Occupation-based Assessment Research Articles

Interoception and its application to paediatric occupational therapy: A scoping review.

Paediatric occupational therapists assess and provide intervention for children presenting with sensory processing challenges that impact their daily occupational performance. Interoception, the ability to sense internal body signals, is an emerging practice area, yet it remains unclear how and why paediatric clinicians are applying interoception and related concepts in practice. A scoping review was conducted to report on the current body of published literature related to interoception and its application to paediatric occupational therapy practice. A comprehensive search of 10 electronic databases and related grey literature was conducted. Title and abstract screening were completed prior to full-text review of evidence. The PRISMA-ScR Checklist and the Crowe Critical Appraisal Tool were used to support a systematic scoping review process and increase robust extraction and appraisal of data. Narrative synthesis was used to analyse and synthesise data. No consumer and community involvement. A total of 18 articles were included in this review, including original research articles (n= 8), published books (n= 4), theses/dissertations (n= 3), opinion pieces (n= 2), and one government document. Narrative synthesis analysis identified six themes: (1) occupational therapy principles relevant to interoception, (2) what is interoception?, (3) assessment of interoception, (4) clinical application of interoception, (5) clinical populations receiving interoception-based intervention, and (6) relationships between interoception and other performance components. Findings indicated that paediatric occupational therapists are integrating interoception concepts alongside occupational therapy principles to inform assessment and intervention processes. Several assessments and interventions are utilised to support children; however, evidence to strengthen use is lacking. Further, there are limited occupation-based assessments and intervention programs to address interoception deficits in children. Findings from this scoping review contribute to the emerging body of empirical evidence related to interoception and paediatric occupational therapy practice. These findings provide an informed basis for practice and research by occupational therapists in this area. Interoception allows us to feel what is going on inside our body and helps us to notice how our body might be feeling (e.g. if our stomach grumbles, we might feel hungry; if our heart is beating very fast, we might feel scared; if we are sweating, our body is feeling overheated). Some children may present with problems recognising interoceptive feelings in their bodies. Therefore, occupational therapists can help children learn about their own interoception related to their bodies. This is a new topic for therapists, and they need to know more about it so that they best help children and their families. There is not a lot of information about how to use interoception in occupational therapy practice, and we wanted to know what information already exists about interoception and occupational therapy. This review provides a summary of the current knowledge that is available and summarises it. Some information about interoception and how it relates to occupational therapy services with children was found, but more research knowledge about this topic is needed.

Restful Rehabilitation: Sleep's Essential Role in Occupational Therapy Education, Intervention, and Research.

All humans have the occupational right to sleep; therefore, occupational therapy practitioners must prioritize sleep with their clients. In this column, we identify ways to incorporate sleep health into the education and training of occupational therapy practitioners. This starts with identifying entry-level and continuing education opportunities to proclaim sleep as an occupation and a basic biological need. Current practitioners must recognize that sleep health is multidisciplinary, and existing interventions can help clients achieve good sleep health throughout their lifespan. Given the paucity of sleep research in occupational therapy, the potential exists to investigate new, occupation-based assessments and interventions. We provide specific approaches to expand sleep and sleep health knowledge in occupational therapy education, practice, and research.

Are occupational therapists in hand therapy working in an occupation-centered way? A cross sectional survey.

The dominance of the biomedical approach has previously caused a limited focus on occupation within hand therapy. This study aimed to investigate the rehabilitation offered to patients with a hand-related disorder (HRD) in Denmark including to determine the extent to which occupation-focused and/or occupation-based assessments and interventions are used and to identify barriers against their use. A cross-sectional survey with 45 questions was conducted among members of the Danish Association for Hand Therapy. Data were analysed with descriptive statistics. Categorical variables were reported with frequency and percentage, and continuous variables with average and standard deviation. One hundred and six occupational therapists working as hand therapists (n = 106) completed the survey. They reported common use of assessments measuring range of motion, pain, edema, and occupational performance. Occupational performance was assessed by non-standardized occupation-focused assessments, such as informal conversations. Exercise, pain management, and occupation-focused informal conversations were reported as the most frequently used interventions. Out of 82 respondents, 74 (91.4%) reported that they used interventions focused on body function and structures to the extent they wanted. Only 41 (50.0%) used occupation-focused or occupation-based interventions to the extent they wanted. Assessments and interventions reporting body function and structure were used most frequently whereas assessments and interventions reporting activity and participation were used to a lesser extent. Occupation-focused assessments and interventions were used more commonly than occupation-based. Hand therapists considered occupation-based assessments and interventions to be important in rehabilitation after HRD, despite using them with few patients. Several barriers were reported regarding the implementation of an occupation-centered approach: habit, workload, time constraints, and setting.

