OBJECTIVE. Junior tenure-track faculty report high levels of stress and low satisfaction; the increasingly competitive funding environment compounds this discontent. We examined factors associated with junior investigators who were thinking about quitting research. METHOD. Data were collected as part of a program evaluation of an interdisciplinary research mentoring program in an academic medical center. RESULTS. Of the 62 mentees, 44 responded to the survey (71%). When asked “In the past year, have you considered quitting research?” 39 mentees answered the question; 17 (44%) answered in the affirmative. Those who had considered quitting had lower scores on the Clinical Research Appraisal Inventory–12 (CRAI–12) and job satisfaction and higher scores on burnout. In a regression model, we found that only CRAI–12 scores were significantly, inversely associated with thinking about quitting. CONCLUSION. Factors associated with thinking about quitting included lower confidence in research skills, reduced job satisfaction, and higher levels of burnout.

OBJECTIVE. This study applied Rasch analysis to test four versions of the Clinical Assessment of Modes (CAM), an assessment based on Taylor’s Intentional Relationship Model: CAM–P, which assesses clients’ pretreatment preferences; CAM–E, clients’ treatment experience; CAM–T, therapists’ self-reported perspective; and CAM–O, an observer rating scale. METHOD. The CAM–P was administered to 63 inpatients. The CAM–E was administered to 110 inpatients and outpatients. Trained raters rated therapists’ modes with 59 inpatients and outpatients on the CAM–O. The CAM–T was administered to 38 therapists. Analyses of reliability and validity were conducted. RESULTS. The CAM demonstrated adequate construct validity. All versions showed acceptable internal consistency and unidimensionality within each of the subscales. Disorder between the 5 points on the ordinal rating scale was found for the client measures (CAM–P, CAM–E) and was resolved by modifying the ratings to encompass a 4-point scale. CONCLUSION. The four CAM versions are reliable and valid measures of therapeutic communication in rehabilitation.

OBJECTIVE. This study evaluated the reliability, minimal detectable change (MDC), and construct validity of the Evidence-Based Practice Confidence (EPIC) scale among occupational therapists. METHOD. In a cross-sectional mail survey, 126 occupational therapists completed the EPIC scale and a questionnaire to provide data for validity testing. Seventy-nine occupational therapists (63%) completed a second EPIC scale a median of 24 days later. RESULTS. Test–retest reliability was .92 (95% confidence interval [.88, .95]). The MDC values at the 90% and 95% confidence levels were 3.9 percentage points and 4.6 percentage points, respectively. The total EPIC score was significantly associated with holding a master’s or doctoral degree; education in evidence-based practice (EBP); higher EBP knowledge and skill; and frequently searching, reading, and using research findings in clinical decision making (p < .05). CONCLUSION. The EPIC scale has excellent reliability and acceptable construct validity for use in evaluating EBP self-efficacy among occupational therapists.

OBJECTIVE. We present a novel, knowledge-driven approach to prescription of pointing devices that uses the Ontology-Supported Computerized Assistive Technology Recommender (OSCAR), a clinical decision support system (CDSS). METHOD. Fifty-five occupational therapists were divided into four groups: two assistive technology (AT) expert groups and two novice groups. Novice Group 1 used the OSCAR CDSS for the prescription process, and Novice Group 2 used the conventional method. OSCAR’s effectiveness and its impact on users were evaluated. RESULTS. The ability of Novice Group 1 to make suitable pointing device prescriptions was similar to that of the two expert groups and was significantly better than that of Novice Group 2. The system positively affected Novice Group 1’s learning of the prescription process. CONCLUSION. The structure and organized framework for clinical reasoning of the OSCAR CDSS appear to enable occupational therapy practitioners inexperienced in AT to achieve performance levels comparable to those of experts.

