Canadian Association of Occupational Therapists

Research papers from the Canadian Journal of Occupational Therapy which examine the relationship of occupation to health

The following are papers that we hope you will find interesting and helpful.

Children

Children with disabilities’ perceptions of activity participation and environments: A pilot study.
Home and community occupational therapy for children and youth: A before and after study.
The influence of virtual reality play on children’s motivation.
The effects of Family-Centred Functional Therapy on the occupational performance of children with cerebral palsy.
Occupational therapy intervention with children survivors of war.

Older Adults

The psychosocial effects of exercise and relaxation classes for persons surviving a stroke.
Quality of life indicators in long term care: Opinions of elderly residents and their families.
Living in a restricted occupational world: The occupational experiences of stroke survivors who are wheelchair users and their caregivers.

Mental Health

It’s the activity that counts: What clients value in psycho-educational groups.
Occupational value among individuals with long-term mental illness.
Occupation as a means to mental health: A review of the literature and a call for research.

Specific Conditions

In the eye of the dragon: Women’s experience of breast cancer and the occupation of dragon boat racing.
Health education for people with macular degeneration: Learning experiences and the effect on daily occupations.
Using occupation to facilitate self-awareness in people who have acquired brain injury:A pilot study.
The process of change: Listening to transformation in meaning perspectives of adults in arthritis health education groups.

Assistive Technology

Measuring the outcomes of word cueing technology.
Impact of wheeled seated mobility devices on adult users’ and their caregivers’ occupational performance: A critical literature review.

Other

The Winter Walkability project: Occupational therapists’ role in promoting citizen engagement.
Dimensions of meaning in the occupations of daily life.
Occupation, health and well-being
Le retour thérapeutique au travail comme une intervention de réadaptation centralisée dans le milieu de travail : Description et fondements théoriques.


Carin-Levy, G., Kendall, M., Young, A., & Mead, G. (2009). The psychosocial effects of exercise and relaxation classes for persons surviving a stroke. Canadian Journal of Occupational Therapy, 76(2), 73-80.
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.
Key words
Stroke, Exercise, Relaxation, Qualitative study, Psychosocial benefits

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Harding, J., Harding, K., Jamieson, P., Mullally, M., Politi, C., Wong-Sing, E., & Petrenchik, T. M. (2009). Children with disabilities’ perceptions of activity participation and environments: A pilot study. Canadian Journal of Occupational Therapy, 76(3), 133-144.
Background. Children with disabilities are particularly vulnerable to participation restrictions resulting from the interactions between children and their physical and social environments. Purpose. The purpose of this study was to gain a better understanding of how children with disabilities view their participation in out-of-school-time (OST) activities in a range of environmental settings. Methods. A case-study design was used to examine six children’s views on their OST activities using the Children’s Assessment of Participation and Enjoyment (CAPE), photographs of their OST activity settings, and semi-structured interviews. Findings. CAPE results indicated that the children participated most often in recreational activities. Through the use of photographs and interviews, four major themes emerged that emphasized a deep interconnection between childhood activities and settings. Implications. This unique pilot study contributes to developing an understanding for occupational therapists about how children with disabilities view their participation, their activity environments, and how photographs can be used to engage children in research.
Key words
Participation,  Children, Disability, Photographs,  Case study

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Ripat, J. D., Redmond, J. D., & Grabowecky, B. R. (2010). The Winter Walkability project: Occupational therapists’ role in promoting citizen engagement. Canadian Journal of Occupational Therapy, 77(1), 7-14. doi: 10.2182/cjot.2010.77.1.2
Background. Walkability is one feature of a person-friendly community that citizen engagement can influence. Purpose. Describe a winter walkability project and how an occupational therapist supported citizen engagement and participation in local policy decision making.  Methods. Seven stakeholder representatives undertook a participatory research project to address winter walkability. Through focus groups and walking logs, 10 citizens provided feedback on barriers to winter walking and a new sidewalk snow-clearing method. Analysis ascertained factors contributing to winter sidewalk walkability and factors promoting citizen engagement. Findings. Results identified reasons for and barriers to walking, perceived reasons for sidewalk conditions, and perceived effectiveness of the snow-clearing intervention. Citizens recommended against using the new snow-clearing method. Factors promoting citizen engagement included individual actions producing nominal results, individual and community-level interest, and development as citizen-experts. Implications. This project provides one example of how occupational therapists can take a socio-political role and facilitate citizen and occupational engagement.
Key words
Action research, Communities, Occupational therapists, Professional role, Public spaces

