Executive functioning: a scoping review of the occupational therapy literature.

BACKGROUND: Increasingly recognized as an important factor in the performance of complex, goal-directed tasks, executive functioning is understood in different ways across disciplines. PURPOSE: The aim was to explore the ways in which executive functioning is conceptualized, discussed, described, and implied in the occupational therapy literature. METHOD: A scoping review of the occupational therapy literature was conducted following Levac, Colquhoun, and O'Brien's (2010) recommended methodology. RESULTS: Executive functioning is described both as a set of performance component skills or processes and as the executive occupational performance inherent in complex occupations. Executive functioning is implicit in occupational performance and engagement, and some health conditions seem to be commonly associated with impaired executive functioning. Assessing executive functioning requires dynamic occupation- and performance-based assessment. Interventions targeting executive functioning are grounded in metacognitive approaches. CONCLUSION: Executive functioning is a complex construct that is conceptualized with considerable variance within the occupational therapy literature, creating barriers to effective service delivery.

Broadening the occupational therapy toolkit: an executive functioning lens for occupational therapy with children and youth.

OBJECTIVE: Attention to executive functioning (EF) and its effect on occupational performance is increasing in the occupational therapy literature. This study explored occupational therapists' perceptions of how EF is recognized and addressed within occupational therapy for children and youth. METHOD: Inductive qualitative content analysis was used to analyze the in-depth interview data from 13 occupational therapists with a range of practice contexts and experience. RESULTS: EF should be explicitly considered during clinical reasoning. System and professional barriers create challenges to occupational therapists, constraining their ability to recognize, label, and address EF performance issues. Occupational therapists who have integrated EF into their practice perspective have acquired knowledge and skills through interprofessional collaborations, client interactions, and professional development opportunities. CONCLUSION: Occupational therapists working with children and youth need an occupational EF framework and practice resources if they are to integrate an EF lens to more broadly enable occupational performance.

Experiences of burnout and coping strategies utilized by occupational therapists.

BACKGROUND: Work-related stress and burnout have been found to lead to job dissatisfaction, low-organizational commitment, absenteeism, and high turnover. PURPOSE: The purpose of this study was to examine the burnout experiences of occupational therapists practicing in Ontario and to describe the practice implications and coping strategies employed. METHODS: Data for this mixed methods study were collected using the Maslach Burnout Inventory-General Survey, Areas of Worklife Survey, focus groups, and interviews in the hermeneutics tradition. FINDINGS: High levels of emotional exhaustion were reported by 34.8% of participants, high levels of cynicism by 43.5%, and low professional efficacy by 24.6%. Practice issues included excessive demands on time, conflict, and lack of autonomy and respect. Coping strategies included spending time with family and maintaining professional/personal balance, control of work responsibilities, maintaining a sense of humor, and self-awareness/self-monitoring. IMPLICATIONS: This study contributes to understanding the practice challenges for occupational therapists, factors that contribute to therapist burnout, and strategies employed to maintain competent practice.

An exploration of social support as a factor in the return-to-work process.

Despite evidence that inter-personal relationships are important in human resource management, little is understood about the nature of workplace social support in a disability context, or what features of support are important to the success of return-to-work programs. The purpose of this qualitative study was to explore workplace disability support from worker and supervisory perspectives and to identify salient features for work re-entry. A total of 8 supervisors and 18 previously injured workers from a range of work units in a Canadian municipality were interviewed, and their views concerning supportive and unsupportive behaviours in work-re-entry situations were recorded and analyzed. A full range of social support dimensions were reported to be relevant, and were seen as arising from a variety of sources (e.g. supervisor, co-workers, disability manager, work unit, and outside of work). Respondents identified trust, communication and knowledge of disability as key precursors to a successful return-to-work process. Future research should explore the specific contributions of support to work rehabilitation outcomes as well as interventions to enhance available supports.

Approaches to worker rehabilitation by occupational and physical therapists in the United States: factors impacting practice.

Work-related rehabilitation services have changed in nature and scope since their inception in the late 1970s. A review of the literature reveals a large body of published data concerning the various approaches used by therapists in this practice area, but a limited number of comparison studies documenting the value of one approach over the other. This national survey of physical and occupational therapists in the US was conducted in 2002, and examined the prevailing trends in service provision, and factors that determine the nature of services provided to clients. Results indicate that services continue the move to onsite service provision and an emphasis on prevention, but that select services, such as onsite job analysis and comprehensive, inter-disciplinary programs are being used to a limited degree. Research that examines the relative contributions of selected work-related services to successful and efficient return to work outcomes is necessary to identify best practice approaches. Therapists and insurance providers should work more closely in exchange of data that will ensure optimal program design and funding.