Showing papers in "Otjr-occupation Participation and Health in 2004"

Activity Participation and Well-Being of People with Dementia in Long-Term—Care Settings:

Abstract: This study examines the activities engaged in by nursing home residents with dementia and their states of well-being. Dementia Care Mapping was used to record the activities engaged in by, and the well-being of, 43 participants during a 6-hour period. The average age of the group was 81 years and length of stay at the nursing home was 27 months. Fourteen percent of participants had received a Clinical Dementia Rating (CDR) score of 1 (mild level of cognitive impairment), 35% had a CDR score of 2 (moderate impairment), and 51% had a CDR score of 3 (severe impairment). Results indicated that the three CDR groups engaged differently in activities. The CDR1 group participated significantly more in therapeutic/leisure activities and activities of daily living than did the CDR2 group (p < .001 and p < .05) and CDR3 group (p < .001). Conversely, the CDR3 group engaged in significantly more passive activities than did the CDR1 group (p < .001), and had fewer social interactions and displayed more negative behavio...

Removing Environmental Barriers in the Homes of Older Adults with Disabilities Improves Occupational Performance

Abstract: The current study examines the effectiveness of an occupational therapy home modification intervention program by examining differences in self-reported occupational performance before and after in...

Mothers of Children with Disabilities: Occupational Concerns and Solutions:

Abstract: Mothers of children with disabilities have identified multiple challenges associated with achieving occupational balance in their lives. Occupational therapists are just beginning to explore the occupational and time use strategies that mothers use to successfully care for their children and get through the day in a positive manner. The Person—Environment—Occupation model was used to guide an occupational therapy intervention program called “Project Bien Estar,” which was designed to increase the satisfaction, time use, and occupational performance of mothers of school-aged children with disabilities. This article focuses on the rich content of the group discussions and individual reflections, providing insight into the world of women caring for children with disabilities. Thematic analysis was used to identify person, environment, and occupation factors that contribute positively and negatively to the mothers' well-being, and the effects of the occupational therapy intervention are discussed.

The Nature of Occupation Surrounding Dying and Death

Abstract: This article presents the findings from a study intended to help occupational therapists better understand the meaning of occupation surrounding dying and death at a small residential hospice in th...

The Effect of Training Older Adults with Stroke to Use Home-Based Assistive Devices:

Abstract: This study evaluated whether an additional home training program on bathing devices would improve the rate of use, personal independence, and service satisfaction of older adults who had experienced strokes. A prospective pretest and posttest randomized control trial design was adopted. Fifty-three older adults who had experienced strokes were randomly assigned to either the intervention group or the control group. The prescription of and training in the use of devices was conducted with both groups while they were in the hospital. The intervention group received additional home-based intervention in the use of devices immediately after discharge, but the control group did not. All of the subjects were assessed before discharge and 3 months after discharge using the Functional Independence Measure and the Quebec User Evaluation of Satisfaction with Assistive Technology. The results showed that the intervention group improved significantly in functioning (t = 3.89; df = 51; P = .01) and satisfaction (t = 6...

Frail Older Adults' Self-Report of Their Most Important Assistive Device:

Abstract: The increasing number of older individuals, especially those in the oldest-old age group, has resulted in a significant increase in the number of people with disabilities. Assistive technology offe...

Daily Occupations with or without Pain: Dilemmas in Occupational Performance:

Abstract: This explorative study examined the influence of chronic lower back pain on the motives for occupational performance. A narrative interview was conducted with seven Dutch clients. Three phases in the process of living with lower back pain were identified in which the self, the pain, and the environment were seen as interrelated elements that influence the creation of motives. In the first phase, clients wanted to meet social and personal expectations, which led to their ignoring the lower back pain. In the second phase, the pain took control and the clients withdrew from social participation, which led to “emotional pain.” In the third phase, clients became more conscious of the dynamics and dilemmas between the self, the pain, and the environment. Analysis of study results suggests that clients' narratives can help occupational therapists gain a deeper understanding of clients' experiences of dealing with chronic pain.

Content Validity of the Relative Mastery Measurement Scale: A Measure of Occupational Adaptation:

Abstract: This research addressed the need for a clinically practical and psychometrically sound measure of a central construct of Occupational Adaptation theory. As an indicator of Occupational Adaptation, the Relative Mastery Measurement Scale (RMMS) was developed and evaluated for content and construct validity. The RMMS assesses individuals' perceptions of their effectiveness, efficiency, and satisfaction regarding their responses to occupational challenges. In the first phase, the content validity of the RMMS was statistically evaluated using the ratings of five experts in Occupational Adaptation. Lu's Coefficient of Agreement among the experts for the final 12-item RMMS was an acceptable .95. In phase two, construct validity and reliability were examined using a combination of Rasch analysis and traditional measurement statistics. Participants were 150 rehabilitation clients. Reliability and validity was supported through the unidimensionality of 11 of 12 RMMS items by the ordering of item difficulty, goodness-of-fit statistics, factor analysis, and point-biserial correlations.

