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The theme of mind-body unity is fundamental to occupational therapy. Nonetheless, the field continues to embrace a dualism of mind and body. This dualism persists because the field views the body only as an object, ignoring how the body is lived. Drawing upon phenomenological discussions of bodily experience, this paper illustrates how the lived body is a locus of intelligence, intentionality, adaptiveness, and experience. It also considers the bodily ground of motivation and thought and discusses how the body constitutes and incorporates its world. Finally, the paper considers implications of the lived body for therapy.

Objective:The purpose of this study was to propose a process for the study of clinical utility and to illustrate its implementation in the development of an assessment.Method:A mixed methods approach was used to understand the clinical utility of an assessment in development. An exploratory qualitative/quantitative (QUAL?QUANT) approach was used to identify perspectives of the clinical utility of the assessment. The design placed equal status on the two methods used: focus groups and surveys.Results:The proposed process for the study of clinical utility resulted in targeted revisions based upon data obtained from 21 practitioners in three focus groups during a systemised examination of clinical utility.Conclusion:A mixed methods process can be used to ensure the clinical utility of assessments during the development process.

Aim: The central aim of this study was to measure the extent of utilization of the Model of Human Occupation (MOHO) according to an existing conceptual framework ( Melton et al, 2010 ) and to examine whether professional development efforts aimed to support the use of this model were associated with a higher degree of incorporation of this model into everyday practice. 4secondary aim was to determine whether certain pre-identified contextual and personal variables influenced the use of MOHO in everyday mental health practice. Methods: The authors solicited participation from 429 occupational therapy practitioners from six NHS mental health trusts in England using an online survey method and 262 (61.1%) responded. Findings: A vast majority (92.1%) of the respondents indicated that they used MOHO as a primary treatment approach. Moreover, therapist participation in professional development efforts aimed to increase MOHO use were associated with higher levels of MOHO use, and the extent of MOHO use was associated with positive client (r=0.33, P Conclusion: Findings suggest that there may be a significant payoff for professional development efforts that aim to support client-centered, occupation-focused approaches to mental health rehabilitation practice.

Purpose: Payment by Results (PbR) was recently introduced to mental health care in England. The system allocates service users to one of 20 clusters and will provide funding based on cluster membership, rather than on block contracts. Occupational therapists are challenged to define care packages for each of the clusters. Method: To facilitate their development, this study identified the occupational profiles of service users in each cluster based on measures offered by the Model of Human Occupation. The study used existing data from the clinical records of 625 service users from two organisations, collected through use of the Mental Health Clustering Tool and the Model of Human Occupation Screening Tool. Results: Across the sample, service users showed greatest problems with habituation, followed by volition and process skills. Qualitatively distinct occupational profiles were identified across the clusters. Service users with non-psychotic problems showed the least interference with occupational participation; those in clusters involving psychosis showed moderate levels of interference; and those in clusters involving cognitive impairment demonstrated the most difficulty with occupational participation. Conclusion: These findings provide an important evidence base for thinking about the occupational needs of service users within the various PbR clusters and the corresponding services that might be offered.

Introduction: This study examined the psychometric properties of the Model of Human Occupation Screening Tool, using both item response theory and classical test theory. Method: One hundred and one people with mental health problems, aged 18–65 years, were recruited. The Chinese version of the Model of Human Occupation Screening Tool, the National Taiwan University Hospital Symptom Checklist, the Volitional Questionnaire, the Assessment of Communication and Interaction Skills, and the Mini Mental State Examination were administered. Rasch analysis and correlational analysis were used to examine the construct, convergent, divergent validity and known group validity. Results: Rasch analysis confirmed that there were six subscales within the Chinese version of Model of Human Occupation Screening Tool. The Volitional Questionnaire strongly correlated with the volition subscale (r = 0.583). The Assessment of Communication and Interaction Skills strongly correlated with the communication and interaction subscale (r = 0.815). The Mini Mental State Examination was moderately correlated with the process subscale (ρ = 0.334) and the symptomatology was not associated with any of the subscales as expected. There were significant differences on selected subscale scores across four known groups of participants. Conclusion: The Chinese version of the Model of Human Occupation Screening Tool was valid when applied to people with mental health problems.

Aim: The aim of this study was to understand volition in people with moderate dementia. The study provided an in-depth description and analysis of volition in eight older people in a memory-support assisted living unit. Method: Guiding questions focused on understanding past life interests, demonstration of volition, volitional continuity, and the relationship among the social environment, volition and daily occupations. Data collection included participant observation, family and staff interviews, and the Volitional Questionnaire. The Mini-Mental State Examination provided a measure of cognitive impairment. Findings: Three interacting themes emerged: variation in volitional expression, redefining meaningful occupation and potency of the social environment. The participants differed in volitional expression, showed changes in continuity between past and present interests, and tended to modify their occupations to match their abilities. Conclusion: The participants' lived experiences consistently reflected dynamism between the social environment and the person in volitional expression.

