The present study has an explorative design with its starting point in Törnebohm´s theory of paradigms. The aim of this study was to identify and describe how newly enrolled occupational therapy students perceived their future profession, especially regarding world view and field of action view. Written data were collected using essay questions. Data analysis/synthesis were accomplished qualitatively. Three themes were identified in the material: Notions of some concepts fundamental to occupational therapy; Notions of the “setting” of occupational therapy reality and Notions of the operational reality of occupational therapy. With their limited personal experience of occupational therapy, the students´ conceptions reflected interested outsiders´ views on the topic, influenced by information available in society and the questions given. They were shown to possess relevant and varied information about occupational therapy, but had difficulties in designating the different phenomena.

The present study has an explorative, comparative design with its starting point in Törnebohm´s theory of paradigms. The aim of the study was to identify and describe how qualified OT students perceived their future profession, especially regarding world view and field of action view, and to compare their conceptions with those of newly enrolled OT students in order to find out the differences and similarities between the two aggregations of paradigms. Data were collected in writing, using essay questions. Data analysis/synthesis was accomplished qualitatively. The comparision between the two groups was carried out through the structure of three themes with appurtenant categories. The qualified occupational therapist students´ notions gave expression to a constant application of a holistic health perspective which in contrast to those of the newly enrolled occupational therapist students resulted in numerous examples of interrelations between themes belonging to different paradigm components. In line with Törnebohm (1987) this is characteristic for paradigms.

This study describes the transformation of 15 occupational therapist students’ paradigms into occupational therapists’ paradigms according to Törnebohm’s theory of paradigms, over a period of six years. This research particularly considers the paradigm components world view and field of action view in Törnbohm’s sense. Qualitative data were collected using essay-questions on three occasions: first week, and last semester, at the Occupational Therapy Programme at the School of Health Sciences, Jönköping, Sweden, and after three years of occupational therapy practice. A content-analysis of the collected materials was performed and the transformation of the informants’ views could be characterized as comprising three different perspectives: a ‘public’ view in 1995, a ‘theoretical’ view in 1998 and an ‘experiential/contextual’ view in 2001.

Background/aim: Determination of fitness-to-drive after illness or injury is a complex process typically requiring a comprehensive driving assessment, including off-road and on-road assessment components. The competency standards for occupational therapy driver assessors (Victoria, Australia) define the requirements for performance of a comprehensive driving assessment, and we are currently revising these. Assessment of cognitive and perceptual skills forms an important part of the off-road assessment. The aim of this systematic review of systematic reviews (known as an overview) is to identify what evidence exists for including assessment of cognitive and perceptual skills within fitness-to-drive evaluations to inform revision of the competency standards.

Methods: Five electronic databases (MEDLINE, CINAHL, PsycINFO, The Cochrane Library, OT Seeker) were systematically searched. Systematic review articles were appraised by two authors for eligibility. Methodological quality was independently assessed using the AMSTAR tool. Narrative analysis was conducted to summarise the content of eligible reviews.

Results: A total of 1228 results were retrieved. Fourteen reviews met the inclusion criteria. Reviews indicated that the components of cognition and perception most frequently identified as being predictive of fitness-to-drive were executive function (n = 13), processing speed (n = 12), visuospatial skills, attention, memory and mental flexibility (n = 11). Components less indicative were perception, concentration (n = 10), praxis (n = 9), language (n = 7) and neglect (n = 6).

Conclusion: This overview of systematic reviews supports the inclusion of assessment of a range of cognitive and perceptual skills as key elements in a comprehensive driver assessment and therefore should be included in the revised competency standards for occupational therapy driver assessors. 

Introduction: Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice.

Methods: A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors.

Results: Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants’ views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%.

Conclusion: The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

INTRODUCTION: The importance of holidays, traditions, and family celebrations to human culture and occupational engagement has been neglected. The aim of this study was to explore how older adults experienced holidays and celebrations with social and physical distancing during the COVID-19 pandemic.

METHODS: A secondary analysis was made on data from the At-Risk Study. Seventeen community-living adults (11 women and 6 men) aged 71-87 years, from Sweden participated. They were interviewed remotely four times during the first year of the pandemic. Data were analysed with qualitative content analysis. No consumer/community involvement occurred.

