Australian occupational therapy journalAleksandra Westcott, Lorrae Mynard, Gabrielle Pitt, Susan Darzins
INTRODUCTION: Identifying and addressing the support needs of forensic mental health patients in daily life occupations is critical yet complex due to the health comorbidities and environmental restrictions impacting their participation. Occupational therapists support forensic patient recovery by facilitating their performance in daily life occupations required at home and in the community. Standardised assessments of daily living are important for guiding interventions. The Home Support Needs Assessment (HSNA) is a standardised measure identifying unmet support needs in daily life occupations. The aim of this study was to evaluate its initial acceptability and feasibility for occupational therapists' use in a forensic mental health setting. METHODS: An exploratory convergent, parallel mixed-methods design was used. Semi-structured interviews with five forensic occupational therapists explored their perspectives about using the HSNA in practice. Interview transcripts were analysed using reflexive thematic analysis. HSNA data were extracted from 13 patient medical records and summarised using descriptive statistics. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer and community involvement in this research as the focus of the study was on occupational therapists. FINDINGS: Three overarching themes were generated: value of the assessment, informed care planning, and applicability to the environment. The HSNA was found to structure observations, facilitate discussions about daily life occupations, and clarify ongoing support needs. An over-support of some needs emerged as a unique factor of the forensic mental health environment. Some items were viewed as not applicable to the setting. CONCLUSION: The HSNA highlighted that the safety focus of the secure environment inadvertently limited opportunities for patients' involvement in daily life occupations. Acceptability was associated with enabling holistic occupational assessment. Further tailored training may increase overall implementability.
INTRODUCTION: There is an increase in the number of graduates entering the occupational therapy workforce with graduates having to navigate both broader systemic influences and personal preferences in their decision-making process. This study investigated how and why occupational therapy graduates from a regional Australian university selected their first job as practising occupational therapists. METHODS: An online exploratory, cross-sectional survey design was utilised to collect quantitative and qualitative data from new graduate occupational therapists. Descriptive statistics were used to analyse quantitative responses. Free-text responses were interpreted using reflexive thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer or community involvement. RESULTS: A total of 30 new graduate occupational therapists completed the survey. The most commonly reported practice areas of work were disability, health and aged care. The most commonly reported practice settings were community, clinic and hospital. Participants rated work-life balance, professional development opportunities and interpersonal relationships as the most important factors that are considered when seeking their first job. Proactive and multifaceted processes, combining practical job-seeking strategies, reflective decision-making and the use of professional networks, were used to navigate the employment process. CONCLUSIONS: Job selection was influenced more by relational, developmental and lifestyle workplace factors than by specific practice settings. Understanding these factors is important for informing occupational therapy education and recruitment strategies.
INTRODUCTION: Chronic pain is a biopsychosocial experience that can impact peoples' ability to participate in everyday occupations. Mobile health applications, or apps, have the potential to make chronic pain services more effective and accessible. However, the quality of many health apps is not known, which creates a critical challenge for occupational therapists who aim to deliver evidence-informed intervention. This study rated the quality of apps available for Australian occupational therapists to use with clients who have chronic pain. CONSUMER AND COMMUNITY INVOLVEMENT: No consumer and community involvement. METHODS: This study used a cross-sectional descriptive design to (1) identify chronic pain-relevant apps through browser and app store searches, and through a survey of Australian occupational therapists; and (2) evaluate the quality of the apps relevant to occupational therapy practice, at a single point in time, using the Mobile Application Rating Scale. RESULTS: A total of 27 eligible apps were identified (n = 27). The 27 apps were rated for quality. The mean Objective Quality score of all apps was 3.33/5.00 (acceptable), with a range of 2.14 (poor) to 4.13 (good). The mean Objective Subsection Quality scores were 3.88 (acceptable) for Functionality, 3.25 (acceptable) for Aesthetics, 3.23 (acceptable) for Information, and 2.96 (poor) for Engagement. The mean Subjective Quality score of all apps was 2.67 (poor), with a range of 1.00 (inadequate) to 4.25 (good). CONCLUSION: There was no consistent standard to the quality of chronic pain-relevant apps identified. Occupational therapists may not be identifying all high-quality chronic pain-relevant apps currently available. Findings highlight that occupational therapists lack access to an easy method to identify and verify high-quality apps for use with clients who have chronic pain. Further work is needed to ensure occupational therapists can identify and evaluate the quality of chronic pain-relevant apps in a rapidly changing field of practice.
Australian occupational therapy journalClare Stephenson, Sophia Hadjimichael, Kasia Bail, Diane Gibson, Stephen Isbel, Michelle Bennett, Nathan M D'Cunha
INTRODUCTION: There is limited availability of community-based rehabilitation for people with dementia. This study explored stakeholder perspectives to inform the design of an occupational therapy-led at-home dementia rehabilitation programme. METHODS: Four co-design workshops were conducted over 6 months with 16 participants, including people with dementia, care partners and health-care professionals. Transcribed workshop discussions underwent iterative thematic analysis to inform the final intervention components and philosophical foundations. CONSUMER AND COMMUNITY INVOLVEMENT: People with dementia and their care partners discussed what an at-home dementia rehabilitation programme should entail. As consumer and community contributors, they informed programme refinements by shaping decisions about intervention content at each workshop. FINDINGS: Four themes underpinned the intervention components and philosophical foundations for the programme: (1) accessible dementia care, driven by increased community awareness; (2) person-centred care: understanding a person's unique needs, preferences and goals; (3) empowerment through community engagement and continuous support; and (4) coordinated multidisciplinary care, essential for continuity and effectiveness. Person-centred care requires tailoring individual goals within a multidisciplinary structure, with allied health assistant intervention delivery and personalised resources prepared with oversight from the occupational therapist. Stakeholders endorsed programme leadership by occupational therapists, with physiotherapy support where mobility or exercise components were required and delivery by allied health assistants under clinical supervision. CONCLUSION: Codesign workshops defined an at-home dementia rehabilitation intervention founded on occupational therapy philosophies of care, with accessibility, empowerment and a comprehensive referral and intake process as central to individualisation. Assessing the programme's feasibility and effectiveness may enable personalised care that helps people with dementia maintain independence at home. Allied health assistants may offer a cost-effective option, improving access to rehabilitation for people with dementia, as with other chronic conditions.
Australian occupational therapy journalGülşah Zengin Yazıcı, Kardelen Yıldırım, Müberra Tanrıverdi
BACKGROUND: The Cognitive Orientation to Daily Occupational Performance (CO-OP) approach is a cognitive strategy-based, occupation-focussed intervention designed to improve functional performance in children with neurodevelopmental conditions. Although CO-OP has been increasingly used in paediatric rehabilitation, evidence from randomised controlled trials examining its effectiveness across different populations and outcomes has not been comprehensively synthesised. This systematic review and meta-analysis examined the effects of CO-OP on occupational performance and related outcomes in children with disabilities. METHOD: Randomised controlled trials involving children aged 3-18 years were identified through PubMed, Scopus, and CENTRAL. Seventeen eligible reports representing 13 distinct trial cohorts were included. Risk of bias was assessed using RoB 2. Where clinically appropriate, COPM Performance and Satisfaction outcomes were synthesised using random-effects meta-analysis; other outcomes were synthesised using a SWiM-informed approach. Certainty of evidence was assessed using GRADE. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer or community involvement in the conduct of this systematic review. RESULTS: In five trials comparing CO-OP with active alternative interventions, meta-analysis did not demonstrate clear superiority for COPM Performance (MD = 1.03, 95% CI [-0.38, 2.44], I2 = 77.7%) or Satisfaction (MD = 1.53, 95% CI [-0.13, 3.19], I2 = 75.1%); certainty was very low. Low-certainty evidence from inactive/waitlist comparisons and trials adding CO-OP to background rehabilitation suggested improvements in individualised occupational performance. Evidence for generalised motor capacity, functional status, broader participation-related outcomes, and executive functioning was limited or inconsistent. Neuroimaging findings were exploratory. CONCLUSION: CO-OP may improve individualised, goal-oriented occupational performance compared with inactive controls or when added to background rehabilitation. However, current evidence does not establish clear superiority over other active interventions. Further adequately powered trials examining participation, generalisation, and longer term outcomes are needed.
