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Background. The Canadian Occupational Performance Measure (COPM) assists occupational therapists to identify occupational performance problems using a client-centred approach. Since its first publication in 1991, there has been abundant evidence of the ability of the COPM to detect a statistically significant difference as an outcome measure. There has also been a tacit understanding that a difference of 2 points from pre-test to post-test on either Performance or Satisfaction COPM score represents a clinically significant difference. There is however, some confusion about the origins of this claim. Purpose. To ascertain empirical evidence for the claim that a clinically significant difference is a change score ≥2 points. Method. We conducted a scoping review of peer-reviewed literature (1991-2020) for intervention studies using the COPM as an outcome measure and examined intervention type and change scores. Findings. One hundred studies were identified. The COPM was used to assess effectiveness of eight types of occupational therapy interventions. The common belief, however, was not empirically supported that clinical significance can be asserted on the basis of a two-point change in COPM scores. Implications. Further research is needed to test alternative approaches to asserting clinical significance or a minimal clinically important difference.

Background: The national policy on disability in Namibia is overdue for review having been in existence for over 20 years. In 2017 the government of Namibia expressed intentions to review the policy. Concerns that can be framed as occupational injustice were raised by persons with disabilities in Namibia. Aim: To gather evidence from persons with disabilities; disability policy decision makers and occupational therapists for contributing towards disability policy formulation using an occupational justice perspective. Method: In-depth interviews were conducted with 15 persons with disabilities and eight disability policy decision-makers. Two focus groups were conducted with a total of 17 occupational therapists working in Namibia. NVivo 11 Pro version was used for thematic data analysis to generate themes with critical disability theory as the theoretical framework. Findings: Occupational participation barriers identified in the study were: attitudinal, access, physical, expertise, and systemic. These barriers can be framed as occupational marginalization, occupational deprivation and occupational alienation. All participant groups suggested policy reforms to promote occupational participation among persons with disabilities. Conclusion/Significance: There is potential for applying the participatory occupational justice framework in disability policy formulation to promote participation in occupations that are meaningful, and culturally relevant to persons with disabilities in Namibia.

This article presents a scoping review of 74 papers from the peer reviewed literature dealing with occupational therapy in palliative care. Five themes emerged regarding the parameters of occupational therapy in palliative care. The themes include: the importance of valued occupations even at the end of life, an exploration of how occupations change over the trajectory of a terminal illness, the balance between affirming life and preparing for death, valued occupations might be doing, being, becoming, or belonging occupations and the emphasis of a safe and supportive environment as an essential dimension for effective palliative care. These five themes are combined to form a model to guide occupational therapy in palliative care. The model offers structure and direction for occupational therapists in order to offer an opportunity for clients in palliative care to flourish toward the end of their lives.

Background: Wheelchairs, scooters, and related equipment are essential for the well-being of individuals with limited mobility and impact participation, health, and quality of life., Purpose: Our objective was to identify and evaluate policies governing equipment funding for Canadian adults. We reviewed funding legislation and program documentation for adult Canadians (≥18 years of age) covered by their provincial, territorial, or federal health care plan. Documents were obtained online or through administrative staff. Policy evaluation was guided by the Disability Policy Lens from the Canadian Disability Policy Alliance., Key Issues: Coverage ranges from full funding for all individuals within the jurisdiction to programs limited by strict eligibility criteria. Each jurisdiction defines "disability" or "basic/essential need" differently, contributing to further funding disparities., Implications: Funding policies differ substantially across Canada, resulting in unequal access to equipment dependent on province or territory. We identified eligibility, funding, definitions of mobility, repair and replacement, and prescriber requirement benchmarks that represent policy targets for improved access.

Background: Client-centered care, a core value of occupational therapy (OT) and the gold standard of health care, presents challenges in practice. Learning client-centered practice (CCP) in health professional education has been linked to use of "expert patients". How this learning occurs was acknowledged as a gap in research., Objectives: This article aims to describe OT students' experience interacting with "expert patients"; describe students' learning regarding CCP; identify conditions for learning CCP., Methods: MScOT students participated in a qualitative study with the research question: "How does the students' experience interacting with the 'expert patient' relate to learning regarding client-centred practice?" In-depth interviews were conducted with six OT students subsequent to their "expert patient" sessions. Transcripts were analyzed using CAQDAS., Findings: Students described admiration, discomfort, humility, and gratefulness; learning regarding collaboration; respect for autonomy; and recognition of client expertise. Three coexistent conditions fostered learning regarding CCP: the client is an expert; students experience power; and the environment includes guided reflection/discussion., Conclusion: This study adds to the literature particular conditions that facilitate learning client-centered practice. All stakeholders in health professional education can benefit.

