Occupational Therapy Intervention Research Articles

Telehealth interventions in occupational therapy with older adults: Results from a scoping review targeting better health promotion.

Telehealth interventions have the potential to enhance access to care and improve efficiency while reducing the burden on patients. Although telehealth interventions are well accepted and adopted in physical therapy, their usage in occupational therapy for older adults is less common, and limited information exists regarding their setting and context. To provide an inventory and synthesis of telehealth interventions in occupational therapy for older adults. For published studies on telehealth-based occupational therapy interventions in older adults between 2000 and 2022, six databases were reviewed. Data extraction and analysis were guided by the taxonomies developed by Tulu, McColl and Law and informed by the Canadian Model of Occupational Performance and Engagement. Twenty-three studies on telehealth interventions in occupational therapy for older adults were identified, mostly from North American authors (n = 11; 47.8%) and randomised clinical trials (n = 9; 39.1%). Most participants had a health problem (n = 20; 87.0%), mainly stroke (n = 9; 39.1%). Interventions focussed primarily on symptom management education (n = 12; 52.2%) of community-dwelling adults with health conditions, using videoconferencing systems or applications (n = 14; 60.7%). Interventions were delivered from the healthcare centre (n = 6; 26.1%) to the person's home (n = 18; 78.3%) synchronously (n = 19; 82.6%). About one third (n = 8; 34.8%) of the studies specified the therapist's location. Published studies on telehealth interventions in occupational therapy with older adults have mainly focussed on the synchronous training and education of participants using videoconferencing systems or applications. According to these studies, the scope of interventions is limited and could be expanded, for example, through occupational development and environmental modification. To better understand and describe best practices in the use of telehealth in occupational therapy, future studies should provide more details about the interventions performed, the technology used and the environmental settings of the therapist.

Pre-sleep routines in adult typical sleepers

ABSTRACT Sleep is the most important restorative occupation in which humans engage and pre-sleep routines, which occur prior to it, have not been explored. The main question this project sought to answer was: “What are the pre-sleep routines of typical adult sleepers?” Sixteen adults identified as good sleepers based on scores from the Pittsburgh Sleep Quality Index, between 23 and 60 years-old, drew pictures of their pre-sleep routines, followed by interviews about their depictions. Data analysis began after the first interview and continued through theoretical saturation, producing a descriptive theory of pre-sleep routines. During the pre-sleep period, participants performed an average of eight occupations in three to four spaces, using an average of five objects, and primarily in solitude. Routines had a clear beginning and end, and were both obligatory and optional. Occupations within the pre-sleep routine included body care, care for home, pets, or plants, engagement with technology, quiet leisure, and communicating with others. The intent of the pre-sleep routines was to ensure that sleep was not disturbed and to prepare for the next day. The construct of routines is important to the understanding of daily patterns of human occupation and is used as an intervention in occupational therapy, the primary profession applying the products of occupational science. This research describes usual routines before sleep, thus contributing to a fuller grasp of daily occupational patterns with potential for supporting sleep in adults with and without sleep issues. Drawings were found to be a useful method to collect information on routines.

Clinicians’ perspectives on motor learning strategy selection and application in occupational therapy and speech-language pathology interventions for children with acquired brain injury

Purpose Explore occupational therapists’ (OTs) and speech language pathologists’ (SLPs) process of selecting and applying motor learning strategies (MLS) in their interventions for children with acquired brain injury (ABI), and identify similarities and differences between OTs and SLPs in MLS selection and application. Methods This qualitative descriptive study involved individual semi-structured interviews with OTs and SLPs from the ABI program at Holland Bloorview Kids Rehabilitation Hospital (Toronto, Canada). Interviews were analyzed using thematic analysis. A modified constant comparison method permitted comparison within and between professions. Results Four OTs and three SLPs were interviewed. Four themes were developed: aligning MLS application with the child’s cognitive ability, using MLS to promote success within a single session, adjusting MLS across treatment sessions, and promoting generalization and transfer of motor skills beyond the therapy session. MLS application was predominately based on child-specific factors with task-specific considerations. OTs and SLPs used similar clinical reasoning processes for selecting and applying MLS. Conclusions This study provides a greater understanding of OTs’ and SLPs’ clinical reasoning process when applying MLS in pediatric ABI interventions. The similarities in MLS selection and application between disciplines suggest that an interprofessional approach to MLS is suitable for pediatric ABI rehabilitation.

