Occupational Therapy Practitioners Research Articles

Functional Cognition: Moving the Field Forward.

The concept of functional cognition has been variously defined, but at its core relates to how cognitive and performance abilities are integrated and used in everyday life. Functional cognition is a fundamental element of occupational performance, and functional cognitive assessment and intervention are central to how occupational therapy can improve client outcomes. Attendees at a conference convened by the American Occupational Therapy Foundation identified areas where the construct of functional cognition required further clarification. This paper briefly reviews these issues setting the stage for further conceptual analysis. The paper also examines the practical challenges that must be addressed before functional cognitive assessment and intervention can be fully integrated into occupational therapy practitioners' professional practice. Potential routes to address these challenges are identified.

Exploring the Occupational Identity of Fathers with Addiction: A Qualitative Study

Most research describing parents with addiction focuses on mothers, and little is known about fathers. Emerging research suggests constructing a positive occupational identity can help a person sustain recovery. Hermeneutic phenomenology was used to explore 10 fathers’ occupational identity from their initial substance use through addiction to recovery. Two themes emerged: 1) I was young, but it wasn’t a problem until later, and 2) Being an addict is a part of who I am. The findings highlight how participants’ occupational identity fluctuated throughout these temporal stages and suggested strategies for occupational therapy practitioners when working with this population were reviewed.

Predictive Factors of State Licensure Board Disciplinary Actions in Occupational Therapy.

One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public. To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States. Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions. A total of 2,400 cases were analyzed across 47 states and Washington, DC. None. Numerous complaint and respondent attribute variables were collected from final consent orders and database entries. Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes. Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics. Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

Exploring Interoceptive Awareness With Adults: Occupational Therapy Practitioner Knowledge, Perception, and Practice Patterns.

As the literature states, interoception is important in health and wellness. Disruption of this system can negatively impact occupational performance. We completed a descriptive study to understand how occupational therapy practitioners working with adults address interoceptive awareness. A researcher-developed survey gathered data on knowledge acquisition of interoception and perceived practice patterns related to assessment, intervention, and outcomes. Participants (N = 44) reported acquiring knowledge of interoception through professional websites, browsing databases, and continuing education as the most common information sources. Client self-report (56.8%) and clinical observation (54.5%) were the most commonly reported assessments. Rehabilitation practitioners (n = 8) reported no use of formal assessments. Most participants (63.89%) reported interoceptive awareness interventions to be effective. Further research is needed on best practices for interoception assessment and intervention related to occupational performance.

Standardizing Identification of Cognitive Impairment in the Acute Hospital Setting: Toward a Common Language.

Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients' function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting. To examine the nursing-therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting. A prospective study using a convenience sample. Acute care hospital. Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist. Interrater reliability for the AM-PAC ACISF among therapists and nurses. Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF. Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting. Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients' function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

Exploratory Factor Analysis and Convergent Validity of the Adult Executive Function Inventory (ADEXI).

The Adult Executive Functioning Inventory (ADEXI)-a short, practical, self-report questionnaire accessible across diverse adult populations and languages-was used to assess executive functions (EFs), primarily inhibition and working memory. To examine the construct validity of the ADEXI Hebrew version through exploratory factor analysis (EFA) and convergent validity by correlating scores with similar measures of EF. Cross-sectional study using online anonymous surveys. Nonclinical sample of 239 adults, 74.1% women, ages 18 to 80 yr (Mage = 44.19 yr, SD = 12.89). The Hebrew version of the 14-item ADEXI, a demographic questionnaire, and the Dysexecutive Questionnaire (DEX). Descriptive statistics, Cronbach's α EFA using varimax rotation, and Pearson's correlations were used. Total internal consistency was good (α = .86). Unlike the two factors in the original English version, our construct validity through EFA revealed three factors-inhibition, working memory, and, uniquely, flexibility-that accounted for 55.71% of the variance. Convergent validity was supported by medium to large significant correlations (r =.29-.76) between the ADEXI and the DEX subscales and total scores. Our findings offer psychometric evidence to support using the Hebrew version of the ADEXI for EF assessments in adult Hebrew-speaking populations. Plain-Language Summary: The Adult Executive Functioning Inventory (ADEXI) assesses three key components: inhibition, working memory, and cognitive flexibility. In this study, we examined the construct validity of the Hebrew version of the ADEXI to assess executive functions. Our findings support using the ADEXI in Hebrew-speaking populations. The ADEXI offers occupational therapy practitioners serving Hebrew-speaking populations in their practice a validated tool for assessing executive functions.

Abortion Law Changes and Occupational Therapy Practice in the United States.

