Occupational therapy's oversight: How science veiled our humanity.

BACKGROUND: Occupational therapy's connection to positivist science predates the profession's formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being. AIMS/OBJECTIVES: This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession's preoccupation with positivist science has obscured. METHODS: This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time. CONCLUSION: Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm. SIGNIFICANCE: The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

Exploring communication in families affected by parental chronic pain: An occupational perspective.

BACKGROUND: Family communication about pain is an important therapeutic target when a parent lives with chronic pain. Occupational therapy literature about communication in families affected by parental chronic pain is currently lacking. AIMS/OBJECTIVES: To bring an occupational perspective to communication within families affected by parental chronic pain, to generate insights for practice. MATERIALS AND METHODS: Five families (total n = 19 family members) were recruited into this collective case study. The gathered data included interviews, observations, and personal documents/artefacts. A cross-case analysis of similarities and differences between families was conducted to distil insights about the relationship between occupation and communication about parental pain. RESULTS: Each family develops its own style of communicating about a parent's pain. On a day-to-day basis, pain-related communication is prompted by experienced, observed and/or anticipated occupational disruption brought about by parental pain. CONCLUSIONS: Occupational disruption and occupational responses need to be components of interest, when designing assessments and interventions targeted at communication in families affected by parental chronic pain. SIGNIFICANCE: The findings from this study point to the importance of communication through occupation in families affected by parental chronic pain and suggest novel targets for occupational therapy intervention.

Inter-rater agreement when linking stroke interventions to the extended international classification of functioning, disability and health core set for stroke.

PURPOSE: To uncover the factors that influence inter-rater agreement when extracting stroke interventions from patient records and linking them to the relevant categories in the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. METHOD: Using 10 patient files, two linkers independently extracted interventions and linked the target of the intervention to relevant functions in the ICF. The percentage agreement of extracted interventions and the ICF codes was calculated. Non-matching interventions and codes were further analysed to determine the reasons for poor agreement. RESULTS: A total of 518 interventions were extracted, with 44.01% agreement between the two linkers. Of the non-agree codes and interventions, 43.79% were due to mismatched ICF codes and 56.20% were due to mismatched interventions. Differences were due to linkers (a) extracting interventions from different parts of the patient note (b) differences in interpreting the target of the intervention, and (c) choosing a different code with similar meaning. CONCLUSION: Greater reliability when linking interventions to ICF codes can be achieved by; health services using a consistent progress note that uses ICF language, recording the intervention aim, linkers knowing the aims of each discipline's interventions and using multiple reliability checks and analysis to inform the linking method.Implications for rehabilitationLinking intervention targets to the ICF and to the ICHI is an emerging research field.Development of trustworthy inter-rater reliability methods is needed to achieve its potential to demonstrate the equity, quality and effectiveness of interventions.Independent linking of patient notes to the ICF can identify factors that impact inter-rater reliability.When writing patient notes, health professionals should use a consistent format that identifies the functional target of the intervention using ICF terms.

The occupational impact of bowel cancer: Survivors' voices and advancing the role of occupational therapy assessment and intervention.

INTRODUCTION: The aim of this study was to investigate the occupational impact (i.e., how engagement in occupation is affected) of having had bowel cancer and the role of occupational therapy with bowel cancer survivors and their significant others. METHODS: Two rounds of semi-structured interviews were carried out with individuals who had completed treatment for bowel cancer, with interviews designed to gain insight into their occupational experiences post treatment. Thematic analysis was utilised to construct themes and patterns founded on the perceptions of participants. Analysis involved concurrent data collection and analysis, constant comparative analysis, and iterative analysis. FINDINGS: Eighteen participants were interviewed, with occupational impact evident across multiple aspects of everyday life. Four themes were identified: Changes in eating habits, changes in toileting habits, changes in relationships, and rethinking occupational choices. CONCLUSION: Findings of the occupational impact of having had bowel cancer reveal a possible role for occupational therapists with people affected by bowel cancer. Occupation focused assessments and self-management programmes are identified as a possible means of meeting the needs of this population, making use of the experiences of peers to provide a credible, relatable voice.

Interprofessional practice: the path toward openness.

