Inclusivity in Occupational Participation: Life Stories of Bangladeshi With Spinal Cord Injury.

This research aimed to describe the process of occupational participation among persons with spinal cord injury (SCI) discharged from the only SCI rehabilitation hospital in Bangladesh. We analyzed seven participants' interview transcripts and observations using the trajectory equifinality model. Study participants demonstrated the following occupational participation trajectories: (a) employing a strategy or difficulty in occupational participation; (b) performing solidarity or experiencing deprivation; (c) creating identity or divergence; and (d) being included in or excluded from everyday life. There are four pathways: (I) discouraging conditions that minimized daily performance; (II) reinforcing obligatory connections to optimization of daily performance; (III) reciprocity to facilitate social activities; and (IV) manipulating mastery in occupational participation. Occupational therapists can consider the trajectory phases and pathways of occupational participation when facilitating the inclusion of service users after discharge from the hospital.

Experience of Occupational Participation Among Persons With Spinal Cord Injury: Life Story Analysis With Trajectory Equifinality Model (TEM)Persons with spinal cord injury (SCI) in Bangladesh demonstrated inadequate skills in community integration because of limited access to health care follow-ups and unfavorable sociocultural conditions. This research focuses on occupational participation experiences among seven persons with SCI living in the community. We used trajectory equifinality model (TEM) to analyze semi-structured interview and observation data to understand human experiences in an irreversible timeline from a starting point to an endpoint. Data analysis revealed a conceptualization of four periods of occupational participation and four common types of non-linear pathways. Participants optimized shared occupational participation and used mastery over occupations to minimize the experience of occupational deprivation. These findings could assist in developing independent peer-led occupation-based health care programs with few skilled occupational therapists and limited financial resources. These 3 years of interviews and follow-up reports with participants who were selected purposively do not necessarily reflect how actual participation unfolded over time.

The Meaning of Occupation for Adults With Advanced Cancer: A Scoping Review.

IMPORTANCE: In this scoping review, we explore the meaning of occupation for people with advanced cancer to develop and improve occupation-based services in oncology. OBJECTIVE: To identify the meaning(s) of occupation for adults with advanced cancer through relevant peer-reviewed literature. DATA SOURCES: Scopus, CINAHL, Medline, and PubMed were used to identify peer-reviewed articles published between 2011 and 2021. STUDY SELECTION AND DATA COLLECTION: Inclusion criteria comprised research studies in English and on meaningful occupations as well as participants age 19 yr or older and diagnosed with advanced cancer. Exclusion criteria comprised non-English publications, studies with participants in an early stage of cancer, and gray literature or nonreviewed articles. FINDINGS: Thirteen articles matched the inclusion criteria: 9 qualitative studies, 1 mixed-methods study, 1 case study, 1 pilot study (pretest-posttest design), and 1 retrospective study (review of clinical data). Four themes emerged from the thematic analysis: occupation benefits important relationships and connections with others, occupation as a source of physical or psychological comfort, managing one's identity through occupation, and occupation as a religious expression. CONCLUSIONS AND RELEVANCE: This scoping review highlights the value of participating in an occupation for people with advanced cancer. It also shows the importance of meaningful occupations to the quality of life and well-being of adults with advanced cancer. What This Article Adds: This scoping review identifies meanings of occupation linked to the health and well-being of adults with advanced cancer to develop and improve occupation-based services in oncology.

Potential roles of occupational therapists in urban planning for age-friendly environments: A Q-methodology.

BACKGROUND: Urban planning for age-friendly environments is an important issue, and occupational therapists and occupational scientists could contribute to planning such environments; however, knowledge of the potential roles of occupational therapists is limited. AIM: To explore the potential roles of occupational therapists in urban planning for age-friendly environments in Japan from the perspectives of occupational therapists and stakeholders. MATERIALS AND METHODS: A Q-methodology study was conducted to gain viewpoints from occupational therapists and stakeholders regarding their roles in the urban planning of age-friendly environments for older people in Japan. Participants included eight occupational therapists and seven stakeholders who completed the Q-sorting process. RESULTS: Three viewpoints emerged which are interpreted as roles of occupational therapists: (1) Promote older people's participation in everyday activities in their communities, (2) Advocate for older people towards policy-making to reflect their occupational needs or perspectives, and (3) Arrange neighbourhood environments towards enhancing participation in occupation through adjustments to compensate for functional limitations. CONCLUSION AND SIGNIFICANCE: Results reveal the potential roles of occupational therapists in urban planning for age-friendly environments in Japan. These roles can be a guide in the continuing professional development of occupational therapists in the fields of urban planning for older people.

