A meditation on the use of hands. Previously published in Scandinavian Journal of Occupational Therapy 1995; 2: 153-166.

The theme of mind-body unity is fundamental to occupational therapy. Nonetheless, the field continues to embrace a dualism of mind and body. This dualism persists because the field views the body only as an object, ignoring how the body is lived. Drawing upon phenomenological discussions of bodily experience, this paper illustrates how the lived body is a locus of intelligence, intentionality, adaptiveness, and experience. It also considers the bodily ground of motivation and thought and discusses how the body constitutes and incorporates its world. Finally, the paper considers implications of the lived body for therapy.

Psychometric properties of the second version of the Occupational Performance History Interview (OPHI-II).

OBJECTIVE: This study examined the validity of the Occupational Identity, Occupational Competency, and Occupational Behavior Settings scales of the second version of the Occupational Performance History Interview (OPHI-II). The study also asked whether the scales' items were targeted to and could effectively discriminate between persons at different levels of adaptation. METHOD: Data were collected from 151 raters on 249 subjects from eight countries and in six languages. Many-faceted Rasch analysis was used to analyze the data. RESULTS: The items of each scale worked effectively to measure the underlying construct for which they were designed. All three scales validly measured more than 90% of the subjects, who varied by nationality, culture, age, and diagnostic status. Each scale's items were appropriately targeted to the subjects, and all three scales distinguished subjects into approximately three different levels. More than 90% of the raters used the three scales validly and had approximately the same degree of severity or leniency. The scales were valid across subjects with physical dysfunction and psychiatric conditions as well as subjects with no active diagnosed condition. CONCLUSION: The three scales of the OPHI-II are valid across age, diagnosis, culture, and language and effectively measure a wide range of persons. Raters can readily use the OPHI-II validly without formal training.

Narratives and experience in an occupational transition: a longitudinal study of the retirement process.

This article presents the results from a longitudinal study of retirement. Data were collected through interviews with 12 Swedish participants over a 7-year period, beginning when they were still working and continuing through their early years of retirement. The findings show that the participants' narrative anticipations of retirement interacted with the events of ongoing life. Sometimes these events influenced the outcomes of the retirement process unpredictably. Consequently, retirement was often full of surprises and temporary periods of turbulence. Although some participants managed a transition into a satisfying pattern of retirement, others found it an ongoing process of frustration and dissatisfaction. Evidence from this longitudinal study indicates that a special type of occupation--engaging occupation with six constituents--was an important determinant of retirement satisfaction. This key finding is discussed with regard to its implications for theory development as well as its practical implications related to the importance of differentiating occupations and attending to the interaction between internal motivation and external expectations in the occupational pattern.

Evolving narratives in the course of retirement: a longitudinal study.

This paper presents results from the second phase of a longitudinal study of retirement. Data were gathered through interviews with 29 participants (65 to 66 years of age) who had previously been interviewed when they were 63 to 64 years of age and still working. Data were analyzed by characterizing each subject's narrative about retirement in terms of its narrative slope--progressive, stability, or regressive. These current narratives also were compared with the earlier narratives these participants told. It was found that, while anticipatory narratives may predispose persons toward action, they are not so much a fixed "script for action" as an orientation to act within circumstances. While participants' narratives anticipating retirement often turned out as expected, they were sometimes reshaped as a consequence of personal action, external events, and unexpected experiences within new retirement occupations. The study suggests that, while narratives play a role in shaping the direction of persons lives, they also interweave with and change directions as a result of ongoing life events and experiences.

Definitions of allied health services in urban community contexts: consumer perspectives.

This study, as part of a larger project designed to increase allied health services to underserved urban community agencies, focussed on understanding how consumers defined the services provided in community agencies. Consumers were asked to describe what they defined as service and what constituted good service provision. Qualitative methods were used to conduct key-informant interviews and focus groups with consumers and staff at six community agencies representing different underserved populations, including ethnic and racial minority groups, the homeless, and individuals with disabilities living in the community. Four major themes emerged across the data: 1) the struggle to maintain a stable life with a chronic illness or disability; 2) services need to help solve life challenges; 3) the challenge of accessing and maintaining services; and 4) the need for a peer community. Data analysis revealed that services are difficult to access within and outside community agencies, services need to address short-term as well as long-term issues, and services in the community are still driven by a professional or expert model despite the availability of peer models. Recommendations for health professionals working in community settings are provided.

The use of Rasch analysis to produce scale-free measurement of functional ability.

