Clinical utility and validity testing of a co-designed outcome measure for hand burn injuries.

INTRODUCTION: A new outcome measure for hand burn injuries was co-designed within a Participatory Action Research framework with expert clinicians and individuals with hand burn injuries. The outcome measure reviews activities which are commonly interrupted post hand burn injuries and includes 18 activities. OBJECTIVE: The aim of this study was to establish the clinical utility, face, and content validity of the newly developed outcome measure. METHODS: Three constructs of interest were examined using study specific questionnaires from the perspectives of clinicians and individuals with hand burn injuries. Clinicians working in burns centres around Australia and New Zealand and individuals attending a burn centre within one tertiary hospital trialled the outcome measure. Upon testing the outcome measure each participant completed the questionnaire. RESULTS: Twenty individuals with hand burn injuries and eight clinicians trialled the outcome measure. There was 85% agreement from individuals and 100% agreement from clinicians for face validity. Content validity was tested across the domains of relevance and clarity. Individuals rated all activities and clinicians rated 16 activities as relevant. Clarity of activities was high for both participant groups (>75% agreement). Clinical utility (measured in the domains of appropriateness, accessibility, practicability, and acceptability) was high, 95% of individuals reported agreement for practicability and 100% agreement for acceptability. Clinicians reported agreement of > 87.5% for appropriateness, accessibility, practicability, and acceptability. CONCLUSION: The results demonstrated agreement for clinical utility, face, and content validity of the co-design outcome measure for hand burn injuries. Further validity and reliability testing is planned, including Rasch analysis.

Occupation-centred practice and supervision: Exploring senior occupational therapists' perspectives.

INTRODUCTION: Occupation-centred practice is core to contemporary occupational therapy; however, knowledge and implementation of occupation in practice vary. New graduate occupational therapists find implementing occupation-centred practice challenging, partly due to the influence of senior occupational therapists. However, little is known about senior therapists' views, knowledge, and use of occupation-centred practice and the impact this has on new graduates. The aims of this study were to explore senior occupational therapists' perspectives on and use of occupation-centred practice and the extent to which they influence the occupation-centred practice of the new graduates they supervise. METHODS: Interpretative phenomenology was used as the research design. Ten senior occupational therapists in Australia were purposively recruited to participate in semi-structured interviews, which we transcribed. Interpretative Phenomenological Analysis (IPA) was used to analyse the data and develop themes. FINDINGS: Five themes were discovered from the data: together, but apart; a link between knowledge and identity; navigating different cultures; making up for what is missing; and good supervisors. The themes revealed participants' varied knowledge and use of occupation-centred practice, the influence of practice context, and the way supervision impacted on the practice of new graduates. CONCLUSION: Senior occupational therapists valued occupation-centred practice, but their understanding and implementation of it varied. Participants acknowledged that they held great power to influence new graduates' use of occupation-centred practice through supervision. Consequently, if occupation is not central to supervision, this could perpetuate the ongoing challenges of delivering contemporary practice.

Environmental sustainability: An exploratory study of the perceived knowledge, attitudes, and skills of occupational therapists practicing in Australia.

INTRODUCTION: The threat of climate change to the health and wellbeing of the Australian population is well documented. Literature is emerging to support the role of occupational therapy in environmental sustainability. To date, the perspectives of occupational therapists practicing in Australia are yet to be explored. This study aimed to explore these perspectives, specifically occupational therapists' knowledge, skills, and attitudes regarding environmental sustainability. METHODS: A mixed methods study using a cross-sectional survey design and convergence model was undertaken. A survey was developed using closed- and open-ended questions drawn from the World Federation of Occupational Therapists Guiding Principles for Sustainability. The online survey remained open from March to September 2021. Quantitative data were analysed descriptively, and inductive content analysis was used to analyse qualitative data. Merged integration was used to identify convergence and divergence between data sets and enable conclusions to be drawn. RESULTS: Responses were received from 37 participants. For occupational therapists practicing in Australia there appeared to be an incongruence between the importance of environmental sustainability in daily life compared to professional practice. In professional practice, there are several perceived barriers that are outside of the locus of control of the therapist. Therapists are motivated to engage in this concept but are unsure how to do so. CONCLUSION: Findings provide an initial understanding about environmental sustainability from the current perspectives of occupational therapists practicing in Australia. More structured guidance is required to integrate environmental sustainability considerations into professional practice. Future research should focus on developing a more in-depth understanding of the concepts preliminarily explored in this study.

