Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective.

This exploratory study was aimed at evaluating the current status of global occupational therapy practice on the use of assessments for clients with cognitive impairments and providing recommendations for ongoing evidence. We targeted international occupational therapy clinicians working with clients experiencing neurocognitive impairments. 323 occupational therapists from a wide range of clinical practice areas participated in the study. A large number of therapists used noncognitive specific assessments with a focus on functional approaches. The most commonly used standardized assessments were the COPM (56.7%), followed by MMSE (54.2%) and MoCA (45.5%), while the nonstandardized assessments were clinical observation (38.4%) and generic ADL assessment (34.1%). The use of main assessments was significantly different across world regions (p < 0.05), as were the reasons for choosing them (p < 0.05). The occupational therapists' use of assessment tools with clients suffering from neurocognitive impairments is inconsistent across the globe. The identification of international best practices for selecting and implementing proper outcome measures is warranted. It is essential to promote the development of an occupational therapy initiative to support the use of appropriate assessments at the international levels to facilitate consistent best practice.

Establishing an occupational therapy assessment clinic in a public mental health service: A pragmatic mixed methods evaluation of feasibility, utilisation, and impact.

INTRODUCTION: Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline-specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS. METHODS: An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi-structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement. RESULTS: Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline-specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success. CONCLUSION: An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery.

Home visits by occupational therapists improve adherence to recommendations: Process evaluation of a randomised controlled trial.

INTRODUCTION: As part of hospital discharge planning, occupational therapists often provide recommendations to improve the interaction between a person and their home environment. The aim of this study was to investigate the number and type of recommendations made by occupational therapists during a home assessment visit compared to hospital-based assessment for patients recovering from hip fracture. A secondary aim was to explore adherence rates to the different types of recommendations. METHODS: Process evaluation of a randomised controlled trial of 65 participants recovering from hip fracture, returning to community living after hospital discharge. All participants received inpatient multidisciplinary rehabilitation and hospital-based assessment by an occupational therapist (usual care). In addition, the intervention group participated in a single home visit with an occupational therapist prior to hospital discharge. Analysis included the number and type of occupational therapy recommendations, adherence to recommendations at 30 days after discharge, and mediation analysis. RESULTS: Participants in the home visit group received more recommendations than the usual care group (mean difference [MD] 2.8, 95% CI 1.6 to 3.9) and adhered to a greater proportion of recommendations for assistive technologies (MD 11.4%, 95% CI 2.6 to 20.2) and task modifications (MD 10.0%, 95% CI 0.7 to 19.3). Participants in both groups had lower rates of adherence to recommendations for home modifications compared with other types of recommendations. Adherence to recommendations was a mediator in the relationship between participants' involvement in a pre-discharge home visit and reduced hospital readmissions. CONCLUSION: There was greater adherence to occupational therapy recommendations when patients recovering from hip fracture participated in a home visit compared to hospital-based assessment, contributing to reduced readmissions to hospital in the first 30 days. Home visits offer additional benefits to hospital-based assessment through the use of a collaborative approach to decision making in the home environment.

Capabilities, Opportunities, Resources and Environments (CORE): Using the CORE approach for inclusive, occupation-centred practice.

BACKGROUND/AIM: Occupational participation is often claimed as a human right and determinant of health by occupational science and therapy scholars. Yet, maintaining occupation at the centre of practice is a challenge. The Capabilities, Opportunities, Resources and Environments (CORE) approach provides a mechanism for occupational therapists to address this challenge by viewing their practice through an inclusive lens, and enacting inclusive, occupation-centred occupational therapy. This paper presents applications of the CORE approach via three case narratives. The aim is to increase occupational therapists' understanding of how to apply the CORE approach and to facilitate research-to-practice knowledge translation. METHODS: The CORE approach is introduced and applied through three case narratives, each highlighting one of the CORE elements within the context of the broader approach. FINDINGS: The narratives contain critical reflective case narratives on the application of the CORE approach in the context of three different practice settings in Australia based on the authors' experiences. Practice settings include working within the National Disability Insurance Scheme, in a secure forensic mental health facility, and in rural community health. The forensic health case narrative documents findings from the authors' research which applied the CORE approach as an analytical tool, providing an additional layer of analysis of the identified themes from the original study. CONCLUSION: This paper provides occupational therapists with a practical understanding of how to apply the CORE approach through diverse case narrative examples. The practical "how to" questions that guided the development of the case narratives can be used by occupational therapists and occupational therapy students in individual or group critical reflection to support development and application of socially inclusive and occupation-centred praxis. If occupational therapists are to claim expertise in enabling occupation and social inclusion, then using the CORE approach is vital to designing and implementing inclusive, occupation-centred interventions.