Innovative applications of Rasch analysis can lead to solutions for traditional measurement problems and can produce new assessment applications in occupational therapy and health care practice. First, Rasch analysis is a mechanism that translates scores across similar functional ability assessments, thus enabling the comparison of functional ability outcomes measured by different instruments. This will allow for the meaningful tracking of functional ability outcomes across the continuum of care. Second, once the item-difficulty order of an instrument or item bank is established by Rasch analysis, computerized adaptive testing can be used to target items to the patient's ability level, reducing assessment length by as much as one half. More importantly, Rasch analysis can provide the foundation for "equiprecise" measurement or the potential to have precise measurement across all levels of functional ability. The use of Rasch analysis to create scale-free measurement of functional ability demonstrates how this methodlogy can be used in practical applications of clinical and outcome assessment.

Occupational Case Analysis Interview and Rating Scale. An examination of construct validity.

The Occupational Case Analysis Interview and Rating Scale (OCAIRS) was developed based on the Model of Human Occupation with the intention of assessing patients' occupational adaptation. Several studies examining the quality of this instrument have been completed; however, none have discussed the internal validity of the instrument or the appropriateness of the rating scale. The purpose of this study is to validate the internal validity of the OCAIRS and to test the quality of the rating scale. The results indicate that the OCAIRS is a valid measure of occupational adaptation. Each item was shown to have its own rating scale structure, however, all items together still shared the same five-point rating scale.

Meaning and misunderstanding in occupational forms: a study of therapeutic goal setting.

OBJECTIVE: This study examined occupational therapists' use of the occupational form of goal setting as therapy and its impact on clients. METHOD: The study method was qualitative, using participant observation and interviewing as the main source of data. RESULTS: The findings illustrated that therapists work both to give substance to the occupational form and to create the context of an implied narrative that imbues it with particular meanings. Simultaneously, clients' experience of meaning is influenced by a personal volitional narrative. When the two narratives do not coincide, therapists' efforts to maintain the occupational form intensify as they encourage clients toward attitudes and performances that do not resonate with the clients' experience of reality. CONCLUSION: The findings underscore the importance of recognizing that occupational forms are embedded in social processes and perspectives that inevitably come into play when occupational forms are used as therapy.

Anticipating retirement: the formation of narratives concerning an occupational transition.

OBJECTIVE: This study is the first part of a longitudinal investigation of the retirement process. This stage of the inquiry concerned how older persons anticipate their retirement. METHOD: Thirty-two workers were randomly selected from all workers age 63 years in a suburb of Stockholm. They participated in semistructured interviews about their work and their expectations for retirement. RESULTS: The participants narratives illustrated the complex work of interpreting the past and expected meaning in one's occupational life. The narratives, which anticipated widely different future trajectories, revealed many of the challenges and dilemmas of anticipating retirement and the close association of work experience to expectations for retirement. In particular, the narratives highlighted the participants' concerns about maintaining the quality of experience in activity. The findings also demonstrate the process by which persons anticipate and make choices about life change. CONCLUSIONS: People anticipate retirement through volitional narratives in which they link together past, present, and future. Understanding this volitional process of interpreting, anticipating, and making choices is important to understanding how people adapt to life changes.

Construct validity of a work environment impact scale.

This study examined the construct validity and the internal consistency of a newly developed assessment, the Work Environment Impact Scale (WEIS). After administration to 20 individuals with psychiatric disabilities, Rasch analysis was utilized to scrutinize the data. For this study, criteria for determining unexpected person/item responses were based on the following criteria: MNSQ > 1.3 and $\underline{t}>2.0$. Persons/items with MNSQ < 0.7 and $\underline{t}<-2.0$ were examined to enhance instrument precision but were not considered misfit. Results suggest that the WEIS is an appropriate and valid instrument to utilize with workers who have psychiatric disabilities. Overall, the items appeared to match the worker's need for performance, satisfaction, and well-being as the mean of persons measure is 0.30 ± 0.49 logits more than the mean of items measured. In addition the hierarchical order of items is consistent with literature identifying environmental press and affordance for workers with psychiatric disabilities. WEIS items constitute a uni-dimensional construct given that the summary statistics for both item and person had a MNSQ of 1.00 and 1.02 respectively and both $\underline{t}$ values were -0.2. However, three items exceeded the established criterion for being too informative given the MNSQ < 0.7 and a $\underline{t}<-2.0$., suggesting these needed to be revised to enhance the quality measurement of the instrument. One hundred percent of the workers fit the expected response pattern of the Rasch model suggesting that workers with greater satisfaction, performance and health had a higher degree of match with his/her occupational environment. In summary, anecdotal data suggested that the WEIS provided clinically relevant information useful for planning of work-related interventions or reasonable accommodations.