Australian occupational therapy journalSarah Louise Miller, Helen Bourke-Taylor, Karen Dixon, Rita Upreti
INTRODUCTION: Autistic transgender and gender diverse (TGD) adults often report additional barriers to health-care access and occupational participation. Gender-affirming hormone therapy (GAHT) consists of hormonal medications a person may choose to take to increase alignment of physical features with their gender identity. CONSUMER AND COMMUNITY INVOLVEMENT: This research project was conducted in response to patient and clinician feedback; however, no consumers were involved in the setup or analysis of the study. METHODS: Six autistic TGD adults undergoing GAHT at a statewide tertiary gender endocrinology clinic participated in in-depth semi-structured interviews and underwent an Adolescent/Adult Sensory Profile (AASP) assessment. Secondary analysis of qualitative data utilised thematic analysis and triangulation with AASP results through the lens of the doing, being, becoming, belonging framework to understand how autistic TGD adults achieve occupational identity. RESULTS: Autistic TGD adults experienced improved quality of life, mental health, and occupational identity outcomes as a result of GAHT. Being TGD and autistic posed unique challenges for autistic TGD adults in doing tasks associated with GAHT, including navigating health-care and social environments. Gender-affirming physical changes and experiences increased participants' engagement in gendered occupations and roles. CONCLUSION: For autistic TGD adults who choose to medically transition, GAHT can be an important gender-affirming occupation in enabling occupational identity acquisition. The results of this study highlight a role for occupational therapists within gender-affirming care settings to enhance patient care.
Australian occupational therapy journalSusan Melchert, Richard Franklin, Daniel Lowrie
INTRODUCTION: Falls among older adults are a major cause of death, injury, and loss of independence. High-certainty evidence demonstrates that comprehensive, occupational therapy-led home fall-hazard reduction interventions can reduce the number of falls among older adults at high risk. Despite this evidence, these interventions are not routinely implemented in practice. Current literature provides limited insight into the factors that influence successful implementation of home fall-hazard reduction interventions. This study seeks to address the following research question: 'What influences the success of occupational therapy-led, home fall-hazard reduction intervention implementation from the perspectives of academic and practising therapists with expertise and experience in this field?' METHODS: Using a descriptive qualitative design, data were gathered via two small group interviews and one individual interview with occupational therapists experienced in implementing home fall-hazard reduction initiatives. Participants were purposively sampled to ensure data collection from participants with relevant experience, either as an academic or practising therapist. Data were analysed using reflexive thematic analysis to identify factors influencing successful implementation. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer or community involvement. FINDINGS: Five academics and four practising therapists were interviewed. Four interconnected themes were derived from the data: (1) multiple and layered measures of implementation success; (2) foregrounding falls prevention; (3) articulating a place for home fall-hazard reduction in the falls prevention landscape; and (4) structured guidance and protocols. The interrelated nature of the themes has been illustrated in a theoretical conceptual model. CONCLUSION: The findings suggest that attending to the multiple measures of implementation success for home fall-hazard reduction intervention, particularly those that are context driven, may strengthen uptake across diverse practice settings. Furthermore, maximised success in implementation requires clear guidance on intervention components, improved articulation of intervention fit within the wider fall prevention landscape, and targeted support to enable occupational therapists to foreground falls prevention in practice.
Australian occupational therapy journalSarah Ninan Fenn, Natasha Jojo, Stephen Isbel, Claire Pearce
INTRODUCTION: Collaborative relationship-focussed practice centres on the relational aspects of co-designing priorities and goals with individuals, collectives, and occupational therapists. To establish a relationship with immigrant families of children with disabilities, aligning the goals with their values and resources is essential. However, this is perceived as challenging, and there is a significant knowledge gap regarding how the goals are set in the occupational therapy process with immigrant families of children with disabilities. OBJECTIVES: This study aimed to explore how immigrant families of children with disabilities contribute to and influence the occupational therapy goal-setting process. METHODS: This study employed a qualitative methodology using constructivist grounded theory. This methodology enabled the researcher to inductively frame theory grounded in data in an area with limited literature. CONSUMER AND COMMUNITY INVOLVEMENT: Consumers and community members were not involved in the development or undertaking of this research. RESULTS: The occupational therapy goal-setting process is complex and is influenced by families' culturally constructed wants, professional frameworks, and the demands of the broader system. Currently, the professional frameworks and demands of the system overshadow the occupational therapy goal-setting process, compromising the focus on the overarching wants of immigrant families. CONCLUSION: Collaborative relationship-focussed occupational therapy practice involves shifting and centring the position of the immigrant families of children with disabilities. This can only be achieved by understanding and integrating families' wants into the occupational therapy process. Recognising and addressing their wants helps occupational therapists contextually position the family within their cultural, social, and political context.
Australian occupational therapy journalEliza Huppatz, Carol McKinstry, Gail Whiteford, Emma George
INTRODUCTION: Emerging scholarship highlights the dominance of Western epistemologies in disaster research, limiting diversity and participation in knowledge production. The occupational therapy profession faces similar critiques of epistemic and hegemonic blind spots, prompting calls for critical reflection on professional assumptions. Drawing on narratives and guided by Whiteford's Occupational Justice PLUS model, we explore how learnings from community members' responses to a bushfire event could broaden our understanding of occupational, epistemic, and hermeneutic justice in the context of disasters and, more broadly, other injustices. METHODS: This qualitative study used a phenomenological hermeneutical approach to explore narratives of disaster recovery. Data included a written narrative from 'Doing Our Best' and the film 'We Are Conjola'. Analysis followed Lindseth and Norberg's three-step process: naïve reading, structural analysis of themes, and comprehensive interpretation informed by literature and theories. FINDINGS: Findings revealed interconnected injustices. Occupational injustice arose from restricted access to resources during bushfire response and recovery, with community-led initiatives critical to restoring occupational justice. Epistemic injustice was evident in government disregard for climate science and Indigenous knowledge, compounded by media erasure, prompting the community to create its own narrative through film. Hermeneutic injustice occurred when aspects of social identity were obscured from collective understanding; residents responded through artistic expression to reclaim identity, share lived experience, and communicate systemic failures. DISCUSSION: Community-driven action addressed occupational, epistemic, and hermeneutic injustices following the Conjola bushfire. These findings highlight the relevance of the Occupational Justice PLUS model for disaster contexts, emphasising the need for occupational therapists to adopt critical, justice-oriented approaches that privilege community voice and foster community-led action in disaster recovery and knowledge creation. CONCLUSION: Advocacy for community voice and future research on applying the Occupational Justice PLUS model are essential to support inclusive, community-driven recovery and strengthen knowledge creation in disaster contexts.
Australian occupational therapy journalBernadette Safe, Lauren Parsons, Rebecca Waters, Lydia Timms, Donna Chung
INTRODUCTION: Intimate partner violence has enduring impacts that persist well beyond the cessation of abuse. Recovery and healing, though recognised as a priority in the Australian Government's national policy, has received less research attention compared with prevention, early intervention, and response. Survivors experience interruptions to their occupations during abuse and face occupational injustice. There is limited understanding of how these occupations recover and whether occupational justice is restored during the recovery phase. METHODS: This scoping review aimed to (1) identify occupational focus and gaps in literature during IPV recovery and healing; (2) analyse person and environmental barriers and enablers associated with survivors' occupational recovery; and (3) examine restoration of occupational justice during recovery. The review followed the PRISMA-ScR Checklist for screening and data extraction. Comprehensive searches of databases and grey literature were conducted. The Person Environment Occupational Performance model guided keyword selection and data synthesis. There was no consumer or community involvement included. RESULTS: Twenty articles were reviewed, with findings primarily centred on paid employment, reflecting the research focus on this productive occupation. Parenting and ongoing education were also examined. Barriers to occupational recovery included physical health impacts, ongoing trauma, depression and anxiety, limited social supports, discrimination, ongoing coercive control, and restricted access to housing, transport, and childcare. These results were then interpreted through an occupational justice lens, including the persisting limit to choice and control in occupations for survivors, which results in continued occupational injustices. CONCLUSION: The review highlighted some of the complex person and environment factors affecting occupational recovery for women after IPV, particularly regarding access to meaningful paid employment. The findings underscore the need for both individualised support and broader systemic changes to achieve occupational justice and promote meaningful recovery. Further research is recommended to explore barriers and enablers beyond employment within the Australian context.