This article seeks to shed light on the meanings healthcare practitioners attach to practicing interprofessionally and how interprofessional relationships play out in "everyday" practice. It draws on findings from a hermeneutic phenomenological study of health professionals' lived experience of practice, interpreted in relation to Martin Heidegger's concept of a path through the dense forest which leads to an open space where there is no predefined path to follow. Analysis of data from in-depth, semi-structured interviews with 12 health professionals from medicine, midwifery, nursing, occupational therapy, physiotherapy, speech and language therapy, and social work suggests that health practitioners come upon the clearing having walked their own track toward practicing interprofessionally. Our argument is that when: getting to know others; genuine dialogue; trust; and respect are in play, a spirit of interprofessional practice flourishes. The ontological view presented, sheds light on the nature of the relationships and the personal qualities that foster a spirit of interprofessional practice in these human-to-human interactions. It highlights how health practitioners need to be free to enact their humanity; to move beyond the "professional" pathway, which encourages them to leave "who they are" at home.

The unsustainability of occupational based model diagrams.

Background: Occupation-based models are generic explanations of occupational engagement. Their associated diagrams are conceptual tools that represent the key concepts and their interrelationships, which have withstood substantial shifts in the profession's knowledge base and scope over the last 30-40 years.Aims: We aim to bring into question the sustainability of the diagrams used to represent models.Methods: Intellectual history and semiotic analysis are combined as tools for examining the history of selected occupation-based models and the convention of representing them diagrammatically. Our critique employs a hermeneutically inspired semiotic technique to scrutinise the diagrams as stand-alone symbolic objects.Results: We argue that the rigid categorisation and oversimplified structure of diagrams keeps the profession pinned to dated perspectives based in positivism and dualism, bypassing the real, lived experiences of people. Our critique highlights the ontological absences from diagrammatic representations of occupation-based models.Conclusions: The continued practice of depicting models with diagrams needs to change, to create space to integrate other theory and perspectives, such as a more fundamentally human, ontological perspective.Significance: An ontological perspective is important for practice to advance past the dualistic or pluralistic stance the profession has held for decade, to understand how people experience their world rather than how the profession sees a person's world.

The making of occupation-based models and diagrams: History and semiotic analysis.

BACKGROUND.: Models provide a structure for organizing knowledge and facilitating learning and are upheld by occupational therapy as epitomizing the cornerstones of its practice. PURPOSE.: This article briefly examines the scientific history of occupation-based model development in the 1950s before addressing the process of conceptual model making in occupational therapy. Using the theory of semiosis, it explains and takes a critical perspective on conceptual model building in occupational therapy. KEY ISSUES.: Since the surge of development in the mid-1970s, models have grown and undergone some revision. However, while the profession has often contested the definitions of its core terms, it has not challenged the accepted models and diagrams that present the constituents of practice. IMPLICATIONS.: Examining the processes of conceptual model development from a critical, semiotic point of view foregrounds models in the historico-theoretical literature and brings into scrutiny a model's relevancy in current practice.

Interprofessional practice: beyond competence.

Interprofessional practice is commonly discussed in the literature in terms of competencies. In this study we move away from the theoretical notions of criteria, concepts and guidelines to adopt an ontological approach which seeks to stay as close to the lived experience as possible. Our research asked 12 participants from a variety of health disciplines to tell their stories of working interprofessionally. We sought to glean meaning from the lived experience. Our phenomenological hermeneutic approach and interpretation were informed by Heidegger and Gadamer. Rather than offering a thematic overview, in this article we share three stories from the research that were congruent with other stories. The first, told by a doctor, is of a resuscitation in an emergency department. It shows how the effective working together of the interprofessional team was more than each member following a resuscitation protocol. There was 'something' about how they worked together that made this story stand out, even though the patient died. The second story showcases how 'who' the person is makes a difference. This nurse makes an effort to get to know other staff as people, to find common interests. In such a way interprofessional practice comes to flourish. The third story shows how a physiotherapist and a psychologist joined in conversation to seek innovative possibilities for a challenging situation. In such a way each built on the others expertise and were excited at the success they achieved for the patient. From these ontological accounts we have come to see that interprofessional practice flourishes when practitioners are their authentic, caring selves. Who the person is matters.

Working in a spirit of interprofessional practice: a hermeneutic phenomenological study.

Interprofessional practice is recognized as essential to providing patient-centered, collaborative and high quality care, contributing to optimal health outcomes. Understandings of how best to cultivate practitioners able to 'be' and 'become' interprofessional remain problematic. To advance that understanding, this hermeneutic phenomenological study addressed the question: 'What are health professionals' experiences of working with people from other disciplines?' In-depth, semi structured interviews with 12 health professionals from nursing, occupational therapy, physiotherapy, speech and language therapy, medicine, social work, and midwifery were undertaken using a conversation style. Three unifying themes revealed things which appear to be at the 'heart' of interprofessional practice; the call to interprofessional practice, working in a spirit of interprofessional practice and safeguarding and preserving interprofessional practice. This paper focuses on the first two themes. The findings contribute to a deeper understanding of interprofessional practice as a way of being that extends beyond known and measureable skills and knowledge, to dispositions and qualities. Dispositional qualities come from within a person and what they care about, and from experiences that shape their understandings. This study points toward interprofessional practice as being about a spirit. Who people are, what they bring and how they act is what matters.