Uncovering the experiences of engaging in an inpatient occupation-based group program: The LifeSkills group.

BACKGROUND: Consumer engagement is an important element for developing and maintaining value-based healthcare standards. Occupation-based practice in the context of a group has been adopted by inpatient rehabilitation clinicians, but little research has explored if these groups are valuable and useful to patients. AIMS/OBJECTIVES: To explore the experiences of patients participating in an occupation-based group intervention for instrumental activities of daily living to understand its value and usefulness in an inpatient rehabilitation setting. MATERIAL AND METHODS: Interpretive description guided the development of the study. Semi-structured interviews were completed with 15 participants of an occupation-based group, the LifeSkills group. Comparative analysis was used to analyse the data and develop themes. RESULTS: Five themes were reported by participants: choice and control, confidence through doing, a real-world connection, the power of the therapeutic relationship and the impact of the shared experience. CONCLUSIONS AND SIGNIFICANCE: In line with current rehabilitation literature, patient experiences around client-centredness, occupational engagement in a 'real-world' environment, and valued relationships can be facilitated through an occupation-based group. This study supports the implementation of valued-based healthcare in understanding patient perceptions of occupation-based interventions into rehabilitation; ensuring that the right intervention is being used at the right time for the right patient.

Evaluation of an inpatient occupation-based group program using a process evaluation framework.

INTRODUCTION: Occupation-based groups are used in inpatient rehabilitation to enhance delivery and intensity of intervention; however, little research is available to understand their effectiveness. The aim of this study was to examine the process of an occupation-based group to understand mechanisms and success factors. METHODS: A mixed methods process evaluation using an evidence-based framework guided implementation and analysis. Participants were those involved in the 'LifeSkills' group run daily in an adult inpatient general rehabilitation ward. Quantitative administrative data, goal achievement outcome measures, group observations and qualitative semistructured interviews were conducted. RESULTS: Thirty participants were recruited. Factors for success included consistency in group structure and support, using meaningful practise opportunities and facilitating a real-world experience. There was no significant relationship between patient outcomes and dose of training or patient demographics. CONCLUSION: This evaluation contributes to a growing body of evidence for incorporating occupation-based approaches into rehabilitation and offers insights into practice implementation.

Exploration of individuals perspectives of recovery following severe hand burn injuries.

INTRODUCTION: Burns to one or both hands can impact how a person interacts with the world around them. Research regarding the specific impact of hand burn injuries and the experiences of individuals who have sustained hand burn injuries remains limited. OBJECTIVE: The aim of this study was to explore the lived experiences of people with severe hand burn injuries, including their return to daily activities. METHODS: This study used an interpretive description approach, incorporating 23 semi-structured interviews with people who had sustained severe hand burn injuries. RESULTS: A major theme, "changes over time ", was identified and reflected the progressive nature of the experience over time. This was present in all three sub-themes: physical recovery, activities of daily living recovery, and psychosocial impact. Participants described a dual process of managing the recovery of the burn injury and burn rehabilitation interventions, whilst simultaneously learning to live with their injury and finding ways to engage in their occupations to the best of their abilities. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The findings of the study suggest that burns recovery could be described in terms of performance rather than impairment and needs to be continuously monitored overtime.

Establishing the normative and comparative needs of assistive technology provision in Queensland from the agency and funding scheme perspective.

BACKGROUND AND AIMS: Assistive technology services and devices support the participation and inclusion of people living with disability. In Australia, the regulatory bodies, agencies and schemes that manage assistive technology provision are governed by national and / or state-based Acts and Legislation. This study examined the assistive technology sector from the perspective of the regulatory bodies, agencies and schemes. DESIGN AND METHODS: Regulatory bodies, agencies and schemes that manage funding for assistive technology in Australia were identified by the research team. A website audit reviewed publicly available documents and information. Semi-structured interviews with representatives from the agencies and schemes were audio-recorded and transcribed verbatim. FINDINGS: The audit (n =17) found that the range and level of information publicly available was variable. The availability of assistive technology for driving and transport, design and building for access and safety, and mobility was most often promoted. The qualitative findings (n = 11) indicated variability and challenges within four themes: operationalising the legislation; internal assistive technology processes; reasonable and necessary; and risks in the assistive technology pathway. CONCLUSIONS: Regulatory bodies, agencies and schemes are critical to the effectiveness of the sector. The findings identified opportunities for the organisations to review how internal processes are communicated publicly, and for the sector to address the perceived risks related to health professional availability, knowledge and skills, and limited accessibility to trial assistive technology. Subsequent studies explored the perspectives of the assistive technology advisors and suppliers and the recipients of assistive technology services and devices.