FINDINGS: Three categories on how the participants hoped for, planned, decided, adapted, avoided, and experienced holidays and celebrations with social and physical distancing included expectations and preparations in unpredictable times; the constant need for re-evaluation; and almost everything turned out differently.

CONCLUSIONS: The desire to celebrate despite pandemic restrictions shows the importance and meaning holidays hold for older adults. Celebrations can be disrupted for many reasons, not only as extreme as the ongoing pandemic. For wellbeing in later life health care, social care, and society need to understand the inherent components and acknowledge ways of supporting participation in occasional events such as holidays, traditions, and family celebrations.

Background/aim: Previous research has shown that children with spina bifida use clean intermittent catheterisation for urination, a rather complex procedure that increases the time taken to completion. However, no studies have analysed the factors impacting on the time taken to complete the urination that could inform occupational therapy practice. Therefore, the aim was to identify the variables that predict extended time children with spina bifida take to complete urination.

Methods: Fifty children, aged 5–18 years old with spina bifida using clean intermittent catheterisation, were observed while toileting and responding to a set of assessments tools, among them the Canadian Occupational Performance Measure. A logistic regression was used to identify which variables were independently associated with an extended toileting time.

Results: Children with spina bifida do take long time to urinate. More than half of this study's participants required more than five minutes completing urination, but not all required extended times. Ambulant, independent girls were more likely to perform toileting in less than six minutes compared with other children with spina bifida. However, age, IQ, maintained focus on the task, Canadian Occupational Performance Measure, time processing abilities and self-reported ratings of independence appeared to be of no relevance, to predict extended toileting times.

Conclusion: To minimise occupational disruption caused by extended toileting times, occupational therapists should utilise the relevant predictors: gender, independence and ambulation when they prioritise children for relevant interventions.

Background/aim: The Tree Theme Method^® is an intervention based on creative activities and occupational storytelling. The Tree Theme Method^® implies that the clients draw and paint trees symbolising various periods in their life. The pictures are then used as a starting point to tell their life story to enhance their wellbeing and management of their everyday life. This study aimed to evaluate if changes observed among clients regarding their wellbeing and everyday occupations, between baseline and the end of their term of the Tree Theme Method^® therapy, persisted three years after the completion of the intervention.

Methods: This study had a quantitative design. Thirty-one former clients were recruited to a follow-up three years after completing the intervention. Self-rating questionnaires were used regarding psychological symptoms, self-mastery, sense of coherence, activity level, occupational performance and satisfaction with occupational performance. Non-parametric methods were used for the data analysis.

Results: The findings revealed positive significant changes regarding sense of coherence and occupational performance and satisfaction with occupational performance, measured between the end of the intervention and at the time of the three-year follow-up. Furthermore, the respondents' ratings regarding psychological symptoms, self-mastery, activity level and the extent of satisfaction with performed occupations were found to be stable.

Conclusions: The Tree Theme Method^® appeared to function well as an intervention in psychosocial occupational therapy, where the aim was that a client would enhance their wellbeing and management of their everyday life. However, there is need for further evaluation to assess the effects of the Tree Theme Method^® intervention.

INTRODUCTION: Depression and anxiety disorders affect individuals' everyday lives, and treatments that can help them to perform everyday occupations are needed. Occupational therapy for this group has been evaluated from a short-term perspective but not from a long-term perspective; further research is thus warranted. The aim of the study was to investigate the longitudinal outcomes of the Tree Theme Method (TTM) compared with care as usual, provided by occupational therapists, in terms of everyday occupations, psychological symptoms, and health-related aspects.

METHODS: This randomised controlled trial comprised a follow-up 3 and 12 months after an intervention. A total of 118 participants (19-64 years) with depression or anxiety disorders and problems with everyday occupations completed the base line questionnaires, 100 completed the follow-up at 3 months, and 84 completed the follow-up at 12 months. Imputations of missing data were performed using the last observation, and parametric analysis was used.

RESULTS: Both groups showed significant improvements (P value ≤ 0.01) in everyday occupations, psychological symptoms and health-related aspects after 3 and 12 months. No significant differences were found between the groups.

CONCLUSION: This study contributes with knowledge about the outcomes of occupational therapy for clients living with depression and anxiety disorders. Both TTM and care as usual lead to significant improvements over time concerning everyday occupations, psychological symptoms, and health-related aspects. The fact that both occupational therapy methods were associated with improvements for clients with depression and anxiety supports client-centredness in enabling an occupational therapist to choose the method best suited for the individual.