Facilitating open family communication when a parent has chronic pain: A scoping review.

BACKGROUND: When a parent has chronic pain, family communication can become strained. Clinicians are encouraged to identify and support families struggling with open communication. Occupational therapists are commonly involved in the provision of pain management services but their role in facilitating open communication in families affected by this condition has not been clearly articulated. OBJECTIVE: To develop a comprehensive understanding of what is being done and/or thought to be helpful for facilitating open communication in families affected by chronic pain, in order to articulate the role of occupational therapy in this area of care. METHODS: A scoping review was conducted and 24 items analyzed using qualitative content analysis. RESULTS: The facilitation of open communication in families affected by parental chronic pain is dependent on a variety of factors, including the skills that members possess and occupations which they perform individually and together. It can also be prompted by relationship tension or a family accessing professional support. Occupational therapy literature on the matter is currently limited and focused on assertiveness training. CONCLUSION AND SIGNIFICANCE: There is scope for occupational therapist to extend their role beyond assertiveness training and use occupation-centered interventions to facilitate communication within families affected by parental chronic pain.

Showers: from a violent treatment to an agent of cleansing.

In the early nineteenth century, physicians designed the first manufactured showers for the purpose of curing the insane. Sustained falls of cold water were prescribed to cool hot, inflamed brains, and to instil fear to tame impetuous wills. By the middle of the century showers had appeared in both asylums and prisons, but shower-related deaths led to their decline. Rather than being abandoned, however, the shower was transformed by the use of warm water to economically wash the skins of prison and asylum populations. In stark contrast to an involuntary, deliberately unpleasant treatment, by the end of the century the shower was a desirable product for the improvement of personal hygiene and population health.

Cluster-randomised controlled trial of an occupational therapy intervention for children aged 11-13 years, designed to increase participation to prevent symptoms of mental illness.

BACKGROUND: The impact of occupational therapy on mental health outcomes for children is largely unexplored. The aim of this study was to investigate an evidence-based occupational therapy intervention designed to increase participation in daily occupations to prevent symptoms of mental illness for children and run in schools. METHODS: The study used a pragmatic, cluster-randomised controlled trial design with two arms. Fourteen clusters (schools), equating to 151 child participants, were stratified by school decile-rank category and block randomised. Blinding of participants post-randomisation was not feasible; however, outcomes assessors were blinded. Outcomes were measured at baseline, after the parallel and crossover phases, and at follow-up; and were anxiety symptoms (primary), depression symptoms, self-esteem, participation and wellbeing. Intention-to-treat analysis was applied and mixed linear modelling was used to account for clusters and repeated measures, and to adjust for covariates identified. RESULTS: This trial found significant positive effects of the intervention on child-rated satisfaction with their occupational performance and teacher-rated child anxiety. No evidence was found to support the effect of the intervention on anxiety and depression symptoms, self-esteem and wellbeing. CONCLUSIONS: This was the first known cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. No compelling evidence was found to support the use of the intervention in schools in its current format, however, results were promising that the focus on occupations influenced participation. Recommendations are made to redesign the intervention as an embedded intervention in the classroom, cotaught by teachers and including parental involvement.

Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning, Disability and Health Core Set for Stroke.

PURPOSE: This study aim was to evaluate whether the Extended International Classification of Functioning, Disability and Health Core Set for Stroke captured the interventions of a community stroke rehabilitation team situated in a large city in New Zealand. It was proposed that the results would identify the contribution of each discipline, and the gaps and differences in service provision to Maori and non-Maori. Applying the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in this way would also inform whether this core set should be adopted in New Zealand. METHOD: Interventions were retrospectively extracted from 18 medical records and linked to the International Classification of Functioning, Disability and Health and the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. The frequencies of linked interventions and the health discipline providing the intervention were calculated. RESULTS: Analysis revealed that 98.8% of interventions provided by the rehabilitation team could be linked to the Extended International Classification of Functioning, Disability and Health Core Set for Stroke, with more interventions for body function and structure than for activities and participation; no interventions for emotional concerns; and limited interventions for community, social and civic life. Results support previous recommendations for additions to the EICSS. CONCLUSIONS: The results support the use of the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in New Zealand and demonstrates its use as a quality assurance tool that can evaluate the scope and practice of a rehabilitation service. Implications for Rehabilitation The Extended International Classification of Functioning Disability and Health Core Set for Stroke appears to represent the stroke interventions of a community stroke rehabilitation team in New Zealand. As a result, researchers and clinicians may have increased confidence to use this core set in research and clinical practice. The Extended International Classification of Functioning Disability and Health Core Set for Stroke can be used as a quality assurance tool to establish whether a community stroke rehabilitation team is meeting the functional needs of its stroke population.