Exploring Patient Outcomes After Participation in an Inpatient Occupation-Based Group: A Longitudinal Observational Cohort Study.

IMPORTANCE: Occupation-based interventions are used during inpatient rehabilitation, and group models may enhance intervention delivery. However, little is known about the impact of occupation-based groups on patient outcomes. OBJECTIVE: To examine the effect of an occupation-based group on patient outcome measures of instrumental activities of daily living (IADL) skills over time and explore demographic differences among patients. DESIGN: Longitudinal observational cohort study with four time points: preintervention, postintervention, 30-day follow-up, and 90-day follow-up. SETTING: Tertiary hospital general rehabilitation ward. PARTICIPANTS: Inpatient adults age 18 or older recruited using consecutive sampling from those referred to the group. INTERVENTION: The LifeSkills group, which focused on repetitive practice of meaningful occupation-based activities. OUTCOMES AND MEASURES: Demographic data were obtained, and the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling, Lawton IADL scale, and a self-efficacy scale were administered at each data point. RESULTS: Thirty people (21 women, 9 men; ages 35-91 yr) participated, with 5 lost to follow-up. A statistically significant increase in scores postintervention occurred on all measures and was also seen at 90-day follow-up for COPM occupational performance, satisfaction, and self-efficacy scores. Lawton IADL scale scores at follow-up were lower than those at preintervention and statistically significant. No significant differences were found for age and diagnosis. CONCLUSIONS AND RELEVANCE: Positive patient outcomes of goal achievement, occupational performance, satisfaction, and self-efficacy were seen at discharge, with evidence of sustainability over time. This could be a resource alternative for addressing skill retraining because people with different diagnoses and in different age groups benefited equally. What This Article Adds: Occupation-based group programs have encouraging application in general inpatient rehabilitation for addressing patient outcomes.

Exploring stroke survivors' experiences and understandings of occupational therapy.

BACKGROUND: Occupational therapists view people with stroke as occupational beings who may experience occupational issues. Concurrently, occupational therapy practice is guided by research evidence that supports predominantly impairment-based practices. There has been limited exploration of how people with stroke experience and understand occupational therapy in the context of the potential tension between the professional philosophy and the research-based evidence. AIMS/OBJECTIVE: To explore the experience and understanding of occupational therapy with stroke survivors. MATERIAL AND METHODS: Interpretative phenomenology guided semi-structured interviews with nine participants from five states across Australia. RESULTS: Three themes emerged: Understanding of occupational therapy grows by 'doing' outlines how participants understood occupational therapy based on their individual experiences over time; Personal factors influence the experience highlights how participants had diverse expectations for recovery that influenced their occupational therapy experience. Context shapes occupational therapy experience identified that the therapeutic relationship and context of occupational therapy were important factors in shaping experiences. CONCLUSION: Both impairment-based and occupation-based therapy were considered valuable aspects of occupational therapy, representing the proposed tension between the professional philosophy and research-based evidence. Occupation-based and client-centred practice was more often experienced in the outpatient setting, with challenges described for both within the inpatient setting.

Occupation-based group programs in the inpatient hospital rehabilitation setting: a scoping review.

PURPOSE: Occupation-based practice involves the inclusion of meaningful occupations in the therapeutic process and is promoted within hospital-based general rehabilitation contexts for individual clients or within a group setting. The purpose of this paper is to summarise the current literature regarding the types of occupation-based group programs used within general inpatient rehabilitation and the reported outcomes. METHODS: A scoping review was conducted and included papers if they described an occupation-based intervention, delivered in a group setting, conducted in an inpatient rehabilitation hospital context, with an adult population. Studies were collated, summarized and key findings are presented. RESULTS: Ten articles met inclusion criteria. The results indicate that occupation-based groups are used in inpatient rehabilitation across a variety of settings, the approach is valued by the occupational therapy profession and it appears to have an influence on patient satisfaction and experience. However, the impact on a patient's confidence and occupational performance outcomes post-inpatient rehabilitation remains unclear. CONCLUSIONS: There is a dearth of evidence on the impact of occupation-based group service focus in the inpatient rehabilitation setting. Considering the importance of occupation to the profession, further investigation into the use of this approach in a group setting is required.Implications for rehabilitationOccupation-based groups are used in inpatient rehabilitation to achieve more therapy time but there is variability in group processes and outcomes measured.Patient centred occupation-based groups appear to have an influence on patient satisfaction and experience.For the occupation-based groups reviewed, providing explicit links between patient goals, therapeutic activity and real life was important for improving outcomes.There is a growing focus for the use of occupation-based groups in occupational therapy and more research is needed to establish effectiveness.

