American Journal of Occupational Therapy

This article synthesizes research findings regarding the effects of occupational therapy on the restoration of role, task, and activity performance for persons who have had a stroke, with the purpose of guiding practice and research. It is the first of a two-part review of studies. Part II synthesizes research findings regarding the effects of occupational therapy on remediating impairments. Part I includes 15 studies involving 895 participants (mean age = 70.3 years). Of these studies, 11 (7 randomized controlled trials) found that role participation and instrumental and basic activities of daily living performance improved significantly more with training than with the control conditions. We conclude that occupational therapy effectively improves participation and activity after stroke and recommend that therapists use structured instruction in specific, client-identified activities, appropriate adaptations to enable performance, practice within a familiar context, and feedback to improve client performance. Empirical research to verify these findings and to characterize the key therapeutic mechanisms associated with desired outcomes is needed.

This article is the second of a two-part synthesis of research regarding the effects of occupational therapy to improve activity and participation and to reduce impairment for persons with stroke. Part I synthesized research findings for restoration of role participation and activity performance. Part II synthesizes research findings regarding the effects of occupational therapy to remediate psychosocial, cognitive-perceptual, and sensorimotor impairments. Only 29 studies involving 832 participants (mean age = 64.3 years) addressed these goals. No studies directly researched the effects of occupational therapy on depression after stroke. Eight studies addressed cognitive-perceptual abilities. The findings indicated that homemaking tasks resulted in greater improvement of cognitive ability than paper-and-pencil drills and that tasks that forced awareness of neglected space, including movement of the opposite limb into that space, improved unilateral neglect. Fifteen studies examined the effect of occupational therapy on various motor capacities after stroke. Coordinated movement improved under these conditions: (a) following written and illustrated guides for movement exercises, (b) using meaningful goal objects as targets, (c) practicing movements with specific goals, (d) moving both arms simultaneously but independently, and (e) imagining functional use of the affected limb. Research on inhibitory splinting was inconclusive. Based on these few studies and lack of replication, we could make only tentative recommendations for practice. Further definitive research is needed.

OBJECTIVE. The purpose of this study was to examine how U.S. occupational therapists access and use clinically relevant research results.

METHOD. During the spring of 2000, 209 clinically practicing occupational therapists who were members of the American Occupational Therapy Association responded to a survey (58% response rate). The distribution of opinions and self-reported behavior was portrayed by descriptive statistics, and chi-square cross-tabulations and Pearson correlation coefficients were calculated between demographic and evidence-based practice variables.

RESULTS. Respondents occasionally accessed research information through a variety of resource media. The majority (57%) implemented between one and five new, research-based treatment plans in the past year. Compared with respondents with less experience, a greater proportion of respondents with 15 or more years of clinical experience did not believe that research conclusions usually translated into treatment plans for individual clients (X ² = 20.620, p < .01). Almost three fifths (59%) of respondents reported that time was provided on the job to attend continuing education; however, 45% strongly disagreed that time was available at work to access research information. Other reported barriers to research utilization included lack of time on the job, high continuing education costs, weak research analysis skills, and placing higher value on clinical experience than on research.

CONCLUSIONS. These findings suggest that therapists are currently engaging in a modest amount of evidence-based practice. Removing the barriers identified in this study may increase research utilization among clinicians.

OBJECTIVE. Life-threatening illness profoundly affects people’s occupational functioning, yet continuing occupational engagement seems vital to their well-being. This qualitative study used a doing-being-becoming framework to explore the place of occupation in human lives threatened by illness.

METHOD. The experiences of 13 male and 10 female day hospice participants were investigated through a combination of focus groups, individual interviews, and participant observation. These data were interpreted by a process of constant comparison, coding, and theme building.

RESULTS. Experiences of doing were evident in accounts of losing and maintaining valued occupations and striving to preserve physical and mental functioning. A sense of being through occupational engagement arose in social relationships and self-exploration that enhanced feelings of self-worth. Occupation promoted the experience of becoming by providing fresh learning opportunities and a sense of contributing to others’ welfare.

CONCLUSION. The data offer new insights into the potential benefits of occupational engagement for persons dealing with life-threatening illnesses. Use of the doing-being-becoming framework enriched analysis of these data, which, in turn, have contributed to the understanding of the framework’s theoretical concepts.

OBJECTIVE. The purpose of this study was to investigate the characteristics of the school social environment experienced by children with physical disabilities and the social interactional characteristics of children with physical disabilities in the school environment. The goal was to understand the interactive processes that support or inhibit these children’s social interactions.

METHOD. Naturalistic observation and participant interviews were used to collect data on social interaction patterns of three children with physical disabilities 5 to 8 years of age who were enrolled in age-appropriate regular education classrooms. Descriptive codes were obtained through constant comparative analysis.