Background: With a growing increase in the population of older people worldwide, there is an undeniable need for efficient and cost-effective service delivery in occupational therapy. Method: This randomised clinical trial employed a parallel design, with an experimental and a control group and a pre-test and post-test, to evaluate the effectiveness of a wellness programme based on the Model of Human Occupation (MOHO). Participants were 65 years of age or older, community-dwelling Japanese older people. Data were analysed for 30 experimental participants who received a 15-session MOHO programme and 33 controls who received a 15-session standard care, crafts programme. Quality of life and psychological wellbeing were compared between groups using the Japanese versions of the Life Satisfaction Index — Z (LSI-Z) and the World Health Organisation Quality of Life-26 (QOL26), respectively. Results: The LSI-Z score for the experimental group improved an average of 3.4 points whereas the control group's mean score improved by 0.1 point. The mean change for the experimental group (m.chg = 3.4, SD = 5.8) was significantly different (p = 0.01) from that of the control group (m.chg = 0.1, SD = 4.8) and the effect size (Cohen's d) was 0.62 (95% confidence interval = 0.13–1.11). The psychological domain score (QOL26) improved slightly for the experimental group whereas it declined slightly for the control group. The mean change was significantly different (p = 0.02) between the experimental (m.chg = 0.1, SD = 0.5) and control (m.chg = −0.1, SD = 0.3) groups; effect size (Cohen's d) was 0.49 (95% confidence interval = 0.02–0.96). Conclusion: The findings support the conclusion that MOHO-based occupational therapy interventions can promote wellness effectively in older people by having an impact on quality of life and sense of wellbeing.

Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists' use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixty-four percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population. Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.

The Occupational Self Assessment (OSA) was designed to guide collaborative treatment planning and measure client-reported change to document therapy outcomes. This study examined the stability of t...

This phenomenological study explored and described the lived experience of falls self-efficacy (i.e., perceived self-efficacy in avoiding a fall during basic activities of daily living) among six individuals with multiple sclerosis and its relationship to their overall volition and occupational lives. Participants were interviewed three times over a 3-month period. All interviews were analyzed using the Empirical, Phenomenological, Psychological method. One main theme (managing fall risk as a means of supporting activity) and six subthemes were reflected in participants' lived experiences: (1) understanding personal multiple sclerosis symptoms, abilities, and fall risk; (2) accepting one's changed capacity; (3) focusing on what you can control; (4) ongoing learning by doing; (5) vigilance while doing; and (6) taking personal responsibility to reduce fall risk. The findings show how falls self-efficacy operates as part of a larger volitional process and can be used to inform the development of fall prevention programs for individuals living with multiple sclerosis.

Autism is a prevalent developmental disorder that affects numerous aspects of a child's daily functioning, including but not limited to communication, social interaction, cognitive functioning, motor functioning, and sensation. The many impairments that characterize autism also have the potential to affect a child's volition, defined by the Model of Human Occupation as a child's interests, self-efficacy, and motivation to engage in new activities. The objective of this study was to determine the effects of a 16-week hippotherapy program on the volition of three children with autism. Using the Pediatric Volitional Questionnaire, two occupational therapists rated the three participants’ volition at three timepoints—before, during, and after the hippotherapy program. Visual analysis of the data using methods derived from single-subject design research revealed an increase in participants' volition over time. The study provides preliminary evidence that improved volition may be an important and under-recogniz...

The Model of Human Occupation (Kielhofner, 2008) postulates that occupational participation is influenced by volition, habituation, three skill areas, and the environment. The Model of Human Occupation Screening Tool (MOHOST) (Parkinson, Forsyth, & Kielhofner, 2004) was developed to provide a broad assessment of the factors that influence a client's occupational participation. The purpose of this study was to ask whether there was evidence that the items of the MOHOST meaningfully cluster into these theoretical sub-constructs. Nine occupational therapists used the MOHOST with 166 clients in the US and the UK, and a series of confirmatory factor analyses (CFA) were conducted. The six-dimensional model fit better than the one-dimensional model, and the standardized coefficients also indicated that the items were well designed and captured each factor. The results of this study confirmed the hypothesis that the MOHOST contains six factors and provides further evidence of the validity of the MOHOST.

