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Objective: To investigate the relationship between on-road driving remediation and achieving fitness to drive following acquired brain injury. Design: Randomized controlled trial. Setting: Tertiary hospital outpatient driver assessment and rehabilitation service, Australia. Participants: Thirty-five participants (54.3% male), aged 18–65 years, 41 days-20 years post-acquired brain injury (including stroke, aneurysm, traumatic brain injury) recommended for on-road driving remediation following occupational therapy driver assessment were randomly assigned to intervention (n = 18) and waitlist control (n = 17) groups. Intervention: Intervention group received on-road driving remediation delivered by a qualified driving instructor in a dual-control vehicle. The waitlist control group completed a 6 week period of no driving-related remediation. Main measure: Fitness to drive rated following the conduct of an on-road occupational therapy driver assessment with a qualified driving instructor where outcome assessors were blinded to group allocation. Results: The intervention group were significantly more likely to achieve a fit to drive recommendation than no driving specific intervention (p = 0.003). Conclusion: Following comprehensive assessment, individualized on-road driving remediation programs devised by an occupational therapist with advanced training in driver assessment and rehabilitation and delivered by a qualified driving instructor are significantly associated with achieving fitness to drive after acquired brain injury. [ABSTRACT FROM AUTHOR]

Describing how occupation is used in practice can be challenging for occupational therapists. Occupation-centred, occupation-based, and occupation-focussed terminology are frequently used interchangeably and ambiguously to describe practice. However, ambiguous language creates confusion and inadequately demonstrates the value of occupation. This scoping review aimed to identify how occupation-centred, occupation-based, and occupation-focussed terminology are defined and represented in occupational therapy literature. A five-step scoping review included papers published between 2014 and 2019 from four databases. Extracted data were summarised to outline how the terms were being used within the literature. Initial searching yielded 819 articles and 35 papers met inclusion/exclusion criteria. Within current literature, occupation-focussed and occupation-based terminology were inconsistently described. A limited number of articles used occupation-centred and occupation-focussed terminology to describe practice, whilst occupation-based was more prominent. Occupation-based terminology was represented in numerous ways to describe assessments, practice tools, interventions, research, and theory. Discrepancies between the description and implementation of occupation-based practice were most prominent within interventions. Findings demonstrated that occupation-based and occupation-focussed terminology were used interchangeably and inconsistently in literature. It is timely to consider how this is problematic for our professional identity and perceptions of occupation in practice. [ABSTRACT FROM AUTHOR]

A strong professional identity helps occupational therapists maintain professional values and thrive when facing work-related challenges and opportunities including generic, blurred or emerging roles, funding pressures and a push for outcome evidence. A scoping review will build understanding of professional identity and how to maintain it in such circumstances. To scope what is currently understood of professional identity in occupational therapy and factors which influence ability to maintain this and adapt in challenging work environments. Using Arksey and O'Malley's scoping review framework three databases were searched using the terms 'occupational therap*' and 'professional identity'. Data extraction and thematic analysis highlighted the extent and nature of current literature and mapped key concepts. 89 papers were included. Professional identity was revealed as a multidimensional construction. Four themes emerged: developing a shared ontology, embracing the culture, enacting occupational therapy, and believing in occupational therapy. Factors which influenced development and maintenance of professional identity included occupation-centred practice, ontological reflexivity, linking theory to practice and professional socialization. The enhanced understanding of professional identity and factors which preserve or enhance it can help the profession identify how to position itself to remain resilient and adaptive in an ever-changing environment. [ABSTRACT FROM AUTHOR]

Return to independent driving is an important goal following acquired brain injury which may be explored through driving rehabilitation. Whilst on-road driving remediation often form the basis for rehabilitation, the efficacy of such intervention is uncertain. To describe current evidence regarding the use of on-road driving remediation to facilitate return to independent driving following acquired brain injury and define gaps in research. CINAHL, Embase, MEDLINE (OVID), PsycInfo and Scopus were the primary information sources searched 8th and 29th January 2020 using the Joanna Briggs Institute protocol for scoping review. Searching identified 904 studies, after 442 duplicates were eliminated, 462 studies screened. Title and abstract screening revealed 447 irrelevant studies with 13 full-text studies assessed for eligibility. Six studies [cohort studies (n=4) and case report (n=2)] were selected for data extraction. c Emerging evidence indicates a level of support for the use of on-road driving remediation as a rehabilitation tool following acquired brain injury. Further research is required to define which goals are suited to on-road remediation as a return to driving intervention and explore the capacity of participants to sustain any gains made through on-road driving remediation at follow-up. [ABSTRACT FROM AUTHOR]

Occupational therapists have sought to reconnect with the foundations of the profession for many years, and a key focus has been the place of occupation in practice. Existing literature suggests that therapists working in acute settings experience difficulties practicing in ways that centralise occupation. This scoping review aimed to explore the existing literature on contemporary occupational therapy philosophy and practice in acute hospital settings. A five step scoping review process was implemented. Four electronic databases were searched using a combination of search terms. Searching reference lists of papers was also completed. Results were summarised using numeric and thematic analysis. Twenty four publications were included. Four themes were identified; attitudes towards occupation-based practice, benefits of occupation-based approaches, challenges implementing occupation-based practice, and strategies to overcome challenges. Findings highlighted therapists value occupation as an important aspect of practice, however they experience many environmental and personal challenges in acute settings. Strategies to overcome these challenges related to individual's changing their practice to be more occupation-focussed and changes within the practice context including adapting environments, documentation and intervention protocols to focus on occupation. These strategies may support therapists to align practice with their professional values. [ABSTRACT FROM AUTHOR]