Occupational Priorities of People on Hemodialysis Who Participated in Energy Management Education.

Background. People with kidney failure who undergo hemodialysis treatment and experience chronic fatigue identify negative effects on occupational performance and participation as a key aspect of their illness experience. Purpose. To describe the occupational performance and participation problems of people treated with hemodialysis who live with debilitating fatigue. Method. Fifteen participants, who were randomized to participate in an energy management intervention as part of a randomized controlled trial, completed two occupation-based assessments at baseline and chose three priority occupational performance or participation problems to address as goals during the intervention. Results were analyzed using descriptive statistics (counts and percentages). Findings. Fifteen participants (mean age 60, 53% male) completed the occupation-based assessments. Participants stated that they wanted or needed more energy for a median of 22 of 55 occupations. Going out for food/drinks (n = 11), going to a movie/concert/performance (n = 10), and food preparation/clean-up (n = 10) were the top occupations for which participants required more energy. Prioritized occupational performance and participation problems most often fell within the household management (14 goals), self-care (6 goals), and hobbies (5 goals) domains. Conclusion. Occupational performance and participation problems are extensive among people treated with hemodialysis who live with debilitating fatigue. There is a clear need for occupation-based interventions that optimize occupational performance and participation in this population.

An Occupation-Based Review of Outcome Measures used to Assess Hand Function after Burn Injury.

While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this paper is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment (OBPA). Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity (SPA) may be a viable addition to an assessment battery to address this essential need.

Profile of Assessments in Pediatric Occupational Therapy Practice.

Occupational therapy practice is intended to reflect the core construct of occupation throughout all aspects of service delivery. In pediatric occupational therapy, the evidence examining regularly selected assessment tools and the occupational constructs of those assessment tools is insufficient. To examine the assessment tools regularly selected by practicing pediatric occupational therapists and the therapists' classification of assessment tools as occupation-based. A cross-sectional quantitative design through the dissemination of an anonymous, close-ended assessment tool inventory with completion of descriptive statistics. Pediatric occupational therapist practice specific to the assessments used. There were 337 pediatric occupational therapists recruited through targeted sampling via social media. The participants were included if they had provided direct client care to individuals ages of 0 to 21 yr during their career. The assessment tools most commonly used by pediatric occupational therapists are the Sensory Profile (86.4%) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (85.2%). The primary assessment tools selected by pediatric occupational therapists were skill-based regardless of years of practice or practice setting. Therapists were unable to correctly classify assessment tools as occupation-based. The limited use of occupation-based assessments in conjunction with decreased recognition of the occupational nature of assessment tools hinders the integration of occupation-based assessment tools across pediatric clinical practice. Pediatric occupational therapists' integration of occupation-based assessment tools is needed to promote the occupational constructs of the profession. What This Article Adds: This article identifies the common assessment tools utilized by pediatric occupational therapists. Additionally, this article brings awareness to the inconsistent identification and integration of occupation-based assessment tools within pediatric clinical practice.

Occupation-Based Assessments in Pediatric Occupational Therapy Practice.

In pediatric occupational therapy, there is insufficient evidence examining assessment tool selection by occupational therapists and how assessment tools contribute to occupation-based practice. To examine the perceptions of occupation-based assessment tool selection by pediatric occupational therapists, a phenomenological research study was conducted with six pediatric occupational therapy practitioners. Three themes emerged from participants' perspectives: the centrality of occupation, selecting the just right tool, and practice implications. Participants recognized the need to integrate occupation-based assessments into practice but reported decreased opportunities secondary to training, available supplies, lack of awareness of foundational constructs, and organizational expectations. The use of occupation-based assessments positively enhances pediatric occupational therapists' clinical practice by upholding the core occupational beliefs of the profession throughout all phases of service delivery.