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Eklund, K., & Dahlin Ivanoff, S. (2006) Health education for people with macular degeneration: Learning experiences and the effect on daily occupations. Canadian Journal of Occupational Therapy 73(5):272-280. doi:10.2182/cjot.06.004

Background. Discovering New Ways, a program for people with macular degeneration, was developed based on a health education model incorporating occupation. Purpose. The purpose of this study was to evaluate the participants' learning experience in the program and the significance for their daily occupations. Method. Within an experimental design format, a content analysis was performed. Ninety-two people with macular degeneration were interviewed 1 and 16 months after the intervention. Results. Participants in the individual intervention program stated that they mastered occupational tasks as a result of the provision of assistive devices. Participants in the health education program stated that the problem-solving toolbox provided them with hope and confidence to master daily occupations. The participants' experience of learning within the health education program has provided important feedback regarding the structure of the health education model and its learning process. Practice Implications. The health education model may be seen as a model to design early interventions for individuals with health conditions which can impact occupational performance.
Key words
Models, educational , Macular degeneration , Occupational therapy practice

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Robichaud, L.,Durand, P. J., Bédard, R.,& Ouellet, J-P. (2006) Quality of life indicators in long term care: Opinions of elderly residents and their families. Canadian Journal of Occupational Therapy 73(4):245-251.

Background. There are very few studies that have integrated the opinions of nursing home residents and their families into the process of developing valid outcome measures for the quality of life in long-term care facilities. Purpose. The objective of this study was to identify the interpersonal and environmental characteristics for the best substitute living environment, as perceived by recently (< 6 months) and not as recently (> 6 months of residency) admitted residents and their families. Methods. A qualitative research approach was used with 27 elderly residents and families from five nursing homes. Results. Of the 11 quality of life indicators identified by the participants, the three most important ones were being treated with respect, sympathetic involvement in relationships, and perceived competency through technical (nursing) acts and attitudes. Practice Implications. As nursing home resident’s age, substitute homes have to adapt if they are to continue offering opportunities for self-actualization and a continuing sense of identity. Opinions of elderly residents and their families are very helpful for occupational therapists particularly when designing programs in long-term care facilities.
Key words
Quality of life • Aged • Long term care

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Laliberte Rudman, D., Hebert, D., & Reid, D. (2006) Living in a restricted occupational world: The occupational experiences of stroke survivors who are wheelchair users and their caregivers. Canadian Journal of Occupational Therapy 73(3):144-152.

Background. In order to meet the responsibilities of understanding and enabling occupation, occupational scientists and therapists must conduct research that is framed within an occupational perspective. Purpose. This paper reports the results of a qualitative investigation of the occupational experiences of stroke survivors (n=16) who use wheelchairs and their primary caregivers (n=15).  Results. Inductive analysis of data collected via in-depth interviews resulted in two major themes related to occupation, specifically: living in a restricted occupational world and challenges to participation in occupation. These results highlight the overall experience labeled occupation by default, and the intricate interconnections or spill-over effect between the occupations of stroke survivors and caregivers.  Practice Implications. In addition to providing empirical support for the importance of having a sense of control over occupation and the connection between occupation and identity, the results have implications for practice aimed at enabling occupation and directions for future research. As well, the results illustrate that occupational therapy services need to extend beyond wheelchair prescription in order to enable occupation with clients.
Key words
Occupation (human)  •  Cerebral Vascular Accident  •  Wheelchairs

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Fleming, J.M., Lucas, S.E., & Lightbody, S. Using occupation to facilitate self-awareness in people who have acquired brain injury:A pilot study. Canadian Journal of Occupational Therapy 73(1):44-55.

