Canadian Journal of Occupational Therapy-Revue Canadienne D Ergotherapie最新文献

Background: To address the learning needs of student Occupational Therapists with diverse academic backgrounds, educators must understand the factors that influence anatomy academic outcomes. Purpose: To compare anatomy learning outcomes of students with and without previous anatomy coursework over time and on higher- versus lower-order thinking skills. Method: An observational cohort study was conducted with entry-level occupational therapy students. Anatomy quizzes, were designed using the Blooming Anatomy Tool, were administered progressively throughout the term. Grades and thinking skills were compared between groups. Findings: At the start of term, students with anatomy coursework fared better than those without; the difference between groups was no longer present in the last four quizzes of the term. In general, students had lower grades on higher-order assessments; this did not differ between groups. Conclusion: Students without anatomy coursework achieved similar assessment outcomes as their peers; however, lower grades at the start of the term indicate that there was an adjustment period to anatomy learning.

Background.: Amid growing calls for relational teaching approaches in higher education to improve student learning outcomes and student and educator well-being, a need remains for effective relational pedagogies. Therapeutic-use-of-self (TUS) is an occupational therapy skill that centers the client-occupational therapist relationship, yet there is a dearth of research exploring its application as a pedagogy. This presents an opportunity for a widely used occupational therapy skill, TUS, to be adapted as a much-needed relational pedagogy. Objective. We explored the experience of TUS as a relational pedagogy in occupational therapy education from educator and student perspectives. Method. This qualitative description study borrowed from the evocative methodology of collaborative autoethnography. We, six researcher-participants, across two Canadian entry-to-practice occupational therapy programs, engaged in five discussions exploring the relationship between participant stories and contexts. Reflective memoing and reflexive thematic analysis were applied for analysis. Findings. Four themes were described: (a) education as transaction, (b) authenticity in learning, (c) experiencing TUS, and (d) relationship as resistance. Conclusion. With an emphasis on authenticity, empathy, power equity, and critical reflexivity, TUS challenges status quo approaches to education. Although neoliberalism challenges the feasibility of relational pedagogy in higher education, TUS holds promise as a relational and critical pedagogy.

Background: Societal structures and systems compel occupational therapists, at times, to behave in ways that perpetuate injustices. Justice theorists have described how Global North social structures have created the conditions for oppression of some groups while enabling additional groups to have unearned privileges. Mobilizing critical occupational therapy praxis is an essential response.

Purpose: This lecture addresses three questions: why should occupational therapists integrate structural justice, equity, and rights into their everyday practices?; what gives occupational therapy the potential to be a structural justice-, equity-, and rights-oriented profession?; and, how can occupational therapy mobilize critical praxis that will promote structural justice, equity, and rights?

Key issues: Occupational therapy's embeddedness in structures of injustice and therapists' obligations to integrate justice, equity, and rights into their everyday practices are increasingly evident. A focus on occupational participation, growing critical consciousness, socially transformative practices, and capacity for collective action position occupational therapy to be a structural justice-oriented profession. Critical reflexivity and reflection; justice-, equity-, and rights-based lenses; and acts of resistance and disobedience to oppressive systems can help mobilize critical praxis.

Implications: Occupational therapists have individual and collective opportunities for exercising the moral imagination and moral courage to mobilize critical occupational therapy praxis.

Background. The COVID-19 pandemic led to abrupt occupational disruption for all people. However, some populations, like older adults, were disproportionately impacted particularly in the earlier waves. Purpose. The purpose of this study was to explore and understand how the occupational participation of community-dwelling older adults was experienced during the COVID-19 pandemic, using the Canadian Model of Occupational Participation (CanMOP) to contextualize findings. Method. Sixty-seven older adults participated in semi-structured interviews from September 2020 to May 2021, 37 of which also participated in a follow-up interview one-year later. Findings. Using reflexive thematic analysis, four themes were generated: (1) experiences of loss are complex and layered for older adults, (2) technology as a medium for occupational participation, (3) risk perception influences return to occupation, and (4) age-related challenges for older adults resuming volunteer work. Conclusion. Increasing frequency and severity of influenza pandemics and other disasters are a global concern, and OTs can use their skillsets to foster participation and expand occupational possibilities for older adults. The CanMOP was a helpful tool to understand the nuances underlying the participation of older adults in this context.