Efficacy Studies of Home-Based Occupational Therapy Services Following Stroke: A Scoping Review

The aim of this scoping review was to review and assess recent studies on the efficacy of home-based occupational therapy interventions for adults post-stroke. The number of efficacy studies is limited. The few studies available suggest that occupational therapy delivered in home settings may improve outcomes for stroke patients. There is also limited use of occupation-based assessments, interventions, and outcome measures in studies addressing home-based occupational therapy. Methodologies should be improved to include contexts, caregiver training, and self-efficacy. Further high-quality studies are needed on the efficacy home-based occupational therapy services.

Feasibility of Increasing Occupation-Based Assessment Using the Knowledge to Action Framework.

The Assessment of Motor and Process Skills (AMPS) is a standardized occupation-based measure; however, barriers often limit use in practice. The Knowledge to Action Framework (KTA) is one of the most widely used implementation approaches to induce practice change. The objective of the study is to examine the feasibility and acceptability of a KTA-informed intervention to increase the use of the AMPS. AMPS-trained occupational therapists were recruited through convenience sampling. Interventions included workshops, action planning, goal setting, peer support, and organizational resources. Recruitment and retention were tracked. Pre- and post-survey results of interventions' helpfulness, AMPS behaviors, and motivational changes informed acceptability. Participants (n = 5) rated 7/7 (100%) intervention strategies as helpful, reported decreased barriers and increased frequency of AMPS administration, increased resources for AMPS implementation, and improved compatibility with practice. Implementation of a KTA-informed intervention to increase AMPS practice was feasible and supported by environmental changes and peer support in a physical rehabilitation setting.

Describing Occupational Therapy Practice for Evaluating Older Adults with Cognitive Impairments

Aims This study aimed to describe how occupational therapists evaluate older adults with cognitive impairments. Methods A descriptive qualitative study design was used. Four focus groups were conducted with 16 occupational therapists working with cognitively impaired older adults in institutional and community care settings. An inductive thematic analysis of the content of the interviews was applied. Results Occupational therapists described a three-stage assessment process that was predominantly occupation-based, linear and iterative: (a) gathering information from the older adult, their care network and family members to plan the assessment, (b) assessing cognitive impairment and occupational performance using non-standardized observations and standardized tests, and (c) applying clinical reasoning to predict further performance issues and safety. Despite using a predominantly occupation-based assessment process, occupational therapists reported a lack confidence to predict safety. Conclusion Occupational therapists may require additional knowledge, skills and tools to support them in assessing older adults with cognitive impairments.

Pediatric Mental Health Treatment and Confidence through the Lens of the School Based Occupational Therapist’s Role

Given the rise in mental health needs in children and adolescents and the historical roots of occupational therapy in psychiatry, occupational therapists may be well-equipped and well-suited to offer expert contributions on school-based mental health teams. Occupation-based assessments and interventions for schoolchildren with mental health conditions are essential but are often overlooked because occupational therapy is traditionally solicited to support children with physical health concerns. The research problem for this study was that it was unclear how school-based occupational therapists perceive pediatric mental health treatment preparedness and confidence. The purpose of this basic qualitative study was to explore school-based occupational therapists’ perceptions of their preparedness and confidence to offer pediatric mental health treatment. Semistructured interviews were conducted through video conferencing. Self-efficacy and adult learning theories were used as guiding frameworks. Results of thematic analysis exposed five themes: the importance of university and fieldwork education; professional self-directness and intrinsic motivation; readiness to learn and role clarity; collaboration and communication; and advocacy. These findings have significant implications for occupational therapy students as well as their educators and employers.