Australian occupational therapy journalLisa Licciardi, Aislinn Lalor, John Olver, Libby Callaway
INTRODUCTION: Following mild traumatic brain injury, people can experience persistent post-concussion symptoms (PPCS) that lead to the need for rehabilitation, including occupational therapy services, to support recovery. There is, however, limited literature documenting the occupational therapy role in adult PPCS rehabilitation. This study aimed to explore the role of occupational therapy, including the assessments and interventions used, in the rehabilitation of adults with PPCS in Australia and New Zealand. METHODS: A qualitative descriptive research design was employed. Occupational therapists working with adults with PPCS in Australia or New Zealand were recruited via advertisements on professional email listservs and via social media. Semi-structured interviews were undertaken via videoconference, transcribed verbatim, deidentified, and underwent member checking and reflexive thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: No consumers were involved in the study design or analysis. FINDINGS: Fifteen occupational therapists were recruited from Australia (n = 11) and New Zealand (n = 4). The majority were women (n = 14). Interviews ranged from 48 to 127 minutes (M = 74 minutes), with four main themes identified: timing and reasons for occupational therapy referral; assessments and interventions used in practice; current and future occupational therapy practice opportunities; and occupational therapy practice resources that are utilised or needed. CONCLUSION: Given that occupational therapy is increasingly being included in multi-disciplinary PPCS programs, this research provides evidence of the current and potential future scope of occupational therapy practice in adult PPCS rehabilitation. Further research exploring occupational therapy roles in other countries, and including perspectives of people with PPCS, will be of benefit to guide rehabilitation service design.
BACKGROUND: Occupation-based practice (OBP) has been demonstrated to enhance occupational performance and goal attainment in stroke rehabilitation. However, existing evidence is predominantly derived from hospital-based settings, with limited investigations into OBP implementation in community contexts. In Thailand, particularly in rural areas, there remains a need to establish effective OBP service delivery models and to evaluate their outcomes across diverse client populations receiving community-based rehabilitation services. OBJECTIVE: This study aimed to develop an OBP service delivery model for community-based stroke rehabilitation in the Doi Lor community, Chiang Mai Province, Thailand, and to evaluate its effects on occupational performance, goal attainment, and quality of life among community-dwelling stroke survivors. Additionally, the study explored the occupational therapist's experience and perceptions of implementing the model, particularly the practicality of implementation in long-term community-based occupational therapy services. METHODS: This study used an embedded mixed methods feasibility design comprising a 1-group pretest-posttest intervention study and a qualitative descriptive interview. An OBP service delivery model for community-based stroke rehabilitation was developed based on the Dynamic Model of Occupation-Based Practice; the Occupational Therapy Practice Framework, Fourth Edition; and evidence-based stroke rehabilitation principles. The model was implemented by a trained occupational therapist with 7 stroke survivors at a rural community rehabilitation center over 14 sessions spanning 7 weeks. Quantitative outcomes were assessed before and after the intervention using the Canadian Occupational Performance Measure, goal attainment scaling, and the World Health Organization Quality of Life-Brief Version. Qualitative data were collected through a semistructured interview with the occupational therapist to explore experiences of implementing the OBP service delivery model. RESULTS: In the quantitative analysis, participants demonstrated statistically significant improvements in occupational performance and satisfaction as measured by the Canadian Occupational Performance Measure (P=.02), higher levels of goal attainment on the goal attainment scaling (P=.02), and improved overall quality of life as assessed by the World Health Organization Quality of Life-Brief Version (P=.02). Qualitative findings from the occupational therapist interview indicated 2 themes, including facilitating client-centered outcomes through OBP implementation and enhancing professional confidence and supporting the practical implementation of OBP in community-based practice. The occupational therapist described the model as practical and feasible and reported increased confidence in delivering occupation-based interventions. The findings also highlighted the potential applicability of the model within long-term, community-based occupational therapy services. CONCLUSIONS: This preliminary study suggests that an OBP service delivery model grounded in therapist preparation, client-centered goal setting, and outcome-focused intervention may support improvements in occupational performance, goal attainment, and quality of life among stroke survivors receiving community-based rehabilitation. This approach may contribute to strengthening long-term stroke care, particularly in rural communities where access to hospital-based rehabilitation services is limited.
Journal of allied healthPiper Hansen, Alicen Garza, Andrew Bodine
The Bilateral Task Assessment (BTA) was developed to address the need for a clinically relevant and feasible measure of bilateral upper extremity function. The assessment was administered by occupational therapists as part of standard care to 4,362 individuals receiving inpatient rehabilitation. Retrospective data were analyzed using multiple psychometric methods to evaluate internal consistency, concurrent validity, to determine dimensionality, and item response theory (IRT) to calculate scores and assess task difficulty. Both individual task scores and completion times were analyzed. Results demonstrated good internal consistency for both task scores (0.92) and time scores (0.85). Factor analysis revealed a large effect size for task scores and a moderate effect size for completion times. Rating scale analyses further supported high internal consistency (0.92) and strong item-to-total correlations (0.86-0.90). Concurrent validity analyses identified significant correlations between the BTA and seven established measures of upper extremity function. Overall, findings indicate that the BTA is a valid, reliable, and feasible assessment that effectively evaluates bilateral upper extremity integration within a functional rehabilitation context.
Journal of allied healthPamela Lewis-Kipkulei, Brittany Saviers
BACKGROUND: Understanding how occupational therapy practitioners (OTPs) engage in advocacy and factors influencing their efforts has potential to position practitioners as empowered change agents. While advocacy is essential to occupational therapy (OT) practice, literature reveals inconsistencies in how OTPs conceptualize and implement advocacy. This study explored OTPs' perspectives on the definitions, knowledge, meaning, challenges, and experiences with professional advocacy in OT. METHOD: This mixed-methods study used a researcher-designed, 23-question electronic survey to collect data from OTPs across the United States. The survey explored practitioners' advocacy-related perceptions, experiences, and engagement. RESULTS: Seventy-six OTPs completed the survey, with themes emerging around advocacy as voice, education, action, and community. Practitioners cited insufficient resources and support as barriers but emphasized that advocacy training and professional community involvement could improve engagement. Analysis revealed that advocacy impacts OTPs' roles and identities, supporting the doing-being-becoming-belonging framework's relevance in conceptualizing advocacy within OT. CONCLUSIONS: This study highlighted advocacy's trans¬formative potential across the dimensions of doing, being, becoming, and belonging. Findings suggested encouraging participation in micro- and macro-level initiatives by encouraging increased student involvement, offering advocacy information to all stakeholders, considering small advocacy initiatives, and offering feasible options for support to enhance practitioner participation in the advocacy process.
AIMS: This study examined whether virtual reality mindfulness-based practice (VR-MBP) enhances cognitive function, specifically attention, memory, and reasoning, in graduate students compared to auditory mindfulness and no intervention. METHODS: A mixed-methods within-subjects design was used. Fourteen occupational and physical therapy graduate students participated in this study. Cognitive performance was assessed at four intervals using the Cognitive Assessment Battery (CAB) PRO by CogniFit. Participants completed the Cognitive Test Anxiety Scale-2 (CTAS-2) as a pre and post-test to measure self-perceived testing anxiety. RESULTS: Significant improvements were found in memory domains, particularly short-term, working, and non-verbal memory following VR-MBP. Higher cognitive scores were associated with lower anxiety levels and testing in a controlled classroom environment. CONCLUSION: A significant correlation between VR-MBP intervention and improvements in short-term, working, and non-verbal memory adds to the growing body of evidence supporting the cognitive benefits of mindfulness-based practices, while also highlighting the effectiveness of VR as a delivery model.