A randomised controlled trial exploring the impact of a dedicated health and social care professionals team in the emergency department on the quality, safety, clinical and cost-effectiveness of care for older adults: a study protocol.

BACKGROUND: Older people are frequent emergency department (ED) users who present with complex issues that are linked to poorer health outcomes following the index visit, often have increased ED length of stay, and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and an improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCP teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, and clinical- and cost-effectiveness of care of older adults when compared with usual care. METHODS: The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30 days, and 4 and 6 months of follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; cost-effectiveness in terms of costs associated with ED-based HSCP compared with usual care; and perceptions on implementation by ED staff members. DISCUSSION: This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, and clinical- and cost-effectiveness of care for older patients. The findings of this study will provide important information on the effectiveness of this model of care for future implementation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03739515 . Registered on 12 November 2018.

Performance of an occupational therapist in a neonatal intensive care unit.

BACKGROUND: The following article constitutes an effort to make explicit an experience in neonatology within the framework of the exercise of occupational therapy, a discipline belonging to the health sciences. The occupational therapist (OT) in the Neonatal Intensive Care Unit in which he participates in an interdisciplinary health group. Exalts the interaction of person-environment-occupation-performance. Encourage self-regulation of the baby. Encourages family participation in co-participation in routine activities. OBJECTIVE: To determine the realities and knowledge about the practice of OT in the Neonatal Intensive Care Unit (NICU) by the occupational therapist in the interaction between the baby, the occupation, the caregivers and the environment of the NICU. METHODS: A systematic exploratory review of the performance of the OT in the NICU was made. RESULTS: The results transcended the thematic variables, the theories, the methods, the approaches, the characteristics of the baby, the occupations, and the contexts of the management of the premature baby. CONCLUSION: The education in concepts concerning the occupation of the baby, the interaction with her/his environment and her/his caregivers, the procedures, the guide for the stimulation as the modification of the physical, temporal and social environment facilitate the self-regulation of the baby and we will all be working in pro of your recovery.

ANTECEDENTES: El siguiente artículo constituye un esfuerzo por explicitar una experiencia en neonatología en el marco del ejercicio de la terapia ocupacional, disciplina concerniente a las ciencias de la salud. El terapeuta ocupacional (TO) en la Unidad de Cuidado Intensivo Neonatal como parte del grupo interdisciplinario de salud exalta la interacción de persona-ambiente-ocupación-desempeño. Fomenta la autorregulación del bebé. Alienta la participación de la familia en la coparticipación en actividades rutinarias. OBJETIVO: Determinar las realidades y conocimientos sobre la práctica del TO en la Unidad de Cuidado Intensivo Neonatal (UCIN) del terapeuta ocupacional en la interacción entre el bebé, la ocupación, los cuidadores y el entorno de la UCIN. MÉTODOS: Se hizo una revisión exploratoria sistemática del desempeño del terapeuta ocupacional en la UCIN. RESULTADOS: Los resultados trascendieron las variables temáticas, las teorías, los métodos, los enfoques, las características del bebé, las ocupaciones, los contextos de la gestión del bebé prematuro. CONCLUSIÓN: La educación de conceptos concernientes a la ocupación del bebé, la interacción con su ambiente y sus cuidadores, los procedimientos, la guía para la estimulación como la modificación del entorno físico, temporal y social facilitan la autorregulación del bebé y todos estaremos trabajando en pro de su recuperación.

