Canadian Journal of Occupational Therapy

Background. Many Canadians experience health disparities when accessing health care. Occupational therapists have historically advocated for the elimination of health disparities. However, occupational therapy was founded in colonial ideals and systems, which continue to perpetuate health disparities. Purpose. Understand how Canadian occupational therapists describe the challenges and opportunities involved in addressing health disparities in provision of care. Methods. We used an interpretative descriptive methodology. Criterion and snowball sampling was used to recruit participants across Canada. Data from semistructured individual interviews were analyzed using reflexive thematic analysis. Findings. A total of 11 occupational therapists (M = 1, F = 10) participated. Four central themes were identified: (1) health equity is a core principle of occupational therapy, (2) systemic barriers are central to the occupational therapy process and can affect the delivery and access of equity-centric care, (3) occupational therapists as advocates against health disparities, and (4) health disparities must be considered when hiring and retaining occupational therapists in practice. Conclusion: Our study highlights the successes and challenges of the field of occupational therapy in addressing health disparities, providing constructive suggestions to move the field forward. Our study provides important implications for research, practice, and policy; these goals are aligned with recent initiatives from the Canadian Association for Occupational Therapists.

Background. Recovery after traumatic brachial plexus injury (BPI) involves complex interactions between injury, physical, psychosocial, and environmental factors that affect occupational performance and participation in life roles. This study examined the interrelationships between these outcomes. Method. This cross-sectional, mixed-methods study included 41 adults one-year postsurgical BPI repair. Quantitative measures included the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) (upper-extremity disability), the Canadian Occupational Performance Measure (COPM: performance, satisfaction), and the Participation Behaviour Questionnaire (PBQ). Qualitative data from semistructured COPM interviews were thematically analyzed (interpretive description) and linked to International Classification of Functioning Disability and Health categories using standard linking rules. Results. Self-care (88%) and productivity (68%) were the most frequently reported challenges. The mean QuickDASH score was 38.40/100 (SD = 22.70); COPM performance and satisfaction scores averaged 4.6/10 (SD = 1.61) and 4.0/10 (SD = 1.80); COPM performance showed a moderate, nonsignificant negative correlation with QuickDASH scores (r = –.32, P = 0.093) and a strong positive correlation with satisfaction (r = .90, P < 0.001). The QuickDASH scores were strongly correlated with PBQ participation restriction (r = .84, P < 0.001). Qualitative findings revealed a capacity–performance gap and psychosocial impacts, emotional regulation difficulties, altered identity, and existential concerns, that were not captured by quantitative measures. Implications. One year after BPI, participants showed partial functional recovery but continued to face personal and environmental barriers to real-world participation. Qualitative interviews identified areas of concern not sufficiently revealed by quantitative outcomes. Rehabilitation should incorporate physical restoration, environmental adaptation, and psychosocial support to rebuild occupational competence, identity, and participation.

Background. Psychotherapy encompasses a range of evidence-based mental health interventions adopted by healthcare providers, including occupational therapists. Advocacy for public funding and regulation of psychotherapy requires critical reflections on occupation-based approaches within this changing landscape. Purpose. To explore the perspectives and practices of Canadian occupational therapists regarding psychotherapy. Method. An online survey of Canadian therapists providing mental health services (n = 487) was conducted, followed by 8 regional focus groups (n = 63) to explore perspectives in more depth. Analysis of the survey and focus group data identified key trends in practice patterns and beliefs. Findings. There was variation in the extent to which psychotherapy was adopted, but trends in the types of approaches and perceived competence in foundational skills. Tensions were noted in the extent to which psychotherapy was linked to occupational therapy (OT) practice. Most felt that occupational therapy offered a unique occupation-based approach, but practice was shaped by differences in the regulatory context, and recognition of their role. Implications. Lack of clarity regarding the definition of psychotherapy, provincial differences in regulation, and limited external awareness of our role speaks to the need for national conversations, research and guidelines regarding occupation-based psychotherapy.