OBJECTIVE. We sought to describe occupational therapy practitioners’ perceived levels of preparedness for and involvement in school-based Response to Intervention (RtI) initiatives. METHOD. We mailed a survey to a random sample of 1,000 practitioners from the American Occupational Therapy Association’s Early Intervention and School Systems Special Interest Section. RESULTS. Of 295 returned surveys (29.9% response rate), 19 were excluded because of missing or incomplete data. Three-quarters of respondents (77.6%) reported that their districts implemented RtI. Two-thirds of respondents (66.3%) indicated that lack of resources limited their involvement in RtI; two-thirds (67%) said that district guidelines that describe expectations for practitioners’ involvement would help increase their participation. Many respondents cited the need for continuing education and supported moving from a caseload to a workload model. CONCLUSION. Occupational therapy practitioners would benefit from specific district guidelines outlining the services they are able to provide within the context of RtI.

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.

OBJECTIVE. We examined the development, implementation, and effectiveness of a theory-based workshop to facilitate knowledge translation for occupational therapists addressing upper-limb poststroke sensory impairments. METHOD. Nineteen therapists participated in a quasi-experimental pretest–posttest study that included an 8-hr evidence-based workshop designed using the Theory of Planned Behavior. We measured changes in knowledge, attitudes, and perceived behavioral control and intended behaviors regarding sensory impairment management, research utilization, and shared decision making. RESULTS. We noted significant changes in knowledge, attitudes, and perceived behavioral control and intended behaviors about sensory impairment management, research utilization, and shared decision making and made recommendations for changes in recruitment strategies, outcome measures, and workshop content. CONCLUSION. A theory-based workshop can potentially affect knowledge, attitudes, and intended behaviors about sensory impairment management, research utilization, and shared decision making. A randomized controlled trial evaluating this intervention is warranted and will potentially improve understanding of methods to facilitate knowledge translation.

This article represents the efforts of an interdisciplinary work group, the Dementia Measures Work Group (DWG), composed of representatives of diverse national organizations who convened specifically to define optimal standards of dementia care for individual practitioners as well as multidisciplinary teams. The DWG measurement set includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care prior to the advanced stages of illness, and provides evidence-based support for its recommendations and guidance on the selection of instruments for tracking patient-centered outcomes. In addition, it specifies annual reassessment and updating of interventions and care plans for dementia-related problems that affect families and other caregivers as well as patients.

OBJECTIVE. Attention to executive functioning (EF) and its effect on occupational performance is increasing in the occupational therapy literature. This study explored occupational therapists’ perceptions of how EF is recognized and addressed within occupational therapy for children and youth. METHOD. Inductive qualitative content analysis was used to analyze the in-depth interview data from 13 occupational therapists with a range of practice contexts and experience. RESULTS. EF should be explicitly considered during clinical reasoning. System and professional barriers create challenges to occupational therapists, constraining their ability to recognize, label, and address EF performance issues. Occupational therapists who have integrated EF into their practice perspective have acquired knowledge and skills through interprofessional collaborations, client interactions, and professional development opportunities. CONCLUSION. Occupational therapists working with children and youth need an occupational EF framework and practice resources if they are to integrate an EF lens to more broadly enable occupational performance.

OBJECTIVE. To test the effectiveness of an educational intervention aimed at improving mental health knowledge and skills in occupational therapists working with older rehabilitation patients. METHOD. The DVD-format educational intervention was evaluated using a two-group randomized wait-list control design. Occupational therapists (n = 75) completed a 32-item knowledge questionnaire at three time points. Patient charts were reviewed (n = 960) at 3 months before and 3 and 6 months after DVD training to evaluate clinical practice change. RESULTS. A two-way analysis of variance showed knowledge scores increased significantly for both groups after DVD training. A significant Group × Time interaction and significant main effects for time and group were found. Chart review data also showed significant increases in desired clinical behaviors in both groups after training. The greatest single item of clinical practice change was use of a standardized depression screen. CONCLUSION. DVD-based training can significantly improve mental health practice.