Quality of life, sense of coherence and occupational balance one year after an occupational therapy intervention for people with depression and anxiety disorders.

Quality of life (QOL), sense of coherence (SOC) and occupational balance (OB) have been found to increase after rehabilitation among people living with depression and anxiety. However, these aspects have not been investigated over time in participants with different paid work situations, such as being on sick leave or not. To describe and compare the self-rated QOL, SOC and OB after participation in occupational therapy in three groups of people with depression and anxiety disorders based on their work situation during the study period: continuous sick leave, return to work and continuous work. Forty-seven women and seven men, 19-60 years old with depression and anxiety were followed over time. They completed questionnaires on QOL, SOC and OB on four occasions. Data were analyzed with non-parametric statistics. No statistically significant differences between the groups were identified. All groups improved in at least one of the studied areas over time: the sick leave group in OB; the return-to-work group in QOL and OB; and the Work group in QOL and SOC. The results indicate variations in QOL, SOC and OB between people with different work situations over time after occupational therapy. Studies with larger samples are, however, warranted.

"Being Holistic Is a Lot to Ask": A Qualitative, Cross-National Exploration of Occupational Therapists' Perceptions and Experiences of Holistic Practice.

Being holistic is often used by occupational therapists to describe their practice and philosophy worldwide. This study explores the perspectives of 33 occupational therapists, working in 13 different countries, on their understanding of holistic epistemology and practice and how they seek to incorporate holism in their work. On the basis of a qualitative study design, individual interviews were conducted with the participants by 18 Norwegian undergraduate occupational therapy students, supported by their supervisors. The authors subsequently analyzed the transcribed data, using a thematic analysis approach. Three principal themes emerged: (1) holism as a broad and narrow concept, (2) being holistic spans from treating body parts to teaching marginalized children, and (3) being holistic is a lot to ask. When talking about holism and holistic practice, participants described their holistic practices in various ways, and their accounts reflected different understandings and cultural contexts. Participants characterized a holistic approach as one emphasizing the importance of occupations and activities and helping patients regain independence in their everyday lives. However, they also highlighted the specific challenges they faced, including cultural factors and inadequate resources. Significantly, participants from both Western and non-Western contexts emphasized the importance of holistic practice, suggesting that a dichotomous understanding of Eastern versus Western philosophical approaches does not necessarily make sense in occupational therapy interventions. Therapists' degree of commitment to client-centered practice appears of greater relevance. With its international perspective, our study sheds light on important areas of contemporary occupational therapy practice, including the difficulties occupational therapists face when seeking to cover "everything" in an effort to be more holistic.

Multispecies Occupations Involving Equines: An Action-Oriented Inquiry to Inform Occupational Therapy Practitioners.

Research related to human-animal engagement often fails to address the complexity and nuance present in occupations and occupational therapy services that incorporate animals. The goal of this research was to develop a basic understanding of multispecies occupations (MSO) involving humans and equines, focusing on the action-oriented processes and transactions during socialization in outdoor, non-therapeutic contexts. We employed a multi-modal qualitative design with interviews and videography with n = 6 horse-human dyads, creating opportunities to understand and represent engagement beyond anthropocentric norms. Findings included a variety of dyad-specific features of occupation, including processes of embodied communication, the presence of behavioral synchrony, and perceptions of attunement arising from these processes. Examining MSO via a multi-modal inquiry offers new perspectives about the nature and experience of such occupations and supports a deeper understanding of potential mechanisms of change when animals are incorporated in occupational therapy interventions and practice.