Background: Many adolescents with autism face difficulties with the transition from high school into post-school activities. The Better OutcOmes & Successful Transitions for Autism (BOOST-A™) is an online transition planning program which supports adolescents on the autism spectrum to prepare for leaving school. This study describes the development of the BOOST-A™ and aimed to determine the feasibility and viability of the program.

Methods: Two pilot studies were conducted. In Pilot A, the BOOST-A™ was trialled by six adolescents on the autism spectrum, their parents, and the professionals who worked with them, to determine its feasibility. In Pilot B, 88 allied health professionals (occupational therapists, speech pathologists, and psychologists) reviewed the BOOST-A™ to determine its viability.

Results: Participants rated the BOOST-A™ as a feasible tool for transition planning. The majority of allied health professionals agreed that it was a viable program. Based on participant feedback, the BOOST-A™ was modified to improve usability and feasibility.

Conclusion: The BOOST-A™ is a viable and feasible program that has the potential to assist adolescents with autism in preparing for transitioning out of high school. Future research will determine the effectiveness of the BOOST-A™ with adolescents across Australia. 

Background/aim: Occupational therapists play a key role in addressing the social difficulties of children with ASD. However, interventions are often time intensive, without outcomes generalising beyond the clinic setting. To examine the feasibility and preliminary effectiveness of an intervention to address the social play skills of children with ASD.

Methods: Participants in this multiple case study design were five children with autism spectrum disorder (ASD), five typically developing playmates and five parents of children with ASD. Two therapists and parents delivered the intervention involving clinic play sessions and home modules. Parents' treatment adherence was recorded. The Test of Playfulness was scored by a blinded rater to examine child outcomes following the intervention. Line graphs were used to examine case data. Percentage of non-overlapping data (PND) was used to calculate the single-case effect size for each child.

Results: Parents completed 92.2% of the intervention. Children's case data showed an upwards trend from pre- to post-intervention in four of the five pairs (child with ASD and playmate). However, there was a decrease in scores from post-intervention to the two-month home follow-up for all but one pair. PND indicated the intervention was effective for two children with ASD and three of their playmates, had a questionable effect on three children with ASD and no observable effect on two playmates.

Conclusion: The intervention demonstrated preliminary feasibility and effectiveness for improving the social play skills of some children with ASD. Careful consideration is needed to identify which children with ASD and which playmates would be best suited for this intervention approach. 

BACKGROUND/AIM:

More knowledge is needed about the role of perceived control in the associations between different perceptions of daily occupations and positive health outcomes. The aim was to explore the associations between different subjective perceptions of daily occupations, in terms of occupational balance, occupational meaning, occupational value and satisfaction with occupations, and life satisfaction, and the role of perceived control in those associations.

METHODS:

A questionnaire including questions about perceptions of daily occupations, perceived control and life satisfaction were answered by a random sample of 488 middle-aged Swedish women. Multiple logistic regression analysis was used to test the associations between perceptions of daily occupations and life satisfaction, and the role of perceived control.

RESULTS:

After adjustments for perceived control women who perceived a high level of satisfaction with work and leisure, occupational balance, occupational meaning and occupational value perceived greater life satisfaction than the other women. Perceived control was not significant in the model.

CONCLUSIONS:

It seems that occupational balance and occupational meaning were pivotal for the women's life satisfaction, but satisfaction with work and leisure, as well as perceived occupational value, was also of importance. The assumption that perceived control would have a role in the association between perceptions of occupations and life satisfaction was not confirmed.

SIGNIFICANCE OF THE STUDY:

The results indicate that occupational therapists need to focus on occupational balance, occupational meaning, occupational value and satisfaction with work and leisure to promote positive health outcomes, in terms of life satisfaction, when working with middle-aged female clients.

Background/aim

Difficulties with management of time are frequently observed in children and youth with intellectual disabilities (IDs). The aim of this study was to evaluate a new intervention programme ‘My Time’ to improve time‐processing ability (TPA) in children with IDs aged 10–17 years (n = 61).

Methods

Cluster randomised and waiting‐list control group design was used. Data collection included the Kit for assessment of TPA, the Time‐Parent scale and a self‐rating of autonomy to assess occupational performance in daily life. The method was implemented over an 8‐week period. Effect size (ES) was calculated and an analysis of covariance on the individual level and a two‐stage process on the cluster level.