European journal of pediatricsTuran Emre Özdemir, Ayşenur Baysal Yiğit, Ceren Davutoğlu, Mustafa Tezer Kutluk, Sedef Şahin
UNLABELLED: Determining the occupational therapy needs of hospitalized children with cancer is important. The present study was conducted to evaluate the validity, reliability, and clinical utility of a 25-item checklist developed to quickly and accurately identify occupational therapy needs in pediatric cancer. This cross-sectional methodological study included 402 children with cancer (aged 6-17 years). Construct validity was evaluated using exploratory factor analysis with the unweighted least squares method based on a tetrachoric correlation matrix. Internal consistency reliability was assessed using Kuder-Richardson 20 (KR-20) and McDonald's Omega (ω) coefficients. Clinical utility and known-groups validity were examined via quartile analysis and the Kruskal-Wallis H test. Regarding construct validity, parallel analysis and Scree Plot evaluation confirmed a strong unidimensional structure measuring the general occupational therapy needs construct, replacing the initial multidimensional assumptions. The checklist demonstrated excellent internal consistency (KR-20 = 0.881, ω = 0.888). Known-groups validity analysis revealed significant differences among diagnostic groups (p = 0.005). Post hoc tests indicated that the central nervous system and solid organ tumors group had significantly higher occupational therapy needs compared to the bone and soft tissue tumors group (p = 0.004). Regarding clinical utility, quartile analysis effectively classified patients into low, moderate, and high-priority triage groups. CONCLUSION: The 25-item checklist is a highly valid and reliable screening tool for determining the occupational therapy needs of children with cancer. Its clinical utility, reflected in its ability to rapidly classify patients into priority groups, supports its integration into busy clinical workflows. We recommend its use for rapid triaging and routine assessment in busy clinical settings. WHAT IS KNOWN: • Children with cancer experience functional limitations, but current assessment methods are time-consuming. • There is a lack of rapidly applicable screening tools for occupational therapy needs in intensive clinical workflows. WHAT IS NEW: • A 25-item checklist demonstrated evidence of validity, reliability, and a unidimensional structure as a clinical screening tool. • The tool categorizes patients into triage priority groups, which may support clinical decision making.
BACKGROUND: An aging population and an ongoing transition toward person-centered and integrated care highlight the need for health-promoting interventions for older adults, requiring new approaches within municipal health and social care. AIM: The aim of this study was to explore and describe how professionals in municipal health- and social care discuss opportunities and challenges within their organization related to health-promoting interventions directed at older adults. MATERIAL AND METHODS: A qualitative focus group design was used. Twenty-two participants, including occupational therapists, development managers, area managers, operations managers, and case managers from seven municipalities, participated in five focus group discussions. Data were analyzed inductively using a focus group analysis approach. RESULTS: One overarching theme was identified: Creating organizational readiness for health-promoting interventions, comprising three subthemes: Supportive structures for health-promoting work within the organization are needed, A shared health-promoting focus and new collaborations are required, and New working methods are necessary to facilitate health promotion. These subthemes are interrelated together dynamically shape organizational readiness for health-promoting interventions. CONCLUSIONS AND SIGNIFICANCE: Taken together, The results indicate that organizational readiness within municipal health and social care is currently insufficient for health-promoting interventions to permeate practice yet has inherent potential to be actively created. Creating such readiness therefore requires coordinated, long-term efforts across the organization. For occupational therapy, these results underscore the importance of engaging in ongoing dialogue, both within the profession and across organizational levels, on how their competencies can be utilized and translated from reactive into more proactive and health-promoting approaches into everyday practices.
International journal of qualitative studies on health and well-beingT Swinson, B Littlechild, G Howcroft, K McNamara, S Prowse, B White, K Almack
PURPOSE: Adults with learning disabilities experience a poorer quality of life than the general population. Social care can critically support such adults and their informal carers, but limited literature exists about occupational therapy provision. This study explored the extent to which social care occupational therapists support communication and collaboration, and make a difference. METHODS: Eight social care occupational therapists were recruited through professional networks. Online interviews were undertaken using topic guides co-designed with professionals and experts by experience. Reflexive thematic analysis was employed, informed by critical realism. FINDINGS: Therapists pursued inclusive practices with adults with learning disabilities and valued informal carers. The communication challenges increased the reliance on carer input and raised doubts about interventions reflecting the wishes of adults with learning disabilities. Carer disagreements were navigated through diplomacy and positive risk-taking, but concerns about moving and handling safety led to faltering collaboration. Therapists felt that they enhanced community engagement and reduced carer burden, but workload limited their scope of practice. CONCLUSIONS: Social care occupational therapists strive to work inclusively with adults with learning disabilities and their informal carers, with beneficial outcomes, requiring various profession-based and interpersonal skillsets. However, communication difficulties create uncertainty. Practice-improvement opportunities include additional training and enhanced multidisciplinary working.
The American journal of occupational therapy : official publication of the American Occupational Therapy AssociationYuichi Murata, Toshihiko Matsumoto, Naomichi Yamamoto, Toyohiro Hamaguchi, Toshiyuki Ishioka
ImportanceIdentifying factors associated with sustained engagement in harm reduction-oriented occupational therapy may help inform more accessible interventions for individuals with substance use disorders (SUDs).ObjectiveTo examine participant characteristics associated with sustained engagement in the Real-Life Program (RLP), a harm reduction-oriented outpatient occupational therapy program for individuals with SUDs, and to explore changes in occupational and psychosocial outcomes among participants who continued the program.DesignRetrospective cohort study.SettingSingle-site outpatient occupational therapy program.ParticipantsFifty-five individuals with SUDs enrolled in the RLP. Participants were classified into continued (≥47% attendance) and noncontinued (<47%) groups based on the median participation rate.Outcomes and MeasuresCanadian Occupational Performance Measure (COPM), Rosenberg Self-Esteem Scale-Japanese version, Shitsu-Taikan-Sho Scale, and visual analog scales for craving intensity and perceived connectedness to others.ResultsPrior self-help group experience was significantly associated with continued participation. Older age showed a nonsignificant association. No other demographic or clinical characteristics differed significantly between groups. Among participants who continued the program, COPM Satisfaction improved significantly, whereas COPM Performance, self-esteem, alexisomia, craving intensity, and perceived connectedness did not.Conclusions and RelevancePrior self-help group experience was associated with sustained engagement in the RLP. Among participants who continued the program, satisfaction with daily occupations improved, although the clinical significance of this change remains uncertain. The RLP may provide a feasible harm reduction-oriented occupational therapy option for individuals with SUDs who have difficulty engaging in abstinence-based treatment programs.
Age and ageingThomas Bloch, Kelly Melekis, Mathew Failla, Reuben Escorpizo
Frailty is highly prevalent in skilled nursing facilities (SNFs), yet little is known about how physical and occupational therapists (PTs/OTs) apply clinical reasoning (CR) when designing and progressing EPs for frail older adults. This study used a three-round Delphi method (DM) to generate expert consensus on the reasoning strategies therapists employ in SNF practice. Licensed PTs and OTs from the USA and Canada were recruited through professional directories and completed iterative surveys focused on assessment, goal-setting and intervention adaptation. Round 1 consisted of open-ended questions analysed through thematic coding; Rounds 2 and 3 involved Likert-scale ratings of synthesised statements, with consensus defined as ≥75% agreement. Forty-four therapists participated in Round 1, with 39 completing all rounds (89% retention). Participants represented a wide range of experience levels and both professional disciplines. Five core themes reached consensus: (i) engagement in therapy, emphasising meaningful, patient-centred activities to enhance motivation; (ii) mobility and movement confidence, reflecting the importance of addressing fear of falling and psychological readiness; (iii) functional outcomes and endurance, prioritising activities aligned with real-world activities of daily living (ADLs) and stamina; (iv) pain and cognition, recognising daily fluctuations that require dynamic clinical adjustment and (v) task-specific interventions, integrating ADL-focused and dual-task activities to promote carryover and ecological validity. These findings illustrate the complexity and adaptability of therapist decision-making when treating frail older adults in SNFs. The themes highlight how PTs and OTs integrate patient goals, functional demands and fluctuating physical and cognitive status into individualised exercise planning. This study provides a foundation for developing frailty-focused education, clinical pathways and interdisciplinary guidelines to support high-quality rehabilitation in SNFs.