Investigating the Occupational Performance Problems in Individuals with Multiple Sclerosis in Relapsing-remitting Phase: A Cross-sectional Study

Introduction: Multiple sclerosis (MS) is one of the most common disabling neurologic diseases worldwide. Although occupational performance problems are reported in many people living with MS, there is little information on these problems in people with relapsingremitting MS (RRMS). This study aims to determine occupational performance problems in people with RRMS.
 Materials and Methods: The Canadian occupational performance measure was used to collect data from 58 participants in the age range of 20 to 50 years. The participants were recruited via the convenience sampling method from a neurology outpatient unit in a general hospital in Tehran City, Iran, in 2020. The data were analyzed using the Spearman, ManWhitney, and Kruskal-Wallis tests.
 Results: A total of 91 activities in self-care, 96 activities in productivity, and 67 activities in leisure were identified by the participants as their priorities. No significant difference was observed between the mean scores of occupational performance with age, gender, employment status, and marital status. Still, there was a considerable difference between occupational performance and education level.
 Conclusion: People with RRMS suffer from many occupational performance problems, especially in productivity areas. Although occupational therapy interventions are essential in promoting self-care and activities of daily living, engaging in productive and instrumental activities of daily living is more cost-effective and valuable to promote independence in people with RRMS.

Perspectives on Promotion of Quality of Life for Individuals Recovering from Substance Abuse: Priority for Occupational Therapy Programmes

The prevalence of substance abuse in South Africa is growing fast, impacting negatively on quality of life. Individuals abusing substances present with impaired occupational functioning, which warrants occupational therapy intervention. Meaningful engagement in occupations contribute to well-being and quality of life of an individual. It is important for the occupational therapist to be aware of the enhancers of quality of life for the intervention programme of persons living with substance use issues. The barriers of quality of life need to be addressed in the programme in order to guard against relapse. A holistic approach to the intervention of substance abuse is of paramount importance.

Effectiveness of occupational therapy interventions on function and occupational performance among adults with conditions of the hand, wrist, and forearm: A systematic review and meta-analysis.

This systematic review and meta-analysis examines the effectiveness of occupational therapy interventions for adults with conservatively managed conditions of the hand, wrist, and forearm. Searches were carried out in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, MEDLINE (OVID), EMBASE, and PubMed. Grey literature was searched for via Google Scholar. A systematic literature search was undertaken for randomised studies that examined occupational therapy interventions for treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of occupational performance, satisfaction with occupational performance, pain, and quality of life. Meta-analyses were completed, and GRADE was used to determine the certainty of evidence. Twelve studies with 1429 participants were identified. Interventions included combinations of occupation-based intervention, assistive device provision, education, orthosis provision, and exercise programmes for arthritis, carpal tunnel syndrome, and fracture and tendon injuries of the hand, wrist, and forearm. Occupational therapy resulted in an improvement of function (REM, SMD -0.27, 95% CI -0.00 to -0.53, I2 = 69%, low certainty evidence) (p = 0.05), occupational performance (REM, SMD 0.83, 95% CI 1.61-0.06, I2 = 91%, low certainty evidence) (p = 0.04), satisfaction with occupational performance (REM, SMD 0.74, 95% CI 1.42-0.05, I2 = 89%, low certainty evidence) (p = 0.03), and pain reduction (FEM, MD -1.35, 95% CI -0.84 to -1.86, I2 = 0%, moderate certainty evidence) (p < 0.00001). Further high-quality research is recommended to determine the effects of occupational therapy interventions on specific upper limb conditions, inclusive of a broader range of clinical and patient reported outcome measures.

Sensory modulation interventions for adults with mental illness: A scoping review.

Sensory Modulation Interventions (SMI) assist people with mental illnesses to regulate emotional and physiological arousal. We aimed to conduct a scoping review to identify the study designs, geographical distribution, modality/regimen, barriers and facilitators in using SMI for individuals with mental illnesses. A systematic search was conducted using Arksey and O'Malley's framework with studies published on SMI from January 2010 to November 2020. 17 articles were found to be relevant. One was a case-control study, qualitative (N = 3), mixed-method (N = 3), and case studies (N = 3), and the rest were pilot interventional studies (N = 8). The duration of sessions ranged from 2 to 30minutes for 2days to 3years. The facilitators in using SMI were of being cost-effective and easily adaptable. Barriers were in terms of maintenance of sensory items. Sensory modulation based items related to proprioception, vestibular and tactile were the frequently used in the SMI based interventions used in the included studies. SMI as an occupational therapy intervention for individuals with mental illnesses is evolving and more robust studies in the future are recommended.