Translating knowledge into practice: An exploratory study of dementia-specific training for community-based service providers.

Objective To develop, deliver, and evaluate dementia-specific training designed to inform service delivery by enhancing the knowledge of community-based service providers. Methods This exploratory qualitative study used an interdisciplinary, interuniversity team approach to develop and deliver dementia-specific training. Participants included management, care staff, and clients from three organizations funded to provide services in the community. Data on the acceptability, applicability, and perceived outcomes of the training were gathered through focus group discussions and individual interviews. Transcripts were analyzed to generate open codes which were clustered into themes and sub-themes addressing the content, delivery, and value of the training. Findings Staff valued up-to-date knowledge and "real stories" grounded in practice. Clients welcomed the strengths-based approach. Contractual obligations impact on the application of knowledge in practice. Implications The capacity to implement new knowledge may be limited by the legislative policies which frame service provision, to the detriment of service users.

Quality and Reporting of Cluster Randomized Controlled Trials Evaluating Occupational Therapy Interventions: A Systematic Review.

Growing use of cluster randomized control trials (RCTs) in health care research requires careful attention to study designs, with implications for the development of an evidence base for practice. The objective of this study is to investigate the characteristics, quality, and reporting of cluster RCTs evaluating occupational therapy interventions to inform future research design. An extensive search of cluster RCTs evaluating occupational therapy was conducted in several databases. Fourteen studies met our inclusion criteria; four were protocols. Eleven (79%) justified the use of a cluster RCT and accounted for clustering in the sample size and analysis. All full studies reported the number of clusters randomized, and five reported intercluster correlation coefficients (50%): Protocols had higher compliance. Risk of bias was most evident in unblinding of participants. Statistician involvement was associated with improved trial quality and reporting. Quality of cluster RCTs of occupational therapy interventions is comparable with those from other areas of health research and needs improvement.

The Mutual Relationship Between Immigrants' Disrupted Everyday Activities and Their Health: A Grounded Theory of Experiences of Korean Immigrants Settling in New Zealand.

For Asian immigrants, immigration has the potential to disrupt all familiar routines. That is a threat to their health and well-being. This grounded theory study explored how immigrants adjust to a new environment by analyzing the experiences of 25 Korean immigrants in New Zealand. The findings suggest that immigration is a stress-inducing phenomenon that requires adjustment of valued activities and adversely affects their health. In response, participants worked on regaining control over disrupted activities by opting for two world perspectives. The study helps social workers to develop effective interventions and services for immigrants to better handle health problems.

The experience of having psoriasis through the lens of the International Classification of Functioning, Disability and Health (ICF).

BACKGROUND/OBJECTIVE: The International Classification of Functioning, Disability and Health (ICF) was developed by the World Health Organization to comprehensively describe the ways that health conditions can affect people. The identification of ICF categories of most relevance to people with a particular disease can increase the usefulness of the ICF and create a reference for outcome studies. This study aimed to ascertain, through focus group interviews with psoriasis patients and an online Delphi survey with health professionals, the impacts of psoriasis as categorised by the ICF. METHODS: We conducted and transcribed verbatim focus group interviews with 32 outpatients with psoriasis from two New Zealand cities. The interview transcripts were analysed to yield meaning units and concepts contained in the meaning units were extracted. These concepts were linked to ICF categories. An online Delphi survey among 23 health professionals was conducted to obtain similar information. The ICF categories were rated for their perceived relevance to psoriasis by health professionals over three iterations. RESULTS: In total, 32 patients participated in six focus groups. Interview saturation was reached after five focus groups. The concepts were linked to 83 ICF categories and two separate health conditions. Among health professionals, 167 ICF categories were rated, mostly in the moderately relevant (four to six) range. CONCLUSION: Applying the established method of meaning condensation to focus group interview transcripts allowed the accurate linking of concepts to ICF categories. This will be of use to researchers developing the first ICF core set for psoriasis in the future.