Background. Impaired self-awareness in people who have had an acquired brain injury (ABI) is a complex phenomenon that impedes rehabilitation progress and outcome. Purpose. This pilot study investigated the effect of an occupation-based intervention program on the self-awareness and emotional status of people after ABI. Four male adults with impaired self-awareness following ABI participated in this study. Each received a 10-week individualized program that focused on the performance of three occupations for 1 to 2 hours per week. A facilitative approach was taken, using techniques to improve self-awareness described in the literature. Repeated measures of participants' self-awareness and emotional status were taken pre- and post-intervention, and analyzed descriptively. Results. Results indicated preliminary support for the effectiveness of the program in facilitating participants' self-awareness. However, consideration of baseline and follow-up data indicated a complex picture. Increased anxiety was found to accompany improvements in participants' self-awareness in all four cases. Practice Implications. This study will assist occupational therapists with program development for clients who have had an acquired brain injury.
Key words
Self-awareness • Brain Injury • Occupational Therapy Practice

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Ashe, B., Taylor, M., & Dubouloz, C-J. (2005). The process of change: Listening to transformation in meaning perspectives of adults in arthritis health education groups. Canadian Journal of Occupational Therapy 72(5): 280-288.

Purpose. This study explored client experiences in two different arthritis education groups to develop an understanding of meaningful group experiences in the process of change leading to desired health outcomes. Method. A qualitative framework with an inductive, descriptive, phenomenological method guided the study. Ten participants with rheumatoid or inflammatory arthritis were recruited. Individual and focus group interviews provided descriptions of experiences. Results. Arthritis education group experiences led to improved client perceptions of ability to cope with chronic disease through a process of change in feelings, values and beliefs known as meaning perspectives. The change in meaning perspectives occurred through perceptions about disease, self and illness. Practice Implications. This study provides important insights into the client’s process of change in meaning perspectives that can lead to health behaviors and desired health outcomes. The study demonstrates the use of the group context as a tool to enable the process of change.
Key words
Occupational therapy practice, evidence-based • Arthritis • Group practice

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Law, M., Majnemer, A., McColl, MA., Bosch, J., Hanna, S., Wilkins, S., Birch, S., Telford, S., & Stewart, D. (2005). Home and community occupational therapy for children and youth: A before and after study. Canadian Journal of Occupational Therapy 72(5): 289-297.

Background. There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth. Purpose. To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost. Methods. Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion. Results. A statistically and clinically significant improvement in occupational performance was demonstrated (p<0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome. Practice Implications. Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.
Key words
Home occupational therapy • Health care costs • Rehabilitation, community-based  

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Tam, C., Archer, J., Mays, J., & Skidmore, G. (2005). Measuring the outcomes of word cueing technology. Canadian Journal of Occupational Therapy 72(5): 301-308.

Background. Measurement of assistive technology outcomes is complex because many factors (e.g., environment and model of service delivery) influence the successful use of the technology. Purpose. Using the example of measuring the outcomes of word cueing technology, this paper presents an approach for measuring assistive technology outcomes. Method. The Canadian Occupational Performance Measure (COPM) was administered to 29 children with physical and learning disabilities, between the ages of 3.9 and 19 years. Participants were provided with WordQ, a software program designed to assist the development of  writing skills. Follow-up data were collected through telephone interviews. Results. The COPM findings supported the effectiveness of WordQ Version 1 to enhance written productivity, with a mean performance change score of 3.5 (SD = 1.5). The COPM was an effective tool for measuring clients’ perceived outcome of word cueing technology. Telephone interview was considered a successful method for collecting outcome data. Practice Implications. A mix of tools and methodologies should be used to gain a comprehensive understanding of the impact of assistive technology.
Key words
Assistive technology devices • Pediatric occupational therapy • Cognition • Canadian Occupational Performance Measure (COPM)

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Cowls, J., & Hale, S. (2005) It’s the activity that counts: What clients value in psycho-educational groups. Canadian Journal of Occupational Therapy 72(3)176-182.