The U.S. Supreme Court overturned Roe v. Wade in 2022, changing access to abortion in many states. The impact of these changes on occupational therapy practice has not yet been explored through empirical research. To explore the perspectives of occupational therapy practitioners on how restrictions to abortion in the United States may have influenced their clients' needs and thus their practice. This was a qualitative research study. We used an interpretivist epistemological approach and an inductive, thematic content analysis. Participants were recruited through state occupational therapy associations and social media. Two independent researchers coded data and had an initial agreement percentage of 88%. Data trustworthiness was enhanced through documentation of decisions, reflexive thinking about our positionality and the data, and team-based discussions. Occupational therapy practitioners (N = 15) working in states with new abortion law changes at the time of interviews. The four key themes of this study were as follows: (1) abortion restriction laws are affecting some occupational therapy clients' mental health, (2) clients are discussing reproductive health with occupational therapy practitioners across a variety of settings, (3) occupational therapy practitioners are using clinical judgment and their personal beliefs to support clients affected by abortion restrictions, and (4) occupational therapy practitioners are seeking guidance and evidence-based resources to best support clients in the wake of abortion-related legislation changes. Our findings underscore the relevance of reproductive health to occupational therapy practice and highlight the importance of preparing occupational therapy practitioners to respond to client needs related to abortion care. Plain-Language Summary: We sought to determine whether occupational therapy practitioners perceive that the 2022 abortion-related restrictions are affecting occupational therapy practice; specifically, we wanted to know whether and how practice is being affected and what resources occupational therapy practitioners might need to address clients' needs. Fifteen occupational therapy practitioners were interviewed and revealed that many of their clients were experiencing stress and anxiety (i.e., mental health challenges) specifically related to abortion access. We also found that occupational therapy practitioners who routinely discuss reproductive health with clients were commonly hearing from clients about abortion-related needs. Overall, this research uncovers a need for resources and guidance from state or national occupational therapy organizations so that occupational therapy practitioners can better support their clients given these new changes in abortion access. Positionality Statement: We are a team of three researchers who identify as cisgender women, and we reside in an urban area in the northeastern United States. Two of us identify as White, and one identifies as a person of color. We have all participated in reproductive health access advocacy and critically examined our own lenses as we engaged in this analysis.

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.

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.

Exploring performance patterns of family members caring for a loved one with mental illness in rural and remote Capricorn District of South Africa: A secondary analysis

Caregiving in rural African communities is a central co-occupation deeply affected by limited resources. This study re-analyzed qualitative semi-structured interviews with 15 caregivers of loved ones with mental illness from Capricorn District, to explore how caregiving influences their performance patterns.13 caregivers were female and two caregivers were male. Findings reveal that caregiving routines evolve from habits that gradually solidify into ritualistic practices, leading to shifts in roles and new responsibilities that demand resilience and sacrifices. The study advocates for collaboration between academia and occupational therapy practitioners to develop context-specific interventions that empower caregivers to navigate the multifaceted co-occupation of care.

General education inclusion of students with significant disabilities: the role of the school-based occupational therapy practitioner

ABSTRACT Since the passage of The Individuals with Disabilities Education Act (IDEA) in 2004, it has been mandatory for disabled children to be educated with non-disabled children within public agencies to the greatest extent possible. While school systems have responded by creating academic and functional programs better suited for educating students with disabilities, they tend to be self-contained environments with limited opportunities for exposure to typical peers throughout the school day. The inclusion of special education students, especially those with significant impairments, is currently not meeting the expectations set forth by IDEA. The reasons for this vary widely and have led to the pervasive restrictive placement of students with extensive support needs (ESN) despite the numerous benefits of inclusive placement presented in available research. This manuscript will compile the existing evidence on the educational placements of significantly disabled students and use it to paint a picture of the current state of inclusion, identify the barriers to its implementation, list the benefits of inclusion for all students, and discuss how occupational therapy practitioners can facilitate, enhance, and expand inclusion of these children. This manuscript serves as a call to action for school-based occupational therapy practitioners to expand their role in this setting by emphasizing their unique skill sets to educators and fully utilizing their strengths to act as advocates for the significantly impaired students they serve.

Impact of Training on Addressing Farmer Mental Health in Occupational Therapy Practice.

Farmers experience high rates of mental health conditions and suicide. It is within occupational therapy's scope to address mental health conditions in patients as it pertains to their participation in meaningful occupations. The aim of this study is to assess the efficacy of training provided to occupational therapy practitioners and students on addressing farmer mental health. Participants were directly recruited from occupational therapy state associations and graduate programs in the American Midwest to attend a 1-hour presentation and complete pre- and post-training surveys. A total of 119 participants completed the pre- and post-training surveys. Both occupational therapy practitioners and students significantly increased their confidence in assessing and addressing mental health concerns and providing resources to farmers following the training. Occupational therapy-specific training can increase therapists' confidence in addressing farmer mental health. Further research should assess multi-faceted interventions related to farmers' mental health in occupational therapy practice.