Caregiver Support Role in Occupational Therapy Video Telehealth: A Scoping Review.

Caregiver involvement may facilitate patient participation in occupational therapy (OT) video telehealth. However, little is known about the extent to which caregivers participate and what they do. This scoping review aims to, 1) describe the caregiver role supporting patient participation in OT video telehealth, and, 2) identify barriers and facilitators to caregiver involvement. Findings reveal caregiver involvement in a range of OT evaluation and intervention processes, with details on what caregivers did overall lacking. Barriers and facilitators are also described. This study underscores the need for clear and robust descriptions of caregiver participation to increase best practices in video telehealth.

Exploring the Evolution and Utility of Neuro-Occupation: A Scoping Review.

Neuro-occupation was developed to study the relationship between the nervous system and occupation. Pragmatic implications of neuro-occupation have not been previously summarized. This study aimed to determine how neuro-occupation has been defined, applied across relevant fields, and evolved over time. We performed a scoping review following the Arksey and O'Malley framework. Twenty-five works related to neuro-occupation published between 1997 and 2020 were included. We found that neuro-occupation evolved from utilization primarily in the United States to an international term applied to different clinical populations. Common themes were: (a) the reciprocal relationship between the nervous system and occupations; (b) the Intention, Meaning, and Perception (IMP) model of neuro-occupation; and (c) pragmatic implications for occupational therapy practice and interventions. We suggest an updated definition of neuro-occupation. In addition, we contend that although the term neuro-occupation was developed in response to historical debates in occupational therapy, continued use creates more confusion than clarity.

Individuals with Eating Disorders’ Perspectives on a Meal Preparation Intervention

Meal preparation interventions involve people actively cooking food item(s). This study sought to add to the minimal literature by researching patients’ perceptions of the effectiveness of occupational therapy meal preparation activities in preparing them for lower levels of care. Participants engaged in meal preparation groups as part of standard occupational therapy treatment. Quantitative and qualitative data were concurrently analyzed using an embedded mixed-methods approach. Many participants (72%) felt prepared to transition to a lower level of care because of the meal preparation groups. These groups appear to offer critical and beneficial experiential learning for individuals in treatment for eating disorders.

The lived experiences of adults with learning disabilities: Taking part in a community gardening group

Introduction: People with Learning disabilities (LD) are marginalised within society and experience reduced occupational participation compared to the general population. Research exploring the lived experiences of adults with LD is limited. Gardening has a long history as an Occupational Therapy (OT) intervention with evidence of its benefits for well-being. Yet, previous work with adults with LD has focused on the perspective of the practitioner and has failed to address participant experience. This study aimed to understand the lived experiences of people with LD taking part in a gardening group. Methods: Adults with LD, participating in a charity-run gardening group were recruited to a qualitative, phenomenological study. With consent, participants engaged in a semi-structured interview exploring their experiences of being a member of the gardening group. Thematic analysis was utilised to interpret the results. Results: Seven interviews were completed. Four main themes indicated that the gardening group helped aid relaxation, provided sense of achievement, developed practical and social skills, and was a lifeline to make friendships. Conclusions: OTs should utilise these findings to inform practice and reduce occupation deprivation. Future research should explore how environment, activities and participation time, impact the occupation of gardening for adults with a LD.