In a globalised world, with injustices and inequities, occupational therapists have a moral and ethical obligation to use their knowledge and skills to work at a collective level with groups, communities, and populations rather than focus solely on individualistic approaches. To review the literature exploring the question: What do occupational therapists do in their everyday practice that could be characterised as having a collectivist orientation? A scoping review with searches on Web of Science, Scopus and CINAHL databases with the keywords 'occupational therapy' AND collectiv*. 161 articles were found and after screening of abstracts and/or full text, 19 were included. Articles were published in English (13) and Portuguese (6), in 12 different journals and one book, from 1988 to 2018. They were categorised as focussing on: social welfare – collectivism (n = 2); collective occupations (n = 11); and collective oriented practices (n = 6). A clear definition of collectivist approaches in occupational therapy practice was not found. What was evident, however, was a focus on experiential accounts of working with groups of people and the methods and processes utilised. It is argued that occupational therapy needs to further develop knowledge and practices aimed at injustices grounded in a collectivist epistemology. [ABSTRACT FROM AUTHOR]

Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement. Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation. Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred. Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility. Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility. [ABSTRACT FROM AUTHOR]

Purpose: Studies highlighting the time spent in self-isolating and inactive activities during stroke rehabilitation have led to the introduction of group programs and environmental enrichment to improve activity levels. A less explored perspective is to understand how the introduced changes align with the occupational needs of the stroke survivors. Therefore, the aim of this study was to explore stroke survivors experiences of engagement in occupations during stroke rehabilitation. Methods: A descriptive phenomenological approach with semi-structured interviews explored stroke survivors experiences. Results: Eight participants (five male and three female, mean age 72 years) described their experiences with two themes emerging: (1) "I'm here for that reason:" which highlighted therapy as an occupation which participants wanted to perform and (2) "Celebration of quiet moments:" exploring the value of rest and recreation. Conclusion: This study provides a preliminary understanding of how stroke survivors experience occupational engagement during rehabilitation. There was an apparent shift in priorities with therapy considered the most important occupation and a strong need expressed for rest and relaxation to be factored into people's days. It appears the increasing activity levels may not always align with people's occupations and that due consideration of this malalignment may further enhance engagement and outcomes. During hospital-based stroke rehabilitation, stroke survivors prioritized the occupations of therapy, rest, and recreation. People with stroke are motivated to participate when the activities within and outside of, therapy align with their pre-stroke life and occupations. A daily stroke rehabilitation program should be balanced with opportunities for rest to support recovery time from therapy and possible consolidation of learning [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo examine the lifespace of participants referred for occupational therapy driving assessment following acquired brain injury, to understand how, why, where and with whom access and participation in community-based occupations is occurring during the period of driving disruption.The mixed methods, convergent research design utilised a travel diary and Lifespace Mobility Assessment-Composite quantitative elements and semi-structured interviews analysed qualitatively with an interpretive description lens.Forty-eight participants (56.25% male) aged between 26 and 65 years, left home on average once/day, primarily to conduct instrumental activities of daily living, health management, and social participation community-based occupations. Most reported restricted lifespace (54.2%) requiring assistance to conduct community occupations (68.1%). Support was primarily provided by family members (80.3%). Analysis of semi-structured interviews (n = 15) created three themes that shaped participant occupational experience during driving disruption: (i) changes to occupational participation; (ii) reliance on others for community access and participation; and (iii) trying to move forward.The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace, changing how, why, where and with whom participation in community-based occupations occurs. Rehabilitation facilitating occupational adaptation process to enhance community access capacity is indicated.The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace and influences participation in community-based occupations.Occupational therapists should provide an individualised potential pathway to return to driving with frequent and varied means of reinforcing interim advice to abstain from driving.Implementing occupational adaptation can progress community participation goals by establishing community access skills, habits, routines and confidence to foster participation and satisfaction and rebuild occupational identity following acquired brain injury.The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace and influences participation in community-based occupations.Occupational therapists should provide an individualised potential pathway to return to driving with frequent and varied means of reinforcing interim advice to abstain from driving.Implementing occupational adaptation can progress community participation goals by establishing community access skills, habits, routines and confidence to foster participation and satisfaction and rebuild occupational identity following acquired brain injury. [ABSTRACT FROM AUTHOR]

Background Mothers of children with autism experience poorer health and wellbeing compared to mothers of children with other disabilities or typically-developing children. This qualitative phenomenological study aimed to explore the daily life experiences of mothers of children with autism, and the strategies they use to manage their roles, their emotions, and their child's behaviours. Method In-depth interviews were conducted with 7 mothers and the data were analysed using interpretative phenomenological analysis. Results Findings revealed that the mothers were challenged by the demands of their multiple roles while dealing with the paradox of accepting their child for who they were, and at the same time also desiring their typical growth and development. However, the mothers reported various strategies they used to manage their roles, their emotions, and their child's behaviours. Conclusions The findings indicate that health professionals working with these families must support mothers in managing various aspects of their lives, including those not directly related to their child with autism. [ABSTRACT FROM AUTHOR]