The Use of Occupational Adaptation in Research: A Scoping Review.

The aim of this scoping review was to identify and describe how occupational adaptation has been used in different research studies published from 1992 to 2015 and to identify possible gaps in study design. Four categories of studies were identified: those focused on understanding how occupational adaptation occurs in different life situations and different health conditions, those focused on the use of occupational adaptation as a guide or model in organizing the occupational therapy process, and those using occupational adaptation as a part of instrument development. Several gaps in research are evident including updating the theory development on occupational adaptation, types of maladaptation, studies conducted in less affluent countries, quantitative studies with robust designs, inclusion of men and younger persons as subjects, vulnerable groups, health promotion, and community settings.

Art therapy for patients with depression: expert opinions on its main aspects for clinical practice.

BACKGROUND: Art therapy is based mainly on clinical experience and is rarely described and evaluated scientifically. There is a need for further exploration of its use in patients with depression. AIM: The aim of this study was to explore what experts consider to be the main aspects of art therapy in clinical practice for patients with depression. METHOD: Eighteen occupational therapists experienced and educated in art therapy participated. The experts answered three rounds of Delphi questionnaires and ranked their agreement with 74 assertions. Consensus was defined as 70% or higher. RESULTS: The experts agreed more on assertions about theoretical frames of reference than about clinical practice. The main aspects of art therapy were agreed to be the patients' opportunity to express themselves verbally and through making art. It was equally important that art tasks provided an opportunity to address depressive thoughts, feelings, life experiences, and physical symptoms. CONCLUSIONS: Experts in the field of art therapy considered that the main aspect of clinical practice in art therapy for patients with depression is that art themes should promote expression related to both to depression and personal history.

Problem-based self-care groups versus cognitive behavioural therapy for persons on sick leave due to common mental disorders: a randomised controlled study.

PURPOSE: To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. METHODS: In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). RESULTS: Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. CONCLUSION: PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

Sustainable enhancement in clients who perceive the Tree Theme Method(®) as a positive intervention in psychosocial occupational therapy.

BACKGROUND/AIM: The Tree Theme Method(®) is an intervention based on creative activities and occupational storytelling. The Tree Theme Method(®) implies that the clients draw and paint trees symbolising various periods in their life. The pictures are then used as a starting point to tell their life story to enhance their wellbeing and management of their everyday life. This study aimed to evaluate if changes observed among clients regarding their wellbeing and everyday occupations, between baseline and the end of their term of the Tree Theme Method(®) therapy, persisted three years after the completion of the intervention. METHODS: This study had a quantitative design. Thirty-one former clients were recruited to a follow-up three years after completing the intervention. Self-rating questionnaires were used regarding psychological symptoms, self-mastery, sense of coherence, activity level, occupational performance and satisfaction with occupational performance. Non-parametric methods were used for the data analysis. RESULTS: The findings revealed positive significant changes regarding sense of coherence and occupational performance and satisfaction with occupational performance, measured between the end of the intervention and at the time of the three-year follow-up. Furthermore, the respondents' ratings regarding psychological symptoms, self-mastery, activity level and the extent of satisfaction with performed occupations were found to be stable. CONCLUSIONS: The Tree Theme Method(®) appeared to function well as an intervention in psychosocial occupational therapy, where the aim was that a client would enhance their wellbeing and management of their everyday life. However, there is need for further evaluation to assess the effects of the Tree Theme Method(®) intervention.

Perceptions of life balance among a working population in Sweden.

A life in balance is commonly related to health and well-being. However, our knowledge regarding the perceptions of life balance among the general population is limited. Our aim was to explore the perception of life balance among working people without recent long-term sick leave. Individual interviews were conducted with 7 men and 12 women and analyzed according to grounded theory, aiming at achieving a description. The results showed that life balance includes four interrelated dimensions: activity balance, balance in body and mind, balance in relation to others, and time balance. Life balance was regarded by the participants as health related, promoted by a sense of security, and affected by context and individual strategies. Life balance was also seen as being individually defined and dynamic. The results indicate that the perceptions of life balance might be quite general because they show similarities with previous research on different populations.

'I start my day by thinking about what we're going to have for dinner'--a qualitative study on approaches to food-related activities among elderly men with somatic diseases.

