Occupational Therapy Practice Research Articles

The development of quality indicators to increase effectiveness and efficiency in school-based practice

ABSTRACT Effective measures of the quality of services provide transparent and accountable standards to examine and illustrate high-quality care and contributions to client outcomes. They identify priorities for professional development action planning and allow practitioners to detect gaps in knowledge. Drawn from the need to measure and articulate effectiveness and to guide quality improvement efforts, the Quality Indicators of School Practice (QISP) was developed to provide school-based occupational therapy practitioners and collaborators a mechanism to examine occupational therapy practice, consider its contextual meaning, and illustrate the application of the indicators in practice. A rigorous and extended process grounded in content analysis, reflection, and member checking was used to develop the resource. The QISP creates a baseline to strengthen the profession’s knowledge of school practice, reduces barriers to evidence implementation, provides meaningful data for practitioner reflection and best practice decision making, and offers occupational therapy and its collaborators a deepened and consistent understanding of what effective and efficacious occupational therapy looks like in school settings.

Implementation of Learn to Play Therapy for Children in Special Schools.

Play is the primary occupation in childhood and fundamental to occupational therapy practice. To evaluate a play intervention in special school settings. Pre- and postinvolvement of a 7-mo play program. Four special schools in Victoria, Australia, for children with IQs < 70. Thirty-eight children with diagnoses including intellectual disability, autism, and global developmental delay, 7 teachers, 2 speech pathologists, and 2 occupational therapists. Learn to Play Therapy for 1 hr per week over a 7-mo period. Pre-post outcome measures included children's pretend play skills, language, social skills, emotional regulation, and academic competence. Mean age of 38 children (15 girls and 23 boys) at baseline was 5 yr 7 mo (SD = 0.46 yr). Results showed significant changes in children's pretend play (p = .03), ability to recall sentences (p = .02), social skills (p = .022), and academic competence (p = .012). Learn to Play had a large effect on children's narrative skills (d = 2.72). At follow-up, object substitution at baseline influenced expressive language (p < .001), narrative mean language utterance (MLU; p = .015), social skills (p < .001), and academic competence (p < .001); elaborate play at baseline plus time influenced social skills (p < .001); and elaborate play at baseline influenced narrative MLU (p =. 016), sentence recall (p = .009), and academic competence (p = .001). Embedding pretend play within practice positively influenced children's language, narrative, social, and academic skills. Plain-Language Summary: This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. Children participated in Learn to Play Therapy, during which an occupational therapist, who has observed and assessed the child's play and understands the child's play abilities, played beside the child. Learn to Play Therapy is a child-centered therapy that is used to increase a child's ability to self-initiate and enjoy pretend play. The positive impacts of supporting the children's pretend play ability were highlighted by increases in their pretend play, language, social skills, academic competence, and narrative language after participating in Learn to Play Therapy in their special schools.

Culturally responsive occupational therapy practice with First Nations Peoples-A scoping review.

First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce-cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment. To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework. A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors. OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident. Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems. To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.

Integrating nature into practice: Occupational therapists’ perspectives

ABSTRACT Nature-based settings are unique in that they enhance occupational performance and well-being. Subsequently, the use of nature has recently been adopted by schools as a supplemental environment to support student performance and educational outcomes. While previous studies have investigated the effects of nature on general education students and educator impressions, little research exists regarding the perceptions of school-based occupational therapists (OTs) who use outdoor environments and their impact on special education students. This qualitative pilot study will examine the perceptions of school-based OTs who provide interventions to special education students in nature-based settings. A phenomenological approach will capture the essence of OTs’ experiences to better understand why and how OTs use nature in school-based practice, perceived benefits and challenges, and the roles they assume as they implement nature-based interventions within their schools. Study results will inform and enhance occupational therapy practice by increasing the awareness and understanding of an alternative learning environment to support students who receive special education services.

Occupational therapy practice for post-acute COVID-19 inpatients requiring rehabilitation.