Background. To evaluate effectiveness of The Greenhouse for autonomy and independence to prepare adults with severe cerebral palsy (CP) for the transition from assisted to independent living. The intervention combines weekly individual sessions using Pathways and Resources for Engagement and Participation together with weekly group sessions. Method. Seven adults with severe CP ages 23-45 years (M = 35; SD = 10) participated in the 20-week program. An Interrupted Time Series quasi-experimental design was used, assessing the intervention effect over time. The Canadian Occupational Performance Measure was administered bi-weekly from baseline to post-intervention to assess activity performance. Functional Independence Measure (FIM), Wheelchair use Confidence scale (WheelCon) and Impact on Participation and Autonomy (IPA) were administered baseline (4 weeks pre-intervention), mid and post-intervention, using Freidman test. Interviews were conducted four weeks after intervention. Findings. All participants' activity performance improved over time with significant clinical improvement in 95% of COPM goals. Significant improvement was seen in FIM (χ²= 8.07, p = .018) and WheelCon (χ²= 7.18, p = .028) though not in IPA. Participants described being better prepared, however more aware of challenges. Conclusion. The findings suggest the program may be effective to help adults with severe CP attain goals related to independent living and enhance function.

Background. Meaningful activity participation has been identified as a key outcome of services designed to support individuals during and following homelessness. Little is known about the effectiveness of interventions for promoting this outcome. Purpose. To identify the range and effectiveness of interventions on promoting meaningful activity participation among persons with experiences of homelessness. Method. We conducted a systematic review using the Joanna Briggs Institute methodology following PRISMA guidelines including a critical appraisal and narrative synthesis. Findings. Of 12,343 titles and abstracts screened, we included 12 studies. The authors of the included studies primarily used standardized measures of meaningful activity engagement. Critical appraisal scores ranged from 50.0 to 77.8. The most common interventions evaluated in the included studies were psychosocial interventions (n = 6; 50.0%), followed by case management and housing support interventions (n = 4; 33.3%) and Housing First (n = 2; 16.7%). While several interventions demonstrated effectiveness in promoting meaningful activity participation including psychosocial and case management interventions, Housing First, Critical Time Intervention, and a peer support intervention were found to be ineffective for promoting engagement in meaningful activity. Conclusion. Few intervention studies have been conducted that demonstrate effectiveness for promoting participation in meaningful activity for individuals during and following homelessness. Occupational therapy researchers and practitioners can build on existing evidence by developing and evaluating novel approaches by co-designing interventions in collaboration with persons with experiences of homelessness and service providers.

Background. Clinical expertise is the mechanism through which practitioners implement other components of evidence-based practice (EBP). Within occupational therapy practice, intervention approaches that are both closely and loosely aligned with Ayres' Theory of Sensory Integration are widespread, offering a unique opportunity to investigate the subjective nature of clinical expertise in EBP. Purpose. This qualitative study explored motivations to offer sensory integration-based interventions, and factors informing occupational therapists' clinical decision making in relation to an arguably contentious evidence base. Method. Six post-graduate sensory integration trained UK occupational therapists participated in individual semi-structured interviews. Interviews were transcribed, member-checked and analyzed using thematic coding analysis. Findings. Despite sound understanding of theory and continuous efforts to develop clinical knowledge, non-traditional hierarchies of evidence notably inform clinical decisions. The clinical expertise required for integration of patient preferences, clinical state and circumstances, and research evidence is informed by pragmatic responses to facilitators and barriers across contexts, combined with unique profession-specific identity factors. Implications. While empirical healthcare research is ideally undertaken under controlled conditions, realities of clinical practice are rarely so clear cut. Study findings highlight important subjective factors that are central to real-world research knowledge translation and further understanding of the clinical expertise component of EBP.

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.