Occupational therapists are increasingly being asked to engage in occupation-focused practice that goes beyond a focus on impairment. The Model of Human Occupation Screening Tool (MOHOST) is an occupation-focused assessment that determines the extent to which client factors and environmental factors facilitate or restrict an individual's participation in daily life. The purpose of this study was to examine the utility of the MOHOST as a valid outcomes assessment. A retrospective design was used to gather admission and discharge MOHOST ratings from an inpatient rehabilitation unit from over a 20-month period. A Many Faceted Rasch Model was used to analyze MOHOST admission and discharge data. The five therapists were fairly consistent in their scoring of the MOHOST, and four of five therapists used the MOHOST in a valid manner. There was significant increase in MOHOST measures from admission to discharge. The study findings indicate that, with minimal training, occupational therapists can use the MOHOST in ...

Practitioners’ preparation for, attitudes toward, and experience of the therapeutic relationship and use of self were explored using a survey study with a random sample of 1,000 American Occupational Therapy Association members. Participants reported a high value for the therapeutic relationship and use of self; most felt that they were inadequately trained and that the field lacks sufficient knowledge in these areas. Regardless of practitioners’ age, gender, experience level, setting, treatment intensity, and client impairment, those who placed higher value on the use of self and had more training related to the therapeutic use of self were more likely to report interpersonal difficulties and feelings of positive regard for clients and were more likely to report concerns about clients. The findings suggest that more attention needs to be paid to the therapeutic relationship and to the therapeutic use of self in education and in research.

This paper reports the results of three studies that examined the internal validity, sensitivity and reliability of the Occupational Self Assessment (OSA), a self-report of Occupational Competence and Value for occupational performance and participation (Baron et al 2006). All three studies used a Rasch measurement approach to explore the psychometric properties of iterative versions of the OSA. The first study showed that the ‘Myself’ Occupational Competence and Values items constituted a unidimensional construct, but did not discriminate optimally between participants. The results also suggested that the two ‘My Environment’ scales did not contain enough items to exhibit adequate measurement properties. Next, the rating scales were changed from three-point to four-point categories. The second study examined these changes and provided evidence to support the use of a four-point Occupational Competence scale. The Values rating scale was further revised because sensitivity did not improve. The third study confirmed that the OSA items in combination have good internal validity and measure the unidimensional constructs of Occupational Competence and Values. Further, both four-point rating scales resulted in improved person separation, indicated increased sensitivity, and could be used in a consistent manner by 90% of participants with a range of disabilities from a variety of contexts.

Objective. To identify how therapists choose and use the Model of Human Occupation (MOHO). Method. A systematic random sample of 1,000 occupational therapists was surveyed as to whether they used MOHO in their practice. Those who were using MOHO were then sent a detailed questionnaire; 259 therapists responded to the survey questionnaire, forming a response rate of 60.2 percent. Results. A total of 80.7% of therapists indicated that they had used MOHO in their practice. A number of factors influenced therapists' choice to use MOHO. The most frequently cited factors were therapists' judgment that MOHO fit their own practice philosophy and their clients' needs. Most therapists used multiple means of learning about MOHO, and the number of means they used was related to both self-reported levels of knowledge and utilization of this model. Many therapists are also actively engaged in sharing their knowledge and utilization of this model. Conclusion. Multiple factors contribute to therapists' choice and use of MOHO. Therapists actively make a decision to use MOHO in practice and put forth substantial efforts to learn and share their knowledge of MOHO.

This paper documents efforts in Canada, France, Finland, Germany, Hispanoamerica, Israel, Japan, The Netherlands, and Taiwan to disseminate the Model of Human Occupation (MOHO). We aim to characterize the challenges involved, the strategies used, and the impact of these efforts in diverse cultural and social conditions.

OBJECTIVE. This study assessed the effectiveness of a model program designed to increase productive participation among people living with HIV/AIDS within supportive-living facilities. METHODS. Using a nonrandomized, two-group design, 65 study participants were assigned to either the model program or standard care. Data on productive participation were collected at 3, 6, and 9 months after completion of the model or standard program. Outcomes were compared at each time point. RESULTS. Forty-six participants completed the study. Participants in the two programs did not differ significantly on baseline demographic variables. Model program participants showed significantly higher levels of productive participation at all three time points (p < .05). Odds ratios were all > 3, reflecting that participants attending the model program were at least twice as likely to be productively engaged at all three time points. CONCLUSION. Results support the effectiveness of the model program in achieving sustained productive participation in persons living with HIV/AIDS.

This study aims to determine the utility of the narrative slope in predicting the vocational/productive outcomes of participants. For 65 participants living in supportive facilities for adults with HIV/AIDS in the United States, narrative slopes, based on the Occupational Performance History Interview II, were constructed and classified as progressive, stable, or regressive. Information regarding participants' productive activities was collected at discharge from intervention programming, and at 3-month intervals, up to 9 months. Data were analyzed to examine the relationship between narrative slope and engagement in employment and other productive activity post-intervention. Demographic variables were also analyzed. None of the demographic factors significantly correlated to outcomes. It was found that a more positive narrative slope was predictive of a higher likelihood of being employed or engaged in other productive activity.

