L’ergothérapie axée sur les relations collaboratives pour promouvoir la participation occupationnelle répond à l’objectif fondamental de l’ergothérapie - aider les autres à avoir accès, à initier et à maintenir la participation occupationnelle. Ce livre souligne que le processus d’ergothérapie est axé sur les relations collaboratives avec les personnes, les familles, les groupes, les communautés et les populations. Il s’appuie sur des concepts et des processus pour souligner les forces, les connaissances, les talents et les ressources des individus et des collectivités. Le livre présente trois développements
importants :

• la caractérisation des relations entre les ergothérapeutes et la clientèle;
• l’objectif fondamental de la pratique; et
• le processus d’ergothérapie qui met l’accent sur la justice, l’équité et les droits des individus et des collectivités.

Le nouveau Modèle canadien de participation occupationnelle (MCPO) fournit un cadre essentiel pour la collecte et la prise en considération de l’information afin d’envisager de façon significative des occupations valorisées et d’élargir les possibilités occupationnelles en tenant compte des contextes micro, méso et macro. Le cadre Canadien pour un processus de pratique ergothérapique axé sur les relations collaboratives (CanPPERC) est un guide pour les processus d’ergothérapie axés sur les relations collaboratives.

Publié par l’Association canadienne des ergothérapeutes (ACE), ce livre a été élaboré par les co-rédactrices, 40 auteurs et autrices, et le comité consultatif composé d’ergothérapeutes du Canada et d’autres pays et de membres du public. Il est divisé en quatre sections :

Section I : Contextes national et international de l’occupation et de l’ergothérapie
Section II : Modèle, approche et cadre pour l’ergothérapie
Section III : Ergothérapie auprès des personnes, des familles, des groupes, des communautés et des populations
Section IV : Promouvoir une participation occupationnelle juste et équitable

Background: Carers report unmet need for occupational therapy services addressing sensory difficulties in autism, yet insufficient evidence exists to recommend a therapeutic approach.

Objectives: Our aim was to determine the clinical effectiveness and cost-effectiveness of sensory integration therapy for children with autism and sensory difficulties across behavioural, functional and quality-of-life outcomes.

Design: We carried out a parallel-group randomised controlled trial, incorporating an internal pilot and a process evaluation. Randomisation utilised random permuted blocks.

Setting and participants: Children were recruited via services and self-referral in Wales and England. Inclusion criteria were having an autism diagnosis, being in mainstream primary education and having definite/probable sensory processing difficulties. Exclusion criteria were having current/previous sensory integration therapy and current applied behaviour analysis therapy.

Intervention: The intervention was manualised sensory integration therapy delivered over 26 weeks and the comparator was usual care.

Outcomes: The primary outcome was problem behaviours (determined using the Aberrant Behavior Checklist), including irritability/agitation, at 6 months. Secondary outcomes were adaptive behaviour, functioning and socialisation (using the Vineland Adaptive Behavior Scales); carer stress (measured using the Autism Parenting Stress Index); quality of life (measured using the EuroQol-5 Dimensions and Carer Quality of Life); functional change (according to the Canadian Occupational Performance Measure); sensory processing (determined using the Sensory Processing Measure™ at screening and at 6 months to examine mediation effects); and cost-effectiveness (assessed using the Client Service Receipt Inventory). Every effort was made to ensure that outcome assessors were blind to allocation.

Results: A total of 138 participants were randomised (n = 69 per group). Usual care was significantly different from the intervention, which was delivered with good fidelity and adherence and minimal contamination, and was associated with no adverse effects. Trial procedures and outcome measures were acceptable. Carers and therapists reported improvement in daily functioning. The primary analysis included 106 participants. There were no significant main effects of the intervention at 6 or 12 months. The adjusted mean difference between groups on the Aberrant Behavior Checklist - irritability at 6 months post randomisation was 0.40 (95% confidence interval -2.33 to 3.14; p = 0.77). Subgroup differences in irritability/agitation at 6 months were observed for sex of child (intervention × female = 6.42, 95% confidence interval 0.00 to 12.85; p = 0.050) and attention deficit hyperactivity disorder (intervention × attention deficit hyperactivity disorder = -6.77, 95% confidence interval -13.55 to -0.01; p = 0.050). There was an effect on carer stress at 6 months by region (intervention × South England = 7.01, 95% confidence interval 0.45 to 13.56; p = 0.04) and other neurodevelopmental/genetic conditions (intervention × neurodevelopmental/genetic condition = -9.53, 95% confidence interval -18.08 to -0.98; p = 0.030). Carer-rated goal performance and satisfaction increased across sessions (p < 0.001), with a mean change of 2.75 (95% confidence interval 2.14 to 3.37) for performance and a mean change of 3.34 (95% confidence interval 2.63 to 4.40) for satisfaction. Health economic evaluation suggests that sensory integration therapy is not cost-effective compared with usual care alone.