Feasibility of using the Cognitive Orientation to daily Occupational Performance in a population of Danish stroke survivors: Adaptation and study protocol

Background A need was identified for an occupational therapy intervention for stroke survivors in a Danish municipal healthcare setting with emphasis on its ability to transfer and generalise what is learned in occupational therapy to everyday life post therapy. Being a possible candidate, the Cognitive Orientation to daily Occupational Performance (CO-OP) approach needed to be adapted to the target group and context, and its feasibility needed examination regarding reach, dose, intervention components, fidelity, perceived value, benefits, harms, and potential outcomes. Aim To adapt the CO-OP to a Danish healthcare setting and present a protocol for examining its feasibility. Material and methods The Adapting interventions to new contexts (ADAPT) guidance was followed to (1) Assess the rationale for intervention and consider intervention-context fit, (2) Plan and undertake adaptations, and (3) Plan a feasibility study. Results Intervention materials and procedures were translated and adapted for home-based occupational therapy with people in the subacute phase of stroke. A protocol was developed to examine feasibility aspects. Quantitative and qualitative evaluations were planned and measurements chosen. Conclusions and significance The planned feasibility study will contribute to further developing and refining the intervention before performing a possible large-scale effectiveness study.

A scoping review of sleep management as an occupational therapy intervention: expanding a niche area of practice in mental health

Purpose This study aims to examine the existing literature on sleep-related interventions and confirm the intervention methods and their effectiveness led by occupational therapists. Design/methodology/approach All the relevant literature published from 2010 to June 31, 2022, in five prominent databases were searched using the five-stage review framework proposed by Arksey and O’Malley. Findings In this review, four types of sleep-related interventions were led by occupational therapists (tool use, exercise program, sleep education and occupational-based program). When the intervention was analyzed based on its content, occupational therapists demonstrated excellent ability in interventions based on sensory intervention and lifestyle redesign. Originality/value Various factors cause sleep problems; hence, the development of individualized and extensive occupational therapy intervention methods is required.

İnsan Aktivite Modeli Temelli Ergoterapi Müdahalesinin Aile İçi Şiddet Yaşayan Kadınlarda Etkinliği

Purpose: Experiences of violence negatively affect women's independence and daily activities. The aim of this study was to investigate the effectiveness of the "Model of Human Occupation (MOHO)"-based occupational therapy intervention on the occupational competence and occupational participation of women affected by domestic violence and living in a women's shelter. Materials and Methods: The MOHO-based occupational therapy program, which includes 10 intervention areas, was applied to 13 women in two women’s shelters. Four-week (16 sessions) individual and group training and environmental interventions were provided. Participants' occupational competence was assessed with the “Occupational Self-Assessment” and occupational participation with the “Model of Human Occupation Screening Tool”. Assessments were conducted before the intervention, after the intervention, and at the 3-month follow-up. Results: Statistically significant differences were found in occupational competence (p=0.002) and occupational participation (p=0.004) between pre-intervention and 3-month follow-up assessments. Improvements were noted in all domains (OSA-competence, and volution, habituation, communication-interaction, process skills, and environment parameters of MOHOST) (p0.05). Discussion: MOHO-based occupational therapy interventions delivered in women's shelters could have a positive impact on the occupational competence and occupational participation of women experiencing violence.

75 The COVID-19 pandemic and social frailty: an evaluation of Occupational Therapy practice in a day hospital

Abstract Background Restrictions imposed to limit transmission of COVID-19 and to protect vulnerable persons led to loss of roles and routines, social isolation, sedentary lifestyles, increased anxiety, depression, and increased frailty among older people. In Occupational Therapy (OT) literature, ‘occupational deprivation’ describes this state of enforced disengagement in meaningful occupations which negatively impacts wellbeing. Clients attending a Day Hospital for Comprehensive Geriatric Assessment (CGA) reported residual elements of occupational deprivation and negative effects of COVID-19 restrictions with associated social frailty. OT practice was evaluated to determine the extent of services offered to remediate or improve social frailty and overall wellbeing. Methods During CGA, OTs assess clients’ occupational performance including cognition, mood, mobility, social environment and engagement in meaningful occupations. Routine (quantitative) data collected to evaluate the service was inputted and analysed using Microsoft Excel. OTs logged numbers of clients referred to services to remediate social frailty including day centres, social prescribing and an OT-led anxiety management group in the Day Hospital. Six months of data in 2023 was analysed. Results 288 clients received CGA by OT. The average age was 83. 33% were referred to Memory Technology Resource Rooms. 6% were referred to Day Centres or Active Retirement. 7% were referred to OT anxiety management group in the Day Hospital. 3% were referred to ALONE befriending. As part of routine OT practice, almost all clients were advised to continue with or to re-engage with previously enjoyed (meaningful) occupations such as attending mass, playing bridge, and visiting friends. Conclusion Occupational deprivation experienced by older adults during the COVID-19 pandemic contributes to increased social frailty. Older adults attending a Day Hospital received routine OT intervention focusing on enhancing their wellbeing and reversing social frailty associated with the COVID-19 restrictions. Assessment and management of social frailty is vital to understand the effects of the pandemic on older people and provide appropriate services.