The aim of this study was to examine how women experience occupations as they live with chronic pain and more specifically to gain detailed knowledge regarding the meaning of important occupations in their life. The article is based on an analysis of 17 narratives based on an Occupational Performance History Interview. Participants were interviewed as part of their occupational therapy assessment at Orton Rehabilitation. The narratives were analysed in order to identify the experiences of doing occupations in everyday life. When interpreting their problems in and solution for doing occupations women in this study used four basic metaphors: (1) moving forward, (2) slowing down, (3) fighting and (4) standing still. The tone of the narratives varied from hopeful to hopeless and from fearful to frustrated. Each of these four types of narratives differed in: (a) the tone of the narrative, (b) the meaning ascribed to occupation, (c) how others are viewed in relation to one's doing, and (d) how the future is envisioned. The experience of occupation in the lives of women with chronic pain is heterogeneous and depends on the underlying meaning of the narrative used to experience and interpret occupational life.

Disability studies seeks to reframe rehabilitation’s understanding and responses to disability. Disability scholars point out that rehabilitation’s perspectives and practices are not objective, but instead reflect particular historical and ideological forces. By demonstrating how rehabilitation practitioners can unintentionally do things that are unhelpful or even harmful, disability scholars challenge the profession of occupational therapy to reconsider aspects of practice, education, and research. In order to provide a context for a special issue devoted to disability studies, this paper examines disability studies’ major critiques of rehabilitation and considers their implications for occupational therapy. The paper identifies ways that occupational therapy can continue to respond reflectively to the themes of disability studies. It also identifies a number of questions raised by disability studies that will need to be addressed in practice, education, and research.

SUMMARY Occupational therapy has experienced a tremendous growth both of theory and research. However, there is little evidence that this renaissance of knowledge has been paralleled by changes in practice. Instead, academics tend to express concern that practice lags behind scholarship while clinicians bemoan the irrelevance of theory and research to their everyday work. This paper discusses the scholarship of practice. This approach is based on the assumption that those who ultimately will use the knowledge must be partners in its generation. Thus, it emphasizes cooperative efforts in which practitioners and scholars work together as partners to advance both knowledge and practice.

Background: Over the past decade, the need to measure work-related impairment of individuals with chronic fatigue syndrome (CFS) and develop rehabilitation programs focusing directly on employment has become increasingly clear.Aims: Evidence in the scientific literature was sought to determine the extent of work-related impairment and the efficacy of rehabilitation programs that specifically focus on issues of work-related impairment and employment.Methods: Three evidence-based medical review sources and five specialist databases were searched. English-language studies of adults with CFS published between 1 January 1966 and 15 July 2004 were included if functional or work-related impairment and employment were primary variables measured in the study.Results: Few studies of work-related impairment and work-focused rehabilitation in CFS exist. Rates of unemployment ranged from 35 – 69% and rates of job loss ranged from 26 – 89%. Work-related impairment encompassed getting out of bed, transportation to work,...

National and local policies require the profession to provide evidence on which practice is based. This paper illustrates an approach to meeting the expectations of these policies. Specifically, it describes the development of the United Kingdom Centre for Outcomes Research and Education (UKCORE). UKCORE was developed within a ‘scholarship of practice’ framework, which supports the development of robust partnerships between academia and practice whereby academic knowledge influences practice and practice knowledge influences academia. Within the partnership, all academic participants (educators, researchers and students) and practice participants (clinicians, clients and administrators) are called ‘practice scholars’ and are focused on practice scholarship. UKCORE was founded in London in 2001 in order to support the delivery of existing evidence into occupational therapy practice while simultaneously supporting practice to engage in generating new evidence for occupational therapy practice. This article provides an overview of the academic and practice changes that have been put into place. The changes are designed to support the development of practice that is occupation focused, theory driven and evidence based.

The Pediatric Volitional Questionnaire (PVQ) is a 15- item play-based assessment of a child's motivational strengths and weaknesses in various settings based on the Model of Human Occupation. A previous study examined the PVQ's ability to provide a valid measure of volition in ten non-disabled children. This study combined data from the previous study with data on eight children with disabilities to further test the instrument's psychometric properties. Data on 36 observations of the 18 participants were observed by a total of 20 raters. Each rater was randomly assigned to rate videotapes. Data were analyzed using the Rasch Measurement Model. Results indicate that the 15 items of the scale work well together to measure volition and were well matched to the volitional levels of the sample group. Nineteen of the twenty raters used the scale in a valid manner, though scores were affected by the extent of severity/leniency of the rater. All eighteen participants were validly rated and the scale items effectively differentiated levels of volition among the eighteen children. These findings supported the conclusion that the PVQ provides a valid and sensitive measure of volition. The study also found that the 4-point rating scale operated as a 3-point scale in this study and that raters differentiated in their severity/ leniency. These latter findings indicate the need to further clarify the rating scale.

