Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Peer support specialists (PSS) are persons with lived experience of mental illness who have transitioned from service consumer to provider. This transition can bring occupational challenges (competence) and role confusion (identity) that affect occupational adaptation. The aim of this study was to identify the occupational needs of PSS and explore how OT practitioners can support this transition and further develop OT’s distinct value in the mental health settings to which PSS are integral. Primary Author and Speaker: Carol Lambdin-Pattavina Additional Authors and Speakers: Alexandra Burdo, Christina McLaughlin, Ashley Spain, Julianna Guilmartin, Mihaela Ghita, and Lauren Goudreau

Date Presented 04/22/21 The Occupational Adaptation Practice Guide (OAPG) is an instrument used to operationalize the theory of occupational adaptation and promote client-centered care. This study assessed the usability and reliability of the OAPG in an inpatient rehabilitation setting. The results indicate a high percentage of agreement for the person and environment sections of the instrument. All respondents agreed that the OAPG promotes client-centered care, but results regarding its efficiency were mixed . Primary Author and Speaker: Jackie Green Additional Authors and Speakers: Ashley Marks, Jamison Hogan, Brett Campbell, and Dustin Cox

Importance: Fibromyalgia (FM) is a chronic pain disorder that interferes with daily activities. Because occupational adaptation varies among people, there is a need to determine which factors can influence adaptation to FM in order to better intervene with them. Objective: To understand the occupational adaptation process of people living with FM. Data Sources: A systematic review of the literature was conducted in the AMED, CINAHL, MEDLINE, OTseeker, OTDBASE, and PsycINFO databases. Articles dated before September 2020 were searched using a strategy with the keywords fibromyalgia and occupation. Study Selection and Data Collection: This article follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Qualitative articles were included if they documented occupational aspects of participants with FM. Two independent reviewers screened the articles and performed the quality assessment using the Critical Appraisal Skills Program checklist. A thematic synthesis was conducted. Findings: Of the 560 articles identified, 347 remained after duplicates were removed. After screening titles and abstracts, 303 articles were rejected, and 44 articles were read in their entirety. Twelve qualitative articles were included in the review. The synthesis highlights that support from relatives is a key to successfully adapting to FM. Identity is crucial to a fulfilled life, and occupational competence is greatly affected by the experience of FM. Occupational adaptation is an issue for some people, but maintaining routines and integrating management strategies would help them to achieve it. Conclusions and Relevance: This review highlights the importance of considering the components of occupational adaptation while caring for people with FM. What This Article Adds: This systematic review identifies the factors influencing the occupational adaptation of people living with FM and emphasizes the importance of addressing those factors.

The investment of time and self to develop therapeutic relationships with clients appears incongruent with today’s time-constrained health care system, yet bridging the gap of these incongruencies is the challenge therapists face to provide high-quality, client-centered, occupation-based treatment. This case report illustrates a shift in approach from biomechanical to occupational adaptation (OA) in an orthopedic outpatient clinic. The progress of a client with lupus-related arthritis who was 6 days postsurgery is documented. The intervention initially used a biomechanical frame of reference, but when little progress had been made at 10 weeks after surgery, a shift was made to the more client-centered OA approach. The Canadian Occupational Performance Measure was administered, and an OA approach was initiated. On reassessment, clinically important improvements were documented in all functional tasks addressed. An OA approach provides the bridge between the application of clinical expertise, client-centered, occupation-based therapy and the time constraints placed by payer sources.

Objective. This study compared the effectiveness of the Occupational Adaptation frame of reference with the bio mechanical–rehabilitation model in the treatment of two groups of 20 patients post–hip fracture. Method. Using a quasi-experimental design, groups were compared on changes in scores on the Functional Independence Measure (FIM™), a satisfaction questionnaire developed for this study, and discharge environment. Results. No group differences in FIM changes for the total stay were found. However, average FIM score change per day of hospitalization and overall patient satisfaction were higher in the Occupational Adaptation group. No significant differences in the discharge environment were present. Conclusion. Both groups benefited from occupational therapy intervention. Occupational Adaptation was associated with a more efficient outcome and greater patient satisfaction.

Objective. The purpose of this study was to examine the use of the Occupational Adaptation frame of reference in the evaluation and treatment of patients with cerebrovascular accident (CVA). Method. Outcomes of functional independence and discharge environment were measured through a quasi-experimental design. Twenty-five former patients served as the control subjects, and 25 patients admitted after the programmatic implementation of Occupational Adaptation served as the treatment subjects. Results. Data analyses indicated that the Occupational Adaptation subjects achieved higher levels of functional independence and were discharged to less restrictive environments compared with the control subjects. Conclusion. Use of intervention guided by the Occupational Adaptation frame of reference was associated with improved functional independence and discharge to less-restricted environments for this group of patients with CVA.

Objective. Effects of a 6-day snow skiing trip on 14 adolescents with limb deficiencies were explored. The purpose was to determine whether components of mastery and self-esteem could be identified. Method. Participant observation data collection methods included videotape, interviews, daily progress notes by ski instructors, and a 1-month posttrip questionnaire. Data were analyzed for evidence of efficiency, effectiveness, and satisfaction to self and others (properties of relative mastery described in occupational adaptation.) Skier reports of positive effects were analyzed for indications of an impact on self-esteem. Three occupational therapists who have extensive experience working with adolescents also reviewed videotapes and written information. Results. The therapists acknowledged the presence of skill mastery as an important component of skiers’ positive self-evaluation. They also commented that evidence of preexisting self-esteem and social aspects of the trip were as likely to produce positive effects as mastery of skiing. Conclusion. Research method considerations (use of participant observation for hypothesis testing) preclude definitive interpretation of a link between skill mastery and self-esteem. Short-term positive effects of the skiing experience reported by questionnaire were present 1 month after the trip. Long-term effects should be studied.

Objective. The purpose of this study was to test the validity of a model of professional development that was based on occupational adaptation. This model proposes that students have three classes of adaptive response behaviors available for use: primitive, transitional, and mature. Method. Eight Level II fieldwork students were assigned to the Department of Veterans Affairs Medical Center, Dallas, Texas, for 12 weeks. Experienced fieldwork supervisors at the medical center developed a taxonomy of behavioral statements consistent with the developmental model’s three classes of adaptive response behaviors. This taxonomy was converted to a student log in which supervisors rated the frequency with which the Level II fieldwork students exhibited these behaviors. Results. The patterns of behaviors, which were represented graphically for each of the students, generally supported the predictions of the model. Students demonstrated all three classes of behaviors. Primitive and transitional behaviors emerged when the students experienced increased or unusual demands, even when the students’ modal behaviors was mature. Students temporarily reverted to lower level behaviors when faced with situations that they perceived as too difficult or as too unfamiliar. Conclusion. This model of professional development facilitates an understanding of students’ development during their transition from classroom to practice setting. Generalization to other settings will require validation of the student log.