OBJECTIVE. We sought to identify and describe the number, topics, and publishing trends of systematic reviews relevant to occupational therapy indexed in the OTseeker database. METHOD. We performed a cross-sectional survey of the systematic reviews contained in OTseeker in December 2011. RESULTS. Of the 1,940 systematic reviews indexed in OTseeker, only 53 (2.7%) were published in occupational therapy journals. The most common diagnostic categories were stroke (n = 195, 10.1%) and affective disorders (n = 204, 10.5%). The most common intervention categories were consumer education (n = 644, 33.2%) and psychosocial techniques (n = 571, 29.4%). Only 390 (20.1%) of the 1,940 systematic reviews specifically involved occupational therapy. CONCLUSION. Occupational therapists need to search broadly to locate relevant systematic reviews or, alternatively, to use databases such as OTseeker. Clarity about the involvement of occupational therapy in reports of future research will improve the ability to identify occupational therapy research for all stakeholders. Finally, occupational therapy practitioners need to read systematic reviews critically to determine whether review conclusions are justified.

Historical inquiry enriches occupational therapy practice by identifying enduring values and inspiring future excellence. This study presents for the first time the pioneering life and work of Philip King Brown, a San Francisco physician who used occupation to treat the physical, mental, and social effects of tuberculosis (TB) at Arequipa Sanatorium, the institution he founded in 1911. Through textual analysis of the Arequipa Sanatorium Records, this article evaluates and defends Brown’s assertion that his institution was medically and socially experimental. The Arequipa Sanatorium promoted occupational therapy by demonstrating its viability in the treatment of TB, the era’s most critical health threat. It also put into practice the ideals of holism, humanism, and occupational justice that resonate within the profession today. Finally, Arequipa provided an example of how an occupation program can change the public perception of disability.

OBJECTIVE. Clinical reasoning studies have acknowledged tacit aspects of practice, and recent research suggests that clinical reasoning contains intuition informed by tacit knowledge. Intuition also appears to be influenced by awareness and understanding of emotions. This study investigated the relationship between intuition and emotional intelligence among occupational therapists in mental health practice. METHOD. We mailed a survey containing measures of cognitive style and of use of emotional competencies at work and demographic questions to 400 members of the national occupational therapy association; 134 occupational therapists responded. RESULTS. A moderate relationship was found between intuitive cognitive style and emotional intelligence. Experienced therapists scored higher on the use of emotional competencies at work and reported a preference for an intuitive cognitive style to a greater extent than novices. CONCLUSION. This study represents the first attempt to explore occupational therapists’ preferred cognitive style and self-reported emotional intelligence. Findings suggest that exploring emotions through reflective practice could enhance intuitive aspects of clinical reasoning.

This qualitative research study examined the experiences of practitioners who developed and implemented driving rehabilitation programs within the past 5 yr. Researchers interviewed 4 occupational therapists with 10–19 yr of experience, who identified the following facilitators of and barriers to driving program implementation: funding and equipment, institutional support, interdisciplinary conflict, role expectations, professional development, and staffing. Results support prior quantitative research identifying barriers to developing and sustaining driving and community mobility programs. Findings also suggest that program success is dependent on much more than clinical expertise. Results provide occupational therapists with a foundation of expectations when developing new programs to assist them with anticipating and counteracting barriers to success.

OBJECTIVE. To begin to address the shortage of driving rehabilitation and community mobility programs to meet the community mobility needs of older adults and clients with rehabilitative needs, we sought to identify the key barriers to developing and sustaining such programs. METHOD. We used a survey design to solicit input from a nationally representative sample of occupational therapy practitioners, rehabilitation managers, and health care administrators. RESULTS. The 2,869 completed surveys revealed widespread and largely contextual barriers related to fiscal support, infrastructure, physical environment, and institutional culture. The barriers were highly correlated with each other and did not differ across regions, practitioner experience levels, or facility types. CONCLUSION. This study was an important preliminary step in constructing a resource toolkit with strategies to overcome the identified barriers to developing and sustaining driving and community mobility programs that meet the needs of older adults and clients with rehabilitative needs. This toolkit, which is available on the American Occupational Therapy Association’s Web site, is a necessary resource for use in all practice settings to meet the driving and community mobility needs of this population in support of engagement in community-based occupations.

