Assessing the Usability and Reliability of the Occupational Adaptation Practice Guide in an Adult Inpatient Rehabilitation Setting

To better align with the current health care trajectory and solidify the value of the profession, the field of occupational therapy must work towards client-centeredness and increased client satisfaction. The theory of Occupational Adaptation (OA) is a client-centered approach that focuses intervention on the internal adaptation process of the person by helping individuals generate appropriate occupational responses to self-identified challenges. Consistent with OA, the Occupational Adaptation Practice Guide (OAPG) engages clients in the intervention planning process through guided reflection on factors that inhibit and facilitate their occupation performance. Client goals and a plan for occupational responses to overcome occupational challenges are collaboratively generated by the client and therapist. The purpose of this quantitative descriptive study was to evaluate the usability of the OAPG and the reliability of the person and environment sections following changes to the instrument. This research intended to expand and support the literature for the use of an instrument that operationalizes the use of the theory of OA in practice. Details of this research project were modeled upon Boone and George-Paschal’s (2017) OAPG feasibility study and sought to answer similar research questions. These included: (1) What is the percentage of agreement for the person and environmental systems section of the OAPG? and (2) How do occupational therapists rate the usability of the OAPG instrument in an inpatient rehab setting? Three adult inpatient rehabilitation facilities, located within a 30-mile radius, partnered with the researchers for this study. A purposive sample of twenty registered and licensed occupational therapy practitioners were recruited through in-service trainings provided at each facility. For attending the in-service and participating in the study, participants received a certificate of participation for in-service hours (contact hours). During the in-service, participants completed the person and environment sections of the OAPG as they followed along with a demonstration video. The video showed an occupational therapy student using the OAPG to conduct an intake session with a mock client. The percentage of agreement was determined between the therapists’ ratings. The researchers identified patterns in the open-ended responses and compiled the findings into categories of related responses and percentages were calculated for each category. A second instrument, the Usability Questionnaire, was designed by the researchers to gather participants’ perceptions on the usability of the OAPG after using it with a client on their caseload. The questionnaire asked about the amount of time it took to implement the OAPG, how realistic its use was in the inpatient rehabilitation setting, and whether the OAPG was a useful instrument for client-centered practice. It also included questions to gather demographic information about the participants, including years in practice, education level, and prior exposure to the theory of OA. Responses were coded into themes using inductive content analysis. The revised OAPG was reported to be effective in successfully facilitating client-centered care and client satisfaction through client involvement in goal planning and meaningful collaboration with their therapist. A high percentage of agreement was found among therapists related to personal and environmental factors that facilitated or inhibited occupational performance. All respondents identified benefits to using the OAPG in practice while a few questioned the efficiency for practice.

References

Boone, A.E., & George-Paschal, L.A. (2017). Feasibility testing of the occupational adaptation practice guide. British Journal of Occupational Therapy, 80(6), 368-374. https://doi.org/10.1177/0308022616688018

Schkade, J.K., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part 1. American Journal of Occupational Therapy, 46(9), 829-837. https://doi.org/10.5014/ajot.46.9.829

Schultz, S., & Schkade, J.K. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, part 2. American Journal of Occupational Therapy, 46(10), 917-925. https://doi.org/10.5014/ajot.46.10.917

George-Paschal, L.A., & Bowen, M.R. (2019). Outcomes of a mentoring program based on occupational adaptation for participants in a juvenile drug court program. Occupational Therapy in Mental Health. https://doi.org/10.1080/0164212X.2019.1601605