"Together on the Way": Occupational Therapy in Mainstream Education-A Narrative Study of Emerging Practice in Switzerland.

In Switzerland, recent changes in legislation have reformed special needs education; more children with special needs are now integrated into mainstream schools. Health professionals such as occupational therapists are not embedded in the Swiss education system, but pediatric occupational therapists are starting to work at schools, with the aim of enabling children's full participation as school students. This is bringing a change to the practice of pediatric occupational therapists. Cultural, political, and social factors differ in many ways from those of other countries where most of the current research on pediatric occupational therapists in mainstream education has been conducted. The need for school-based research that is situated within the political, structural, and cultural context of a country has been stressed in different studies. This qualitative study employed narrative analysis to explore the practice experiences and clinical reasoning of Swiss pediatric occupational therapists when working with children with special needs in the school context. Three main themes were identified in the narratives: "bringing in an occupational therapy perspective," "focusing on school-related occupations," and "collaborating with different inclusion players." These represent three different aspects of the therapists' emerging practice. The participants highlight different approaches for children with special needs to enable their participation in everyday life at school through learning, playing, and being with their peers. The findings are discussed in relation to current international research and with respect to European countries with a similar political and structural context, thus complementing approaches to school-based occupational therapy.

Assessment priorities in cerebral palsy using ICF core set by Iranian occupational therapists.

BACKGROUND.: International Classification of Functioning, Disability and Health (ICF) core set for cerebral palsy allows for the description of the levels of functioning in cerebral palsy. It is not exactly clear which of these levels is more important for evaluation from the perspective of occupational therapists in Iran. By identifying these priorities, we can establish a better plan for intervention. PURPOSE.: This study defines assessment priorities in children with cerebral palsy (<6 years). METHOD.: Sixty-two Iranian occupational therapists studied the priorities of assessment based on the Iranian ICF core set. The therapists were asked to rate the code categories from 1 to 3. The results are presented as mean values. FINDINGS.: Occupational therapists first focus on body functions assessment, then activities/participation, and ultimately, environmental factors. IMPLICATIONS.: Occupational therapists in Iran have a bottom-up approach toward clients with cerebral palsy. It may be necessary to revise the educational curriculum, prepare a training course, and provide more supervision for practising occupational therapists.

Performance of an occupational therapist in a neonatal intensive care unit / Desempeño profesional del terapeuta ocupacional en la Unidad de Cuidado Intensivo Neonatal

Abstract Background: The following article constitutes an effort to make explicit an experience in neonatology within the framework of the exercise of occupational therapy, a discipline belonging to the health sciences. The occupational therapist (OT) in the Neonatal Intensive Care Unit in which he participates in an interdisciplinary health group. Exalts the interaction of person-environment-occupation-performance. Encourage self-regulation of the baby. Encourages family participation in co-participation in routine activities. Objective: To determine the realities and knowledge about the practice of OT in the Neonatal Intensive Care Unit (NICU) by the occupational therapist in the interaction between the baby, the occupation, the caregivers and the environment of the NICU. Methods: A systematic exploratory review of the performance of the OT in the NICU was made. Results: The results transcended the thematic variables, the theories, the methods, the approaches, the characteristics of the baby, the occupations, and the contexts of the management of the premature baby. Conclusion: The education in concepts concerning the occupation of the baby, the interaction with her/his environment and her/his caregivers, the procedures, the guide for the stimulation as the modification of the physical, temporal and social environment facilitate the self-regulation of the baby and we will all be working in pro of your recovery.