BACKGROUND: Chronic kidney disease and treatment have a severe and detrimental impact on life participation, reducing independence, autonomy, physical and cognitive function requiring a multidisciplinary approach. Occupational therapists have comprehensive skills in enabling independence and quality of life, yet the role in a kidney team is poorly understood. OBJECTIVES: To identify occupational therapy services for adults diagnosed with kidney disease which will inform future practice, service planning and role definition. METHODS: Following Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR guidelines, PubMed, Scopus, PsycINFO-OVID, ProQuest, and CINAHL were searched from inception to 15 December 2025. The population of interest was adults at any grade of kidney disease, the concept being occupational therapy services/models of care, and the context of any service setting. Results were transferred from Endnote to Covidence, duplicates removed and the title and abstract of articles screened. The full text of the remaining articles was assessed by two researchers, and themes were identified in alignment with the research questions. RESULTS: The search provided 1603 results, with 434 duplicates removed leaving 1169 articles. Following title and abstract screening, 40 papers remained for full text review, resulting in 23 studies for data extraction and analysis. Themes identified included types of occupational therapy interventions, grade of disease progression when interventions were undertaken, models of care and service location. The most reported occupational therapy roles related to activities of daily living, equipment prescription and mental health interventions. CONCLUSIONS: While the occupational therapy role for patients with kidney disease is evolving worldwide, notably over the past 5 years, it is still underutilised. Further research is required to inform the development of clinical practice guidelines for clear role delineation.
Child: care, health and developmentLina Ianni, Chantal Camden, Wenonah Campbell, Heather Colquhoun, Dana Anaby
INTRODUCTION: Supporting students with special needs in inclusive schools requires collaboration between teachers and occupational therapists (OTs). While service models promoting health, in-class support and shared knowledge are recommended, relational and organizational barriers persist. This multimethod study evaluates the impact of a tailored knowledge translation (KT) intervention on collaborative attitudes and behaviours of OT-teacher teams. METHODS: A 12-week KT intervention, including six sessions with OTs and elementary teachers (n = 6), was conducted. Participants established two collaborative goals using the Canadian Occupational Performance Measure (COPM), rated weekly, and completed the Modified Index of Interdisciplinary Collaboration (MIIC) at three time points. Changes were analysed descriptively using mean scores to summarize. Postintervention, individualized interviews were conducted and analysed using inductive thematic analysis. RESULTS: While MIIC scores indicated stable perceived collaboration, improvements were observed in 11/12 collaboration-based goals, with average changes of +3.25 and +4.25 points on COPM performance and satisfaction scales, respectively. Four themes supported this shift: Embracing collaboration is valued personally and professionally; organizational and relational contexts shape collaboration; engaging environments support reflection and active learning; and self-efficacy and perspectives can shift postintervention. CONCLUSION: Findings highlight the importance of adopting contextualized, tailored KT strategies in school settings to enhance OT-teacher collaboration and teamwork through dedicated time, space and intentional reflection.
Soins; la revue de reference infirmiereÉmilie Bichon, Théa Bouteille
Neurovisual disorders in neurodegenerative diseases are not always well identified and may have significant consequences. Indeed, they may impair quality of life, independence in activities of daily living and the person's environment. The combination of occupational therapy and orthoptics provides real added value in the rehabilitation pathway proposed to the patient.
PloS oneIsabelle Caven, Yani Hamdani, Yona Lunsky, Courtney Weaver, Melanie Penner
OBJECTIVES: Given the differing opinions among interest holders on services that are commonly accessed by autistic children, exploration of parent perspectives is needed to contribute to this knowledge base. Our objective was to explore perspectives of parents of autistic children on select services accessed by autistic children in Canada. METHODS: Using a mixed methods survey, the perspectives of parents of autistic children living in Canada on occupational therapy (OT), speech-language pathology (SLP) services, and applied behaviour analysis (ABA) based therapies were sought. The Theoretical Framework of Acceptability (TFA) and its constructs were used to develop the survey and served as a framework for qualitative content analysis. RESULTS: Eighty-seven parents completed the survey. Acceptability scores were higher for OT and SLP compared to ABA (F (2, 239) = 43.42, p < 0.01). Related to the TFA construct of Ethicality, parent respondents shared concerns about potential harms of negative therapy experiences, emphasized the value of neurodiversity-affirming services and held mixed views on behavioural approaches. Under the construct of Perceived Effectiveness, acceptability was contingent on parents attributing improvements to the therapy and therapist fit. For the construct of Self-Efficacy, respondents reported the importance of therapist engagement with parents. CONCLUSIONS: Across OT, SLP, and ABA, Ethicality, Perceived Effectiveness, and Self-Efficacy informed the perceived acceptability of autism services. This work highlights that many parents are concerned with promoting a positive autistic identity for their children, including through therapies. Future work should seek to develop shared definitions and goals for therapy between clinicians, parents/care partners, and autistic people.
PloS oneYazeed Temraz, Wafa Bin Salamh, Naif Alsayahi, Mohammed Alrehaili, Fahdah Aljamaan, Hend Alqudaimi, Dina Alqueflie
BACKGROUND: Functional decline associated with acute hospitalization may persist at hospital discharge. This study examined associations between routinely documented admission-time characteristics and return to the same pre-admission functional category among acute inpatients receiving physical therapy and/or occupational therapy. METHODS: This exploratory single-center retrospective cohort study included 444 unique adults who received acute inpatient physical therapy and/or occupational therapy at a tertiary hospital. Ninety patients classified as bedridden before admission were excluded because no outcome variation was observed in that stratum. Modified Poisson regression with robust variance was used to estimate adjusted risk ratios (aRRs) for return to the same pre-admission documentation-derived functional category at discharge. RESULTS: The primary cohort included 354 patients, of whom 146 (41.2%) returned to the same pre-admission documentation-derived functional category at discharge. Each one-level worsening in admission functional severity was associated with a lower probability of return (aRR 0.59, 95% confidence interval [CI] 0.47-0.75). In the exploratory subgroup of 164 patients independently ambulatory before admission, worse admission functional severity was associated with a higher risk of discharge below the pre-admission category (aRR 1.17, 95% CI 1.03-1.32). Associations with premorbid functional category reflected different premorbid functional targets and were not interpreted as comparative recovery probabilities. CONCLUSIONS: Routinely documented premorbid and admission functional information may help identify acute inpatients receiving physical therapy and/or occupational therapy who may be at risk of leaving hospital below their pre-admission functional category. Because the endpoint represents no net decline relative to premorbid function and reflects different targets across baseline strata, findings should not be interpreted as evidence that patients with greater premorbid dependency recover better.
BMJ openErika Kemp, Lisa Juckett, Isabella O Sansone, Katherine M Walton, Marilly Palettas, Tana B Carson, Jewel E Crasta
INTRODUCTION: Drowning is a leading cause of unintentional death among children on the autism spectrum, emphasising the need for tailored water competency interventions. Autism-related factors such as wandering, sensory differences and limited danger awareness increase drowning risk. Evidence suggests structured aquatic programmes improve water safety, yet guidance on effective components and implementation fidelity in community settings remains limited. METHODS AND ANALYSIS: This type 1 hybrid effectiveness-implementation randomised controlled trial will evaluate AquOTic, an occupational therapy-based water competency intervention for children on the autism spectrum aged 5-9 years. A total of 108 participants will be randomised into three arms: (1) AquOTic delivered by professional student swim buddies, (2) AquOTic delivered by community swim buddies and (3) usual water exposure control. Primary outcomes include water competency and swim skills measured by standardised performance-based and caregiver-report measures. Secondary aims assess implementation determinants (fidelity, engagement, attitudes) using mixed methods, while exploratory analyses calculate costs and resources. ETHICS AND DISSEMINATION: Ethical approval has been obtained from The Ohio State University Institutional Review Board (protocol number: STUDY20250101). Written informed consent will be obtained from parents or legal guardians and assent from children when appropriate. Findings will be disseminated through peer-reviewed publications, conference presentations and partnerships with community organisations involved in autism and water safety. TRIAL REGISTRATION NUMBER: NCT07076264.