Pediatric occupational therapists have a unique opportunity to foster self-determination by involving young clients in assessment and intervention planning. Self-assessment is an appropriate way to support client-centered practice and self-determination. This study is the first in a series of two studies that examined the psychometric properties of the Child Occupational Self Assessment (COSA), a self-report tool based on the Model of Human Occupation. The COSA comprises 24 statements, which the child rates in terms of personal competence and importance. The Rasch Rating Scale Model was used to evaluate the measurement properties of the Competence and Values scales that result from these self-ratings. Analysis indicated that the items worked well together to constitute measures of occupational competence and values. However, the instrument was not sufficiently sensitive to discriminate among respondents. Future recommendations are made to expand the rating scales in order to increase client discrimination so that the COSA can also be used as an outcome assessment. The results provide initial evidence that the COSA can be used as meaningful and reliable client directed assessment tool.

Occupational therapists routinely use rating scales to indicate a client's level of functioning, monitor progress, and evaluate intervention success. Rating scales yield ordinal data, whereas true measurement requires interval level data. Rasch analysis can convert rating scale data into true interval measures, but the use of measures derived from this method is limited in everyday occupational therapy practice because raw data must be computer scored. The keyform is an alternative to computer scoring. It is a paper-and-pencil form with which the therapist can record and convert ratings to interval measures while exercising intuitive quality control of the data. This article illustrates the application of this methodology to the Occupational Performance History Interview-2nd Version (OPHI-II). The authors discuss the OPHI-II scales, describe the methodology for developing the keyforms, and demonstrate how they are used.

Clients’ occupational narratives reveal the overall meaning of life events, signifying their place in a plot that integrates past, present and future. Occupational narratives have also been demonstrated to predict how clients respond to therapy. A closer examination of the details of occupational narratives and how they unfold in the therapeutic context has the potential to give new insights into the experience of therapy by clients. This paper presents narratives of two clients in a vocational program for persons living with AIDS. Comparing their occupational narratives enables us to shed light on the differences between narratives that account for different client outcomes and the extent to which narratives can be impacted upon through occupational therapy intervention.

This article presents two themes related to the development and implementation of sound outcomes research that emerged from a 3-year dialogue among fellows of the University of Illinois Center for Outcomes Research and Education (CORE). These themes are: that outcomes research needs to be an interrelated multi-method system of investigation, and it should be developed in collaboration with its key stakeholders (consumers and practitioners). Examples from the literature and from a cluster of papers published in this focus issue are used to exemplify the themes.

Advances in medical treatment combined with changes in the demographics of persons who are becoming infected with autoimmune deficiency syndrome (AIDS) have transformed this illness from a rapidly progressing to a chronically disabling condition in a short period of time. This paper describes the development, implementation, and outcomes of a program of vocational services for persons with AIDS. This program was studied using a single group design, in which participatory action research strategies were used to investigate and improve the program as it unfolded. In addition to examining the overall outcomes of services, the study aimed to discover which components were most helpful to participants and which participants were most likely to benefit from the program. Of 129 participants of who initially enrolled, 39 dropped out before finishing the program. Sixty of the 90 participants who completed the program achieved employment, returned to school, or began a volunteer position or internship. Consequently, the overall success rate was 46.5% and the success rate for program completers was 66.7%. The occupational narrative, which participants told in their initial assessment interview, was closely associated with both program completion and successful outcomes. This association adds support to the importance of narrative for understanding participants and predicting future behavior, as well as for the therapy process.

The purpose of this study was to validate the Swedish translation of the Assessment of Communication and Interaction Skills (ACIS-S) and its applicability in Sweden. The ACIS is an observational rating scale designed to capture, in detail, a person's social interactional ability, while he/she is participating in meaningful occupations. Eighteen occupational therapists trained in administering the ACIS-S, completed 157 ACIS-S assessments of 67 subjects with psychosocial and learning disabilities. Many-faceted Rasch analysis was used to analyse the data. The results supported internal, construct and person response validity of the ACIS-S, and rater validity and reliability. The scale effectively categorized subjects according to the levels of communication and interaction ability.

