Fig. 3.1
Basic categories of the Occupational Therapy Intervention Framework (OTIF). The occupational therapists’ (OTs) roles are as follows: to manage internal, temporal, occupational, and environmental adaptations that affect clients’ occupational behavior and performance and that influence his/her patterns of daily occupations; to teach activities of daily living so that that clients learn/relearn to accomplish desired and expected tasks at home, at work, at school, in leisure time, and in the community; to enable the client to perform meaningful and purposeful occupations, which thus influence his/her recovery and well-being ; and to promote health and wellness, i.e., through preventions of accidents and illness (Soderback 2009). The figures are stylized Ankh signs (means key of life) (see Fig. 4.1 p. 55)
Table 3.1
A clinical framework on occupational therapists’ (OTs) roles and occupational therapy intervention (OTIs) goals
OTs manage and facilitate clients’ adaptations | |
|---|---|
Manage is to make modifications, decisions, or adjustments to a client, directly or indirectly, that results in the change Adaptation is any adjustment of a client’s environment , design of devices, tools, or mechanisms, to be suitable to person’s most functional, rational, practical, effective, and ergonomic use. Adaptation is also a person’s ability to adjust habits or behaviors to meet a new, or challenging, situation | |
Interventions | Definition |
Environmental adaptations | Changes that modify the physical environment, home or outdoor space, making them accessible to all people regardless of disability |
Housing adaptations | Accommodations that alter a client’s dwelling, indoors and outdoors |
Accessibility | Is the application of ergonomically appropriate body positions; ability to reach and enter physical environments |
Accommodations | Providing wheelchairs or accessibility options, indoors and outdoors |
Electric prostheses, orthotics, and splints | Artificial devices used to support or supplement damaged muscles, joints, or skin (arms/hands) |
Assistive device | Equipment that provides increased opportunities for independence and supports function |
Universal design | The design of products and environments to be accessible to all people |
Occupational adaptationsa | Make use of tools, material, gravity, and universal design to adjust a task to be performed in the most functional, rational, practical, effective, and ergonomically appropriate way |
Temporal adaptations | The relationship between a person’s activity patterns, time allocation, and experience of health or illness |
Intrinsic adaptations (comparable with coping) | Is a person’s internal motivation and skill set that supports strategies to reduce occupational stress, thereby forming habits or behavior |
Table 3.2
A clinical framework on occupational therapists’ (OTs) roles and occupational therapy intervention (OTIs) goals
OTs teach and clients learn or relearn | |
|---|---|
Definition | |
Teach (inform, demonstrate, instruct, arrange) applies learning methods to impart new or changed information that influences a person’s ways of doing occupations Learning is the process of acquiring knowledge and skills. A person’s ability to participate in teaching situations, which fosters their ability to gain knowledge through doing (occupational process), thereby altering their habits, behavior, and nature | |
Definition | Interventions |
Problem solving | Is the pedagogic approach of a goal-directed process aimed to help clients and caregivers with strategies that fix problems in daily activities and performances |
Cognitive teaching approach | Integrates clients with cognitive impairments to use strategies for monitoring how they are thinking and processing information. The aim is to develop self-awareness and facilitate realistic goal setting. The teaching process uses various techniques, i.e., questioning, visualizing, feed-forward, and feedback that is mediated by meaningful occupations in the context of daily living activities |
Active learning—energy conservation | Is the ability of the client to engage in understanding new material, skills, or tasks through problem solving, collaboration, and trial and error The abilities to use resources in the most efficient manner in order to maintain occupational performances for longer time durations and with less fatigue or pain |
Psychoeducation | Aims to integrate a client, with mental illness, to use strategies to reinforce strength and coping skills that he/she deals with lasting symptoms. The teaching process is mediated by the activities that are performed in a social context of daily life |
Neuromusculoskeletal and movement-related learning | Are the techniques aimed to improve a client’s range of motion, muscle strength/endurance, gross/fine motor coordination, maintain functional postural control, muscle tone, or joint protection without pain or risk for injury |
Occupational rehabilitation programs | Concerns the client’s ability to work. Most often, the OT works as a member of the rehabilitation team |
Table 3.3
A clinical framework on occupational therapists’ (OTs) roles and occupational therapy interventions (OTIs) goals
OTs enable clients to be meaningfully occupied for reasonable recovery | |
|---|---|
