Importance: Depressive and anxiety symptoms across physical disability inpatient rehabilitation (IPR) patient groups are well documented and negatively affect functional recovery. The strategies within the occupational therapy scope of practice to address these symptoms in IPR are unclear. Objective: To determine what interventions within the occupational therapy scope of practice have been used to address depressive and anxiety symptoms in IPR and to determine intervention efficacy. Data Sources: Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus. Findings: Five of 8,082 articles met inclusion criteria. Diagnoses included stroke (n = 1), traumatic brain injury (n = 1), spinal cord injury (n = 1), and musculoskeletal conditions (n = 2). Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy. Conclusions and Relevance: Limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning. What This Article Adds: This systematic review provides an evaluation of the evidence within the occupational therapy scope of practice to address depressive and anxiety symptoms within the physical disability IPR setting. This research can support occupational therapy practitioners to comprehensively address physical and mental health for participation in IPR.

Importance: Women with disabilities face a heightened risk of intimate partner violence (IPV) compared with those without disabilities. The damaging impact of IPV compromises the ability of survivors with disabilities to competently and independently engage in daily occupations. Objective: To examine the impact of occupational deprivation on survivors of IPV who have physical disabilities. Design: The findings presented in this article are part of a larger qualitative study. Semistructured interviews were conducted over the course of 18 mo, primarily focusing on questions related to four areas: abuse experience and risk assessment, use and nonuse of self-protective strategies, necessary support services, and impact of disability in relation to these phenomena. Setting: A nonresidential domestic violence agency serving people with disabilities located in New York City. Participants: Twenty-five women with physical disabilities receiving services from a domestic violence agency that specializes in assisting people with disabilities. Results: The findings reported here focus on educational, vocational, financial, and physical barriers to occupational engagement faced by IPV survivors with disabilities. Conclusion and Relevance: The occupational deprivation experienced by IPV survivors with disabilities can entrap women in abusive relationships, preventing them from independently supporting themselves and their children. Occupational therapy practitioners can provide education and interventions that increase their ability to live independently. What This Article Adds: This article provides a novel consideration of how occupational therapy practitioners can help survivors with disabilities escape IPV through occupational engagement.

OBJECTIVE. To analyze the content of publications in 5 occupational therapy journals to determine the strengths and weaknesses of the literature base from 2006 to 2010. METHOD. A content analysis for 2006 through 2010 of the American Journal of Occupational Therapy (AJOT), Australian Occupational Therapy Journal (AOTJ), British Journal of Occupational Therapy (BJOT), Canadian Journal of Occupational Therapy (CJOT), and Scandinavian Journal of Occupational Therapy (SJOT) was completed. RESULTS. AJOT and SJOT had the highest percentage of articles focusing on physical disabilities, whereas a majority of articles in AOTJ, BJOT, and CJOT focused on education. SJOT published articles with the highest median number of participants in all research designs excluding descriptive studies. The majority of the research articles were descriptive for all journals. CONCLUSION. From 2006 to 2010, AJOT provided stronger evidence conducted at higher levels than the other journals by publishing more articles investigating interventions used to support clinical practice.

We examined household task participation patterns of 46 children and youth with and without physical disability (PD) and explored the effects of age on roles of and expectations for these children in household task participation. Children with PD did not differ significantly from those without PD in the number of household tasks they performed; however, they did require more assistance than those without PD. In both groups, younger children performed significantly fewer household tasks and required significantly more help than older children. These findings further support the discriminant validity of the Children Helping Out: Responsibilities, Expectations, and Supports ( Dunn, 2004 ) measure of household task participation and its use with adolescents. Assessing such participation would help caregivers and practitioners more successfully prepare children and youths with PD for independent living. Considering the roles and opportunities for social participation inherent in many household tasks will contribute to the usefulness of examining such participation.