Dementia: The need for attitudinal change.

OBJECTIVE: To undertake a systematic inquiry into the experience of living with dementia in the community. DESIGN: Action research, underpinned by critical hermeneutics, brought together action and reflection, theory and practice to generate knowledge. Data were gathered by interviews and observations in participants' homes, and focus group discussions in community settings. PARTICIPANTS: Eleven people with mild to moderate dementia and their primary caregiver aged 59-84, living in Auckland, New Zealand. RESULTS: The findings reveal a conflict between living positively with dementia, and enduring the negative attitudes that typify the dominant social discourse. The central argument arising from the findings is the significance of personal attitudes. CONCLUSIONS: Implications for policy makers, health care providers, and caregivers highlight the need to change the ways in which dementia is perceived. The pursuit of positive attitudes will do much to change social perceptions and enable people with dementia to live with a sense of well-being.

Cluster-randomised controlled trial of an occupational therapy group intervention for children designed to promote emotional wellbeing: study protocol.

BACKGROUND: Symptoms of anxiety and depression are common in childhood, as are risk factors that undermine wellbeing: low self-esteem and limited participation in daily occupations. Current treatments focus primarily on modifying internal cognitions with insufficient effect on functional outcomes. Occupational therapists have a role in measuring and enabling children's functional abilities to promote health and wellbeing. To-date there is no evidence for the use of occupational therapy as an intervention to promote mental health or increase self-esteem, participation and wellbeing in a preventative context. The aim of this cluster-randomised controlled study is to investigate the effectiveness of an 8-week occupational therapy group intervention (Kia Piki te Hauora) at reducing symptoms of anxiety and depression and improving self-esteem, participation and wellbeing in children aged 11-13 years. METHODS/DESIGN: In this two-arm, pragmatic, cluster-randomised controlled trial, 154 children will be recruited from 14 schools. All mainstream schools in the region will be eligible and a convenience sample of 14 schools, stratified by decile ranking (i.e. low, medium, and high) will be recruited. Eight to twelve students aged 11-13 years from each school will be recruited by senior school personnel. Following consent, schools will be randomised to either the intervention or waitlist control arm of the trial. The study will employ a parallel and one-way waitlist-to-intervention crossover design. Each cluster's involvement will last up to 19 or 31 weeks depending on allocation to the intervention or waitlist respectively. The primary outcome is symptoms of anxiety and secondary outcomes are symptoms of depression, self-esteem, participation in daily occupations and wellbeing. Outcome measurement will be repeated at baseline, post-intervention and again at 8-9 weeks follow-up. Planned statistical analyses will utilise repeated measures analysis of covariance. The primary analysis will be based on an intention-to-treat analysis set and include only parallel data. The crossover data will only be used in secondary analyses. DISCUSSION: This is the first cluster-randomised controlled trial to investigate an occupational therapy intervention promoting emotional wellbeing in a non-clinical sample of children. Results will contribute to the limited evidence base for occupational therapists in this field and potentially support investment in these services. TRIAL REGISTRATION: Australia/New Zealand Clinical Trials Register: ACTRN12614000453684.

Capturing the stories behind the numbers: the Auckland Regional Community Stroke Study (ARCOS IV), a qualitative study.

BACKGROUND: Qualitative data can add value and understanding to more traditional epidemiological studies. This study was designed to complement the quantitative data from the incidence study the Auckland Regional Community Stroke Study or ARCOS-IV by using qualitative methods to uncover the richer detail of life as a stroke survivor, thereby extending our understanding of the impact of stroke. AIMS: The aims of the study were to identify how the experience of recovery and adaptation changes over time after stroke; and to elicit the strategies people with stroke and their whanau/family use and find helpful in living life after stroke. The aim of this paper is to describe the methodology and also the challenges and advantages of embedding qualitative research into a large epidemiological study. METHODS: Longitudinal study utilizing a Qualitative Description design in a subset of those taking part in the incidence study. Participants will be interviewed at 6, 12, 24, and 36 months after stroke. Semistructured interviews will explore three key areas: (1) issues of importance to people following a stroke and their whanau/family; (2) the perceived impact on people's sense of recovery, adaptation, and hopes; and (3) key strategies that people with stroke and their whanau/family use and find most helpful in living life after stroke. Thematic analysis will be conducted using iterative constant comparative methods. CONCLUSIONS: This methodology paper demonstrates the application of mixed methods in epidemiology. It also considers some of the practical and methodological issues that have emerged and may provide a useful framework for other qualitative projects in population-based studies.