Australian occupational therapy journalJade Wood, Dillon Tepper, Ben Sellar, Carolyn M Murray
INTRODUCTION: Borderline personality disorder (BPD) is a complex and prevalent diagnosis with impact on occupational performance. Occupational therapists are well-placed to provide rehabilitation services for those diagnosed with BPD. Thus, this study aimed to explore the models, approaches, assessment tools, and interventions used by Australian occupational therapists, including perspectives on current practice. METHODS: An online questionnaire was constructed, piloted, and distributed to occupational therapists in Australia who had experience working with adults diagnosed with BPD within the last 5 years. Demographic details and drop-down responses were analysed using descriptive statistics, while open-text qualitative responses were analysed using summative content analysis. CONSUMER AND COMMUNITY INVOLVEMENT: There was no consumer or community involvement. RESULTS: Sixty-three occupational therapists across Australia responded, with more than half employed in private practice. Occupation-based, trauma-informed, recovery and sensory approaches were most frequently reported. Over three-quarters of respondents used the Sensory Profile, with all except one respondent using open discussion with clients for assessment. Stress management techniques were the most frequently used intervention. The top three limitations and gaps for BPD practice were time constraints, underdevelopment of practitioner knowledge and skills and workload/capacity. Limited funding and fragmented service/system design (n = 32) were the top contributing factors to practice gaps. CONCLUSION: Australian occupational therapists work with people diagnosed with BPD across diverse practice areas, predominantly in private practice settings. Trauma-informed care was valued by occupational therapists in practice, but its application needs to be more explicit in assessment and intervention choices. Occupation-based practice needs a distinct and stronger evidence base to determine effectiveness in promoting occupational performance.
Australian occupational therapy journalLaura Irvine-Brown, Ana Malfitano, Shawna Mastro Campbell, Amelia Di Tommaso, Lisette Farias
INTRODUCTION: Critical thinking is widely recognised as essential for occupational therapy education and practice, yet its conceptualisation, teaching, and assessment remain inconsistent across international contexts. Existing literature highlights a lack of clarity regarding effective pedagogical approaches and a limited understanding of how educators make sense of critical thinking within occupational therapy curricula. This study examined how occupational therapy educators across different countries conceptualise critical thinking and how it features in the programmes they teach. METHODS: A convergent mixed-methods design was used. Occupational therapy educators completed an online survey (available in Spanish, Portuguese, and English) containing 28 quantitative items and six open-ended qualitative questions. Quantitative data were analysed using descriptive statistics, and group comparisons were made using the Kruskal-Wallis and Dunn tests. Qualitative data underwent inductive content analysis within language groups and were later synthesised across datasets through reflexive, collaborative analysis. CONSUMER AND COMMUNITY INVOLVEMENT: No consumers were involved in the study conceptualisation or analysis. RESULTS: Responses revealed a spectrum of conceptualisations of critical thinking, ranging from concrete, pragmatic, and clinically focused understandings to abstract, socially oriented, and transformative perspectives. English-language responses tended to emphasise clinical reasoning, evidence use, and decision-making, whereas Portuguese and Spanish responses more strongly foregrounded reflection on knowledge, sociopolitical structures, and critical action. Teaching practices mirrored this spectrum: Critical thinking was taught unevenly across curricula, most commonly within clinical reasoning or foundational occupational therapy subjects, with fewer programmes explicitly addressing broader sociocultural or transformative dimensions. CONCLUSION: Findings highlight significant epistemological variation shaping how critical thinking is conceptualised and enacted in occupational therapy education. Recognising these epistemological foundations, rather than seeking a universal definition, may support more intentional, inclusive, and socially responsive curriculum design.
Australian occupational therapy journalAmy Lonergan, Miia Rahja, Tamina Levy, Kate Laver
INTRODUCTION: Practice education is an essential component of occupational therapy programmes in Australia, providing supervised opportunities for students to develop skills across diverse practice settings. Rising student enrolments have intensified pressure on universities to secure sufficient practice education opportunities, prompting exploration of alternative models and emerging settings. The research setting, with supervision provided by occupational therapists working in research roles, presents a promising but under-utilised option for practice education. OBJECTIVE: This study aimed to explore the perspectives and experiences of occupational therapy and physiotherapy students, practitioners, and university educators on placements in a research setting. METHODS: Semi-structured interviews (n = 30) were conducted with occupational therapy and physiotherapy students, practitioners with experience working in research-specific roles, and university educators. The Theoretical Domains Framework guided the development of the interview schedules. Participants were recruited using purposeful and snowball sampling. Data were analysed thematically. CONSUMER AND COMMUNITY INVOLVEMENT: The interview schedule was developed in consultation with research practitioners and university educators. FINDINGS: Practice education is occurring within research settings, though it is not yet common, with generally positive perceptions reported among those involved. Participants viewed these placements as an opportunity to strengthen research confidence, develop research readiness, and generate interest, alongside meeting core placement competencies. For some participants, practice education in a research setting was a new concept. University educators questioned whether all research settings could satisfy accreditation requirements. Seven themes were identified: research confidence, professional responsibility, sparking interest, missed opportunity, accreditation requirements, fear of missing out on client contact, and risks to the research quality. CONCLUSION: Utilisation of the research setting for practice education may strengthen students' understanding of how evidence is generated and translated into practice, helping to address persistent concerns about low research confidence and engagement. Effective implementation will require collaboratively developed models that reflect the needs of all stakeholders. Ongoing trial and evaluation are essential to determine feasibility, educational value, and impact.
Australian occupational therapy journalLaine Chilman, Daniel Meloncelli, Alison Houghton, Asmita Mudholkar, Catherine Hilly
INTRODUCTION: Fetal Alcohol Spectrum Disorder (FASD) describes a spectrum of birth defects and developmental disabilities resulting from prenatal alcohol exposure. With a prevalence rate of 3.64%, developing an FASD-informed occupational therapy workforce is essential across all practice contexts. Since the Australian diagnostic guidelines were introduced in 2016 and updated in 2025, awareness has grown. This study aimed to explore Australian occupational therapists' awareness, knowledge, and practice regarding FASD. METHOD: A cross-sectional survey of 90 occupational therapists assessed knowledge, awareness, and confidence regarding FASD via a 22-item online questionnaire. Chi-square tests examined associations between key variables; effect sizes were estimated using Cramér's V. Inductive content analysis was performed on open-ended responses. CONSUMER AND COMMUNITY INVOLVEMENT: The survey was designed for occupational therapists practising in Australia to obtain information on current practice contexts and was piloted by occupational therapists working with the FASD community. RESULTS: Despite 93.3% agreeing FASD knowledge is important, confidence and preparedness were markedly low. Only 26.7% had completed professional development, 37.8% reported easy access to reliable information, and 66.7% were unprepared to discuss FASD concerns. Professional development was strongly associated with confidence in recognising FASD (66.7% vs. 12.1%, P < 0.001, V = 0.517) and confidence working with adolescents and children. Clinical experience showed a categorical threshold effect: 40.7% with experience reported confidence in recognising FASD versus 0% without. Access to reliable information was a significant predictor of preparedness (58.8% vs. 17.9%, P = 0.008). Qualitative findings highlighted an absence of FASD-specific guidance, with occupational therapists drawing on frameworks and knowledge from other diagnoses. CONCLUSION: This study indicates a need for occupational therapy-specific FASD research and practice guidance. Access to reliable information and professional development is critical to building workforce confidence and preparedness in FASD recognition and management.
Australian occupational therapy journalEmma Kleindienst, Tamara Wanklyn
INTRODUCTION: There is limited information about why students decide to study occupational therapy as a course in Australian higher education. Understanding what influences students' decisions is important to ensure adequate workforce growth to support Australia's growing population. Therefore, the study's aim was to identify what influences students' decisions to study occupational therapy at a regional Australian university, as well as potential facilitators and barriers affecting these decisions. METHODS: An explanatory mixed methods design was used. One hundred and thirty-four student participants completed an online survey through purposeful sampling, and a convenience sample of 13 survey participants completed follow-up semi-structured interviews. Descriptive statistics were used to analyse survey data, and reflexive thematic analysis was used to analyse the interview data. CONSUMER AND COMMUNITY INVOLVEMENT: Consumers and community members were not involved in the development or undertaking of this research. RESULTS: Occupational therapy aligned with students' values, skills, and roles, which influenced their decision to study the profession. These influences included making a positive impact on people's lives (83.2%) and a desire to work in health care (77.1%). Financial supports facilitated their decision to study occupational therapy through family, flexible employment, and government supports. Students primarily heard about the profession through family (30.6%) or friends (18.7%), with their decision heavily influenced by personal connections affording positive exposure to the profession. Narrow societal knowledge and perception of occupational therapy resulted in students gaining a limited understanding of the broad scope and role of the profession. CONCLUSION: The key findings showed the influence of personal networks in course decision-making, in addition to a narrow societal knowledge and perception of occupational therapy. This finding suggests the need for greater opportunity for diverse exposure to the occupational therapy profession, with more information provided to prospective students about the scope of occupational therapy practice.