Resumen Antecedentes: El siguiente artículo constituye un esfuerzo por explicitar una experiencia en neonatología en el marco del ejercicio de la terapia ocupacional, disciplina concerniente a las ciencias de la salud. El terapeuta ocupacional (TO) en la Unidad de Cuidado Intensivo Neonatal como parte del grupo interdisciplinario de salud exalta la interacción de persona-ambiente-ocupación-desempeño. Fomenta la autorregulación del bebé. Alienta la participación de la familia en la coparticipación en actividades rutinarias. Objetivo: Determinar las realidades y conocimientos sobre la práctica del TO en la Unidad de Cuidado Intensivo Neonatal (UCIN) del terapeuta ocupacional en la interacción entre el bebé, la ocupación, los cuidadores y el entorno de la UCIN. Métodos: Se hizo una revisión exploratoria sistemática del desempeño del terapeuta ocupacional en la UCIN. Resultados: Los resultados trascendieron las variables temáticas, las teorías, los métodos, los enfoques, las características del bebé, las ocupaciones, los contextos de la gestión del bebé prematuro. Conclusión: La educación de conceptos concernientes a la ocupación del bebé, la interacción con su ambiente y sus cuidadores, los procedimientos, la guía para la estimulación como la modificación del entorno físico, temporal y social facilitan la autorregulación del bebé y todos estaremos trabajando en pro de su recuperación.

Pre-discharge home visits: A qualitative exploration of the experience of occupational therapists and multidisciplinary stakeholders.

INTRODUCTION: The evidence base surrounding occupational therapy pre-discharge home visits discusses current practices, potential beneficial outcomes and limitations. However, research is limited, regarding how clinical teams determine which patients receive this service. This study aims to explore perceptions of occupational therapists and multidisciplinary stakeholders concerning pre-discharge home visits through their experiences and current practice in the Australian context. METHOD: A qualitative descriptive approach, using thematic analysis, was employed. Four focus groups were included, comprising 27 health professionals: novice occupational therapists (n = 6), experienced occupational therapists (n = 8), occupational therapy managers (n = 5), and multidisciplinary team members (n = 8). RESULTS: Three key themes relating to pre-discharge home visits in clinical practice emerged. The first theme of 'Recognition of Clinical Factors' reflected that aspects of the person's occupational performance, environmental and care needs, were prime indicators considered for a pre-discharge home visit. Secondly, 'Contextual and Pragmatic Influences', described clinical setting realities as being significant considerations and strongly mediating practice. A third theme of 'Perceptions of Value' showed awareness of the utility of pre-discharge home visits, while also recognising need to enhance ongoing practice. CONCLUSION: This qualitative study provides information on factors influencing decision-making regarding pre-discharge home visits from the hospital setting. Clinical factors were presented as key considerations, but clinicians' experiences and perceptions of contextual influences suggest an explanatory factor for practice variation. While multidisciplinary stakeholders' broadly demonstrated similar rationales for pre-discharge home visits as those of occupational therapists, therapists' decision-making processes for pre-discharge home visits were shaped by their experience level. Clinicians' experience finds pre-discharge home visits to have value and in the absence of clear evidence-based criteria for whom this element of practice should be provided, participants supported the development of a decision-making support tool to assist in decision-making.

What factors influence time-use of occupational therapists in the workplace? A systematic review.

BACKGROUND: Health-care expenditure is rapidly increasing in Australia with increasing pressure on health-care services to review processes, improve efficiency and ensure equity in service delivery. The nursing profession have improved efficiency and patient care by investigating time-use to describe current practice and support development of workforce planning models. There is, however, a lack of information to understand factors that impact on occupational therapists time-use in the clinical setting impacting the development of workforce planning models which adapt occupational therapy service delivery to match resources with demand. The objective of this review was to systematically identify known factors which impact on occupational therapists time-use in the clinical setting. METHOD: A systematic review of Medline, PsycINFO and CINAHL databases and grey literature was completed in September 2016. Two authors independently screened studies for inclusion and quality was evaluated using the Downs and Black scale. Variables impacting on occupational therapists time-use were categorised and thematically analysed to synthesise key themes. RESULTS: Twenty studies met the inclusion criteria and were included in the review. Three key categories of factors influencing time-use were identified. These were: patient-related factors (e.g. level of function, therapy required, type, complexity of injury), therapist-related factors (e.g. experience, clinical vs non-clinical responsibility), and organisational-related factors (e.g. workplace characteristics, availability of staff, presence of students). CONCLUSION: Occupational therapist time-use in clinical settings is complex and difficult to quantify in research. How occupational therapists spend their time is impacted by a number of patient, clinician and service related factors reflecting the breadth of occupational therapy practice and client-centred nature of the profession.