The Volitional Questionnaire: psychometric development and practical use.

This article describes the Volitional Questionnaire and presents recent empirical efforts to develop and validate this instrument. The Volitional Questionnaire is an observational method of gathering data on motivation that is designed for persons who are unable to self-report their own motives. Studies to date suggest that the instrument can provide a valid measure of volition, though a number of limitations of the tool are noted. Implications for use of the Volitional Questionnaire in practice and for further refinement and future research are discussed.

Metaphor and meaning in a clinical interview.

This study examined the narrative features of 20 life histories gathered from psychiatric patients with the Occupational Performance History Interview. The aim was to identify how narrative features were present in the patient interview responses and to illustrate how such narrative features can be located. We found that the patients organized their interview responses with deep metaphors that served to "emplot," or give meaning to, the life story. This article illustrates how patients used the deep metaphors to both circumscribe and frame possible solutions to the problems in their lives. Deep metaphors are consistent, recurring images of a life story that give coherence to, and aid in, the interpretation of the events of that life. Moreover, we explored how metaphors can be located in patient life histories and their implications for occupational therapy.

Volition as narrative: understanding motivation in chronic illness.

This paper expands the current concept of volition in the Model of Human Occupation. The present version views personal causation, values, and interests as traits that determine choices to engage in occupations. Through a detailed investigation of the life histories of two persons with psychiatric disorders, this paper illustrates how volition is embedded in a personal narrative. Two features of narratively organized volition are highlighted: (a) how narrative places decisions and actions within a plot, thus giving them meaning in the context of a whole life, and (b) how the personal narrative motivates the person by serving as a context for choosing and action. Thus, the paper illustrates how persons seek to narrate their lives and live their life narratives.

Volitional narratives and the meaning of therapy.

OBJECTIVES: Occupational therapy literature has long recognized meaning as central to therapy. By focusing almost exclusively on how the therapy process influences the experience of meaning, the literature has neglected to examine how the patient's experiences before therapy influence the creation of meaning in therapy. METHOD: Building on a previous study of how patients discover and recount the meaning of their own lives in volitional narratives, we investigated the effect of those narratives on the experience of therapy. RESULTS AND CONCLUSION: Our examination of the therapeutic experiences of two patients enrolled in a psychiatric day hospital program reveals how they assigned meaning to therapy as an episode within their larger volitional narrative.

Adaptive equipment:.

This article describes a quality assurance study of patient utilization of adaptive equipment. A major component of occupational therapy practice has been the prescription of equipment to increase independent living. However, little information exists in the literature regarding patients use of equipment. The researchers found an unexpected high rate (85%) of utilization. Reasons for non-utilization are described. Caution is needed in interpreting the results as non-responders (22%) may have been primarily non-users. Based on the findings, the authors suggest establishing a system to retrieve items needed for a short time and individualizing the process of issuing equipment based on environmental and personal needs as opposed to the standard protocol based on a diagnosis.

Research values of occupational and physical therapists.

A national survey was conducted to determine occupational and physical therapists' values toward research. While members of both professions were found to have similar research-related values, therapists identified as researchers held somewhat more positive views of research than did clinicians. The primary differences between clinicians and researchers related to values regarding the relationship between research and professional status, and to the relationship between research and clinical practice.

Development and investigation of the occupational performance history interview.

This article describes the development of the Occupational Performance History Interview, an instrument designed to gather an accurate and clinically useful history of an individual's work, play, and self-care performance from psychosocially and/or physically disabled adolescents, adults, and older persons. Following the identification and validation of content and the development of format, the instrument was field-tested and revised. An examination of reliability across time and raters indicated that although part of the instrument ratings met or exceeded levels of acceptable stability, further development and testing is indicated.

Organized activity and the adaptive status of nursing home residents.

This study examined one aspect of the hypothesis that the environment influences the adaptive status of elderly people. Specifically, it looked at the relationship between the amount of organized activities offered in three nursing homes and 44 residents' perceptions of their roles in the present and future and their future time perspective. No relationship was found between future time perspective and the amount of activity offered; however, positive relationships existed between present and future roles and the amount of activity. The study supports the premise that when activity is available, individuals are likely to form and maintain images of themselves as actively engaging with their environment.