Limitations: Limitations included variability of the intervention setting (i.e. NHS vs. private), delay for some receiving therapy, an error in administration of Vineland Adaptive Behavior Scales and no measurement of comparator arm goal performance.

Conclusions: The intervention did not demonstrate clinical benefit above standard care. Subgroup effects are hypothesis-generating only. The intervention is likely to be effective for individualised performance goals, although it is unclear whether effects were in addition to standard care or were maintained.

Future work: Further investigation of subgroup effects is needed.

Trial registration: This trial is registered as ISRCTN14716440.

Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 29. See the NIHR Journals Library website for further project information.

Introduction.L’ennui est un ressenti complexe qui peut avoir des effets délétères sur la santéphysique et psychique. Les personnes atteintes d’un trouble de santémentale y sont particulièrement vulnérables lors d’une hospitalisation en établissement psychiatrique.La problématique de l’ennui est toutefois peu considérée dans la prise en charge hospitalière. Les ergothérapeutes, en leur qualitéde professionnels de l’occupation, souhaitent le prendre davantage en compte dans leurs interventions.Méthode.Les objectifs de cette étude sont de documenter les pratiques actuelles des ergothérapeutes et de concevoir un modèle d’intervention pour la prise en charge de l’ennui en contexte hospitalier. Il s’agit d’une étude qualitative basée sur un design descriptif-interprétatif. Deux groupes de discussion focalisée (GDF) ont étémenés avec des ergothérapeutes (n=16) travaillant dans le département de psychiatrie d’un hôpital universitaire suisse francophone.Résultats.Les deux groupes de discussion ontpermis de décrire la problématique et d’identifier les pistes d’intervention actuelles et potentielles concernantl’ennui en contexte hospitalier psychiatrique. Les pistes sont développées en 10thèmes et ont étéschématisées pour obtenir un processus d’intervention.Conclusion.Cette étude propose des pistes d’intervention concrètes organisées sous la forme d’un processus pour la pratique en ergothérapie. Elle relève l’importance pour les professionnels de considérer l’ennui dans l’environnement hospitalier psychiatrique et de valoriser la notion de sens des activités dans leur prise en charge.

Background. Calls to Action outlined by the Truth and Reconciliation Commission (TRC) necessitate critical reflection and urgent action to improve occupational therapy with Indigenous Peoples in Canada. Purpose. This scoping review aims to synthesize the literature related to Indigenous Peoples and occupational therapy practice, research, and education in Canada, and appraise empirical research using adapted Indigenous Health Research criteria. Method. A scoping review was conducted across published academic and grey literature with additional appraisal of empirical studies. Findings. A total of 6 themes emerged from 47 articles spanning from 1970 to 2020: recognizing colonial history, responding to the TRC, participating in personal and professional reflection, identifying Western ideologies, engaging in partnership in practice, and recognizing social and systemic barriers. Empirical studies met appraisal criteria inconsistently. Implications. To meaningfully engage in reconciliation, the profession of occupational therapy must generate Indigenous-led and relevant research, critically transform curricula, and address tensions between themes in practice.

Purpose: Clinical practice guidelines establish that occupational therapy (OT) services are indicated for people with early Parkinson's disease (PD). However, OT is uncommon compared to other rehabilitation services. This study describes the development and evaluation of a proactive, consultative OT program for people with early PD as a part of an integrated care approach.

Materials and methods: The program was developed by an occupational therapist adapting practice guidelines for people with early PD. Retrospective program evaluation occurred at an outpatient rehabilitation clinic. The consultative OT program for early PD includes a 90-minute evaluation with instruction in self-management techniques, individually tailored exercises, and follow-up recommendations. The program was evaluated with the RE-AIM framework. Postprogram semistructured interviews provided patient-reported program effectiveness and satisfaction.

