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Volume 76, Number 2
Table of Contents
From the Editor
Are we ready for an impact factor?
Marcia Finlayson and William C. Miller
Identifying occupational issues among children with intractable epilepsy: Individualized versus norm-referenced approaches
Nora Fayed, Elizabeth N. Kerr
Background. Anecdotal and empirical evidence indicates children with intractable epilepsy have difficulty completing daily occupations. There is a paucity of literature describing these issues from a client-centred perspective. Occupational issues in childhood epilepsy have historically been assessed by disability inventories. Purpose. This pilot study seeks to determine similarities and differences between occupational issues identified using a disability inventory and an individualized outcome measure among children with intractable epilepsy and their parents. Method. Goal identification was determined using two approaches to standardized measurement with 10 child-caregiver dyads. The Canadian Occupational Performance Measure (COPM) was the individualized measure for both parents and children. The Scales of Independent Behavior-Revised (SIB-R) disability inventory was completed by parents only. Agreement between the top three issues identified by the child COPM, parent COPM, and subscales of the SIB-R were compared. Findings. Although both of the outcomes employed in this study are standardized measures, they resulted in low agreement and the identification of different occupational issues for children with intractable epilepsy. Implications. This study provides a comparison of two different approaches to identifying goals. It also provides preliminary information on the types of occupational performance issues prioritized by children with intractable epilepsy and their parents.
Children, Epilepsy, Occupational therapy assessment
The psychosocial effects of exercise and relaxation classes for persons surviving a stroke
Gail Carin-Levy, Marilyn Kendall, Archie Young, Gillian Mead
Background. This study was set up to explore unexpected findings emergent from a randomized controlled trial of exercise versus relaxation post-stroke. Purpose. Stroke survivors’ experiences of taking part in exercise and relaxation classes were explored. Methods. In-depth, semi-structured interviews carried out with 14 community-dwelling stroke survivors in Edinburgh. The informants previously participated in a randomized exploratory trial of exercise versus relaxation. Findings. The classes motivated participants to take part in other purposeful activities, to continue to practice what they had learned, and/or to attend another class in the community. Class participation also led to an improvement of self-perceived quality of life, specifically, improved confidence, physical ability, psychosocial functioning, and a sense of empowerment. Implications. Taking part in either exercise or relaxation classes after stroke can contribute to improved self-perceived quality of life, improved psychosocial functioning, and improved motivation to take an active role in the recovery process.
Stroke, Exercise, Relaxation, Qualitative study, Psychosocial benefits
Stroke patients’ experience with the Australian health system: A qualitative study
Jennifer H. White, Parker Magin, Michael R. P. Pollack
Background. Consumer feedback about experiences with the health system is integral to service planning and is consistent with growing interest in patient-centred care. Purpose. To explore the experiences of community-dwelling stroke survivors at one, three, and five years using a community-based, cross-sectional study. Methods. The quantitative study was comprised of 90 participants post-stroke (3 cohorts, each including 30 participants). Qualitative interviews were undertaken with 12 participants (4 participants from each cohort). This paper presents findings from the qualitative component of the project. Findings. The majority of participants in each cohort were independent and a high proportion required community services. Qualitative data identified varied experiences with the health system, including knowledge about stroke, communication with the health system, and influences on transition home. Implications. The results presented identify the need for ongoing health professional education to enhance stroke service delivery. There is a particular need to address stroke risk-factor modification and to ensure close collaboration with patients and other health professionals with regard to rehabilitation processes. Results identify experiences with health systems up to five years post-stroke. Occupational therapy can play an essential role in post-stroke education and in rehabilitation focused on adjustment to stroke.
Outcomes, Post-stroke depression, Cerebrovascular accident, Qualitative research
Practice style traits of student occupational therapists and physical therapists
Saliha Hadouda, Hanane Rabiaa Laroui, Amélie Lemay, Benoit Martin, Nicol Korner-Bitensky,
Anita Menon, Caroline Storr, Liliane Asseraf-Pasin, Sara Ahmed
Background. Intensive efforts are aimed at understanding student attributes in anticipation that this will lead to effective knowledge translation (KT) strategies. One attribute of interest is practice style trait: four have been identified ranging from the seeker, who is driven by scientific evidence, to the pragmatist, who is driven by practicality. Purpose. To identify the prevalence of the four traits among student clinicians and explore associations between these traits, clinician characteristics and practice behaviours. Methods. Ninety-two occupational therapy and 86 physical therapy students completed a survey that elicited information on traits, clinician characteristics, and practice behaviours. Findings. The most prevalent trait was pragmatic, the least, seeker at <1%. The most prevalent reason for choosing an intervention was “it was used by my clinical supervisor”. Implications. Educators should carefully reconsider the implication of using KT strategies that cater primarily to seekers. Research is warranted to explore the impact of matching educational strategies to traits.
Evidence-based practice, Knowledge translation, Practice behaviours, Student education, Occupational therapy, Physical therapy
Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational “categories”
Karen Whalley Hammell
Background. Critics contend that occupational therapy’s theories of occupation are culturally specific, class-bound, and ableist, and that the division of all occupations into three simplistic categories of self-care, productivity, and leisure is arbitrary, lacks supportive evidence, and promotes a doctrine of individualism. Purpose. To add to the work of critics who advocate a fundamental rethinking of occupational therapy’s conceptualizations of occupation in terms of subjective qualities of experience that address intrinsic needs. Key issues. This paper suggests that if categories of occupation were informed by the ways in which people experience their occupations, these might be labelled as restorative, as ways to connect and contribute, as engagement in doing, and as ways to connect the past and present to a hopeful future. Implications. If occupational therapists enabled diverse clients’ perspectives to inform occupational categories, perhaps relationships between occupations and well-being might more easily be identified in theory and addressed in practice.
Occupation, Theory, Well-being
Using the Cognitive Orientation to Occupational Performance (CO-OP) with adults with executive dysfunction following traumatic brain injury
Deirdre R. Dawson, Arvinder Gaya, Anne Hunt, Brian Levine, Carolyn Lemsky, Helene J. Polatajko
Background. Meta-cognitive strategies have a positive effect on the rehabilitation of executive dysfunction. However, achieving generalization to daily life remains a challenge. We believe that providing rehabilitation in the person’s own physical environment and using self-identified tasks will enhance the benefits of meta-cognitive training and promote generalization. Purpose. This pilot study tested the applicability of the Cognitive Orientation to Occupational Performance (CO-OP) approach for use with adults with executive dysfunction arising from traumatic brain injury (TBI). Methods. A single-case design was used with 3 adults, 5 to 20 years post-TBI and their self-identified significant others. Assessments included neuropsychological tests and the Canadian Occupational Performance Measure. The intervention entailed guiding participants to use a meta-cognitive problem-solving strategy to perform self-identified daily tasks that they needed and wanted to do and with which they were having difficulties. The intervention occurred over 20 one-hour sessions in participants’ environments. Findings. Performance improved to criterion (2-point positive change) on 7 of 9 trained goals and on 4 of 7 untrained goals (self-report). Improvement was maintained at a 3-month follow-up assessment. Implications. The CO-OP approach has the potential to improve performance in daily functioning for adults with executive dysfunction following TBI.
Executive dysfunction, Rehabilitation, Brain injury, Cognition, CO-OP, Problem solving