Enable is providing a client with opportunities that make it possible for him/her to participate in meaningful occupations Recovery is a person’s actions to regain control of a balanced state of mind and body that supports an optimal quality of life | |
Interventions | Definition |
Creating opportunities for participation mediated by occupations | Is to provide opportunities, guidance, support, and facilitation which allows for clients to interact with occupations shaped by their interests, desires, or values in all daily activities. The experiences and feelings of the ongoing task implementation can be an individual or a shared experience with others. These interventions are mediated by multifaceted activities, which are often supported by adaptations of materials, tools, or processes that suit the clients’ abilities |
Recreational activities | Are the clients interacting with therapeutic occupations/activities, which offer them enjoyment , satisfaction, pleasure, self-esteem, and can facilitate relaxation which may result in good health and social interactions (i.e., handicraft, hobbies, reading newspapers or books, playing games, watching movies or TV, sports, discussions, and travel) |
Music | Is any kind of organized sound, where clients are either a performer or listener |
Gardening comparable term: horticulture therapy | Is an organized event where clients interact as active participants or observers with plants, flowers, or nature, thereby making positive impressions and feelings |
Table 3.4
A clinical framework on occupational therapists’ (OTs) roles and occupational therapy interventions (OTIs) goals
OTs prevent ill-health and promote a clients’ ability to sustain health and wellness, helping to foster a clients’ overall wellbeing | |
|---|---|
Promotion is any activity that supports or encourages a client to take actions that increases their overall health and wellness Health is a state of complete physical, mental , and social well-being and not merely the absence of disease or sickness Wellness is the state or condition where a person maintains a healthy balance of the mind, body, and spirit that results in an overall feeling of well-being | |
Interventions | Definition |
Preventing fall accidents | Are all measures that reduce a person’s risk for ending up on ground and thereby preventing injury |
Preventing traffic accidents | Are all attempts, physically, environmentally, and behaviorally, to reduce injuries and disabilities caused by traffic accidents |
Preventing accidents at work | Are all measures taken at redesigning work (the work processes, structures, equipment, tools, and materials) used for increasing on-the-job safety that reduces work accidents and sick leave |
Preventing illnesses | Are the strategies taken in education, engineering, and enforcement by a person aimed to modify their behavior or lifestyle for improved safety, health, and quality of life |
Method
Design of the study was a comparative literature analysis. An interpretive comparison was performed between the OTIF definitions (i.e., the “lens”; Tables 3.1–3.4) through which the data sources (i.e., the content of the scientific review publications’ abstracts) were viewed (Harvard College Writing Center 2014). Publications where the data were contrasted, i.e., interpreted not to suit the OTIF, were excluded. Included publications (n = 74) were those publications where the data were interpreted to be compatible with OTIF definitions.
Data sources were scientific review publications, i.e., studies that investigated the effects of OTIs. These include randomized controlled trials (RCTs), controlled clinical trials (CCTs), and comparative studies (CIMTs).
Data selection: The keyword search criteria were (a) the words “occupational therapy interventions,” either as a single word or in combinations, or (b) originated from an occupational therapy department, or (c) written by OTs (c), and (d) abstracts available in English. The database searches were performed from 2008 to July 2013, because this was the time period after IHOTI first edition (Söderback 2009) was published. Only review studies were selected for the analyses, aimed to assure that more than one study underpinning the interpretation for each OTI category.
Results of data collection
The results of the collected data comprised 276 scientific publications/studies, where 30 were duplicates. About 3% of the publications were written by the authors of the first edition of IHOTI and therefore excluded (see Appendix 1).
The following databases were used:
The Cochrane Collaboration database, Cochrane reviews, includes reviews of RCTs (http://www.cochrane.org/search/reviews/occupational%20therapy); using the search words “occupational therapy” contributed with 52 results, where 13 publications (known participants: n = 7390) were included for further analyses. Thirty-nine results were excluded (Appendix 1) because the studies were (a) not complete, withdrawn from the database, or abstracts were not available; or (b) it was expressed in the abstract that the content of the study concerned another interventions than is commonly known as occupational therapy (e.g., drug or pharmacy therapy, psychological intervention approaches, health economics, hearing rehabilitation, language therapy, occupational health, physical therapy, physiotherapy, radiotherapy, surgery); or (c) the interventions were mixed, e.g., performed by a rehabilitation team that the OTIs included were impossible to separate.
