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Background:As stroke can result in functional impairments that impact driving ability, many jurisdictions mandate a 30-day period of driving restriction post-stroke. However, between 26% and 38% of clients drive against medical advice during this period. Purpose:Informed by critical reflexivity of the literature and the first author's practice, this critical analysis paper (1) explicates and critiques how adherence to guidelines regarding driving after stroke in the first 30 days is conceptualized in individualistic, biomedically centred research and (2) argues for expanded understandings of driving based on a transactional occupational perspective. Key Issues:Individualistic, biomedical perspectives view driving against medical advice as an individually located phenomenon, generating partial understandings and individually focused solutions. Re-conceptualizing driving after stroke as a transactional occupational choice provides a productive basis for understanding and addressing driving within practice and research. Implications:Concepts from occupational science can generate new insights for research and client-centred practice regarding driving following stroke.

Background. Given the sociopolitical roots of widening occupational, social, and health inequities, it is imperative that occupational therapy move forward in mobilizing occupation for social transformation.Purpose. Three key aims are addressed: articulating the imperative to mobilize occupation for social transformation; highlighting the political nature of occupation and occupational therapy; and providing guideposts for embracing a radical sensibility to inform moving forward in mobilizing occupation for social transformation.Key issues. Conditions of possibility within occupational therapy leave the profession ill equipped to enact social transformation. Enacting calls to mobilize occupation for social transformation requires radically reconfiguring these conditions of possibility to inform practices that resist, disrupt, and re-configure sociopolitical conditions perpetuating occupational inequities.Implications. Mobilizing occupation for social transformation holds much potential to contribute toward creating more equitable, humane societies. Realizing this potential involves committing to transforming our profession, as well as societal discourses, structures, systems, relations, and practices.

Background. As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as “street-level bureaucrats” (Lipsky, 1980/2010) who effect and are affected by policy.Purpose. Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being.Key Issues. By highlighting practitioners’ everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice.Implications. Framing occupational therapists as street-level bureaucrats reinforces practitioners’ situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists’ exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

Background. Globally, occupational therapists are taking up the transformative potential of occupation to mobilize the profession’s commitment to social change.Purpose. This study examined ideal constructions of occupation-based social transformative practices and challenges that may arise when enacting these practices.Method. Five participants with experiences developing practices aligned with social transformative goals in diverse locations were recruited. In this critical dialogical study, three dialogical interviews were conducted with each participant. Critical reflexivity was enacted through the exchange of transcripts and critical reflections with participants. A critical discourse analysis was conducted to examine how such practices are shaped within discourses and other contextual features.Findings. The findings address constructions of ideal practice and three threads that provide critical insights into ways discourses shape possibilities to enact social transformation through occupation.Implications. This study brings together experiential and theoretical knowledge to advance social transformative practices by problematizing underexamined discourses in occupational therapy.

Background. Enhancing occupational therapy practice requires critical examination of assessment tools and the conclusions being drawn from their use. When working with cognitively impaired older individuals, judgments about occupational competence are often informed by an assessment of cognitive competence.Purpose. The Cognitive Competency Test (CCT) is a frequently used measure in Canada to inform predictions of occupational competence. However, there is an absence of published evidence that addresses its validity.Methods. To appraise validity of the CCT, a retrospective chart review (n= 107) of CCT reports for inpatient and outpatient clients with cognitive impairment was conducted. Data were subjected to exploratory factor analyses to examine the factor structure, and the measure was compared with commonly used clinical variables reflecting cognitive and occupational competence.Findings. Results suggest that the CCT measures a unitary construct and provide some support for its predictive capacity.Implications. CCT scores can add incremental validity to cognitive screens, such as the Mini Mental State Exam, when evaluating occupational competence.

Background Within the area of dementia care, occupational therapists are asked to predict occupational competence in everyday living and often do so by assessing cognitive competence. Considering the cognitive changes that occur with dementia over time, the construct of cognitive competence is a key consideration. Still, a gap exists in the literature examining the relationship between cognitive competence and occupational competence.Purpose This study developed a consensus among participating Canadian occupational therapists regarding the components of cognitive competence they considered essential to predict occupational competence in people with dementia.Method A three-round Delphi study was completed with English- and French-speaking occupational therapists (n= 127; 116; 125) experienced in dementia care.Findings Ten cognitive components were identified as essential to predict occupational competence in individuals with dementia.Implications The 10 identified components provide direction for assessment practices and education in dementia care and for development of measurement tools.

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.

Background.There is a growing emphasis in academic, policy and popular literature within Western societies on positive discourses of aging. Although such discourses appear to be consistent with central beliefs of occupational therapy, particularly with respect to the health-promoting potential of occupation, critical social gerontologists are raising concerns about how such discourses are being shaped in relation to consumer culture and the rise of neoliberalism. Method and Purpose.Literature examining the emergence and evolution of positive aging discourses was reviewed and reflected upon using an occupational perspective. Results.Positive aging discourses are being shaped in ways that limit occupational possibilities and promote occupational injustices. Clinical Implications.Occupational therapists need to consider ways to enact discursive, practice and policy changes that enable aging persons with diverse abilities and resources to pursue occupations that fulfill needs and promote health.

Background.In the late 1980s, occupational science was introduced as a basic discipline that would provide a foundation for occupational therapy. As occupational science grows and develops, some question its relationship to occupational therapy and criticize the direction and extent of its growth and development. Purpose.This study was designed to describe and critically analyze the growth and development of occupational science and characterize how this has shaped its current status and relationship to occupational therapy. Method.Using a mixed methods design, 54 occupational science documents published in the years 1990 and 2000 were critically analyzed to describe changes in the discipline between two points in time. Data describing a range of variables related to authorship, publication source, stated goals for occupational science and type of research were collected. Results.Descriptive statistics, themes and future directions are presented and discussed. Practice Implications.Through the support of a discipline that is dedicated to the pursuit of a full understanding of occupation, occupational therapy will help to create a new and complex body of knowledge concerning occupation. However, occupational therapy must continue to make decisions about how knowledge produced within occupational science and other disciplines can be best used in practice.

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.

Health care facilities have been forced to re-evaluate traditional methods of quality assurance and consider quality improvement techniques. The Toronto Hospital Occupational Therapy Department has developed a quality programme that incorporates a foundation and supporting structures that can be adapted to accommodate the shift from quality assurance to continuous quality improvement. The foundation consists of a philosophy and principal functions, while the supporting structures include mechanisms to monitor principal functions and for communication. With a shift to continuous quality improvement, the quality programme was expanded to include clinical indicators and greater involvement of front-line staff and consumers. The programme also incorporates a framework that directs the development and implementation of clinical indicators related to occupational performance outcomes. Issues pertaining to the implementation and adaptation of the quality programme are discussed. Although initially developed in an occupational therapy environment, the framework and processes of this quality programme are being applied to multidisciplinary quality programmes in which occupational therapists are taking on leadership roles.

With the trend towards decreasing lengths of hospital stays, comprehensive discharge assessment is essential to facilitate continuity of care between hospital and community, minimize readmissions, and maximize client satisfaction. Predischarge assessment is often part of the occupational therapy role, especially in acute care. The Predischarge Assessment Tool (PAT) outlines a method of conducting comprehensive assessments in a manner consistent with the Occupational Therapy Guidelines for Client-Centred Practice. The tool is designed to inform decisions regarding: occupational readiness for discharge to the community from acute care; physical and social supports required to support occupational performance; and follow-up therapy. Two studies provide initial support for the content validity and clinical utility of the PAT and, at the same time, indicate that some modifications to the PAT are required.