Learning, translating, and applying the perceive, recall, plan, perform system of task analysis assessment to practice: Occupational therapists’ experiences

Introduction This study explored occupational therapists’ experiences of embedding the Perceive, Recall, Plan, Perform System of Task Analysis (PRPP) assessment in practice and gained understandings of the clinical utility. Methods Qualitative interpretive description research using data from semi-structured interviews with 11 New Zealand registered occupational therapists and a focus group with two Māori occupational therapists. Thematic data analysis was used to develop themes. Results Five themes emerged: Resonating with practice as it should be, Translating to practice, Communicating assessment findings using an occupational performance focus on cognition, Validating the practice fit and Cultural application. Participants described the PRPP assessment as a flexible tool, which was applied in different ways in varied practice settings, with clients performing a range of culturally specific occupations. Embedding the assessment in practice was an involved process that challenged many participants’ existing assessment procedures and included managing team expectations to perform cognitive-based assessments. Conclusions The PRPP assessment added value to occupational therapists’ practice. Effective implementation of the assessment required a secure occupation-focused perspective and client-centred culturally responsive communication skills. Commitment was needed to both adopt a new assessment process and to communicate occupation-based assessment results. Participants connected as social learners to address practice challenges post-training.

The use of occupation-based interventions and assessments in hand therapy: A cross-sectional survey

IntroductionThe purpose of this study was to gather information on how hand therapists incorporate occupation-based interventions in their clinical practice and what outcome measures hand therapists use to measure the occupational performance of their clients Study DesignCross-Sectional Survey Design. MethodsThe 16-item Survey was distributed to members of the American Society of Hand Therapists on two occasions. ResultsThree hundred eleven hand therapists responded to the survey. Hand therapists use a variety of occupation-based interventions (OBI) in clinical practice and most believe they are important. Findings from this study reveal that incorporating an occupation-based assessment along with or in place of an assessment of body functions and structures is not performed routinely. One hundred twenty-six (41%) respondents indicated that they use occupation-based activities 26-50% of the time with their clients. DiscussionThe top three OBI interventions used by hand therapists included dressing tasks, cooking and meal preparation, and in hand manipulation of coins and medication. The lack of understanding of the theoretical models regarding occupation-based interventions may be a barrier toward implementation of occupation-based interventions and assessments as many hand therapists may have trained under a medical model. ConclusionMost respondents to this survey indicated that they believe OBI should be performed by hand therapists and use them routinely in practice. The most frequently used type of assessment was the DASH (Disabilities of the Shoulder Arm & Hand). The least frequently used assessment was the Short Form 36 and patient specific occupation-based assessment.

The Occupational Experience Helps to Express the Clients’ Occupational Needs in Goal Setting: A Retrospective Study in Subacute Care Setting

This study investigates whether reflection on occupational experience during assessment and intervention would help clients express their occupational needs in goal setting. Sixty-two participants who were not able to express their occupational needs in the initial assessment process were either allocated to the occupational experience group who undertook occupation-based assessment and intervention, or the physical training group who engaged in physical training only. The ratio of participants who expressed their occupational needs in each group was 67% (30/45) and 12% (2/17) respectively. Reflection on occupational experience during assessment and intervention to help clients express their occupational needs would have significant implications for practice, as it may encourage clients to reflect on their performance more easily.

Spatial Dimension of the Employment Market Exposition to Digitalisation—The Case of Austria

Digitalisation, referred to as the fourth industrial revolution, is gradually becoming part of all areas of life. The progressing digitalisation inspires new business models, restructures production processes and provides new revenue and value-producing opportunities. Simultaneously jobs are becoming abdicable and livelihoods can get threatened. To analyse the spatial context of the susceptibility of regional labour markets to 4.0 technology in Austria, the occupation-based assessment of digitalisation probability was projected on the industry standard classification and linked to the statistical employee data at the municipal level. The outcomes reveal to what extent the economic sections and divisions are exposed to digitalisation. Results representing spatial distribution reveal that digitalisation risks cannot be explicitly assigned to certain spatial structures or localities. Still, it can be stated that urban areas and small towns are relatively less exposed to disappearing of existing jobs. Municipalities with the highest vulnerability to labour replaceability are located mainly in rural areas. The discussion focuses on regional resilience, social vulnerability and possible development paths for different frameworks and spatial context of consequences. The study emphasizes the importance of digitalisation processes for regional development and presents an approach of analysing their territorial dimensions.