Results

The estimated mean improvement in the KaTid‐Child score from baseline (t1) to t2 was significantly higher in the intervention group compared to the waiting‐list group, ES Cohen's d = 0.64.

Conclusion

The results present first evidence of the effectiveness of a new occupational therapy intervention programme (‘My Time’) to facilitate TPA in children with mild to moderate IDs. Children with IDs aged 10–17 years could improve their TPA at a measurable pace when given intervention. The method could complement interventions using time‐assistive devices. Children with IDs should be identified to guide intervention. Further research is necessary to establish whether using the intervention programme can facilitate the development of TPA in younger children.

Background/aim: Women and men are shaped over the courses of their lives by culture, society and human interaction according to the gender system. Cultural influences on individuals’ social roles and environment are described in occupational therapy literature, but not specifically from a gender perspective. The purpose of this qualitative study was to explore how a sample of occupational therapists perceives the ‘gender’ concept.

Method: Four focus group interviews with 17 occupational therapists were conducted. The opening question was: ‘How do you reflect on the encounter with a client depending on whether it is a man or a woman?’ The transcribed interviews were analysed and two main themes emerged: ‘the concept of gender is tacit in occupational therapy’ and ‘client encounters’.

Results: The occupational therapists expressed limited theoretical knowledge of ‘gender’. Furthermore, the occupational therapists seemed to be ‘doing gender’ in their encounters with the clients. For example, in their assessment of the client, they focussed their questions on different spheres: with female clients, on the household and family; with male clients, on their paid work.

Conclusions: This study demonstrated that occupational therapists were unaware of the possibility that they were ‘doing gender’ in their encounters with clients. There is a need to increase occupational therapists’ awareness of their own behaviour of ‘doing gender’. Furthermore, there is a need to investigate whether gendered perceptions will shorten or lengthen a rehabilitation period and affect the chosen interventions, and in the end, the outcome for the clients.

Background/aim: Families of children with autism spectrum disorder (ASD) use family routines to provide predictability and structure to support occupational engagement of their family members. Mothers assume the major role to orchestrate occupations in constructing family routines, which may impact their health and wellbeing. However, the experiences of mothers in managing family routines and their health and wellbeing have not been the main focus in previous research. Thus, this study explored the experiences of mothers of children with ASD in managing family routines and their perceptions of the impact of family routines on their health and wellbeing.

Methods: An interpretive phenomenological approach was used. Twenty mothers of children with ASD, aged between 28 and 56 years, participated in semi-structured interviews. Data were transcribed verbatim and each transcript was analysed.

Results: Five themes that summarise mothers’ perceptions towards health and wellbeing when managing family routines emerged: (i) Keeping on track keeping healthy; (ii) My life is busy, because I do everything for everyone else; (iii) Keeping on track all the time is tiring or frustrating; (iv) Looking after my family by looking after myself; and (v) I am not perfect and it is OK.

Conclusion: This study highlighted the substantial efforts required in constructing family routines that may be at the cost of mothers’ health and wellbeing. However, mothers may be able to cope with everyday demands in managing family routines by changing their perspectives. By integrating ‘me-time’ activities in family routines, mothers may be able to support their own health and wellbeing. Mothers’ values and needs are reflected in family routines; hence, thorough understanding of family routines may be a key to support mothers’ occupational engagement. 

Introduction: Participating in family gatherings can provide enjoyment and quality time together as a family. However, being the primary carers, mothers of children with autism spectrum disorder may experience this phenomenon differently. The purpose of this study is to explore how available literature describes mothers' experiences of participation in family gatherings and social events with their children with autism spectrum disorder.

Methods: A scoping review was used to explore available literature and identify studies describing mothers' experiences of family gatherings and social events with their children. A thematic synthesis was performed to analyse and synthesise the findings.

Results: A total of 8 articles were included for review. The analysis of the included studies resulted in one central theme-Negative experiences despite strategies-and four analytical themes: Feeling fear, stress, and anxiety; Avoiding family gatherings; Enjoying less and becoming less confident; and Using strategies.

Conclusion: These findings indicate that mothers of children with autism spectrum disorder experience difficulties during gatherings even when using strategies, hence limiting their participation.