Cognitive-behavioral Interventions in Occupational Therapy for Chronic Upper Limb Pain - A Qualitative Study

Aim: Within the framework of the Perezoso research group at the Carinthian University of Applied Sciences, which deals with the interdisciplinary treatment of patients with osteoarthritis, it was necessary to focus on the topic of pain. Therefore, the present research work was conducted. But beyond that, it's also essential for the increasing knowledge and awareness in the field of (chronic) pain especially in occupational therapy but also in other health professions. Background: In the treatment of chronic pain, occupational therapists use cognitive-behavioral therapy interventions (CBT) among other methods. The aim is to learn new behaviors and to question and change negative interpretations and constructions. Possible effects of CBT in chronic pain can be a reduction of pain, anxiety, disease activity, psychological effects and disability on the one hand and an increase in self-efficacy, pain control and quality of life on the other hand. Methods: To find out how occupational therapists apply CBT when treating clients with chronic upper limb pain, a systematic literature search was conducted in various databases. Within the framework of a qualitative research approach, five experts were interviewed using semi-structured guided interviews. The transcription was done according to Dresing and Pehl, supplemented by Rädiker and Kuckartz and was analyzed using the deductive-inductive approach by means of qualitative content analysis according to Elo and Kyngäs. Results: The approach is highly individualized, but aims to incorporate both the biological, social and psychological aspects of chronic pain. Everything from individual or group sessions, inpatient or outpatient stays and different emphases are involved. Pain education, awareness and coping measures are applied. Through the orientation to everyday life, a distinction is made between occupational therapy and other professions. The involvement of relatives is sometimes considered useful, but the final decision should be made by the clients. Discussion and Conclusion: Different pain patterns as well as hardly any current studies, especially in which occupational therapists explicitly apply CBT, only lead to a limited comparability. There is a need for more psychological and interdisciplinary interventions in order to be able to optimally treat clients with persistent pain. An advanced knowledge of pain, conversation management or CBT is considered essential.

Success or Failure? Are We Meeting the Needs of Children With Developmental Coordination Disorder?

Background. Current international clinical practice guidelines indicate that children with developmental coordination disorder (DCD) should receive therapy, yet school and community-based occupational therapy is not standard of care. Purpose. To understand parent perspectives on best practice for treatment and what supports and services are required to meet their children's needs. Method. An online cross-sectional survey (impACT for DCD) was distributed to parents of children <18 years with self-reported suspected or diagnosed DCD living in British Columbia. Data analysis included descriptive statistics and contingency analyses to explore whether access to therapy differed with income, age of child, or geographical location. Open-ended questions were analyzed using content analysis. Findings. Of the 237 respondents, 194 children had suspected/confirmed DCD; however, only 20% (38/198) of the children had received therapy at school. Some parents (32/58) pursued private therapy. Geographic location and income had no relationship with therapy access (p > 0.05). Parents expressed frustration with poor awareness and understanding of the impact of DCD among educators, health-care professionals, and community members, and identified the need for funded and accessible school and community services and supports. Conclusion. Evidenced-based occupational therapy intervention should be standard of care for children with DCD as per clinical guidelines and parent-identified need.