Results: In 2018, 23 individuals used OT out of 77 people with early PD who attended the proactive rehabilitation program. Most individuals (n = 16, 69.6%) were within Hoehn and Yahr stages 1-2 and were seen within 3 years of PD diagnosis. Participants presented with deficits in hand strength (60.0 ± 23.4 pounds) and dexterity (right hand 30.0 ± 8.0 seconds) and reported complaints about basic and/or instrumental activities of daily living (n = 15, 65.2%). Semistructured interviews (n = 16) revealed that most individuals (75%) reported high satisfaction. Of the 10 who recalled a home exercise program, 60% reported continued adherence. Consultative OT was delivered with fidelity in 22/23 individuals (96%). After one year, only two occupational therapists at one clinic had adopted the program, and the program is maintained in the organization.

Conclusion: Occupational therapists reached people in the early stages of PD when a specific program was tailored to evaluate and target their specific needs. Motor activity deficits noted in individuals with early PD support future scaling and sustainability efforts of OT within this population. Quality improvement suggestions are discussed for future implementation and clinical trials.

Importance: Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address.

Objective: To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke.

Data Sources: MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases.

Study Selection and Data Collection: Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Findings: Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low.

Conclusions and Relevance: Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation.

What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.

Importance: The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns’ performance.

Objective: To develop a pediatric occupational therapy–specific Mini-CEX and examine its psychometrics.

Design: Stage 1 had a retrospective design; Stage 2 had a prospective design.

Setting: Pediatric occupational therapy unit in a hospital in Taiwan.

Participants: Thirty-four occupational therapy interns were evaluated with the Mini-CEX (physician version), and 57 were evaluated with the occupational therapy–specific Mini-CEX.

Outcomes and Measures: The occupational therapy–specific Mini-CEX was developed with seven items on a 9-point scale categorized into three levels (unsatisfactory, satisfactory, highly satisfactory).

Results: In Stage 1, the frequency of Mini-CEX (physician version) items receiving a rating of not applicable ranged from 1.9% to 88.1%. In Stage 2, the frequency of occupational therapy–specific Mini-CEX items receiving a rating of not applicable ranged from 3.5% to 31.6%. With the theme of evaluation taken into consideration, the frequency of not-applicable ratings was 0% to 8.8%. For the occupational therapy–specific Mini-CEX, content validity (item-level content validity index = 1, scale-level content validity index = 1) and internal consistency (Cronbach’s α = .93) were excellent. The interns’ scores on the second evaluation were significantly higher than those on their first evaluation, indicating good discriminant validity.

Conclusions and Relevance: The occupational therapy–specific Mini-CEX appears to be reliable and valid, and it is appropriate for evaluating interns’ skills and attitudes in pediatric occupational therapy practice.

What This Article Adds: The results support the development of the occupational therapy–specific Mini-CEX and its application in pediatric internship training.

Importance: To enable community-dwelling older adults to continue to live satisfying lives, a feasible health promotion program is needed that consists of relatively few sessions and can be implemented over a brief period.

Objective: To verify the relationship between a short-duration group program using an occupational diary and changes in satisfaction with occupation, a sense that life is worth living, and life satisfaction among community-dwelling older adults 3 mo after program cessation and to identify factors associated with changes in satisfaction with occupation after the program.

Design: Before-and-after comparison study and case-control study.

Setting: Public university in Japan.

Participants: Community-dwelling older adults (N = 144).

Intervention: Four weekly group sessions and daily occupational diary keeping.

Outcomes and Measures: Activity and Daily Life Satisfaction Scale for the Elderly, K–I Scale for the Feeling that Life is Worth Living among the Aged, and Life Satisfaction Index–Z.

Results: Scores 3 mo postprogram were significantly higher than the pretest scores. Continued use of the diary was selected as a factor associated with changes in participants’ satisfaction with occupation after the program.

Conclusions and Relevance: The program may improve satisfaction with occupation, a sense that life is worth living, and life satisfaction among community-dwelling older adults 3 mo after conclusion. Continued use of the diary may increase the possibility of maintaining or improving older adults’ satisfaction with occupation beyond the duration of the program.

