Date Presented 04/04/19 This study demonstrates the effectiveness of a novel, client-centered OT intervention, named PREP, for improving the participation of youth with disabilities. By removing environmental barriers, OTs enabled 28 youth to successfully take part in the activities they identified, such as shopping with friends, riding a bike, and joining a glee club. These findings support a shift toward community-based ecological practices that occur in real-life situations. Primary Author and Speaker: Dana Anaby Additional Authors and Speakers: Rachel Teplicky, Laura Turner Contributing Authors: Mary Law, Lisa Avery, Annette Majnemer, Debbie Feldman

Many articles have been written on the barriers to and facilitators of the use of evidence in practice in nursing and medicine, but to date no extensive review has been published of the literature on evidence-based practice (EBP) supports in occupational therapy. This article presents the results of a scoping review that examined factors that support the integration of research into practice. A review of 69 articles revealed four themes: (1) attitudes toward, perceptions of, confidence in, and use of research and EBP; (2) factors that support the use of research in practice; (3) effects of interventions targeting changes in knowledge, attitudes, skills, behaviors, and evidence-based practices; and (4) identification of the processes involved in the acquisition of EBP skills and their application in clinical practice. A process that integrates client-centered practice, structured reflection, case application, and peer consultations within a scholarship of practice model facilitates occupational therapists’ evaluation and integration of research evidence.

OBJECTIVE. The Health Promoting Activities Scale (HPAS) measures the frequency with which mothers participate in self-selected leisure activities that promote health and well-being. We undertook an initial evaluation of the scale with mothers of school-age children with developmental disabilities (N = 152). METHOD. We used a mixed methodology in the instrument design: a qualitative study to generate items and a quantitative study to evaluate the instrument. Our statistical analysis assessed the internal consistency, factor structure, and construct validity of the HPAS. RESULTS. The HPAS showed good internal consistency (Cronbach’s α = .78). Construct validity was supported by moderate correlations with subjective maternal mental and general health (Short Form 36, Version 2) and by differentiation in leisure participation among groups of mothers reporting differences in mental health status. CONCLUSION. Initial evaluation of the HPAS indicates that this brief tool is psychometrically sound. The HPAS allows professionals to evaluate clients’ participation in leisure occupations that promote health and well-being. Further development of the HPAS is warranted.

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.

OBJECTIVE. This study investigated the effects of cerebral palsy (CP) and gender on youth participation in activities outside of formal school. METHOD. Twenty-two participants with CP and 30 typically developing peers, ages 12–16 years, completed the Children's Assessment of Participation and Enjoyment (CAPE; King et al., 2004). RESULTS. Typically developing youths engaged in a broader range of activities and did so more frequently than did youths with CP. Similar levels of enjoyment in activity were found in both groups. In some scales of the CAPE, youths with CP participated in proportionally more activities alone and at home. Gender differences and Group ×Gender interaction were found in some scales with respect to participation in and enjoyment of activities. CONCLUSIONS. Physical limitations associated with CP may affect the frequency of a child's participation in activity outside of school. However, youths with CP may express levels of enjoyment similar to those of typically developing peers while participating in activity.

OBJECTIVE. This study compared the participation in activities outside of formal school among Jewish and Druze Israeli children. It also examined the impact of gender and the interaction of culture and gender on participation. METHODS. Participants included 30 Jewish and 30 Druze children ages 8–10 years, who completed the Children’s Assessment of Participation and Enjoyment (CAPE). RESULTS. On most of the scales measured, the Jewish children showed a significantly higher participation level than the Druze children, and the Druze children performed more activities alone. The Jewish children demonstrated a higher enjoyment level than the Druze children on half of the scales. Some scales revealed higher participation by girls than by boys as well as a significant cultural group by gender interaction. CONCLUSION. Culture may have an impact on children’s level of participation in the community. The CAPE was found to be a sensitive tool in elucidating differences between the Druze and Jewish children in community participation.

This study sought to determine the extent to which the Canadian Occupational Performance Measure (COPM) assessed performance in elderly people after hip fracture. Correlations were found between the COPM and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Although functional improvement was noted, participants did not attain the functional status they had before hip fracture. The greatest recovery occurred within the first 130 days after surgery. These findings suggest some central implications for occupational therapy practice, although further research is required to determine the optimal time for intervention to begin. Because the COPM is sensitive to change in function in patients recovering from hip fracture, COPM use with this population is desirable and advisable.

The Perceived Efficacy and Goal Setting System (PEGS) is an instrument and a process that enables children with disabilities to reflect on their ability to perform everyday occupations and to identify goals for occupational therapy intervention. In this study, 117 children with disabilities in grades 1–3 completed the PEGS with occupational therapists who work in school settings. Children from 6–9 years of age with a variety of disabilities were able to self-report perceptions of their effectiveness performing 24 activities that would be expected of them each day. Parents and teachers, who completed a parallel questionnaire, rated their abilities lower than the children did. The School Function Assessment, a measure of the amount and type of support required for school participation, had low correlations with the Parent and Teacher PEGS questionnaires and did not correlate with the Child PEGS. No differences in perceived efficacy were found for children across grades or gender; however, differences were found across types of disabilities. Children were able to use the perceived efficacy information to identify and prioritize goals for intervention and these goals remained stable 2 weeks later. Occupational therapists can use the PEGS within a client-centered practice to help the child set goals for therapy and to incorporate explicitly the perspectives of parents and teachers.

Participation or involvement in everyday occupations is vital for all humans. As described by the World Health Organization, participation has a positive influence on health and well-being. The presence of disability has been found to lead to participation that is less diverse, is located more in the home, involves fewer social relationships, and includes less active recreation. Occupational therapy is in a unique position to contribute to the development and fulfillment of participation for persons with and without disabilities. This article describes the nature and outcomes of participation. Characteristics to define and measure meaningful participation are outlined. Information about time use will help to develop an understanding of patterns of participation across locations, gender, culture, and the life span. Factors that affect participation within the environment, family, and persons are summarized. Occupational therapy research is needed to examine the complex relationship among person, environment, and participation in occupations. In practice and education, knowledge about participation can enhance the client-centered and evidence-based nature of occupational therapy services.

Changes in the health system require occupational therapy practitioners to focus their concerns on the long-term health needs of people and to help them develop healthy behaviors not only to improve their health, but also to minimize the health care costs associated with dysfunction. Occupational therapy practitioners must initiate efforts in the community to integrate a range of services that promote, protect, and improve the health of the public. This article shares the experiences of Canadian occupational therapy practitioners, who were challenged by their government nearly 15 years ago to establish a system that demonstrates effectiveness by improving the health of occupational therapy clients. By focusing on occupational performance, occupational therapy practitioners assist clients in becoming actively engaged in their life activities. This requires client-centered and family-centered practice and services that span from the agency or institution to the community. Occupational therapy practitioners must work collaboratively with persons in the client’s environment (e.g., family members, teachers, independent living specialists, employers, neighbors, friends) to assist the client in obtaining skills and to make modifications to remove barriers that create a social disadvantage. A focus on occupational performance requires occupational therapy personnel to reframe how we think about occupational therapy to a sociomedical context and to take an active role in building healthy communities.