Objective: We reviewed the evidence regarding the effectiveness of community occupational therapy interventions, delivered alone or within a multidisciplinary team, in improving occupational outcomes for adults with selected chronic diseases., Method: We completed a scoping review of randomized controlled trials published from 1988 through 2008. Studies included participants with heart disease, depression, rheumatoid arthritis, osteoarthritis, chronic obstructive pulmonary disorder, or diabetes., Results: Sixteen studies met the inclusion criteria. Ten studies found significant differences between intervention and control groups for at least one outcome of function in activities of daily living, functional self-efficacy, social or work function, psychological health, general health, or quality of life. Conflicting evidence exists regarding the impact of intervention on physical function and health., Conclusion: Occupational therapy can improve occupational outcomes in adults with chronic diseases. Using and building on this evidence, occupational therapists can continue to promote their role in helping to meet this population's needs.

Background: An underlying premise of occupational science and occupational therapy is that humans do better with a balanced lifestyle. What life balance means, how to design it, and to recognize when one has it have not been defined., Purpose: Our intention is to offer another perspective on life balance, one that we believe is at the root of what the term means., Key Issues: We suggest the notion underlying life balance is the extent to which a person designs and lives in integrity with his or her own personal values, strengths and what has meaning for them. The term we propose is occupational integrity and that it be regarded as an essential precondition to life balance., Implications: Occupational integrity expands the focus of therapy beyond "doing" to interventions at the level of the person and identity, helping clients to identify their strengths, values and purpose, what is meaningful and satisfying for them, and then designing and living their lives in congruence with that.

Background: What does it mean to focus on the spiritual in occupational therapy? What interventions would qualify as spiritual modalities? This paper attempts to define the boundaries of what may be considered legitimate uses of spirituality in occupational therapy by using the example of prayer., Purpose: The purpose of this paper was to provide an in-depth analysis of the use of prayer in practice., Method: Medical and allied health journals were searched using the terms spirituality, spirit, religion, and prayer. Identified articles were synthesized to identify potential advantages and disadvantages of using prayer in therapy., Findings: Prayer can be considered an appropriate occupational therapy intervention so long as four questions can be answered positively., Implications: To answer these questions, guidelines are provided that will lead the therapist through a decision making process to determine the appropriateness of incorporating prayer into any clinical situation.

Purpose: The purpose of this study was to understand how the term independence is used in rehabilitation. In particular, we asked occupational therapists in Canada and Japan to interpret the term independence in terms of people with disabilities. In rehabilitation, independence has long been a key concept. A review of the literature shows that the term's meaning has shifted throughout the past century. However, despite its significance, the word's meaning has never been deeply analysed, and it is left to the interpretation of the individual practitioner; consequently, there is a conceptual confusion surrounding the term. Furthermore, no studies have been conducted from an inter-cultural viewpoint that included non-Western societies., Method: A qualitative interpretive study was conducted, based on semi-structured interviews with 18 occupational therapists. Nine Canadian and nine Japanese therapists were interviewed in depth and their perspectives analysed for themes and categories corresponding to their working definition of independence., Results: Therapists' interpretation of the term independence consisted of three perspectives: "Independence as competence,""Independence as autonomy," and "Independence as psychological qualities". These perspectives were typically combined into two patterns of dealing with independence in practice. Differences between Canadian and Japanese perspectives were explored., Conclusions: The study's findings confirm some ideas about independence that have been pointed out in the professional literature, but they also add several important ideas - the idea of psychological characteristics as key to independence, and the notion of a cultural overlay on the definition and application of the concept independence. This study's findings should contribute to the ongoing discussion in the professional literature about the virtues and limitations of pursuing independence as the ultimate goal in rehabilitation.

Background: The Canadian Occupational Performance Measure (COPM) is an outcome measure designed to assess performance and satisfaction with occupation. It was developed to coincide with the occupation-focused, client-centred Canadian Model of Occupational Performance., Purpose: The COPM has been a feature of the occupational therapy landscape for approximately 15 years and has pervaded the consciousness of occupational therapists around the world. In this paper, we examine issues associated with application of the COPM in targeted clinical and non-clinical situations., Results: The paper suggests considerations required to ensure that the highest quality of information is derived from the COPM in all situations., Practice Implications: Although the paper emphasizes the centrality of the client-centred approach, it also demonstrates the flexibility and adaptability of the COPM to different situations, clients, settings and purposes.

Background: There has been an increased focus on home care service provision in recent years, yet there are few data available about the provision of home and community occupational therapy for children and youth., Purpose: To evaluate key elements of a service provision model for home care occupational therapy in terms of occupational performance outcomes, perception of care and cost., Methods: Eleven centres in Ontario and Quebec recruited 167 children and youth up to 18 years of age to a before and after study of occupational therapy services in the home and community. Occupational performance, quality of life and costs were measured at baseline and study end. Perception of care was measured at study completion., Results: A statistically and clinically significant improvement in occupational performance was demonstrated (p < 0.001). The clients' families gave high ratings to the process of care provided by the occupational therapists. These data did not demonstrate a clear relationship between amount of service, cost and occupational performance outcome., Practice Implications: Children receiving home and community occupational therapy services change in their occupational performance abilities. These changes are not directly related to the amount or focus of the occupational therapy services.