OBJECTIVE. We investigated the factors that facilitate or hinder school participation of students with physical disabilities and explored the interaction of those factors. METHOD. The study used a mixed-methods design that used qualitative and quantitative data. Qualitative data were gathered on 49 participants: 14 students, 17 parents, and 18 teachers. Data analysis was based on grounded-theory procedures. Quantitative data were gathered on 32 students using the School Function Assessment. RESULTS. The characteristics of each school setting influenced students’ participation. Some settings presented more challenges than others, particularly those with open spaces and limited structures such as the school playground and field trips. Possibilities of student participation decreased with increasing numbers of risk factors, but the interaction between factors was equally important. CONCLUSION. To promote school participation of students with disabilities, occupational therapists should consider a confluence of child, environmental, and task factors rather than focusing on individual aspects.

One method to determine trends in occupational therapy research is to survey the literature published in occupational therapy journals. This study describes the types and topics of articles published in five prominent occupational therapy journals over a 5-year span. Feature articles published between 2001 and 2005 were analyzed to determine the types of articles and research and subject areas. The percentage of research articles published between 2001 and 2005 increased from 65% to 78% of all articles published and is higher than previous reports. More than 70% of the research articles used designs that substantially contribute to the evidence base for occupational therapy (defined by Kielhofner, Hammel, Finlayson, Helfrich, & Taylor [2004] as correlational–comparison, experimental, qualitative, and meta-analysis). Of the research articles, 60% addressed pediatric, physical disability, and rehabilitation topics. The 5-year period showed a trend of increasing frequency of geriatric and pediatric topics in research reports. Scholars should emphasize research designs that build the evidence for occupational therapy approaches and practices and focus on research topics of highest value to society.

OBJECTIVE. With physical disabilities, persons often experience secondary pain that adds to restrictions in activity and participation. We investigated pain-management strategies used by those with physical disabilities. METHOD. Qualitative phenomenological inquiry was used in multiple interviews with (N = 28) adults with physical disabilities (9 with amputation, 7 with cerebral palsy, and 12 with spinal cord injury) and subsequent thematic analysis. RESULTS. Among those with physical disabilities, a distinction is made between usual and unexpected pains. Usual pain is experienced consistently or as a consequence of not getting adequate rest, exercise, or stress-free time. Managing usual pain involves uses of prevention (e.g., exercise/fitness) and/or pragmatic actions through scheduling and pacing daily activities and taking interim retreats. Unexpected pain is experienced periodically and requires an immediate response and change of activity. To manage, persons describe making efforts to create a mind and body disassociation, activating safety nets to support function and alleviate pain, and making decisions to persevere with activity and participation. CONCLUSION. Advising those with physical disabilities to do proactive planning for both usual and unexpected pain may help them to use varied pain-management strategies to enhance function and minimize negative impacts on participation.

The purpose of this phenomenological study was to explore the experiences of occupational adaptation among a small number of older Dutch persons with physical disabilities. Occupational adaptation was tentatively defined as overcoming disabling influences on occupational functioning. Eight occupational therapy clients, who were living in the community, were interviewed using an open in-depth interview format. A phenomenological analysis resulted in descriptions of occupational adaptation as a process that required these clients’ active engagement. The clients recruited already familiar problem-solving strategies and personal resources as well as resources in their social and physical environments to identify prospects of potential solutions and to create solutions to overcome constraints on occupational functioning. Furthermore, participants strived for finding satisfaction through occupations, a meaning theme which emerged as the object of occupational adaptation. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations.

Although occupational therapists emphasize a balance among the three occupational areas of self-care, productivity, and leisure in people’s lives, leisure often is focused on less than the other areas in both the research literature and clinical practice. Very little research has been conducted on the benefits of leisure activities in adults with congenital disabilities. The information contained in this article is a secondary analysis of the interview protocols of nine adults (30–50 years of age) with either cerebral palsy or spina bifida. The primary purpose of the interview was to determine protective processes surrounding turning points in the lives of persons with disabilities. This secondary analysis allowed us to determine the benefits and meaning of leisure for this population. Consistent with literature that focused on either persons without disabilities or persons with acquired disabilities, the participants in the present study reported that involvement in leisure activity provides mental and physical health benefits, enjoyment, opportunity to develop a self-concept and increase self-esteem, and opportunities to build and enhance social relationships. All these benefits enable people to find meaning in life through doing, belonging, and understanding self in the context of their worlds.