Background. This qualitative pilot research study provides client-centred outcomes by evaluating psycho-educational groups from the clients’ perspective. Purpose. This study was designed to determine what clients value in three psycho-educational groups offered in an acute inpatient psychiatric setting. Methods. Interviews lasting 30 to 60 minutes relating to the 8 participants group experiences were recorded and transcribed verbatim. A constant comparative approach was used to analyze data allowing for both expected and emergent themes to be integrated into later interviews. Results. Identified themes were group structure, readiness to attend groups and process information, and group milieu. Participants valued voluntary attendance and supportive milieu of groups. Insertion of relevant activity into groups to promote interaction, learning and information retention was also valued. Practice Implications. Occupational therapists offering mental health groups should consider a number of factors. These include the importance of transitioning clients from activity groups to psycho-educational groups, as well as the value clients place in determining their readiness to attend a group and having a supportive milieu with limits to emotional disclosure.
Key words
Rehabilitation, psychosocial • Occupational therapy practice • Evidence-based mental health treatment 

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Harris, K., & Reid, D. (2005). The influence of virtual reality play on children’s motivation. Canadian Journal of Occupational Therapy 72(1): 21-29.

Purpose. This study explored the degree of motivation children exhibit during virtual reality (VR) play sessions. Method. Sixteen children with cerebral palsy aged 8 to 12 years participated. They were observed during a variety of VR environments that were video recorded. The Pediatric Volitional Questionnaire (PVQ) was used to measure children’s motivation. The PVQ provides insights into children’s inner motives as well as how the virtual environment enhances or attenuates children’s motives. Nine VR environments were randomly selected to score with the PVQ. Results. Data were analyzed and descriptive statistics were calculated for modes and medians of total volition scores for each VR environment. Different environments produced varying levels of volitional behaviour. The features of environments that produced higher levels of volition included challenge, variability and competition. Practice Implications. The overall volitional scores of children with cerebral palsy in the current study indicate that VR play is a motivating activity and thus has potential as a successful intervention tool.
Key words
Paediatric occupational therapy, Virtual reality, Cerebral palsy

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Whalley Hammell , K. (2005). Dimensions of meaning in the occupations of daily life. Canadian Journal of Occupational Therapy 71(5): 296-305.

Background. According to the existential philosophers, meaning, purpose and choice are necessary for quality of life. Qualitative researchers exploring the perspectives of people who have experienced health crises have also identified the need for meaning, purpose and choice following life disruptions. Although espousing the importance of meaning in occupation, occupational therapy theory has been primarily preoccupied with purposeful occupations and thus appears inadequate to address issues of meaning within people's lives. Purpose. This paper proposes that the fundamental orientation of occupational therapy should be the contributions that occupation makes to meaning in people's lives, furthering the suggestion that occupation might be viewed as comprising dimensions of meaning: doing, being, belonging and becoming. Drawing upon perspectives and research from philosophers, social scientists and occupational therapists, this paper will argue for a renewed understanding of occupation in terms of dimensions of meaning rather than as divisible activities of self-care, productivity and leisure. Practice implications. Focusing on meaningful, rather than purposeful occupations more closely aligns the profession with its espoused aspiration to enable the enhancement of quality of life.
Key words
Human activity and occupations  • Life change events  • Quality of life

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Unruh, A., & Elvin, N. (2004). In the eye of the dragon: Women’s experience of breast cancer and the occupation of dragon boat racing. Canadian Journal of Occupational Therapy 71(3)138-149.