RESULTS. Four themes were identified that characterized aspects of the social environment affecting the social interactions of children with disabilities: reciprocity, characteristics of social and play interactions, effects of adult involvement, and quality of occupational engagement.

CONCLUSION. The study supports the need for occupational therapists to focus intervention on multiple aspects of the social environment to facilitate children’s socialization.

OBJECTIVE. The purpose of this study was to describe the current practices of school-based occupational therapists regarding their use of multisensory modalities and activities in handwriting remediation.

METHOD. A survey was sent to 313 school-based occupational therapist members of the American Occupational Therapy Association who identified themselves as working in a school system as their primary employment setting. Of these, 198 surveys were returned and analyzed descriptively, resulting in a response rate of 63.3%.

RESULTS. More than 130 different multisensory modalities and activities were documented. Twenty-five of these had previously been reported in the literature, the other 114 were documented, by respondents, within the “other” category. Most respondents reported using 5 or more modalities and activities per student, the most frequent being chalk and chalkboard. No consensus among respondents is apparent about the primary sensory systems stimulated by the modalities and activities. No difference in modality and activity use was found on the basis of demographic variables.

CONCLUSION. Overall findings indicate that the breadth of modalities and activities being used is far greater than that currently found in the literature. The results suggest a need for completing studies designed to examine the use and effectiveness of multisensory modalities and activities in handwriting remediation.

Many factors contribute to homelessness, including extreme poverty, extended periods of unemployment, shortages of low-income housing, deinstitutionalization, and substance abuse. As a result, the needs of people who are homeless are broad and complex. This needs assessment used literature reviews, review of local documents and reports, participant observation, focus groups, and reflective journals to guide the development of an occupational performance skills program at one homeless shelter in south Florida. Through these methods, the role of occupational therapy was extended beyond direct service to include program and resource development, staff education, advocacy, and staff–resident mediation. The findings of the needs assessment and the actions taken as a result of this work point to the huge potential for occupational therapists and students to work together with staff and residents of homeless shelters.

OBJECTIVE. The purpose of this randomized, longitudinal study was to investigate the impact of a health education program on perceived security in the performance of daily occupations 4 months after the intervention period.

METHOD. Two groups of persons with age-related macular degeneration were compared: Those who had followed a newly developed health education program that was based on occupation and those who took part in a standard individual intervention program.

RESULTS. Significant differences in the level of perceived security between the groups were found for 13 of 28 occupations. Participants in the health education group maintained or improved their level of perceived security in 22 daily occupations, whereas those in the individual intervention group declined to a lower level in 17 daily occupations.

CONCLUSION. This study provides support for the effectiveness of the health education program to enhance security and hinder a progressive decline in perceived security in daily occupations.

The purpose of this study was to examine the current research performance patterns of occupational therapy faculty, identify factors that influence individual faculty members productivity, and compare current faculty research performance with earlier studies in occupational therapy. Survey questionnaires from 158 faculty members were analyzed. Compared to earlier data, the results showed that today’s occupational therapy faculty members have obtained higher degrees, published more refereed articles, acquired larger external grants, stayed in academia longer, and developed clinical specialty areas. Tenured senior faculty members spent more time on research-related tasks, produced more publications and grants, and perceived institutional factors as more favorable for research than did untenured faculty in lower ranks. The overall enhancement in productivity among occupational therapy faculty members in the 1990s suggests an increase in academic scholarly activities.

OBJECTIVE. The purpose of this study was to evaluate, from the participants’ perspective, the effectiveness over time of 10 occupational therapy faculty development workshops conducted between 1994 and 1998.

METHOD. Surveys were mailed to 179 occupational therapy faculty participants to gather demographic data and perceptions of the following aspects of the workshops: benefits over time of the instructional content, changes made in current teaching practices, progress as a faculty member, and future needs for faculty development.

RESULTS. The response rate was 63% (n = 106). The majority (72%) of respondents had less than 5 years of teaching experience. Respondents were women in their early 40s with approximately 12 years of clinical experience and a master’s degree. Respondents perceived the most effective aspect of the faculty development workshops as the opportunity to participate in a face-to-face environment in which they observed the skills of a master teacher demonstrating instructional principles. Further, respondents reported that the greatest changes in their current teaching practices occurred in their ability to design, implement, and evaluate a course of instruction, thus increasing their perceptions of progress as a faculty member.

CONCLUSION. The 10 faculty development workshops conducted between 1994 and 1998 were judged effective by occupational therapy faculty members who perceived that their participation resulted in benefits over time to their current teaching practices.