Australian occupational therapy journalGema Puig-Esteve, Rodolfo Morrison
INTRODUCTION: Occupational resilience has emerged as a construct that links the capacity to face adversity with the role of meaningful occupations in the adaptation and recovery of individuals, groups, and communities. However, its definition, theoretical frameworks, and applications remain heterogeneous and partial. This lack of systematisation hinders its integration into occupational therapy and occupational science. OBJECTIVE: The objective of this study is to map and synthesise the scientific literature on occupational resilience, identifying how it is conceptualised and operationalised. METHODS: Using established scoping review frameworks, publications from 2000 to 2025 were searched in databases and through manual searching, including empirical studies and conceptual literature that addressed occupational resilience and its relationship with occupational participation in contexts of adversity. CONSUMER AND COMMUNITY INVOLVEMENT: There was no direct participation of consumers or community representatives in the design, conduct, or interpretation of the findings of this study. RESULTS: Thirty-seven studies were included that show diverse uses of the term occupational resilience and related concepts, tending to conceptualise it as a trait, an individual capacity, a dynamic process, and an adaptive outcome linked to occupational performance. The findings highlight the role of meaningful occupations in modulating suffering and emotional activation and in rebuilding purpose, agency, roles, routines, and identities after adversity. They also reveal marked differences in definitions, measures, and designs, with a predominance of approaches focussed on individual resilience, mainly in work-related contexts, and limited attention to structural dimensions and occupational justice. CONCLUSION: This review offers a structured view of occupational resilience and of the place that meaningful occupations occupy in resilience processes, proposing a process-oriented definition that articulates personal, contextual, and occupational dimensions. The results underscore the need to define integrated theoretical frameworks and occupational therapy interventions explicitly oriented towards the occupational effects of trauma, which validate pain, support the restoration and reinvention of occupational participation, and question the social conditions that make sustained resilience necessary.
INTRODUCTION: The primary school setting is a dynamic practice context for occupational therapists. Despite a clear interest in understanding and intervening in self-regulation in the classroom, little school-specific literature is available. METHODS: A scoping review was conducted to examine how occupational therapists understand self-regulation in the mainstream primary school setting. The literature was searched as follows: occupational therapists (population [P]); self-regulation intervention, assessment, or program (concept [C]); and education, school, and classrooms (context [C]). CONSUMER AND COMMUNITY INVOLVEMENT: No consumers were directly involved in this review. The topic was informed by occupational therapy practice with teachers and families to ensure relevance to school and community needs. RESULTS: Literature was scoped from five key health databases (CINAHL Complete, Embase via Ovid, ERIC, Ovid MEDLINE, and APA PsycInfo), with 192 papers initially identified. Two authors completed initial title and abstract screening, and full-text papers were reviewed by the entire research team. Data were charted into tables following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and JBI Manual for Evidence Synthesis. Papers were included if occupational therapists were the main population of interest; included an intervention that improved classroom self-regulation skills (student or teacher), and occurred in a mainstream primary school (public or private). CONCLUSION: Twelve papers were included in the final review. Seven papers were from a peer-reviewed source, and five papers were dissertations (i.e. grey literature). Self-regulation continues to be incompletely considered in the included papers, with papers either focussed on related constructs or on self-regulation-targeting programmes. Self-regulation was also not well understood occupationally, with little to no operationalisation in terms of students' school-related occupational performance and/or engagement outcomes. Further research is needed to appropriately conceptualise, define, and map self-regulation occupationally.
Australian occupational therapy journalArabella Hely, Claire Pearce
INTRODUCTION: Occupational therapists in the Australian context provide significant value to mental health, including through Better Access, a Medicare initiative that gives individuals access to up to 10 sessions with a psychologist, social worker, or occupational therapist following a referral from a medical practitioner. However, the experiences of occupational therapists working under the initiative are not widely understood, with no recent occupational therapy-specific research. This study aims to explore the experiences of occupational therapists working under Better Access, their distinct role, and how the system shapes the care clients receive. METHODS: The study used a qualitative, inductive approach. Thirteen occupational therapists who work with people funded by Better Access participated in 30-minute, semi-structured interviews. Data were analysed via thematic analysis. CONSUMER AND COMMUNITY INVOLVEMENT: The lead researcher for this study has lived experience of mental illness and Better Access, but further consumer and community involvement was not undertaken. FINDINGS: Analysis generated themes highlighting the complexity of occupational therapy practice within a psychology-centric system. Participants described how occupational therapists drew on specialised skills to support clients with complex needs, yet worked within structural constraints such as restrictive practice rules, session caps, and limited remuneration. Themes also reflected the undervaluation of occupational therapy and the need for ongoing advocacy to ensure equitable access to services, appropriate funding, and recognition of the profession's contribution. CONCLUSION: The design of Better Access restricts the ability of occupational therapists to provide meaningful and sustainable occupational therapy services. Findings provide further evidence that longstanding issues identified in early research have persisted and that the burden occupational therapists face of consistently advocating for the profession and their clients is symptomatic of broader structural inequities. Findings highlight the need for systemic reform.
Health expectations : an international journal of public participation in health care and health policyCiara Ryan, Juman Simaan, Fiona Maclean
BACKGROUND: Patient and public involvement and engagement (PPIE) is increasingly prioritised in health professional education; however, how it is conceptualised, implemented, and evaluated within pre-registration occupational therapy programmes remains unclear. This protocol outlines a scoping review designed to map how PPIE in occupational therapy education is conceptualised, operationalised, and reported internationally, and to identify reported barriers, facilitators, and outcomes. METHODS: This scoping review will adhere to the methodological framework of Arksey and O'Malley (2005), as refined by Levac et al. (2010). We will search seven databases (MEDLINE, CINAHL, PsycINFO, ERIC, ASSIA, Web of Science and OTseeker) and grey literature from 2000 onward. Using the Person-Concept-Context framework, eligible sources will include peer-reviewed empirical studies and recognised grey literature reporting PPIE in pre-registration occupational therapy education. Two reviewers will independently screen titles/abstracts and full texts, and extract data using a piloted charting tool, with third-reviewer resolution. Findings will be synthesised using descriptive statistics and directed content analysis through a rights-based lens. Reporting will follow PRISMA-ScR. DISCUSSION: The review will generate the first occupational therapy specific, rights-based synthesis of how PPIE is conceptualised, enacted, and evaluated in pre-registration education internationally. Findings will inform evidence-based, feasible, and equitable approaches to involvement, offering co-created recommendations for educators, programme leaders, and regulatory bodies. This work will also identify gaps to guide future research and policy. LIVED EXPERIENCE OR PUBLIC CONTRIBUTION: People with lived experience who contribute to occupational therapy education will be recruited as contributors to this review and involved at key stages, including search strategy development, screening, data interpretation, and synthesis. Contributors will be supported and remunerated in accordance with National Institute for Health and Care Research (2024) and Royal College of Occupational Therapists (2022) guidance, and their involvement will be documented using the GRIPP2 (Staniszewska et al., 2017) reporting framework.