The aim of this study was to address the question of how older men with somatic diseases living in their own home approach the question of food-related activities (FRA). Further, any adaptations of these activities necessitated by effects of diseases and of altered life circumstances were explored. Interviews were conducted with a purposeful sample of 18 co-living and single-living men, 64-84 years old. They were diagnosed with Parkinson's disease, rheumatoid arthritis or stroke. In the analysis, a thematic framework was used. The findings revealed three food-related approaches, namely 'Cooking as a pleasure', describing joy in cooking; 'Cooking as a need', indicating no habits or skills in cooking; and 'Food is served', that is, being served meals by a partner. It was found that gender-related roles in particular, but also changed life circumstances, activity limitations, personal interests, and a wish to maintain continuity and independence, affected the men's approaches to these activities. This knowledge may be useful in attempts to facilitate and support FRA among elderly men with diseases. Health care efforts to promote FRA should preferably be individualised in respect to older men's approaches to these activities.

Relevance and focal view point in occupational therapists' documentation in patient case records.

The Code of ethics for occupational therapists stipulates how occupational therapists should think about the profession's central concepts in practice, where "Activity" and "Health" are two such concepts. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study was to identify and describe how occupational therapists at a hospital in Sweden accomplished documentation of occupational therapy cases in patient case records. A stratified and random sample of one hundred occupational therapy cases was evaluated in relation to a checklist. The results showed that only 21% of the documented occupational therapy cases were complete. Often, the notes were found under the wrong keyword and 12% of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the documented occupational therapy cases reflected the ICF's Activity/Participation component. Our conclusion of this study is that even if not all of the occupational therapy cases documented in the patient records included all relevant information, the documentation still reflected a focus on "activity" and holistic health notions.

Adulthood transitions in health and welfare; a literature review.

AIM: The aim of the literature review was to describe how adulthood transition is used in health and welfare. DESIGN: A qualitative design with a deductive approach were used. METHODS: As material, 283 articles published in scientific journals, between 2011-August 2013, were selected. The search was conducted August 2013. The data were analysed and sorted in a categorization matrix. RESULTS: Transition was identified as a process mainly related to the four types previously identified; developmental, situational, health-illness and organizational transitions. Another one transition was also identified, lifestyle transition.

Activities of daily living among St Petersburg women after mild stroke.

The aim of the present study was to determine how women living in St Petersburg, Russia, who have had a mild stroke, describe their performance in activities of daily living (ADL) and to elicit possible causes of their occupational dysfunction. Thirty-six women who had experienced a mild stroke and been referred to a rehabilitation centre participated in the study. Data collection was conducted through interviews, including the 'ADL Staircase' and a modified 'Frenchay Activities Index for Stroke Patients'. Additional data were collected through field notes and information from team members and relatives. The results showed that women who have had a mild stroke and ADL limitations experience occupational dysfunction in ADL that is most often caused by a combination of overprotection from relatives, the women's own feelings of anxiety and insecurity, and an overemphasizing of their disability. The results are limited, based on the small sample and restricted geographic area. There is a need to further investigate how individuals who have had a mild stroke can be physically and socially rehabilitated and reintegrated into the community in countries with developing economies such as Russia.

Experiences of returning to work after acquired brain injury.

The purpose of this qualitative study was to explore experiences of returning to work after rehabilitation, from the viewpoint of people with acquired brain injury. A purposive sampling of eight informants was made, and data were collected through personal interviews with open questions. The data were then analysed through qualitative content analyses in five steps, resulting in four main categories of experiences: "A new person", "Stimulants and fellowship", "Understanding and support", and "To reach insight" with appurtenant sub-categories. The overarching theme was "Returning to work after acquired brain injury is a long process". The conclusion of this study is that returning to work after acquired brain injury requires motivated individuals, flexible work, accommodating labour management, and prolonged environmental support. This study also shows that the informants need support for a long period of time to reach a balance and to obtain a functional working role. In order to achieve this, client-centred rehabilitation, professional teamwork, and longer follow-up periods than those of today are required.

The experience of returning to work.

The purpose of this qualitative study was to explore from an environmental perspective the experiences of returning to work of former unemployed sickness absentees. Five separate focus-group interviews were carried out with themes concerning different environmental areas. The findings showed that the participants in their process of being off work and then attempting returning to work experienced a personal transition manifesting itself as a negative self-image, change of life-rhythm and restrictions in their roles and activities. In their progression, the participants experienced a need for reorientation and expressed feelings of alienation, and for that reason felt need of support from a network, especially a professional one. Regarding attitudes in society, the participants reported experiences of social stigmatization, both in mass media and in their immediate social environment, and an increasing egocentricity among their fellow-workers. They perceived their progression back to work as a 'time quarantine' and as a long and destructive wait for support. The findings indicate that the phenomenon of 'returning to work' after unemployment and sick leave could not be reduced to a single issue. It should rather be seen as a dynamic problem with individual and structural, environmental aspects.

Constituents of healthy workplaces.