Usability of Public Play Spaces for Children with Disabilities.

Purpose: To investigate the usability of public play spaces for children with disabilities by exploring their experiences in accessing and using these spaces and to further discuss recommendations for designing such spaces that are usable for these children. Methods: A hermeneutic phenomenological approach was employed to explore the experience of children with disabilities regarding the public play spaces. Seven children and their caregivers from two inclusive elementary schools in Central Java Province, Indonesia, participated in the study. Online semistructured interviews with the children were held using Zoom, followed by telephonic interviews with their parents. In addition, video recordings of the observation of the children's participation in the play spaces were gathered. The interview and video observation data were analyzed using van Manen's hermeneutic phenomenology thematic analysis method. Results: Five themes arose regarding the experiences of children with disabilities of accessing and using the public play spaces: (1) where time appeared to speed up, (2) "I like the tall one … I like extreme," (3) fostering connectedness, (4) the need for a safe space, and (5) how a play space should be. Conclusion: The public play spaces have meaningful values for the children with disabilities and their family, as they offered the opportunities to play, explore, interact with friends and families, enjoy nature, interact with animals, and learn. However, it is essential to provide a safe space in which children are free from physical and emotional harm, so that they can fully participate with confidence and a sense of autonomy. Nevertheless, it was also found that children, regardless of their abilities, craved risky and challenging play opportunities. This study also highlights the necessity of awareness-raising intervention programs to foster the inclusion of children with disabilities in public play space settings.

Cocreation from Emerging Opportunities: Occupational Therapists' Perspectives on Supporting Older Persons, in Japan.

Introduction: Practices of occupational therapists, particularly those supporting older persons with physical impairments, remain overly focused on remediating impairments, and implementation of occupation-centered practices remains fraught with difficulties. In Japan, this issue exists across the continuum from acute care to rehabilitation settings and into the community. This is despite the existence of international models and frameworks that place occupation at the core of the profession. Accordingly, there is a need to better understand how occupational therapists respond to the call for occupation-centered practices across the said continuum of care with this population. The aim of this study was at exploring and understanding occupational therapists' experiences of supporting the resumption of occupations among older persons with physical impairments, in Japan. Methods: Embedded in a constructivist world view, this was a qualitative focus group study. Four focus groups (two in urban areas and one each in rural and semirural areas), consisting of seven or eight occupational therapists with at least three years of relevant practice experience, convened twice to narrate and explore their support of older persons. All were participating voluntarily with confidentiality of their participation being guaranteed by the researchers. They met for a third time to verify emerging analytic results. Data were analysed using a reflective thematic analysis. Results: Identified were three themes, namely, calling forth powers of occupations, imagining client's future, and cocreating plots, which we synthesized into recurring cocreations from emerging opportunities. Discussion. Supporting the resumption of occupations among older persons with physical impairments hinges on repeated processes of identifying possibilities for occupation, followed by actions to bring these (e.g., images of clients' future) into reality. Occupations' healing properties (i.e., occupations' powers) can be used to assist clients in experiencing health and well-being. The results suggest a reframing of occupational therapy practices as recurring processes of recognizing opportunities for occupation, followed by actions whereby these possibilities are turned into reality. Occupational therapy effectiveness might be enhanced when goals and methods are repeatedly and creatively aligned with the evolving plots cocreated between the client, therapist, and stakeholders.

Benefits of Daily Occupational Diary Use 3 Months After a Health Promotion Program for Community-Dwelling Older Adults.

