOC being cost effective was estimated to be 65.3%.Conclusions: The results show that the occupation-based approach is associated with significantly improved QALYs and has potential cost effectiveness, compared with the impairment-based approach.

Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial.

BackgroundCare-home residents are mostly inactive, have little interaction with staff, and are dependent on staff to engage in daily occupations. We recently developed an iPad application called the Aid for Decision-making in Occupation Choice (ADOC) to promote shared decision-making in activities and occupation-based goal setting by choosing from illustrations describing daily activities. This study aimed to evaluate if interventions based on occupation-based goal setting using the ADOC could focus on meaningful activities to improve quality of life and independent activities of daily living, with greater cost-effectiveness than an impairment-based approach as well as to evaluate the feasibility of conducting a large cluster, randomized controlled trial.MethodIn this single (assessor)-blind pilot cluster randomized controlled trial, the intervention group (ADOC group) received occupational therapy based on occupation-based goal setting using the ADOC, and the interventions were focused on meaningful occupations. The control group underwent an impairment-based approach focused on restoring capacities, without goal setting tools. In both groups, the 20-minute individualized intervention sessions were conducted twice a week for 4 months.Main Outcome MeasuresShort Form-36 (SF-36) score, SF-6D utility score, quality adjusted life years (QALY), Barthel Index, and total care cost.ResultsWe randomized and analyzed 12 facilities (44 participants, 18.5% drop-out rate), with 6 facilities each allocated to the ADOC (n = 23) and control (n = 21) groups. After the 4-month intervention, the ADOC group had a significantly greater change in the BI score, with improved scores (P = 0.027, 95% CI 0.41 to 6.87, intracluster correlation coefficient = 0.14). No other outcome was significantly different. The incremental cost-effectiveness ratio, calculated using the change in BI score, was $63.1.ConclusionThe results suggest that occupational therapy using the ADOC for older residents might be effective and cost-effective. We also found that conducting an RCT in the occupational therapy setting is feasible.Trial RegistrationUMIN Clinical Trials Registry UMIN000012994

症例報告 Aid for Decision-making in Occupation Choice for Hand(ADOC-H)紙面版のCI療法における試用

症例報告 Aid for Decision-making in Occupation Choice for Hand(ADOC-H)紙面版のCI療法における試用

Comparison of occupation-based and impairment-based occupational therapy for subacute stroke: a randomized controlled feasibility study

Objective: To compare occupation-based and impairment-based approaches in occupational therapy and determine the feasibility of patient recruitment and retention. Design: A multicenter, randomized, controlled pilot trial with a single blind assessor. Setting: Ten subacute rehabilitation units in Japan. Participants: Fifty-four patients with subacute stroke. Interventions: The experimental group used the iPad application, Aid for Decision-making in Occupation Choice, to establish occupation-based goals, and evaluation and intervention were conducted mainly through real occupations. The control group was evaluated according to patients’ generic abilities and activities of daily living (ADL), and the intervention mainly involved the impairment-based approach. Main outcome measures: Short Form-36, Functional Independence Measure, Brunnstrom recovery stages, The Client Satisfaction Questionnaire, and length of hospital stay. Results: Of the 1465 potential participants, 54 (3%) subacute stroke patients were enrolled over 16 months and 68% (n = 36) were retained to the 2-month assessment: experimental group (n = 16); control group (n = 21). Although there was no significant intergroup difference for any outcomes, the experimental group had a small effect size advantage on the Short Form-36 “General health” (d = 0.42) and “Role emotional” (d = 0.43) subscales relative to the control group. A sample of 118 subacute stroke patients per group would be required for a lager study. Conclusions: Results suggest that the occupation-based approach has more potential to improve “General health” and “Role emotional” scores on the Short Form-36 than the impairment-based approach. Further investigation of study protocol with interventions and recruiting is needed prior to a larger trial.

Examination of a cut-off score to express the meaningful activity of people with dementia using iPad application (ADOC)

Purpose: To determine a quantifiable measure to identify patients with dementia who can choose an illustration of meaningful activity using an iPad application, Aid for Decision-making in Occupation Choice (ADOC). Method: We recruited 116 patients from 5 institutions in Japan. Occupational therapists interviewed patients with dementia to determine meaningful activities using ADOC. The most meaningful activity was confirmed by their primary caregivers. The cut-off was estimated from Mini-Mental State Examination (MMSE). Results: Receiver operating characteristic analysis indicated that an MMSE score of 8 was the cut-off for choosing meaningful activities using ADOC. Sensitivity and specificity was 91.0% and 74.1%, respectively, and the area under the curve value was 0.89. Conclusion: ADOC can provide individualized information regarding meaningful activities for patients with moderate dementia. Implications for Rehabilitation As dementia progresses, difficulty in expressing needs or desires regarding meaningful activity may increase. The iPad application (Aid for Decision-making in Occupation Choice; ADOC) can be useful to promote shared decision-making through a systematic goal-setting process involving a choice of 95 illustrations describing daily activities. Mini-Mental State Examination (MMSE) score greater than 8 points is required to use the ADOC to choose most meaningful activities. ADOC provides individual information regarding meaningful activities for patients with moderate dementia.

Utilization of the iPad Application: Aid for Decision‐making in Occupation Choice

The purpose of the study was to develop and evaluate an iPad (Apple) application, Aid for Decision-making in Occupation Choice (ADOC), so as to promote shared decision-making in an occupation-based goal setting. This application involves the client choosing from 94 illustrations describing daily activities related to the category of "activities and participation". One hundred occupational therapy clients evaluated the ADOC for goal setting; the clients and 37 occupational therapists underwent a survey to determine their perceptions of decision-making in the goal setting. More than 90% of the clients felt that they could give their opinions using the ADOC regarding goal setting. The majority of the occupational therapists (>90%) felt that ADOC would be useful in their clinical practice for setting client goals. The results indicated that ADOC is a useful and acceptable tool for both clients and occupational therapists in shared decision-making in occupation-based goal setting.