Background. Women with breast cancer are at risk of developing lymphedema following surgical and/or medical treatment of the disease. Recently, women have challenged traditional advice about limiting upper extremity activity to prevent lymphedema by participation in dragon boat racing. Purpose. In this qualitative pilot study, three women were interviewed about the meaningfulness of dragon boat racing in their lives. Methods. The women were interviewed twice and their interviews analyzed using thematic analysis. Results. Seven themes are discussed: attraction of dragon boat racing; physical and emotional well-being; competition; social support; transcendence/connectedness/oneness; re-occurrence of cancer; and, public awareness. Competition enabled the participants to rebuild self-confidence and to regain control over their physical health and emotional well-being. Balancing support and competition was key to finding satisfaction in this occupation. The women did not believe that dragon boat racing affected their risk for developing lymphedema. Practice Implications. People who engage in the occupation of dragon boat racing find it meaningful and develop new coping strategies. Participating in dragon boat racing can decrease stress and shift the meaning of having breast cancer to a more positive view of the experience.
Key words
Occupation (human) • Breast diseases • Dragon boat racing

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Eklund, M.,  Erlandsson, LK.,  &  Persson, D. (2003). Occupational value among individuals with long-term mental illness. Canadian Journal of Occupational Therapy 70(5): 276-284. 

Purpose. The study compared the perceived value of occupation among a sample of individuals with long-term mental illness to a sample of people not diagnosed with mental illness. As well, it investigated whether diagnostic and demographic factors were related to perceived occupational value among the individuals with mental illness. Finally, the study examined the relationship between occupational value and ratings of health and well-being. Method. One hundred and three individuals with mental illness and 28 healthy individuals were recruited for the study. Results. Overall occupational value among the individuals diagnosed with mental illness differed only marginally from the healthy group, indicating that perceived occupational value was by and large not related to mental illness. Among the individuals with mental illness, having children living at home was related to occupational value. There were moderate to strong associations between occupational value and measures of health and well-being. Practice Implications. This study provides important insights into occupational value among individuals with persistent mental health problems and provides some preliminary evidence in support of the Value, Meaning and Occupation Model.
Key words
Occupation (Human) • Quality of life • Rehabilitation, psychosocial

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McGibbon Lammi, B., & Law, M. (2003). The effects of Family-Centred Functional Therapy on the occupational performance of children with cerebral palsy. Canadian Journal of Occupational Therapy 70(5): 285-297. 

Background. Family-Centred Functional Therapy (FCFT) is a comprehensive approach to paediatric occupational therapy that considers and addresses the skills of the child, the requirements of functional tasks and the elements within the tasks environment, including family goals and preferences. Purpose. The purpose of the present study was to determine if interventions based on FCFT, but limited to addressing elements of the task and environment, would improve task performance. Method. A single subject, multiple baseline design was applied to three children, for three tasks each. Tasks were selected by parents and measured during baseline and intervention phases. Results. Results indicate that for each child at least one of the two tasks for which intervention was provided demonstrated improved performance.  Parents reported a clinically significant improvement in satisfaction with their children’s performance in the tasks that were addressed.  Practice Implications. This study provides preliminary evidence of the effectiveness of the FCFT approach.
Key words
Paediatric occupational therapy • Family centred care • Evaluation research

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Reid, D., Laliberte-Rudman, D., & Hebert, D. (2002). Impact of wheeled seated mobility devices on adult users’ and their caregivers’ occupational performance: A critical literature review. Canadian Journal of Occupational Therapy 69(5): 261-280. 