Describing the occupational nature of practice: A scoping review.

BACKGROUND: Describing how occupation is used in practice can be challenging for occupational therapists. Occupation-centred, occupation-based, and occupation-focussed terminology are frequently used interchangeably and ambiguously to describe practice. However, ambiguous language creates confusion and inadequately demonstrates the value of occupation. AIMS/OBJECTIVES: This scoping review aimed to identify how occupation-centred, occupation-based, and occupation-focussed terminology are defined and represented in occupational therapy literature. MATERIALS AND METHODS: A five-step scoping review included papers published between 2014 and 2019 from four databases. Extracted data were summarised to outline how the terms were being used within the literature. RESULTS: Initial searching yielded 819 articles and 35 papers met inclusion/exclusion criteria. Within current literature, occupation-focussed and occupation-based terminology were inconsistently described. A limited number of articles used occupation-centred and occupation-focussed terminology to describe practice, whilst occupation-based was more prominent. Occupation-based terminology was represented in numerous ways to describe assessments, practice tools, interventions, research, and theory. Discrepancies between the description and implementation of occupation-based practice were most prominent within interventions. CONCLUSION AND SIGNIFICANCE: Findings demonstrated that occupation-based and occupation-focussed terminology were used interchangeably and inconsistently in literature. It is timely to consider how this is problematic for our professional identity and perceptions of occupation in practice.

Identifying the characteristics of occupation-centred practice: A Delphi study.

INTRODUCTION: Occupation-centred practice is key to aligning with the contemporary paradigm. Benefits of this approach for clients and the profession are well documented, yet how to identify occupation-centred practice is not yet understood. Therefore, this study aimed to uncover the characteristics of occupation-centred practice and how they can be identified in practice. METHODS: A three round Delphi survey was conducted to gain consensus on the defining characteristics of occupation-centred practice. Purposive, convenience, and snowball sampling were used to distribute three survey rounds to occupational therapists internationally. Content analysis was used to create characteristics, descriptions, and examples of occupation-centred practice. Percentage agreement between occupational therapists were calculated to determine consensus. RESULTS: Responses were received from 100 participants in round one, 89 in round two, and 70 in round three. Round one generated 12 characteristics that were refined and finalised into four defining characteristics, one of which had three subcharacteristics. The four characteristics are as follows: guided by theory and philosophy grounded in occupation, language and documentation promotes occupation among stakeholders, understanding and incorporating the person's context, and occupation as core to practice, which includes occupation in goal setting, assessment, and intervention. Descriptions and examples were generated for each characteristic. CONCLUSION: This study presents valuable information for occupational therapists wanting to practise in an occupation-centred manner. The characteristics, descriptions, and examples provide a foundation upon which occupational therapists can understand and identify occupation-centred practice. Examples provided were highly influenced by factors including practice settings and preferred terminology. Future research will explore the creation of a tool for occupational therapists to evaluate their own practice against the characteristics to demonstrate areas of strength and for development.

Re-engaging in our role with communities: The coupling of occupational therapy and community development.

INTRODUCTION: A growing number of occupational therapists are re-engaging in work with communities and populations to advance a social justice agenda. To assist in this endeavour, many are coupling occupational therapy and community development theory, as reflected in the social occupational therapy field. Social occupational therapy practitioners work with groups of people who do not necessarily have a health diagnosis or illness but who nonetheless experience occupational issues due to structural barriers within society. Practitioners work across micro- and macro-levels to not only alleviate symptoms of these issues but also to transform their root causes. Although community development is a logical partner to assist such practice, there are inherent tensions in the coupling of these disciplines. This study aimed to explore what theory occupational therapists were using from occupational therapy and community development to guide them in their social occupational therapy practice. METHODS: This study employed a collaborative and participatory qualitative research method. Four occupational therapy community development practitioners each participated in two one-on-one dialogical interviews with the first author. These were transcribed and analysed using Braun and Clarke's method of thematic analysis. FINDINGS: Findings were grouped into two themes: (a) Occupational therapy and community development - synergies and tensions, and (b) Of the profession but not in it. Findings highlighted the theoretical shortcomings of occupational therapy for community development practice, theoretical tensions between the two disciplines, and the 'underground' nature of occupational therapy community development practice. CONCLUSION: Practitioners should be supported by the occupational therapy profession to be effective community development practitioners, capable of advancing the profession's vision of social justice. Future research should explore methods to support practitioners to navigate tensions between occupational therapy and community development, and bring this practice 'above ground'.