IMPORTANCE: To enable community-dwelling older adults to continue to live satisfying lives, a feasible health promotion program is needed that consists of relatively few sessions and can be implemented over a brief period. OBJECTIVE: To verify the relationship between a short-duration group program using an occupational diary and changes in satisfaction with occupation, a sense that life is worth living, and life satisfaction among community-dwelling older adults 3 mo after program cessation and to identify factors associated with changes in satisfaction with occupation after the program. DESIGN: Before-and-after comparison study and case-control study. SETTING: Public university in Japan. PARTICIPANTS: Community-dwelling older adults (N = 144). INTERVENTION: Four weekly group sessions and daily occupational diary keeping. OUTCOMES AND MEASURES: Activity and Daily Life Satisfaction Scale for the Elderly, K-I Scale for the Feeling that Life is Worth Living among the Aged, and Life Satisfaction Index-Z. RESULTS: Scores 3 mo postprogram were significantly higher than the pretest scores. Continued use of the diary was selected as a factor associated with changes in participants' satisfaction with occupation after the program. CONCLUSIONS AND RELEVANCE: The program may improve satisfaction with occupation, a sense that life is worth living, and life satisfaction among community-dwelling older adults 3 mo after conclusion. Continued use of the diary may increase the possibility of maintaining or improving older adults' satisfaction with occupation beyond the duration of the program. What This Article Adds: The program consists of a small number of sessions and can be implemented in a short period. Occupational therapists can include it as an option for promoting the health of community-dwelling older adults.

Self-Management Embedded in Daily Activities: A Photoelicitation Focus Group Study among Persons with Spinal Cord Injury and Their Primary Caregivers in Bangladesh.

Purpose: This study explored how community-dwelling persons with spinal cord injury (SCI) and their primary caregivers execute self-management strategies in daily activities. These strategies were mapped to a preexisting self-management framework. Methods: Photoelicitation focus group discussions were conducted among 14 adults with SCI and their primary caregivers (in two groups). Moreover, a constant comparative framework was used to analyze the data. Results: This study identified nine groups of self-management strategies, some of which could not be categorized under the three main self-management components generally accepted in the literature. Accordingly, a new component is proposed based off of this analysis, entitled management of social complexities, which includes crucial strategies such as (1) relocating to another environment, (2) behaving in an assertive manner, and (3) advocating for social change. Conclusion: The results show that self-management, traditionally described as medical, emotional, and role management, should also include the management of social complexities. The identified strategies could be considered in the development of self-management enhancement programs in lower-middle-income countries.

Developing an international research of health-care ICT applied for rehabilitation and daily living support between Japan and the Netherlands.

While many health-care issues and technological solutions are viewed locally, developing new technological solutions might benefit from lessons learned globally. The aim of this study was to develop a shared international research agenda of health-care ICT, applied to rehabilitation and daily living support. This study was focused on sensor technology and social robots used for supporting older persons in the Netherlands (Amsterdam) and Japan (Tokyo). Three researchers from Amsterdam University of Applied Sciences visited Japan and four researchers from Tokyo Metropolitan University visited the Netherlands and conducted field-visits and mutual presentations. Using a nominal group technique (NGT) facilitated the expert panel deliberations. Research priorities were identified qualitatively through in-action critical reflection on emerging ideas, and quantitatively by ranking of identified knowledge gaps (using the Mentimeter© app). The resulting joint research agenda identified topics around the utility of sensor monitoring and processes of acceptance of health-care ICT among older persons and occupational therapists. The agenda was complemented by formulating underlying assumptions prescribing such research to be embedded in real-life situations with the participation of stakeholders.

Experience of Filipinos with Spinal Cord Injury in the Use of Assistive Technology: An Occupational Justice Perspective.

Assistive technology (AT) is often required to facilitate the performance of occupations and promote inclusion and reduction of dependency among persons with spinal cord injury (SCI). However, only 5-15% of individuals in developing countries have access to AT. This study is aimed at exploring the experience of Filipinos with SCI as they use AT and understand these from an occupational justice (OJ) perspective. This study utilised a hermeneutic phenomenological approach to explore the participants' experiences with AT usage. Ten participants were recruited from a hospital and communities within Metro Manila, Philippines, and interviewed last January 2020. Hermeneutic analysis was done to interpret the shared meaning embedded within their experiences and was informed by an occupational justice perspective. Exploring the experience of the participants in using AT yielded four themes, namely, (1) engaging in occupations despite limited opportunities, (2) going to various locations amidst an inaccessible environment, (3) striving towards inclusion in spite of attitudinal barriers, and (4) securing needs in light of unfavourable life conditions. Filipinos with SCI deal with numerous structural and contextual factors in daily life. There has been partial enablement of OJ as they incorporate AT in their daily lives as occupational rights are far from being recognised and respected. In infusing an OJ perspective to understanding AT use, OT practitioners are bound to identify problems and courses of action that go beyond traditional service delivery.