Factors Influencing Acceptability and Perceived Impacts of a Mandatory ePortfolio Implemented by an Occupational Therapy Regulatory Organization.

INTRODUCTION: The use of ePortfolios has been implemented in several regulatory organizations to encourage clinicians' engagement in continuing professional development (CPD). However, their use has achieved mixed success, and multiple personal and contextual factors can influence their impacts on practice change. The aim of this study was to identify which factors influence the acceptability and perceived impacts of an ePortfolio implemented by an occupational therapy regulatory organization in one Canadian province. METHOD: A cross-sectional online survey design was used. The survey was sent to registered occupational therapists in Quebec. Multiple regression analyses were conducted to identify factors influencing acceptability and outcomes: ease of use, satisfaction, impact on implementation of the CPD plan, and competence improvement. RESULTS: The survey was fully completed by 546 participants. Factors significantly influencing the ePortfolio acceptability and perceived impacts were attitude toward and familiarity with the portfolio, confidence in reflective skills, engagement in the CPD plan, and desire for feedback. Time spent completing the ePortfolio and the fact of completing it in teams were negatively associated with the outcomes. DISCUSSION: Shaping more favorable user attitudes, helping users recognize and experience the tool's benefits for their practice, and fostering confidence in their reflective skills are important factors that can be addressed to improve ePortfolio acceptability and outcomes. Contextual factors, such as time spent completing the ePortfolio and completing it in teams, seem to reflect greater difficulty with using the tool. Study findings can contribute to improving ePortfolio implementation in the CPD context.

Partnership, inclusion and innovation in occupational therapy: Essential or optional ingredients to flourish in a changing environment?

BACKGROUND/AIM: Historically occupational therapy has evidenced a tenacity to adjust and adapt to societal changes. Currently in Australia we are in the midst of significant change in health, disability and aged care service delivery alongside increasing numbers of new graduates seeking employment. Both of these changes create challenges and opportunities for the profession. How the profession adjusts to new service delivery models and supports new graduates in this changing work environment will influence our future. METHODS: Using examples from practice the paper explores ways in which partnership, inclusion and innovation can be effective in a changing environment. RESULTS: Doing effective partnership takes time, energy and a shared commitment of all involved and often requires negotiations and compromise. Inclusion can be tricky and requires vigilance and ongoing reflection on actions to determine if the outcomes are what was intended. Innovation can play two roles; it can be used to conserve current practice in new ways or it can offer agency to disrupt and redefine practice. CONCLUSION: The way in which the profession chooses to enact partnerships and inclusion will play a vital role in shaping the future. Similarly the space and support made for conservative or disruptive innovation will determine how we choose to define ourselves going forward. Moreover, these choices and actions will govern how effective we are in navigating the changing environment and supporting new graduates transitioning into the profession.

[Peace experiences in occupational therapy: contributions from Colombian regions]. / Experiencias de terapia ocupacional para la paz: aportes desde las regiones colombianas.

OBJECTIVE: To identify and characterize professional experiences in occupational therapy in different regions of Colombia regarding the overcoming of the armed conflict. METHODS: Cross-sectional, descriptive study in which the digital version of the Survey on professional experiences in the Colombian armed conflict was applied using Type-form. 34 occupational therapists responded the survey. The sample filled the corresponding informed consent to participate in the study. RESULTS: The overall balance shows that experiences are mostly concentrated in the Andean region and cover 18 departments of the country, while a representative percentage are observed in works with indigenous communities. Intervention has targeted mainly adults and victims and people with disabilities, although greatest emphasis is on communities. Therapists are involved mainly as executors and university professors. Finally, there is concern about the presence of illegal armed actors and the reality of an overwhelming problem. Achievements include the impact of the intervention and the capitalized professional and personal learning. CONCLUSIONS: A territorial approach requires greater presence in the regions and cultural sensitivity. Strengthening the work carried out with the population that was linked to illegal armed groups through occupational resignification processes allow to make progress in the expected economic and social reincorporation.