The prescription of wheeled seated mobility devices for clients with mobility impairment is a growing area in occupational therapy practice. The goal is to enhance client participation in occupation through technical intervention. This critical review examines the body of knowledge concerning the impact and effectiveness of the provision of wheeled seated mobility on the occupational performance of wheelchair users and their caregivers. The scope and gaps in the literature are defined to identify areas for future research. While the focus is on the methodological issues of the research reports, the relevance of findings to occupational therapy practice will also be reviewed. The results of the 46 studies in this review indicate that the majority of research conducted thus far have methodological limitations, which limits the extent to which this body of research can be drawn upon to provide evidence for the effectiveness of wheeled mobility systems. While most of the studies reviewed addressed constructs of relevance to occupational therapy practice, there was an emphasis on performance components and inadequate attention to engagement in occupations. This review is an important first step in building the ability of occupational therapists to demonstrate effectiveness in wheeled seating interventions.
Key words
Meta analysis • Evidence-based practice • Wheelchairs • Occupational performance

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Simó-Algado , S., Mehta, N., Kronenberg, F., Cockburn, L., & Kirsh, B. (2002).  Occupational therapy intervention with children survivors of war. Canadian Journal of Occupational Therapy 69(4): 205-217.

A preventive occupational therapy program with children surviving the Kosovo conflict is examined. The objective of the program was to facilitate the emotional expression of traumatic experiences in order to prevent the development of future psychological problems. The intervention was based on a community-centred approach with spirituality as a central focus of the intervention. The Model of Human Occupation and the Occupational Performance Process Model were utilized to guide the identification and intervention of occupational performance issues. The children’s return from a land of war to a land of children demonstrates the potential of occupational therapy intervention in this field. With increasing awareness of populations  facing social and political challenges, there is a growing importance of the concept of occupational justice and the need to work against occupational apartheid.
Key words
Paediatric occupational therapy • Mental health • Preventive health care

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Law, M., Steinwendner, S. & Leclair, L. (1998). Occupation, health and well-being. Canadian Journal of Occupational Therapy, 65, 81-91.

Occupational therapists believe that there is a relationship between occupation, health and well-being but there is little evidence in the occupational therapy literature to support this belief. This paper describes the results of a critical review of research examining the relationship between occupation and health and well-being. Twenty-two studies from the health and social sciences literature were reviewed using specific methodological review criteria. The findings of these studies provide moderate to strong evidence that occupation has an important influence on health and well-being. Because most of this research has been completed with persons without disabilities, further research is required to explain the nature of the relationship between occupation and health and well-being for persons who experience a disability which affects their daily occupations.

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Rebeiro, Karen. (1998). Occupation as a means to mental health: A review of the literature and a call for research. Canadian Journal of Occupational Therapy, 65, 12-19.

Occupational therapy is a profession which is based upon many beliefs about occupation. One belief is that engagement in occupation can promote physical and mental health. This belief appears to support the profession's jurisdictional claim to the use and application of occupation in psychosocial practice. A review of the psychosocial occupational therapy literature yielded few empirical studies which addressed the use of occupation-as-means to mental health. A discrepancy exists between what the profession theoretically advances about occupation and the research conducted in this area. This discrepancy is highlighted as a possible explanation for the lack of recognition of the value of occupational therapy in mental health and is forwarded as a potential risk to the profession's jurisdictional claim to the use and application of occupation. A call to research is advanced to develop a knowledge base on occupation, to empirically support the use of occupation as therapy, and to secure a unique role for occupational therapy in psychosocial practice.

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Durand, M.J. Loisel, P., & Durand, P. (1998). Le retour thérapeutique au travail comme une intervention de réadaptation centralisée dans le milieu de travail : Description et fondements théoriques. Canadian Journal of Occupational Therapy, 65, 72-80.

Occupational therapists are becoming more and more involved in the treatment of work related musculoskeletal disorders. In this field of practice, an innovative intervention called Therapeutic Return to Work has been developed. This intervention includes, as part of the rehabilitation programme, a rapid return of the injured individual to his regular work station, while under the supervision of a therapist. Occupational therapists make use of the natural work environment as a basic element of the rehabilitation process. This article briefly describes the different steps and the theorical foundations of this intervention. Moreover, the Therapeutic Return to Work fits perfectly into the guidelines for the integration of occupational therapy practice into the community.

For the full paper, download work-relatedOT.pdf    

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