OBJECTIVE. The purpose of this study was to investigate the characteristics of the school social environment experienced by children with physical disabilities and the social interactional characteristics of children with physical disabilities in the school environment. The goal was to understand the interactive processes that support or inhibit these children’s social interactions. METHOD. Naturalistic observation and participant interviews were used to collect data on social interaction patterns of three children with physical disabilities 5 to 8 years of age who were enrolled in age-appropriate regular education classrooms. Descriptive codes were obtained through constant comparative analysis. RESULTS. Four themes were identified that characterized aspects of the social environment affecting the social interactions of children with disabilities: reciprocity, characteristics of social and play interactions, effects of adult involvement, and quality of occupational engagement. CONCLUSION. The study supports the need for occupational therapists to focus intervention on multiple aspects of the social environment to facilitate children’s socialization.

Objective. This study examined the occupations of mothering very young children with physical disabilities. Method. Two single, urban, Black mothers in their mid-20s were interviewed with a semistructured protocol. The audiotaped, transcribed data were analyzed with a phenomenological method. Results. The context of the challenging urban environment was a constant influence that shaped the participants’ occupations of mothering. The major overarching theme derived from the data was that mothering was “what I got to do” in relation to their particular child. Two subthemes were identified: (a) mothering as caring and (b) the impact of social supports on the occupations of mothering. Conclusion. To plan meaningful, effective interventions, occupational therapy practitioners need to understand the context in which mothering occupations occur and to ensure that mothers’ caring occupations and social support needs are addressed in the therapeutic partnership.

Objective. This study described occupational therapy practitioners’ perceptions about the content and method of training or education necessary for gaining theoretical and technical competence in the use of nine physical agent modalities (PAMs). Method. A survey was developed and sent to 543 members of the Physical Disabilities Special Interest Section of the American Occupational Therapy Association who had identified their primary area of practice as hand therapy. One hundred and fifty-one completed surveys (28% response rate) were returned. Results. The respondents indicated that theoretical and technical expertise necessary for competent use of PAMs varied according to the type of modality being considered Continuing education courses were identified as the best method for gaining theoretical and technical competence for the use of deep thermal agents, such as ultrasound and electrical stimulation agents, whereas entry-level professional education and on-the-job training were identified as most appropriate for superficial thermal agents, such as paraffin bath and hot and cold packs. Conclusion. The results suggest that considerations regarding the type and amount of education necessary for gaining theoretical and technical competence in the use of PAMs depend on the type of modality being addressed. These differences should be considered in the future development of competency objectives for the use of PAMs.

Objective. The use of physical agent modalities is not considered an entry-level skill and requires postprofessional education, according to the American Occupational Therapy Association. The purpose of this survey was to determine how occupational therapy practitioners who use physical agent modalities are trained. Method. Two hundred fifty occupational therapists were randomly selected from the American Occupational Therapy Association’s Physical Disabilities Special Interest Section. The practitioners were surveyed about their use of, education in, competency testing for, and opinions on eight physical agent modalities. Result. Results were based on 100 responses (40% response rate). Of the eight modalities, the most commonly used were hot and cold packs, and the least were transcutaneous electrical nerve stimulators. The most common means of education was on-the-job training, and the least common was higher level accredited education. A majority (71) of respondents reported that no competency testing was being performed at their facilities. In the remaining facilities (29), the majority performed competency tests with no routine frequency, using no particular guidelines for testing and no formal methods for maintaining standards for physical agent modality use. Eighty-five respondents indicated they would be interested in attending continuing education programs on the use of physical agent modalities, and 88 believed that functional activities should follow the use of physical agent modalities within the same treatment session. Conclusion. The occupational therapy profession may need specific educational and competency guidelines to assure the qualifications of therapists using physical agent modalities.