Background. Occupational therapists have identified a critical need for resources to support addressing driving after stroke. A previous feasibility study found that the Practice Resource to Address Driving After Stroke (PReDAS) was a useful practice resource. However, more robust research is needed to examine how use of the PReDAS-2 may support professional development. Purpose. To evaluate the relationship between use of the PReDAS-2 and self-reported clinical reasoning and self-efficacy of occupational therapists for addressing driving in acute care settings. Method. A concurrent, multiple baseline design was employed. Visual and Tau-U analyses were conducted. Findings. Occupational therapists’ self-reported clinical reasoning and self-efficacy to address driving after stroke improved with use of the PReDAS-2. Visual and Tau-U analyses indicated a large treatment effect of the PReDAS-2 for self-reported clinical reasoning (Tau-U = 0.7) and self-efficacy (Tau-U = 0.9). Conclusion. The present study provides preliminary evidence that the PReDAS-2 increases self-reported clinical reasoning and self-efficacy for addressing driving. Making the PReDAS-2 available to occupational therapists seeking to supplement their clinical practice may be warranted. Further research is necessary to determine if the PReDAS-2 should be recommended for use in acute care settings.

Description. In recent years, some occupational therapists have joined family medicine groups (FMGs). Despite certain integration obstacles identified in the literature, this practice remains poorly documented. Objective. To explore the practice of occupational therapists in FMGs and identify the factors influencing it. Methodology. This descriptive qualitative study includes six semi-structured interviews conducted with occupational therapists in FMGs. The interviews were analyzed using mixed thematic analysis. Results. Four professional occupational therapy activities emerged: 1) deploying service offer; 2) conducting assessment; 3) carrying out intervention; and 4) supporting team skills. Practice is influenced by various factors, mainly related to how the FMG is organized (internal rules, part-time employment, availability of equipment, size and layout of premises) and the individuals involved (previous experience, colocation within the FMG, mentorship opportunities, and collaborations outside the FMG). Conclusion. Occupational therapy practice within FMGs is promising, but it requires short-term development and dissemination activities to ensure the implementation of the full scope of occupational therapists' role within FMGs.

Background. Cultural humility is increasingly embraced as a theoretical lens that occupational therapists, educators, and researchers can use to promote justice and inclusion in diverse contexts. Cultural humility differs from cultural competence in its recognition of power and bias and its invitation to embrace advocacy and lifelong learning. Key Issues. Occupational therapy scholarship on cultural humility neither confronts the profound challenges of putting cultural humility into practice nor articulates strategies to integrate cultural humility into daily life and work. These challenges, including perceived objectivity, difficulty identifying power structures, and emotional responses to difference, are particularly salient when belief systems are in clear opposition. In such situations enacting cultural humility requires intellectual, emotional, relational, and community building strategy and skill. Implications. To support development of such skills, conceptual practices are outlined here with a focus on uprooting biases, building self-compassion, identifying multiple, co-occurring dimensions of power, and supporting development of collaborative advocacy vision and strategy. This work offers both theoretical and practical knowledge to advance cultural humility praxis in occupational therapy.

Background: The 2021 competencies for occupational therapists in Canada require therapists to promote equity, work to reduce power inequities, and engage in anti-oppressive practice. This means not only examining how we may be reproducing oppression and privilege within workplaces and therapeutic spaces, but also working to transform harmful social conditions in the world around us. While advocacy is well-established in the profession, activism may be less familiar. Purpose: The authors reflect on experiences and relevant literature to examine how advocacy, activism, and agitating may be part of a spectrum of justice-oriented change-making efforts in occupational therapy. Key concepts: All require careful analysis and mobilization of power, identifying the roots of inequities and potential strategies for change. There are multiple ways to engage in this work, but it has often been construed as “unprofessional.” The authors argue that it is in fact professional, demanding nuanced, ethical commitment, and moral courage. Implications: Arguably, confronting social inequities is an essential part of a professional duty to the public. Collective action is most effective for change-making, building solidarity with others around a clear analysis of power and processes for social transformation.