What This Article Adds: The program consists of a small number of sessions and can be implemented in a short period. Occupational therapists can include it as an option for promoting the health of community-dwelling older adults.

Importance: Autism spectrum disorder (ASD) is a neurological condition characterized by impairments in social interaction, communication, and behavior. Occupational therapy practitioners use creative arts interventions for children with ASD, but relevant evidence for these interventions is lacking.

Objective: To provide occupational therapists evidence of the benefit of creative arts interventions for children with ASD by evaluating treatment efficacy and connecting the evidence with the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF–4).

Data Sources: We searched peer-reviewed articles in six databases: CINAHL, Cochrane, PubMed, Ovid, PsycInfo, and Scopus. Eighteen articles published between 2000 and 2020 met Level 1b or 2b evidence criteria and were retrieved for full review; 15 were included in this scoping review.

Study Selection and Data Collection: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to extract data. Inclusion criteria were as follows: (1) Level 1b or 2b study; (2) quantitative data; (3) published in English; (4) population of children (ages <18 yr); (5) primary diagnosis of ASD; and (6) creative arts intervention in the forms of drawing, painting, or coloring; music; or theater.

Findings: Creative arts interventions benefited children with ASD in two OTPF–4 areas (process and social interaction) pertaining to the Performance Skills domain and one OTPF–4 area (body functions) pertaining to the Client Factors domain. We found similar effects for group and individual intervention sessions, and significant improvements required multiple sessions.

Conclusions and Relevance: Our findings provide evidence for the efficacy of creative arts interventions to enhance occupation-based outcomes for children with ASD.

What This Article Adds: Our findings support occupational therapy practitioners’ use of creative arts interventions to improve OTPF–4-based client factors and process and social interaction skills for children with ASD.

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = −1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = −1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.

Background: Outcomes of using art in therapy overlap with goals of occupational therapy with older adults in long-term care, which include improving and maintaining health and well-being through engagement in occupations. There is a lack of evidence about how art activities could complement or inform occupational therapy. Purpose: The purpose of this scoping review is to map existing literature about how art activities are used in long-term care. Methods: Six electronic databases were searched. Fourteen studies met inclusion criteria and were analyzed to identify patterns and discrepancies. Findings: The analysis suggests art activities can contribute to well-being by improving mood, promoting communication and reminiscence, and supporting the development and deepening of social relationships. Implications: Occupational therapists should consider incorporating art activities as these offer therapeutic benefits and can be adapted to individual strengths and preferred type and level of participation.

Background. There is an emerging evidence base about the scope of occupational therapy in palliative and end-of-life care, but little is known about this practice in Québec or barriers impeding it. Purpose. To describe Québec occupational therapists’ practice in palliative and end-of-life care and barriers they encounter. Method. Using the Québec regulatory board members list, we invited occupational therapists working in palliative and end-of-life care to answer an online survey comprising 24 closed- and 5 open-ended questions. We analyzed data using descriptive statistics and content analysis. Findings. The 67 survey participants mainly optimized comfort and safety in meaningful occupations such as mobility, transfers, and hygiene. Barriers to their practice included organizational obstacles and unfamiliarity with their role. Implications. Findings highlight the need to improve education and awareness among occupational therapists and other healthcare professionals about the scope of what occupational therapists can do in palliative and end-of-life care.

Background. Fatigue is a disabling symptom of Parkinson’s disease (PD). Managing Fatigue: A Six-Week Energy Conservation Intervention was developed to improve the occupational performance of people with fatigue. Efficacy of this program has not been established in PD. Purpose. This study will assess feasibility of the Managing Fatigue: Individual Program (MFIP) delivered via videoconference, the Randomized Controlled Trial (RCT) protocol, and the preliminary effectiveness of the MFIP. Methods. A mixed-methods approach nested in a pilot RCT, randomizing 54 participants 1:1 to usual care or MFIP arms, will be employed to evaluate the feasibility and preliminary effectiveness of MFIP. Qualitative and quantitative data will be collected simultaneously. Implications. Results will identify evidence for establishing protocol requirements for a full-scale RCT. Knowledge of the effectiveness of the one-to-one videoconference delivery format of the program has the potential to enhance the accessibility and the quality of care of the PD population.