Everyday Problem Solving among Four Groups of Individuals with Cognitive Impairments: Examination of the Discriminant Validity of the Observed Tasks of Daily Living—Revised

Abstract: To examine the discriminant validity of the Observed Tasks of Daily Living—Revised (OTDL-R) assessment test, performance was compared across four groups of participants (N = 140) expected to have different problem-solving skills and everyday competencies (community-dwelling older adults, older adults living in nursing homes or assisted living facilities, individuals with schizophrenia, and individuals with brain injuries). Analysis of variance with covariates (age and education) was used to examine differences in total OTDL-R scores across the four groups. OTDL-R performance was significantly better for community-dwelling older adults and significantly worse for participants with schizophrenia than for all other groups. No statistically significant differences were found for older adults living in nursing homes or assisted living facilities or participants with brain injuries after controlling for age and education. The OTDL-R was found to be a sensitive performance-based assessment tool of potential impo...

Revisiting Culture in Occupational Therapy: A Meaningful Endeavor

Abstract: Occupational therapy's epistemology, theory, and practice during the past century have been intimately tied to matters of discourse and praxis in the medical sciences. Within such a universal paradigm, occupational therapists could share concerns with their medical colleagues, reducing health and constructions of well-being into terms of pathology and the consequences of impaired bodily function. Since the latter half of the 20th century, occupational therapists appear to be making an intentional move back toward matters of occupation, the core concept of occupational therapy. This return to occupation presents a formidable challenge to our profession because it inevitably brings with it a profound cultural dimension that compels us to go beyond medically defined problems of the individual. The renaissance of occupation (Whiteford, Townsend, & Hocking, 2000) has elicited a dramatic shift in orientation toward meaning and a compelling interest in understanding the relationship between what people participate in and their experiences of health and well-being. Occupation encompasses issues of existential meaning and social, cultural, and even spiritual dimensions of human experience in the context of our environs. If the enterprise of occupational therapy, which subsumes practice and production and dissemination of knowledge, now requires understanding of meaning in human agency and must resonate with broader concerns of our clients, the issue of culture should draw greater attention. In this editorial, the issue of culture and its crucial importance in the scientific discourse that continues to emerge and carry substantial explanatory power in the field of occupational therapy is contemplated. Culture remains among the more difficult concepts to definitively pin down. In our professional literature, culture often seems to represent an afterthought or a factor detached from the main concerns of our enquiries into human phenomena and performance. There is much awareness of the need to be culturally sensitive in both research and practice as a mitigating or limiting factor in the study of occupation, but there is a dearth of reflection on how culture is embedded in the very concepts and principles of occupational therapy itself, including its research endeavors. Relatively few studies critically regard the profession of occupational therapy and its core concept of occupation as cultural constructions. Perhaps because most of us have never experienced life outside of the familiar Western social contexts that generated these significant ideas in the first place, their peculiar cultural features are taken for granted as normal and therefore remain largely invisible. By taking a closer look, we can better appreciate the cultural nature of our profession. Occupational therapy possesses a shared specialized language, tacit rules of conduct in performing its activities, established social practices that follow a recognizable pattern that helps to distinguish its members from other professionals, and certain institutional conditions of knowledge production that help to reify its discourse. Researchers and occupational therapists alike can be observed along organized systems that abide in such shared spheres of social experience. Unless we acknowledge and understand the cultural boundaries of occupational therapy, we may never confidently know whether our profession is meaningful and useful to the world we serve. Many non-Westerners encountering the idea of occupation and occupational therapy for the first time find these constructs difficult to comprehend. A deeper analysis of the particular and often disparate understanding of these constructs reveals worldviews that may differ significantly between cultures. It would appear that the current popular construction of the meaning of occupation is supported by a modal Western worldview that sees the world as orderly, as if everything was held together by some REVISITING CULTURE IN OCCUPATIONAL THERAPY: A MEANINGFUL ENDEAVOR The guest editorial for this issue has been written by Dr. Michael Iwama, occupational scientist, sociologist, and occupational therapist. He is Associate Professor at the School of Occupational Therapy at Dalhousie University in Halifax, Nova Scotia, Canada. Dr. Iwama’s life experience and education has led him to the area of international comparative sociology and his passion for his profession has led him to provide a critical perspective on human agency and occupation as they cross cultural boundaries. His essay “Revisiting Culture in Occupational Therapy: A Meaningful Endeavor” challenges us to bring culture to the forefront of our thinking as we go forward with our science. We thank him for the challenge his essay is offering to us.