OBJETIVOS: Identificar y caracterizar las experiencias profesionales de terapia ocupacional en las regiones de Colombia, relacionadas con la superación del conflicto armado. MÉTODOS: Estudio descriptivo transversal, con la aplicación de una encuesta sobre experiencias profesionales en el conflicto armado colombiano, versión digital, en el aplicativo Typeform, respondida por 34 terapeutas ocupacionales. La muestra diligenció el respectivo consentimiento informado para participar en el estudio. RESULTADOS: El balance general de las experiencias reportadas se concentran en la región andina; cubren 18 departamentos del país; un porcentaje representativo se desarrolla con comunidades indígenas; la intervención se ha dirigido especialmente a adultos y a la atención de víctimas y personas con discapacidad; el mayor énfasis ha sido comunitario; el terapeuta se ha vinculado principalmente como ejecutor y docente universitario; preocupan los problemas de presencia de actores armados ilegales y la realidad de una problemática desbordante; y como logros se resaltan el impacto de la intervención y los aprendizajes profesionales y personales capitalizados. CONCLUSIONES: El enfoque territorial demanda mayor presencia en las regiones y sensibilidad cultural. Fortalecer el trabajo con la población que estuvo vinculada a los grupos armados ilegales, con procesos de resignificación ocupacional que permitan avanzar en la reincorporación económica y social esperada.

Exploring the occupational therapist's role in primary health care: Listening to voices of stakeholders.

BACKGROUND: Re-engineering of primary healthcare (PHC) was initiated nationally in 2009. There is, however, little information on the role expected of occupational therapists (OTs)in PHC. OBJECTIVES: This research aimed to understand how stakeholders of the Department of Health (DOH) perceived the role of OT in PHC service. METHOD: This exploratory, qualitative study used purposive sampling to recruit community health-care workers (CHW; n = 23), primary healthcare nurses (PHC; n = 5), DOH management (n = 5), experienced (n = 14) and novice OTs (n = 37) who graduated from the University of KwaZulu-Natal. The PHC nurses and the CHW represented PHC clinics in one district in KwaZulu-Natal. Data were collected through semi-structured interviews and focus groups. Interviews with CHWs were conducted in isiZulu. These were transcribed and translated prior to data analysis. Audio recordings of English interviews and focus groups were transcribed. Data for each participant group were inductively and thematically analysed to identify the themes. RESULTS: The findings provided an indication of the role of OTs in PHC settings. All participants perceived the role of OTs as predominantly curative/rehabilitation-based and individualised. Participants had a limited understanding of the key principles of PHC. They identified a need for adult and paediatric rehabilitation and early childhood intervention. Limited mention was made of population-based approaches, collaborative, and health promotion and prevention programmes. CONCLUSION: The study has highlighted that neither management nor OTs seemed to align practice and planning according to PHC principles. A review of the theory and experiential learning in the OT programme is required.

Roles of Occupational Therapists in Theater, Past and Present.

The impetus to deploy occupational therapy (OT) assets into theaters of operation lies in the occupational therapist's ability to evaluate the effect of physical and/or behavioral symptoms on functional performance and effectively develop individualized interventions. Occupational therapy utilization has been robust during 14 years of continuous deployments in Iraq and Afghanistan. Occupational therapy's indoctrinated role in combat is solely with the combat and operational stress control missions, however, the skills and capabilities of this profession have demonstrated efficacy in other specializations, including concussion care. The effectiveness of OT interventions is demonstrated with improved return to duty (RTD) rates for casualties suffering with combat and operational stress reactions where OT was a major component of a restoration and reconditioning program. As well, postconcussion RTD rates have been linked to the broad skill sets inherent in OT that allow casualties to remain in theater from the point of injury to complete recovery and RTD.