Intra- and interpersonal agency: Resuming occupational participation among persons with spinal cord injury after discharge from in-patient rehabilitation.

Background: This research aim was to understand and describe how changes occur in occupational participation among persons with spinal cord injury (SCI) following discharge from a rehabilitation center in Bangladesh.Materials and methods: Using a selected ethnographical research design, nineteen participants were selected following a purposive sampling technique, then interviewed and observed on three occasions. Data analysis consisted of an iterative approach combining thematic narrative and narrative slopes analyses.Results: Eight themes determined the transitional progress, regression and stability, in which, three of the eight themes characterized the ascending slopes, namely developing affirmative attitudes, adapting the occupational environments and working on identities. Three themes characterized the descending slopes, which were reducing confidence created difficulties, becoming bored in daily life, and declining health reduced social connections. The final two themes characterized periods of stability, namely, maintaining daily life through skills and helplessness to participate in occupations.Conclusions and significance: Each of participants' transitions unfolded in unique, complex patterns. The processes directions of the transitions were understood as waning and waxing of agency. This agency could be individual, and shared with or dedicated by others, when participants and other persons combined their skills or when participants were supported by others.

Interprofessional learning in an international context: the unfamiliar as impetus for learning, also about oneself.

Studying experiences of interprofessional learning (IPL) in international contexts can contribute to better understand its nature. The aim of this study was to evaluate students' IPL in the context of a two-week study-abroad program. There were 28 health-care students from Tokyo Metropolitan University, Japan, who participated in a two-week interprofessional education program provided by Karolinska Institutet, Sweden, from 2013 to 2016. The program consisted of classroom-based activities, a literature study (since 2015) and study-visits to health-care facilities. The data were two pre-course questionnaires with open-ended questions that inquired about students' motivation, expectations and goals, and one post-course questionnaire that inquired about their learning. A qualitative KJ-method analysis of students' completed questionnaires revealed two understandings about the nature of IPL. Namely, the 'unfamiliar', presented by both interprofessional and international contexts, provided students' with unique learning, with the international context reinforcing interprofessional learning. Secondly, developing one's individual collaborative skills and one's professional expertise was important aspects of their learning. International context can add value to students' IPL by affording learning opportunities considered unique to the different socio-cultural context. IPL may also pertain to 'learning about oneself', in addition to 'learning with, about and from each other'.

Student Perceptions of Growth-Facilitating and Growth-Constraining Factors of Practice Placements: A Comparison between Japanese and United Kingdom Occupational Therapy Students.

This study compared growth-facilitating and growth-constraining experiences of practice placements as perceived by occupational therapy students from Japan and the United Kingdom (UK). Fifteen students from Japan and 14 from the UK used a nominal group technique (NGT) to rank, individually and in groups, their subjective learning experiences during practice placements. Qualitative analysis and simple tabulation based on ranking of items obtained in the NGT were performed. Five item categories were identified from both Japanese and UK students: self-reflection, the role of supervisor, sense of responsibility, clinical knowledge and skills, and time management. Results showed that all students perceived opportunities for self-reflection and feedback from supervisors as growth facilitating and students' passive attitudes towards requirements of practice placements as growth constraining. Country-specific differences between students were observed in clinical knowledge and skills, sense of responsibility, and time management. Japanese students perceived that preparatory study led to successfully treating clients during placement, and they tended to commit to placement assignments at the expense of time outside. UK students valued working independently with a sense of responsibility but considered time-management problems within their placement hours as growth constraining. These differences can be explained by different social norms and expectations of students from Japan and the UK.