Building a Family-Centered Practice in Vietnam: Validation and Translation of Occupation-Based Pediatric Assessments

Abstract Date Presented 04/05/19 Primary Author and Speaker: Patty Coker-Bolt Additional Authors and Speakers: Thomas Platt, Emily Graves, Ashley Brady, Haley Ranson, Kat Jones, Craig Velozo

The Power of a Play Partner: Assessing the Influence of Parent Behavior on Young Children's Playfulness in Joint Play

Abstract Date Presented 04/04/19 An occupation-based assessment tool is needed to support therapists in their assessment of how parents’ behavior impacts how their young children's play. The usefulness of the Parent's Caregiver Support of Young Children's Playfulness (a new assessment tool) for identifying how parents' behavior influences their children's playfulness, was examined through a mixed-methods study. Primary Author and Speaker: Amiya Waldman-Levi Additional Authors and Speakers: Laurette Olson Contributing Authors: Sherraine Grinon

Role of occupational therapy in improving quality of life of physically challenged persons

Occupational therapy is a branch of medicine which uses different methods to help physically and mentally ill people to develop, maintain, and recover skills needed to function in day to day life, as well as in workplace environments. Thus lives of millions of disabled all over the world are enhanced to a meaningful quality of life. Occupational therapists also focus much of their work on identifying and eliminating environmental barriers to independence and participation in daily activities. This is a client-centered practice that places emphasis on the progress towards the client’s goals. The interventions are made on adapting the environment, modifying the task, teaching the skill, and educating the client/family in order to increase participation in and performance of daily activities, particularly those that are meaningful to the client. They often find it challenging to implement client-centered and occupation-based assessment tools into practice. This part of rehabilitation medicine is neglected in our country. More work is needed to understand how best practices can be incorporated into a changing occupational therapy daily practice. The aim of this review article is to highlight the importance of occupational therapy and its application in improving the quality of life and quality adjusted life years in physically challenged persons.
 Bangladesh Journal of Neuroscience 2017; Vol. 33 (1): 34-38

Integrating Occupational Therapy Specific Assessments in Practice: Exploring Practitioner Experiences.

Background Occupational therapists sometimes find it challenging to integrate client-centered and occupational therapy specific assessments in practice. The aim of this study was to explore the use of occupational therapy specific assessments such as the Assessment of Motor and Process Skills (AMPS) among occupational therapists in Sweden and Japan. Methods Interviews and qualitative thematic analyses were utilized. Findings Four themes are reported: (1) use it or lose it, (2) simply no space until after hours, (3) biggest barriers can be colleagues, and (4) being more specific: communication. Conclusion In keeping with previous studies, occupational therapists often find it challenging to implement client-centered and occupation-based assessment tools into practice. However, more work is needed to understand how best practices can be incorporated into a changing occupational therapy daily practice.

Being visible: PhotoVoice as assessment for children in a school-based psychiatric setting

Background: Recovery-oriented mental health services empower all clients, including youth and their families, to be actively involved in directing their own care. In order to develop person-driven interventions, clinicians must understand what matters from their perspective. Thus, recovery-oriented assessments need self-report measures that adequately capture the domains and content that matter to a range of particular persons.Aim: This study examined if and how PhotoVoice, a participatory research method used to empower and highlight the unique experiences of vulnerable groups, could be used as a recovery-oriented self-report measure for children with a mental health disorder.Methods: We used PhotoVoice to engage four children with mental health related disorders at a day hospital program for severe behavioural disorders. The children, as co-researchers in this participatory approach, created life books from photographs and images of what mattered to them across nine sessions. To examine the PhotoVoice process, we used ethnographic methods, including child interviews and participant observations in their classes and at recess before, during and after the weekly sessions. Our overarching narrative-phenomenological theoretical framework focused data collection and analysis on what mattered most to the children.Results: The PhotoVoice method engaged and empowered the children in articulating what mattered in their everyday lives from their perspective that resulted in a novel, child-generated domain of ‘mattering to others’ for future self-report measures, and facilitated changes that generalized outside of the group. We illustrate these results by drawing a particularly illustrative case example from the study.Conclusion: The PhotoVoice method foregrounded children’s perspectives on what matters more explicitly than clinical or parent perspective on function.Significance: The participatory philosophy and methods of PhotoVoice provides a viable approach to recovery-oriented self-report measures as well as an occupation-based assessment and intervention.