The OTseeker database includes RCTs (http://www.otseeker.com); using the search words “occupational therapy intervention” contributed with 25 results. Of these 12 studies (known participants: n = 1680) were included for further analyses. Thirteen results were excluded (Appendix 1) due to the (a) OTIs were mixed with other interventions; or (b) concerned: physiotherapy, health economic, visits to physician; or (c) was not complete. All results from the OTseeker database were also possible to identify in the PubMed.
US National Library of Medicine National Institutes of Health: National Library of Medicine (NCBI; PubMed; (http://www.mrc-lmb.cam.ac.uk/genomes/madanm/pres/pubmed1.htm) contributed with 159 results; using the search words “occupational therapy interventions” restricted with the categories: “abstract available,” “humans,” “review.” Forty-seven results (unknown participants) were included for further analyses. Excluded were 110 results (Appendix 1), due to the (a) OTI were mixed with other interventions; or (b) concerned: chiropractor therapy, cognitive psychotherapy, education of health professions, ergonomics, health economics, speech therapy, occupational health medicine, medical rehabilitation, physiotherapy; or (c) no interventions, or no results, were specified, or the studies were not complete or withdrawn.
The references of excluded publications are presented in Appendix 1.
Process. The data search results were converted to Excel files with columns for the publications: (a) title, (b) references, (c) OTIF main category, (d) participants’ diagnoses, and (e) evidence of the intervention [(e) is not used in this study]. The Excel’s sorting function was used to extract the data.
Interpretation. Two interpreter: the first author (OT with > 40 years’ experience) and the second author (OT with > 5 years’ experience) independently classified the studies to be included or excluded in this study. The authors had an agreement of ~ 90 %. The comparative interpretation analyses were performed by the second author (aimed to avoid bias).
Results
The client’s diagnoses/diseases/dishabilles represented in the included scientific publications concerned a variation of diagnoses/diseases/disabilities, where clients surviving a stroke or a cerebral brain injury (n = 20) were most often represented. Clients living with Alzheimer’s disease and dementia disease and their spouses (n = 12) were also common subjects among the studies. Single studies with clients who had a variation of physical disabilities (n = 15), for example, a shoulder condition, carpal tunnel syndrome, rheumatoid arthritis, chronic pain, and musculoskeletal disorders, were well represented. Studies of mental illness and psychotic conditions (n = 4) were few, and there was only one study each of the patients living with a cancer diagnosis or in the end of life. The studies of older people (e.g., lower limb amputation, hip fracture, prevention of falls; n = 7) and of children (congenital hemiplegia, cerebral palsy developmental conditions, motor impairment; n = 8) were relatively well represented. Two studies concerned people’s work condition. In four studies, the diagnoses/diseases were not mentioned.
Validation of the OTIF
This initial validation of the OTIF (as presented in Fig. 3.1 and Tables 3.1–3.4) was interpreted to be essentially supported by the included scientific review publications 2008–2013 (n = 74), as shown in Tables 3.5–3.8.