Quality of Life for Individuals with Schizophrenia: Validating an Assessment That Addresses Client Concerns and Occupational Issues

Abstract: This article describes the initial validation study of the Quality of Life Measure for Persons With Schizophrenia (QOLM-S). This new assessment is grounded in a holistic conceptual framework, addre...

A Measure of Perceptions of Generalized Self-Efficacy Adapted for Adolescents

Abstract: The primary domain of concern for occupational therapy is a knowledge base that supports an understanding of the range of influences impacting the activity participation of individuals. Self-efficacy beliefs are reported to underpin a person's capacity to initiate behaviors and produce performance outcomes. The purpose of this study was to test a measure of self-efficacy against which occupational performance outcomes may be predicted in adolescents. This study examined the extension of a generalized measure of self-efficacy, the Perceived Self-Efficacy (PSE) scale, for use with adolescents. Psychometric properties of the PSE scale were tested in a sample of 850 adolescents aged 12 to 18 years. The PSE scale exhibited adequate reliability and validity consistent with past research and theory. A one-way analysis of variance produced significant differences in responses by age, demonstrating support for perceived self-efficacy as a developing self-construct during the early transition adolescent years. The ...

Relationship of Number of Medications to Functional Status, Health, and Quality of Life for the Frail Home-Based Older Adult

Abstract: Number of medications and its relationship to functional status, health, and quality of life in 1,099 frail home-based older adults were examined. Using a general linear model, the number of medications was significant to cognition (P = .004; β = 0.16), instrumental activities of daily living (P < .0001; β = 0.13), and health (P = .0001; odds ratio = 0.92, 95% confidence interval = 0.83 to 0.96). But increased age (P < .0001; β = −.12) and male gender (P < .0001; β = −1.9), inversely associated with cognition, point to the emergence of a high-risk group who have a greater need for occupational therapy intervention, specifically medication management.

Stories of Clients with Mental Illness: The Structure of Occupational Therapists' Interactions

Abstract: The objective of this study was to examine therapist—client interactions in the psychosocial rehabilitation process. Data comprised narratives of clients with severe mental illness as told by the therapists. Some additional data were taken from field notes collected at the interviews. Narrative analysis was based on Ricoeur's concept of mimesis. An occupational therapy perspective was employed to both generate and interpret the narratives. One of the key findings highlighted how occupational therapists' actions functioned as emplotment—supporting the clients in handling the suspense they experienced. This suspense inhibited them from taking risks and thus hindered them in taking the next step in the rehabilitation process. Another key finding was the importance of designing a supportive, tolerant, and safe therapeutic environment that could enable clients the opportunity to grow. The essential roles of the occupational therapists in this context were role model, supervisor, and overall collaborator. The n...

Contexts of the Flow Experience of Women with HIV/AIDS:

Abstract: This descriptive within-subjects design examined differences in frequency of the Flow experience in the lives of women with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS...

Community Participation: Challenges for People with Disabilities Living in Oaxaca, Mexico, and New Mexico, United States:

Abstract: The use of wheelchairs or other mobility aids often limits the community participation of people with disabilities because of architectural barriers present in buildings Although this has been recognized as a global problem, little research has been done to document accessibility standards on an international level This study reports results from a survey using the Americans With Disabilities Act Accessibility Guidelines Checklist for Buildings and Facilities to measure the differences in levels of accessibility in Albuquerque, New Mexico, United States, and Oaxaca, Oaxaca, Mexico Investigators surveyed four building types (stores, restaurants, churches, and government buildings or public museums) in both geographic locations to determine whether each building was accessible The findings showed that buildings in Albuquerque were significantly (p < 0001) more accessible than buildings in Oaxaca on all measurement items and across all four building types However, many buildings in Albuquerque were not

The Validity of a Methodology to Describe Videotaped Mother—Toddler Interactions

Abstract: The validity of a methodology to describe mother—toddler interaction was examined in an exploratory study. The Parent—Toddler Coding System (PTCS) and Rating Scales of Dyadic Interaction (RSDI) were designed to quantify the task-supporting and socioemotional behaviors observed in exchanges between parents and their toddlers. The PTCS and RSDI were used to describe the videotaped interactions of mothers and toddlers engaged in play and eating activities in the home. The ability of the PTCS and the RSDI to discriminate between socioemotional and task-supporting dimensions of interactions was examined through a forced choice sort procedure. The construct validity was examined through principal component analyses and through procedures to examine the convergent and discriminant validity using correlational analyses. Both the PTCS and the RSDI were found to capture the socioemotional and task-supporting aspects of interactions in a sample of four mothers and their toddlers. This methodology may be useful for e...