Objectives. Motivation is an important factor in and predictor of a person’s recovery from illness, yet no information exists about how occupational therapists actually evaluate patient motivation in clinical practice. This article describes a pilot study of how occupational therapists in physical disabilities settings evaluate patient motivation. Method. A sample of 150 fieldwork coordinators in physical disabilities treatment centers were surveyed about whether they evaluate patient motivation and about the methods they used to evaluate patient motivation. Results. Most respondents reported that they evaluate motivation informally and throughout treatment. Respondents evaluate motivation mostly via general discussion, observation of patient conduct and actions, and information from others. Less than one third discussed interests and goals with patients to evaluate motivation. Despite questionable methods of evaluation of motivation, a majority of respondents reported that their evaluation influences their treatment approaches and improves treatment outcomes. Conclusion. Instruction about the definition and evaluation of motivation may increase the frequency of motivation evaluation in occupational therapy.

Objectives. Recent studies have suggested that occupational therapists working with adults with physical disabilities do not use narrative reasoning in practice as much as they use procedural reasoning. This focus on procedural reasoning may be partially shaped by the occupational therapy educational process. The purpose of this analysis was to see whether one accredited occupational therapy curriculum was promoting narrative reasoning relative to its information on adult orthopedics. Method. An accredited occupational therapy undergraduate and certificate curriculum was analyzed from both student and faculty perspectives to see what types of clinical reasoning were most emphasized relative to treatment of adults with orthopedic injuries. The student analysis, done by a senior as part of an independent study, looked at the clinical reasoning content of journal articles, an occupational therapy textbook, and occupational therapy lectures relative to adult orthopedic injuries. The faculty analysis, part of a curriculum revision process and independent of the student analysis, looked at the clinical reasoning content of all courses in the curriculum. Results. The student and faculty analyses concurred that although narrative reasoning is taught in this curriculum, narrative reasoning concepts are not well integrated into the adult physical dysfunction course that deals with adult orthopedic injuries. Conclusion. Occupational therapy educators may not be integrating narrative reasoning into more procedurally oriented physical dysfunction courses as fully as possible and may, therefore, be fostering procedurally oriented practice in physical dysfunction settings. Curricula evaluations, like the one described in this article, can be a mechanism for examining the types of clinical reasoning emphasized in a given curriculum for a given diagnostic group.

Objectives. This study compares the occupational role profile of a large sample of community-living persons without disabilities with the profile of a population of patients with psychosocial or physical disabilities and suggests areas of occupational therapy intervention. Methods. The Role Checklist was used to compare the roles of 1,020 community-living persons without disabilities with the roles of 292 adults with physical or psychosocial disabilities. Specifically, community-living persons were matched to the entire patient group, a group of patients with psychosocial dysfunction, and a group of patients with physical dysfunction to compare the groups in terms of their past, present, and future role profiles and the value they assigned to those roles. Results. There were significant differences in the types of roles identified. In general, the patients identified involvement in fewer present roles than the community-living persons. Differences between the two groups also appeared in the identification of future roles and value of those roles. Conclusions. Roles appear to be affected by disability, whether physical or psychosocial in nature. If role participation is seen as part of the occupational functioning of the person, occupational therapy needs to address this area.

Objectives. A prediction model of performance in physical disabilities fieldwork was generated with grades received in the occupational therapy curriculum and in prerequisite courses. Method. Grades included those from functional anatomy, neuroanatomy, physical disabilities lecture, physical disabilities clinic, and prerequisite anatomy and physiology courses. Sampling was done collectively over graduated occupational therapy classes from 1987 to 1992 at the University of Puget Sound. A multiple regression analysis was performed and prediction equations were generated far each subscale of the Fieldwork Evaluation for the Occupational Therapist. Equations for combinations of the subscale categories were also produced. Results. Adjusted R² values were found to be less than 10% in all equations. Conclusion. This poor ability of grades to predict fieldwork performance suggests that future investigation be focused on variables other than grades. Such variables might include student motivation, rapport between the student and fieldwork supervisor, and hospital experience in physical disabilities.