Table 3.5
References to publications interpreted to concern the OTIF category manages for adaptation
Validation of the OTIF category manages for adaptation | |
|---|---|
Interventions | References to included articles |
Environmental adaptations | |
Housing adaptations | Pighills et al (2011) J Am Geriatr Soc 59(1):26–33 |
Accessibility | Arbesman and Logsdon (2011) Am J Occup Ther 65(3):238–246 Cook et al (2009) Clin Rehabil 23(1):40–52 Winkle et al (2012) Occup Ther Int 19(1):54–66 |
Accommodations | Bohr (2013) Am J Occup Ther 65(1):24–28 Laver et al (2011) Cochrane Database of Syst Rev Issue 9. Art. No.: CD008349 Leland et al (2012) Am J Occup Ther 66(2):149–160 Letts L, Minezes J, Edwards M, Berenyi J, Moros K, O’Neill et al (2011) Am J Occup Ther 65(5):505–513. Retrieved 3 July 2013 from PubMed database Padilla (2011) Am J Occup Ther 65(5):514–522. Retrieved 1 July 2013 from PubMed database Padilla (2011) Am J Occup Ther 65(5):523–531, 2011. Retrieved 3 July 2013 from PubMed database Shaw et al. Health Technol Smits-Engelsman et al (2013) Dev Med Child Neurol 55(3):229–237. Retrieved 3 July 2013 from PubMed database. doi: 10.1111/dmcn.12008. Epub 2012 Oct 29 Van Niekerk et al (2010) BMC Musculoskelet Disord 13:145, 2012 Assess (2010) BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. May;14(26):1–113, iii–iv. doi: 10.3310/hta1426 Winkle et al (2012) Occup Ther Int 19(1):54–66 |
Electric prostheses, orthotics, and splints | Beasley (2012) J Hand Ther 25(2):163–171 Demetrios et al (2013) Cochrane Database Syst Rev (Issue 6. Art. No.: CD009689) Drummond et al (2012) Clin Rehabil 27(5):387–97 Mehrholz et al (2012) Cochrane Database Syst Rev (Issue 6. Art. No.: CD006876) Novak et al (2009) Pediatrics 124(4):e606–e614 Page et al (2013) Cochrane Database Syst Rev (Issue 3. Art. No.: CD009601) Spiliotopoulou and Atwal (2012) Prosthet Orthot Int 36(1):7–14 Wallen and Gillies (2006) Cochrane Database Syst Rev (Issue 1. Art. No.: CD002824) |
Assistive devices | Intiso et al (2012) J Nephrol 25(Suppl 19):S90–S95 |
Universal design | Jensen and Padilla (2011) Am J Occup Ther 65(5):532–540 |
Temporal adaptations | None |
Intrinsic adaptations (comparable with coping) | Carnes et al (2012) Clin J Pain 28(4):344–354 Kim et al (2012) Neuro Rehabil 31(2):107–115 Lam et al (2010) Int J Geriatr Psychiatry 25(2):133–141 Lambeek et al (2010) JRBMJ 340:c1035, 2010 McEwen et al (2009) Brain Inj 23(4):263–277 Robinson et al (2011) Aust Occup Ther J 58(2):74–81 Polatajko and Cantin. Exploring the effectiveness of occupational therapy interventions, other than the sensory integration approach, with children and adolescents experiencing difficulty processing and integrating sensory information Sakzewski et al (2009) Pediatrics 123(6):e1111–e1122 Thinnes and Padilla (2011) Am J Occup Ther 65(5):541–549 Zwicker and Harris (2009) Can J Occup Ther 76(1):29–37 |
The 74 publications supported that 20 out of 23 were scientifically documented after 2008, apart from the “enabling interventions” (gardening and music) and the “promoting interventions” (prevention for traffic accidents).
Moreover, the results showed OTs overwhelmingly act in the role of teacher for the clients’ learning/relearning. This OTIF category encompasses six interventions: problem solving, cognitive teaching approach, active learning, i.e., energy conservation , psychoeducation, neuromuscular and movement-related learning, and occupational rehabilitation programs, which were interpreted to be supported by 35 of the included publications (Table 3.5). Among these, interventions concerning neuromuscular and movement-related learning were dominant and interpreted to be the content of 13 of the abstracts.
OTs’ role as manager and facilitator for clients’ adaptations. This category was interpreted to be supported by the publications to a similar extent (n = 34; Table 3.6). The majority of analyzed abstracts interpreted fell under the OTI: environmental adaptation , i.e., electronic prosthesis, orthotics splints (n = 9) and under the OTI: internal adaptation (coping; n = 10). There was no review concerning temporal adaptation and intrinsic adaptation.
Table 3.6
References to articles interpreted to concern the OTIF category teaches for learning or relearning
Validation of the OTIF category teaches for learning or relearning
Interventions
References to included articles
Problem solving
Poulin et al (2012) Top Stroke Rehabil 19(2):158–171
Cognitive teaching approach
Bowen et al (2013) Cochrane Database Syst Rev (Issue 7. Art. No.: CD003586)
Chung et al (2013) Cochrane Database Syst Rev (Issue 4. Art. No.: CD008391)
Clare et al (2010) Am J Geriatr Psychiatry 18(10):928–939
Das et al (2007) Cochrane Database Syst Rev (Issue 3. Art. No.: CD002293)
Dodson (2010) Work 36(4):449–457
Hoffmann et al (2010) Top Stroke Rehabil 17(2):99–107
Hoffmann et al (2010) Cochrane Database Syst Rev (Issue 9. Art. No.: CD006430)
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