Contemporary occupational therapy philosophy and practice in hospital settings.

BACKGROUND: Occupational therapists have sought to reconnect with the foundations of the profession for many years, and a key focus has been the place of occupation in practice. Existing literature suggests that therapists working in acute settings experience difficulties practicing in ways that centralise occupation. AIM/OBJECTIVE: This scoping review aimed to explore the existing literature on contemporary occupational therapy philosophy and practice in acute hospital settings. METHODS: A five step scoping review process was implemented. Four electronic databases were searched using a combination of search terms. Searching reference lists of papers was also completed. Results were summarised using numeric and thematic analysis. RESULTS: Twenty four publications were included. Four themes were identified; attitudes towards occupation-based practice, benefits of occupation-based approaches, challenges implementing occupation-based practice, and strategies to overcome challenges. CONCLUSION AND SIGNIFICANCE: Findings highlighted therapists value occupation as an important aspect of practice, however they experience many environmental and personal challenges in acute settings. Strategies to overcome these challenges related to individual's changing their practice to be more occupation-focussed and changes within the practice context including adapting environments, documentation and intervention protocols to focus on occupation. These strategies may support therapists to align practice with their professional values.

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.

Uncovering educator perspectives of occupation-centred education in Australia: A qualitative study.

BACKGROUND/AIM: Occupation and an occupational perspective of health and wellbeing are required to be taught in accredited occupational therapy programmes internationally. Current research into occupational therapy education has commonly focused on curriculum design and the experience of students and their developing skills for practice. Little research has focused on the perspectives of educators and in particular their own reflections and beliefs on the use of occupation in occupational therapy education. The aim of this study was to uncover Australian educator perspectives of occupation in occupational therapy education. METHOD: This study utilised a qualitative research framework. Eight occupational therapy educators and practice education coordinators completed semi-structured interviews. Educators ranged in experience from two to over 20 years in the university sector. The interview transcripts were transcribed verbatim, forming the data for analysis. Braun and Clarke's thematic analysis was used to analyse the dataset. RESULTS: Three themes emerged from the data: occupation is our framework; the balance between practice education and occupation-centred education; and educators changing the focus. Overall, educators believed that the 'occupation for health' philosophy and its application are important foundations for education. However, educators provided varied responses on how to teach these concepts to students. CONCLUSION: Gaining educators' opinions on the importance of occupation in education is beneficial for ensuring consistency throughout occupational therapy curricula. Theoretical models were endorsed by educators to foster occupation-based practice. Educators must continue to innovate within the profession for occupation-based approaches in practice and education to be strengthened in the future.

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective.

BACKGROUND/AIM: Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective. METHOD: This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes. RESULTS: The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity. CONCLUSION: Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.

Occupational therapists' perceptions of occupation in practice: An exploratory study.

BACKGROUND/AIM: The World Federation of Occupational Therapists' minimum standards state occupation and its relationship with health must be concepts covered in occupational therapy education. Therefore, it is assumed that Australian graduates have sound knowledge of the principles of occupation-based practice. In some practice settings, the link to occupation may not be explicit and graduates could face challenges to being occupation-based. The aims of this pilot study were to explore graduates' perceptions of occupation in their practice and to investigate whether graduates felt sufficiently prepared for occupation-based practice. METHODS: Two focus groups with eight therapists in total were employed to uncover experiences and perceptions of occupation. Themes were synthesised using Braun and Clarke's method of thematic analysis, where line by line coding was employed to inductively build themes. RESULTS: Participants believed that occupation-based practice was important but did not necessarily need to be implemented as a means of intervention. From the participants' perspective, simply striving for occupation as the end goal of therapy was acceptable. A strong focus on impairment-based practice hindered some therapists from exploring the use of occupation-based practice. For recent graduates, workplace culture was pervasive and inhibited the use of occupation. In addition, participants felt university educators did not provide an integrated or consistent approach when teaching how to apply occupation in practice. CONCLUSION: Workplace expectations and limited power to influence practice are impeding graduates from authentically applying occupation in practice. Insights from recently graduated therapists about occupation have the potential to inform future directions of occupation-based practice.