Australian occupational therapy journalTayla Grant, Kylie Wales, Laura Jolliffe, Emma J Schneider, Jade Glascott, Danielle Sansonetti, Avril E Drummond, Natasha A Lannin
INTRODUCTION: Early after stroke, inpatients commonly experience difficulty performing activities of daily living (ADL). Occupational therapists are key to providing early rehabilitation to optimise recovery. However, the effectiveness of early, activity-based retraining of ADLs is not clear. The aim of this systematic scoping review is to determine whether activity-based retraining targeting basic activities of daily living (b-ADL) and/or simple cognitive instrumental activities of daily living (C-IADL) delivered early after stroke improves functional independence. METHODS: MEDLINE, CINAHL, and Embase were searched. Eligible studies included randomised controlled trials or quasi-randomised trials, with at least 75% of participants over the age of 18, with a stroke diagnosis, and who received activity-based interventions within the hospital setting. Articles were screened by two authors using Covidence. Risk of bias was assessed using Cochrane's Risk of Bias tool (RoB2). All results were meta-analysed using Comprehensive Meta Analysis software (V4.0). CONSUMER AND COMMUNITY INVOLVEMENT: No consumer or community involvement was included in this study. RESULTS: A total of 7546 articles were screened, and six studies including n = 254 participants met the inclusion criteria. Performance outcome measure results were meta-analysed; there was no statistically significant impact of activity-based interventions on functional performance (standardised mean difference [SMD] = 0.41; 95% confidence interval [CI] -0.06, 0.87; P = 0.09). Two studies reviewed quality of life and satisfaction outcomes; data were not synthesised. CONCLUSION: Whereas individual trials suggested improvements early after activity-based training, our meta-analysis showed variability in effects in trials to date. Further research is required to determine the clinical and cost-effectiveness of activity-based interventions within the hospital setting to guide occupational therapy practice.
Australian occupational therapy journalEmma Dempsey, Laura Manley, Anne Honey, Yu Zhuang Germaine Lim, Yu-Wei Chen, Margaret McGrath
INTRODUCTION: Understanding the form, function, and meaning of occupations is essential for effective occupational therapy practice. Parenting is widely recognised as a meaningful and valued occupation. The Parenting Occupations and Purposes (POP) Framework conceptualises parenting occupations and their underlying purposes, but its validity in real-world contexts has not been tested. This study aimed to evaluate the applicability of the POP Framework among parents in Ireland. METHODS: An exploratory descriptive design using Experience Sampling Methodology captured real-time data on parenting occupations and purposes via the Participation In Everyday Life mobile application. Data were analysed using descriptive and inferential statistics as well as deductive and inductive content analysis to assess the framework's applicability to the sample. CONSUMER AND COMMUNITY INVOLVEMENT: Collaboration with the POP Framework developers ensured accurate application of its concepts. Partnership with the developer of the Participation In Everyday Life mobile application supported correct setup and usability. RESULTS: Forty-four parents completed 1150 surveys over 7 days. All categories in the POP Framework were represented. The most frequent occupation was attending to the child's basic needs (223 occurrences) while seeking help appeared only once. Among purposes, having the child's basic needs met dominated (571 occurrences), whereas purposes related to continuous parental development were least frequent. New examples of occupations emerged, including faith-based activities, purchasing discretionary goods, and technology-mediated monitoring (e.g., texting a spouse to check on a child), suggesting areas for framework expansion. CONCLUSION: Findings support the validity of the POP Framework in a real-world context while highlighting opportunities for refinement to capture cultural and technological dimensions of parenting. Enhancing the framework may improve understanding of parenting occupations and inform more comprehensive occupational therapy services for parents.
Australian occupational therapy journalLeanne van Diemen, Genevieve Pepin, Rachel Knight
INTRODUCTION: Occupational therapists are important members of mental health multidisciplinary teams. Despite aligning with mental health reform priorities, including promoting client centredness and participation, the role of occupational therapists in mental health, particularly in acute psychiatric inpatient units, is poorly understood. This study explored the role, function, and scope of practice of occupational therapists in Australian acute psychiatric inpatient units. METHODS: This mixed methods, convergent parallel design study combined in-depth interviewing and a cross-sectional survey. Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics, respectively. Both forms of data were analysed separately and then integrated and merged using a contiguous approach. The Occupational Therapy Australia Mental Health Capability Framework guided survey questions and interview guide development. The Model of Human Occupation informed interview guide development, while maintaining an occupational focus across the study. CONSUMER INVOLVEMENT: Consumer involvement was not relevant for this study. FINDINGS: Fifty-nine mental health occupational therapists participated in the study. All completed the survey, and 13 also participated in interviews. Participants were mostly females (83%), aged under 30 (58%), from Victoria (70%), with less than 3 years' experience in acute psychiatric inpatient units (77%). Four themes were identified: (1) a day in the life-same same but different, (2) the underutilised potential of occupational therapy, (3) an evolving practice and increasing demand, and (4) practice shaped by and shaping the environment. Key functions of the role included assessment, completed by survey participants either once a day (37%) or more (16%); individual interventions, completed once a day (48%); group work, completed several times a day (43%); and discharge planning. CONCLUSION: Occupational therapists working in Australian acute psychiatric inpatient units share common functions, challenges, and experiences. Limited resources and challenges advocating for their role impact occupational therapists' ability to demonstrate their value within multidisciplinary teams.
Scandinavian journal of occupational therapyJennifer Wort, Danielle Hitch, Chelsea Baxter
BACKGROUND: Occupation-Based Practice (OBP) is fundamental to occupational therapy, enhancing consumer engagement and outcomes, yet implementation is challenging due to local environments and dominance of impairment-based interventions. AIM: To investigate implementation of a service-wide OBP strategy in a large metropolitan tertiary health service over 6 years; understand its influence on occupational therapists; identify barriers and facilitators; and observe changes in clinician perceptions supporting sustainability. METHODS: Qualitative case study at two time points. Participants were occupational therapists and allied health assistants (n = 95 in 2017; n = 39 in 2023). Data was collected through focus groups (n = 8 in 2017; n = 3 in 2023) and multiple documents. Descriptive thematic analysis identified themes and sub-themes. RESULTS: Strategic leadership cultivated an OBP culture. Barriers included resource limitations and systemic pressures; facilitators included interdisciplinary support and professional development. Over time, perceptions shifted from conceptual understanding to practical application as OBP became integrated into service culture. CONCLUSION: A service-wide OBP strategy was effectively used in practice. Implementation depended on consistent application, a supportive service culture, and responsive systems. Although COVID-19 negatively impacted OBP, commitment to the strategy supported re-establishment, demonstrating sustainability. SIGNIFICANCE: A service-wide OBP strategy increases OBP and can be sustained in a tertiary healthcare setting.
BMJ openKeshavaram Pandian, Harin Mohammed Manzoor, Shania Ann John, Nis Anna Benoy, Bessy Sunny
INTRODUCTION: Caregivers of children with neurodiversity, particularly autism spectrum disorder and attention deficit hyperactivity disorder, experience sustained occupational, emotional and participation-related challenges. Occupational therapy (OT) plays a crucial role in supporting caregivers through skill training that enhances daily routines, participation and family functioning. Although caregiver training programmes are described across multiple disciplines, the scope, nature and specific contribution of OT-related caregiver skill training interventions remain insufficiently synthesised, with fragmented terminology, heterogeneous theoretical foundations and inconsistent reporting. To date, there appears to be limited synthesis specifically mapping OT-related caregiver skill training programmes for caregivers of children with neurodiversity. OBJECTIVES: This scoping review aims to identify and map the range, characteristics and implementation features of OT-related caregiver skill-training programmes for caregivers of children with neurodiversity. Secondary objectives are to describe how these programmes are structured and to examine delivery characteristics, including mode, provider, setting, duration and contextual or cultural adaptations. METHODS AND ANALYSIS: This protocol follows the Joanna Briggs Institute methodological framework for scoping reviews and will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review guidelines. Eligibility criteria are guided by the Population-Concept-Context framework. The review will include mixed-methods studies, intervention studies (randomised and non-randomised), feasibility studies and programme descriptions published in English from 2000 to 2025. Electronic searches will be conducted in PubMed, Embase, CINAHL, Scopus and Web of Science. The PubMed search strategy will undergo peer review in accordance with the PRESS 2015 guidelines. Study selection and data charting will be performed independently by multiple reviewers. Data will be synthesised descriptively and narratively, with results presented in tables, conceptual maps and an evidence gap map. ETHICS AND DISSEMINATION: Ethical approval is not required as this review uses publicly available data. Findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant scientific and professional forums to inform clinical practice, policy development and future research in caregiver-focused OT interventions.