The aim of the study presented here was to identify and characterize the constituents of a healthy workplace from the viewpoints of employees at four different companies with low rate of absenteeism due to illness. A non-randomized, purposive selection was made of 27 respondents -- four department heads, 16 white-collar workers, and seven blue-collar employees. The respondents were told to describe in writing how they experience factors contributing to good health at their workplace. The data analysis was carried out with a phenomenographic approach. Four main categories of health-related factors emerged: Good Work Environment, Active Keep-Fit Measures, Functional Leadership and Individual Responsibility. The employers fulfil demands for a good physical working environment, but the need for improvements in the psychosocial environment remains. The most promising finding is that the respondents' accept personal responsibility for maintaining their own good health.

Staff views on how to improve mealtimes for elderly people with dementia living at home.

Dementia commonly leads to difficulties in performing daily activities, which can also often affect the ability to prepare and eat meals. As a result, formal support to maintain good nutritional intake might be needed, but there is a lack of knowledge concerning how to support older persons with dementia living at home. The aim of this study was to explore and describe staff views on how to improve mealtimes for persons with dementia who are still living at home. A qualitative descriptive study was performed and data were collected during 2011-2012 through four focus group interviews with staff working in the homes of persons with dementia. Data were analyzed using inductive content analysis. The participants described several ways to improve mealtimes for persons with dementia and advocated adjustments facilitating the preservation of the persons' independence. Finding suitable actions calls for knowledge about the person and his/her individual situation. Proposed actions were enabling meals at home, taking over, and moving meals outside of the home. In addition, it was found that, the types of meals served to these persons should be as familiar to the individual as possible. The results of this study indicate the importance of using a person-centered approach and meeting the individual needs when supporting people with dementia in regards to their meals when living at home. Individualized care in the home may be expensive, however, it is fair to say that people who become malnourished and admitted to hospitals is even more costly. Furthermore, sharing and reflecting experiences and knowledge can assist staff to identify ways to manage complex situations. Therefore, the use of refection should be a part of staff members' everyday work.

Holistic and biomedical concepts of health: a study of health notions among Swedish occupational therapists and a suggestion for developing an instrument for comparative studies.

The objectives of this study were to inquire into notions of health among a group of 439 Swedish occupational therapists and to test a model derived from a qualitative study by Björklund & Svensson with a representative sample of occupational therapists in Sweden. The data were collected through a questionnaire and were analyzed using descriptive statistics, cluster analysis, and confirmatory factor analysis. The means and ranking of the health notions showed that Swedish occupational therapists most frequently hold holistic notions of health, and to a lesser extent biostatistical ones. Most Swedish occupational therapists indicate that being clearly conscious of one's health notions is important both to themselves and to their profession. The test of the model provides a step towards developing an instrument for measuring notions of health that clearly distinguishes between holistic and biomedical ones and that could possibly be used for comparative studies.

A Delphi study of occurring information in housing adaptation certificates.

BACKGROUND: Since 1993, the Housing Adaptation Act has provided disabled people the opportunity to receive grants for adapting their homes. A housing adaptation certificate certifying the necessity of adaptations must accompany any application and if information in housing adaptation certificates is not sufficient, the applicant is risking not having necessary housing adaptations. OBJECTIVE: The aim of this study was to identify and describe what information is missing, unnecessary or vague, in the housing adaptation certificates; to determine how often this occur, and how problematic this can be for the decision process. MATERIAL AND METHODS: 105 housing adaptation grant managers took part in a three-round Delphi survey. RESULTS: At least 65% consensus was reached regarding the following six statements: missing information about disability duration, possession of relevant assistive devices, consequences of the disability in housing, prognosis of consequences, who the informant is, or contains preferences for specific solutions. Missing, unnecessary or vague information pose serious or less serious problems and 38-72% of the participants reported that this often or always occur. CONCLUSION: Housing adaptation certificates need to be improved. SIGNIFICANCE: The results of this study are used to design a checklist for use by housing adaptation certificate writers.

The impact of occupational therapy and lifestyle interventions on older persons' health, well-being, and occupational adaptation.

AIM: The aim of this study was to investigate whether a four-month occupational based health-promoting programme for older persons living in community dwellings could maintain/improve their general health and well-being. Further, the aim was to explore whether the programme facilitated the older persons' occupational adaptation. METHODS: The study had a quasi-experimental design, with a non-equivalent control group combined with semi-structured interviews. The intervention group comprised 22 participants, and the control group 18. Outcomes were measured using the Short Form 36, Life Satisfaction Index-Z and Meaningful Activity Participation Assessment. Content analysis, based on concepts from the Model of Occupational Adaptation, was used to analyse the interviews. RESULTS: The intervention group showed statistically significant improvements in general health variables such as vitality and mental health, and positive trends for psychological well-being. There were no statistically significant differences between the intervention group and the control group, but the groups were not fully matched. The qualitative analysis based on Occupational Adaptation pointed out social aspects as a compliment to the overall results. CONCLUSIONS: Participating in meaningful, challenging activities in different environments stimulates the occupational adaptation process; this is something occupational therapists could use to empower older persons to find their optimal occupational lives.