Use of AI in Pediatric Occupational Therapy: A Review

The utilization of artificial intelligence (AI) in pediatric occupational therapy (OT) has emerged as a promising avenue for enhancing assessment, intervention, and outcomes for children with diverse developmental needs. This paper provides a comprehensive review of the current state of AI applications in pediatric OT, highlighting key findings, benefits, challenges, and future directions. AI technologies, including machine learning algorithms, computer vision systems, and wearable sensors, offer innovative approaches to assess children's motor skills, sensory responses, and cognitive functions objectively and efficiently. AI-driven intervention strategies, such as personalized treatment planning, adaptive task selection, virtual reality environments, and gamified activities, promote engagement, motivation, and skill acquisition among pediatric patients. AI can be helpful in early diagnosis as well as early intervention. Additionally, AI-powered telehealth platforms enable remote delivery of OT services, real-time monitoring of patient progress, and access to care for underserved populations. However, challenges related to data privacy, ethical decision-making, disparities in access, and therapist education must be addressed to ensure the ethical, effective, and equitable integration of AI into pediatric OT practice. By embracing ongoing research, collaboration, and innovation, pediatric OT practitioners can harness the transformative potential of AI to improve outcomes and quality of life for children and families worldwide.

Introducing a New Paradigm in Occupational Therapy for Mental Health in Bangladesh

Bangladesh is making strides in supporting mental health needs by incorporating occupational therapy into rehabilitation care. Despite challenges like social stigma and limited resources, a shift toward a socio-humanistic approach is underway. Occupational therapy practitioners have set up a mental health day treatment service to help individuals transition from hospitals to the community, focusing on daily living skills and meaningful activities. Integrating mental health day treatment service with government psychiatric hospitals and improving rehabilitation and home care follow-up can significantly enhance support for people with mental health needs in low-resource settings.

Interrater Reliability and Precision of a Novel Hand Strength Assessment and Treatment Device: The GripAble.

Occupational therapy practitioners need modern tools for the assessment of maximal grip strength in clinical and remote settings. To establish the (1) interrater reliability and (2) precision of the GripAble among three raters with different expertise in occupational therapy when testing healthy participants, and to (3) evaluate the relative reliabilities of different approaches to estimating grip strength (i.e., one trial, mean of two trials, and the mean of three trials). Measurement study. Minnesota Translational Musculoskeletal and Occupational Performance Research Lab, University of Minnesota, Minneapolis. Thirty volunteers, age ≥18 yr, without any hand problems. Using GripAble, three occupational therapy raters with varied experience measured the maximal grip strength of the dominant and nondominant hands of all participants. Using the mean of three trials when testing grip strength with GripAble adds precision. GripAble has excellent interrater reliability (i.e., intraclass correlation coefficient > .75) and acceptable precision (minimal detectable change < 15%) among healthy adults. GripAble allows occupational therapy practitioners with different experiences to assess grip strength in healthy hands quickly, precisely, and with excellent reliability. Additional research is needed on its psychometrics in clinical populations and capacities in remote monitoring and exergaming. Plain-Language Summary: The results of this study show that grip strength, an important biomarker and commonly assessed construct in occupational therapy, can be evaluated reliably, precisely, and rapidly with GripAble. The use of GripAble by occupational therapy practitioners in clinical settings may help to build an infrastructure for remote measurements and exergaming interventions in the future.

Patient-Reported Variables Affecting Self-Perceived Overall Recovery Among People With Subacute Stroke.

Patients' perception of overall recovery is a critical outcome for stroke rehabilitation. However, the perception of overall recovery cannot be obtained using multidimensional measures, because satisfaction in most domains of life does not guarantee satisfaction in overall recovery. A single overall recovery score seems a straightforward measure. However, the clinical implications of overall scores are restricted, because factors affecting patients' overall recovery are unclear, which can be prioritized to optimize the effectiveness of rehabilitation. To examine patient-reported variables affecting overall recovery scores in patients with differing stroke severity. The 59 items of the Stroke Impact Scale 3.0 were selected using regression analysis with a forward selection to explain the overall recovery score (0% = no recovery; 100% = full recovery). Stroke severity was determined with the National Institutes of Health Stroke Scale. Hospitals. Data of 950 patients collected 90 days after stroke. The models explained about 55% of the variance of the overall recovery scores with five to nine variables, but merely 16% of the variance was explained for patients with moderate stroke. As stroke severity increased, the number of identified variables decreased. Most identified variables were related to social participation and self-care activities (e.g., ability to help others, control the bowels, and dress the torso). Differences in the remaining variables depended on stroke severity. Patients' priorities differ depending on stroke severity. The identified variables may be set as treatment goals to optimize patients' self-perceived overall recovery. Plain-Language Summary: How patients perceive their overall recovery after a stroke is a critical outcome for their stroke rehabilitation. This study demonstrated that patients with different stroke severity may have different priorities that influence their self-perceived levels of overall recovery. The variables identified in this study may help occupational therapy practitioners identify meaningful goals to optimize patients' self-perceived overall recovery.