OBJECTIVE. The purpose of this study was to gain an understanding of social environmental influences on occupational experience and performance over the course of rehabilitation of four persons with unilateral neglect. METHODS. The Phenomenological Psychological Method (Karlsson, 1993) was used to gather and analyze qualitative data on four women over a 4-month period. Four women were interviewed five to seven times each and observed during their rehabilitation process. Analysis focused on how these persons with unilateral neglect experienced and responded to their interactions with others in their everyday lives. FINDINGS. As perceived by the study participants, rehabilitation professionals and relatives demonstrated a sequence of strategies for dealing with and helping the women perform despite their unilateral neglect. The sequence of strategies reflects the changing experience of neglect over time. The strategies used by professionals and family members during the rehabilitation process enabled these women to reclaim and occupy the neglected half of the world. Moreover, the women with neglect learned to incorporate others as extensions of their bodies in order to compensate for their ongoing inability to directly experience the left half of the world. CONCLUSION. The results suggest that it is important for others (e.g., therapists, nurses, or relatives) to understand the client’s changing experience of neglect and adjust their support and collaboration accordingly. Occupational therapy intervention for persons with neglect could potentially become more effective by systematically incorporating the kinds of strategies identified in this study. Moreover, therapists could consult with others to increase their understanding and effectiveness in interacting with persons who have unilateral neglect.

Analyses of life stories has increasingly been used to understand how different individuals interpret and respond to an experience such as the onset of disability. This paper presents findings of a prospective qualitative study of 12 men living with AIDS who attempted to return to paid employment. Narrative analysis of four interviews over 12 months was used to explore the relationship between return-to-work efforts and whether participants' narratives progressed, remained stable, or regressed. Findings suggest that the men who demonstrated progressive narratives recreated an identity including a view of themselves as workers and recaptured a sense of competence. Men with regressive narratives demonstrated decreased identity and competence while men with stable narratives showed little change in either identity or competence. This paper contributes to our understanding of how the framing of an illness or disability by an individual may influence the progression of his life history narrative.

Objective. This study examined the validity of the Occupational Identity, Occupational Competency, and Occupational Behavior Settings scales of the second version of the Occupational Performance History Interview (OPHI-II). The study also asked whether the scales’ items were targeted to and could effectively discriminate between persons at different levels of adaptation. Method. Data were collected from 151 raters on 249 subjects from eight countries and in six languages. Many-faceted Rasch analysis was used to analyze the data. Results. The items of each scale worked effectively to measure the underlying construct for which they were designed. All three scales validly measured more than 90% of the subjects, who varied by nationality, culture, age, and diagnostic status. Each scale’s items were appropriately targeted to the subjects, and all three scales distinguished subjects into approximately three different levels. More than 90% of the raters used the three scales validly and had approximately the same degree of severity or leniency. The scales were valid across subjects with physical dysfunction and psychiatric conditions as well as subjects with no active diagnosed condition. Conclusion. The three scales of the OPHI-II are valid across age, diagnosis, culture, and language and effectively measure a wide range of persons. Raters can readily use the OPHI-II validly without formal training.

The purpose of this study was to validate the Occupational Self Assessment (OSA). The Occupational Self Assessment is an evaluation tool and an outcome measure based on the Model of Human Occupation and concepts of client-centered practice. It is a two-part rating form that elicits client's perceptions and values concerning their own occupational competence, values, and the impact of the environment on their occupational behavior. Data were collected from 302 clients which included physically disabled, psychiatrically disabled and non-disabled adults. Rasch analysis was used to analyze the data. Results supported the preliminary validity and reliability of the OSA and recommendations are given for further improvement of the tool.

This paper presents results from the second phase of a longitudinal study of retirement. Data were gathered through interviews with 29 participants (65 to 66 years of age) who had previously been interviewed when they were 63 to 64 years of age and still working. Data were analyzed by characterizing each subject’s narrative about retirement in terms of its narrative slope—progressive, stability, or regressive. These current narratives also were compared with the earlier narratives these participants told. It was found that, while anticipatory narratives may predispose persons toward action, they are not so much a fixed “script for action” as an orientation to act within circumstances. While participants’ narratives anticipating retirement often turned out as expected, they were sometimes reshaped as a consequence of personal action, external events, and unexpected experiences within new retirement occupations. The study suggests that, while narratives play a role in shaping the direction of persons lives, they also interweave with and change directions as a result of ongoing life events and experiences.

The purpose of this study was to develop and validate the Assessment of Communication and Interaction Skills (ACIS). The ACIS is an observational rating scale designed to capture, in detail, a person's social Interactional ability while he or she is participating in a meaningful social context. Fifty-two occupational therapists, trained to administer the ACIS, completed 244 ACIS assessments of 117 subjects with psychosocial disabilities. The subjects had a wide range of communication and interaction abilities. Many-faceted Rasch analysis was used to analyse the data. The results supported internal, construct and person response validity of the ACIS. Both intrarater and inter-rater reliability were established. The scale was shown to discriminate between people with psychosocial dysfunction who had varying communication and interaction abilities. In addition, the results indicated a need to do minor revisions to the assessment.