COVID-19 caused significant occupational disruption to people's life roles, with some people requiring an inpatient rehabilitation admission. Occupational therapists assessed and treated these patients using previous knowledge of similar conditions due to limited specificity in available guidelines to inform practice. The aim of this study was to investigate current practice with post-acute COVID-19 (PAC) patients within an inpatient rehabilitation setting in Australia, to better understand the role and impact of occupational therapy. A mixed-method study was conducted, including electronic medical record audits (October 2021 October 2022) and descriptive patient interviews at a large metropolitan subacute service. Descriptive statistics and qualitative analysis were used to summarise and interpret data. No involvement. A total of 24 patient electronic medical records were audited, and 10 patient interviews were completed. Three overarching categories were identified within the 685 occasions of occupational therapy service audited-occupational engagement, education provision and discharge planning. Patients identified the value of occupational therapy by reflecting on their lived experiences of engaging with occupational therapists and associated changes in occupational performance between COVID-19 diagnoses and discharge home. Occupational therapists possess a unique skill set that directly addresses the occupational needs and priorities of PAC patients. This study adds to the growing body of evidence supporting the contribution of occupational therapy to the management of COVID-19; however, further research is needed to develop evidence-based practice resources and advocate for system changes that improve quality of life for COVID-19 patients. During the COVID-19 pandemic, a lot of people got very sick. Some of these people needed more time and support to get better. Occupational therapists were important during this time because they helped these people to do their daily activities again. Because there were not many resources on how to do this, we looked into what occupational therapists were doing to help these people. We looked at patient hospital files and also talked to them to understand this better. We found that occupational therapists focused on three main areas: helping patients do activities that were important to them, teaching them about COVID-19 and helping them plan to leave the hospital. This study shows that occupational therapists are skilled at helping people with COVID-19. But more research is needed to make resources and also help with changing the healthcare system to further help people get better from COVID-19.

Community-Working Occupational Therapists’ Involvement in Research and Development Projects in Norway

The aim of this study was to explore community-working occupational therapists’ involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.

The Effects of Culture and Gender on Occupational Therapy Practice for Adults: From Palestinian Therapists’ Perspective

As the occupational therapy profession is rooted in Western ideals, it may encounter complexities in culturally traditional settings like Palestine, especially for adults. This study reveals the challenges faced by occupational therapists in Palestine. A phenomenological qualitative approach was used, interviewing six experienced female therapists using semi-structured interviews. Purposive sampling ensured a diverse participant selection. Thematic analysis revealed several key themes, such as the continuous adaptation to Western practices to fit the Palestinian context, the value of interdependence, and the unique life balance. Results show that cultural and gender norms significantly shape occupational therapy practices in Palestine. The discussion emphasizes the theoretical necessity for cultural sensitivity in occupational therapy, advocating alignment with local values and addressing resource limitations for effective service delivery.

Attitudes and perceived barriers to evidence-based practice among occupational therapists in Jordan.

Evidence-based practice (EBP) refers to the clinical decision-making process incorporating the best available evidence from research, therapists' clinical experience, and patient values. The current study aimed to examine the experience of Jordanian occupational therapy practitioners (OTs) in using EBP and to identify the perceived barriers to implementing EBP among OTs in Jordan. The study utilized a cross-sectional descriptive study design. A questionnaire was emailed to OTs who have been working in Jordan for the last six months of their practice in a clinical setting. The majority of the participants had a positive attitude toward EBP. However, they reported several barriers to implementing EBP, including a lack of tools and equipment in clinical settings as a major barrier (65.8%). National collaborative actions are needed to develop strategies to improve the utilization of EBP in occupational therapy (OT) practice and to overcome the barriers therapists experience with implementing EBP.

Acceptability and usability of assistive equipment and technology by individuals with multiple sclerosis: A qualitative study with occupational therapists

Introduction: Assistive equipment and technology (AE&amp;T) is often part of occupational therapy practice for individuals with multiple sclerosis (MS). We aim to explore the acceptability and usability of AE&amp;T by people with MS from the perspective of occupational therapists. Methods: Our study applied a qualitative descriptive design, using semi-structured interviews conducted with five qualified occupational therapists with at least 6 months of experience in providing occupational therapy to adults with MS. Reflexive thematic analysis was used for data analysis. Findings: Three developed themes describe the occupational therapists’ experiences: ‘The cognitive impact of the illness rather than the physical’, ‘There’s a drive to not let the MS win’ and ‘They have to experience it by doing’. Therapists perceive cognitive changes, the meaning of technology and a person-centred approach as elements influencing the acceptability and usability of AE&amp;T. Conclusion: Our findings highlight the importance of using core occupational therapy principles and approaches to best support people with MS in using AE&amp;T effectively.

