Perspectives and Influences on Occupation-Based Hand Therapy.

Background. Occupational therapists practicing hand therapy are challenged to implement occupation-based practices (OBPs) due to the strong influence of the medical model. Purpose. To explore hand therapists' perceptions of OBP and describe occupation-based interventions (OBIs) in hand therapy. Method. Qualitative content analysis (QCA) was used to analyze semi-structured interviews with seven hand therapists. Findings. Six themes emerged: (1) OBP denotes treatment that is customized to ensure individual meaningfulness to each client; (2) the client-therapist relationship is a foundational element central to OBP in hand therapy; (3) goal setting serves as an important link between biomechanics and occupation; (4) OBP in hand therapy encompasses a spectrum of both OB and non-OB interventions; (5) various contextual factors influence OBI; (6) advanced experience in hand therapy facilitates enactment of tailored OBI. Implications. Comprehension of multiple aspects of occupation-based methods in hand therapy exemplifies best practices for clinicians to benefit clients and the profession's identity.

Beyond research literature: Occupational therapists' perspectives on and uses of "evidence" in everyday practice.

BACKGROUND: Recent literature in evidence-based practice indicates that evidence is defined differently from practice and research perspectives. However, few published works address therapists' perspectives of the nature and use of evidence in everyday practice. PURPOSE: This study describes the definition, types, and use of evidence from the perspective of six school-based occupational therapists. METHOD: Data were collected through focus groups and participant-submitted documentation and analyzed using qualitative and quantitative content analysis. FINDINGS: Two categories of evidence emerged: internalized evidence and evidence gathered during the intervention process. Clinical reasoning, identified as a key skill in evidence-based practice, supported the synthesis of therapist internalized evidence with "in-the-moment" evidence gathered from activity, contextual, and occupational analyses of the client. IMPLICATIONS: The findings support current literature that has suggested expanding the definition of evidence (i.e., more than research findings alone). Further investigation of evidence building in practice may help in constructing a more inclusive professional culture of evidence-based practice.