Innovative applications of Rasch analysis can lead to solutions for traditional measurement problems and can produce new assessment applications in occupational therapy and health care practice. First, Rasch analysis is a mechanism that translates scores across similar functional ability assessments, thus enabling the comparison of functional ability outcomes measured by different instruments. This will allow for the meaningful tracking of functional ability outcomes across the continuum of care. Second, once the item–difficulty order of an instrument or item bank is established by Rasch analysis, computerized adaptive testing can be used to target items to the patient’s ability level, reducing assessment length by as much as one half. More importantly, Rasch analysis can provide the foundation for “equiprecise” measurement or the potential to have precise measurement across all levels of functional ability. The use of Rasch analysis to create scale-free measurement of functional ability demonstrates how this methodology can be used in practical applications of clinical and outcome assessment.

Three studies were conducted to examine the validity of the Worker Role Interview (WRI), a semi-structured interview and rating scale designed to assess psychosocial capacity for return to work in injured workers. The first Rasch analysis study of 119 work-hardening clients with low back pain showed that scale items worked together to measure unidimensional construct, except for two work-environment items (work setting and boss); and the items were logically ordered representing the least to most psychosocial capacity for return to work. The second Rasch analysis study involved a refined scale (including redefinition of environment items to reflect the worker's perception of the environment) applied to 55 work-hardening clients with diverse injuries. All items except perception of boss defined a unidimensional construct. The ordering of items was similar to that in the first study and similar across two different diagnostic groups (low back and upper extremity injuries), indicating the scale was sample invariant. The third study of 42 work-hardening clients examined the predictive validity of the WRI. A logistic regression, which included demographic variables (chronicity, diagnosis, number-of-surgeries, attorney involvement and age), showed that none of the variables predicted return to work (odds ratio ranged from 0.3–1.0). This initial series of studies present a theoretically based instrument, which shows promising psychometric qualities. While the predictive study indicated that the WRI was not useful in predicting return to work, this finding may have been a function of the small n-size in the study or that the WRI may mediate its effect through other variables.

The Occupational Performance History Interview (OPHI) was developed to gather data on a person's past and current occupational functioning. The OPHI includes both a life history narrative component designed to render the life history from the client's perspective and a rating scale designed to measure the client's past and present occupational adaptation. Previous research documented the reliability of the OPHI, but there has been limited study of its construct validity. This study used Rasch analysis to determine the construct validity of a modified version of OPHI scale (OPHI-R). Data previously gathered on 20 clients in a psychiatric setting were analyzed. The results indicate that the items of the OPHI-R do not effectively measure a single construct of occupational adaptation as originally thought. Rather, the OPHI-R items appear to measure three underlying constructs reflecting occupational competence, identity and environment. These findings suggest that revision of the OPHI scale should seek to capture these three underlying constructs for the measurement of occupational adaptation.

Objective. This study examined occupational therapists’ use of the occupational form of goal setting as therapy and its impact on clients. Method. The study method was qualitative, using participant observation and interviewing as the main source of data. Results. The findings illustrated that therapists work both to give substance to the occupational form and to create the context of an implied narrative that imbues it with particular meanings. Simultaneously, clients’ experience of meaning is influenced by a personal volitional narrative. When the two narratives do not coincide, therapists’ efforts to maintain the occupational form intensify as they encourage clients toward attitudes and performances that do not resonate with the clients’ experience of reality. Conclusion. The findings underscore the importance of recognizing that occupational forms are embedded in social processes and perspectives that inevitably come into play when occupational forms are used as therapy.

This study examined the construct validity and the internal consistency of a newly developed assessment, the Work Environment Impact Scale (WEIS). After administration to 20 individuals with psychiatric disabilities, Rasch analysis was utilized to scrutinize the data. For this study, criteria for determining unexpected person/item responses were based on the following criteria: MNSQ1.3 andformula$\underline{t}2.0$/formula. Persons/items with MNSQ0.7 andformula$\underline{t}-2.0$/formulawere examined to enhance instrument precision but were not considered misfit. Results suggest that the WEIS is an appropriate and valid instrument to utilize with workers who have psychiatric disabilities. Overall, the items appeared to match the worker's need for performance, satisfaction, and well-being as the mean of persons measure is 0.30 ± 0.49 logits more than the mean of items measured. In addition the hierarchical order of items is consistent with literature identifying environmental press and affordance for workers with psychiatric disabilities. WEIS items constitute a uni-dimensional construct given that the summary statistics for both item and person had a MNSQ of 1.00 and 1.02 respectively and bothformula$\underline{t}$/formulavalues were -0.2. However, three items exceeded the established criterion for being too informative given the MNSQ0.7 and aformula$\underline{t}-2.0$/formula., suggesting these needed to be revised to enhance the quality measurement of the instrument. One hundred percent of the workers fit the expected response pattern of the Rasch model suggesting that workers with greater satisfaction, performance and health had a higher degree of match with his/her occupational environment. In summary, anecdotal data suggested that the WEIS provided clinically relevant information useful for planning of work-related interventions or reasonable accommodations.