A terapia ocupacional no SUAS: produção e divulgação de conteúdos fomentados por uma comunidade de práticas

The insertion and growth of occupational therapists in the Unified Social Assistance System have generated demands for professional training and dissemination in Brazil. In view of this, the Community of Practice in Occupational Therapy was organized for professionals working in this field. Among its various actions, there was the creation of a Blog and an Instagram account. This article aims to report the trajectory of the creation and maintenance of social media as Community of Practice strategies for the dissemination and visibility of occupational therapy in this policy. 131 publications were identified on the Blog, the majority of which dealt with general topics about SUAS, while 35.2% addressed specific population groups. Instagram had 118 publications and 1425 followers. Analysis of Instagram metrics revealed reach of 1,872 accounts and 7,280 impressions. The Community of Practices initiative highlights the importance of Occupational Therapy in this system, aiming to increase visibility and exchange of knowledge between professionals. In this way, these tools represent successful strategies to strengthen and disseminate the work of occupational therapy in this context through the recognition of methodological strategies, in addition to providing support for consistent action in the field of social assistance.

Using time diaries to inform occupational therapy practice for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: An exploratory study

Introduction: Myalgic encephalomyelitis/chronic fatigue syndrome affects an individual’s occupational participation. There is little understanding in Australia of occupational interventions for myalgic encephalomyelitis/chronic fatigue syndrome. This study explored how Australian adults with myalgic encephalomyelitis/chronic fatigue syndrome use their time and whether the National Institute of Health Activity Record can inform occupational interventions. Method: Using a convergent mixed method, nine participants completed the National Institute of Health Activity Record time diary and five survey questions exploring clinical utility and the impact of myalgic encephalomyelitis/chronic fatigue syndrome. Data analysis included descriptive statistics for time-use data and an inductive thematic analysis for survey responses. Results/Findings: Participants (aged 29–59 years) reported 58% of their time was spent awake and in recreation and leisure occupations. Quantitative data reflected no statistically significant change in participants’ symptoms, performance and motivation throughout the day. Six themes emerged from the qualitative data that highlighted participants’ experiences completing the National Institute of Health Activity Record and the impact of myalgic encephalomyelitis/chronic fatigue syndrome on their time-use. Conclusion and Relevance: The National Institute of Health Activity Record provided insights into a participant’s time-use, which could inform occupational interventions. Modifying the National Institute of Health Activity Record format would improve usability for participants and reduce time for completion. Discussing results and extending the data collection period may capture the impact and fluctuations of myalgic encephalomyelitis/chronic fatigue syndrome more accurately.

Technology trends in practice: A survey of occupational therapy practitioners.

Given the evolving digital revolution, technology and digital tools are becoming inseparable from work and daily occupations. Occupational therapy practitioners (OTPs) focus on supporting individuals in their desired and needed activities. Many of these daily activities (i.e., online banking, shopping, social media, smartphone use) require digital skills at a growing rate, and insufficient technological skills may subject individuals to limited engagement and social isolation. To understand OTPs attitudes regarding technology utilization. We surveyed 109 OTPs about their attitudes, work practices, and barriers to addressing their clients' digital technological functioning. The findings of our study suggest that while OTPs acknowledge the importance and potential benefit of technology for their clients, there is a notable professional gap in the training and skills of OTPs to support their clients' digital functioning effectively and to integrate technology into their practice. There is a need to improve and expand OTP's digital skills and knowledge regarding addressing clients' digital functioning and technology implementation in occupational therapy practice.

Fostering the discussion of planetary health in occupational therapy and physiotherapy.

Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals. This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH. The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field. Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.

Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan.

Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.

Occupational Therapy and Imprisoned Adolescents: An Analysis of Professional Practices.

The care of adolescents in reclusion has been a field of work for occupational therapists in different parts of the world. The objective of this study was to describe and analyze Brazilian occupational therapists' practices with adolescents in reclusion. Research conducted in Brazil, identifying 56 professionals, invited to answer a questionnaire (n = 43); participate in discussion groups (n = 9); and interview (n = 4). Professionals reported different visions that guide their practices, including the identification of individual skills and the profession's possibilities for social action. Occupational therapists have specificities to work in these institutions, highlighting the possibilities of acting with a focus on social change. Practices in occupational therapy can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements that inform the profession. Reflections on the practice carried out, according to a critical perspective, enable a performance in occupational therapy that intends social change.

Profile of paediatric occupational therapy practice in Eastern Mediterranean countries

Background Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries. Aims/objectives This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists’ usage of evidence-based practice in their practice. Material and methods We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children. Results The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice. Conclusion Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist. Significance Within the EM region, knowledge regarding therapists’ practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

Relationship Between Directly Observed Sensory Reactivity Differences and Classroom Behaviors of Autistic Children.