Occupational Therapy Practice Guidelines for Adults Living With and Beyond Cancer

Abstract Importance: Occupational therapy practitioners play an important role in addressing the impairments, occupational performance, and participation needs of adults living with and beyond cancer. Objective: These Practice Guidelines aim to assist occupational therapy practitioners, educators, and researchers in applying evidence and expert opinion to occupational therapy practice across the cancer continuum of care, including identifying gaps in care. Key focus areas include psychosocial function, fatigue, cognition, pain, sleep, and physical activity. These guidelines can serve as a reference for policymakers, health care professionals, health care managers, regulators, third-party payers, and managed care organizations to manage, reimburse, and set policy. Method: We examined, synthesized, and integrated the results of systematic reviews, supporting literature, and expert opinion to develop and provide clinical recommendations for practice in the care of adults living with and beyond cancer. Results: Sixteen systematic reviews with moderate to strong strength of evidence published between 2019 and 2022 served as the foundation for these Practice Guidelines. Conclusions and Recommendations: To support symptom management for adults living with and beyond cancer, occupational therapy practitioners can consider using psychosocial interventions for anxiety, depression, posttraumatic growth, and overall psychological distress. Practitioners can consider using physical activity interventions for cancer-related fatigue, cognitive performance, and sleep. Practitioners could also consider using interventions for cognition, pain management, and self-management for the improvement of cancer-related symptoms. Plain-Language Summary: These Practice Guidelines provide strong and moderate levels of evidence for occupational therapy practitioners to support adults living with and beyond cancer. They provide specific guidance for addressing pain, cancer-related fatigue, cancer-related cognitive impairments, psychosocial well-being, sleep, and physical activity. The guidelines also include case examples and an infographic to support occupational therapy practitioners in integrating evidence to support interventions in cancer care, and they highlight gaps and expert opinions in practice for continued clinically relevant research.

Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review.

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.

Real-world occupational therapy interventions for early-stage dementia: Characteristics and contextual barriers.

There is an absence of evidence generated in a UK context to support interventions based on occupational therapists' core skills for people living with early-stage dementia. To inform the development of a programme theory and a future evaluation, this paper aimed to describe real-world (routine) community-based occupational therapy interventions for this population and contextual barriers. Occupational therapy practitioners (n = 21) from five Health Boards in Wales, UK participated in semi-structured interviews (n = 17) which were audio recorded, transcribed, and analysed thematically. The availability of, and access to, real-world community-based interventions was variable, and associated with multilevel contextual barriers (resources, understanding of dementia specialist occupational therapy, professional influence, and evidence base). Where available and accessible, contents comprised a pre-intervention component (relational work, assessment, and goal setting) and intervention component (personalised problem-solving and coping strategies, emotional support, and advice and signposting), to meet needs associated with everyday activities and poor wellbeing. Variation in mode, duration, contents, and who received interventions, was associated with contextual barriers. Findings indicate that the development of an intervention programme theory and future evaluation design, will need to account for the impact context may have on the variability of real-world intervention characteristics, and how this in turn may influence outcomes.

Parent Perspectives of Co-Occupations in Neonatal Intensive Care: A Thematic Review of Barriers and Supports.

Co-occupations within the neonatal intensive care unit (NICU), which include parenting activities, such as bathing, feeding, diapering, comfort care, and bonding for attachment, are consequential for optimal infant development. This thematic systematic review examines supports and barriers for facilitating co-occupations between parents and infants in the neonatal setting. A search of four databases (MEDLINE, CINAHL, PsycINFO, and PubMed) resulted in 20 studies that met inclusion criteria for data extraction. Family-centered NICU design, good communication between parents and NICU staff, increased physical contact, parent involvement in caregiving, psychological wellness, parent education, peer support, and established parental roles are identified as supports to co-occupational engagement. Identified barriers include physical separation, loss of parental role, restrictions of the NICU environment, medical technology, role strain, psychological burden, lack of knowledge, and poor communication. Findings suggest that neonatal occupational therapy practitioners can facilitate parent-infant co-occupations by addressing barriers and augmenting existing supports.