The model of human occupation has evolved since it was first published. A number of important changes and refinements have been made. These changes reflect research findings, new interdisciplinary theory and insights encountered in practice. This article provides an overview of the current theoretical arguments. These concepts attempt to offer a way of understanding how human occupation is motivated, organised, performed and influenced by the environment. This is followed by a discussion of how occupational therapists can use this framework in their clinical practice.

The Worker Role Interview (WRI) was developed as an assessment of psychosocial factors which influence work success and return to work following an injury. The instrument has been translated and adapted for Swedish culture. This article presents the findings from a study of the validity of the Swedish Worker Role Interview (SWRI) with a psychiatric population. Results indicate that the Swedish instrument is a valid measure of psychosocial capacity for work. Comparison of findings from the SWRI with research on the WRI indicates that the instrument is valid across both cultures and languages and can be used effectively with both physically and psychiatrically disabled clients.

Chronic Fatigue Syndrome (CFS) is a highly disabling condition that significantly interferes with occupational life. Occupational therapy services are very relevant for this population. Yet, information about the assessment and treatment of CFS is almost absent from occupational therapy literature. As a result, few occupational therapists possess expertise in evaluating and providing therapy for this complex condition. This paper describes an approach to evaluating and providing services for individuals with CFS according to the Model of Human Occupation. This model offers an integrative means of understanding the synergistic and evolving relationships between motivation, values, roles, habits, functional capabilities, and the environment as they influence individuals with CFS, and it provides a framework for the types of changes required in these different domains during the rehabilitation process. A case study illustrates recommended assessment and intervention approaches.

The occupational role of a university student can create challenges that negatively affect subjective well-being. Cultural factors can make these problems particularly acute for students from Arab backgrounds. This study examined the relationship between variables derived from the Model of Human Occupation (MOHO) and Jordanian university students' subjective well-being. Using cluster sampling, a total of 670 participants were recruited from the undergraduate student body at the University of Jordan. Data were collected from these students using the Role checklist, the Occupational Self-Assessment, the Affectometer 2, and the Satisfaction with Life Scale. As hypothesized, reported roles, valuation of roles, perceived competence in volition, habituation, performance capacity/skills, and the environment were significantly correlated with subjective well-being. A discriminant analysis using the most strongly correlated items significantly classified students into known groups of high and low subjective well-being. Overall, MOHO-based variables offered an effective explanation of factors that influence subjective well-being in Jordanian university students.

SUMMARY The Occupational Performance History Interview-Second Version (OPHI-II) is a semi-structured interview that gathers life history information. The interview data is used to score three rating scales and complete a narrative slope. Previous research has primarily examined the validity of the scales. This qualitative study sought to understand from the perspectives of therapists and clients how they experienced the interview process and narrative slope of the OPHI-II. Clients and therapists agreed that the OPHI-II interview built rapport, generated insights into the client's life experiences, and was helpful in planning goals and services and both groups generally found the narrative slope valuable. Both therapists and clients indicated the importance of tailoring the interview process and the narrative slope to each client's unique perspective and needs. Study findings both support the usefulness of the OPHI-II and provide suggestions for how it can be used most effectively.

SUMMARY The Scholarship of Practice involves an ongoing, reflective discourse among the theoretical concepts of occupational therapy, the empirical verification of those concepts through research, and the application of those concepts in real-world clinical practice. This article illustrates how the Scholarship of Practice framework is applied by occupational therapy faculty members as a key aspect of their scholarly and teaching roles. Two distinct perspectives are provided-one describes the scholarship and teaching of a clinical-track faculty member and the other describes that of a research-track faculty member. Both examples illustrate how each faculty member's work involves an integration of teaching and advising, scholarship (i.e., developing occupational therapy theory and conducting research), and practice. In both cases, the faculty member uses the Scholarship of Practice approach to better understand the kinds of problems and needs of clients and the ways in which practitioners can use knowledge generated by theory and research to most effectively address them. In turn, each faculty member relies heavily on the feedback from students and practitioners regarding the outcomes of the practical application of the concepts offered by theory and research. This feedback is then utilized to revise and refine existing theory, generate new research questions, and ultimately inform best occupational therapy practice. Finally the process serves as an ideal context for teaching and advising.