Differences in sensory reactivity are a core feature of autism; however, more remains to be learned about their role in classroom learning. To use direct observational measures to investigate whether there is a link between sensory reactivity differences and classroom behaviors of autistic children. Correlational study. Two special educational needs schools. Children with a clinical diagnosis of autism, ages 5 to 18 yr (N = 53). Sensory reactivity differences were assessed with the Sensory Assessment for Neurodevelopmental Differences. Classroom behaviors were measured using the Behavior Assessment for Children-Second Edition Student Observation System. Total sensory reactivity differences were correlated positively with behaviors that impede learning (r = .31, p < .05) and negatively with behaviors that facilitate learning (r = -.38, p < .05). Hyporeactivity differences were correlated positively with behaviors that impede learning (r = .28, p < .05) and negatively with behaviors that facilitate learning (r = -.31, p < .05). Hyperreactivity and sensory-seeking differences were not significantly correlated with behavior. Results suggest a link between sensory reactivity differences and classroom behaviors, highlighting a need for further research using observational measures in special education settings. Plain-Language Summary: Differences in hyporeactivity for children with autism may play a bigger role in classroom behavior and learning than previous literature has suggested. This has implications in occupational therapy practice for how to tailor support for children with hyporeactivity differences.

Enlightening Stakeholders on the COVID-19 Pandemic Impacts and Preparation for Minimizing Future Pandemics’ Negative Effects on Occupational Therapists

The COVID-19 pandemic has affected all aspects of professional disciplines including occupational therapy; however, little is known about how much of an impact the COVID-19 pandemic affected occupational therapy practice in Ghana. This study examined the impacts, coping strategies, and COVID-19 pandemic lessons for occupational therapy practices in the future. A descriptive qualitative design was employed with a purposive and convenience sampling methods to recruit occupational therapists from four practice settings in Ghana. Semi-structured interviews were conducted with seven participants. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Four major themes were identified from the analysis enlightening stakeholders on the impact and preparation for minimizing the impact of future pandemics on the workloads of an occupational therapist. The major themes are (1) impacts of the COVID-19 on occupational therapy practice and practitioners; (2) aspects or domains of work significantly affected by the pandemic; (3) the existing strategies employed to handle the challenges; and (4) strategies to minimize these challenges in the future. The current study has enlightened stakeholders on the need to make alternate preparations including telehealth, continuous support for telehealth infrastructures, training of practitioners, and research to adapt intervention strategies effectively.

Practicing During the COVID-19 Pandemic: Experiences of Canadian Hospital-Based Occupational Therapists.

Background. The COVID-19 pandemic disrupted hospital operations worldwide, including services delivered by occupational therapists (OTs). Purpose. This study aimed to understand the experiences of OTs at one Canadian, tertiary care hospital during the 2021-2022 period of the pandemic. Method. We used a qualitative descriptive approach to describe the experiences of OTs during the pandemic. Findings. While there were similarities in the 10 participating OTs' experiences, salient differences were largely linked to the method of service delivery. Inpatient OTs benefitted from the support of colleagues and developed coping strategies in response to high levels of workplace stress and anxiety and a perceived lack of support from many levels of society. Clinically, they spent more time on discharge planning with fewer resources. OTs providing virtual/hybrid services experienced unique challenges related to adapting their practice to a virtual platform, including challenges assessing patients. They described benefits associated with virtual/hybrid service delivery and brought up concerns around equity of service provision. Conclusion. OTs in this hospital setting faced challenges in providing patient care and supporting their own wellness during the pandemic. Future research could explore the role of leadership in supporting occupational therapy practice during public health emergencies.

Occupational Therapists’ Experiences in Providing Training to Caregivers of Hospitalized Older Adults: A Way Forward for Occupational Therapy Practice

Aims This study explores the experiences of occupational therapists in training caregivers of hospitalized older adults, with the aim of identifying strategies to enhance this practice. Methods Six occupational therapists participated. Results Two major themes were generated: (1) challenges in providing training to caregivers and (2) ways to improve caregiver training services. Seven sub-themes were also identified. The findings highlighted several challenges regarding the provision of training to caregivers that need to be taken into consideration by occupational therapists, as well as valuable suggestions regarding the need for effective guidelines, appropriate content, and the utilization of technology to support occupational therapists in the provision of quality caregiver training services Conclusions Integrating healthcare professionals’ experiences is vital for improving services, recognizing the need for ­caregiver-centric approaches, emphasizing communication improvement within healthcare teams, and advocating for deeper insights into older adults’ needs, while highlighting the importance of technology integration in caregiver training.