The concept of `work ability' from the view point of employers.

BACKGROUND: Since work ability is manifested in working life and ``bought'' by employers, employers perceptions of the concept are important to understand. Studies have shown that people with health problems want to take part in the labour market, but experience difficulties in gaining access. Additionally, studies have demonstrated the doubt felt by employers when they consider hiring a person with a disability. OBJECTIVE: The aim was to identify and characterise employers' conceptions of work ability. METHODS: The study design was qualitative with a phenomenographic approach. Six male and six female employers from various workplaces and geographical areas in Sweden were interviewed. RESULTS: Three domains were identified: employees' contributions to work ability, employers' contributions to work ability and circumstances with limited work ability. Work ability was regarded as a tool in production and its output, production, was the main issue. The employees' commitment and interest could bridge other shortcomings. CONCLUSIONS: The employers highlighted their own contributions in shaping work ability in order to fit with work circumstances. Health problems were not the only limiting issues; other circumstances, such as individual characteristics and contextual factors, could limit work ability too. Knowing the importance of commitment and interest is valuable in work rehabilitation.

Occupational therapy culture seen through the multifocal lens of fieldwork in diverse rural areas.

BACKGROUND: Existing occupational therapy culture has not yet fully articulated diverse worldviews on occupation, health, and well-being and the link between them. Taking into consideration the diversity of the global world, incorporating different worldviews would be a valuable contribution to expanding the relevance of occupational therapy. AIM: The aim of this research was to analyse worldviews regarding human occupation and the link between occupation, health, and well-being among people from rural Honduras, Morocco, Burkina Faso, Tanzania, and Ecuador. METHODS: This ethnographic research used three methods, i.e. semi-structured interviews, participant observations, and in-depth interviews, to collect data from 27 participants in five countries. The material was analysed using a Grounded Theory approach. RESULTS: One core category, "Occupations are social practices", was identified and it included three subcategories: "Occupation, health and well-being as a personal and community experience"; "Co-occupations, collective occupations and collaborative occupations are the most important occupations"; and "Occupation, health and well-being mutually influence each other". Conclusion and significance. The overall findings showed that taking different worldviews into account is needed for developing an occupational therapy culture that is useful globally and hosts diverse meanings and occupation-focused practices.

Changes in community mobility in older men and women. A 13-year prospective study.

Community mobility, defined as "moving [ones] self in the community and using public or private transportation", has a unique ability to promote older peoples' wellbeing by enabling independence and access to activity arenas for interaction with others. Early predictors of decreased community mobility among older men and women are useful in developing health promoting strategies. However, long-term prediction is rare, especially when it comes to including both public and private transportation. The present study describes factors associated with community mobility and decreased community mobility over time among older men and women. In total, 119 men and 147 women responded to a questionnaire in 1994 and 2007. Respondents were between 82 and 96 years old at follow-up. After 13 years, 40% of men and 43% of women had decreased community mobility, but 47% of men and 45% of women still experienced some independent community mobility. Cross-sectional independent community mobility among men was associated with higher ratings of subjective health, reporting no depression and more involvement in sport activities. Among women, cross-sectional independent community mobility was associated with better subjective health and doing more instrumental activities of daily living outside the home. Lower subjective health predicted decreased community mobility for both men and women, whereas self-reported health conditions did not. Consequently, general policies and individual interventions aiming to improve community mobility should consider older persons' subjective health.

Work and everyday activities: experiences from two interventions addressing people with common mental disorders.

OBJECTIVE: Lengthy sick leave makes demands on work ability enhancing interventions in primary health care. Problem-based method (PBM) and cognitive behavioural therapy (CBT) are interventions aimed at people with common mental disorders. This study aimed to describe how individuals experienced interventions and the impact the interventions had on the individuals' ability to work and perform other everyday activities. METHOD: Fourteen women and two men, eight each from two interventions, were interviewed. The interviews were analysed using qualitative content analysis. RESULTS: The analysis revealed one overarching theme: "Reaching safe ground or continuing to seek help". Four categories were identified: "From being passive to making one's own efforts in the rehabilitation process", "Being stuck on a treadmill or daring to change", "Evolving from routine to more aware behaviour", and "Fitting in or not fitting in with workplace situations". CONCLUSIONS: According to the participants, experiences from both PBM and CBT had a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. In general, the results support the use of active coping-developing interventions rather than passive treatments.