https://www.archives-pmr.org/article/S0003-9993(05)01272-4/pdf

Participation survey/mobility: psychometric properties of a measure of participation for people with mobility impairments and limitations.

Study Design: Non-experimental lex post facto) survey research design involving the use of a fixed alternative format questionnaire. Objectives: To investigate variables influencing vocational outcome, to identify barriers to gaining and sustaining employment and to identify the effects of variables on the type of work engaged in following spinal cord injury. The two sets of independent variables considered were, individual and injury-related factors (age at onset of injury, time since injury, extent/ level of injury, highest educational qualification achieved pre-injury, and pie-injury occupation) and circumstantial factors (means of transport, access difficulties, perceived workplace discrimination, financial disincentives to work and perceived level of skill). Setting: The Princess Alexandra Hospital Spinal Injuries Unit, Queensland, Australia. Methods: Data on the variables and the vocational outcomes of having ever worked or studied post-injury, current employment status and post-injury occupation were obtained from survey responses. Demographical and medical data were gathered from medical records. Results: Forward stepwise logistic regression revealed that having ever worked or studied post-injury was associated with all individual and injury-related factors except pre-injury occupation, and two circumstantial factors, namely means of transport and access difficulties, Current employment was associated with all circumstantial factors as well as age at injury and pre-injury occupation. Standard multiple regression analyses revealed that post-injury occupation was correlated with all individual and injury-related factors as well as means of transport and perceived workplace discrimination. Conclusions: Tailored rehabilitation programs for individuals with characteristics associated with less successful vocational outcomes may facilitate their employment status after injury.

/pdf/vocational-outcome-following-spinal-cord-injury-1twnsv26to.pdf

Vocational outcome following spinal cord injury.

In the Netherlands, Dutch health care professionals, including occupational therapists, are confronted with a growing number of patients whose cultural backgrounds differ from theirs. Acknowledging this influx, the Dutch government allocated a grant for educating occupational therapy students on cross-cultural care. This paper summarizes the information we collected from a survey of Dutch occupational therapists on treatment of immigrants and briefly describes the eight educational tools we developed for the two occupational therapy curricula. Two of these tools are described fully--first, a critical essay on the white middle-class values and norms that underlie occupational therapy theory and practice, and second, the guidelines for developmental policies to use in the treatment of immigrant patients. Case studies illustrate how the values of our profession create obstacles to cross-cultural care.

Cross-cultural occupational therapy: a critical reflection.

Research articles cross-indexed in Index Medicus under the subject headings "quality of life" (QOL) and "spinal cord injury" (SCI) were examined in order to compare their relative merits in terms of research design, sampling techniques and the type of QOL criteria included. Of 3,710 citations indexed for the ten year period 1983 through 1992 under "quality of life," thirty-two research articles (< 1 percent) were cross-indexed with the subject heading "spinal cord injury." The modal design was a descriptive survey or case study (n = 23 or 72 percent). None of them were randomized clinical trials. Because of limited rigor of research design and poor validity of measurements, conclusions about the ability of rehabilitative care to improve the QOL for SCI persons could not be drawn from the studies reviewed. Meta-analysis indicated that severity of injury is associated with QOL, with more severe injury being correlated with poorer quality. The critique concludes that QOL research with SCI persons needs to be better designed and should include more uniform and valid criteria.

Quality of Life After Spinal Cord Injury: A Literature Critique and Meta-analysis (1983–1992)

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a "critical incident" interview approach with 12 Australian occupational therapists, we identified the therapists' explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call "the safety clause." That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

Independence as a practice issue in occupational therapy: the safety clause.

During the late 1960s and early 1970s, a new concept related to rehabilitation and improvements in quality of life began to emerge and be expressed by people with spinal cord injuries and other disabilities. This concept, independent living, is the foundation of the independent living movement, which has helped to overcome the barriers to a higher quality of life for disabled people. Of the many organizations and programs set up to provide support for disabled people living in the community, the independent living program seems to be comparatively successful at facilitating independence by people with spinal cord injuries. Independent living programs provide the kind of community-based support services necessary to expand the range of living options for disabled people beyond those traditionally available in most communities. The role of occupational therapists in the independent living stage of the rehabilitation process can be similar in some respects to their role during earlier phases of medical rehabilitation. However, the definition of independence as a "mind process" leads to considerable expansion of the therapist's role beyond the focus on physical skills, which are usually key priorities during medical rehabilitation. Occupational therapists typically possess knowledge and skills that equip them well for assisting clients in the independent living stage of the rehabilitation process.

Jean A. Cole

Papers

Independence: the ultimate goal of rehabilitation for spinal cord-injured persons.