The history of articles in the American Journal of Occupational Therapy and its predecessors reflects trends and changes in professional terminology and the thoughts underlying that terminology. In this study, we investigate use of occupation, activity, and related terms across 9 decades of occupational therapy literature from the 1920s to the 2000s. The literature for 3 years of each of the 9 decades was scanned electronically. A random numbers table was used to equalize the number of words across decades, and a computer search function was used to determine each term’s frequency of use for each decade. Results indicated that the term occupation was widely used in the 1920s but then declined until the 1980s. With a rapid increase in use in the 2000s, the term occupation actually appeared more often than it did in the 1920s. The term activity appeared infrequently in the 1920s but gained popularity from the 1930s to the 1960s. From the 1970s to the 1990s, the use of both terms was quite low. This study shows that basic occupational therapy terminology has fluctuated dramatically over time. Given the essential link between terminology and theory, these changes arguably reflect authors’ and editors’ changing viewpoints on the profession’s fundamental nature.

In the campaign to implement evidence-based practice, the current single-hierarchy model of levels of evidence fails to incorporate at parity all types of research evidence that are valuable in the practice of occupational therapy. A new model, originally developed by Borgetto et al. (2007) and modified and expanded, is presented. By separating the evidence-level criteria of internal and external validity, by incorporating explicitly the evidence provided by qualitative studies, and by retaining the critical notion of rigor, a pyramidal evidence model emerges. This model, the Research Pyramid, aligns itself with the revised model of evidence-based medicine and, more important, with the basic modes of clinical reasoning in occupational therapy. It constitutes a beginning attempt to order evidence-based practice in accordance with the epistemology of the profession. It may better guide occupational therapy research and meta-synthesis and their incorporation into practice decisions.

We describe the development and evaluation of a clinical research training program designed specifically for such health professionals as occupational and physical therapists. Outcomes of program success included trainees’ self-rating of research skills before and after the program, as well as submission of a formal grant application to a grant competition for program participants. At program completion, participants reported improvements in their research skills, with the most gain in formulating research questions and writing a testable hypothesis and the least gain in understanding statistics. Of the 21 participants, 43% submitted a grant proposal to a competitive intramural grant program. In the next year, grantees of the program will continue to be mentored by the program mentors while conducting their research projects. Given the initial successes, this program represents a promising model for providing research training to practicing clinicians.

Occupational therapy practitioners may encounter challenges when they try to incorporate evidence into practice. To embrace evidence-based practice (EBP), clinicians must have readily available, relevant, and concisely summarized evidence. Although researchers have described the importance and process of EBP, less has been written about how to efficiently integrate evidence into practice. Clinicians may benefit from examples of reasoning, strategies, and resources to successfully integrate evidence. This article reviews the steps of EBP and offers recommendations to overcome common barriers. For EBP to become integrated into practice, greater communication and collaboration among all stakeholders must occur. EBP and knowledge translation require multiple processes and coordinated efforts. Therefore, everyone from practitioners to employers has a role in increasing EBP and transferring knowledge for practice. To encourage discussion and actions, the article provides implications and recommendations for practitioners, researchers, educators, organizations, and policymakers.

The purpose of this study was to gather formative evaluation data to determine students’ perceptions of effective aspects of professional behavior feedback for use in program development. A qualitative design was used to gather data from baccalaureate-level occupational therapy students. Through focus groups and semi-structured interviews, data were gathered about the students’ beliefs, feelings, and recommendations for policy changes. Four themes emerged: Not Just “Contact With a Piece of Paper”; Fieldwork Needs To Be Taken Into Account; Faculty Fairness and Support Need To Be Present; “This Is Like Therapy for Me.” Aspects of these themes have implications for classroom and fieldwork settings. The type of feedback these students found helpful and the desire to have fieldwork performance considered along with their classroom behavior were salient perceptions. As educators, it is important to listen to the voices of students to gain insights into their perceptions of the effective aspects of the feedback process for professional behaviors.