Staying current on new evidence and practice across the field of early childhood can be challenging and time consuming. This comprehensive new text covers all aspects of occupational therapy in early childhood across early intervention, preschools, and health care, providing the most effective, evidence-guided practices to equip practitioners working with young children. Best Practices for Occupational Therapy in Early Childhood addresses legislative, professional, and contextual influences on providing occupational therapy to young children and their families and promotes coordination of services across settings. Chapters cover essential considerations, best practices, case examples, and key terms and concepts of occupation, development, participation, family- and client-centered practices, and community partnerships. Wide in scope but detailed in practical, evidence-based information, Best Practices for Occupational Therapy in Early Childhood prepares practitioners to support and enhance outcomes for occupational therapy’s youngest clients and their families.

L'autisme représente une particularité du développement humain qui altère la participation sociale de l'enfant dès son plus jeune âge. Mais une intervention précoce et multidisciplinaire peut modifier positivement le parcours de vie de ces enfants et de leur famille.

L'ergothérapeute est alors un intervenant essentiel pour favoriser le développement harmonieux du jeune enfant avec autisme. Les interventions en ergothérapie se caractérisent par l'analyse des occupations, des environnements physiques et sociaux (membres de la famille, entourage, personnel soignant, accompagnants scolaires, camarades) de l'enfant. L'implication de tous ces individus dans le suivi de l'enfant permet à l'ergothérapeute de construire avec eux des solutions réalistes et respectueuses du potentiel de chacun afin de faciliter leur vie quotidienne.

La démarche ergothérapique auprès d'enfants avec autisme de la naissance à 6 ans est décrite et illustrée par de nombreux exemples. Dans ce livre, les pratiques proposées se fondent sur les preuves scientifiques récentes. La phase d'observation, l'analyse des besoins, l'exploration des différents espaces de vie ainsi que la mise en place de solutions individualisées sont détaillées. L'ouvrage examine les différentes retombées des actions en ergothérapie, tout en abordant des particularités : sensorielles, ludiques, motrices, de la cognition sociale.

Le processus de raisonnement clinique en ergothérapie est illustré par trois histoires de vie. Elles donnent des exemples concrets de formulation d'objectifs centrés sur l'occupation et de méthodes d'intervention avec l'enfant et son entourage.

Occupational Therapy for Adults With Intellectual Disability provides occupational therapy practitionners and students with occupation-based solutions to serve and empower individuals with intellectual disability, as well as their families and caregivers, toward more self-determined, authentic lives.

There are few texts that exist within occupational therapy that support this population. Dr. Kimberly Bryze and the contrinuting authors are all occupational therapists who have provided or currently provide occupational therapy services to adults with intellectual disability in various settings. They bring their expertise in scholarship and offer thoughtful, evidence-based approaches for practitionners to create change for individuals, communities, organizations, and society.

This text presents an occupational perspective of individuals with intellectual disability, given its focus on the following:
* Quality of living
* Social well-being
* Role competence
* Occupational identity
* Self-advocacy
* Occupational justice

Occupational Therapy for Adults With Intellectual Disability is ideal for occupational therapy edicators who teach content related to adults with intellectual and developmental disabilities, occupational therapy practitionners who provide services to adults with intellectual disability in various clinical, community, and residential settings, and occupational therapy students.

Background.
Youth with Duchenne muscular dystrophy (DMD) and other neuromuscular disorders are living well into adulthood and often need help engaging in meaningful occupations.

Purpose.
Our purpose was to explore enablers and barriers to engaging in meaningful occupations, from the perspectives of youth, parents, and practitioners.

Method.
This qualitative study involved 26 participants (11 parents, eight youth ages 19 to 28 [mean = 22.3 years], seven practitioners). Data were obtained from semistructured interviews and analyzed using an interpretive descriptive approach.

Findings.
Youth with DMD and neuromuscular disorders engage in meaningful occupations in a variety of ways. Occupational enablers were supports and accommodations and self-care skills and coping strategies, while occupational barriers involved societal expectations of a normative adulthood, discrimination and inaccessible environments, lack of supports and resources, medical challenges, fatigue, lack of motivation, and social isolation and depression.

Implications.
Practitioners should work to uncover what youth consider important and connect them to appropriate resources so they can engage in meaningful occupations.