Factors Influencing Participation in Daily Activities by Persons With Spinal Cord Injury: Lessons Learned From an International Scoping Review.

Background: It is important to develop further understanding regarding the facilitating and constraining factors that influence participation in daily activities, including social and human rights issues faced by persons with spinal cord injury (SCI) that affect their opportunities to lead full social lives. Objectives: To identify, describe, and compare factors that influence participation in daily activities by persons with SCI living in high-income countries (HICs) and in low- and middle-income countries (LMICs). Method: We performed a scoping review of 2,406 articles published between 2001 and 2016 that were identified from electronic databases. From these, 58 remained after checking inclusion and exclusion criteria. Analyses included (a) identifying factors that facilitate and constrain participation in daily activities; (b) categorizing the identified factors as issues related to medical, social, and human rights models; and (c) comparing determinants between LMICs and HICs. Results: The medical model factors pertained to long-term physical health and functional capacities, self-efficacy and adjustment skills, relearning capacities for performing daily activities, and availability of cost-effective adaptive equipment. The social model factors pertained to developing accommodating communities (accessible environments and mutual understanding). The factors of the human rights model pertained to autonomy (empowerment) and development of social justice (application of policies, advocacy, and negotiation). Conclusion: Eight lessons are proposed to enhance health and functional abilities, ensure disability friendly environments, develop social justice, and provide empowerment to enhance participation in daily activities among person with SCI living in LMICs.

(Re-)Establishing familiarity: Resumption of occupations by older adults with physical disabilities.

BACKGROUND: There is a need for in-depth understanding of how elderly persons resume their occupations while recovering from physical disabilities in their home and community. The aim of this study was to explore and understand how engaging in occupations unfolded over time for some older persons with physical disabilities in Japan. MATERIALS AND METHODS: In this narrative-in-action study four elderly participants were recruited following a mixed purposive and convenience sampling method. Data was gathered at two to three weeks' intervals over six months, with a follow-up visit at nine months. Qualitative interviews and participant-observations were analyzed using narrative analysis. RESULTS: This study identified the central meaning of resuming occupations as reestablishing former and establishing new familiarity. Familiarity was expressed in three features, namely as repertoires of occupations fulfilling needs and meanings, as performing occupations according to expectation, and as a resource for dealing with problems of engaging in occupation. What was experienced as familiar could be adjusted to accommodate ones changing needs or situation. CONCLUSION AND SIGNIFICANCE: (Re-)establishing familiarity is a new concept representing transitions from an occupational perspective. Facilitating familiarity can assist older persons to experience health and well-being, even while transitioning after an illness or injury.

Balancing struggles with desired results in everyday activities: strategies for elderly persons with physical disabilities.

The number of elderly persons with disabilities needing support with everyday activities increasing in Japan and around the world. Yet, engagement in everyday activities can support the quality of their daily life. Despite research focusing on reported meanings of people's actions, there is still limited knowledge on how engagement in everyday activity is enacted along with the meanings of persons' actions. The aim of the present study was to identify meanings of persons' actions within everyday activities of elderly Japanese with physical disabilities. Five elderly persons with physical disabilities living in the community participated in this study. Data were gathered by 10 participant observations of everyday activities supplemented with 13 unstructured interviews. Narrative analysis was used to identify meanings of persons' actions. The analysis identified an overall plot termed 'balancing struggles with desired results'. This plot illustrated that participants' and other involved individuals balanced problematic situations with finding situations that accommodated their needs. Meanings of these actions were further identified as three complementary strategies. Two of three strategies aimed to mitigate given problems, one by 'acting on a plan to achieve one's goals', the other by 'taking a step in a preferred direction by capitalising on emerging opportunities'. The third strategy focused on avoiding undesirable experiences by 'modifying problematic situations'. In conclusion, these findings call for care and rehabilitation providers' sensitivity to shifting foci of what matters in daily life's situations as well as aligning with persons' skills, resources and perspectives. Accordingly, the judicious and flexible use of these complementary strategies can enhance elderly persons' quality of daily living through everyday activities.

Resilience in Daily Occupations of Indonesian Mothers of Children With Autism Spectrum Disorder.