Background: Many postsecondary Canadian healthcare students report mental health challenges. Meaningful participation may reduce stress and enhance well-being. While participation encompasses both attendance and involvement, little is known about how involvement relates to emotional well-being (EWB) in occupational and physical therapy (OT/PT) students. Purpose: Using Experience Sampling Method, this study examined the association between momentary ratings of involvement in outside-of-school activities and EWB among OT/PT students, and whether this association differed by program. Method: Thirty-eight students (87% female) participated. Using the m-Path app, participants completed a set of five questions several times daily over a period of two weeks, reporting current activity, involvement level, and three emotional states. Pearson correlations and mixed-effect models were used. Findings: Of the 957 observations, non-academic activities were most common (80%). Involvement was most strongly associated with happiness and cheerfulness (0.4 > r > 0.9), seen in 53% of the participants. These associations were significant in both programs, with greater effects among OT students (0.52 >β > 0.59). Conclusion: Involvement in outside-of-school activities, captured in real-time, is important to students’ well-being, particularly happiness and cheerfulness. Findings may interest OT/PT students and directors seeking to support well-being through occupation.

Background. Return to driving following acquired brain injury enhances participation in community-based occupations, yet may be difficult to achieve and not without risk. Evidence supports on-road driving remediation to achieve functional fitness to drive post-acquired brain injury. Purpose. To determine if skills acquired through on-road driving remediation are maintained. Method. Secondary analysis of randomized controlled trial findings compared functional fitness to drive status and driving performance as rated by on-road occupational therapy driver assessment post-intervention and six-month follow-up. Findings. Of 25 participants with acquired brain injury (26–65 years), 95% of the 19 deemed functionally fit and 50% of the six deemed not functionally fit to drive retained that status at follow-up. Four changed status, with most (n = 3) shifting from not fit to fit. No significant change in functional fitness to drive status or driving performance observed at follow-up (p = .625). Being fit to drive at follow-up was significantly associated with competent observation, awareness, speed control, planning, judgement, and self-navigation. Conclusions. Following on-road driving remediation devised by an occupational therapist with advanced training in driver assessment and delivered by a qualified driving instructor, skills were maintained six-month follow-up post-acquired brain injury.

Introduction. Occupational therapy (OT), a profession deeply entrenched in colonial ideologies, also holds the potential to re-imagine healthcare in collaboration with Indigenous communities. Purpose. This review aims to (1) identify decolonizing practices in OT that can be applied at micro, meso, and macro levels of service delivery and (2) elevate the voices and viewpoints of Indigenous scholars. Method. I conducted a literature review based on a decolonized and relationship-focused approach, using the work of Tynan and Bishop. Seventeen articles were reviewed and guided by moss bag teachings. Findings. By encouraging actions people can do to enact decolonization practices, we hope that non-Indigenous people can critically think about ways in which to challenge coloniality and enact meaningful, relational, and respectful relationships. (1) micro: Before building relationships, occupational therapists need to understand their work environment to create meaningful connections and improve service delivery. (2) meso: occupational therapists in leadership should support Indigenous occupational therapists and fairly compensate them to respect Indigenous knowledge genuinely. (3) macro: occupational therapists involved in creating knowledge must recognize and promote Indigenous knowledge to benefit Indigenous OT students and communities. This paper is not meant to be a prescriptive “what not to do” as this varies across each unique situation. Conclusion. Effective actions must be implemented at all levels of service provision, recognizing that all clinicians, researchers, and educators are urged to transform and challenge the normative and colonial status quo ingrained in the OT profession.

Background. Little is known about assistive device use by young children with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) III–V. Purpose. This secondary analysis examined use of mobility, adaptive seating, bathing, and toileting devices in young children participating in a larger power mobility study. Method. Data from 42 participants aged 18–87 months were gathered, using the parent-report Home Use of Technology for CHildren (HUTCH), within the first 3–4 weeks and at the end of the 6-month power mobility loan. Associations were examined between device, time spent in each device and gross motor, manual abilities, and Level of Sitting Scale functional classifications. Results. Age, gross motor function, and manual abilities were associated with use of either a stroller, tilt-in-space, or upright manual wheelchair, while age, postural, and manual abilities were associated with use of wheelchair seating rather than separate adaptive seating or a typical high-chair or booster seat. Children with greater impairments were more likely to use bathing devices, while few used toileting devices. More time was spent by children using tilt-in-space wheelchairs compared with upright wheelchairs or strollers. Conclusion. Statistically significant associations were identified between child profile and use of manual mobility, seating and bathroom devices.