Objective: In this paper, I propose a population-level analysis of disability to raise issues of access and equity in terms of use of health services., Method: The study was a cross-sectional analysis of the National Population Health Survey (Statistics Canada, 1998-1999). The sample consisted of 10,898 adults between 20 and 64 years of age., Findings: The study showed that adults with disabilities used significantly more of all types of health professionals and health services than nondisabled adults. Disability was a significant determinant of all types of health service use, representing a two- to threefold increase in risk of seeing health professionals. Although poor health explained a large proportion of variance attributable to use of medical and nursing services, it did not explain the use of other allied health services. The results are interpreted in terms of structural barriers to access to health services. The findings also remind us of the potential role for occupational therapists as advocates within the health care system for persons with disabilities.

Background: It has been 13 years since the Canadian Occupational Performance Measure (COPM) was published. In that time there has been a remarkable growth in its acceptance as an outcome measure within the occupational therapy practice and research., Purpose: The purpose of this paper is to review the emerging research and clinical literature related to the COPM since 1994 and to document its impact upon occupational therapy practice and research throughout the world., Method: A systematic search was conducted to the professional and research literature in English publications (primarily occupational therapy). Eighty-eight papers that met the inclusion criteria were reviewed, 86% of which examined the COPM in relation to its psychometric properties (19 papers), research outcomes (33 papers) or practice (33 papers)., Results: Overall, although there are a few limitations discussed in the review, the conclusion is that the COPM is a valid, reliable, clinically useful and responsive outcome measure acceptable for occupational therapist practitioners and researchers., Practice Implications: The COPM is used with a wide variety of clients, enables client-centred practice, facilitates evidence-based practice and supports outcomes research.

A phenomenological study of seven teenagers with physical disabilities attending a regular secondary school focused on social integration and the factors influencing it. Results showed extrinsic and intrinsic factors that facilitate or limit integration. Occupational therapists can ensure that schools are inclusive and that clients are capable of participating fully. (Contains 50 references and the interview questions.) (JOW)

Discusses the development and psychometric evaluation of the Social Support Inventory for Stroke Survivors, a multidimensional instrument for measuring social support and its influence on the rehabilitation of stroke patients. Examines the test-retest reliability and internal consistency of the instrument and suggests modifications and clinical implications. (SK)

Introduction: COVID-19-related restrictions resulted in changes to time use and occupational participation, impacting individual and collective well-being. This study addressed a knowledge gap concerning the adaptive process during periods of occupational disruption. We explored the experience of occupational disruption and how people managed disruption during the COVID-19 pandemic. Methods: We used a qualitative descriptive approach and interviewed 18 participants of a larger survey study of time use during the COVID-19 pandemic undertaken around a medium-sized city in Canada. Transcript analysis was conducted inductively using conventional content analysis. Findings: Two overarching themes were constructed during data analysis: The Disruption Experience and Adopting New Habits and Routines. In the face of disruption, participants described a sense of loss and disconnection, and challenges with time management. Establishing new habits and routines required new learning associated with increased time and flexibility, connecting with others and health and wellness. Conclusion: During changing pandemic restrictions, participants expressed a sense of loss, disconnection and time management challenges associated with occupational disruptions, but also described ways they adapted, improving their health and well-being. Strategies identified through this work may be used to enhance adaptation during disruptions. Future research should explore differences in adaptation, among more diverse populations. [ABSTRACT FROM AUTHOR]

Objective: To identify best practices and promising practices to enhance participation in meaningful and productive activities.Method: An electronic search of the ABI rehabilitation research literature since 1990 yielded 974 articles of which 30 focused on interventions that targeted participation and evaluated effectiveness using direct measures of participation. Three reviewers rated these articles according to the standards set out by the Centre for Reviews and Dissemination. Following the systematic review, an interpretive review of the same articles was completed.Results: Only three studies were rated as strong. No best practices were identified. Three promising practices found some support. The interpretive review suggested ‘Participate to learn’ as a useful rehabilitation model. The model rests on roles as goals, learning by experience in real-life contexts and the use of personal and environmental support to enable participation.Conclusions: ‘Participate to learn’ is both a credible rehabilitation model and deserving of more study. [ABSTRACT FROM AUTHOR]

Date Presented 4/19/2018 A scoping review of 70 articles explored the contribution of occupational therapists in palliative care. The analysis resulted in five themes and three major findings focusing on promoting valued occupations, intervening from diagnosis to death, and forming a model to guide practice and research. Primary Author and Speaker: Hsin-Hsiu Yeh Additional Authors and Speakers: Mary Ann McColl, Lin-Jye Huang [ABSTRACT FROM AUTHOR]

A scoping review was used to determine how research literature describes mental health issues and needs among children growing up in military families. The 220 studies included identified particular mental health vulnerabilities that are important for occupational therapists to note. [ABSTRACT FROM AUTHOR]