This qualitative study investigated how resilience functions in the context of daily occupations for mothers of children with autism spectrum disorder (ASD). Fourteen mothers of children with ASD participated in two focus groups that were used to elicit stories of the mothers' resilience in daily occupations. A constant comparative method was used for data analysis. A model of resilience in daily occupations of mothers of children with ASD was developed consisting of four categories: (1) creating and re-creating accepting conditions, (2) finding solutions, (3) striving for balance among daily occupations, and (4) thinking about the child's future. Sources of resilience were found to reside in both the mothers themselves and their social environments. Occupational therapy practitioners can use these findings in developing supportive approaches aimed at mothers, family members, and other people in the lives of children with ASD.

Cultural adaptation and validating a Japanese version of the readiness for interprofessional learning scale (RIPLS).

Readiness for interprofessional education (IPE) can be an important factor to evaluate because of the influences of attitudes toward the outcomes of interprofessional learning activities. However, a dearth of Japanese evaluation tools hinders its evaluation. The readiness for interprofessional learning scale (RIPLS) was selected, because it has been validated in different countries and its items reflected our local situation best. This research aimed to develop and validate a Japanese version of the original 19-item RIPLS. We developed a Japanese RIPLS employing forward/backward translation. Reliability of the Japanese version was studied using classical test theory and structural equation modeling to construct a model to inform curriculum development. We obtained a 0.74 Cronbach's α, which indicates adequacy. Subscales of "interprofessional education opportunities" (α = 0.90) and "uniqueness of profession" (α = 0.60) have relatively little weight compared to "teamwork and collaboration" (α = 0.92). A one-way structure suggests that readiness for interprofessional learning starts with "teamwork & collaboration" followed by changes in "learning opportunities" and subsequently "uniqueness of profession" (root mean square error of approximation = 0.06, comparative fit index = 0.93). This Japanese RIPLS can be used in undergraduate health sciences students with appropriate caution. Further development of the subscales and a client-centered subscale would be beneficial to fully achieve its potential. The need for further research into its reliability and validity is identified. Recommendations are provided for cross-cultural adaptation and for establishing validity across different contexts.

Japanese older adults' perspectives on resuming daily life during hospitalization and after returning home.

Throughout Japan, occupational therapy for older adults is available in an increasing array of institutional and community settings. However, there is a need for more knowledge of "how" older adults resume their daily lives particularly in the community. The aim of this qualitative research was to identify and describe how some older adults in Japan describe their experiences of resuming daily life during hospitalization and after returning home. Nine older adults with various physical impairments were interviewed. The open interviews were conducted 10 months to 5 years from the onset of their physical impairment. Data analysis on the basis of a constant comparative methodology resulted in three themes that characterize their experiences of resuming daily life: "doing the right thing", "reconciling to dependence" and "becoming invigorated". These themes may inform occupational therapists to take into consideration older clients' perspectives when assisting them to recapture the quality of their daily life according to their preferences. Adaptive change is promoted by assisting older clients to generate the energy they need by judiciously varying approaches appropriate to their goals and by helping older clients to make decisions that are "right" for them, which may fluctuate during processes of resuming daily life. Limitations of this study are found in the small sample size, and additional research may help to clarify how moral aspects, vigour (physical and mental energy/force) and other dimensions shape processes of resuming daily life as well as the influences of time.

The Assessment of Awareness of Ability (A3) in a Japanese context: a Rasch model application.

The overall aim of this study was to evaluate the validity of the Assessment of Awareness of Ability (A3) in a Japanese context. The A3 (formerly known as the Assessment of Awareness of Disability, AAD) is a standardized 11-question interview used to explore the discrepancy between observed strengths and limitations in the performance of activities of daily living (ADL) according to the Assessment of Motor and Process Skills (AMPS) and the limitations described by the client. In this study, 259 matched Swedish and Japanese A3 data records were analyzed using a Rasch partial credit model (PCM). The analysis of rater consistency and items demonstrated acceptable goodness-of-fit according to the PCM, indicating rater consistency and internal scale validity. The A3 can help clients and therapists understand discrepancies between observed and self-reported performance aspects of various everyday tasks within Japanese and Swedish contexts.