Background/aim: Life roles are integral to occupational therapy practice. Goal setting is a method of establishing priorities to measure outcomes. While acquired brain injury can impact a person's ability to fulfil meaningful life roles, the alignment of goals set in rehabilitation to life roles, is unclear. This study aimed to (i) explore the alignment of goals with life roles for people with an acquired brain injury participating in inpatient rehabilitation; and (ii) identify barriers and enablers to life role discussions within a patient-directed goal setting framework.

Method: A mixed-methods study was conducted on an inpatient rehabilitation unit in Victoria, Australia. Quantitative data were obtained from a retrospective file audit of randomly selected medical records. Qualitative data were collected through: a) interviews with patients and their families; and b) A focus group with occupational therapists. Thematic analysis of both audit data and narrative data was undertaken.

Results: Thirty files were examined and demonstrated 33% alignment between goals and life roles. Four interviews were completed with patients, with a family member participating in two of these. Themes identified were: readiness, role concept, recovery concept and goal review. Five therapists attended the focus group. Themes identified were: Patient factors, goal review, expectations, role change and environment. Interview and focus group data identified that barriers to life role discussions included: lack of patient and family readiness, patients’ difficulty understanding role concept, focus on impairments and lack of family/ significant others support. Enablers included: having early conversations involving family, regular goal review and use of standardised tools.

Conclusion: Goal setting in alignment with life roles is important in acquired brain injury rehabilitation, but may be limited. This process can be enhanced by including patients and their significant others in early goal setting conversations, along with regular goal review across the rehabilitation process. 

BACKGROUND/AIM: A vast majority of the journeys made by children with disabilities in Sweden are in the family car, which usually is bought and adapted for the child with governmental subsidies. Despite the important philosophical views about accessible vehicles, little is known about the impact of vehicle adaptations on families' lives. The aim of the study was to investigate parent views about the impact of vehicle grants and vehicle adaptation grants on their children's transport mobility and community access.

METHODS: In total, 434 parents of children with disabilities in Sweden who had received vehicle grants and/or vehicle adaptation grants between 1998-2007 responded to a questionnaire comprising questions with both pre-selected and open-ended answers. A non-responder analysis was performed.

RESULTS: Children with disabilities were found to increase their transport mobility and community access in society as vehicle grants and/or vehicle adaptation grants were given to their parents. Their travel patterns and their travel priorities with their family car indicated that family friends and relatives and leisure activities were frequently visited and prioritised destinations. The grants were linked to access to social and family activities, provided environmental gains and led to increased experienced security. The results also showed that the potential to make spontaneous trips had increased substantially and that families experienced feelings of freedom and enhanced community access. The non-responder analysis confirmed these results.

CONCLUSIONS: According to parents, vehicle grants and vehicle adaptation grants for children with disabilities have a positive impact on the children's transport mobility and community access.

Introduction:

The prescription of powered mobility devices for clients is an important role for occupational therapists. However, the skill of may powered mobility device users to drive their devices remains unknown and clients are provided with only brief education on their use. Few assessments exist to guide mobility device use assessment, and none of these incorporate the training clients need. The aim of this paper was to investigate the inter-rater reliability of a new assessment and training tool called the Powered Mobility Device Assessment Training Tool (PoMoDATT).

Method:

The PoMoDATT comprises an initial interview and then Part A- cognitive skills, Part B physical and psychosocial skills and Part C driving skills and behaviours. The assessment outcome is a profile of the client's physical, cognitive and psychosocial skills related to powered mobility device use. The driving assessments of 24 powered mobility device users were video-recorded, and four experienced occupational therapists scored the clients on the 26 items of Part C of the PoMoDATT.

Results:

Following clarification of three items which included re-scoring and data re-analysis, the inter-rater reliability for the PoMoDATT Part C items ranged from ICC (2, 1) 0.641 to 0.938 suggesting moderate to excellent agreement.

Conclusions:

The PoMoDATT Part C has demonstrated adequate inter-rater reliability to support its use by occupational therapists to assess powered mobility device user's capacities and abilities and to highlight ongoing training needs.

Introduction: Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity. Methods: Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness- to-drive as the outcome. Results: Twenty-one physical, 13 sensory and seven assessments of cognition / perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy -Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations. Conclusion: This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy -Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the offroad driving capacity of clients.